NACCHO Aboriginal Health and #CoronaVirus News Alert No 21 #KeepOurMobSafe : What are the remote area travel restrictions? Frequently Asked 15 Questions

  1. What are the remote area travel restrictions?
  2. Why is this being done?
  3. What is happening everywhere in Australia?
  4. When to they start and when do they end?
  5. What are the areas? (see attached maps)
  6. How do the restrictions work? (see attached flow chart)
  7. How do they affect community people in community?
  8. How do they affect community people outside of the areas?
  9. How will services still being provided?
  10. Can I travel between my homeland and community?
  11. What about other essential services or activities?
  12. What about construction activities?
  13. Does this effect pastoralists and miners?
  14. Who can I talk to for more information?
  15. More information and resources

See NACCHO Corona Virus Home Page

Read all 21 NACCHO Aboriginal Health and Coronas Virus Alerts HERE

What are the remote area travel restrictions?

On 20 March 2020, the National Cabinet provided in-principle agreement to the Commonwealth Minister for Health taking action under the Commonwealth Biosecurity Act 2015 to restrict travel into remote Indigenous communities to prevent the spread of coronavirus (COVID-19).

States and territories have nominated areas in consultation with Indigenous communities, and emergency requirements determined under the Biosecurity Act 2015 will restrict persons from entering those nominated areas from 11:59pm AEDT Thursday 26 March 2020.

This follows the decisions of a number of Indigenous communities and Governments to implement similar measures.

State and Territory Hotlines and Contact Details

Northern Territory: 1800 518 189 remote travel hotline

Western Australia: Covid19rcr@communities.wa.gov.au

Queensland: 13 QGOV (13 7468)

South Australia: 1800 253 787

Why is this being done?

These restrictions are to protect some of our most vulnerable Australians.

The restrictions have been requested by many leaders, communities and organisations.

Isolation and remoteness offer opportunities for delaying or potentially preventing an outbreak of COVID-19 in remote communities. However, high mobility of community members and a reliance on visiting and outreach activities and services increase the risk of COVID-19 occurring in these communities.

These rules are aimed at preventing the spread of COVID-19 in remote communities and to rapidly address outbreaks.

What is happening everywhere in Australia?

Governments are focused on working together to slow the spread of COVID-19 to save lives. Every extra bit of time allows us to better prepare our health system and put measures in place to protect Australian lives.

We will be living with this virus for at least six months, so social distancing measures to slow this virus down must be sustainable for at least that long to protect Australian lives, allow Australia to keep functioning and keep Australians in jobs.

Practicing good hygiene and keeping a healthy physical distance between individuals is our most powerful weapon in fighting this virus and saving lives. Some members of the community who are disregarding social distancing measures are putting the lives of older and vulnerable Australians at risk.

To slow the spread, everyone must implement appropriate social distancing in accordance with state and territory laws. We need every Australian to do their bit to save the lives of other Australians.

When to they start and when do they end?

Restrictions to travel to remote areas to protect community members from COVID-19 came into effect at 11.59 PM AEDT Thursday 26 March 2020.

The restrictions currently end on 18 June 2020 under the Biosecurity Act. This period can be extended if considered necessary.

What are the areas? 

States and Territories have nominated areas in consultation with Indigenous communities where this was possible in the time available.

The designated remote areas include most of the Northern Territory, except the major urban centres and pastoral properties; north and east Western Australia; the north-west of South Australia and selected communities; and in Queensland Cape York Peninsula, the Torres Strait, western Gulf and other communities.

More areas may be added, including in other States.

The designated areas are indicated on the following maps:

How do the restrictions work? (see attached flow chart)

Consistent with expert health guidance, individuals will be required to undergo a minimum period of isolation (currently 14 days) before entry or re-entry into the area will be allowed.

There will be exemptions for essential activities. Exempted people still need to not have any of the signs or symptoms of COVID-19 and in the 14 days immediately before entry, not been outside Australia. All people must take all reasonable steps to minimise exposure to other people.

How do they affect community people in community?

The safest place for community people is in their community, homeland or outstation.

If people are in community, they are encouraged to stay there. If they are away in town or the city, they should return home before Friday 27 March 2020.

How do they affect community people outside of the areas?

If people want to enter community after the restrictions come into place, they will need to self-isolate for 14 days before return. Isolation is from the general public.

State and Territory Governments are making arrangements to assist isolation.

If people leave their community now, they will not be able to return for 14 days once the restrictions start at 11.59 PM AEDT on Thursday 26 March 2020.

How will services still being provided?

Once the restrictions start, only essential service personnel will be exempt so they can keep delivering essential services.

These essential services include health care, education, domestic violence prevention, child protection, policing, emergency, local government – such as rubbish collection, Services Australia, correctional, funerary and courts.

Essential services also include operating, maintaining or repairing equipment for providing electricity, gas, water or telecommunications services; other essential infrastructure; delivering food, fuel, mail or medical supplies; obtaining medical care or medical supplies; and transporting freight to or from a place in the designated area.

Remember, all people entering designated remote areas still need to not have any of the signs or symptoms of COVID-19 and in the 14 days immediately before entry, not been outside Australia. All people must take all reasonable steps to minimise exposure to other people.

Governments and community organisations are working hard to ensure essential services continue in these communities.

Can I travel between my homeland and community?

Designated areas are generally large and include groups of communities and homelands/outstations. Travel within the designated area (including between islands within that area) is permitted and will not be disrupted with these restrictions. However, it is important that everyone tries to minimise travel and practises social distancing.

Local regulations and norms still apply for travel within those areas.

What about other essential services or activities?

Under the emergency requirements have nominated decision-makers who will be empowered to permit additional people to enter the community in certain circumstances with the advice of a Human Biosecurity expert.

Remember, all people entering designated remote areas still need to not have any of the signs or symptoms of COVID-19 and in the 14 days immediately before entry, not been outside Australia. All people must take all reasonable steps to minimise exposure to other people.

What about construction activities?

Some construction of houses and roads is underway. These activities will be able to continue to completion as an essential activity.

Does this effect pastoralists and miners?

With most of the Northern Territory nominated as a designated area, all pastoral leases are excluded.

Mining, oil and gas and related operations are classed as an essential activity. However, there is an additional requirement to strictly minimise the extent to which other persons in the area are exposed to the persons carrying out those operations through agreed protocols with a relevant biosecurity officer.

Who can I talk to for more information?

Implementation of these restrictions will be the responsibility of each jurisdiction. Hotlines and contact details for your State or Territory Governments are below.

More information and resources

State and Territory Hotlines and Contact Details

Northern Territory: 1800 518 189 remote travel hotline

Western Australia: Covid19rcr@communities.wa.gov.au

Queensland: 13 QGOV (13 7468)

South Australia: 1800 253 787

NACCHO Aboriginal Remote Communities Health and #CoronaVirus News Alerts :  #APYLands  @Nganampa_Health @NLC_74 #CAAHSN @AMSANTaus @RACGP All ensuring remote communities are resourced , protected and provided with appropriate information #COVID19

 

“As health and medical research organisations, we are calling for an absolute priority to be given to minimising risk and preventing death in communities across central Australia.

A major priority in our endeavours is working with Aboriginal communities and support to the primary health services in the bush and our regional centres.

Things that might work in. the big cities simply won’t work out bush, so we need to focus on local solutions.

Both Aboriginal community-controlled and government primary health services face enormous day-to-day challenges—and we strongly support them as the real heroes of health care in remote Australia, from Aboriginal Health Practitioners, to nurses to allied health workers to doctors, to all staff doing such vital work “

CAAHSN would continue to be informed by COVID19  messaging from AMSANT Aboriginal Medical Services Alliance and the Department of Health.

AMSANT has already been supplying advice to member services, with a focus on updating vaccinations and a focus on day-to-day preventive measure such as had washing.

Read full press release Central Australia Academic Health Science Network Part 2 Below

Graphic above QAIHC

Read all NACCHO Corona Virus Articles HERE

” As GPs try to navigate national guidelines for coronavirus (COVID-19), a number of Aboriginal and Torres Strait Islander community leaders have stepped in to manage their own infection control.

For example, in the Northern Territory quite a few communities are putting in place their own procedures around how they’re going to manage it. ’ 

‘[They’re] isolating themselves from [the] outside and I gather even saying, “Actually, we don’t want health professionals coming in at the moment to keep ourselves safe”.’

Dr Tim Senior, Medical Advisor for RACGP Aboriginal and Torres Strait Islander Health, told newsGP. See report part 4 below

“We need to be vigilant and follow these guidelines in order to protect Anangu from this virus,

There have been no known COVID-19 cases among APY Lands residents to date, but the Prime Minister has expressed concern about the vulnerability of those in remote Indigenous communities, including the APY Lands.

During the 2009 A(H1N1) swine flu outbreak, Aboriginal and Torres Strait Islander people made up 11 per cent of all identified cases, 20 per cent of hospitalisations and 13 per cent of deaths. Indigenous people are 8.5 times more likely to be hospitalised during a virus outbreak.”

APY General Manager Richard King has issued the directive to all APY staff and contractors. The directive also has been issued to Nganampa Health Council and major allied non-government organisations. State and Commonwealth government agencies, that are not required to apply for a permit to enter the APY Lands, have been contacted seeking their co-operation.

