NACCHO Aboriginal Health News: Queensland contributes $10 million to Closing the Gap

 

Queensland to contribute nearly $10 million towards Closing the Gap agreement

The Palaszczuk Government will support the implementation of the new national Closing the Gap agreement, with $9.3 million as part of a national joint funding effort with the federal government and other states and territories.

The Federal Government today announced that it would provide $46.5 million over four years to building the capacity of the Indigenous community-controlled sector, to be matched by the state and territory jurisdictions, based on the Aboriginal and Torres Strait Islander population.

Minister for Fire and Emergency Services and Minister for Aboriginal and Torres Strait Islander Partnerships Craig Crawford said that investment in building an effective community-controlled sector will be critical to improving life outcomes for Aboriginal and Torres Strait Islander people.

Read the full media release here.

Draft Prescribing Competencies Framework input request

NPS MedicineWise, as the stewards of Quality Use of Medicine in Australia, has undertaken a review of the Prescribing Competencies Framework, to ensure the Framework remains relevant and continues to support safe and quality prescribing for all prescribers.

Feedback is being sought from practitioners and stakeholders on the new draft framework by COB Friday 4 September 2020. The feedback will be used to finalise the revised framework document for publication.

The revised Prescribing Competencies Framework can be viewed here.

To access the questionnaire relating to this revised Framework click here.

Photo of Aboriginal hands holding pills

Image source: The Medical Journal of Australia.

NT diabetes in pregnancy rates rise

The burden of diabetes in pregnancy has grown substantially in the NT over the last three decades and is contributing to more babies being born at higher than expected birth-weights according to a new study undertaken by the Menzies School of Health Research.

The study, Diabetes during pregnancy and birth-weight treads among Aboriginal and non-Aboriginal people in the Northern Territory of Australia over 30 years, was recently published in the inaugural edition of The Lancet Regional Health – Western Pacific.

The full study can be found here.

Aboriginal woman's hands on her pregnant belly painted with red, white, black and yellow dotted concentric circles

Image source: Bobby-Lee Hille, the Milyali Art project.

Community collaboration delivers better oral health

Aboriginal children in rural Australia have up to three times the rate of tooth decay compared to other Australian children. Recently published research demonstrates the benefits of working alongside communities to establish the most effective ways to implement evidence-based strategies, and sustain them.

Co-design is about sharing knowledge to enable long-term, positive change to complex problems and enables much needed health-care services to be delivered in ways that strengthen communities, respect culture and build capacity.

Aboriginal girl with toothbrush in her mouth

Image Source: The Conversation.

To read more about the research Outcomes of a co-designed, community-led oral health promotion program for Aboriginal children in rural and remote communities in New South Wales, Australia click here.

Job Alerts

FT Suicide Prevention Officers x 2

PT Aboriginal Dental / Allied Health Administration Officer x 1 – 3 days/week

Yerin Aboriginal Health Services Limited are looking for highly motivated Aboriginal people to undertake the above roles at their modern new clinic in Wyong, NSW.

For further information about these positions click here.

NACCHO Aboriginal and Torres Strait Islander Health Research Alert : Download @AIHW National report card examining Indigenous Health , COVID-19 and other health issues in Australia

” Generally, Australians can expect to enjoy long and relatively healthy lives, however, there are disparities across some population groups.

Often, people living in rural and remote and/or lower socioeconomic areas, people with disability, and Aboriginal and Torres Strait Islander people experience higher rates of illness, hospitalisation and death than other Australians.

For example, people living in remote and very remote areas are 1.2 times as likely to have diabetes as people in major cities; people living in the lowest socioeconomic areas are twice as likely to have diabetes as people in highest socioeconomic area; and Indigenous Australians are 2.9 times as likely to have diabetes as non-Indigenous Australians.

There have been some improvements in the health of Indigenous Australians in recent years, including a fall in the Indigenous death rate across all age groups—except for those aged 75 and over—between 2008 and 2018 and rates of ear disease among Indigenous children are decreasing.’

See pages 107 to 131 in attached report for Indigenous Health report or read online HERE

Aboriginal and Torres Strait Islander people and communities COVID-19 see below 

Download full report 

aihw-australia Health 2020

Life expectancy, chronic conditions, social determinants of health and the COVID-19 pandemic are some of the issues under the spotlight in the latest two-yearly report card on the health of Australians.

Australian Institute of Health and Welfare (AIHW) Chair Mrs Louise Markus today launched Australia’s Health 2020 

AIHW Deputy CEO Mr. Matthew James said the report had come at an important time.

‘More than any other event in recent history, the pandemic has led Australians to focus on our health, the health of our families and communities, and demonstrated the importance of the health system,’ Mr. James said.

Doing well but room for improvement

Australians are living longer—life expectancy for males born in 2016–2018 was 80.7 years and 84.9 years for females, this is up from 55.2 and 58.8 years, respectively, for those born in 1901–1910. Australian males had the ninth highest and Australian females had the seventh highest life expectancy at birth among the 36 OECD (Organisation for Economic Co-operation and Development) countries in 2018.

An estimated 11.6% of Australian adults (aged 18+) were daily smokers in 2019—a decrease from 12.8% in 2016, and 25% in 1991. Similarly, the number of homes with children where someone smoked in the home has fallen over time—from 19.7% in 2001 to 2.8% in 2016, and 2.1% in 2019.

The coronary heart disease death rate has fallen 82% since 1980 but it is still our leading single cause of death. About 7 in 10 (69%) people survived at least 5 years after a cancer diagnosis during 2012–2016––an improvement from about 5 in 10 (51%) people during 1987–1991.

‘Unfortunately, Australia has the fifth highest rate of obesity out of the 23 OECD countries for which data is available. In 2017–18, around two-thirds (67%) of adults and one-quarter (25%) of children and adolescents were overweight or obese,’ Mr. James said.

‘Almost half (47%, or more than 11 million people) of Australians have a chronic condition such as heart disease, cancer, stroke, diabetes, arthritis, asthma or a mental health condition. Many—but not all—chronic conditions are largely preventable by addressing risk factors such as tobacco smoking, high blood pressure and high blood cholesterol, insufficient physical activity, poor diet and nutrition and overweight and obesity.’

The health system

On an average day, Australians make 430,000 visits to general practitioners, fill 830,000 prescriptions under the Pharmaceutical Benefits Scheme and the Repatriation Pharmaceutical Benefits Scheme and there are 32,000 hospitalisations.

Over the past 2 decades, the health sector in Australia has grown faster than the rest of the economy, as well as the population.

‘In the 20-year period to 2017–18, total health expenditure in Australia increased from $77.5 billion to $185.4 billion in real terms, and spending per person increased from $4,200 to $7,490,’ Mr. James said.

‘As a proportion of Gross Domestic Product (GDP), health expenditure increased from 7.6% in 1997–98 to a peak of 10.3% in 2015–16. It has since declined to 10% in 2017–18.’

Governments funded about two-thirds (68%) of health spending in 2017–18, with funds primarily raised through tax revenue. As a proportion of tax revenue, health spending by governments represented 24% in 2017–18, a decline from 26% in 2016–17 (reflecting strong revenue growth in 2017–18).

Over the past 5 years, the proportion of health spending funded by individuals declined and in both 2016–17 and 2017–18, personal spending on health reflected less than 0.4% of individual wealth, the lowest proportion since 2000–01.

Between 2014–15 and 2018–19, the total number of hospitalisations in Australia increased by an average of 3.3%—faster than the average population growth of 1.6% over the same period.

Data to be released by the AIHW later this year will give an indication of how the COVID-19 pandemic, including the temporary suspension of elective surgery during April 2020, affected surgical and emergency department waiting times for 2019–20.

