NACCHO Aboriginal Health : Pat Dudgeon “Closing the Mental Health Gap ” Special Issue : Indigenous Psychology

 
” The available data on Aboriginal and Torres Strait Islander disadvantage has shone a light on the Indigenous mental health and wellbeing gap.

In their commentary in this special issue, Calma, Dudgeon, and Bray (2017) provide details of the challenges in mental health for Aboriginal and Torres Strait Islander peoples and what needs to happen to change the situation.All articles in this issue are concerned with and aimed at contributing to closing the mental health gap.”

Pat Dudgeon Pictured above with NACCHO CEO Pat Turner at the recent launch of the ATSISPEP report

Download all reports HERE

Articles

  1.  
  2.  

    The Australian Psychological Society’s Apology to Aboriginal and Torres Strait Islander People (pages 261–267)Timothy A Carey, Pat Dudgeon, Sabine W Hammond, Tanja Hirvonen, Michael Kyrios, Louise Roufeil and Peter Smith

  3.  
  4.  
  5.  
  6.  
  7.  
  8.  
We acknowledge the Traditional Owners of the land across Australia and pay our respect to the Elders past, present and future.

We also acknowledge young people as they are our future leaders, the custodians of our stories, cultures, histories and languages.

We as seniors must create opportunities and encourage our youth to realise their full potential (Calma, 2015).This special issue on Indigenous psychology is timely in a changing landscape for Aboriginal and Torres Strait Islander (hereon Indigenous) people and their participation in an Australian nationhood. A range of significant landmark events suggests that both Aboriginal and Torres Strait Islander people and Australians are in a process of decolonisation.

In our first special issue of Australian Psychologist: Indigenous Australian Psychologies (2000), we marked the changes that were taking place and our hopes for a better future. Here our focus was on psychology, Indigenous issues, and reconciliation. Looking back to that time 17 years ago, Aboriginal and Torres Strait Islander affairs have clearly advanced.As a result of the work of Indigenous communities, their leaders, and social justice advocates, there is now a greater public awareness of the social and cultural determinants of Indigenous health and a range of government policies and actions aimed at closing the health and life expectancy gap between the Indigenous peoples of the land and other Australians.In his role as the Aboriginal and Torres Strait Islander Social Justice Commissioner, Professor Tom Calma released a landmark document, the Social Justice Report (2005).This called for the nation to commit to achieving health equality for Indigenous people by 2030, and saw the establishment of the Close the Gap campaign in 2007.Dialogues about the underlying and deeply entrenched socio-economic disadvantage that contributes to this gap are now part of the national dialogue. Government policies and action to close the gap have also now become a national priority that is annually reviewed.This year, the Prime Minster presented the ninth annual report card to Parliament (Closing the Gap Prime Minister’s Report, 2017).Notably, Indigenous mental health and suicide prevention is highlighted as a priority in this report, which is acknowledged by all Australian governments.
Closing the Mental Health Gap

The available data on Aboriginal and Torres Strait Islander disadvantage has shone a light on the Indigenous mental health and wellbeing gap.

In their commentary in this special issue, Calma, Dudgeon, and Bray (2017) provide details of the challenges in mental health for Aboriginal and Torres Strait Islander peoples and what needs to happen to change the situation.
All articles in this issue are concerned with and aimed at contributing to closing the mental health gap.
For example, in Addressing the Mental Health Gap in Working with Indigenous Youth: Some Considerations for non-Indigenous Psychologists Working with Indigenous Youth (Ralph & Ryan, 2017), an overview of therapeutic approaches with Aboriginal and Torres Strait Islander people, particularly youth, is provided.
Ralph and Ryan (2017) stress that an understanding of Indigenous social and emotional wellbeing (SEWB) is necessary for all those who work with youth: “for practitioners working with Indigenous youth and others there is a need to work from within a social and emotional wellbeing framework and a need to adapt the application of any focused psychological strategies to the cultural context of the individual client.” They also express justifiable concerns that “the average number of sessions provided under ATAPS for youth aged 12–25 is only 4.8 sessions.”

The SEWB of Aboriginal and Torres Strait Islander youth is also the focus of Using Culturally Appropriate Approaches to the Development of KidsMatter Resources to Support the Social and Emotional Wellbeing of Aboriginal Children (Smith, O’Grady, Cubillo, & Cavanagh, 2017).

In this article, Smith, O’Grady, Cubillo, and Cavanagh (2017) describe the methodology behind the development of resources in the KidsMatter Aboriginal Children’s Social and Emotional Wellbeing Project. An inclusive process of workshops and consultations with Aboriginal people was informed by participatory action, narrative therapy, and critically reflexive practice. This process enabled researchers and the community to build effective learning tools for children for use by Aboriginal families, schools, and early childhood and health and community services.

Another article in this special issue, Narratives of Twitter as a Platform for Professional Development, Innovation and Advocacy (Geia, Pearson, & Sweet, 2017) offers a compelling argument for the online engagement of psychologists—both Indigenous and non-Indigenous—in raising community awareness of strategies for decolonisation, for circulating empowering, strength-based approaches to Indigenous wellbeing, and supporting and recruiting potential practitioners.

This paper describes the significant success of some transformative Indigenous Twitter movements. Lynore Geia, a Bwgcolman woman from Palm Island in Queensland, discusses #IHMayDay the day long Twitter festival raising awareness of health issues; Luke Pearson, a Gamilaroi man, describes how he set up @IndigenousX and the subsequent global and local impact on healing and knowledge building, and Melissa Sweet discusses the important #JustJustice campaign.

The connections between the criminal justice system and SEWB are also focused on in a significant paper on the urgent need for justice reinvestment, Keeping on Country: Understanding and Responding to Crime and recidivism in Remote Indigenous Communities (Dawes, Davidson, Walden, & Isaacs, 2017). Outcomes from a qualitative study using a multidisciplinary research team that engaged the community through a specific participatory action research process are discussed.

Their findings resonate with the principles of justice reinvestment; Dawes, Davidson, Walden and Isaacs (2017) suggest that with the right methodological approach Indigenous communities themselves can easily identify the underlying factors contributing to crime. With the community, localised strategies to address over-representation in the justice system can be developed. Further, adopting a self-determination approach provides a strength-based position for psychologists working in the area.

Cross-cultural understanding and developing and maintaining local culture in remote communities is the focus of another unique article, The Uti Kulintjaku Project: The Path to Clear Thinking. An Evaluation of an Innovative, Aboriginal-led Approach to Developing Bi-cultural Understanding of Mental Health and Wellbeing (2017).

The results of 3 years of research was an innovative approach to strengthen shared understandings in mental health. The research work undertaken is at the heart of cross-cultural relationships, that is, exploring and articulating deep understandings of language and concepts. Both the community leaders and the non-Indigenous workers in the research team have benefited from this appropriately long-term project.

 

It increased the empowerment and capacity building of the leaders involved, and increased the cultural understanding of non-Indigenous service providers. Togni (2017) demonstrates that the building of stronger bi-cultural wellbeing literacies will “lead to increased help-seeking, strengthened cultural competency within health services and Anangu leadership in strengthening Anangu social and emotional wellbeing (SEWB).”

The importance of recognising the contributions of Indigenous concepts of SEWB is also the focus of Decolonising Psychology: Validating Social and Emotional Wellbeing (Dudgeon, Bray & D’Costa, Walker, 2017) which uses findings from the National Empowerment Project to explore the seven domains of SEWB, namely body, mind and emotions, family, community, culture, Country, and spirituality.

 

In this article, Dudgeon, Bray, D’Costa, and Walker (2017) highlight how SEWB, (an emerging concept within Indigenous psychology), is important in holistically addressing the well being needs of Indigenous people.

The breadth of topics and approaches of the articles in this special issue are a testament to the strong emergence of Australian Indigenous psychology and are just some of the numerous innovations being made in the field across the nation. New methodologies, important findings, strategies for research futures, and guides for practitioners are offered. Each paper makes a significant contribution to both the discipline, the project of Indigenous social justice, and closing the mental health gap.

Indigenous PsychologyIndigenous psychology is emerging as a powerful new discipline and was recognised at a global level with the establishment of the Task Force for Indigenous Psychology in the Society for Humanistic Psychology, Division 32, American Psychological Association in 2010. The Task Force describes Indigenous psychology as:

  1. A reaction against the colonisation/hegemony of Western psychology.
  2. The need for non-Western cultures to solve their local problems—Indigenous practices and applications.
  3. The need for a non-Western culture to recognise itself in the constructs and practices of psychology.
  4. The need to use Indigenous philosophies and concepts to generate theories of global discourse.

We address each of these factors below; however, it is noted that implicit within these is a recognition that the principle of self-determination, confirmed as an underlying principle in the United Nations Declaration of the Rights of Indigenous People (UNDRIP) (2007), is central to wellbeing and the survival of cultural rights. Specifically, there are provisions regarding obligations to respect, recognise, and uphold Indigenous peoples’ individual and collective rights to develop, maintain, and use their own health systems, institutional structures, distinctive customs, spirituality, traditions, procedures, and practices in pursuit of their right to health and mental health and wellbeing. Authors such as Dudgeon and Walker (2015) have examined this relationship in other papers.

  • 1.A reaction against the colonisation/hegemony of Western psychology

The measured and principled response of Australia Indigenous psychology to the colonising impacts of Western psychology has challenged the discipline to re-think foundational assumptions. Since the 1990s Indigenous psychologies across the world have illuminated the ways in which Western therapeutic paradigms have privileged a concept of individual mental health. In short, the normalisation of Western individualism has reduced our understanding of psychological distress and healing. Indigenous therapeutic knowledge about the self as a dynamic flow of connections have until quite recently been silenced, and even pathologised. Yet gains in the discipline over the last few decades have seen a shift from Indigenous people being framed as objects of research to being agents of meaning and transformation. The marginalisation of Indigenous psychological research within the academy is still, however, an issue which requires change.

  • 2.The need for non-Western cultures to solve their local problems—Indigenous practices and applications

There is a broad consensus across Australian Indigenous communities that culturally strong therapeutic knowledge and practices are ones which articulate solutions identified by local communities (Dudgeon et al., 2014). Respect for the cultural knowledge of Elders is also important in the capacity building of on-country healing programs aimed at reducing youth suicide and “highlight the need for continued support for Elders in maintaining and passing on their cultural knowledge to young people” (Solutions That Work: What the Evidence and Our People Tell Us, 2016, p. 22).