Mr King said communities on the APY Lands were particularly vulnerable because of well-documented poor health and living conditions. See full press release part 3

Part 1 NLC

“ The NLC supports the NT Government’s call to cancel all non-essential trips to remote communities as it tries to prevent the spread of coronavirus to vulnerable populations and has taken steps to ensure that all NLC employees who have recently travelled overseas do not travel to remote communities unless they have been cleared to do so.

“We agree with the NT Government’s decision to ask all workers to cancel their trips if they are not essential and the same goes for NLC staff,”

NLC CEO Marion Scrymgour.

Part 1 :The Northern Land Council’s Executive Council met today with officials from the Northern Territory Department of Health and the Danila Dilba Health Service’s CEO Ms Olga Havnen to examine strategies and information focused on protecting Aboriginal communities in the NLC’s region from the risk of coronavirus.

The NLC supports the NT Government’s call to cancel all non-essential trips to remote communities as it tries to prevent the spread of coronavirus to vulnerable populations and has taken steps to ensure that all NLC employees who have recently travelled overseas do not travel to remote communities unless they have been cleared to do so.

“We agree with the NT Government’s decision to ask all workers to cancel their trips if they are not essential and the same goes for NLC staff,” said NLC CEO Marion Scrymgour.

Ms Scrymgour will meet with NT Tourism tomorrow (March 13) to discuss how tourism operators can minimise their potential impact on remote communities.

NLC chairman Samuel Bush-Blanasi said the NLC is working closely with the NT Government and health service providers to  working

“We want people to really think about their need to visit remote communities. Especially if they have returned from an at risk country they must not travel to Aboriginal communities and must take every precaution.”

NT Government website COVID19 Information for Aboriginal communities

  • There are currently no suspected cases of COVID-19 in any Territory communities.
  • Residents should stay alert but carry on with normal activities.
  • There is no risk to eating traditional animals and plants.
  • The virus is not spread by mosquito bites.
  • The virus is not spread on the wind.
  • The most important thing for everyone to remember is to maintain hygiene by:
    • Washing your hands
    • Avoid shaking hands with people who may be unwel
    • Stay at a distance of 1.5 m away from someone who is unwell
    • Coughing or sneezing into your elbow
    • Don’t go to crowded places if you’re unwell.
  • If you get sick, go to your health clinic.

Recordings in language

A Coronavirus (COVID-19) Public Health Remote Communities Plan has been developed and distributed to all remote Territory communities. This plan provides high level guidance and each community will tailor their individual plans to suit their specific circumstances and community requirements.

Part 2

At a Council meeting of the Central Australia Academic Health Science Network [CA AHSN] today, a call was made for decisive and urgent action on the prevention of COVID-19 spreading to remote Australian communities, Executive Director Chips Mackinolty said today.

“We are in this together, and we have a collective responsibility at all levels of government and health service delivery to keep people safe,” said Mr Mackinolty.

“As health and medical research organisations, we are calling for an absolute priority to be given to minimising risk and preventing death in communities across central Australia.

“A major priority in our endeavours is working with Aboriginal communities and support to the primary health services in the bush and our regional centres.

“Things that might work in. the big cities simply won’t work out bush, so we need to focus on local solutions.

“We believe it is critical that rapid and extensive testing be rolled out as soon as possible, so that such work is timely and localised. As a first step this should be located in Alice Springs, rapidly followed by other regional centres.

“Of paramount concern is that our health services—already severely under resourced—not be further burdened. Just as happened in the recent bush fire crises, we would see it as essential that Commonwealth-funded remote area health medical workers being brought in to help.

“Both Aboriginal community-controlled and government primary health services face enormous day-to-day challenges—and we strongly support them as the real heroes of health care in remote Australia, from Aboriginal Health Practitioners, to nurses to allied health workers to doctors, to all staff doing such vital work.

“Meanwhile, our research activities will limit fieldwork, and researchers recently overseas will not be allowed to travel remotely. This follows the initiatives already of some of our partner organisations

In any case, we will also seek to follow the recommendations of local Aboriginal community organisations in our work.

“A major priority, from the Commonwealth and NT governments should be a major effort in proving accurate and concise information to Aboriginal people—with a stron

Part 3 MEDIA STATEMENT: APY enacts border protection to reduce coronavirus risk

APY has introduced strict new rules for entry into its remote lands in response to the Federal Government’s concerns about the potential for coronavirus to spread in vulnerable Indigenous communities.

The Executive Board that governs the remote Anangu Pitjantjatjara Yankunytjatjara Lands, in South
Australia’s far northwest, addressed the threat of a coronavirus outbreak at its latest meeting.

The Board has resolved not to routinely issue entry permits for the next three months to anyone who has:

  • Been in mainland China from 1 February 2020.
  • Been in contact with someone confirmed to have coronavirus.
  • Travelled to China, Iran, South Korea, Japan, Italy or Mongolia.

If a person who wishes to enter the APY Lands has travelled to any of the affected countries, experienced coronavirus symptoms in the previous 14 days, been seen by a doctor and recorded a negative test, they must submit a copy of the test results along with a Statutory Declaration to be considered for an entry permit.

APY has the legal authority to exclude persons from entering the APY Lands pursuant to section 19 of the Anangu Pitjantjatjara Yankunytjatjara Land Rights Act. APY General Manager Richard King has issued the directive to all APY staff and contractors.

The directive also has been issued to Nganampa Health Council and major allied non-government organisations. State and Commonwealth government agencies, that are not required to apply for a permit to enter the APY Lands, have been contacted seeking their co-operation.

Part 4 RACGP 

Media report RACGP Dr Tim Senior : Chronic diseases and a lack of access to culturally appropriate care makes Aboriginal and Torres Strait Islander people vulnerable to coronavirus.

 

 

NACCHO Aboriginal and Torres Strait Islander #RuralHealth : @RuralDoctorsAus President and CEO says quality rural and remote health care essential to #ClosingtheGap

“Both Federal and State governments, right across the country, need to step up and invest in rural health if they are serious about this.

There have been numerous examples of initiatives developed to improve access to health care in rural and remote areas being extended into urban areas to prop up under-funded services in for the socially disadvantaged.

This has resulted in the unintended consequence of further disadvantaging Aboriginal and Torres Strait Islander people living in rural and remote Australia.

We need continued investment in health infrastructure and services aimed at addressing the disparity in health outcomes between those who live in the city and those who live in the bush… and this extends across both our Indigenous and non-Indigenous populations.

Without this, as a nation we are never going to close the gap, and the divide for the health outcomes of Aboriginal and Torres Strait Island people living in rural and remote Australia will never be addressed.”

Dr John Hall, President of the Rural Doctors Association of Australia (RDAA), said that without access to high quality health services in rural areas, the gap will never close.

Photo above : Here is what GPs said about working in Indigenous health

” I’m particularly concerned with successive government failure to halve Indigenous child mortality rates.

A lot of this is about access, it’s around health literacy.

It’s also about the holistic care, it’s also around education, housing and a whole range of other things”.

Australia needs to boost hospital and birthing facilities in rural and regional areas in order to overcome entrenched Indigenous health disadvantage, according to Rural Doctors Association of Australia CEO Peta Rutherford told SkyNews .

Watch SkyNews interview HERE 

Read over 70 Aboriginal Rural and Remote Health NACCHO Articles HERE

Another disappointing Closing the Gap Report, released this month [12 February 2020], demonstrates why health care in rural and remote Australia is a key driver to Closing the Gap in health.

“The Government’s Closing the Gap Report 2020 showed that the Gap between Indigenous and non-Indigenous Australians on key health indicators has not closed,” Dr Hall said.

“Two key health-related benchmarks were chosen by the

Government in 2008, with a target of halving the gap in child mortality by 2018, and to close the gap in life expectancy by 2031.

“Neither of these targets are on track.

“The main cause of Aboriginal and Torres Strait Islander child deaths are perinatal conditions such as complications of pregnancy and birth.

“With 85 per cent of these deaths occurring during the first year of life, maternal health and risk

factors during pregnancy play a crucial role.

“Access to quality, culturally safe, medical care is the most direct way of improving these outcomes,” Dr Hall said.

Similarly, life expectancy in Aboriginal and Torres Strait Islander people is strongly influenced by health and health care, with the report attributing 34 per cent of the gap to social determinants (such as education, employment status, housing and income), 19 per cent to behavioural risk factors (such as smoking, obesity, alcohol use and diet), leaving 47 per cent attributed to what is clearly a disparity in health outcomes and associated health care issues.

In rural and remote areas there is a noticeable difference of a more than six year reduction in life expectancy of Aboriginal and Torres Strait Islander males and females, when compared to those living in major cities.

This demonstrates a failure across the board in these key areas, all of which are influenced by the provision of quality health care.

“Clearly we can’t close the gap without a functional health system in rural and remote Australia,” Dr Hall said.

“And this cannot just be solved through funding Aboriginal Medical Services (AMS); the other parts of the health system need to be equally funded to service these communities in order to be able to provide the standard of care that will result in a reduction in the gap in health outcomes.

“We can’t have hospital services downgraded and expect to close the gap.

“We can’t have communities with no access to medical birthing services and expect to close the gap.