Looking back on the first 4 months of COVID-19 in Australia

The report includes new analysis to try to fill the gaps in our understanding of COVID-19. It contains data on the first 4 months of COVID-19 in Australia, covering the period from 25 January 2020 (when the first Australian cases were confirmed) to the end of May.

The data demonstrates COVID-19’s potential to seriously affect not just those who are elderly or in very poor health, but also people who may not have been considered to be at the highest risk.

‘One way of understanding a disease’s death toll is in terms of how many years of life it cost the victim, based on their expected lifespan. For example, if a young, healthy person dies, they have probably lost many more years of life compared with an elderly person,’ Mr. James said.

‘There is perception that the majority of COVID-19 deaths are among people who did not have a long expected lifespan prior to developing the disease. However, the Australians who died lost more years of their expected lifespan on average than those who died of our 3 leading causes of death: coronary heart disease, dementia and stroke.’

Mr. James said that Australian governments and the Australian community have responded well to this crisis so far and, as a result, it appears at this point that we may have avoided some of the large adverse impacts that have been seen in some other countries.

‘However, it is important to remember that COVID-19 continues to pose a threat to the community and to the health system—as seen by the current situation in Victoria—and has broadly affected the lives of Australians in other ways, particularly regarding employment.’

While the data in this report largely predates the pandemic, its impacts on both the health system and people’s physical and mental health will be the subject of analysis for several years.

The importance of data to our health

Data have been central to the COVID-19 response because governments have needed immediate and accurate information to make swift, evidence-based decisions.

In addition to seconding staff to the Department of Health to assist with responding to the COVID-19 crisis, the AIHW compiled data on the use of hospital, mental health, and homelessness services and data from various crisis help lines.

‘While the long-term health effects of COVID-19 are largely unknown at present, health data—in particular, linked data—will be critical to understanding its impact on health, society and the economy,’ Mr James said.

‘We expect the demand for ‘near real-time’ data will increase as a result of COVID-19 and the AIHW’s future planning will consider our capacity to deliver information more quickly, while maintaining quality and accuracy.’

In partnership with the Australian National University (ANU), the AIHW worked to add a range of questions to the Life in Australia panel survey to explore the impact of COVID-19 on mental health, housing, alcohol consumption and service use.

The most recent report focuses on mental health and relationships, and is available at https://csrm.cass.anu.edu.au/research/publications/covid-19

Aboriginal and Torres Strait Islander people and communities 

 

There have been substantial improvements in Aboriginal and Torres Strait Islander health over the past 30 years, with decreases in cardiovascular death rates and infant mortality, and increases in life expectancy and in the number of people accessing preventive or health monitoring services (such as health checks, chronic disease management plans, and antenatal care) (AHMAC 2017).

However, Indigenous Australians as a group still experience poorer health outcomes compared withnon-Indigenous Australians.

The reasons for this disparity are complex, and key among these is the impact of colonisation and separation from Country on the wellbeing of Indigenous Australians (Osborne et al. 2013). It is also well recognised that disparities in upstream factors—the social determinants of health—result in differences in risks, exposures, access to services and in outcomes throughout life.

One social determinants having a substantial impact on Indigenous health is housing conditions.

This article considers common factors underlying a number of diseases prevalent in the Indigenous Australian population, particularly those in remote areas, but less commonly or even rarely seen among non-Indigenous Australians: chronic kidney disease, rheumatic heart disease, and certain eye and ear diseases. Bringing together the available information, and highlighting data gaps, can help us to

draw out critical issues and to identify potential points of intervention that would produce benefits across multiple areas. Given that many of the social determinants, including housing, lie outside of the health system, the efforts of a range of systems, government departments and other organisations will be needed to support and drive interventions. Establishing agreed indicators across the main domains of interest, and regularly monitoring these, can also help to ensure that all parties, both within and outside the health system, are able to gauge progress and to make sure their efforts are having the desired impact.

Social determinants of health and Indigenous Australians

The World Health Organization (WHO) describes social determinants of health as ‘the structural determinants and conditions of daily life’—that is, the conditions of work or leisure; people’s homes, communities and environments; and their access to education and health care (WHO CSDH 2008). People’s opportunities and circumstances are shaped by the distribution of power, income, goods and services, which are in turn affected by policy choices, and are a major component of health inequities between and within countries.

Commonly recognised social determinants of health include housing, education, employment, income, and social networks and connections. For Indigenous Australians and other Indigenous peoples across the world, cultural factors—including connection with land and waters, identity, and language, as well as the ongoing effects of dispossession, marginalisation, racism, and discrimination—also play a key role in influencing health outcomes (Figure 4.1).

Other important social determinants affecting health outcomes include:

  • health literacy (the ability to obtain, read, understand and use health-related information to make appropriate health decisions), and
  • availability of health resources (the funds, equipment, facilities, personnel and other items such as medicines and medical supplies) needed to provide health

The social determinants of health act through complex and multidirectional pathways, and underlie a broad range of poor health and welfare outcomes. A combination of factors may act at the community and the individual level to influence health.

For example, an individual’s level of education and household income may influence their food choices, while the area in which they live may affect the availability and cost of various foods.

Other articles in this report and the Australia’s health 2020 snapshots (for example, ‘Social determinants of health’ https://www.aihw.gov.au/reports/australias-health/ social-determinants-of-health and ‘Social determinants and Indigenous health’ https://www.aihw.gov.au/reports/australias-health/social-determinants-and- indigenous-health) detail the range of social determinants and how they relate to health; their impact throughout life; and their contribution to the gap in health outcomes between Indigenous and non-Indigenous Australians. This article examines key health conditions disproportionately impacting Indigenous Australians, which are affected by housing conditions and access to services.

Two of the critical factors connecting housing conditions to health are the impact of overcrowding and the state of domestic health hardware. ‘Health hardware’ refers to the physical equipment needed to support good health. This includes safe electrical systems; access to water; working taps, showers, and sinks with plugs; toilets; waste and wastewater removal systems; and facilities needed for the safe storage and preparation of food.

If any of these facilities are unavailable, not working, or inadequate to support the number of residents, illness or injury can occur. Also implicit in this is that local infrastructure should minimise environmental health risks, by providing access to safe drinking water, and by supporting sanitation and waste management services.

Aboriginal and Torres Strait Islander people and communities COVID-19 

Aboriginal and Torres Strait Islander people and their communities are at high risk of COVID-19 outbreaks and severe outcomes for a number of reasons.

They are a mobile population and remote communities have frequent visitors (including fly-in fly-out health care workers), increasing the chances of disease importation. They often have reduced access to health services either due to physical distance for those in remote areas or due to other barriers related to institutional racism, and mistrust of mainstream health services (CDNA 2020b). In addition, Indigenous Australians experience a burden of disease 2.3 times the rate of non-Indigenous Australians, with 64% of the burden due to chronic diseases such as diabetes and CHD (AIHW 2016).

Overcrowding in homes and lack of infrastructure to support personal hygiene in remote areas can promote disease transmission and make physical distancing and efforts to self-quarantine challenging.

To protect remote communities from COVID-19, governments working in collaboration with Aboriginal and Torres Strait Islander organisations and communities began restricting the movement of people in and out of remote areas and began setting up respiratory clinics to support Indigenous Australians (Hunt & Wyatt 2020). The National Management Plan for Aboriginal and Torres Strait Islander Peoples has been developed by the Aboriginal and Torres Strait Islander Advisory Group on COVID-19 and endorsed by the Australian Health Protection Principal Committee, and was released on 30 March 2020.

As of 24 May, less than 1% of notified cases had been reported in Indigenous Australians (59 cases; with 95% Indigenous identification completeness for notified cases), who represent 3.3% of the Australian population. Ten per cent of these cases were acquired in Outer Regional areas, and none in Remote or Very Remote areas; 47% were acquired overseas (COVID-19 NIRST 2020d).