  • 3.The need for a non-Western culture to recognise itself in the constructs and practices of psychology

This form of recognition is foundational to the process of decolonisation and for communities to identity their own solutions and articulate their own cultural concepts. However, it is equally important for Western psychology to recognise how the discipline has constructed Indigenous subjectivity and practiced culturally inappropriate therapeutic interventions. In this respect, the Australian Psychological Society has made history by being the first to formally apologise to Indigenous peoples for past oppressive practices and to vow to make systemic changes. The 2016 people was made at the Australian Psychological Society Congress 2016 in Melbourne. This has become a significant event that gained considerable worldwide media attention and has impact not only in Australia but internationally, with the American Psychological Association now developing a similar apology to their Indigenous people. It is fitting that those involved with progressing the APS apology comment in this special edition. Carey et al. provide a brief overview of the APS’s involvement with Aboriginal and Torres Strait Islander people and issues, tracing the history that contextualises the apology. The apology, how it came about and the reaction to it, particularly by APS members, describes a changing discipline. Following the Australian Government’s landmark apology to Aboriginal and Torres Strait Islander people Stolen Generations in 2008, the APS apology speaks to a maturing sense of race relations and nationhood. In my opinion, the apology formally owns and acknowledges the wrongs done, and the denial of the past, the injustice and oppression that was the lot of many Aboriginal and Torres Strait Islander people. In some respects, Aboriginal and Torres Strait Islander people have suffered a double burden—of suffering injustice and also of having that suffering denied. The apology from the nation and the APS is important; they value people and their experiences and give people respect and a genuine presence. A shared journey of healing for us as a nation can progress.

  • 4.The need to use Indigenous philosophies and concepts to generate theories of global discourse

There is a growing recognition of how psychology has been complicit in the processes of colonisation and oppressing Indigenous peoples. Recognising and acknowledging this past is important, hence the importance of the APS apology. Such acknowledgement and apology allows us to move forward, acknowledging colonisation allows decolonisation for both groups and into a more advanced discipline. It allows space for other viewpoints and understandings to emerge that not only benefit Indigenous peoples but all Australians. There is reason for optimism and the potential for empowerment and genuine inclusion of Aboriginal peoples in the discipline. In order to decolonise psychology in Australia, the discipline needs to consider and incorporate Aboriginal culture and beliefs into mental health services and research. We see this happening from the papers in this special edition. There is focus on the development of Aboriginal paradigms, standpoints, and concepts such as social and emotional wellbeing. Further, there is a deep appreciation of cultural difference and a willingness to work to develop mutual understandings. The papers in the special edition show the promise of different approaches and the development of a new phase of Australian psychology.

In 2017 we stand at a new beginning. We are living in a time of continual change. Twenty years ago Ernest Hunter wrote:

Self determination’, ‘quality of life’, ‘wellbeing’: these are terms that have only recently entered the vocabulary of mental health professionals working in indigenous settings. They are unfamiliar and handled with uncertainty and, at times, temerity; they are also unavoidable (1997, p. 821).

This special issue attests to how such terms are now a common part of discussions about Aboriginal and Torres Strait Islander wellbeing, and part of a vanguard movement in psychology.

Such terms have a substantial material force and a political history, as well as being part of the discourse of Indigenous psychology. Globally, the focus on decolonisation has emerged as a new defining movement which is in the process of transforming all disciplines, not only psychology. Decades of complex Indigenous struggles, debates, and victories are driving decolonisation, and it is because of this that terms such as “self-determination” and “wellbeing” resonate with a particular historical dignity.

The Aboriginal and Torres Strait Islander mental health movement is decolonising the discourse of Australian mental health not only within specialised journals but within the public sphere through the opening up of national debates about the relationship between racism and wellbeing. In doing so, the movement has also contributed to the national projects of overcoming racism and de-stigmatising psychological distress by providing insights into the social and cultural determinants of mental health.

TerminologyA range of words are used to describe Aboriginal and Torres Strait Islanders and non-Aboriginal peoples. The term Indigenous is also used by authors, as this includes both Aboriginal and Torres Strait Islander people. While encouraging authors to use terms that best fit the people they write with, I acknowledge that the preferred term is “Aboriginal and Torres Strait Islander peoples.” The Australian Human Rights Commission explains this term in further detail:

Aboriginal and Torres Strait Islander peoples retain distinct cultural identities whether they live in urban, regional or remote areas of Australia. The word ‘peoples’ recognises that Aborigines and Torres Strait Islanders have a collective, rather than purely individual, dimension to their lives. This is affirmed by the United Nations Declaration on the Rights of Indigenous Peoples (2012, p. 6).

NACCHO Aboriginal Health and Smoking : Download Tackling Indigenous Smoking Program prelim. evaluation report

 ” The overall goal of the national Tackling Indigenous Smoking (TIS) program is to improve the health of Aboriginal and Torres Strait Islander people through local population specific efforts to reduce harm from tobacco.

The purpose of this preliminary report is to provide a mid-term evaluation of progress to date in implementing the first year of the three year (2015-2018) TIS program.

The TIS programme with a budget of $116.8 million over 3 years ($35.3 million in 2015-16; $37.5 million in 2016-17 and $44 million in 2017-18) was announced by the Government, on 29 May 2015.”

Download 133 page PDF report Here :

NACCHO Download Dept Health Tackling Indigenous Smoking Evaluation June 2017

The report found the program is operating effectively, using proven approaches to change smoking behaviours, and delivering evidence-based local tobacco health promotion activities. I am pleased the report recommends it continues,

Smoking is the most preventable cause of disease and early death among Aboriginal people and accounts for almost one-quarter of the difference in average health outcomes between indigenous and non-indigenous Australians.

“The program provides grants in 37 urban, rural, regional and remote areas to assist local communities to develop localised anti-smoking campaigns

Minister Ken Wyatt

Read over 100 plus NACCHO articles published in past 5 years

This mid-term evaluation looks at progress to date of the TIS program, particularly in terms of regional grants delivering localised Indigenous tobacco interventions.

Source of intro

See list all 35 Recipients below

It does not look at long-term impact in relation to a reduction of smoking rates at a national level.

Findings focus on (see in full below 1-9)

  • the shift to TIS
  • community engagement and partnerships
  • localised health promotion
  • access to quit support
  • contribution to evidence base
  • National Best Practice Unit and TIS portal
  • governance and communications.

A number of key recommendations emerging from the evaluation are included in the report.(see Below Part 2)

Findings

1. Shift to TIS

Since the implementation of the TIS program, all grant recipients are primarily focused on planning for, and/or delivering, targeted and tailored activities that directly address reduction of smoking prevalence within communities.

For some grant recipients, broader health promotion activities without a clear link to tobacco reduction have dropped off significantly as a result of the shift to TIS, whilst for others the integration of healthy lifestyle and tobacco control strategies has been successful. There are varying degrees of clarity among grant recipients about the extent to which there is flexibility to tap into healthy lifestyle activities under the new guidelines.

2.Community engagement and partnerships

Community engagement and involvement in the design and planning of localised TIS programs is a key priority for grant recipients, and a key indicator of successful TIS activities.

While challenges were identified in terms of handling competing priorities in community, adhering to cultural protocols, and the change in focus of the TIS program and uncertainty about ongoing funding, in the main, grant recipients have demonstrated substantial progress in involving community in design and planning and garnering support for TIS activities.

This is evidenced by the popularity of community events hosted/attended by the TIS team and the proactivity of local community and Elders in advocating for tobacco control.

The success of the TIS program and the capacity for grant recipients to operate as a multi-level population health program in their region is highly dependent upon the quality and reach of partnerships between grant recipients and other agencies/organisations.

Whilst challenges to regional collaborations were reported, overall there has been a noticeable increase in the reporting of grant recipient collaboration and partnerships, representing an important shift to both a wider regional focus and wider community approach to tobacco reduction.

3.Localised health promotion

At the local level, a range of multi-component health promotion activities around tobacco control are being undertaken by grant recipients, in collaboration with external stakeholders. Local partnerships are crucial to the successful implementation of localised health promotion activities through facilitating access to priority populations, supporting capacity-building and enabling a broader population reach to achieve awareness and understanding of the health impacts of smoking and quitting pathways. viii

Increased levels of community support and ownership for local solutions to tackling Indigenous smoking are being seen across the TIS sites.

4.Community education

Community education, is being undertaken by all grant recipients. This manifests in a range of ways, including health promotion activities at community/sporting events, drama shows and comedy and social marketing.

The involvement of local champions and Elders in local education and awareness raising events and activities is recognised as central to tobacco control messages resonating with target audiences.

It has also been recognised that targeting priority groups, such as young people and pregnant women, requires the adaptation of messages so that they resonate with those groups.

Grant recipients are partnering with key local organisations (e.g. schools, other AMS etc.) to overcome some of the challenges around access to these priority groups.

Many grant recipients have established or showed progress in establishing social marketing campaigns to supplement other health promotion activities. Campaigns are developed largely through a strength-based approach, with ‘local faces and local places’ taking precedence. Grant recipients have acknowledged the challenges in measuring the impact of social marketing campaigns although some are demonstrating a commitment to collecting data on awareness, and influences on motivations and attempts to quit.

5.Smoke-free environments

An area that has been recognised by grant recipients as requiring attention is the promotion and establishment of smoke-free environments, particularly in rural and remote locations. Modelling smoke-free environments within the grant recipients’ own workplace is one way in which this issue is being addressed, with some evidence of success.

Challenges to the implementation of smoke-free workplaces include getting support from senior leaders or Board members who smoke, and organisations where tobacco control is not the main priority. Monitoring the compliance of smoke-free environments presented an additional challenge to grant recipients. Some external organisations have requested support to become smoke-free, and successful examples of smoke-free environments including smoke-free community events are evident.

Shifting attitudes around second-hand smoke (e.g. smoking indoors and in cars) and some evidence of behaviour change were reported by grant recipients and community members.

6.Access to quit support

TIS funded organisations are encouraged to take a systems approach to activity planning. The TIS program is part of a larger preventive health care system, all connected in different ways such as through referral pathways, and client appointments.

