Aboriginal Health and #CDP Debate : Download Senate Report : Are Aboriginal voices finally being heard on #CDP failure

 

 ” The inquiry heard the voices of Indigenous CDP participants, their organisations and other concerned Australians and revealed the deep-seated flaws with this top-down, punitive and discriminatory program.

Finally, our concerns have been heard.

APO NT has put considerable effort into developing an alternative to the CDP (APO NT alternative to CDP).  

 We are extremely pleased that the committee has recognized this Indigenous-led work and drawn on many key elements of the APO NT proposal.

John Paterson, from APO NT See full press release Part 1

The Senate inquiry report released last week  into the fraught Community Development Program (CDP) calls for a total overhaul of the unfair CDP system

Download Senate CDP report 2017

“Labor is deeply disappointed with Minister Scullion’s response to the Senate Inquiry into the Community Development Program (CDP).

Labor secured the Inquiry into the CDP in March after communities across the Northern Territory and Western Australia told us that they were trapped in a cycle of poverty, waiting on the end of a phone line for hours and then giving up, feeling hopeless and still struggling with an infuriating bureaucratic reporting process.

Minister Scullion’s response to the inquiry has been outrageously cynical

His response to the inquiry is insulting to all the organisations and individuals who gave substantial and significant evidence to the Senate Committee, telling of disrespectful consultation, poor program design and unfair penalties that has led not to jobs, but to poverty, pain and hunger.”

Labor Press Releases see 2 Part and 4 below

 ” Just like it’s failed Remote Jobs and Communities Program, Labor’s partisan report into the successful Community Development Program is not accurate and does nothing to promote better employment outcomes in remote Australia.

I am committed to a broad consultation and will continue to engage on remote employment widely, including with remote communities, job seekers, the Prime Minister’s Indigenous Advisory Council, Empowered Communities leaders and CDP providers.

This consultation has been ongoing since I became Minister and I will continue to consult in the months ahead,

The Remote Employment and Participation discussion paper is available at: www.pmc.gov.au/cdp.

Submissions to the consultation are open until 5:00pm EST, Friday 9 February “

Senator Nigel Scullion see Part 3.1 and 3.2 below

 

Part 1  : The Aboriginal Peak Organisations NT (APO NT)[1] today welcomed the release of the Senate inquiry report into the Community Development Program (CDP), which found that ‘CDP cannot and should not continue in its current form’[2].

In particular, the inquiry found:

  • The committee is broadly supportive of an effective program for remote jobseekers that provides the opportunity for job placement and community development.
  • there should be a move away from the compliance and penalty model towards the provision of a basic income with a wage-like structure to incentivise participation.
  • a jobseeker program must create and sustain real local jobs.
  • A new program needs to be developed which moves away from a centralised, top-down administration in which communities are told what to do and move towards a model where the local communities are empowered to make decisions that are best for them[3].

It also explicitly recommends that any reform process give consideration to the APO NT model.”

“It is extremely disappointing that the Minister for Indigenous Affairs has already labelled the report misleading and partisan.  On the contrary, it provides valuable evidence and recommendations that should inform the CDP reform process,” said Mr Paterson.

The Government committed to consulting with remote communities in May 2017 and just hours before the release of the senate inquiry report the Minister finally released a Discussion Paper outlining very broad reform models for CDP.

“The consultation process announced by the Minister does not answer our calls for a transparent, independent review process conducted in partnership with Indigenous people.

The review process is being conducted by the department that currently administers the program, does not appear to include any external oversight or the creation of a high level reform committee to guide and inform the process, and is being undertaken during the wet season and hot summer months when cultural business occurs in many communities,” said Mr Paterson.

“CDP affects the lives of around 29,000 Indigenous people and has caused immense harm.

We will continue to work hard to shape the development of a new program to replace CDP that is non-discriminatory, ensures access to the social security safety net, empowers local communities, creates jobs with proper entitlements, and drives development in remote communities.

In the meantime, as recommended by the Senate committee, there must be immediate reform of the compliance and penalty regime of the CDP.”

KEY FACTS ABOUT THE COMMUNITY DEVELOPMENT SCHEME

  • The CDP is the main program of job related assistance for unemployed people in remote areas of Australia.  It is the equivalent of jobactive (formerly JSA) and Disability Employment Services in the rest of the country.
  • The CDP has around 35,000 participants, around 83% of whom are identified as Indigenous.
  • People with full time work capacity who are 18-49 years old must Work for the Dole, 25 hours per week, 5 days per week, at least 46 weeks per year (1150 hours per year).
  • Under jobactive Work for the Dole only starts after 12 months, and then for 390-650 hours per year.
  • Despite having a caseload less than a twentieth the size of jobactive, more penalties are applied to CDP participants than to jobactive participants.
  • In the 21 months from the start of CDP on 1 July 2015 to the end of March 2017, 299,055 financial penalties were applied to CDP participants. Over the same period, 237,333 financial penalties were applied to jobactive participants.

Part 2 : Labor is deeply disappointed with Minister Scullion’s response to the Senate Inquiry into the Community Development Program (CDP).

Labor secured the Inquiry into the CDP in March after communities across the Northern Territory and Western Australia told us that they were trapped in a cycle of poverty, waiting on the end of a phone line for hours and then giving up, feeling hopeless and still struggling with an infuriating bureaucratic reporting process.

Minister Scullion’s response to the inquiry has been outrageously cynical.

  • He rebuffed Labor’s attempts to engage the Minister in a bipartisan way throughout the entire committee process.
  • He refused to provide a public submission to the inquiry, but then sent his own partisan, confidential, embargoed report on the eve the Senate Committee was due to report.
  • In an attempt to save face the on the day the Senate Committee released its report into the failed CDP the Minister released his own report – which makes recommendations for wage like conditions which parallel Labor’s report.

The Minister has claimed that only one of the public hearings of the inquiry took place in a Community Development Program Area – the fact is three of the hearings took place in a CDP region – Alice Springs, Papunya and Palm Island. Kalgoorlie also sits within one of the regions impacted by the CDP.

His response to the inquiry is insulting to all the organisations and individuals who gave substantial and significant evidence to the Senate Committee, telling of disrespectful consultation, poor program design and unfair penalties that has led not to jobs, but to poverty, pain and hunger.

The Senate inquiry heard from NGOs, community members, Indigenous leaders and employment providers who were not consulted by the Minister about the CDP.

The reality is the Minister was pushed by Labor to reform the CDP and his tardy and belated efforts to do so will leave many people in communities hungry this Christmas because of the Minister’s failure to deal with this discriminatory and punitive CDP program.

It is seriously disappointing that Minister Scullion would prefer to play political one-upmanship than address the real issue of reforming this deeply flawed, cruel and poorly administered CDP program.

The Australian Council of Trade Unions have condemned the Minister for his handling of the CDP and called for total reform:

‘This Abbott/Turnbull program should shame all Australians. Minister Nigel Scullion, whose lack of action despite a mountain of evidence that his program has failed and is causing harm, is alarmingly negligent.

We further condemn the decision of the Minister to release a review of the program.

We don’t need a review. We need the program scrapped.’

Labor could not agree more.

 

Part 3.1 Senator Nigel Scullion Press Release

Just like it’s failed Remote Jobs and Communities Program, Labor’s partisan report into the successful Community Development Program is not accurate and does nothing to promote better employment outcomes in remote Australia.