While the number of cases in Australian Indigenous communities has been low, there have been outbreaks in Indigenous populations in Brazil and in Navajo Native Americans in the USA (SBS 2020, The Guardian 2020).

NACCHO Aboriginal and Torres Strait Islander Health Research News : New look @HealthInfoNet Community Portal – expanded content and focus better supports Elders and community members working to reduce harms from #AOD use in their communities.

The Community Portal on the Australian Indigenous HealthInfoNet Alcohol and Other Drugs Knowledge Centre has recently been updated to better meet the information needs of Elders and community members working to reduce harms from alcohol and other drug (AOD) use in their communities.

The redevelopment of the Community Portal was guided by focus groups in Perth and Adelaide as well as feedback from a national user survey which found that people wanted to see a web resource that was strength-based, easy to use, and had a more visual format.

The portal has refreshed its content with a focus on strength-based resources, information on healing and trauma and up front, factual information on mental health and addiction.

The collection of health promotion resources for each topic has a visual format which is easy to use and navigate.

The refreshed portal also now features the artwork of Aboriginal artist Melanie Robinson with a vibrant piece about families coming together on the land (pictured above).

Family, friends and community members are often the first to respond to people who may be in crisis or distressed. The expanded content on the Community Portal includes more information on events, courses, funding and programs to support community members who may be seeking training, resources, or services to address AOD issues in their community.

short webinar has been recorded to provide an overview of the process and results to update the Community Portal.

It also describes the changes that have been made based on the feedback we received from stakeholders.

This is followed by a tour of the Community Portal, including information on:

  • the new subsections, including Healing
  • how to navigate around the portal
  • the new search and filter features
  • factsheets subsection.

The webinar can be viewed here.The AOD Knowledge Centre would like to acknowledge and thank the community members and Aboriginal and Torres Strait Islander AOD workers from Whadjuk Country (Perth) and Kaurna Country (Adelaide) who participated in the focus groups and those who responded to the user survey for their ideas and advice on the redevelopment of the Community Portal.

Find out more, visit the Community Portal on the AOD Knowledge Centre

NACCHO Aboriginal Health Research Alerts : Download @AIHW Report Indigenous primary health care results : Our ACCHO’s play a critical role in helping to improve the health of our mob

 ” Comprehensive and culturally appropriate primary health care services play a key role in improving the health and wellbeing of Indigenous Australians through prevention, early intervention, health education, and the timely identification and management of physical and psychological issues. “

Download the 77 Page AIHW Report HERE

Indigenous-primary-health-care-results-from-the-OSR-and-nKPI-collections

Primary health care organisations play a critical role in helping to improve the health of Indigenous Australians.

In 2018–19:

To this end, the Australian Government provides funding through the IAHP to organisations delivering Indigenous-specific primary health care services (referred to hereafter as organisations).

These organisations, designed to be accessible to Aboriginal and Torres Strait Islander clients, are administered and run by:

  • Aboriginal community-controlled health organisations (ACCHOs)
  • state/territory/local health services
  • non-government organisations (NGOs), such as women’s health services (a small proportion of services).

They vary in size, location, governance structure, length of time in operation, workforce composition, sources of funding, the services they offer, the ways in which they operate (for example, stand-alone or part of a consortium), and the needs of their clients.

What they all share in common is a holistic approach to meeting the needs of their Indigenous clients, which often involves addressing a complex mix of health conditions.

Each organisation provides contextual information about their organisation to the OSR once each financial year (covering the period July–June). The OSR includes all activities of the funded organisations, regardless of the percentage of those activities funded by IAHP.

This chapter presents a profile of organisations delivering Indigenous-specific primary health care services, including staffing levels, client numbers, client contacts, episodes of care and services provided. It excludes data from organisations that received funding only for maternal and child health services.

Trends over time are presented where possible, noting that the organisations providing data can vary over time which may limit comparability for some purposes (see Technical notes and Glossary for more information). Also, in 2018–19, the OSR collection underwent significant change and was scaled back to include only ‘core’ items. Plans are underway to reintroduce key items in a staged approach over the next few years.

The following boxes show key results for organisations providing Indigenous-specific primary health care in 2018–19.

Clicking HERE will go to more information on the selected topic.

NACCHO Aboriginal and Torres Strait Islander #ClosingTheGap Health Research : Report calls for increased support for Aboriginal Community Controlled Health Organisations and acknowledge the importance of bringing focused attention to bear on our primary and preventive health needs

” We strongly support calls for increased support for Aboriginal Community Controlled Health Organisations and acknowledge the importance of bringing focused attention to bear on primary and preventive health needs within Aboriginal and Torres Strait Islander towns.

It is difficult to rationalise the poorer access to local inpatient hospital services found here. It cannot be explained by proximity to larger centres or by a lesser need for services, as neither of these are true.

The Aboriginal and Torres Strait Islander towns without hospital services within 50 kilometres are all very remote towns in Northern Australia, which experience disproportionately high burdens of morbidity and mortality.

The lack of locally accessible hospital services does not only increase the risk of death and disability, it also contributes to substantial health costs associated with retrieval and relocation to distant centres for hospital care.

Such an initiative is likely to require a combination of federal and state or territory funding and should involve communities in the development and control of these services. “

Disparity in distribution of inpatient hospital services in Australia

First published HERE

The AMA stands with Aboriginal and Torres Strait Islander people. They suffer health disparities that see them become sicker and die earlier than non-Indigenous Australians.

In usual times, many doctors and medical students would be marching in these protests. We want to see change. “

Read AMA Press Release HERE

The gap that exists between health outcomes for Aboriginal and Torres Strait Islander Australians and non‐Indigenous Australians is multi‐factorial.

Some of the gaps that exist may be attributed to or exacerbated by limitations in access to health services faced by rural and remote towns.

In Australia, 19% of Aboriginal and Torres Strait Islander people live in remote or very remote areas.1

These people have, on average, worse health outcomes than Aboriginal and Torres Strait Islander people who live in urban settings, further amplifying the gap.2

We used census data from the Australian Bureau of Statistics1 and jurisdictional and federal health department website data3 to conduct a review of the availability of inpatient hospital services in Australian towns with a population between 1,000 and 4,999, based on the Accessibility/Remoteness Index of Australia (ARIA+) classification system.4

We compared towns with a population of more than 80% being Aboriginal and Torres Strait Islander people with other towns using Fisher’s exact test for comparison of categorical variables, and a p value <0.05 was considered significant

There are 533 towns in Australia with a population between 1,000 and 4,999 (median population 1,819). Of these, 14 (3%) have an Aboriginal and Torres Strait Islander population that accounts for more than 80% of the total population.

The vast majority of these towns either have a hospital with acute inpatient beds (226/533, 42%) or are within 50 kilometres of a nearby hospital (282/533, 53%). Towns with a population of more than 80% Aboriginal and Torres Strait Islander people are less likely to either have a hospital or be within 50 kilometres of one (5/14, 36% vs 503/519, 97%; <0.001), see Table 1.

The lack of locally accessible hospital services does not only increase the risk of death and disability, it also contributes to substantial health costs associated with retrieval and relocation to distant centres for hospital care.

In such towns where hospital services are not currently available, consideration should be given to developing these concurrently with efforts to improve primary and preventive health care and to facilitate increasing Aboriginal control and strengthening of the Aboriginal and Torres Strait Islander health workforce.5

Such an initiative is likely to require a combination of federal and state or territory funding and should involve communities in the development and control of these services.