A key component of the TIS program is therefore enhancement of referral pathways and promoting access to quit support. Grant recipients have developed a range of opportunities for community members to achieve smoking cessation, with referral pathways having been established in two key areas: clinic-based referrals within their organisation and referrals made during localised TIS health promotion activities.

For some, successful referral pathways are dependent upon grant recipients partnering with external organisations.

Improving access to culturally appropriate support to quit has been a key focus of the grant recipients over the past 12 months.

Quitline enhancements are a component of the TIS program and data suggests that referrals to Quitline are higher in urban and some rural areas. Continuing to build strong partnerships between grant recipients and Quitline will be key to increasing referrals from local TIS programs into Quitline where appropriate.

Another key focus for grant recipients has been in increasing the skills of TIS workers and other professionals in contact with Aboriginal and Torres Strait Islander people to provide smoking cessation education and brief interventions. Quits kills training, and other smoking cessation education programs, have been accessed to support this goal.

7.Contributions to evidence base

The shift to delivering activities based in evidence and focusing more on outcomes than outputs has been welcomed by grant recipients, in the main, and has provided greater direction for activities and a goal to work towards.

A range of activities were undertaken by grant recipients to develop or strengthen their evidence base and work towards measurable outcomes. Collecting data remained challenging for some remote grant recipients operating in contexts with low literacy levels and where English is not the first language. Health service grant recipients wanting to collect population level data was also challenging when services are operating on different databases within a region and where there was an unwillingness to share data.

Overall, grant recipients expressed a willingness to focus on outcomes, and the confidence and capability to obtain data, although interpreting and reporting on data was presented as a challenge.

8.National Best Practice Unit and TIS portal

Advice and guidance around monitoring, measuring and further improving local TIS programs is provided to grant recipients through the NBPU TIS. Grant recipients have indicated that they value the support and advice provided through the NBPU TIS and this has aided in building their confidence and capacity to undertake monitoring and evaluation activities.

Some grant recipients reported that an additional level of support from NBPU TIS was needed. Resistance to change is common in any business when new processes are set in place. NBPU TIS therefore expected, and has witnessed, some resistance to this change. However, it continues to engage with grant recipients and support significant processes of change, not just reporting and compliance.

Another component of the work of the NBPU TIS is the development and ongoing maintenance and improvement of the Tackling Indigenous Smoking Resource and Information Centre (TISRIC) and its home, the TIS Portal (hosted by Australian Indigenous HealthInfoNet).

Information and resources to support grant recipients in planning, monitoring, and evaluating activities, as well as information on workforce development is provided through the TIS Portal.

In addition, the Portal hosts an online forum (TIS Yarning Place) that enables grant recipients from across the country to share information and ask questions. Evaluation findings suggest that, whilst grant recipients are utilising the TIS Portal, some grant recipients have identified opportunities to enhance the useability of the TIS Portal.

9.Governance and communications

Various components of support are provided to grant recipients by the department and the NBPU TIS regarding the new focus and priorities and expectations of the TIS program.

To ensure consistent program messaging, and to enhance performance reporting, a range of initiatives were undertaken in the latter half of 2016 to clarify the roles and responsibilities of the various ‘players’ in the national TIS program.

The loss of experienced staff due to funding uncertainty has represented a significant challenge for several grant recipients in their planning and implementing activities.

Particularly in remote areas, recruitment has been an issue for many grant recipients due to the mix of skills demanded of TIS staff. Grant recipients report continued issues attracting and retaining staff with only short term contracts under the new TIS program.

Despite these concerns, indications are that providing grant recipients are given sufficient time and support to execute their Action Plans, they are on track for achieving stated tobacco reduction outcomes. The key risk to this is workforce stability, which would be mitigated by timely advice about the outcome of ongoing funding arrangements.

A number of key recommendations have emerged out of the evaluation findings:

Overall recommendations

1. Department: The TIS program in its current form should be continued, with a move away from short-term funding cycles.

2. Department: Provide immediate advice about the funding of TIS from June 2017 to end of current funding cycle.

Shift to TIS

3. Department: Provide clarity around what is allowable in relation to healthy lifestyle activities within the current iteration of the TIS program  Community engagement and partnerships

4. Grant recipients: Continue to broker partnerships and leverage relationships.

5. NBPU TIS: Continue to build capability of grant recipients to broker partnerships and leverage relationships through the distribution and promotion of relevant resources.

Community education and awareness

6. Grant recipients: Continue to identify and prioritise key groups, especially pregnant women.

7. Grant recipients: Ensure evidence-based best practice community education models (including monitoring and evaluation approaches) are sought and adopted where appropriate.

8. NBPU TIS: Ensure the evidence-based best practice community education models (including monitoring and evaluation approaches) are available, particularly for priority target groups such as pregnant women and activities around social marketing.

Smoke-free environments

9. Grant recipients: Continue to explore implementing smoke-free workplaces and enhance support for smoke-free public spaces.

10. National Coordinator: Lead a dialogue between regional leaders, including CEOs, Board members of TIS and non-TIS funded organisations around establishing smoke-free environments.

Access to quitting support

11. Grant recipients: Continue to strengthen partnerships with Quitline and other quit support structures where appropriate.  Contribution to larger evidence base

12. Grant recipients: Build on routine and existing data sources to reduce data collection burden.

National support

13. Grant recipients: Continue to seek feedback from NBPU TIS regarding M&E activities where required.

14. NBPU TIS: Continue to respond to feedback from GRs around M&E needs and TIS portal content and use ability.

15. Department: Articulate the role of the National coordinator  in the context that the program has evolved and as such his role has evolved. Governance and communication

16. Department: Provide greater clarification of TIS funding parameters, especially in terms of incorporation of healthy lifestyle activities and one-on-one smoking cessation support.

The Tackling Indigenous Smoking (TIS) regional tobacco control grants aim to improve the wellbeing of Aboriginal and Torres Strait Islander people through population health activities to reduce tobacco use. It is an initiative of the Australian Government Department of Health (DoH).

At the end of 2015, a number of organisations were notified of their success in gaining a TIS grant for culturally appropriate tobacco cessation programs. The grants were awarded to a variety of service providers across the nation.

The 35 organisations that have commenced their programs are:

With the program funding provided until 2018, the successful organisations will work towards the intended outcomes of the TIS programme, including:

  • encouraging community involvement in and support for local tobacco control activities
  • increasing community understanding of the dangers of smoking and chewing tobacco
  • improving knowledge, skills and a better understanding of the health impacts of smoking.

Aboriginal Health #NAIDOC2017 : New Aboriginal-led collaboration has world-class focus on boosting remote Aboriginal health

“One of the clear innovations that our Centre already offers is acknowledging that the principle of Aboriginal community control is fundamental to research, university and health care partnerships with regional and remote Aboriginal communities,”

Ms Donna Ah Chee Congress CEO said it was satisfying to achieve recognition for the strong health leadership and collaboration that already exists in Central Australia ( see editorial Part 3 below)

  ” The centre’s accreditation this week with the National Health and Medical Research Council proved the “landmark research” by consortium members had “huge potential” to address serious indigenous health issues.

The objective is to evaluate problems and find practical solutions fast, to prevent health problems and give speedy but lasting benefits to patients within community,”

Announcing $222,000 in seed funding, Federal Indigenous Health Minister Ken Wyatt see full story PART 2 from the Australian below

Photo above : Traditional Arrernte owners welcome Ken Wyatt MP to Alice Springs to launch the Central Australia Academic Health Science Centre

An academic health science centre in Central Australia is the first Aboriginal-led collaboration to achieve Federal Government recognition for leadership in health research and delivery of evidence-based health care.

The Federal Minister for Indigenous Health and Aged Care, the Hon Ken Wyatt MP, today announced that the Central Australia Academic Health Science Centre (CAAHSC) was one of only two consortia nationally to be recognised as a Centre for Innovation in Regional Health (CIRH) by Australia’s peak funding body for medical research, the National Health and Medical Research Council (NHMRC).

To be successful in their bid, the 11-member consortium was required to demonstrate competitiveness at the highest international levels across all relevant areas of health research and translation of research findings into health care practice.

With NHMRC recognition, the CAAHSC joins an elite group of Australian academic health science centres that have so far all been based in metropolitan areas including Melbourne,

Sydney and Adelaide. The CAAHSC is also in good company internationally, with long established collaborations including Imperial College Healthcare in the UK and Johns Hopkins Medicine in the USA.

The CAAHSC, whose membership includes Aboriginal community controlled and government-run health services, universities and medical research institutes, was formally established in 2014 to improve collaboration across the sectors in support of health.

Such synergy is vital in order to make an impact in remote central Australia, considering the vast geographical area (over 1 million square kilometres) and the health challenges experienced particularly by Aboriginal residents.

The CAAHSC consortium reflects the importance of Aboriginal leadership in successful research and health improvement in Central Australia.

The Chairperson of CAAHSC is Mr John Paterson, CEO of the Aboriginal Medical Services Alliance Northern Territory, the peak body for the Aboriginal community controlled health services sector in the NT.

With the leadership of CEO Ms Donna Ah Chee, Central Australian Aboriginal Congress was the lead partner on the group’s bid to become a CIRH.

The CAAHSC is a community driven partnership, where Aboriginal people themselves have taken the lead in identifying and defining viable solutions for the health inequities experienced in the Central Australia region.

The CAAHSC partners have a long and successful track record of working together on innovative, evidence-based projects to improve health care policy and practice in the region.

Such projects include a study that examined high rates of self-discharge by Aboriginal patients at the Alice Springs Hospital, which in many cases can lead to poor health outcomes.

This research was used to develop a tool to assess self-discharge risk which is now routinely used in care, and to expand the role of Aboriginal Liaison Officers within the hospital.

Another collaborative project designed to address the rising rates of diabetes in pregnant women involves the establishment of a patient register and birth cohort in the

Northern Territory to improve antenatal care in the Aboriginal population.

CAAHSC Chair, Mr John Paterson agrees, saying the CIRH would serve as a model for other regional and remote areas both nationally and internationally, particularly in its governance, capacity building, and culturally appropriate approaches to translational research.

Mr Paterson said he hoped NHMRC recognition would attract greater numbers of highly skilled researchers and health professionals to work in Central Australia, and that local Aboriginal people would become more engaged in medical education, research and health care delivery.