“We can’t have people needing to travel hundreds of kilometres to access cancer or surgical treatment and close the gap.

“We need quality rural hospitals, staffed by Rural Generalist doctors, with the skills needed to meet the needs of these communities in both the General Practice and hospital settings, if we are serious about improving health outcomes and actually closing the gap.

NACCHO Aboriginal Health and Remote Communities News : I. @SenatorDodson The Need to empower remote Communities 2.@abcnews Empowering Young Leaders’ in the Kimberley call for change to curb suicides

Indigenous people living in remote communities are still betrayed. The truth of this nationally is seen in the government’s “duck, dive” approach to entrenching a voice in the Constitution.

On the first day of parliament sittings next year, the Prime Minister will present the annual Closing the Gap report, an index of the disadvantage experienced by First Nations people.

It will be another recitation of government failures to improve their lives — lives that in remote communities end many years shorter than elsewhere.

Not only do they die younger, their existence also is miserable. It’s not just a matter of poor service delivery, it’s that their lives are not their own. Governments, unwilling to trust First Nations people to take charge of their own lives, continue to intrude and manage.

Patrick Dodson is the Labor senator for Western Australia writing in the Weekend Australian

See Part 1 Below

“The Empowered Young Leaders’ report, released last week, calls for more education for young people around social and emotional wellbeing and increased efforts to embed Indigenous culture in schools.

They also want a permanent forum for young people to voice their concerns.

It comes as the State Government considers a formal response to the WA coroner’s inquest into the suicides of 13 Indigenous young people in the remote region.” 

See Part 2 Below

After 2,800 Aboriginal Health Alerts over 7 and half years from www.nacchocommunique.com NACCHO media will cease publishing from this site as from 31 December 2019 and resume mid January 2020 with posts from www.naccho.org.au

For historical and research purposes all posts 2012-2019 will remain on www.nacchocommunique.com

Your current email subscription will be automatically transferred to our new Aboriginal Health News Alerts Subscriber service that will offer you the options of Daily , Weekly or Monthly alerts

For further info contact Colin Cowell NACCHO Social Media Media Editor

Part 1 : The nation’s treatment of remote indigenous communities is an international scandal. We need a Marshall Plan to end the squalor.

Labor MPs Murray Watt, Linda Burney, Warren Snowdon, Sharon Claydon and Patrick Dodson on their indigenous road trip. Picture: supplied

In January 1994, then Labor senator Graham Richardson, health minister in Paul Keating’s government, toured remote Aboriginal communities in Western Australia and the Northern Territory.

Conditions in those communities, he said, were “miserable”. He “saw things … that would barely be tolerated in a war-ravaged African nation”.

In August, with a party of fellow federal Labor parliamentarians, I did a big sweep through remote communities in WA and the Territory. From Port Hedland we dropped in at Marble Bar, Jigalong, Newman, Meekatharra, Wiluna, Leonora,

More than 25 years after Richardson’s expedition, I can attest that conditions for Aboriginal people in those places are still miserable and intolerable.

Last month WA Aboriginal Affairs Minister Ben Wyatt visited remote communities in his jurisdiction and wrote in The Australian of their “institutionalised ghetto status”.

How many inquiries or reports will it take, how often can the UN Special Rapporteur on the Rights of Indigenous Peoples declaim against this tragedy, before Australia confronts the crisis that cripples these communities, and sets about fixing things?

The people out there did not choose to live in those places. By and large, those communities were artificially designed by bureaucrats and Aboriginal people were shepherded there — sometimes for their protection (from Woomera rockets, for example), sometimes as a consequence of assimil­ationist policies. But, having plonked them there, governments have failed to maintain adequate basic services.

Forget the trumped-up national emergency John Howard and Mal Brough declared across the Northern Territory in June 2007 (although Aboriginal people will never forget).

The real emergency was staring them right in the face and they never dealt with it: the parlous plight of thousands of Aboriginal people forced to live in squalor and denied basic rights of citizenship.

It’s interesting to recall that back in 1994 when Richardson pledged to “clear up that mess” he said: “I hope perhaps out of the social justice package we’ve promised for Mabo, there will be scope to address some of these wrongs.”

The Keating government’s response to the High Court’s Mabo decision had three elements: the Native Title Act, the land fund — out of which grew the (now) Indigenous Land and Sea Corporation — and a social justice package.

Robert Tickner, Keating’s Aboriginal and Torres Strait Islander affairs minister, told the 12th session of the UN Working Group on Indigenous Populations in 1994: “The social justice package presents Australia with what is likely to be the last chance this decade to put a policy framework in place to effectively address the human rights of Aboriginal and Torres Strait Islander people as a necessary commitment to the reconciliation process leading to the centenary of Federation in 2001.”

Hollow words. The justice package was doomed: the Keating government did not press its pro­gress and passed to the Aboriginal and Torres Strait Islander Commission the job of consulting with First Nations about what it should embrace.

Keating’s successor, John Howard, rejected ATSIC’s visionary report in 1996 and went off on his own “practical reconciliation” frolic. ATSIC itself was dispatched by Howard a few years later, but it’s worth restating a few words from the ATSIC report on the social justice package because they continue to resonate: “Indigenous people have been too often betrayed over the last two centuries by fine words that have soon withered in the grim drought of inaction and indifference.”

Indigenous people living in remote communities are still betrayed. The truth of this nationally is seen in the government’s “duck, dive” approach to entrenching a voice in the Constitution.

On the first day of parliament sittings next year, the Prime Minister will present the annual Closing the Gap report, an index of the disadvantage experienced by First Nations people. It will be another recitation of government failures to improve their lives — lives that in remote communities end many years shorter than elsewhere.

Not only do they die younger, their existence also is miserable. It’s not just a matter of poor service delivery, it’s that their lives are not their own. Governments, unwilling to trust First Nations people to take charge of their own lives, continue to intrude and manage.

Remote communities, especially those in the desert region straddling the Territory,WA and South Australia, have the foundations of their customary law, kinship relationships and knowledge of country pretty much underpinning their continuing survival. It is the world of art, sport and ceremonial obligations that makes their world partly tolerable.

But, as long as we view these places through the prism of reform­ing public sector outlays, we will continue to contribute to their demise. They must have a real say in their destiny, and governments have a duty to reorder ideological and biased views about their futures.

In the Territory, the federal government wants to foist its cashless debit card on 23,000 people deemed to be “beneficiaries”, who are already subject to income management (a hangover from the intervention). There is no choice being offered here and the policy will impact severely on First Nations people living remotely.

As the Central Land Council has pointed out, the transfer to the CDC will require people to have an email address, access to mobile phone coverage and a smartphone, the skills to navigate online card activation, and access to the internet. But access to the National Broadband Network is limited in remote communities, home computers are rare, and most internet access through mobile phones is intermittent and unreliable. CDC holders will need to receive an activation number by post, but the post in remote communities is slow or non-existent.

The federal government’s plan to introduce the CDC is yet another example of top-down policy, and recipients in remote communities have not been consulted.

So much for the government’s mantra it wants to do things with First Nations people, not to them.

How will this card help build the capacity of people in these remote communities? How will it help them manage their lives?

We need new frameworks that enable people in remote communities to determine their destiny, and for governments to treat them as sovereign peoples.

These remote communities must be helped to lift themselves out of “institutionalised ghetto status”. Relief is beyond the capacity of states and territories. The federal government has the remit to avert disaster — after all, what was the 1967 referendum all about?

It will require a Marshall Plan to correct the decades of neglect.

However, until we grasp that sort of commitment and empower remote Aboriginal communities, the lives of their residents will be further accursed.

Part 2

Aboriginal youth leaders in Western Australia’s far north have made sweeping recommendations to curb the chronic rates of suicide among their peers.

PHOTO: The Empowered Youth Leader delegates have proposed a set of recommendations. (Supplied: WA Primary Health Alliance)

Key points:

  • Suicide remains the leading cause of death for Aboriginal and Torres Strait Islander children
  • The Empowered Young Leaders’ report calls for more education for young people around social and emotional wellbeing
  • It also recommends increased efforts to embed Indigenous culture in schools, and a permanent forum for young people to voice concerns

From Here

The Empowered Young Leaders’ report, released last week, calls for more education for young people around social and emotional wellbeing and increased efforts to embed Indigenous culture in schools.

They also want a permanent forum for young people to voice their concerns.

It comes as the State Government considers a formal response to the WA coroner’s inquest into the suicides of 13 Indigenous young people in the remote region.

Too many lost’

In an impassioned statement, the delegates put policy makers on notice, saying they would no longer accept the “normalisation of suicide”.

“We have lost too many loved ones to suicide,” the statement read.

“Through our own lived experience, we bear witness to the heavy burden our families and communities endure in grappling with the never-ending cycle of grief and loss.

“We no longer choose to be disempowered by the issues that continue to impact on us as a result of intergenerational trauma. The lives of our children and grandchildren are in our hands.”

Jacob Smith, 23, has been working in suicide prevention for two years.

As a member of the Empowered Young Leaders, he spent 12 months working intensely with 10 youth delegates across the Kimberley.

He said the recommendations were the starting point for creating generational change.

“There’s endless possibilities, there’s a lot more focus now on young people stepping up and getting involved,” he said.