References download 

1753-6405.12996

 

 

 

NACCHO Aboriginal Health Research Alert : @HealthInfoNet releases Summary of Aboriginal and Torres Strait Islander health status 2019 social and cultural determinants, chronic conditions, health behaviours, environmental health , alcohol and other drugs

The Australian Indigenous HealthInfoNet has released the Summary of Aboriginal and Torres Strait Islander health status 2019

This new plain language publication provides information for a wider (non-academic) audience and incorporates many visual elements.

The Summary is useful for health workers and those studying in the field as a quick source of general information. It provides key information regarding the health status of Aboriginal and Torres Strait Islander people across the following topics:

  • social and cultural determinants
  • chronic conditions
  • health behaviours
  • environmental health
  • alcohol and other drugs.

The Summary is based on HealthInfoNet‘s comprehensive publication Overview of Aboriginal and Torres Strait Islander health status 2019. It presents statistical information from the Overview in a visual format that is quick and easy for users to digest.

The Summary is available online and in hardcopy format. Please contact HealthInfoNet by email if you wish to order a hardcopy of this Summary. Other reviews and plain language summaries are available here.

Here are the key facts

Please note in an earlier version sent out 7.00 am June 15 a computer error dropped off the last word in many sentences : these are new fixed 

Key facts

Population

  • In 2019, the estimated Australian Aboriginal and Torres Strait Islander population was 847,190.
  • In 2019, NSW had the highest number of Aboriginal and Torres Strait Islander people (the estimated population was 281,107 people, 33% of the total Aboriginal and Torres Strait Islander population).
  • In 2019, NT had the highest proportion of Aboriginal and Torres Strait Islander people in its population, with 32% of the NT population identifying as Aboriginal and/or Torres Strait Islanders
  • In 2016, around 37% of Aboriginal and Torres Strait Islander people lived in major cities
  • The Aboriginal and Torres Strait Islander population is much younger than the non-Indigenous population.

Births and pregnancy outcomes

  • In 2018, there were 21,928 births registered in Australia with one or both parents identified as Aboriginal and/or Torres Strait Islander (7% of all births registered).
  • In 2018, the median age for Aboriginal and Torres Strait Islander mothers was 26.0 years.
  • In 2018, total fertility rates were 2,371 births per 1,000 for Aboriginal and Torres Strait Islander women.
  • In 2017, the average birthweight of babies born to Aboriginal and Torres Strait Islander mothers was 3,202 grams
  • The proportion of low birthweight babies born to Aboriginal and Torres Strait Islander mothers between 2007 and 2017 remained steady at around 13%.

Mortality

  • For 2018, the age-standardised death rate for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT was 1 per 1,000.
  • Between 1998 and 2015, there was a 15% reduction in the death rates for Aboriginal and Torres Strait Islander people in NSW, Qld, WA, SA and the NT.
  • For Aboriginal and Torres Strait Islander people born 2015-2017, life expectancy was estimated to be 6 years for males and 75.6 years for females, around 8-9 years less than the estimates for non-Indigenous males and females.
  • In 2018, the median age at death for Aboriginal and Torres Strait Islander people in NSW, Qld, WA, SA and the NT was 2 years; this was an increase from 55.8 years in 2008.
  • Between 1998 and 2015, the Aboriginal and Torres Strait Islander infant mortality rate has more than halved (from 5 to 6.3 per 1,000).
  • In 2018, the leading causes of death among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT were ischaemic heart disease (IHD), diabetes, chronic lower respiratory diseases and lung and related cancers.
  • For 2012-2017 the maternal mortality ratio for Aboriginal and Torres Strait Islander women was 27 deaths per 100,000 women who gave birth.
  • For 1998-2015, in NSW, Qld, WA, SA and the NT there was a 32% decline in the death rate from avoidable causes for Aboriginal and Torres Strait Islander people aged 0-74 years

Hospitalisation

  • In 2017-18, 9% of all hospital separations were for Aboriginal and Torres Strait Islander people.
  • In 2017-18, the age-adjusted separation rate for Aboriginal and Torres Strait Islander people was 2.6 times higher than for non-Indigenous people.
  • In 2017-18, the main cause of hospitalisation for Aboriginal and Torres Strait Islander people was for ‘factors influencing health status and contact with health services’ (mostly for care involving dialysis), responsible for 49% of all Aboriginal and Torres Strait Islander seperations.
  • In 2017-18, the age-standardised rate of overall potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people was 80 per 1,000 (38 per 1,000 for chronic conditions and 13 per 1,000 for vaccine-preventable conditions).

Selected health conditions

Cardiovascular health

  • In 2018-19, around 15% of Aboriginal and Torres Strait Islander people reported having cardiovascular disease (CVD).
  • In 2018-19, nearly one quarter (23%) of Aboriginal and Torres Strait Islander adults were found to have high blood pressure.
  • For 2013-2017, in Qld, WA, SA and the NT combined, there were 1,043 new rheumatic heart disease diagnoses among Aboriginal and Torres Strait Islander people, a crude rate of 50 per 100,000.
  • In 2017-18, there 14,945 hospital separations for CVD among Aboriginal and Torres Strait Islander people, representing 5.4% of all Aboriginal and Torres Strait Islander hospital separations (excluding dialysis).
  • In 2018, ischaemic heart disease (IHD) was the leading specific cause of death of Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT

Cancer

  • In 2018-19, 1% of Aboriginal and Torres Strait Islander people reported having cancer (males 1.2%, females 1.1%).
  • For 2010-2014, the most common cancers diagnosed among Aboriginal and Torres Strait Islander people living in NSW, Vic, Qld, WA and the NT were lung cancer and breast (females) cancer.
  • Survival rates indicate that of the Aboriginal and Torres Strait Islander people living in NSW, Vic, Qld, WA, and the NT who were diagnosed with cancer between 2007 and 2014, 50% had a chance of surviving five years after diagnosis
  • In 2016-17, there 8,447 hospital separations for neoplasms2 among Aboriginal and Torres Strait Islander people
  • For 2013-2017, the age-standardised mortality rate due to cancer of any type was 238 per 100,000, an increase of 5% when compared with a rate of 227 per 100,000 in 2010-2014.

Diabetes

  • In 2018-19, 8% of Aboriginal people and 7.9% of Torres Strait Islander people reported having diabetes.
  • In 2015-16, there were around 2,300 hospitalisations with a principal diagnosis of type 2 diabetes among Aboriginal and Torres Strait Islander people
  • In 2018, diabetes was the second leading cause of death for Aboriginal and Torres Strait Islander people.
  • The death rate for diabetes decreased by 0% between 2009-2013 and 2014-2018.
  • Some data sources use term ‘neoplasm’ to describe conditions associated with abnormal growth of new tissue, commonly referred to as a Neoplasms can be benign (not cancerous) or malignant (cancerous) [1].

Social and emotional wellbeing

  • In 2018-19, 31% of Aboriginal and 23% of Torres Strait Islander respondents aged 18 years and over reported high or very high levels of psychological distress
  • In 2014-15, 68% of Aboriginal and Torres Strait Islander people aged 15 years and over and 67% of children aged 4-14 years experienced at least one significant stressor in the previous 12 months
  • In 2012-13, 91% of Aboriginal and Torres Strait Islander people reported on feelings of calmness and peacefulness, happiness, fullness of life and energy either some, most, or all of the time.
  • In 2014-15, more than half of Aboriginal and Torres Strait Islander people aged 15 years and over reported an overall life satisfaction rating of at least 8 out of 10.
  • In 2018-19, 25% of Aboriginal and 17% of Torres Strait Islander people, aged two years and over, reported having a mental and/or behavioural conditions
  • In 2018-19, anxiety was the most common mental or behavioural condition reported (17%), followed by depression (13%).
  • In 2017-18, there were 21,940 hospital separations with a principal diagnosis of International Classification of Diseases (ICD) ‘mental and behavioural disorders’ identified as Aboriginal and/or Torres Strait Islander
  • In 2018, 169 (129 males and 40 females) Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA, and the NT died from intentional self-harm (suicide).
  • Between 2009-2013 and 2014-2018, the NT was the only jurisdiction to record a decrease in intentional self-harm (suicide) death rates.