Of the 46 organisations or individuals who appeared before the enquiry, only around 35 per cent were Indigenous organisations based in Community Development Program areas. Even more concerning, only one of the public hearings of the enquiry took place in a Community Development Program Area.

This lack of direct feedback is reflected in the findings of the report which is based on anecdotal reports rather than proper evidence – for example claims by Labor Senators that Indigenous communities will go hungry this Christmas despite there being no evidence of changes to the revenue of remote community stores.

It is disappointing that today’s report has ignored the success of the Community Development Program:

  • An increase in attendance from under 7 per cent to over 70 per cent since the end of Labor’s Remote Jobs and Communities Program.
  • Remote job seekers have been supported into around 20,000 jobs including a remarkable 72 per cent increase in the number of 13 week outcomes and an even more remarkable 227 per cent increase in the number of 26 week outcomes in comparison to Labor’s Remote Jobs and Communities Program.
  • More local Indigenous organisations delivering the program with their community rather than the big mainstream non-Indigenous companies that former Minister Macklin forced on to the Remote Jobs and Communities Program.

The Government strongly believes that all Australians can make a contribution to their community and that the best form of welfare is practical support to find a job. This includes holding welfare recipients to account for turning up to their work for the dole activities and addressing the scourge of passive welfare.

Unfortunately, this report is another example of Labor’s approach to social policy – doing and saying what is needed to fend off Greens’ candidates in inner city seats rather than doing what remote communities want and need.

Instead of reading this deeply partisan and misleading report, I encourage those genuinely interested in learning more about the Community Development Program to read the Independent Australian National Audit Office report which found that the transition to the Community Development was largely effective and supported by an external review – https://www.anao.gov.au/work/performance-audit/design-and-implementation-community-development-programme.

Or better yet, I encourage people to listen to the stories of the job seekers who have benefited from the training and work experience they needed to transition into work (for example see http://www.indigenous.gov.au/news-and-media/announcements/minister-scullion-cdp-participants-bring-ngukurr-community-closer-vital).

The Coalition Government has already committed to further reforms to the Community Development Program based on feedback from communities which called for a wages like payment, support for real jobs, more local control and more incentives to encourage job seekers to transition into work.

We will consider the recommendations of the report as part of these reforms and consult across Australia including with remote communities and Community Development Program providers and participants.

While Labor is intent on playing petty political games we are getting on with the job of making the CDP even more successful.

To read the Remote Employment and Participation discussion paper which will inform future options for improving the CDP, visit www.pmc.gov.au/cdp.

Part 3.2 Improving employment and participation in remote Australia : Senator Nigel Scullion

Thursday 14 December 2017
The Coalition Government has announced options to further improve employment and participation in remote communities with the release of a discussion paper on future arrangements for the Community Development Program (CDP).

The Minister for Indigenous Affairs, Nigel Scullion, today announced the start of a formal consultation on a new employment and participation model for remote Australia.

“Supporting people in remote Australia to gain skills and find jobs delivers many benefits – for themselves, their families and the broader community,” said Minister Scullion.

“I am committed to ensuring job seekers in remote Australia are supported to get the training and work experience they need to transition into a job and make a contribution to their community.

“It is essential that reforms are developed in partnership with Aboriginal and Torres Strait Islander peoples and remote communities, so I encourage people to share their views.

“The discussion paper explores how to grow the remote labour market, provide more incentives to job seekers, give communities more control and greater decision-making, and improve the support available to job seekers so they can move from welfare and into work.

“Options include a tiered remote job service model that includes:

  • A more simplified system, relying less on a national welfare system, and more on local control and decision making.
  • Reinvesting any efficiencies back into communities, for example through ‘top up’ arrangements for job seekers.
  • A wage-based or ‘wage-like’ model providing weekly payments to job seekers.
  • Streaming jobseekers to enable tailored assistance according to need.
  • Establishing better arrangements for job training and a pathway to real employment.
  • Encouraging businesses to hire and invest in local people.
  • Delivering subsidised labour for contracting opportunities, while not crowding out existing investment and jobs.
  • Increasing the number of Indigenous owned and controlled organisations providing services under CDP.
  • Supporting Indigenous enterprise development, particularly in the delivery of Commonwealth contracts.

The consultation will help guide the development of a new employment and participation model expanding on the success of the CDP.

“The CDP has supported remote job seekers into over 21,000 jobs and overturned the failures of Labor’s Remote Jobs and Communities Program (RJCP) which saw attendance under the program drop to 6 per cent.

“However, more needs to be done to maintain the momentum to get people into work.

The discussion paper outlines three potential options to for discussion. These are an improved version of the current CDP to provide more tailored support, a model based on the CDP Reform Bill introduced in 2015 and a wage-based model.

“I am committed to a broad consultation and will continue to engage on remote employment widely, including with remote communities, job seekers, the Prime Minister’s Indigenous Advisory Council, Empowered Communities leaders and CDP providers.

“This consultation has been ongoing since I became Minister and I will continue to consult in the months ahead,” Minister Scullion said today.

The Remote Employment and Participation discussion paper is available at: www.pmc.gov.au/cdp.

Submissions to the consultation are open until 5:00pm EST, Friday 9 February

Part 4 Labor Press Release

 The report has called on the Government to ensure that CDP participants have the same legal rights and other responsibilities as other income support participants.

Currently CDP remote participants must do 25 hours of “work-like” activities per week to receive welfare payments. This is up to three times longer than the requirement for unemployed people living in towns.

The report also called for a new program to be developed in consultation with First Nations people, so that people doing real work in their community can be properly paid.

CDP participants do not currently receive award wages and cannot access leave, superannuation and workers compensation.

The Senate inquiry and its findings have forced the Government to review the failure of the CDP program.

Less than six weeks ago the Minister was praising CDP as a success but in a complete turnaround, reports of a CDP discussion paper released today show the Government has conceded the multiple failings of CDP.

The Minister’s belated discussion paper on proposed changes does not take into account the damage the discriminatory CDP continues to cause on communities.

The reality is many people on communities will still go hungry this Christmas because of the Minister’s failure to deal with this discriminatory and punitive CDP program.

NACCHO Aboriginal #HealthStarRating and #Nutrition @KenWyattMP Free healthy choices food app will dial up good tucker

“Users simply scan the barcode of a product with their phone to see if it’s a healthy choice,

Once scanned, the app gives a ‘thumbs up’, ‘thumbs down’, or ‘thumbs sideways’ message, according to how healthy the product is.

“One of the app’s best features is that, once it’s downloaded, all the information is on your phone and there’s no need for the internet, so it’s ideal for people living in remote areas.”

Minister for Indigenous Health, Ken Wyatt AM, said the Uncle Jimmy’s Good Tucker app was easy to use and a first for remote communities.

Read over 30 NACCHO Articles about Healthy Food and Nutrition

The GOOD TUCKER app has been launched with the intention to assist people living in remote Aboriginal and Torres Strait Islander communities to make healthier food and beverage choices at the local store.

Federal Minister for Indigenous Health, the Hon Ken Wyatt AM gave the official thumbs up to the free app today. The app allows shoppers to scan a food or beverage product’s barcode and instantly reveal if it is a healthy option, should be consumed in moderation or avoided altogether.