He also hopes that achieving status as a CIRH will be instrumental in attracting further resources to the region, including government, corporate and philanthropic support.

Mr Paterson said the consortium is now focussed on building a plan across its five priority areas: workforce and capacity building; policy research and evaluation; health services research; health determinants and risk factors; and chronic and communicable disease.

This will include development of research support ‘apprenticeships’ for Aboriginal people and pursuit of long-term financial sustainability.

The partners of the Central Australia Academic Health Science Centre include: Aboriginal Medical Services Alliance Northern Territory (AMSANT); Baker Heart and Diabetes Institute; Charles Darwin University; Centre for Remote Health (A joint centre of Flinders University and Charles Darwin University); Central Australian Aboriginal Congress; Menzies School of Health Research; Central Australia Health Service (Northern Territory Health); CRANAplus; Flinders University; Ngaanyatjarra Health Service and the Poche Centre for Indigenous Health and Wellbeing.

1.Chronic Conditions

Chronic diseases are the most important contributor to the life expectancy gap between Indigenous and non-Indigenous Australians. Given their impact on premature mortality, disability and health care utilisation in Central Australia it is unsurprising that chronic disease has become the primary focus for addressing Indigenous Australian health disadvantage.

The Central Australia AHSC has considerable research and translation expertise with those chronic conditions that most impact the Aboriginal Australian population, including diabetes, heart disease, renal disease and depression.

Some of our focus areas are: understanding the developmental origins of adult chronic disease through targeted multi-disciplinary research focused on in-utero, maternal and early life determinants; understanding and preventing the early onset and rapid progression of heart, lung and kidney disease and diabetes within Aboriginal people, and developing and supporting capacity development of the chronic disease workforce within Aboriginal communities and health services.

2.Health Determinants and Risk Factors

In order to support the health of Central Australians, we recognise the importance of transcending boundaries between the biological, social and clinical sciences. The Central Australia AHSC takes an interdisciplinary approach to understanding social gradients, their determinants, and pathways by which these determinants contribute to illness, and consequently to forwarding policy responses to reduce health inequalities.

The Central Australia AHSC is interested in exploring the role of stress, intergenerational trauma and other psychosocial factors, as well as uncovering the biological pathways by which social factors impact on cardiometabolic risk, mental illness and other conditions of relevance to Indigenous communities.

3.Health Services Research

As a regional hub servicing a high proportion of Aboriginal people spread across an extensive area, Central Australia serves as an exemplar environment through which to address critical issues of national importance – for instance, targeted and practical research focused on the National Health and Hospital Reform agenda, the ‘Close the Gap’ reforms and the Indigenous Advancement Strategy.

Through health services research, the Central Australia AHSC is chiefly interested in developing and equipping primary care and hospital services with the skills, methods and tools by which to improve health care quality, appropriateness and accessibility.

Towards this goal, we are involved in developing, trialling, evaluating and establishing the cost-effectiveness of novel health system approaches to the identification, management and prevention of acute care, chronic disease and mental illness

4.Policy Research and Evaluation

The Central Australia AHSC brings together the expertise of leading clinician researchers, public health specialists and health service decision makers.

The Central Australia AHSC provides the capacity to evaluate the systems that underpin change management in health care through policy, protocol and evaluation research, and to support quality improvement processes through health provider training.

While being locally relevant, our works also informs jurisdictional and national health policy and practice in Aboriginal and remote health and implementation of national health reforms.

5.Workforce and Capacity Building

Central Australia’s health care workforce encompasses health care providers in hospitals, remote Aboriginal communities, and outreach services, including Aboriginal health practitioners, nurses, allied health providers, general practitioners and specialists.

Remoteness and the challenging work environment often translate to high levels of health provider staff turnover.

The Central Australia AHSC’s ongoing focus on professional development and capacity building facilitates health work force sustainability by providing relevant training and support and by attracting new health care providers who are also involved in research.

Workforce and capacity building undertaken by the AHSC partners includes the delivery of education programs (including tailored remote and Indigenous health postgraduate awards for doctors, nurses and allied health practitioners), growing research capacity (supervised formal academic qualifications and informal mentoring), and conducting research to inform workforce recruitment and retention.

Part 2 World-class focus on boosting remote health

Alice Springs mother Nellie Impu is part of a grim health statistic profoundly out of place in a first-world nation: one in five pregnant Aboriginal women in the Northern Territory has diabetes.

Photo : Nellie Impu, left, with Wayne, Wayne Jr and nurse Paula Van Dokkum in Alice Springs. Picture: Chloe Erlich

From the Australian July 5

For pre-existing type 2 diabetes, that’s at a rate 10 times higher than for non-indigenous women; more common gestational diabetes is 1.5 times the rate.

Mrs Impu became part of that statistic almost five years ago when she was pregnant with son Wayne. So the announcement of a new central Australian academic health science centre, led by the Aboriginal community-controlled health service sector and bringing together a consortium of 11 clinical and research groups, is a big deal for her and many women like her.

The diabetes treatment she underwent while carrying Wayne will continue for more than a decade as part of a longitudinal study.

“We know there is a link ­between mums with diabetes in pregnancy and outcomes for their babies as they grow, including ­future possibilities of type 2 diabetes, which work like this can help us track,” said research nurse Paula Van Dokkum, who works with consortium member Baker IDI Heart and Diabetes Institute.

Wayne is meeting all his childhood development targets, and his mother said the ongoing association with the centre would help her in “trying to make sure he grows up healthy and strong”.

Announcing $222,000 in seed funding, federal Indigenous Health Minister Ken Wyatt said the centre’s accreditation this week with the National Health and Medical Research Council proved the “landmark research” by consortium members had “huge potential” to address serious indigenous health issues.

“The objective is to evaluate problems and find practical solutions fast, to prevent health problems and give speedy but lasting benefits to patients within community,” Mr Wyatt said.

The academic health science centre model, well ­established internationally, brings together health services, universities and medical research institutes to better produce evidence-based care.

The Alice Springs-based enterprise will aim to tackle a ­cancer-causing virus endemic in indigenous central Australia, its only significant instance outside South America and central Africa.

The human T-lymphotropic virus type 1 causes a slow death over 20 years with leukaemia, chronic cough, respiratory problems and respiratory failure. It can be acquired through breast milk in early childhood as well as through blood or sexual contact.

A recent study found HTLV-1 infection rates in a central Australian indigenous community of more than 40 per cent. One result, the inflammatory disease bronch­iectasis, is a leading cause of death for young adults at the Alice Springs hospital.

The program will also address the soaring demand for dialysis in remote communities, with indigenous Australians five times as likely to have end-stage kidney disease than other Australians.

Alice Springs hospital is home to the largest single-standing ­dialysis service in the southern hemisphere, with 360 patients.

Part 3 Alice Springs: the Red Centre of medical innovation

London, Boston, Toronto, Melbourne … and Alice Springs.

Although there may be little in common between these major cities and the heart of Australia’s outback, an announcement this week brings the Red Centre into the company of international players in translational health research, including prestigious institutions such as Imperial College Healthcare in Britain and Johns Hopkins Medicine in the US.

This week, the Central Australia Academic Health Science Centre was given the official seal of approval by the National Health and Medical Research Council.

The Central Australia consortium was one of only two centres recognised as a centre of innovation in regional health for its leadership in health research and delivery of evidence-based healthcare.

And now there’s opportunity in the Red Centre to do even more.

It may well be the most remote academic health science centre in the world, and perhaps the only academic health science centre in the world led by Aboriginal people. With such esteemed recognition for this remote, Aboriginal-led, evidence-based healthcare collaboration, it is hoped that public and private support will also follow.

As a model well established abroad and gaining momentum in Australia, academic health science centres are partnerships between health services, universities and medical research institutes whose collaborative work ensures that translational health research leads to evidence-based care and better health outcomes for patients.

For the 11 partners behind the Central Australia partnership, recognition as a centre for innovation in regional health acknowledges the outstanding collaboration that has existed in this region for several years, and particularly the leadership offered by the Aboriginal sector.

Working with the other partners in the consortium, Aboriginal community-controlled health services are taking the lead in identifying and defining viable solutions for the health inequities experienced in the region.

The work of the Central Australia partners is practical and responsive.

Interested in resolving what had become a troubling issue at Alice Springs Hospital, a resident physician researcher initiated a study that found nearly half of all admitted Aboriginal patients had self-discharged from the hospital in the past, with physician, hospital and patient factors contributing to this practice.

The research findings were used to develop a self-discharge risk assessment tool that is now routinely used in hospital care, and to expand the role of Aboriginal liaison officers within the hospital.

Considering the vast and remote geographical area — more than one million square kilometres — and the health challenges experienced particularly by Aboriginal residents who make up about 45 per cent of the region’s population of about 55,000 people, the Central Australia consortium faces unique and significant challenges. In this respect, Alice Springs may be more like Iqaluit in the Canadian Arctic than London or Baltimore.

But in other ways this relatively small academic health science centre may be at an advantage.

With its closely knit network of healthcare providers, medical researchers, medical education providers and public health experts working together, community-driven approaches to identifying issues and developing evidence-based solutions have become a standard approach in Central Australia.

In this setting of high need and limited resources, working collectively is sensible, practical and necessary.

Importantly, there is the possibility to do a lot more.

The consortium hopes such recognition will help to attract top healthcare providers and researchers, to increase educational offerings and to develop local talent, especially Aboriginal people.

The evidence is resounding. A research oasis in the desert, this centre for innovation is fertile ground for investment by government, corporations and philanthropists alike.

Donna Ah Chee is chief executive of the Central Australian Aboriginal Congress. John Paterson is chief executive of the Aboriginal Medical Services Alliance Northern Territory.

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

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

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

Dr Robert Amery Medical Journal Australia NAIDOC Week 2017

 

Introduction Press Release

Communication gap puts Indigenous health at risk

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 Download MJA paper here MJA Dr Robert Amery

Published with permission from Robert Amery and Medical  Journal Australia

 See website for references or PDF

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

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

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

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

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

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

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

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

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

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

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

Yolŋu comprehension of 30 common legal terms*

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

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

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

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

Box 3

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

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

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

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

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

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

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

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

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

Communication strategies

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

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

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

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

Aboriginal Health and #prevention : New report : @Prevention1stAU health : How much does Australia spend and is it enough?