Kidney health

  • In 2018-19, 8% of Aboriginal and Torres Strait Islander people (Aboriginal people 1.9%; Torres Strait Islander people 0.4%) reported kidney disease as a long-term health condition.
  • For 2014-2018, after age-adjustment, the notification rate of end-stage renal disease was 3 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people.
  • In 2017-18, ‘care involving dialysis’ was the most common reason for hospitalisation among Aboriginal and Torres Strait Islander people.
  • In 2018, 310 Aboriginal and Torres Strait Islander people commenced dialysis and 49 were the recipients of new kidneys.
  • For 2013-2017, the age-adjusted death rate from kidney disease was 21 per 100,000 (NT: 47 per 100,000; WA: 38 per 100,000) for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and NT
  • In 2018, the most common causes of death among the 217 Aboriginal and Torres Strait Islander people who were receiving dialysis was CVD (64 deaths) and withdrawal from treatment (51 deaths).

Injury, including family violence

  • In 2012-13, 5% of Aboriginal and Torres Strait Islander people reported having a long-term condition caused by injury.
  • In 2018-19, 16% of Aboriginal and Torres Strait Islander people aged 15 years and over had experienced physical harm or threatened physical harm at least once in the last 12 months.
  • In 2016-17, the rate of Aboriginal and Torres Strait Islander hospitalised injury was higher for males (44 per 1,000) than females (39 per 1,000).
  • In 2017-18, 20% of injury-related hospitalisations among Aboriginal and Torres Strait Islander people were for assault.
  • In 2018, intentional self-harm was the leading specific cause of injury deaths for NSW, Qld, SA, WA, and NT (5.3% of all Aboriginal and Torres Strait Islander deaths).

Respiratory health

  • In 2018-19, 29% of Aboriginal and Torres Strait Islander people reported having a long-term respiratory condition .
  • In 2018-19, 16% of Aboriginal and Torres Strait Islander people reported having asthma.
  • In 2014-15, crude hospitalisation rates were highest for Aboriginal and Torres Strait Islander people presenting with influenza and pneumonia (7.4 per 1,000), followed by COPD (5.3 per 1,000), acute upper respiratory infections (3.8 per 1,000) and asthma (2.9 per 1,000).
  • In 2018, chronic lower respiratory disease was the third highest cause of death overall for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT

Eye health

  • In 2018-19, eye and sight problems were reported by 38% of Aboriginal people and 40% of Torres Strait Islander people.
  • In 2018-19, eye and sight problems were reported by 32% of Aboriginal and Torres Strait Islander males and by 43% of females.
  • In 2018-19, the most common eye conditions reported by Aboriginal and Torres Strait Islanders were hyperopia (long sightedness: 22%), myopia (short sightedness: 16%), other diseases of the eye and adnexa (8.7%), cataract (1.4%), blindness (0.9%) and glaucoma (0.5%).
  • In 2014-15, 13% of Aboriginal and Torres Strait Islander children, aged 4-14 years, were reported to have eye or sight problems.
  • In 2018, 144 cases of trachoma were detected among Aboriginal and Torres Strait Islander children living in at-risk communities in Qld, WA, SA and the NT
  • For 2015-17, 62% of hospitalisations for diseases of the eye (8,274) among Aboriginal and Torres Strait Islander people were for disorders of the lens (5,092) (mainly cataracts).

Ear health and hearing

  • In 2018-19, 14% of Aboriginal and Torres Strait Islander people reported having a long-term ear and/or hearing problem
  • In 2018-19, among Aboriginal and Torres Strait Islander children aged 0-14 years, the prevalence of otitis media (OM) was 6% and of partial or complete deafness was 3.8%.
  • In 2017-18, the age-adjusted hospitalisation rate for ear conditions for Aboriginal and Torres Strait Islander people was 1 per 1,000 population.

Oral health

  • In 2014-15, the proportion of Aboriginal and Torres Strait Islander children aged 4-14 years with reported tooth or gum problems was 34%, a decrease from 39% in 2008.
  • In 2012-2014, 61% of Aboriginal and Torres Strait Islander children aged 5-10 years had experienced tooth decay in their baby teeth, and 36% of Aboriginal and Torres Strait Islander children aged 6-14 years had experienced tooth decay in their permanent teeth.
  • In 2016-17, there were 3,418 potentially preventable hospitalisations for dental conditions for Aboriginal and Torres Strait Islander The age-standardised rate of hospitalisation was 4.6 per 1,000.

Disability

  • In 2018-19, 27% of Aboriginal and 24% of Torres Strait Islander people reported having a disability or restrictive long-term health
  • In 2018-19, 2% of Aboriginal and 8.3% of Torres Strait Islander people reported a profound or severe core activity limitation.
  • In 2016, 7% of Aboriginal and Torres Strait Islander people with a profound or severe disability reported a need for assistance.
  • In 2017-18, 9% of disability service users were Aboriginal and Torres Strait Islander people, with most aged under 50 years (82%).
  • In 2017-18, the primary disability groups accessing services were Aboriginal and Torres Strait Islander people with a psychiatric condition (24%), intellectual disability (23%) and physical disability (20%).
  • In 2017-18, 2,524 Aboriginal and Torres Strait Islander National Disability Agreement service users transitioned to the National Disability Insurance Scheme.

Communicable diseases

  • In 2017, there were 7,015 notifications for chlamydia for Aboriginal and Torres Strait Islander people, accounting for 7% of the notifications in Australia
  • During 2013-2017, there was a 9% and 9.8% decline in chlamydia notification rates among males and females (respectively).
  • In 2017, there were 4,119 gonorrhoea notifications for Aboriginal and Torres Strait Islander people, accounting for 15% of the notifications in Australia.
  • In 2017, there were 779 syphilis notifications for Aboriginal and Torres Strait Islander people accounting for 18% of the notifications in Australia.
  • In 2017, Qld (45%) and the NT (35%) accounted for 80% of the syphilis notifications from all jurisdictions.
  • In 2018, there were 34 cases of newly diagnosed human immunodeficiency virus (HIV) infection among Aboriginal and Torres Strait Islander people in Australia .
  • In 2017, there were 1,201 Aboriginal and Torres Strait Islander people diagnosed with hepatitis C (HCV) in Australia
  • In 2017, there were 151 Aboriginal and Torres Strait Islander people diagnosed with hepatitis B (HBV) in Australia
  • For 2013-2017 there was a 37% decline in the HBV notification rates for Aboriginal and Torres Strait Islander people.
  • For 2011-2015, 1,152 (14%) of the 8,316 cases of invasive pneumococcal disease (IPD) were identified as Aboriginal and Torres Strait people .
  • For 2011-2015, there were 26 deaths attributed to IPD with 11 of the 26 deaths (42%) in the 50 years and over age-group.
  • For 2011-2015, 101 (10%) of the 966 notified cases of meningococcal disease were identified as Aboriginal and Torres Strait Islander people
  • For 2006-2015, the incidence rate of meningococcal serogroup B was 8 per 100,000, with the age- specific rate highest in infants less than 12 months of age (33 per 100,000).
  • In 2015, of the 1,255 notifications of TB in Australia, 27 (2.2%) were identified as Aboriginal and seven (0.6%) as Torres Strait Islander people
  • For 2011-2015, there were 16 Aboriginal and Torres Strait Islander people diagnosed with invasive Haemophilus influenzae type b (Hib) in Australia
  • Between 2007-2010 and 2011-2015 notification rates for Hib decreased by around 67%.
  • In 2018-19, the proportion of Aboriginal and Torres Strait Islander people reporting a disease of the skin and subcutaneous tissue was 2% (males 2.4% and females 4.0%).