DOWNLOAD INFO HERE

The app has been championed by the Menzies School of Health Research (Menzies), the University of South Australia (UnisSA) and Uncle Jimmy Thumbs Up! , which has been promoting awareness and the benefits of a healthy diet to Indigenous children for more than 10 years.

Graham “Buzz” Bidstrup, CEO of Uncle Jimmy Thumbs Up!, said there was an overwhelming need for the app.

“We know that there is over consumption of ultra-processed foods particularly in remote Indigenous Australian communities. These foods are typically energy dense and high in added sugar and salt which fuels the obesity epidemic and a raft of early onset chronic diseases.

“The GOOD TUCKER app shows at a glance how healthy or unhealthy a product is with a simple thumbs up, sideways or down message. The Thumbs rating is derived from a combination of the products’ Health Star Rating and Australian Bureau of Statistics’ discretionary food classification,” Mr Bidstrup said.

The app has been more than two years in the making with joint input from Menzies, UniSA and Uncle Jimmy Thumbs Up!.

Associate Professor Julie Brimblecombe, head of the nutrition program at Menzies, said she hoped the GOOD TUCKER app would help to tackle the significant health gap facing many people living in remote communities.

We know that nutrition plays a huge role in contributing to poor health. Making even small changes to our diets, such as consuming a little less salt and added sugar, and eating less fat (particularly saturated fat) and energy (kilojoules) could help prevent diseases including high blood pressure, high cholesterol, obesity and type 2 diabetes.

This app will help people to change their shopping habits as well as generate new learning about healthy food choices for community residents and store managers,” Assoc Prof Brimblecombe said.

The GOOD TUCKER app, which is powered by the highly successful FoodSwitch app, provides Thumbs ratings for tens of thousands of products on sale in food stores all across Australia.

It also provides guidance about take-away foods, such as pizzas and burgers and other non-packaged, non-barcoded items like fresh fruit and vegetables.

Prior to the launch the app was trialled by Indigenous musicians and performers at the Bush Band Bash concert in Central Australia , Wiraduri woman, Johanna Campbell said she found it educational and easy to use and is looking forward to it being introduced into rural and remote communities across Australia.

“The GOOD TUCKER app is great. To be able to scan the barcode on a food packet to find out if it is healthy or not will be really useful. Some foods are not so obviously unhealthy, so to be able to receive a thumbs up, sideways or down will help buy healthier options at the store,” Ms Campbell said.

Dr Tom Wycherley from UniSA’s Alliance for Research in Exercise, Nutrition and Activity (ARENA), said the app uses imagery and branding that is easily interpretable and familiar to communities.

“The GOOD TUCKER app builds on existing Thumbs Up! branding that has been seen in many communities for over 10 years and provides information in a culturally appropriate form. Early feedback is really positive but the real test now will be to see if this can noticeably change food choices.”

A full evaluation of the app is planned to take place after the release.

The GOOD TUCKER app works on:

1. Apple mobile devices that have a camera with auto-focus. Requires iOS 7.0 or later.

2.Android devices running versions 4.0.x and above that have a camera with autofocus.

As all the information is in the app there is no need for the user to be in internet or phone range to use the app

Part 2 Minister Wyatt’s Press Release  :Free healthy food app dials up good tucker for remote Indigenous communities

A new mobile phone app launched today promises to help Aboriginal and Torres Strait Islander people in remote areas make healthy food choices.

The thumbs rating is based on the Government’s Health Star Rating system and the Australian Dietary Guidelines.

“The app is named in honour of legendary singer Jimmy Little, who established the Jimmy Little Foundation and dedicated much of his life to promoting better Indigenous health,” said Minister Wyatt.

“People in remote communities can face considerable food challenges, from the combination of limited supplies, particularly the difficulty in getting fresh fruit and vegetables, and limited storage.

“Uncle Jimmy’s app will complement our work to make good food more accessible in remote areas, through the Outback Stores scheme. The accredited stores provide healthy food cheaper than in other remote area stores and implement a nutrition strategy that includes health promotion activities and cooking demonstrations.

“Improving food choices is one of the most effective ways of helping close the gap in Indigenous health, with poor diet behind 10 per cent of diseases.”

The Good Tucker app was created by the Jimmy Little Foundation, in partnership with the Menzies School of Health Research, the University of South Australia and the George Institute for Global Health.

The app links with the Health Star Ratings system, which has more than 7,500 food products displaying the Health Star Rating logo.

Background

The GOOD TUCKER app was developed by Uncle Jimmy Thumbs Up!, The University of South Australia and Menzies School of Health Research in partnership with The George Institute, to provide a simple way for people to identify the healthiest food and drink options available in stores.

Uncle Jimmy Thumbs Up! was established in 2007 by legendary Australian entertainer Dr. Jimmy Little AO with veteran musician and founding CEO Graham “Buzz” Bidstrup.

The Thumbs Up! program uses music and new media to bring awareness of good nutrition and healthy lifestyle to Indigenous children living in regional and remote communities across Australia. Thumbs Up! engages with the whole of community, including traditional owner groups, schools, local food stores, health services and community groups.

 How do I get the Good Tucker app?

iPhone1 users: Download Good Tucker from the App Store1, either online or on your device.

Android2 smartphone users: Download Good Tucker from Google Play2, either online or on your Android smartphone.

The app is free of charge. An internet connection (mobile/cellular data or Wi-Fi) is required to download it and to share information by social media and email. Standard usage charges may apply – check with your internet and mobile service providers for more information.

Once the Good Tucker app has been downloaded onto your phone you do NOT need to have phone or internet connection for it to operate. All information on products will be stored on the phone.

Other FAQs about the APP

Welcome to the Good Tucker APP!

A simple and easy way of checking out how healthy a food product is.

Download from

NACCHO Aboriginal Health and #Racism : #UN #HRC36 told Australia must abandon racially discriminatory remote work for the dole program

Thank you Mr President,

Australia is denying access to basic rights to equality, income and work for people in remote Aboriginal and Torres Strait Islander communities, through a racially discriminatory social security policy.

Australia should work with Aboriginal organisations and leaders to replace this discriminatory Program with an Aboriginal-led model that treats people with respect, protects their human rights and provides opportunities for economic and community development “

36th Session of the UN Human Rights Council 20 September see in full part 2 below

The program discriminates on the basis of race, with around 83 per cent of people in the program being Aboriginal and Torres Strait Islander. This is a racially discriminatory program that was imposed on remote communities by the Government and it’s having devastating consequences in those communities,”

John Paterson, a CEO of the Aboriginal Peak Organisations NT, told the Council that the Government’s program requires people looking for work in remote communities to work up to 760 hours more per year for the same basic payment as people in non-Indigenous majority urban areas.

Picture above Remote work-for-the-dole scheme ‘devastating Indigenous communities’

The Australian Government is denying access to basic rights to equality, work and income for people in remote Aboriginal and Torres Strait Islander communities, through its racially discriminatory remote work for the dole program.

In a joint statement to the UN Human Rights Council overnight, the Aboriginal Peak Organisations NT and Human Rights Law Centre urged the Council to abandon its racially discriminatory ‘Community Development Program’ and replace it with an Aboriginal-led model.

Adrianne Walters, a Director of Legal Advocacy at the Human Rights Law Centre, said that the program is also denying basic work rights to many people in remote communities.