“Our hope is to amplify our voice and be at the forefront of these conversations with our leaders.

“If we can better consult with our youth they will be way more inclined to engage in these conversations and initiatives.”

Efforts to meaningfully reduce the amount of Aboriginal youth taking their lives have largely failed, despite dozens of reports, inquests and millions of dollars in funding.

It remains the leading cause of death for Aboriginal and Torres Strait Islander children.

In the Kimberley, the rate of youth suicide is among the highest in the world.

In the aftermath of coroner Ros Fogliani’s 2017 inquest into 13 suicides, young people had been given a bigger role in helping governments at both levels forge a solution.

Mr Smith said the top priority was to ensure youth were permanently involved in the design and delivery of policy.

He said this would be achieved by establishing local Aboriginal youth action committees in each town.

“We need to invest and build the skills of our young people … to build a real peer-to-peer network in the Kimberley,” he said.

“There’s a few of us young people working in this space but we don’t feel like we have a strong network.

“There’s no real structure around that at the moment.”

Calls for better education and resources

Education was another key area in which the group wanted improvement.

They called for more social and emotional wellbeing training for young local people so they could support their peers with mental health difficulties.

There was also a push to better involve youth in developing targeted programs.

Delegates raised concerns about the lack of after-hours services, and proposed to establish 24-hour safe houses and a youth-focused rehabilitation centre.

“Delegates expressed frustration at the lack of local training and employment opportunities for Aboriginal people in the youth services sector,” the report stated.

They also identified the poor “cultural and community connection” between mainstream services and local Aboriginal families.

Government to respond to coroner’s inquest

The report is being considered by the WA Government.

Minister for Aboriginal Affairs Ben Wyatt said the recommendations were valued and would be treated with respect.

“The report will have an important role to play in the Government’s understanding of the perspective of young Aboriginal people in the region,” he said.

Mr Wyatt also outlined the McGowan Labor Government’s efforts to improve education and skills training.

“In 2019, there were 60 WA public schools teaching one or more of 21 Aboriginal languages to 5,611 students,” the Minister said.

“WA public schools are increasingly teaching children local Aboriginal languages, benefiting students and helping to keep the languages alive in our communities.

“The Aboriginal Cultural Standards Framework supports all Department of Education staff to reflect on their approaches to the education of Aboriginal students.”

Mr Wyatt pointed to a “range of regional partnerships” that ensured Aboriginal people received adequate skills training.

“A great success story is one of North Regional TAFE’s alumni, Soleil White, who was named the WA Aboriginal and Torres Strait Islander Student of the Year at the 2018 WA Training Awards.”

The State Government is expected to hand down its formal response to the coroner’s inquest in the coming weeks.

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NACCHO Aboriginal Health and #Remote Communities : #WA Minister @benwyatt It is time we have a genuine dialogue about securing the ­future of remote communities and work towards establishing a long-term partnership between Aboriginal communities and state and commonwealth governments

“ The commonwealth has shown it has no interest in sustaining remote communities in Western Australia. In recent years the commonwealth has transferred its long-held responsibilities for housing and essential and municipal services to the state. And its legal responsibility to administer social security payments for people living in remote communities is operated punitively through the CDP and cashless debit card scheme.

Promoters of this approach say it is the most effective way to address passive welfare and to protect children and women in communities — and, to a certain extent, I am attracted to this rationale. Removing the never-ending humbugging between generations is a worthy aim, but removing cash from a vast landmass with no supporting technology is not working.

It is time we have a genuine dialogue about securing the ­future of remote communities and work towards establishing a long-term partnership between Aboriginal communities and state and commonwealth governments.

That partnership should incorporate strategies that break the institutionalised ghetto status of these communities and also understand how communities interact with each other. It should also involve best-practice governance models and vastly improved service delivery.

 To me Ngaanyatjarra would be an ideal trial site for such an approach.”

Opinion article in The Australian from Ben Wyatt the West Australian Minister for Aboriginal Affairs

Last week I drove from Perth to Warburton and Warakurna, two of the most remote communities on Earth.

Arriving at Warburton, population about 500 people, I visited the community’s administration office and became instantly immersed in the madness people there were dealing with.

A single mother was desperately contacting a distant call centre hoping to have her bank account reactivated after keying the wrong pass code given to her.

Unable to produce the required evidence to identify herself she was told to travel a thousand kilometres to Alice Springs to front in person.

She was desperate and broken.

Another woman with children to feed sought emergency relief after her income was suspended by Centrelink for breaching her work-for-the-dole conditions un­der the Community Development Program. At the counter a range of community people queued, demanding that overwhelmed staff help them navigate a social security ­income and banking system that to anyone appears impossibly complex.

This happens regularly, I was told repeatedly, where people have their income cancelled if they fail to report to Centrelink fortnightly on any changes to their living circumstances, miss a monthly report to Jobactive, which runs the CDP scheme, or do not comply with the requirement to work 20 hours a week for the dole all year round.

Given that English is generally not Ngaanyatjarra people’s first language, lack of phone access and the real­ity that people move between communities for all sorts of cultural and social reasons, the numbers of people denied social security payments is, of course, growing.

Other people complained they could not access funds from their bank because they had been conscripted on to the commonwealth’s income management debit card scheme — usually while spending time in Kalgoorlie — without fully understanding the consequences.

The scheme, which quarantines 80 per cent of social security payments to a special bank card that can be used only at certain vendors and cannot be used to buy alcohol and gamble, is being rolled out in Kalgoorlie and the Goldfields as part of a national trial.

The grog-free Ngaanyatjarra lands are not part of the trial and Ngaanyatjarra people who have been ensnared in the scheme through their visits to Kalgoorlie and other Goldfields towns are joining the increasing number of destitute people who rely on their already impoverished families to survive.

A line of these cards is kept behind the office reception in an attempt by the community’s administration to, somehow, turn these cards, inoperable in the lands, into cash.

Clearly there has been significant problems in implementing the scheme, with its Canberra-based designers having no idea how the Goldfields and Ngaanyatjarra Lands operate as an integrated region.

  • Large red dot: 500 people or more
  • Medium red dot: 200 to 499
  • Small red dot: 50 to 199
  • Smaller back dot: less than 50 people

Visiting these communities I was struck by an overwhelming sense that people are disempowered and punished by a digital world of faceless and distant ­bureaucratic controllers.

Centrelink no longer posts cheques, and financial transfers to personalised bank accounts assume people have access to computers and banks. There are no banks in ­remote communities.

This, combined with declining finances coming into the lands through increased payment cancellations as punishment and the increasing conscriptions on to the cashless card scheme has meant the Warburton community council has had to establish its own quasi banking system through recirculating money from the community store.

This situation is unsustainable. There is already a crisis of ­financial security in Warburton and other Ngaanyatjarra communities.

I sense the next phase of this crisis is community implosion resulting in a major population relocation to towns such as Kalgoorlie and Laverton if policies aimed at supporting remote communities don’t change; a ­dynamic that would be replicated throughout remote Australia.

 

Aboriginal #Rural and #Remote Health #ClosingTheGap #HaveYourSayCTG : New @AIHW Report says the mob living in remote and regional areas are dying preventable deaths from treatable conditions because of a lack of access to health services

 “Australians living in remote and regional areas are dying preventable deaths from treatable conditions because of a lack of access to health services.

The damning assessment is contained in a new Australian Institut­e of Health and Welfare report on rural and remote health, which finds that those in the bush rely heavily on general practitioners to provide primary healthcare services in the absence of specialist doctors.

But patients most in need of GPs often can’t access them, with those in remote areas six times as likely as those in metropolitan centres to report they had no access­ to one.”

From Natasha Robinson The Australian October 24 Continued Part 1 below

Aboriginal and Torres Strait Islander people are more likely to have higher rates of chronic conditions, hospitalisations and poorer health outcomes than non-Indigenous Australians

The differences in health outcomes in Remote and Very remote areas may be due to the characteristics of these populations.

The proportion of the population that is Indigenous, is much higher in more remote areas

However, more Indigenous Australians live in Major cities and Inner regional areas (61% of Indigenous Australians) compared with Remote and Very remote areas (19%) “

From the AIHW Report see Part 2 Below

Download full report HERE

Rural & remote health

Part 1 The Australian media report 

The report comes as The Australian revealed yesterday that the numbers of domestically trained doctors entering GP training had fallen for the third year in a row, with rural areas relying heavily on overseas-trained doctors to fill the workforce shortfall.

The AIHW report finds people in remote areas die five years before­ their city counterparts, with a life expectancy of 76 years.

More than 70 per cent of those living in regional areas are overweight or obese, less than one in 10 eat the recommended number of serves of vegetables per day, and one-quarter have high blood pressure or mental health problems.

Rural Australians are dying of diabetes at much higher rates than city dwellers, and many cancers­ go undetected because of a lack of acces­s to screening programs.

“The rate of potentially avoidable deaths increased as remote­ness increased,” the report says. “These are deaths among people aged 75 and under from conditions considered potentially preventable through individualised care, and/or treatment through existing primary or hospital care.”

The Australian College of Rural and Remote Medicine said the situation was a “tragedy”.