NACCHO Aboriginal Health and #Racism #BlackLivesMatter News Alerts : Part 1. Three in four people hold negative view of Indigenous Australians Part 2. How does racism impact on our mental wellbeing?

“Racism isn’t getting worse, it’s getting filmed.”

In 2016, Will Smith made this statement on a US talk show. After the death of African-American George Floyd in the United States last week, the clip, and the sentiment behind it, has been circulating widely.

George’s death sparked global protests over racism and police brutality — and Will’s words have resonated with many Aboriginal Australians across the country. 

University of Western Australia professor, psychologist and proud Bardi woman, Pat Dudgeon, agrees.

“There are very few Aboriginal people who wouldn’t have suffered racism,” she says.

It’s often discussed as a social issue, but a growing body of evidence suggests it’s detrimental to the mental health of Aboriginal people.

Read full ABC article HERE or PART 2 Below

Read over 130 Aboriginal Health and Racism articles published by NACCHO in the past 8 years 

Most Australians tested for unconscious bias hold a negative view of Indigenous Australians which can lead to widespread racism, new analysis from The Australian National University (ANU) shows.

People’s bias is regardless of gender, age, ethnicity, occupation, religion, education level, geography or political leanings, according to the findings.

The ANU researchers say 75 per cent of Australians tested using the Implicit Association Test by a joint initiative of universities including Harvard, Yale and the University of Sydney hold a negative implicit or unconscious bias against Indigenous Australians.

Their findings are published in the Journal of Australian Indigenous Issues.

The researchers analysed the “implicit bias” of over 11,000 Australian participants over a 10-year period, and how this can lead to racist attitudes or behaviour.

“The results are shocking, but not surprising,” said Australian report author

Mr Siddharth Shirodkar, a PhD researcher based in the ANU College of Arts and Social Sciences.

“These results show there may be an implicit negative bias against Indigenous Australians across the board, which is likely the cause of the racism that many First Australians experience.

“It is the first data of its kind for Australia and this evidence shows implicit or unconscious bias toward our first Australians is not imagined.

“This study presents stark evidence of the solid invisible barrier that Indigenous people face in society.

“But the data is actually not about Indigenous Australians, it’s about the rest of us.”

The results show it is likely that many people who hold these views have no awareness of their prejudice.

“As it is often unconscious, implicit bias can seep seamlessly into the everyday decisions at all levels of society,” said Mr Shirodkar.

“If you implicitly see Indigenous people in a negative light then that is going to affect all of your interactions and dealings with Indigenous people. We can only imagine the impact of that collective negativity on outcomes for Indigenous Australians.”

The test measured how quickly participants paired positive and negative words with historical images of Indigenous and Caucasian Australians.

Regardless of their occupations or levels of education, on average people displayed a negative bias against Indigenous faces. The same was found for people from all religions, as well as people who do not identify as being part of any religion.

Almost all ethnicities on average displayed bias against Indigenous Australians but people who identified as Aboriginal or Torres Strait Islander were statistically unbiased toward either group.

“It suggests Indigenous Australians are likely to be in the best position to make unbiased decisions about other Indigenous people,” said Mr Shirodkar.

Australian male participants showed a higher negative bias than females and people with all levels of education were guilty of bias.

Western Australian and Queensland participants recorded the highest average scores for bias. Participants from the Northern Territory and the ACT recorded the lowest average levels of bias in the country.

As the test is online and free for anyone to undertake, researchers say it is more likely to draw in people who want to prove their lack of bias.

“The results may therefore under-report the extent of implicit bias in Australia,” Mr Shirodkar said.

Anyone can take the Australian Implicit Association test from the follow link

https://implicit.harvard.edu/implicit/australia/takeatest.html

Part 2 How does racism impact on mental wellbeing?

What form can racism take?

Yin Paradies is a professor and chair in race relations at Melbourne’s Deakin University.

He defines racism as the unfair and avoidable disparities in power, resources, capacities, or opportunities centred on ethnic, racial, religious or cultural differences.

The Australian Human Rights Commission (AHRC) says that “racism is more than just words, beliefs and actions. It includes all the barriers that prevent people from enjoying dignity and equality because of their race”.

“It’s a form of exclusion and it impacts on people in that way and the stress of it affects mental health directly,” Professor Paradies says.

“If you can’t get a job, or if you can’t get work, or you’re not getting as much out of your education because of discrimination … [these] really have an impact on your health and wellbeing.”

The disadvantage accrues across all spheres of life over time.

The psychological impact

Professor Paradies’ work looks closely at the impact of racism on health.

His findings show that if you experience racial discrimination you’re:

Long-term impacts of trauma

“If they had iPhones in 1788, there’d be riots here too,” says Rulla Kelly-Mansell, a proud Tulampunga Pakana man and a mental health advocate.

For Rulla, the events unfolding in the US have brought to the surface some of the issues Aboriginal people face on a daily basis.

Rulla Kelly-Mansell standing in front of a wall painted like the aboriginal flag
Tulampunga Pakana man Rulla Kelly-Mansell didn’t fully understand intergenerational trauma until he was older.(Supplied)

He says a lot of the problems Aboriginal people face day to day aren’t things you can see.

Aboriginal people are still dealing with the trauma of past generations and the side effects of those traumas.

This can include poor health, high rates of mental illness and family breakdowns. He says this puts many Aboriginal people at a disadvantage.

“As a young man that manifested in anger.”

Research suggests those who experience trauma are more likely to engage in self-destructive behaviours, develop lifestyle diseases and enter and remain in the criminal justice system.

Suicide rates for Indigenous Australians aged 15-34 are more than double the general population, despite being less than 3.3 per cent of the population.

The most recent figures show almost one in three Indigenous adults report high levels of psychological distress.

Marlene Longbottom, a Yuin woman and an Aboriginal postdoctoral research fellow at the University of Wollongong, expresses what this time might mean for Indigenous Australians, moving forward with mental health.

“The current time is an opportunity for us to say, ‘Seeking help is a good thing’,” Dr Longbottom says.

“We need to destigmatise [and say] going to a counsellor or getting support is OK, and the healthy thing to do.

“It’s important that our communities know there are people who will listen.”

Where can Indigenous Australians turn to for support?

Click here to see Beyond Blue’s Aboriginal and Torres Strait Islander Community Controlled Health Services by state.

If you or anyone you know needs help:

NACCHO Aboriginal Health News ALERT : @CREATE_NHMRC Resource Launch – Aboriginal Community Controlled Health Organisations in Practice: Sharing ways of working from the ACCHO sector

NACCHO Aboriginal Health Resources Alert : Download @HealthInfoNet Overview of Aboriginal and Torres Strait Islander health status 2019 : Continuing to show important positive developments for our mob

In the Overview we strive to provide an accurate and informative summary of the current health and well-being of Aboriginal and Torres Strait Islander people.

In doing so, we want to acknowledge the importance of adopting a strengths-based approach, and to recognise the increasingly important area of data sovereignty.

To this end, we have reduced our reliance on comparative data in favour of exploring the broad context of the lived experience of Aboriginal and Torres Strait islander people and how this may impact their health journey “

HealthInfoNet Director, Professor Neil Drew

The Overview of Aboriginal and Torres Strait Islander health status (Overview) aims to provide a comprehensive summary of the most recent indicators of the health and current health status of Australia’s Aboriginal and Torres Strait Islander people.

Download HERE 

Overview+of+Aboriginal+and+Torres+Strait+Islander+health+status+2019

The annual Overview contains updated information across many health conditions.

It shows there has been a range of positive signs including a decrease in death rates, infant mortality rates and a decline in death rates from avoidable causes as well as a reduction in the proportion of Aboriginal and Torres Strait Islander people who smoke.