“Some people are required to do work that they should be employed to do. Instead, they receive a basic social security payment that is nearly half of the minimum wage in Australia. People should be paid an award wage and afforded workplace rights and protections to do that work.” said Ms Walters.

The statement to the Council calls for the Federal Government to work with Aboriginal and Torres Strait Islander people on a model that treats people with respect, protects their human rights and provides opportunities for economic and community development.

“Aboriginal and Torres Strait Islander people in remote communities want to take up the reins and drive job creation and community development. Communities need a program that sees people employed on decent pay and conditions, to work on projects the community needs. It’s time for Government to work with us,” said Mr Paterson.

The Aboriginal Peak Organisations NT has developed an alternative model for fair work and strong communities, called the Remote Development and Employment Scheme, which was launched in Canberra two weeks ago with broad community support.

“The new Scheme will see new opportunities for jobs and community development and get rid of pointless administration. Critically, the Scheme provides incentives to encourage people into work, training and other activities, rather than punishing people already struggling to make ends meet,” said Mr Paterson.

The Human Rights Law Centre has endorsed the Aboriginal Peak Organisations NT’s proposed model.

“Aboriginal organisations have brought a detailed policy solution to the Government’s front door. The Scheme would create jobs and strengthen communities, rather than strangling opportunities as the Government’s program is doing,” said Ms Walters.

Part 2 36th Session of the UN Human Rights Council

Items 3 and 5

Human Rights Law Centre statement, in association with Aboriginal Peak Organisations Northern Territory, Australia

Thank you Mr President,

Australia is denying access to basic rights to equality, income and work for people in remote Aboriginal and Torres Strait Islander communities, through a racially discriminatory social security policy.

The Council has received the report of the Special Rapporteur on Indigenous peoples’ rights following her mission to Australia in 2017. This statement addresses one area of concern in the Special Rapporteur’s report.

The Australian Government’s remote ‘Community Development Program’ requires people looking for work in remote communities to work up to 760 more hours per year for the same basic social security payment as people in non-Indigenous majority urban areas.

The program discriminates on the basis of race, with around 83 per cent of people covered by the program being Indigenous.

High rates of financial penalty are leaving families without money for the basic necessities for survival.

In addition, the program denies basic work rights. People are required to do work activities that they should be employed, paid an award wage and afforded workplace rights to do. Instead, they receive a basic social security payment that is nearly half of the minimum wage in Australia.

The program undermines self-determination and was imposed on Aboriginal communities with very little consultation.

Australia should work with Aboriginal organisations and leaders to replace this discriminatory Program with an Aboriginal-led model that treats people with respect, protects their human rights and provides opportunities for economic and community development.

Mr President,

Australia is a candidate for a seat on the Human Rights Council for 2018. We call on the Council and its members to urge Australia to respect rights to self-determination and non-discrimination, and to abandon its racially discriminatory remote social security program and replace it with an Aboriginal-led model.

Part 3 Fair work and strong communities

Aboriginal Peak Organisations NT Proposal for a Remote Development and Employment Scheme

NACCHO is one of the many organisations that has endorsed this scheme

See full Story here

Download the brochure and full list of organisations endorsing

RDES-Summary_online

All Australians expect to be treated with respect and to receive a fair wage for work. But the Australian Government is denying these basic rights to people in remote communities through its remote work for the Dole program – the “Community Development Programme”.

Around 84 per cent of those subject to this program are Aboriginal and Torres Strait Islander people.

Most people in remote communities have to do more work than people in non-remote non Indigenous majority areas for the same basic social security payment.

In some cases, up to 760 hours more per year.

There is less flexibility and people are paid far below the national minimum wage.

Aboriginal and Torres Strait Islander people are also being penalised more because of the onerous compliance conditions.

In many cases, people are receiving a basic social security payment for work they should be employed to do.

The Government’s program is strangling genuine job opportunities in remote communities.

The Government’s remote Work for the Dole program is racially discriminatory and must be abandoned. Better outcomes will be achieved if Aboriginal and Torres Strait Islander people are given the opportunity to determine their own priorities and gain greater control over their own lives.

NACCHO Aboriginal Health #RUOKDay : Download @RACGP Report underlines crucial role of GPs in #mentalhealthcare

“With a shortage of psychologists and other mental health professionals in rural and remote areas, the role of rural doctors in providing mental healthcare is already absolutely critical, and is becoming more so.

“Feedback from many rural and remote doctors backs up the findings in today’s RACGP report — namely, that there is a significant mental healthcare load in general practice.

“And this area of general practice care is growing.

“Many rural doctors already undertake additional upskilling in advanced mental healthcare.”

President of the Rural Doctors Association of Australia (RDAA), Dr Ewen McPhee

Download a PDF Copy of report

Health-of-the-Nation-2017-report

Read over 150 Aboriginal Mental Health Articles published over the past 5 years by NACCHO

A major report released today on general practice care in Australia shows that the most frequent visits to GPs are for psychological care, demonstrating that the sector plays a critical role in helping patients with their mental health as well as physical health.

The report, General Practice: Health of the Nation, is the first of what will be an annual insight into the state of general practice in Australia, published by the Royal Australian College of General Practitioners (RACGP).

Dr Ewen McPhee continued

“And under the National Rural Generalist Pathway that the Federal Government is progressing, medical graduates training as Rural Generalist doctors will be able to undertake advanced mental healthcare as a key element of their training, alongside other advanced skills.

“Earlier this year, we also welcomed an announcement by the Federal Government that, from November, it will increase access for rural and remote Australians to Medicare-rebated psychological care delivered by video consultations.

“Under the change, psychologists will be able to deliver up to 7 of the currently available 10 face-to-face sessions accessed through a General Practitioner. The rebates for these sessions have previously only been available if provided by a GP.

“This change will help to significantly improve access to tele-psychology services for many rural and remote Australians and the Government deserves full credit for implementing it.”

RDAA has supported concerns raised by the RACGP, however, that despite the fact that over 85% of the Australian population visits their GP each year, the general practice sector receives only 5% of the total annual health budget.

“This should be sending significant warning bells to governments” Dr McPhee said.

“Given the reliance that Australians have on general practice for their primary care — and the ability of investment in general practice to generate significant budget savings by reducing hospital admissions — it is clear that additional investment in general practice needs to be made, sooner rather than later.”

Consumers Health Forum MEDIA RELEASE :

The finding that psychological issues are a leading reason patients see GPs highlights the importance of the GPs’ role as the first base for health concerns in the community.

The Health of the Nation report released by the Royal Australian College of GPs today reveals mental health issues like depression and anxiety are among the most common ailments reported by 61 per cent of GPs.

“That is a disturbingly high figure.  It is also the issue causing GPs most concern for the future,” the CEO of the Consumers Health Forum, Leanne Wells, said.

The next most commonly mentioned as emerging issues by GPs are obesity and diabetes.  The prevalence of these conditions, all of which raise complex challenges for the most skilled GP, underlines the need for a well-coordinated and integrated health system in the community.

“The Consumers Health Forum recognises the GP as the pivotal figure in primary health care who needs more support through such measures as the Government’s Health Care Homes, initiating more integrated care of those with chronic and complex conditions.

“At a recent Consumers Roundtable meeting with Health Minister, Greg Hunt, we set out priorities for a National Health Plan to strengthen Australia’s primary health system, making it more consumer-centred, prevention-oriented and integrated with hospital and social care.