“We have a rural health crisis that extends right across from our Aboriginal and Torres Strait Island­er people to our rural communities,” said college president Ewen McPhee.

“I think it’s a tragedy that rural communities continue to be neglec­ted.”

In many tiny towns across the country, residents rely on the Royal Flying Doctor Service to provide access to a GP.

Yesterday in Stonehenge in remote­ central Queensland, doctor­ Arthur Beggs and nurse Jo Mahony­ flew in to provide the fortnightly mobile GP service for the town and surrounding areas of about 50 people.

“A lot of people don’t want to bother us unless they are really unwell and that’s really typical of the stoic, outback approach,” Dr Beggs said.

The RFDS has introduced a chronic disease management plan to the town, tracking baseline health measurements and flying specialist allied health practitioners in every few weeks to provide extra services.

Dr Beggs knows the challenges of being a rural GP, but says the difficulties are outweighed by the satisfaction of the work.

“I find rural and remote medicine fascinating and much more fulfilling than I do city-based medicine,” he said.

A recent report published by the Medical Deans of Australia found only 15 per cent of medical students in their final year of study said they were interested in becomin­g GPs, the lowest figure in five years.

Dr Beggs said attracting GPs to rural and remote areas was key to improving health outcomes in the bush.

“Modern medicine is all about specialties,” he said.

“The specialties can seem a more lucrative and controlled environm­ent than the realms of general practice, which is unfortun­ate because general practice­ gives you a much better overview of people and their health.”

Part 2

Profile of rural and remote Australians

See AIHW Online version HERE

For more information on Aboriginal and Torres Strait Islander health by remoteness see: The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples: 2015 and the Aboriginal and Torres Strait Islander Health Performance Framework (HPF) report

Overall, more Australians live in Major cities compared with rural and remote areas

. In 2017, the proportion of Australians by area of remoteness was:

72% in Major cities

18% in Inner regional areas 8.2% in Outer regional areas 1.2% in Remote areas

0.8% in Very remote areas (ABS 2019b).

On average, people living in Remote and very remote areas were younger than those living in Major cities ( gures 1a and 1c).

Australians aged 25–44 were more likely to live in Remote and very remote areas and Major cities compared with Inner regional and outer regional areas. However, a higher proportion of people aged 65 and over lived in Inner regional and outer regional areas and Major cities, compared with Remote and very remote areas ( gures 1a, 1b and 1c).

Rural and remote Australia encompasses many diverse locations and communities and people living in these areas face unique challenges due to their geographic isolation.

Those living outside metropolitan areas often have poorer health outcomes compared with those living in metropolitan areas. For example, data show that people living in rural and remote areas have higher rates of hospitalisations, mortality, injury and poorer access to, and use of, primary health care services, compared with those living in metropolitan areas.

Health inequalities in rural and remote areas may be due to factors, including:

  • challenges in accessing health care or health professionals, such as specialists social determinants such as income, education and employment opportunities higher rates of risky behaviours such as tobacco smoking and alcohol use
  • higher rates of occupational and physical risk, for example from farming or mining work and transport-related accidents.

Despite poorer health outcomes for some, the Household, Income and Labour Dynamics in Australia (HILDA) survey found that Australians living in small towns (fewer than 1,000 people) and non-urban areas generally experienced higher levels of life satisfaction compared with those in urban areas (Wilkins 2015).

Rural and remote Australians also report increased community interconnectedness and social cohesion, as well as higher levels of community participation, volunteering and informal support from their communities (Ziersch et al. 2009).

Part 3 National : Closing the Gap / Have your say CTG deadline extended to Friday, 8 November 2019.

 

The engagements are now in full swing across Australia and this is generating more interest than we had anticipated in our survey on Closing the Gap.

The Coalition of Peaks has had requests from a number of organisations across Australia seeking, some Coalition of Peak members and some governments for more time to promote and complete the survey.

We want to make sure everyone has the opportunity to have their say on what should be included in a new agreement on Closing the Gap so it is agreed to extend the deadline for the survey to Friday, 8 November 2019.

This will help build further understanding and support for the new agreement and will not impact our timeframes for negotiating with government as we were advised at the most recent Partnership Working Group meeting that COAG will not meet until early 2020.

There is a discussion booklet that has background information on Closing the Gap and sets out what will be talked about in the survey.

The survey will take a little bit of time to complete. It would be great if you can answer all the questions, but you can also just focus on the issues that you care about most.

To help you prepare your answers, you can look at a full copy here

The survey is open to everyone and can be accessed here:

https://www.naccho.org.au/programmes/coalition-of-peaks/have-your-say/

NACCHO Aboriginal Health @AIDAAustralia News : The @AMAPresident Dr Tony Bartone speech opening #AIDAConf2019 : We must use collective wisdom and advocacy to ensure that #ClosingtheGap is not just words, but a meaningful and deliverable target. #HaveYourSayCTG

 

 “ The basic principles of successful Indigenous healthcare models should be better promoted as exemplars and replicated across the country.

This will support Aboriginal and Torres Strait Islander people to translate their knowledge into innovative practices that will help solve intractable health problems in their communities.

Governments at all levels must ensure that policy frameworks move towards harmonisation with norms recognising the autonomy of Aboriginal and Torres Strait Islander people.

Governments must ensure that these frameworks are bolstered with adequate funding and workforce strategies to enable Indigenous communities to succeed in their pursuit of the right to health and wellbeing.

With the right support, Aboriginal and Torres Strait Islander people stand to address health inequities by transforming services under their purview, as well as health services provided to Indigenous people by the mainstream.

As President of the AMA, I will continue to ensure that Aboriginal and Torres Strait Islander health is a key priority.”

President of the AMA Dr Tony Bartone opening speech

Photo above : Opening of #AIDAConf2019 a Welcome to Country from Larrakia Dr Jessica King. MC Jeff McMullen, keynotes  AIDA President Dr Kris Rallah-Baker, NLC CEO Marion Scrymgour, Danila Dilba ACCHO Olga Havnen, Dr Tony Bartone

I would like to begin by acknowledging the traditional owners and custodians of the land on which we meet today, and I pay my respects to their elders, past and present.

Thank you to the Australian Indigenous Doctors’ Association (AIDA) for inviting me to speak at your annual conference. This is my third year attending, and I feel very privileged to be here.

The theme for this year’s Conference is ‘Disruptive Innovations in Health Care’.

As a General Practitioner who has been practising medicine for over 30 years, I well and truly understand that innovative health care is needed to achieve improved outcomes for patients.

Indeed, innovation will be crucial as we deal with a health system that is so under strain.

This is especially true for Indigenous health, given the much higher burden of disease and mortality rates among Aboriginal and Torres Strait Islander people, and the need for care to be delivered in a manner that is culturally safe.

We all know that Indigenous health statistics paint a bleak picture.

And we all know that Aboriginal and Torres Strait Islander people have poorer health than other Australians.

Medical science is constantly evolving and we have, only in recent times, recognised the innovations and practices of Indigenous people here and overseas.

There are some parallels and similarities in the way Australia and Canada – both former British colonies – are trying to improve health care for First Nations peoples.

In both countries, we are trying to address a legacy of harm from the imposition of policies that resulted in poor health today.

Sadly, investments in Indigenous health are often inadequate, and they are implemented without proper engagement with, and direction by, Aboriginal and Torres Strait Islander people.

We all know that this approach does not work.

However, I know that there are many innovative health services that are delivering high quality health care for their communities, driven by local leadership.

There are models of health care that are delivering proved health outcomes for Aboriginal and Torres Strait Islander people, and these should be supported in terms of funding and workforce.

I was fortunate to visit one such model last year and see first-hand just one example of quality health services and witness the important work that they do.

There are others all underpinned by community oversight and direction. This sense of community leadership is a key feature.

I am sure you will hear of many more positive and innovative healthcare models throughout this Conference.

The problem with such models is that they are not being sufficiently resourced and funded to continue and further their development.

The basic principles of successful Indigenous healthcare models should be better promoted as exemplars and replicated across the country.

This will support Aboriginal and Torres Strait Islander people to translate their knowledge into innovative practices that will help solve intractable health problems in their communities.

Governments at all levels must ensure that policy frameworks move towards harmonisation with norms recognising the autonomy of Aboriginal and Torres Strait Islander people.

Governments must ensure that these frameworks are bolstered with adequate funding and workforce strategies to enable Indigenous communities to succeed in their pursuit of the right to health and wellbeing.

With the right support, Aboriginal and Torres Strait Islander people stand to address health inequities by transforming services under their purview, as well as health services provided to Indigenous people by the mainstream.

As President of the AMA, I will continue to ensure that Aboriginal and Torres Strait Islander health is a key priority.

I am very proud to lead an organisation that champions Aboriginal and Torres Strait health care.

This is demonstrated through:

  • the AMA’s Taskforce on Indigenous Health, which I am honoured to Chair;
  • having AIDA represented on the AMA’s Federal Council;
  • producing an annual Report Card on Indigenous Health;
  • supporting more Aboriginal and Torres Strait Islander people to become doctors through our Indigenous Medical Scholarship initiative;
  • participation in the Close the Gap Steering Committee; and
  • participation in the END Rheumatic Heart Disease Coalition, among many other things.