It has also been found that fewer mothers are smoking and drinking alcohol during pregnancy meaning that babies have a better start to life.

The initial sections of the Overview provide information about:

  • the context of Aboriginal and Torres Strait Islander health
  • social determinants including education, employment and income
  • the Aboriginal and Torres Strait Islander population
  • measures of population health status including births, mortality and hospitalisation.

The remaining sections are about selected health conditions and risk and protective factors that contribute to the overall health of Aboriginal and Torres Strait Islander people.

These sections include an introduction and evidence of the extent of the condition or risk/protective factor. Information is provided for state and territories and for demographics such as sex and age when it is available and appropriate.

The Overview is a resource relevant for the health workforce, students and others requiring access to up-to-date information about the health of Aboriginal and Torres Strait Islander people.

This year, the focus will be mainly on the Aboriginal and Torres Strait Islander data and presentation is within the framework of the strength based approach and data sovereignty (where information is available).

As a data driven organisation, the HealthInfoNet has a publicly declared commitment to working with Aboriginal and Torres Strait Islander leaders to advance our understanding of data sovereignty and governance consistent with the principles and aspirations of the Maiam nayri Wingara Data Sovereignty Collective (https://www.maiamnayriwingara.org).

As we have done in previous years, we continue our strong commitment to developing strengths based approaches to assessing and reporting the health of Aboriginal and Torres Strait Islander people and communities.

It is difficult to make comparisons between Aboriginal and Torres Strait Islander people and non- Indigenous Australian populations without consideration of the cultural and social contexts within which people live their lives.

As in past versions, we still provide information on the cultural context and social determinants for the Aboriginal and Torres Strait Islander population.

However, for the selected health topics and risk/protective factors we have removed many of the comparisons between the two populations and focused on the analysis of the Aboriginal and Torres Strait Islander data only.

In an attempt to respond to the challenge issued by Professor Craig Ritchie at the 2019 AIATSIS conference to say more about the ‘how’ and the ‘why’ not just the ‘what’ where comparisons are made and if there is evidence available, we have provided a brief explanation for the differences observed.

Accompanying the Overview is a set of PowerPoint slides designed to help lecturers and others provide up-to-date information.

  • In 2019, the estimated Australian Aboriginal and Torres Strait Islander population was 847,190.
  • In 2019, NSW had the highest number of Aboriginal and Torres Strait Islander people (the estimated population was 281,107 people, 33% of the total Aboriginal and Torres Strait Islander population).
  • In 2019, NT had the highest proportion of Aboriginal and Torres Strait Islander people in its population, with 32% of the NT population identifying as Aboriginal and/or Torres Strait Islander.
  • In 2016, around 37% of Aboriginal and Torres Strait Islander people lived in major cities.
  • The Aboriginal and Torres Strait Islander population is much younger than the non-Indigenous population.

Download the PowerPoint HERE

Overview+of+Aboriginal+and+Torres+Strait+Islander+health+status+2019_+key+facts

NACCHO Aboriginal Health Research News : Download @LowitjaInstitut and @ourANU Aboriginal Health and Wellbeing Services – Putting community-driven, strengths-based approaches into practice

From the wide range of health and wellbeing practitioners we spoke to – which included nurses, midwives, Aboriginal health workers, therapists, caseworkers and more – there was clear sentiment that in a context of post- colonial power imbalance, Aboriginal people often experience inappropriate treatment in mainstream services.

There was agreement that community-driven, holistic and person-centred approaches are key to delivering better services, yet, increasingly, restrictive and metrics-focus funding regimes constrain what works. ” 

From Aboriginal Health and Wellbeing Services – Putting community-driven, strengths-based approaches into practice Report

Download 80 Page PDF here

Aboriginal_Health_and_Wellbeing_services_DD3_FINALwith_links

” Laynhapuy Health is responsive to a set of distinctly localised, Yolŋu ways of setting goals and priorities. The Traditional Owners, in combination with the local health workers, are effectively the ‘bosses’ of the Laynhapuy Health service.

They make broad decisions about the nature and pace of health delivery, in keeping with the broader self-determined ethos of the homelands movement (see the section on Laynhapuy Homelands self-determination movement).

The Aboriginal health workers, meanwhile, are responsible for the clinics in their communities (see the section Aboriginal health and wellbeing professionals).

Difficult decisions about local health are made in the first instance through adherence to Yolŋu conventions of reciprocity, relational obligation, custodianship and clan-based understandings of the right way to do things.

In the second instance, decision making in Laynhapuy Health is intercultural. The Laynha Health manager (and a range of other staff) regularly meet with community leaders, health workers and a wide range of community members on routine community visits, and the communities are the manager’s first point of contact for discussing new ideas or directions.

This is not always an easy task as it relies on subtleties beyond formal governance. The community needs to trust that the staff and clinicians of Laynhapuy Health will respect and adhere to the decisions made at a homeland level.

At the same time, the manager must ensure power in decision-making continues to reside with the Traditional Owners and the community, while also adhering to the clinical and bureaucratic conventions of biomedical systems.

As we explore here, time, communication and trust are crucial elements in making this work. However, at the heart of Laynhapuy Health’s model is a belief that the people of the homelands are best placed to make decisions about their own health care; in short, Yolŋu concepts of health create healthy Yolŋu.”

From page 32 Laynhapuy Health is an Aboriginal Community Controlled Health Service (ACCHS) operating in East Arnhem Land, Northern Territory (NT). It delivers comprehensive primary health care (CPHC) to Yolŋu people across the remote Laynhapuy Homelands

Executive summary 

This report explores strengths-based, bottom-up approaches to delivering Aboriginal health and wellbeing services.

It focuses on three case study organisations across two sites, all of which have reputations for maintaining highly positive relationships with their communities:

  • Laynhapuy Health is an Aboriginal Community Controlled Health Service (ACCHS) operating in East Arnhem Land, Northern Territory (NT). It delivers comprehensive primary health care (CPHC) to Yolŋu people across the remote Laynhapuy Homelands (see https://www.laynhapuy.com.au).
  • Waminda is an ACCHS that provides a range of health and wellbeing services to Aboriginal women and their families in the Shoalhaven region of New South Wales (NSW) and beyond. This includes general practice, antenatal and postnatal care, lifestyle programs, justice support, social enterprise programs and more (see waminda.org.au).

  • Noah’s is a community-based, not-for-profit organisation catering to children and young people with special needs and their families across the Shoalhaven. Their work includes National Disability Insurance Scheme (NDIS) services, childhood education, playgroups, and behaviour Noah’s has several programs specifically for Aboriginal clients (see https://noahs.org.au/).

Despite the substantial differences between the two field sites and the scope of the three organisations, there were strong commonalities between them in the approaches and challenges they raised.

For all three organisations, strengths-based approaches are inseparable from their community-driven, holistic design. The linking elements are their understandings of power structures and neo-liberal trends in a cross-cultural context in the Australian health and wellbeing sector.

This highlights that strengths always need to be understood in relation to constraints. For example, a narrow focus on strengths risks portraying individuals and communities as responsible for their situations, shading out wider relations of power and socio-economic inequality.

We found that all three organisations strike an important balance between confidence in the strengths of the communities they serve and represent, and consciousness of the constraints on their (and their clients’) room for manoeuvre in a post-colonial and increasingly neoliberal nation-state.

In many ways large and small, the organisations keep working at pushing those boundaries a little further – creating more room for autonomy and for strengths.

This report explores these dynamics, and, in the process, details the three organisations’ approaches and successes. This brings us back to many of the core issues that are well documented in relation to Aboriginal health and wellbeing, including the importance of community-driven design, holism, the social determinants of health, and person- and family-centred approaches.