“We also called for more investment in health systems research, shaped by consumer and community priorities, to stimulate services that reflect advances in health sciences and knowledge.

Too often Australians, particularly those with chronic illness, are confounded by our fragmented health system.

We have world class health practitioners and hospitals. But these are disconnected so that patients don’t get the comprehensive top-quality care that should be routine.

“Investing in primary health care led by GPs is the way to a better performing and more consumer-responsive health system,” Ms Wells said.

 

 

Aboriginal #Health #Research debate : Controlled experiments won’t tell us which #Indigenous health programs are working

 ” For example, it is known anecdotally in Alice Springs that some Aboriginal Australians who could benefit from kidney dialysis treatment prefer, instead, to go back to their community to be on country.

While this can be detrimental to their physical health, it has important cultural significance for them.

The RCT approach in this situation would undoubtedly demonstrate the health benefits of kidney dialysis. But understanding this problem in the context of real lives requires different methodologies.

Unless we design research programs to consider why people would rather stay on country than receive effective health treatments, Aboriginal health may not improve.

From the Conversation August 2017

Picture above Some Aboriginal Australians who could benefit from kidney dialysis treatment prefer to go back to their community to be on country instead. WESTERN DESERT/AAP

Read over 40 NACCHO Research posts published over the past 5 years

Described as “one of the simplest, most powerful and revolutionary tools of research”, the randomised controlled trial (RCT) has yielded a great deal of important information in the health sciences. It is usually held up as the “gold standard” for gathering medical evidence.

The RCT can tell us which procedure or treatment is more effective under tightly controlled situations. This evidence is useful and important, but we also need to know things like what people want from health services, which treatments are preferred, and why some people stick to treatment regimes and some people don’t.

These issues are particularly relevant to remote Australia and Aboriginal and Torres Strait Islander health, where high levels of illness and early death persist, and where what applies to the tightly controlled conditions of a laboratory rarely translates.


Read more: Why are Aboriginal children still dying from rheumatic heart disease?


The government is rolling out its A$40 million plan to evaluate Indigenous health programs. The Evidence and Evaluation Framework aims to strengthen reporting, monitoring and evaluation for programs and services provided to Indigenous Australians.

As Indigenous Affairs Minister Nigel Scullion said last year:

When you don’t know anything about any of the programs, then you’re just relying on gut feelings, and that’s not good enough.

So, the framework will provide information about where government money is being spent, what works and why.

However, from a Western biomedical perspective, the randomised controlled trial is afforded an elevated position in establishing what works and why. While some recommend using RCTs to evaluate Indigenous programs, it is critical to keep in mind why this form of evidence-gathering is not always appropriate in this context.

Randomised controlled trials aren’t real life

In health and medical research, the RCT involves randomly assigning people to different groups and giving the groups different treatments. The random allocation to groups precludes there being systematic differences between participants at the start of the study.

At the end of the study, any differences between the groups can be attributed to the treatment and not some other factor. RCTs, therefore, are an elegant and efficient way of ruling out competing explanations for an observed effect.

However, research participants and scenarios in randomised controlled trials are often unlike the patients and settings to which the evidence will ultimately be applied. For example, RCTs have demonstrated that psychological treatments delivered through the internet can be effective for a wide range of disorders. But in real-world settings, adherence rates to internet treatments are very low, so the RCT result has little practical meaning.

The issue of which particular outcome should take priority can also be difficult to resolve through the RCT approach to research. Most RCTs prioritise the clinical perspective, such as a measurable change in a particular health outcome. However, there can be a mismatch between what doctors view as success and what patients and their loved ones perceive as a positive outcome following drug or other forms of treatment.

For example, it is known anecdotally in Alice Springs that some Aboriginal Australians who could benefit from kidney dialysis treatment prefer, instead, to go back to their community to be on country. While this can be detrimental to their physical health, it has important cultural significance for them.

The RCT approach in this situation would undoubtedly demonstrate the health benefits of kidney dialysis. But understanding this problem in the context of real lives requires different methodologies. Unless we design research programs to consider why people would rather stay on country than receive effective health treatments, Aboriginal health may not improve.

How best to gather evidence

Valuable work can be conducted by health professionals and service providers collecting data during their regular daily activities. The model of the “scientist-practitioner” often observed in clinical psychology could be applied to great effect in remote Australia.

This model promotes a seamless transition between science and practice in which the individual is both researcher and clinician. Scientist-practitioners adopt a critical stance to their clinical practice and routinely demonstrate, through evaluation, the value of the service they are providing.

Such a model was used in a GP practice in rural Scotland. Here, they found one simple change in how appointments were scheduled almost doubled the number of patients (in a six-month period) able to access a psychology service within a reasonable time after referral from their GP.

Rather than clinicians advising patients when to attend the next appointment, systems were organised so patients booked appointments in the same way they would to see a GP. The changes were quantified by clinician-researchers who collected these data in the course of their routine clinical practice.

After this change, patients were able to access the service within two weeks of being referred, rather than waiting for seven months as had been the case. Access to services is typically problematic in rural areas, so discovering a cost-effective means of improving access is an important outcome.

The results were so substantial and sudden that they were unequivocal. A large expensive RCT wasn’t necessary to demonstrate this simple change had made important improvements.


Read more: Aboriginal – Māori: how Indigenous health suffers on both sides of the ditch


This sort of approach could easily be applied in remote Australian settings. An RCT is not the only way, nor even the best way in all situations, to eliminate alternative reasons for the treatment outcomes obtained. Many important questions are ignored or refashioned inappropriately when only one methodology predominates.

Especially in the area of Indigenous health, the health and medical community must be guided by what patients want, not just by what health professionals know how to do.

NACCHO Aboriginal Rural and Remote Health Research Alert : @RoyalFlyingDoc Health Care Access in the bush Survey

 

” The RFDS survey of country health consumer priorities was released 100 years to the day since the first patient was treated by a pioneering doctor in Western Australia, leading to the founding of the RFDS which is now recognised as Australia’s most reputable charity.

The survey of 450 country people drawn from every state and territory saw one-third of responses (32.5%) name doctor and medical specialist access as their key priority. Addressing mental health (12.2%) and drug and alcohol problems (4.1%) were second and third priorities

Around seven million Australians who reside in remote and rural areas.

Of these, more than half a million live in either remote, or very remote, areas of Australia. Aboriginal and Torres Strait Islander (Indigenous) Australians are overrepresented in remote and very remote areas—almost half (45%) of all people in very remote areas and 16% in remote areas are Indigenous Australians, compared with a 3% Indigenous representation in the total population

The research paper “Health Care Access, Mental Health, and Preventative Health; Health Priority Survey Findings for People in the Bush

DOWNLOAD COPY HERE

RN032_Healths_Needs_Survey_Result_P1_U0FsohZ

Extract : 4.2.4 Indigenous health issues

Few respondents identified Indigenous health issues as important.

This was disappointing since across all remoteness areas, Indigenous Australians generally experience poorer health than non-Indigenous Australians (Australian Institute of Health and Welfare, 2014) in relation to chronic and communicable diseases, mental health, infant health, and life expectancy (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2005).

However, this result is unsurprising considering the very low proportion of respondents who were Indigenous.

Indigenous Australians are five times as likely as non-Indigenous Australians to die from endocrine, nutritional and metabolic conditions such as diabetes, and three times as likely to die from digestive conditions (Australian Institute of Health and Welfare, 2015b).