 ” The verdict is in: Prevention is better than cure when it comes to tackling Australia’s chronic disease burden, but is Australia pulling its weight when it comes to tackling the nation’s greatest public health challenge?

A new economic report looking at what Australia invests in preventive health has found Australia ranks poorly on the world stage and has determined that governments must spend more wisely to contain the burgeoning healthcare budget.

Treating chronic disease costs the Australian community an estimated $27 billion annually, accounting for more than a third of our national health budget.

Yet Australia currently spends just over $2 billion on preventive health each year, or around $89 per person.

One in two Australians suffer from chronic disease, which is responsible for 83 per cent of all premature deaths in Australia, and accounts for 66 per cent of the burden of disease.”

The report, Preventive health: How much does Australia spend and is it enough? was co-funded by the Heart Foundation, Kidney Australia, Alzheimer’s Australia, the Australia Health Promotion Association and the Foundation for Alcohol Research and Education.

Download the report HERE

Preventive-health-How-much-does-Australia-spend-and-is-it-enough_FINAL

Produced by La Trobe University’s Department of Public Health, the report examines trends in preventive health spending, comparing Australia’s spending on preventive health, as well as the funding models used, against selected Organisation for Economic Co-operation and Development (OECD) countries.

The report also explores the question: ‘how much should Australia be spending on preventive health?’

Treating chronic disease costs the Australian community an estimated $27 billion annually, accounting for more than a third of our national health budget.

Yet Australia currently spends just over $2 billion on preventive health each year, or around $89 per person. At just 1.34 per cent of Australian healthcare expenditure, the amount is considerably less than OECD countries Canada, New Zealand and the United Kingdom, with Australia ranked 16th out of 31 OECD countries by per capita expenditure.

Michael Thorn, Chief Executive of the Foundation for Alcohol Research and Education (FARE), a founding member organisation of the Prevention 1st campaign, says that when looking at Australia’s spend on prevention, it should be remembered that one third of all chronic diseases are preventable and can be traced to four lifestyle risk factors: alcohol and tobacco use, physical inactivity and poor nutrition.

“We know that by positively addressing and influencing lifestyle factors such as physical activity, diet, tobacco and   alcohol consumption, we will significantly reduce the level of heart disease, stroke, heart failure, chronic kidney disease, lung disease and type 2 diabetes; conditions that are preventable, all too common, and placing great pressure on Australian families and on Australia’s healthcare systems,” Mr Thorn said.

Report co-author, Professor Alan Shiell says we should not simply conclude that Australia should spend more on preventive health simply because we spend less than equivalent nations, and instead argues that Australia could and should spend more on preventive health measures based on the evidence of the cost effectiveness of preventive health intervention.

“The key to determining the appropriate prevention spend is to compare the added value of an increase in spending on preventive health against the opportunity cost of doing so.

“If the value of the increased spending on preventive health is greater than the opportunity cost, then there is a strong case to do so,” Professor Shiell said.

Professor Shiell says there is clear evidence that many existing preventive health initiatives are cost-effective.

“Studies suggest Australia’s health could be improved and spending potentially even reduced if government was to act on existing policy recommendations and increase spending on activities already considered cost-effective.

“We also suspect that the choice of funding mechanism, or how money is allocated to whom for prevention – is an important factor for the overall efficiency of health prevention expenditure,” Professor Shiell said.

The report highlights England’s efforts in evaluating and monitoring the cost effectiveness and success of its public health interventions and Mr Thorn believes Australia would do well to follow their lead.

“In the United Kingdom we have a conservative government no less, showing tremendous leadership to tackle chronic disease, with bold policy measures like the recently introduced sugar tax and broad-based physical activity programs, all of which are underpinned by robust institutional structures,” Mr Thorn said.

The report will be launched at a Forum at Parliament House in Canberra today, where public health experts, including the World Health Organization’s Dr Alessandro Demaio will explain how they would invest in preventive health if given $100 million to spend.

 

 

 

Aboriginal Health : Second Atlas of Healthcare Variation highlights higher Aboriginal hospitalisation rates for all 18 clinical conditions

 

“The report, compiled by the Australian Commission on Safety and Quality in Health Care, shows us that high hospitalisation rates often point to inadequate primary care in the community, leading to higher rates of potentially preventative hospitalization

The most disturbing example of this  has been the higher hospitalisation rates for all of the 18 clinical conditions surveyed experienced by Aboriginal and Torres Strait Islander Australians, people living in areas of relative socioeconomic disadvantage and those living in remote areas.

 Chairman of Consumers Health Forum, Tony Lawson who is a member of the Atlas Advisory Group.

 “Additional priorities for investigation and action are hospitalisation rates for specific populations with chronic conditions and cardiovascular conditions, particularly:

  • Aboriginal and Torres Strait Islander Australians
  • People living in remote areas
  • People at most socioeconomic disadvantage.

Please note

  • Features of the second Atlas include: Analysis of data by Aboriginal and Torres Strait Islander status

DOWNLOAD Key-findings-and-recommendations

Mr Martin Bowles Secretary Dept of Health  launches the Second Australian Atlas of Healthcare Variation

A new report showing dramatic differences in treatment rates around Australia signals a pressing need for reforms to ensure equitable access to appropriate health care for all Australians, the Consumers Health Forum, says.

“A seven-fold difference in hospitalisation for heart failure and a 15-fold difference for a serious chronic respiratory disease depending on place of residence, are among many findings of substantial variations in treatment rates in Australia revealed in the Second Australian Atlas of Healthcare Variation,” the chairman of Consumers Health Forum, Tony Lawson, said.

“While there are a variety of factors contributing to these differences,  the variation in health and treatment outcomes is, as the report states, an ‘alarm bell’ that should make us stop and investigate whether appropriate care is being delivered.

“These findings show that recommended care for chronic diseases is not always provided.  Even with the significant funding provided through Medicare to better coordinate primary care for people with chronic and complex conditions, fragmented health services contribute to suboptimal management, as the report states.

“We support the report’s recommendation for a stronger primary health system that would provide a clinical ‘home base’ for coordination of patient care and in which patients and carers are activated to develop their knowledge and confidence to manage their health with the aid of a healthcare team.

“The Atlas provides further robust reasons for federal, state and territory governments to act on the demonstrated need for a more effective primary health system that will ensure better and more cost effective care for all Australians.

“The Atlas also examined  variations in women’s health care, and its findings included a seven-fold difference in rates of hysterectomy and  21-fold  difference in rates of endometrial ablation.  The report states that rates of hysterectomy and caesarean sections in Australia are higher than reported rates in other developed nations.  These results highlight the need for continuing support and information on women’s health issues,” Mr Lawson said.

The Second Australian Atlas of Healthcare Variation (second Atlas) paints a picture of marked variation in the use of 18 clinical areas (hospitalisations, surgical procedures and complications) across Australia.

This Atlas, the second to be released by the Commission, illuminates variation by mapping use of health care according to where people live.  As well, this Atlas identifies specific achievable actions for exploration and quality improvement.

The second Atlas includes interventions not covered in the first Atlas, such as hospitalisations for chronic diseases and caesarean section in younger women. It also builds on the findings from the first Atlas – for example, examining hysterectomy and endometrial ablation separately, and examining rates of cataract surgery using a different dataset.

Priority areas for investigation and action arising from the second Atlas include use of:

  • Hysterectomy and endometrial ablation
  • Chronic conditions (COPD, diabetes complications)
  • Knee replacement.

Additional priorities for investigation and action are hospitalisation rates for specific populations with chronic conditions and cardiovascular conditions, particularly:

  • Aboriginal and Torres Strait Islander Australians
  • People living in remote areas
  • People at most socioeconomic disadvantage.

Healthcare Variation – what does it tell us

Some variation is expected and associated with need-related factors such as underlying differences in the health of specific populations, or personal preferences. However, the weight of evidence in Australia and internationally suggests that much of the variation documented in the Atlas is likely to be unwarranted. Understanding this variation is critical to improving the quality, value and appropriateness of health care.

View the second Atlas

The second Atlas, released in June 2017, examined four clinical themes: chronic disease and infection – potentially preventable hospitalisations, cardiovascular, women’s health and maternity, and surgical interventions.

Key findings and recommendations for action are available here.

View the maps and download the data using the interactive platform.

What does the Atlas measure?

The second Atlas shows rates of use of healthcare interventions (hospitalisations, surgical procedures and complications,) in geographical areas across Australia.  The rate is then age and sex standardised to allow comparisons between populations with different age and sex structures. All rates are based on the patient’s place of residence, not the location of the hospital or health service.

The second Atlas uses data from national databases to explore variation across different healthcare settings. These included the National Hospital Morbidity Database and the AIHW National Perinatal Data Collection.

Who has developed the second Atlas?

The Commission worked with the Australian Institute of Health and Welfare (AIHW) on the second Atlas.

The Commission consulted widely with the Australian government, state and territory governments, specialist medical colleges, clinicians and consumer representatives to develop the second Atlas.

Features of the second Atlas include:

  • Greater involvement of clinicians during all stages of development
  • Analysis of data by Aboriginal and Torres Strait Islander status
  • Analysis of data by patient funding status (public or private).

Table of Contents

Chapter 1 Chronic disease and infection: potentially preventable hospitalisations

1.1 Chronic obstructive pulmonary disease (COPD)
1.2 Heart failure
1.3 Cellulitis
1.4 Kidney and urinary tract infections
1.5 Diabetes complications

Chapter 2 Cardiovascular conditions

2.1 Acute myocardial infarction admissions
2.2 Atrial fibrillation

Chapter 3 Women’s health and maternity

3.1 Hysterectomy
3.2 Endometrial ablation
3.3 Cervical loop excision or cervical laser ablation
3.4 Caesarean section, ages 20 to 34 years
3.5 Third- and fourth-degree perineal tear

Chapter 4 Surgical interventions

4.1 Knee replacement
4.2 Lumbar spinal decompression
4.3 Lumbar spinal fusion
4.4 Laparoscopic cholecystectomy
4.5 Appendicectomy
4.6 Cataract surgery
Technical Supplement
About the Atlas
Glossary

Australian Atlas of Healthcare Variation data set specifications are available at http://meteor.aihw.gov.au/content/index.phtml/itemId/674758

 

Aboriginal Health Programs-Debate : Evaluating #Indigenous programs : a toolkit for change

 

 ” The Federal Government recently announced it will allocate $10 million a year over four years to strengthen the evaluation of Indigenous programs.