This allows us to celebrate the organisations’ strengths and successes – highlighting ‘beautiful, big, positive’ stories, as one of our interviewees put it.

Throughout this report we have followed the terminologies of our case study organisations, participants, and/or source materials in our use of the terms ‘Aboriginal’, ‘Aboriginal and Torres Strait Islander’ and ‘Indigenous’.

The main section of the report details the organisations’ understandings of effective approaches in the sector, as they have sought to implement them. Although there is much overlap, we have divided this into three areas of focus:

Under the section What Works: Bottom-up approaches we explore broad, organisational issues relating to governance, program design and staffing.

  • Community-driven program design is fundamental to ensuring This requires building long- term relationships with communities that go well beyond superficial consultation.
  • Relationship building goes hand-in-hand with long-term learning based on local histories, culture and socio-economic
  • From these relationships and learning, innovative place-based services that are responsive to community needs and aspirations can
  • Crucial to these processes is having staff who are part of the community, but drawing on expertise and support from staff with a diversity of backgrounds can also help build robust structures and services and provide clients with a wider

Under the section What Works: Holism and wellbeing we then look at how the organisations think about health and wellbeing and what they incorporate within the scope of their work.

  • Much of the health sector treats illness in Aboriginal people, rather than promoting health and
  • Holistic health that addresses social determinants is preventative and protective. It can include supporting culture and language, connection to Country, spirituality, belonging and identity, strength of community and family, and empowerment and control.
  • Holistic health may seem broad, and therefore difficult to implement. However, because the organisations are in tune with community needs and aspirations, it is often clear to them which health-promoting services are most relevant in their context. For example, for one health organisation, enabling people to live and thrive in remote homelands communities is at the core of their work, while another explicitly promotes fitness, nutrition and career pathways among other things.

Under the section What Works: Delivering person- and community-centred care we narrow to a focus on effective approaches at the ‘clinical interface’ of the organisations’ work.

  • Much top-down intervention in the health care sector and beyond relies on externally identifying and seeking to fix Often systems operate based on practitioners’ ‘expert’ values and terms.
  • Person-centred care shifts the power balance and places clients’ needs, desires, goals, values and circumstances at the centre of the care
  • Related strengths-based approaches seek to shift the emphasis away from problems and negative labels through which a person’s or community’s identity can become defined, to instead recognising positive capabilities, goals and
  • All the case study organisations stressed the importance of their services being accessible on a regular and consistent basis. This was closely linked with making a long-term commitment to a place and a population, and building peoples’ familiarity with the service and their trust over
  • Consistency in service provision must be balanced with flexibility, adaptability and responsiveness based on community and client needs. In other words, consistently ‘being there’ for clients is important, but the form this takes need not be prescribed, rigid or
  • Brief consultation times, which are standard in the health care sector, are particularly sub-optimal in the context of Aboriginal health care for a range of reasons we detail. For example, building trust is essential,particularly in light of traumatic histories with institutional services and the prevalence of negative experiences in the health and wellbeing sector. However, building trust and rapport takes time.
  • All the case study organisations see brokering, advocacy and coordination of care as central to their work and success. This ranges from explaining to people the available services and talking them through what to expect, to (in the case of one organisation) escorting them on major hospital visits and translating between

While many of these themes are well-established ‘best practice’ in the health and wellbeing sector, the organisations had remarkably similar Challenges and Constraints in marrying bottom-up, holistic and person-centred approaches with top-down funding regimes.

  • Funding is typically for a specific purpose, falls within a siloed sector or assumes a certain set of realities. The purpose and scope of the funding is decided from the top down and it often assumes a compartmentalised approach to health and
  • Project and programme grants are also often relatively short-term. But, as noted, genuine community relationships take time to build, and many programs that address the social determinants of health are unlikely to show results in such timeframes. Even initiatives with a strong and consistent record of positive results over the long term can be defunded at short notice with little or no This is a threat to the consistency and regularity of services (factors that our participants identified as being so important). It is also a threat to staffing in a context where the organisations have strived to build up Aboriginal staff capacity and cross-cultural understandings, as it can result in the loss of long-term institutional knowledge and produce employment precarity.
  • The organisations are required to report on key performance indicators (KPIs). These are typically determined from the top down and are often strongly metrics-focused. There are frequent disconnects between what KPIs measure and what local organisations value, as well as frustrations that KPIs measure the ‘wrong’ things or fail to capture important successful activity. This is part of a broader international trend toward standardised statistical indicators, despite evidence that they often do not produce the desired

Drawing on the findings throughout the report, we make a range of recommendations for ways forward. These are targeted at funders, policy makers and associated stakeholders seeking to enable non- government organisations (NGOs) in the Aboriginal health and wellbeing field to work more effectively.

Funding that embraces holism, innovation and responsiveness

  • A prevalence of narrow, sector-specific funding may be impeding holistic health and wellbeing approaches, and those driven by community needs, values and More funding streams that allow organisations to define and respond to holistic health and wellbeing in their context are needed.
  • Designing bottom-up, holistic health and wellbeing services sometimes means innovating and taking risks. Funding streams that embrace innovation, but do not force it where it is unneeded, would benefit the

Longer term funding cycles

The availability of more long-term funding options will better allow organisations to design projects and programs from the bottom up. This includes organisations’ efforts to prioritise relationship building;

to address the social determinants of health; to ensure there is leeway for strategies to be tried and, if necessary, amended; to provide consistency of presence over time; and to help build a more skilled and stable workforce that includes training, learning and career development opportunities for Aboriginal and non-Aboriginal staff.

Co-designed KPIs

  • Funding providers should allow organisations the capacity to design or negotiate KPIs according to local realities and community-based aspirations, thereby allowing for greater local relevance, responsiveness and
  • Co-design of KPIs should be an ongoing, reflexive process, allowing for the mitigation of unintended consequences.

Narrative-based reporting

  • Reporting formats need to allow funding recipients the option and scope to detail progress, issues and outcomes in narrative/descriptive form. This may mean incorporating more open-ended questions in report
  • The capacity to integrate or attach multi-media (including videos, audio and photographs) is also merited.
  • Public servants and program managers need professional development in valuing and using qualitative information, and in the dangers of privileging statistical

Reducing over-reporting

  • It is incumbent on funding providers to ensure that reporting requirements and processes are efficient. This includes thinking carefully about how often reports fall due, how user-friendly the reporting templates are to complete, and whether the extent of what they ask applicants to produce is

Relationship building between funders and recipients

  • Policy makers and funders can gain a better understanding of the realities on the ground by talking directly to those implementing services in that Staff at funding institutions should be encouraged to view the funding relationship as a partnership, rather than as a hierarchicalrelationship in which the funder holds the power. It is, after all, usually the service provider that best understands the realities, needs and aspirations of the communities with which they work.
  • Organisations can feel that submitting reports on expended funding is like feeding information into a black hole; there is typically no engagement or feedback from the funding organisation and it is often unclear if or how the submitted information is (or might in future be) used. More transparency around the use of requested information is important, as is engagement with submitted reports.

Career public servants and time for learning

  • The Australian Public Service encourages professional mobility among its staff, but understanding Aboriginal Affairs requires relationship building, substantial cross-cultural knowledge, and comprehension of a range of complex and interrelated historical, socio-economic and political As such, there is strong merit in encouraging public servant stability and specialisation in Aboriginal Affairs.
  • Because knowledge of best practice, and cross-cultural understanding, are central to effective Aboriginal health and wellbeing policy, public servants need time for There is a vast amount of high-quality and accessible research and guidance material on these topics, as well as a plethora of other learning avenues such as courses and cultural immersions. It would be of enormous benefit for public servants to be encouraged to read such materials and to undertake learning opportunities on-the-job with allocated time to do so.