Age-adjusted data demonstrated that in 2014–2015 Indigenous Australians were more than twice as likely as non-Indigenous Australians to be hospitalised for any reason (Australian Institute of Health andWelfare, 2016b).

Indigenous Australians are twice as likely as non-Indigenous Australians to be hospitalised for an injury (Australian Institute of Health and Welfare, 2015a), and 1.8 times as likely to die from an injury than non-Indigenous Australians (Henley & Harrison, 2015).

Indigenous Australians are three times as likely to die from chronic lower respiratory diseases and twice as likely to die as a result of self-harm (suicide) than non-Indigenous Australians (Australian Bureau of Statistics, 2016).

Compared to non-Indigenous Australians, Indigenous Australians demonstrate higher age standardised death rates for a number of illnesses and injuries (Australian Institute of Healthand Welfare, 2015c).

Indigenous Australians also experience higher prevalence rates of communicable diseases compared with non-Indigenous Australians, including shigellosis (2.6 times greater), pertussis (whooping cough) (54.3 times greater), and tuberculosis (6 times greater) (Abdolhosseini, Bonner, Montano, Young, Wadsworth, Williams, & Stoner, 2015).

Similarly, life expectancy is lower and mortality rates are higher among Indigenous Australians compared to non-Indigenous Australians.

In 2010–2012, the estimated life expectancy at birth was 10.6 years lower for Indigenous males (69.1 years) compared to non-Indigenous males (79.7 years) and 9.5 years lower for Indigenous females (73.7 years) compared to non- Indigenous females (83.1 years) (Australian Institute of Health and Welfare, 2015c).

Fatal burden of disease studies have also demonstrated the existence of health inequalities— the fatal burden of disease and injury in the Indigenous population is estimated to be 2.6 times that experienced by non-Indigenous Australians, with injuries (22%) and cardiovascular disease (21%) contributing the most to the fatal  burden of disease for Indigenous Australians (Australian Institute of Health and Welfare, 2015b).

Press Coverage : Rural and remote Australians remain deeply concerned about poor access to healthcare, and want the Federal Government to spend more to fix the problem.

That is the key finding from the latest Royal Flying Doctor Service (RFDS) research, released last week as reported ABC

The RFDS surveyed more than 450 country Australians, and one-third nominated access to doctors and specialists as their single biggest healthcare concern.

A third of respondents called for more government funding of services, particularly for mental health and preventative care.

RFDS chief executive Martin Laverty said it raised a question for governments as to whether policies aimed at bridging that gap had failed.

“We have an oversupply of doctors in this country; the problem is, the doctors are simply not all working in areas where they’re most needed,” he said.

“It brings into question the success of repeated programs of Commonwealth governments to encourage doctors to work in remote and country Australia.

“The question for government is, are our incentives for doctors sending them to where they’re most needed?”

Access to doctors in remote areas a challenge

The survey found encouraging news in other areas.

Two-thirds of respondents said they needed to travel for one hour or less to see their GP or another non-emergency medical professional.

But for Australians living in more remote places, a visit to the doctor could mean a 10-hour round trip or more.

RFDS chief medical officer in Queensland Abby Harwood said governments could do other things to improve their access to care beyond putting more bodies on the ground.

“There is a lot of telephone and email consultation going on between people out bush and their GPs, but that requires actually having a pre-existing relationship with a healthcare provider who knows you,” she said.

“Technology such as video-conferencing is a fantastic opportunity, [but] currently the telecommunications infrastructure out in these areas is not quite sufficient to be able to do that reliably.”

GPs not paid by Medicare for teleconference consultations

Unlike specialists, who can bill Medicare for video-conferencing consultations with patients, GPs currently are not paid unless their patient attends a consultation in person.

Dr Harwood said that meant GPs who assisted remote patients over the phone or by teleconference were doing so on their own time and usually out of their own pocket.

“From my experience, most of us would just do it [for free] out of the service that we provide,” she said.

“At the moment it’s either the healthcare provider doing it for free, or the person accessing the GP is paying for it out of their pocket with no subsidy.

“When you consider the petrol bills, how much it costs in fuel to drive a 1,000km round trip, a lot of them would rather pay out of their own pocket to do that [if the doctor is not already doing it for free].”

Dealing with issues before crisis point

Dr Harwood seconded the call for a greater focus on preventative care for rural and remote patients, who were too often only dealing with medical issues once they had reached crisis point.

She said changing that made medical and economic sense.

“[When there’s a crisis] a patient then has to travel in and out of their regional centre or capital city, which obviously causes a lot of disruption and it’s expensive,” she said.

“I don’t think anyone has actually measured the full cost to Australia as a country, taking into account that social dislocation and the economic disruption when people need to leave their properties, leave their workplace.

“It’s been proven over and over again that good primary health care, delivered to people out there on the ground, can often prevent those crises from happening.”

 

Significant boost in GP numbers ‘in all areas’

Assistant Minister for Health David Gillespie, who has responsibility for regional health issues, is on leave.

But in a statement, a federal Department of Health spokeswoman said there had been a significant boost in GP numbers “in all areas of Australia” over the past decade.

“A 2017 budget announcement included funding of $9.1 million over four years from 2017-18 to improve access to mental health treatment services for people in rural and regional communities,” the statement read.

“Currently, Medicare provides rebates for up to 10 face-to-face consultations with registered psychologists, occupational therapists and social workers for eligible patients under the Better Access initiative.

“From 1 November 2017, changes to Medicare will take effect so that seven of the 10 mental health consultations can be delivered through online channels [telehealth] for eligible patients, that is, those with clinically diagnosed mental disorders who are living in rural and remote locations.

“Relevant services can be delivered by clinical psychologists, registered psychologists, occupational therapists and social workers that meet the relevant registration requirements under Medicare.”

Aboriginal Health : Rhetoric to Reality: Devolving decision-making to Aboriginal communities

Delivering services to Aboriginal communities, in a way that involves them as genuine partners and produces effective results, remains an ongoing challenge for public services across Australia.

 ” There are three ways of dealing with people: you can do TO them, FOR them or WITH them. The historic experience for Aboriginal people is the done to, or done for, experience. We need to be doing it WITH them.”

As one of the participants in the research said:

Download the report here : rhetoric-to-reality-report

Delivering services to Aboriginal communities, in a way that involves them as genuine partners and produces effective results, remains an ongoing challenge for public services across Australia.

A new publication, developed by ANZSOG students in conjunction with the NSW Department of Aboriginal Affairs, looks at how the NSW public service can change the way it works with Aboriginal people and better devolve decision making to local communities.

Rhetoric to Reality: Devolving decision-making to Aboriginal communities focuses on what structural and attitudinal changes might be required to deliver better collaborative relationships with Aboriginal communities.

Interactions between Australian public services and Indigenous communities have historically been hampered by a lack of respect, trust and understanding.

The report finds that devolving decision-making to Aboriginal communities should not be seen as an end in itself. It should be a means of practising different ways of working with Aboriginal people that involve sharing knowledge and power, collaborating, and responding to local contexts. If this is done the ultimate result will be better shared outcomes for communities.

Whilst the Australian and international literature highlights many barriers to effective collaboration with Indigenous communities there are very few specific recommendations which go beyond ‘rhetoric’. Rhetoric to Reality provides a range of concrete approaches that NSW Government departments can consider.