 See all NACCHO and AMA Articles HERE 

The AMA also supports the Uluru Statement from the Heart, and is encouraging the Australian Parliament to make this a national priority.

I firmly believe that giving Aboriginal and Torres Strait Islander people a say in the decisions that affect their lives will allow for healing through recognition of past and current injustices.

The AMA believes respecting the decisions and directions of Aboriginal and Torres Strait Islander people should underpin all Government endeavours to close the health and life expectancy gap.

The AMA is pleased to see the agreement between the Council of Australian Governments and a Coalition of Peak Aboriginal and Torres Strait Islander organisations – an historic partnership to oversee the refresh of the Closing the Gap strategy.

See Coalition of Peaks Press Release this week

But this is not enough.

We must use this collective wisdom and advocacy to ensure that Closing the Gap is not just words, but a meaningful and deliverable target.

This is certainly an innovative approach to improving health and life outcomes for Indigenous Australians.

Since the beginning of the Closing the Gap strategy, progress has been mixed, limited, and, overall, disappointing.

This must change. It has to change.

It is simply unacceptable that year in, year out, we see the same gaps and the same shortfalls in funding and resources.

I hope that the partnership between COAG and the Coalition of Peaks will result in some real, meaningful change. It must.

Governments cannot keep promising to improve health and other services and not deliver on their commitments.

The AMA welcomed the stated intent of the Minister for Indigenous Australians, Ken Wyatt, to hold a referendum on Constitutional recognition for Indigenous peoples.

And I was disappointed by his recent announcement that an Indigenous voice to Parliament enshrined in the Constitution would not be included as part of this process.

Ken Wyatt has achieved a tremendous amount in his time as Minister, and I hope that Constitutional recognition is part of his legacy.

Let me conclude by saying that it is our responsibility as doctors to ensure that Aboriginal and Torres Strait Islander people can enjoy the same level of good health as their non-Indigenous peers – that they are able to live their lives to the fullest.

The AMA recognises that Indigenous doctors are critical to making real change in Indigenous health, as they have the unique ability to align their clinical and cultural expertise to improve access to services and provide culturally safe care.

The Indigenous medical workforce is steadily growing, but we need more Indigenous doctors. And dentists, nurses, social workers, and all other allied health specialists.

The AMA remains committed to working in partnership with Aboriginal and Torres Strait Islander people to advocate for better Government investment and cohesive, coordinated strategies to improve health outcomes.

Thank you, and I wish you the very best for your Conference.

 Part 2  Have your say about what is needed to make real change in the lives of Aboriginal and Torres Strait Islander people #HaveYourSay about #closingthegap

There is a discussion booklet that has background information on Closing the Gap and sets out what will be talked about in the survey.

The survey will take a little bit of time to complete. It would be great if you can answer all the questions, but you can also just focus on the issues that you care about most.

To help you prepare your answers, you can look at a full copy here

The survey is open to everyone and can be accessed here:

https://www.naccho.org.au/programmes/coalition-of-peaks/have-your-say/

NACCHO Aboriginal Health #ClosingTheGap #NAIDOC2019 : @AIHW Key results report 2017-18 Aboriginal and Torres Strait Islander health organisations:

Findings from this report:

  • Just under half (45%) of organisations provide services in Remote or Very remote areas

  • In 2017–18, around 483,000 clients received 3.6 million episodes of care

  • Nearly 8,000 full-time equivalent staff are employed in these organisations and 4,695 (59%) are health staff

  • Organisations reported 445 vacant positions in June 2018 with health vacancies representing 366 (82%) of these
  • In 2017–18, nearly 200 organisations provided a range of primary health services to around 483,000 clients, 81% of whom were Indigenous.
  • Around 3.6 million episodes of care were provided, nearly 3.1 million of these (85%) by Aboriginal Community Controlled Health Services.

See AIHW detailed Interactive site locations map HERE

In 2017–18, Indigenous primary health services were delivered from 383 sites (Table 3). Most sites provided clinical services such as the diagnosis and treatment of chronic illnesses (88%), mental health and counselling services (88%), maternal and child health care (86%), and antenatal care (78%). Around two-thirds provided tobacco programs (69%) and substance-use and drug and alcohol programs (66%).

Most organisations provided access to a doctor (86%) and just over half (54%) delivered a wide range of services, including all of the following during usual opening hours: the diagnosis and treatment of illness and disease; antenatal care; maternal and child health care; social and emotional wellbeing/counselling services; substance use programs; and on‑site or off-site access to specialist, allied health and dental care services.

Most organisations (95%) also provided group activities as part of their health promotion and prevention work. For example, in 2017–18, these organisations provided around:

  • 8,400 physical activity/healthy weight sessions
  • 3,700 living skills sessions
  • 4,600 chronic disease client support sessions
  • 4,100 tobacco-use treatment and prevention sessions.

In addition to the services they provide, organisations were asked to report on service gaps and challenges they faced and could list up to 5 of each from predefined lists. In 2017–18, around two-thirds of organisations (68%) reported mental health/social and emotional health and wellbeing services as a gap faced by the community they served.

This was followed by youth services (54%). Over two-thirds of organisations (71%) reported the recruitment, training and support of Aboriginal and Torres Strait Islander staff as a challenge in delivering quality health services.

Read full report and all data HERE

This is the tenth national report on organisations funded by the Australian Government to provide health services to Aboriginal and Torres Strait Islander people.

Indigenous primary health services

Primary health services play a critical role in helping to improve health outcomes for Aboriginal and Torres Strait Islander people. Indigenous Australians may access mainstream or Indigenous primary health services funded by the Australian and state and territory governments.

Information on organisations funded by the Australian Government under its Indigenous Australians’ health programme (IAHP) is available through two data collections: the Online Services Report (OSR) and the national Key Performance Indicators (nKPIs). Most of the organisations funded under the IAHP contribute to both collections (Table 1).

The OSR collects information on the services organisations provide, client numbers, client contacts, episodes of care and staffing levels. Contextual information about each organisation is also collected. The nKPIs collect information on a set of process of care and health outcome indicators for Indigenous Australians.

There are 24 indicators that focus on maternal and child health, preventative health and chronic disease management. Information from the nKPI and OSR collections help monitor progress against the Council of Australian Governments (COAG) Closing the Gap targets, and supports the national health goals set out in the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.

Detailed information on the policy context and background to these collections are available in previous national reports, including the Aboriginal and Torres Strait Islander health organisations: Online Services Report—key results 2016–17 and National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: results for 2017.

At a glance

This tenth national OSR report presents information on organisations funded by the Australian Government to provide primary health services to Aboriginal and Torres Strait Islander people. It includes a profile of these organisations and information on the services they provide, client numbers, client contacts, episodes of care and staffing levels. Interactive data visualisations using OSR data for 5 reporting periods, from 2013–14 to 2017–18, are presented for the first time.

Key messages

  1. A wide range of primary health services are provided to Aboriginal and Torres Strait Islander people. In 2017–18:
  • 198 organisations provided primary health services to around 483,000 clients, most of whom were Aboriginal and Torres Strait Islander (81%).
  • These organisations provided around 3.6 million episodes of care, with nearly 3.1 million (85%) delivered by Aboriginal Community Controlled Health Services (ACCHSs).
  • More than two-thirds of organisations (71%) were ACCHSs. The rest included government-run organisations and other non-government-run organisations.
  • Nearly half of organisations (45%) provided services in Remoteand Very remote
  • Services were delivered from 383 sites across Australia. Most sites provided the diagnosis and treatment of chronic illnesses (88%), social and emotional wellbeing services (88%), maternal and child health care (86%), and antenatal care (78%). Around two-thirds provided tobacco programs (69%) and substance-use and drug and alcohol programs (66%).

See this AIHW detailed Interactive site locations map HERE

  1. Organisations made on average nearly 13 contacts per client

In 2017–18, organisations providing Indigenous primary health services made around 6.1 million client contacts, an average of nearly 13 contacts per client (Table 2). Over half of all client contacts (58%) were made by nurses and midwives (1.8 million contacts) and doctors (1.7 million contacts). Contacts by nurses and midwives represented half (49%) of all client contacts in Very remote areas compared with 29% overall.

  1. Organisations employed nearly 8,000 full-time equivalent (FTE) staff

At 30 June 2018, organisations providing Indigenous primary health services employed nearly 8,000 FTE staff and over half of these (54%) were Aboriginal or Torres Strait Islander. These organisations were assisted by around 270 visiting staff not paid for by the organisations themselves, making a total workforce of around 8,200 FTE staff.

Nurses and midwives were the most common type of health worker (14% 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 (22%).

  1. Social and emotional health and wellbeing services are the most commonly reported service gap

Organisations can report up to 5 service gaps faced by the community they serve from a predefined list of gaps. Since this question was introduced in 2012–13, the most commonly reported gap has been for mental health and social and emotional health and wellbeing services. In 2017–18, this was reported as a gap by 68% of organisations.

 

NACCHO Aboriginal Health #Prevention2019 News Alert : Downloads @AIHW releases Burden of Disease study and an overview of health spending that provides an understanding of the impact of diseases in terms of spending through our health system.

 ” This report analyses the impact of more than 200 diseases and injuries in terms of living with illness (non-fatal burden) and premature death (fatal burden).