However, given that the average cost of an evaluation is $382,000, the extra $10 million a year for Indigenous program evaluations will not go far.

To make the most of this additional funding the government must change the way it evaluates and monitors programs.”

Sarah Hudson Researcher The Centre for Independent Studies

Download the report HERE

Evaluating Indigenous programs a tool kit for change

” Aboriginal community-controlled organisations treat health not just as a physical problem, but see it as tied in with the social, emotional and cultural wellbeing of the whole community, in which each individual is able to achieve their full potential as a human being.

While this has its roots in Aboriginal cultural norms, she says, it also mirrors well-known social determinants of health.”

 ” Victoria’s peak Aboriginal health body was recently given two days to respond to a draft family violence plan “the size of a PhD”, its CEO says. It’s another example of governments just not getting how to work with Aboriginal communities.

Co-design with community groups cannot work if government asks for input after the big decisions have already been made or rush consultation, warns the head of Victoria’s peak body for the Aboriginal community health system.

“It’s not an equal partnership. We’re at their whim, and we’ve got to run to their agenda,”

Victorian Aboriginal Community Controlled Health Organisation CEO Jill Gallagher said last week in a speech at the University of Melbourne. See Article 2 Below

” Evaluation at the contract, program and outcome level will ensure we not only know where the money is being spent, but we will know what works and why.

“This is important for the government and taxpayers, but more important for communities in whose name the money is spent.

“It will also mean we will be better able to assess where our investm­ent needs to be focused in the future — and ensure the IAS continues to deliver outcomes for indigenous communities.”

From Indigenous Affairs Minister Nigel Scullion Article 3 below

 Feb 3 2017 NACCHO Aboriginal Health #IAS Funding : Turnbull government to spend $40m evaluating effectiveness of Indigenous programs 

Although formal evaluations for large government programs are important, evaluation need not involve outside contractors. Government must adopt a learning and developmental approach that embeds evaluation into a program’s design as part of a continuous quality improvement process.

It is not enough just to evaluate, government must actually use the findings from evaluations to improve service delivery. Unfortunately, many government agencies ignore evaluations when making funding decisions or implementing new programs.

Analysis of 49 Indigenous program evaluation reports, found only three used rigorous methodology.

Overall, the evaluations were characterised by a lack of data and the absence of a control group, as well as an overreliance on anecdotal evidence.

Adopting a co-accountability approach to evaluation will ensure that both the government agency funding the program and the program provider delivering the program are held accountable for results.

An overarching evaluation framework could assist with the different levels of outcomes expected over the life of the program and the various indicators needed to measure whether the program is meeting its objectives.

Feedback loops and a process to escalate any concerns will help to ensure government and program providers keep each other honest and lessons are learnt.

Analysis of Indigenous program evaluations

Mapping of total federal, state and territory and non-government/not-for-profit Indigenous programs identified 1082 Indigenous specific programs. Of these:

49 were federal government programs;

• 236 were state and territory programs; and

• 797 were programs delivered by non-government organisations.

The largest category of programs were health related programs (n=568) followed by cultural programs (n=145) then early childhood and education programs (n=130) — see Figure 1.

The program category with the highest number of evaluations was health (n=44), followed by early childhood and education (n=16). However, percentage wise, more programs were evaluated under the jobs and economy category (15%) than the other program categories.

Of the 490 programs delivered by Aboriginal organisations, only 20 were evaluated (4%). The small number of businesses delivering a program (n=6) meant that while there were only two evaluations of Indigenous programs provided by a business, this category had the highest percentage of programs evaluated (33%).

Similarly, while only six of the 33 programs delivered by schools and universities were evaluated, this category had the second highest percentage of programs evaluated (23%). Conversely, government and non-Indigenous NGO delivered programs had the highest number of evaluations, n=36 and n=24, but much lower percentages of evaluations as the number of overall programs was higher, n=278 and n=276.

A total of 49 evaluation reports were analysed and assessed against a scale rating the rigour of the methodology. Only three evaluation reports utilised strong methodology (see Figure 4).

In general, Indigenous evaluations are characterised by a lack of data and the absence of a control group, as well as an over-reliance on anecdotal evidence

Suggestions for policy makers and program funders include:

  • Embedding evaluation into program design and practice — evaluation should not be viewed as an ‘add on’ but should be built into a program’s design and presented as part of a continuous quality improvement process with funding for self-evaluation provided to organisations.
  • Developing an evidence base through an accountability framework with regular feedback loops via an online data management system — to ensure data being collected is used to inform practice and improve program outcomes and there is a process for escalating concerns.

Suggestions for program providers include:

  • Embedding evaluation into program practice — evaluation should not be viewed as a negative process, but as an opportunity to learn.
  • Developing an evidence base through the regular collection of data via an online data management system to not only provide a stronger evidence base for recurrent funding, but also to improve service delivery and ensure client satisfaction with the program

Article 2 Govt co-design ‘not an equal partnership’: Aboriginal health CEO

Victoria’s peak Aboriginal health body was recently given two days to respond to a draft family violence plan “the size of a PhD”, its CEO says. It’s another example of governments just not getting how to work with Aboriginal communities.

Co-design with community groups cannot work if government asks for input after the big decisions have already been made or rush consultation, warns the head of Victoria’s peak body for the Aboriginal community health system.

“It’s not an equal partnership. We’re at their whim, and we’ve got to run to their agenda,” Victorian Aboriginal Community Controlled Health Organisation CEO Jill Gallagher said last week in a speech at the University of Melbourne.

A particularly vivid example of this is engagement on the establishment of family violence hubs around the state. Gallagher, who is on the family violence industry taskforce, said she was handed a draft plan already outlining the main priorities on Monday, and asked to provide a written response by Wednesday. “A report the size of a PhD,” she added.

“So when they say ‘we want to co-design with you guys’, always ask them what their version of co-designing is,” she told the audience. “Without systematic change in mainstream attitudes and practices, and incorporation of Aboriginal peoples in all stages of policy design, health policies will remain unproductive.”

While Gallagher says she understands the challenges of trying to co-design with a community, government needed to make a more concerted effort to do it properly.

“It doesn’t give us due respect of being part of the beginning right through to the evaluation.”

Culture is strength

Aboriginal culture is often seen in the wider Australian population as a barrier to health, implying that assimilation is the only way forward, Gallagher said.

She rejects this idea. “Cultural differences need to be celebrated and preserved. They are a source of strength and resilience for our peoples, which offer protective factors against traumatic life events.”

Cultural safety and trust can have a big impact on engagement with institutions. She points to the fact that around the country, Aboriginal people are discharged against medical advice or at their own risk at eight times the rate of the rest of the population. This has obvious flow on effects for overall wellbeing.

“When we have a culturally safe place for patients and our people, we improve access to services and improve health for individuals, therefore health for families, therefore health for communities.”

Also in The MandarinIndigenous policy evidence, where it exists, over-relies on anecdotal evidence

Creating that environment should not only be up to Aboriginal employees or a good CEO, but come out of an organisation’s systems. This means more than just creating a few identified positions — it’s everyone’s responsibility.

Aboriginal community-controlled organisations treat health not just as a physical problem, but see it as tied in with the social, emotional and cultural wellbeing of the whole community, in which each individual is able to achieve their full potential as a human being. While this has its roots in Aboriginal cultural norms, she says, it also mirrors well-known social determinants of health.

“Possessing a strong sense of cultural identity is also vital for one’s self-esteem. A positive cultural connection not only contributes to better mental health and physical health, but may lessen the consequences of social prejudice against Aboriginal peoples.”

Yet despite plenty of experience to show the importance of culture as a source of resilience, it “remains largely unexplored” as a public health resource, she says.

Funding models that don’t fit

Governments ignoring the role of culture creates other problems, Gallagher explains.

The Commonwealth made a capital investment a few years ago to create a childcare centre and kindergarten in Melbourne’s northern suburbs called Bubup Wilam. Recurrent funding was only given for two years, with the idea that it would become self-sustaining by the end of that short period.

“Bubup Wilam grew and evolved and it’s a beautiful childcare centre and kindergarten for Aboriginal children, where they can learn and express aboriginal culture but also have access to what every other kid has access to.

Despite the success, it’s “struggling to continue that at the moment” and is trying to raise funds in the community, she says, “because it doesn’t just provide a kindergarten like for a mainstream nuclear family.”

“Because a lot of the kids and families that access Bubup Wilam are families that live well under the poverty line, a lot of them are touched by the child protection system. What Bubup Wilam tries to do is work with the children, but also work with the families — the mum or the dad or the caregiver — and that takes a lot of resources.

“So our model there does not fit within the mainstream model of how they fund a nuclear, non-Aboriginal childcare centre. … So that’s an example of how the differences and different needs and funding formulas don’t fit what we need to achieve.”

This comes back to the co-design problem: governments aren’t paying enough attention to what the community says, and end up designing the system to fit what they think the community needs, which is different to what it really needs.

“It’s about involving us from the word go,” says Gallagher.

“What Fitzroy might need is different to what Fitzroy Crossing might need.”

Part 3 : Indigenous Affairs Minister Nigel Scullion

The Turnbull government will spend $40 million evaluating its indigenous affairs programs in an attempt to counter a national audit office report expected to be harshly critical of the way billions of dollars have been allocated.

Sidelined prime ministerial indigen­ous adviser Warren Mundine said yesterday the report, to be tabled today, was expected to be “damning”, as was the official Clos­ing the Gap report due within days.

The audit office report follows a Senate inquiry last year that blasted the 2014 implementation of the Abbott government’s flagship multi-billion-dollar Indigenous Advancement Strategy.

A 2015 Productivity Commission report found there was insufficient evidence being collected about the outcomes of indigenous programs and that “formal rigorous evaluations of indigenous programs that set the benefits of particular policies for reducing disadvantage against the costs are relatively scarce”.

Spending on mainstream and indigenous-specific programs and services has been estimated by the government to be worth $30 billion. A Centre for Independent Studies report last year found only 8 per cent of 1082 indigenous-spec­ific programs, worth $5.9bn, had been effectively evaluated.