 

Shift 1: Connecting to culture, connecting to Country

Key findings

The theme which emerged most clearly from our research was how important it is for public servants to develop and maintain genuine cultural competence. Almost all participants raised some aspect of cultural awareness or competence training as an example of what works and what does not.

Participants felt strongly that the current approach to cultural competence in the public service can be ad hoc, tokenistic, generic and static. Similarly, we found that ideas about cultural awareness, competence, safety or intelligence are not well articulated or understood in the NSW public service. The following statements provided by participants highlight these ideas:

“We’re underdone on comprehensive support for developing cultural competency.”

“I think we can all put our hand up, ‘Yep, job done,’ but then not actually spending any time with Aboriginal communities or adding on that extra layer to think about them.”

“Cultural competency training must be delivered in the most authentic way possible. It has to be real, practical and relevant for staff in their roles.”

“It needs to be honest and delivered by Aboriginal people.”

Research participants considered genuine cultural competence to be critical to changing public sector attitudes and structures. This finding is supported by the literature, which shows that cultural understanding (Zurba et al 2012) and culturally appropriate or safe service delivery (Thomas et al 2015) are important to building relationships with Aboriginal people. Studies have shown that a combination of practices can change structural racism in organisations (Abramovitz & Blitz 2015).

literature also supports the provision of cultural training for staff (Downing & Kowal 2011, Fredericks 2006, Paradies et al 2008). The limitations of cultural awareness training as a stand-alone activity were noted by our research participants and have been noted in previous research (e.g. Downing & Kowal 2011), including the risk of stereotyping, promoting ‘otherness’ and ignoring systemic responses. However, studies have shown it is possible to change prejudiced attitudes towards Aboriginal people through specific education activities (Finlay & Stephan 2000; Pendersen et al 2000 & 2004).

The local decision-making framework recognises that public servants need a level of cultural competence to participate. The Premier’s Memorandum M2015-01 Local Decision Making, states that “NSW agencies will adhere to the principles of local decision-making and ensure staff are educated to respond to the needs of Aboriginal communities in a culturally sensitive and appropriate manner”.

While cultural competence was recognised by our research participants and supported by the literature as a key enabler, the lack of a current framework for the development of genuine cultural competence by public servants persists as a dominant issue in shifting public service structural and attitudinal frameworks.

“The key is having a culturally competent NSW government.”

Below we note a number of recurring ideas for improvement in the understanding and the application of cultural competence in the public service that were raised by research participants.

Accepting that racism and paternalism still exist in the attitudes and structures of the public service and which may be manifested in ‘unconscious bias’ was noted by many participants: “It’s hard to accept we have unconscious bias because people in the public sector are values driven.”

Participants were candid about what they perceive as paternalistic views and subtle forms of racism and bias shown by individuals and institutions: “I believe government and its agencies a lack of faith and trust in Aboriginal people’s ability to make sound decisions in the best interest of their communities.”

Understanding history and the historical trauma experienced by Aboriginal people was viewed as critical. “From a community perspective there is a lot of historical hurt or pain from previous government decisions… You have to let them vent their anger and frustration of the historical decisions that have been made that have had a significant impact on their communities.”

“[A] lot of our staff don’t understand the stolen generation.”

Re-conceptualising cultural competence in the public service as a lifelong journey was seen by many participants as necessary for meaningful change. This includes real experience of working alongside Aboriginal people and communities, and ongoing reflective learning. “We need our staff to keep asking, ‘Why is that the case?’” This finding is supported by the literature, which notes that enhancing a person’s awareness of their biases is critical in reducing modern forms of prejudice and discrimination (e.g. Perry et al 2015).

Building trust was seen as vital. For example, participants talked about public servants, including senior public servants, taking the time before getting down to business to build relationships with Aboriginal people, by having a cuppa on neutral ground, listening and building rapport: “It may take a couple of meetings before you get down to the nitty gritty of developing your relationship with that community.” Building trust and developing genuine relationships were also a strong theme in the literature (Closing the Gap Clearinghouse 2015; Taylor et al 2013; Zurba et al 2012).

Including Country as critical to the development of cultural competence was a universal theme. Participants provided examples of how this could be achieved, including through site-based training, localised activities, travelling

The report’s three key recommendations are that:

  • Cultural competence is most effective when it is localised, ongoing and taught on-Country. Local communities could benefit from being engaged in this teaching.
  • Public-sector leaders who are fully committed to cultural competence are most likely to establish collaboration with Aboriginal communities as a routine approach within government. Examples of successful leadership of this kind should be recognised and publicised across the public sector.
  • Aboriginal public servants should be supported and nurtured, and should be seen as critically important for a culturally competent NSW public service.

Rhetoric to Reality was prepared as part of the capstone Work Based Project subject by ANZSOG Executive Master of Public Administration students Laura Andrew, Jane Cipants, Sandra Heriot, Prue Monument, Grant Pollard and Peter Stibbard. It exemplifies the quality of applied research conducted by ANZSOG’s EMPA students and the potential impact when our students partner with a government agency to help drive change.

The research involved interviews and focus groups with senior executives and frontline public servants in Sydney and regional NSW, to get their perspective on what needed to change to lift the impact of programs on the Aboriginal community.

All recognised the importance of cultural change, and the value of ensuring that successful programs, designed in partnership with local communities, were used as examples to improve results elsewhere.

Rhetoric to Reality will be available across the NSW public service as a valuable resource to ensure that government support for Aboriginal people delivers benefits to those communities.

NACCHO Research Alert : @NRHAlliance Aboriginal health risk factors #rural and #remote populations

 ” Health risk factors like smoking, excessive drinking, illicit drug use, lack of physical activity, inadequate fruit and vegetable intake and overweight have powerful influences on health, and there are frequently clear inter-regional differences between the prevalence of these.

While it can be argued that there is some degree of personal choice involved in whether individuals have a poor health risk profile, there is clear evidence that external factors such as environment, opportunity, and community culture each have very strong influences.

For example, access to affordable healthy food can often be poor in smaller communities and this, coupled with lower incomes in these areas, adversely affects the quality of peoples’ diets, the prevalence of overweight, and consequently the prevalence of chronic disease.”

From the National Rural Health Alliance Research View HERE

National data pertaining to personal health risk factors typically comes from the ABS National Health Survey and the AIHW National Drug Strategy Household Survey (NDSHS). Some State and Territory Health Departments run their own health surveys (which cannot be aggregated nationally with each other or with the ABS survey because of the different methodologies and definitions used (think different State rail gauges). Consequently data describing aspects of health in regional and especially remote areas can be thin (ie with imprecise estimates in some or all areas).

Example 1

Table 14: Fruit and vegetable consumption, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

Roughly 60% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate fruit intake, closer to 50% in remote areas (compared with around 50% of all Australians 18+ in major cities and regional/rural areas).

Roughly 95% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate vegetable intake, perhaps higher (98%) in Very remote areas (compared with around 90%-94% of all Australians 18+ in major cities and regional/rural areas).

Example 2

NACCHO provided graphic

Table 16 Below : Overweight and Obesity, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

Aboriginal and Torres Strait Islander people in rural/regional and Remote areas (29%-33%) were a little more likely to be overweight than those in Major cities (28%), with those in Very Remote areas (26%) least likely to be overweight.