The study found that: chronic diseases such as cancer, cardiovascular diseases, and musculoskeletal conditions contributed the most burden in Australia in 2015 and 38% of the burden could have been prevented by removing exposure to risk factors such as tobacco use, overweight and obesity, and dietary risks.

The overall health of the Australian population improved substantially between 2003 and 2015 and further gains could be achieved by reducing lifestyle-related risk factors, according to a new report by the Australian Institute of Health and Welfare (AIHW). ‘

Download aihw-bod-22

The Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2015, measures the number of years living with an illness or injury (the non-fatal burden) or lost through dying prematurely (the fatal burden).

In 2015, Australians collectively lost 4.8 million years of healthy life due to living with or dying prematurely from disease and injury,’ said AIHW spokesperson Mr Richard Juckes.

The disease groups causing the most burden in 2015 were cancer, cardiovascular diseases, musculoskeletal conditions, mental and substance use disorders and injuries.

After accounting for the increase in size and ageing of the population, there was an 11% decrease in the rate of burden between 2003 and 2015.’

Most of the improvement in the total burden resulted from reductions in premature deaths from illnesses and injuries such as cardiovascular diseases, cancer and infant and congenital conditions.

‘Thirty eight per cent of the total burden of disease experienced by Australians in 2015 could have been prevented by reducing exposure to the risk factors included in this study,’ Mr Juckes said.

‘The 5 risk factors that caused the most total burden in 2015 were tobacco use (9.3%), overweight & obesity (8.4%), dietary risks (7.3%), high blood pressure (5.8%) and high blood plasma glucose—including diabetes (4.7%).’

For the first time, living with illness or injury caused more total disease burden than premature death. In 2015, the non-fatal share was 50.4% and the fatal share was 49.6% of the burden of disease.

Also released today is an overview of health spending that provides an understanding of the impact of diseases in terms of spending through the health system.

The data in Disease expenditure in Australia relates to the 2015–16 financial year only and suggests the highest expenditure groups were musculoskeletal conditions (10.7%), cardiovascular diseases (8.9%) injuries (7.6%) and mental and substance use disorders (7.6%).

‘Together the burden of disease and spending estimates can be used to understand the impact of diseases on the Australian community. However they can’t necessarily be compared with each other, as there are many reasons why they wouldn’t be expected to align,’ Mr Juckes said.

‘For example, spending on reproductive and maternal health is relatively high but it is not associated with substantial disease burden because the result is healthy mothers and babies more often than not.

‘Similarly, vaccine-preventable diseases cause very little burden in Australia due to national investment in immunisation programs.’

Reports

Table of contents

  • Summary
  • 1 Introduction
    • What is burden of disease?
    • How can burden of disease studies be used?
    • What can’t burden of disease studies tell us?
    • How is burden of disease measured?
    • What is the history of burden of disease analysis?
    • What’s new in the Australian Burden of Disease Study 2015 and this report?
  • 2 Total burden of disease
    • What is the total burden of disease in Australia?
    • How does total burden vary across the life course?
    • Which disease groups cause the most burden?
    • Which diseases cause the most burden?
    • How does disease burden change across the life course?
  • 3 Non-fatal burden of disease
    • What is the overall non-fatal burden in Australia?
    • How does living with illness vary across the life course?
    • Which disease groups cause the most non-fatal burden?
    • Which diseases cause the most non-fatal burden?
    • How does non-fatal disease burden change across the life course?
  • 4 Fatal burden of disease
    • What is the overall fatal burden in Australia?
    • How does years of life lost vary at different ages?
    • Which disease groups cause the most fatal burden?
    • Which diseases cause the most fatal burden?
    • How does fatal disease burden change across the life course?
  • 5 Health-adjusted life expectancy
    • HALE as a measure of population health
    • On average, almost 90% of years lived are in full health
    • Years of life gained are healthy years
    • HALE is unequal across states and territories
    • HALE varies by remoteness of area lived
    • HALE is unequal between socioeconomic groups
  • 6 Contribution of risk factors to burden
    • How are risk factors selected?
    • What is the contribution of all risk factors combined?
    • Which risk factors contribute the most burden?
    • How do risk factors change through the life course?
  • 7 Changes over time
    • How should changes between time points be interpreted?
    • How has total burden changed over time?
    • How have the non-fatal and fatal burden changed over time?
    • How have risk factors changed over time?

  • 8 Variation across geographic areas and population groups
    • Burden of disease by state and territory
    • Burden of disease by remoteness areas
    • Burden of disease by socioeconomic group
  • 9 International context and comparisons
    • What is the international context of burden of disease studies?
    • Can the ABDS 2015 be compared with international studies?
    • How does Australian burden compare internationally?
  • 10 Study developments and limitations
    • What are the underlying principles of the ABDS?
    • What stayed the same between Australian studies?
    • What changes were made in the ABDS 2015?
    • What are the data gaps?
    • What are the methodological limitations?
    • What opportunities are there for further analysis?
  • Appendix A: Methods summary
    • 1 Disease and injury (condition) list
    • 2 Fatal burden
    • 3 Non-fatal burden
    • 4 Total burden of disease
    • 5 Health-adjusted life expectancy
    • 6 Risk factors
    • 7 Overarching methods/choices
  • Appendix B: How reliable are the estimates?
    • ABDS 2015 quality index
  • Appendix C: Understanding and using burden of disease estimates
    • Different types of estimates presented in this report
    • Interpreting estimates
    • What can estimates from 2015 tell us about 2019?
  • Appendix D: Additional tables and figures
  • Appendix E: List of expert advisors
  • Acknowledgments
  • Abbreviations
  • Symbols
  • Glossary
  • References
  • List of tables
  • List of figures
  • Related publications

NACCHO Aboriginal Health #AusVotesHealth #VoteACCHO : @RenBlackman CEO @GidgeeHealing #ACCHO Mt Isa : Highlights Inequality and climate change: the perfect storm threatening the health of our #Remote communities

 

“ Aboriginal Community Controlled Health Services have a long history of working holistically and innovatively to address the wider determinants of health, and Gidgee Healing incorporates legal services, knowing that legal concerns “cause a lot of worry for families”

However, many of the levers for addressing the determinants of health lie outside of the health sector’s control.

 What would help Gidgee Healing clients includes increases to Newstart and other social security payments, with a loading for remoteness.

We would also like to see better access to education and training for remote communities, many of which do not have high schools.

As well, Blackman would like a “whole of government” approach to addressing the social determinants of health, as was recommended in 2008 by the World Health Organisation commission on social determinants of health.

My job is challenging enough at the best of times. But climate change and extreme weather events, such as recent flooding that cut road access to many remote communities for several weeks, are making it ever-more difficult “

Renee Blackman runs Gidgee Health ACCHO health service covering a vast chunk of north-west Queensland – about 640,000 sq km, an area larger than Spain – that provides services to about 7,000 Aboriginal people in communities from Mount Isa to the Gulf.

Reporting in this series is supported by VivCourt through the Guardian Civic Journalism Trust

Written by Melissa Sweet for The Guardian

While the cultures and circumstances of these communities are diverse, Blackman says they share a common health threat: that the harmful impacts of poverty are magnified in remote locations.

Blackman, a Gubbi Gubbi woman and CEO of an Aboriginal community-controlled health service Gidgee Healing, sees poverty contributing to poor health in remote communities in many ways.

People cannot afford healthy foods, to access or maintain housing, to buy vital medications, or to travel to regional centres such as Cairns or Townsville for surgery that would help them or their children, she says.

But mostly, she says, poverty means people have more pressing priorities than whether their diabetes is being well controlled.

“None of that matters if the priority is to put food on the table first, or a roof over the table,” she says. “Worrying about medication or a specialist appointment or an allied health wraparound service isn’t a priority.”

Blackman says she gets really frustrated when health groups put out simplistic messages for people to eat more fresh fruit and vegetables. It reminds her that so much health debate is far removed from the realities of people living in poverty.

Renee Blackman interviewed by NACCHO TV in 2016

Likewise, there is also a disconnect between much of the mainstream debate about health, which tends to focus on funding of medical services and hospitals, and the evidence about what matters most for people’s health.

The Western Australian government’s recent Sustainable Health Review cites US research suggesting that only 16% of a person’s overall health and wellbeing relates to clinical care and the biggest gains, especially for those at greatest risk of poor health, come from action on the social determinants of health. These are “the conditions in which people are born, grow, live, work and age”, and are shaped by the distribution of money, power and resources.

In the case of Gidgee Healing’s clients, the determinants of health include the ongoing legacy of colonisation, such as poverty and racism, as well as protective factors such as connection to culture and country.

Tackling the social determinants of health is critical to address health inequities, which arise because people with the least social and economic power tend to have the worst health, live in unhealthier environments and have worse access to healthcare.

A study cited in the last two editions of Australia’s Health (in 2016 and 2018) estimates that if action were taken on the social determinants to close the health gap between the most and least disadvantaged Australians, half a million people could be spared chronic illness, $2.3bn in annual hospital costs saved and pharmaceutical benefits scheme prescriptions cut by 5.3 million.

In the absence of such action, she says Aboriginal Community Controlled Health Services have to work hard and be creative in the face of government silos in their efforts to provide holistic services.