However, Indigenous Affairs Minister Nigel Scullion, who will announce the four-year evalua­tion program today, said reporting, monitoring and evaluation of the IAS had already been improved­, and accounting for how much was being spent in the portfolio was now possible.

“However, we need to continually build on this and further strengthen the evaluation of our investment to ensure that money allocated through the IAS is invest­ed in ways that make the greatest difference for our first Australians,” Senator Scullion said. “By establishing a multi-year funding allocation, we are ensuring there will be a long-term plan for evaluation and a formal strategy to monitor and review how individ­ual contracts and program streams are contributing to our effort­s to deliver better outcomes for indigenous Australians.

Senator Scullion said the evaluation would be rolled out in close consultation with Aborigines and Torres Strait Islanders, including­ indigenous-run firms. “Indig­enous-run companies are currently delivering rigorous evaluation for the government and this new framework will continue this partnership,” he said.

 

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

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

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

The report shows continuous improvements for the majority of indicators.

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

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

Download HERE NACCHO Resources 7.00 MB

NACCHO AIHW Aboriginal Health 2 National Key Performance Indicators June 2016

Or from AIHW website

You can read NACCHO 1 of 2 HERE

You can read NACCHO 1 of 2 HERE

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

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

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

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

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

The good news

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

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

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

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

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

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

Things to work on

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

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

However, these increases were not statistically significant.

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

Aboriginal Health #NRW2017 Good News Alert 1 of 2 : Download @AIHW 8th National report Aboriginal health organisations

 ” This eighth national report presents information from 277 organisations, funded by the Australian Government to provide one or more of the following health services to Aboriginal and Torres Strait Islander people: primary health care; maternal and child health care; social and emotional wellbeing services; and substance-use services.

These organisations contributed to the 2015–16 Online Services Report downloadable.

Good News see in full below

Many health promotion group activities were provided, including around 7,600 physical activity/healthy weight sessions, 3,300 chronic disease support sessions and 2,000 tobacco-use treatment and prevention sessions.

With respect to maternal and child health care, around 12,900 home visits, 3,300 maternal and baby/child health sessions, 2,800 parenting skills sessions and 1,000 antenatal group sessions were done.

Download HERE NACCHO Resources 9.7 MB

NACCHO AIHW Aboriginal Health Organisations 2015-16

Or from AIHW website

Information is presented on the characteristics of these organisations; the services they provide; client numbers, contacts and episodes of care; staffing levels; and service gaps and challenges.

Key characteristics

Of the 204 organisations providing Indigenous primary health-care services:

  1. 72% (147) delivered services from 1 site, while 11% (23) had 2 sites and 17% (34) had 3 or more sites.
  2. 67% (136) were ACCHOs.
  3. 78% (159) had a governing committee or board and of these 72% had 100% Indigenous membership.
  4. 79% (162) were accredited against the Royal Australian College of General Practitioners (RACGP) and/or organisational standards.
  5. 28% (57) had more than 3,000 clients (see Table S3.2).

Policy context  : The health of Indigenous Australians

An estimated 744,956 Australians identified as Aboriginal and/or Torres Strait Islander in June 2016, representing 3% of the total Australian population (ABS 2014). In 2011, 10% of the Indigenous population identified as being of Torres Strait Islander origin, and almost two-thirds of the Torres Strait Islander population lived in Queensland.

The Indigenous population has a younger age structure compared with the non-Indigenous population.

In June 2011, the median age of the Indigenous population (the age at which half the population is older and half is younger) was 21.8, compared with 37.6 for the non-Indigenous population.

The birth rate for Indigenous women is also higher (2.3 babies per woman in 2013 compared with 1.9 for all women) (AIHW 2015d).

Most Indigenous Australians live in non-remote areas (79% in 2011); however, a higher proportion live in remote areas (21%), compared with non-Indigenous Australians (2%)

 DOWNLOAD THE FREE +NACCHO APP                                                        to find location of our ACCHOS

Here are the URL links to the App – alternatively you can type NACCHO into both stores and they come up!

iPhone/iPad

ios.giveeasy.org/naccho

Android

android.giveeasy.org/naccho

The gap in health outcomes between Indigenous and non-Indigenous Australians is well documented, especially around life expectancy, infant mortality, child mortality, chronic disease prevalence, potentially preventable hospitalisations and the burden of disease (AIHW 2015a).

For example, a recent burden of disease study found that Indigenous Australians experienced a burden of disease 2.3 times the rate of non-Indigenous Australians, with diabetes 6 times as high.

Chronic diseases were responsible for more than two-thirds (70%) of the total health gap in 2011 and for 64% of the total disease burden among Indigenous Australians in 2011.

The 5 disease groups that caused the most burden were mental and substance use disorders (19% of total disease burden), injuries (which includes suicide) (15%), cardiovascular diseases (12%), cancer (9%) and respiratory diseases (8%).

The same study also suggests that much of this burden could be prevented and reducing exposure to modifiable risk factors may have prevented over one-third (37%) of the burden of disease in Indigenous Australians.

The risk factors contributing most to the overall disease burden were tobacco and alcohol use, high body mass, physical inactivity, high blood pressure and dietary factors (AIHW 2016a).

While there have been improvements in the health and wellbeing of Indigenous Australians, they remain disadvantaged compared with non-Indigenous Australians.

There are a number of interlinking issues that contribute to this gap, including the disadvantages Indigenous people experience in relation to the social determinants of health such as housing, education, employment and income; behavioural risk factors such as smoking, poor nutrition, and physical inactivity; and access to health services (AIHW 2015a).

In addition, a broader range of social and emotional wellbeing issues result from colonisation and its intergenerational legacies: grief and loss; trauma; removal from family and cultural dislocation; racism and discrimination (DoH 2013).

Policy responses

In 2008 a framework was developed to tackle Aboriginal and Torres Strait Islander disadvantage, with 6 targets established to close the gap between Indigenous and non-Indigenous people. These targets were agreed with all states and territories through the Council of Australian Governments (COAG).

National Aboriginal and Torres Strait Islander Health Plan

Following on from the COAG targets, the Australian Government worked with Aboriginal and Torres Strait Islander people to produce the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.

This sets out a 10-year plan for the direction of Indigenous health policy and provides a long-term, evidence-based policy framework to close the gap in Indigenous disadvantage.

The vision outlined in the Health Plan around health system effectiveness is that the Australian health system delivers primary health care that is evidence-based, culturally safe, high quality, responsive and accessible to all Aboriginal and Torres Strait Islander people (DoH 2013).

An Implementation Plan sits alongside the Health Plan, detailing the actions to be taken by the Australian Government and other key stakeholders to implement the Health Plan (DoH 2015b).

It identifies 20 goals to support the achievement of the COAG targets around the effectiveness of the health system and priorities across the life course, from maternal health and parenting, childhood health and development, adolescent and youth health, healthy adults and healthy ageing.

A technical companion document to the Implementation Plan outlines these goals and how they will be measured (AIHW 2015b).

The second stage of the Implementation Plan will be released in 2018 and will further develop actions and goals in the domain of social and cultural determinants of health and health system effectiveness.

It will also seek to increase engagement between Australian Government agencies, state, territory and local governments, the Aboriginal community-controlled health sector, the non-government sector and the corporate/private sector (DoH 2017).

Progress on achieving the Implementation Plan goals will be reported every two years in line with the release of the Aboriginal and Torres Strait Islander Health Performance Framework. The findings will be incorporated into the Department of Health’s Annual Report and will inform the Prime Minister’s annual Closing the Gap report. Progress on the goals will also be publically reported on the DoH and AIHW websites from mid-2017 (DoH 2015b).

The good news

• In 2015–16, 204 organisations provided a wide range of primary health-care services to around 461,500 clients through 3.9 million episodes of care. Over 1 million episodes of care (26%) were in Very remote areas and these areas had the highest average number of episodes of care per client (10). Over time there has been an increase in the average episodes of care per client, from 5 in 2008–09 to 8 in 2015–16.

• Around 7,766 full-time equivalent staff were employed and just over half (53%) were Aboriginal and Torres Strait Islander. Nurses and midwives were the most common type of health worker, representing 15% of employed staff, followed by Aboriginal and Torres Strait Islander health workers and practitioners (13%) and doctors (7%). Nurses and midwives represented a higher proportion of employed staff in Very remote areas (24%).

• Many health promotion group activities were provided, including around 7,600 physical activity/healthy weight sessions, 3,300 chronic disease support sessions and 2,000 tobacco-use treatment and prevention sessions. With respect to maternal and child health care, around 12,900 home visits, 3,300 maternal and baby/child health sessions, 2,800 parenting skills sessions and 1,000 antenatal group sessions were done.

• In the 93 organisations funded specifically to provide social and emotional wellbeing services, 216 counsellors provided support services or Link Up services to around 18,900 clients through 88,900 client contacts.

• In the 80 organisations funded specifically to provide substance-use services, around 32,700 clients were seen through 170,400 episodes of care. Most clients (81%) and episodes of care (87%) were for non-residential substance-use services.

Things to note

• Over half the organisations providing primary health-care services reported mental health/social and emotional wellbeing services as a service gap (54%), and two-thirds (67%) reported the recruitment, training and support of Aboriginal and Torres Strait Islander staff as a challenge in delivering quality health services.

• Some organisations felt clients with high needs had to wait too long for some services, in particular to access specialist and dental services. For example, 53 (28%) organisations providing on-site or off-site access to dental services still felt clients with high needs often had to wait a clinically unacceptable time for dental services.

For most specialist and allied health services, more organisations in Remote and Very remote areas felt clients with high needs had to wait too long to access services.

 

NACCHO Aboriginal Health #NRW2017 Elder Care : Audit report Aged Care services were delivered to 35 083 Indigenous elders

 

 ” Health conditions associated with ageing often affect Aboriginal and Torres Strait Islander people earlier than other Australians.3

This is reflected in the Australian Government policy to provide Aboriginal and Torres Strait Islander people access to aged care services from 50 years old, in comparison to 65 years old for the broader population.

Aboriginal and Torres Strait Islander people are also designated as a special needs group under the Aged Care Act 1997 and all aged care service providers must have regard to the particular physical, physiological, social, spiritual, environmental and other health related care needs of individual recipients.4″

From ANAO Audit report Download here

Dep of Health Audit report Indigenous Aged Care

Image above from here

Background

1. The Australian Government provided $15.2 billion in funding to the aged care sector in 2014–15 and $16.2 billion in 2015–16.