Blackman’s job is challenging enough at the best of times. But climate change and extreme weather events, such as recent flooding that cut road access to many remote communities for several weeks, are making it ever-more difficult.

“You have got these massive weather events sweeping through our communities, decimating structures, infrastructure – which means health services,” she says. “If your health service is down, you can’t provide any type of healthcare; it’s almost like you are operating under war conditions sometimes, because things get totally obliterated and you have got to build back from scratch, yet you’ve got people who need your assistance.”

Blackman and many other health professionals are seeing the impact of a perfect storm threatening the health of some of Australia’s most disadvantaged communities. Climate change is exacerbating the social and economic inequalities that already contribute to profound health inequities.

Blackman describes elderly Aboriginal people with multiple health problems stuck in inadequate housing without air-conditioning during increasingly frequent extreme heatwaves. Sometimes it is so hot, she says, the bitumen melts, making it difficult for her health teams to reach communities in times of high need.

As well, patients are presenting to Gidgee Healing clinics with conditions such as dehydration that might be preventable if they could afford their power bills and had appropriate housing.

The mental health impacts are also huge, Blackman says, mentioning the deaths of hundreds of thousands of livestock during the floods. “This is devastation, this is loss, this is grief, we are already facing a suicide crisis in the north-west across all of the community, including the Aboriginal community,” she says. “You’re talking about a region that already has depleted access to mental health professionals.”

Welcome to our special NACCHO #Election2019 #VoteACCHO resource page for Affiliates, ACCHO members, stakeholders and supporters. The health of Aboriginal and Torres Strait Islander peoples is not a partisan political issue and cannot be sidelined any longer.

NACCHO has developed a set of policy #Election2019 recommendations that if adopted, fully funded and implemented by the incoming Federal Government, will provide a pathway forward for improvements in our health outcomes.

We are calling on all political parties to include these recommendations in their election platforms and make a real commitment to improving the health of Aboriginal and Torres Strait Islander peoples and help us Close the Gap.

With your action and support of our #VoteACCHO campaign we can make the incoming Federal Government accountable.

More info HERE 

NACCHO Acting Chair, Donnella Mills

A multiplier effect

Hurricane Katrina is often held up as a textbook example of how climate change hits poor people hardest, and not only because the poorest areas in New Orleans were worst affected by flooding. Much of the planning and emergency response catered to the better off – those with cars and the means to safely evacuate and arrange alternative accommodation.

As Sharon Friel, professor of health equity at the Australian National University, outlines in a new book, Climate Change and the People’s Health, most of those who died because of Hurricane Katrina came from disadvantaged populations. These were also the groups that suffered most in the aftermath, as a result of damage to infrastructure and loss of livelihoods.

“It was also lower-income groups, and in particular children and the elderly, who were at increased risk of developing severe mental health symptoms compared with their peers in higher income groups,” Friel writes.

It is not only the direct and indirect impacts of climate change that worsen health inequities; policies to address climate change can have unintended consequences. Friel cites international evidence that the distribution of green spaces in cities to promote urban cooling and health tends to benefit mainly white and affluent communities.

Friel’s book outlines myriad ways in which climate change interacts with other social determinants of health to create a multiplier effect that deepens and compounds health inequities. Yet policymakers have been slow to respond, although such concerns were clearly identified more than a decade ago, in the landmark WHO report on the social determinants of health, which said it was important to bring together “the two agendas of health equity and climate change”.

While Friel says the relationships between climate change and health inequity are “messy and complex”, she argues that understanding there are common determinants of both problems provides an opportunity to “kill two birds with one stone”.

Friel calls for intersectoral action, with a focus on equality, environmental sustainability and health equity, to tackle the underlying “consumptagenic system” that drives both problems. This system is “a network of policies, processes and modes of understanding and governance that fuels unhealthy, inequitable and environmentally destructive production and consumption”.

An unfair burden

In Victoria, a large community health service provider called Cohealth has had processes in place for at least five years to work with at-risk groups during extreme weather events, in recognition of the need to address climate change as a health threat, especially for disadvantaged populations. During heatwaves, the service checks on homeless people, public housing residents and people with mental illnesses to ensure they can take steps to stay safe.

“The growing frustration of people in the health sector is, this work is eating into our budgets, it’s occupying the time of our staff – and yet there is little or no policy recognition of the way health resources are being taken to address these problems,” says Cohealth chief executive, Lyn Morgain.

She adds that local governments and service providers have been left to carry an unfair burden due to inaction on climate and health by governments, especially the federal government.

Morgain, who is also chair of the Social Determinants of Health Alliance and a board member of the Australian Council of Social Service, notes that Acoss has been championing the need to apply an equity lens to climate policy, to assess whether new policy proposals across a range of portfolios advantage or disadvantage low-income households.

Kellie Caught, senior advisor on climate and energy at Acoss, is calling for the next federal government to invest in vulnerability mapping to identify communities most at risk from climate change, in order to support development of local climate adaptation and resilience plans.

Governments also need to invest in building the resilience of community organisations such as those providing disability, aged care, meals on wheels and services for homeless people, to ensure they have the capacity to undertake disaster management and resilience planning, and continue operating through extreme weather events, she says.

Acoss is advocating for mandatory energy-efficiency standards for all rental properties, for state and federal governments to invest in upgrading energy efficiency and production in all social and community housing, and for a fund to help low-income earners such as pensioners upgrade their homes’ energy efficiency, as well as programs for remote and Indigenous communities.

It is more than a decade since policymakers were presented with evidence showing that such measures bring concrete health benefits for low-income households.

A widely cited randomised trial, published in 2007 in the BMJ, found that insulating low-income households in New Zealand led to a significantly warmer, drier indoor environment, and resulted in significant improvements in health and comfort, a lower risk of children having time off school or adults having sick days off work, and a trend for fewer hospital admissions for respiratory conditions.

“Interventions of this kind, which focus on low-income communities and poorer quality housing, have the potential to reduce health inequalities,” found the researchers.

A big silent killer’

The health of people in Burnie in north-west Tasmania is shaped by rates of poverty, unemployment and poor educational outcomes that are worse than the state’s average.

At the public hospital, emergency physician Dr Melinda Venn is reminded every day how people who are poorer and sicker have difficulty accessing the services they need. She describes seeing patients who struggle to feed their families, or buy medications and who often can’t afford to put petrol in their cars to get to the doctor.

Her prescription for what would help her community’s health and wellbeing is similar to Renee Blackman’s in north-west Queensland. It includes wide-ranging action to address poverty, including through raising the Newstart allowance and more generally ensuring liveable incomes, as well as access to affordable fresh food, public transport and higher education.

Venn also stresses the importance of better funding for preventative health measures and primary healthcare. “Every day we see people come to the emergency department, either because they can’t afford to get into the GP or they can’t get into

Dr Nick Towle, a medical educator at the University of Tasmania who helped organise a recent Doctors for the Environment Australia conference in Hobart, where delegates declared a climate emergency, says that addressing the intertwined issues of health inequities and climate change will require massive transformation in how governments operate. They must move beyond the current siloed approaches whereby, for example, the housing portfolio can be reluctant to invest in improving housing if savings are to the health portfolio.

Towle says a systems approach would reimagine urban development so that communities are within cycling or walking distance of local food production, green spaces and infrastructure such as shops, primary healthcare and aged care centres, and with active and passive solar a requirement for all new developments.

Like Venn, Towle stresses the need to invest far more in primary healthcare and the prevention of chronic conditions such as obesity, diabetes, lung and cardiac disease, which are more common in poorer communities, and make people less resilient to the effects of heat, which he says “is emerging as a big silent killer”.

Back in Mount Isa, Renee Blackman stresses the importance of local action in responding to both health inequities and climate change. Local governments, especially Indigenous local governments, should be given more support for tackling these issues, she says.

“At least talk to the people it’s going to affect,” she says. “As an Aboriginal organisation, we would never tread on someone else’s Country, without first asking, what do you need?”

An assessment of the major parties’ track records and election promises shows Australia has a better chance of acting on poverty and climate change as critical health equity concerns if there is a change of government.

The Acoss’s election policy tracker suggests the Greens have the best policies for addressing poverty and climate change, while the Climate and Health Alliance scorecard gives the Greens top marks (8 out of 8), followed by Labor (4.5 out of 8) and the LNP (zero out of 8).

The Consumers Health Forum of Australia scorecard gives the Greens’ health policies the highest rating (21 out of a potential score of 37), followed by Labor (16/37) and the LNP (7/7). The Public Health Association of Australia has welcomed Labor’s and the Greens’ commitments on preventative health, while the Australian Health Care Reform Alliance has called on both major parties “to follow the lead of the Greens and commit to health policies that deliver both equity and efficiency”.

Like many, the Consumers Health Forum is disappointed in the lack of focus on primary healthcare, saying “the absence of a transformational agenda for primary care is a missed opportunity this election”. Meanwhile, the Australian Healthcare and Hospitals Association scorecard records the Liberal National party as having no explicit commitment to health equity and, days out from an election, the Rural Doctors Association of Australia says the Greens are the only party to have addressed rural health issues so far. Some health organisations have not yet released an election scorecard.

Reporting in this series is supported by VivCourt through the Guardian Civic Journalism Trust