Aged Care services were delivered to 35 083 Aboriginal and Torres Strait Islander people in 2014–15 at an estimated cost of $216 million1 (approximately 1.4 per cent of the total aged care budget).2

2. See above intro 4

3. The Australian Government funds aged care services to assist frail older people, and the carers of frail older people, to remain living at home as well as residential aged care services. The programs funded include:

  • the Commonwealth Home Support Program, which provides entry-level home support for older people who need assistance to keep living independently;
  • the Home Care Packages Program, which provides services tailored to meet individuals’ specific care needs including care services, support services, clinical services and other services to support older people to remain living at home and connected to their communities; and
  • residential aged care, which provides supported accommodation services for older people who are unable to continue living independently in their own homes.

4. Aboriginal and Torres Strait Islander people also have access to aged care services funded through the National Aboriginal and Torres Strait Islander Flexible Aged Care Program (Flexible Program). In 2015–16 funding for the Flexible Program was approximately $37 million, based on agreed funded places rather than occupancy. The Flexible Program aims to provide aged care services that meet the specific needs of Aboriginal and Torres Strait Islander people in a culturally appropriate setting, close to home and community. The majority of Flexible Program services are delivered in regional, remote and very remote locations.5

5. The Department of Health is responsible for leading the development of evidence based policy, determining the allocation of funding, and regulation of the Commonwealth aged care system to improve the wellbeing of older Australians as well as the implementation of the aged care reforms. The Australian Aged Care Quality Agency is responsible for assessing the quality of care of Australian Government funded aged care service providers. This is done through:

  • the accreditation of residential aged care service providers;
  • quality reviews of aged care provided to people living in their own homes or in the community; and
  • education and training on quality aged care to the aged care sector.

Audit objective and criteria

6. The objective of the audit was to assess the effectiveness of Australian Government-funded aged care services delivered to Aboriginal and Torres Strait Islander people. To form a conclusion against the audit objective, the ANAO adopted the following high level criteria:

  • Is there an effective framework in place to support access by Aboriginal and Torres Strait Islander people to quality aged care services?
  • Do the Department of Health and the Australian Aged Care Quality Agency have effective frameworks to oversee the delivery of aged care services to Aboriginal and Torres Strait Islander people?
  • Does the Department of Health have appropriate arrangements in place for monitoring and reporting on the achievement of program objectives and supporting the cost effectiveness and service continuity of aged care delivery to Aboriginal and Torres Strait Islander people?

Conclusion

7. Australian Government-funded aged care services are largely delivered effectively to Aboriginal and Torres Strait Islander people.

8. The ageing of Australia’s population and growing diversity among older people, in terms of their care needs, preferences and socioeconomic status, are placing pressure on the depth and agility of Australia’s aged care system. There are additional challenges in ensuring access to culturally appropriate care and service continuity for Aboriginal and Torres Strait Islander people, particularly for those living in remote and very remote communities. Some Aboriginal and Torres Strait Islander people may also have language or cultural preferences that influence their specific requirements.

9. The National Aboriginal and Torres Strait Islander Flexible Aged Care Program has been effective in increasing the access to culturally appropriate aged care services for elderly Indigenous Australians. The direct selection and recurrent funding approach of the National Aboriginal and Torres Strait Islander Flexible Aged Care Program provides few opportunities for new service providers to enter the market. There would be benefit in the Department of Health extending the application process to new service providers and better aligning the funded places with service capacity.

10. The Department of Health has developed sufficient guidance materials and provides supplementary funding to support Indigenous-focused services that operate under the Commonwealth Home Support, Home Care Packages and residential programs. However, not all Indigenous-focused services are aware of the Department of Health’s sector support programs.6

11. The Department of Health and the Australian Aged Care Quality Agency have been largely effective in their administration of Australian Government-funded aged care services delivered to Aboriginal and Torres Strait Islander people. Each entity has developed sound administrative arrangements to manage the delivery of aged care services and to review the quality of care delivered through aged care programs. The Department of Health can strengthen its administration by implementing a coordinated approach that ensures the timely sharing of relevant information to facilitate risk assessments across the Ageing and Aged Care Group.

12. Consistent with its policy intent, the National Aboriginal and Torres Strait Islander Flexible Aged Care Program is a more cost effective and viable model for specialised aged care delivery to Indigenous Australians when services are located in remote and very remote communities. A 25.8 per cent share of National Aboriginal and Torres Strait Islander Flexible Aged Care Program funding is allocated to services located in major cities and inner regional areas. To optimise recurrent funding decisions, it is important the Department of Health ensures that the existing service providers, their location and number of places, remain the most appropriate.

13. Given that the majority of Aboriginal and Torres Strait Islander people access aged care through Commonwealth Home Support Program, Home Care Packages Program and residential aged care programs, further work is required by the Department of Health to maintain the service continuity of Indigenous-focused service providers in areas where there are no culturally secure alternatives. The Department of Health has an opportunity to leverage its datasets to improve the targeting of sector support initiatives to Indigenous-focused services and to monitor the ongoing impacts of aged care policies and programs on Aboriginal and Torres Strait Islander people.

Supporting findings

Access and use of aged care services by Aboriginal and Torres Strait Islander people

14. Aboriginal and Torres Strait Islander people were most likely to access aged care services through the Commonwealth Home Support Program or the Home Care Packages Program, at rates consistent with their share of the aged care population. Fewer than one per cent of residential aged care places were taken up by Aboriginal and Torres Strait Islander people.

15. The Department of Health has created clear and consistent pathways for individuals to access and progress through the aged care system. The My Aged Care Contact Centre and website are the main entry points to the aged care system. Aboriginal and Torres Strait Islander people are encouraged to connect with the My Aged Care Contact Centre, and can call directly or use a trusted representative to speak on their behalf. Following an initial screening undertaken by Contact Centre staff, the Regional Assessment Service assesses older people’s needs for lower intensity services available under the Commonwealth Home Support Program. Aged Care Assessment Teams assess the more complex needs of people requiring access to higher intensity care available under Home Care Packages, Transition Care, and within residential aged care.

16. A key challenge in targeting aged care services is assessing the eligibility of individuals seeking to access them as well as the scope of services. This can be particularly challenging in the context of facilitating access for individuals in remote or very remote areas, including Aboriginal and Torres Strait Islander people.

17. The Department of Health advised the ANAO that it is working with the aged care sector to identify opportunities to improve client pathways for diverse groups, including Aboriginal and Torres Strait Islander people, to address the specific difficulties they may experience.

18. The Department of Health manages the planning and allocation of aged care residential places and Home Care packages for service providers based on the national planning benchmark, population projections and the current level of service provision. The Commonwealth Home Support Program and the National Aboriginal and Torres Strait Islander Flexible Aged Care Program are funded through a grants process.

19. Between 2012–13 and 2015–16 the number of Home Care Level 1‒2 packages allocated to Indigenous-focused service providers has not grown at the same rate as those allocated to mainstream service providers. However, the growth in Home Care Level 3‒4 package and residential place allocations to Indigenous-focused service providers have both been higher than for mainstream counterparts.

20. The distribution of the National Aboriginal and Torres Strait Islander Flexible Aged Care Program funding has remained largely unchanged since its inception. This is largely due to the continuation of grant agreements to existing services that have been in place over the life of the program. These arrangements limit the potential for new providers to access the program.

21. The Department of Health has developed operational manuals and/or guidelines to support providers in the delivery and management of aged care services for the programs reviewed as part of the audit. The Department of Health also funds two peak bodies to develop additional resources to assist with managing the change introduced by aged care reforms (including resources targeted towards remote and very remote Indigenous-focused service providers).

22. The Department of Health funds a Remote and Aboriginal and Torres Strait Islander Aged Care Service Development Assistance Panel (SDAP) to support aged care providers. ANAO consultations with Indigenous-focussed service providers indicated that awareness of SDAP funding varied across states and territories. There would be benefit in the Department of Health raising the awareness of this assistance in a consistent manner across jurisdictions, and measuring the financial management and governance capacity that has been built and maintained among service providers as a result of having received the funding.

Administration and regulation of aged care services

23. The Department of Health has internal governance committees, templates and guidance to coordinate program administration. Health’s state and territory offices have also adopted various local strategies for engaging with Indigenous-focused service providers. The department has commenced work to strengthen relationships between its National Office and its state and territory offices, to improve links between policy development and program implementation, while still allowing for specific approaches within each jurisdiction.

24. The Department of Health has developed an Enterprise Risk Management Plan that is updated annually as part of the department’s business planning processes. Each of the programs reviewed as part of the audit included risk management (identification, analysis and evaluation) in its business processes. Risk is considered against the type of activity being funded and may result in different risk ratings being given to the same organisation across each activity or program being funded. For service providers that are funded under multiple programs, there is an opportunity for Health to implement a more coordinated approach that facilitates the timely sharing of relevant information across program areas.

25. The Australian Aged Care Quality Agency has developed policies, procedures and guidance materials to support the accreditation of residential aged care service providers, and specific policies for the quality review of Home Care Packages, Commonwealth Home Support Program and National Aboriginal and Torres Strait Islander Flexible Aged Care Program service providers. Documents reviewed by the ANAO demonstrate that the relevant accreditation and quality review procedures were followed internally.

26. The Australian Aged Care Quality Agency has collected information on assessments of all residential service providers against the accreditation standards. This information shows that between 2000-01 and 2015-16, 95 per cent of residential Indigenous-focused service providers had at least one episode of non-compliance, in comparison with 53 per cent of non-Indigenous-focused Residential service providers. Reported instances of non-compliance mostly related to governance, including regulatory compliance, risk management and human resources as opposed to issues relating to quality of care.

27. In 2014–15 the Australian Aged Care Quality Agency delivered 716 courses, seminars and compliance assistance training events to 10 638 participants from residential and Home Care service providers. Flexible service providers receive compliance assistance training as determined through a case management process. There would be benefit in the Australian Aged Care Quality Agency expanding the proposed cost recovery model to include the indirect and direct costs recovered from courses and workshops to be consistent with the Australian Government’s stated policy intention, as well as the Australian Government Cost Recovery Guidelines.