Aboriginal and Torres Strait Islander people in Inner regional areas (41%) were more likely to be obese than those in Major cities (38%), but those in Outer regional (36%) and remote areas (~33%) were less likely to be obese.

Overall, Aboriginal and Torres Strait Islander people in Inner Regional areas were most likely to be overweight/obese (70%), those in Major cities, Outer Regional and Remote areas were less likely to be overweight/obese (~66%), while those in Very Remote areas were the least likely to be overweight/obese (59% )

At the time of writing, the most recent National Health Survey was conducted in 2014-15[1], while the most recent AIHW NDSHS[2] was conducted in 2016, with most recently available results from the 2013 NDSHS. The most recent ABS Australian Aboriginal and Torres Strait Islander Health Survey[3] was conducted in 2012-13.

Some organisations (eg the Public Health Information Development Unit (PHIDU)) have calculated modelled estimates for small areas (eg SLA’s and PHN’s), where the prevalence of some risk factors has been predicted based on the age, sex and socioeconomic profile of the population living there.

Some sites (eg ABS) present risk factor data as crude rates, other sites (eg PHIDU) present risk factor data as age-standardised rates.  The advantage of the age-standardised rates is that the effect of age is largely removed from inter-population comparisons.

For example, older populations (eg those in rural/regional areas) would be expected to have higher average blood pressure than younger (eg Major cities) populations even though the underlying age-specific rates happened to be identical in both populations (because older people tend to have higher blood pressure than younger people).

While crude rates for the older population will be higher, the age-standardised rates in such a comparison would be the same – indicating a higher rate that is entirely explainable by the older age of one of the populations.

Both crude and age standardised rates are useful in understanding the health of rural and remote populations.

 


[1] http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001

[3] http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocumentSmoking

Table 1: Smoking status, by remoteness, 2013 and 2014-15

MC

IR

OR/Remote

Percentage

Current daily smoker (18+) (crude) 2014-15 (a)

13.0

16.7

20.9

Current smoker (18+) (Age standardised) 2014-15 (b) (includes daily, weekly, social etc smoking)

14.6

19.0

22.4

MC

IR

OR

Remote+ Very Remote

Current smoker (daily, weekly, or fortnightly) 14+ (crude) 2013 (c)

14.2

17.6

22.6

24.6

Current smoker (daily, weekly, or fortnightly) 14+ (Age standardised) 2013 (d)

14.2

18.6

23.6

24.4

Mean number of cigarettes smoked per week, smokers aged 14 years or older 2013 (e)

85.9

113.1

109.4

126.2

Sources:

Compared with Major cities (13%), the prevalence of daily smoking by people 18 years and older in Inner regional (17%) and Outer regional/Remote areas (21%) is higher.

The NDSH survey reflects these trends albeit with a slightly different age group (14+) and a different definition of smoking (daily plus less frequently), but the NDSH survey adds detail for remote areas where smoking rates are higher again (around 25% versus around 23% in Outer regional).

In addition, the average number of cigarettes smoked by each smoker is higher in regional/rural areas (~110/week) than in Major cities (86/week), and higher again (126/week) in remote areas.

 

Smoking – exposure, uptake, establishment, quitting

Table 2: Smoking characteristics by Remoteness, 2013, 2014 and 2014-15

MC

IR

OR

remote

8.8

17.8

19.3

27.8

Proportion of pregnant women who gave birth and smoked at any time during the pregnancy (2013, crude, National Perinatal Data Collection, exposure tables, Table 5.1.2 )

8.5

17.0

18.9

27.5

Proportion of pregnant women who gave birth and smoked in the first 20 weeks of pregnancy (2013, crude, National Perinatal Data Collection) exposure tables, Table 5.2.2)

3.6

3.1

4.1

*9.4

Proportion of dependent children (aged 0–14) who live in a household with a daily smoker who smokes inside the home (2013, crude, NDSHS exposure tables, Table 6.3)

2.5

2.0

2.7

*2.9

Proportion of adults aged 18 or older who live in a household with a daily smoker who smokes inside the home (2013, crude, NDSHS, exposure tables, Table 7.3)

16.2

15.4

14.7

15.5

Average age at which people aged 14–24 first smoked a full cigarette (2013, crude, NDSHS, uptake tables, Table 9.3)

17.8

22.7

17.8

28.3

Proportion of 12–17 year old secondary school students smoking at least a few puffs of a cigarette (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, uptake tables, Table 10.3

54.7

61.1

64.9

67.2

Proportion of persons (aged 18 or older) who have smoked a full cigarette (2013, crude,  NDSHS, uptake tables, Table 10.8)

2.5

3.4

2.5

3.7

Proportion of secondary school students (aged 12–17) who have smoked more than 100 cigarettes in their lifetime (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, transition tables, Table 2.3)

20.2

25.9

44.1

45.2

Proportion of young people (aged 18–24) who have smoked more than 100 cigarettes in their lifetime (2013, crude, NDSHS, transition tables, Table 2.6)

21.3

16.8

19.0

15.5

Quitting: Proportion successfully gave up for more than a month (2013, crude, NDSHS, cessation tables, Table 4.3)

29.2

34.2

31.7

32.9

Quitting, Proportion unsuccessful (2013, crude, NDSHS, cessation tables, Table 4.3)

46.3

48.0

47.4

45.2

Quitting: Proportion any attempt (2013, crude, NDSHS, cessation tables, Table 4.3)

35.2

36.3

36.1

36.0

Mean age at which ex-smokers aged 18 or older reported no longer smoking (2013, crude, NDSHS, cessation tables, Table 11.2)

53.1

51.5

46.3

45.0

The proportion of ever smokers aged 18 or older who did not smoke in the last 12 months (2013, crude, NDSHS, cessation tables, Table 12.3)

4.9

6.0

4.8

7.0

Proportion of secondary school students (aged 12–17) who were weekly smokers (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, established tables, Table 1.3)

6.9

9.3

6.8

10.4

Proportion of secondary school students (aged 12–17) who were monthly smokers (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, established tables, Table 13.3)

13.0

16.7

21.2

18.8

Proportion of adults aged 18 or older who are daily smokers (2014-15, crude, ABS NHS, established tables, Table 3.3)

10.9

7.8

2.9

n.p.

Proportion of smokers aged 18 or older who are occasional smokers (smoke weekly or less than weekly) (2014-15, crude, ABS NHS, established tables, Table 14.3)

40.1

44.7

42.3

52.7

Proportion of Aboriginal and Torres Strait Islander people aged 18 or older who are daily smokers (2012-13, crude, ABS Australian Aboriginal and Torres Strait Islander Health Survey 2012–13, established tables, Table 8i.3)

Source: http://www.aihw.gov.au/alcohol-and-other-drugs/data/ (sighted 11/7/17)
Note: Those estimates above with asterix have large standard errors and should be treated carefully.

Women in rural and remote areas were much more likely to smoke during pregnancy, with 28% of women in remote areas smoking during pregnancy, compared with 18-19% in regional/rural areas, and 9% in Major cities.

It is unclear whether exposure to environmental tobacco smoke varies by remoteness.

Young people outside major cities appeared to have their first cigarette at an earlier age (~15 years as opposed to ~16 years in Major cities.

Secondary school students in Inner regional (~23%) and remote (~28%) areas were more likely to have had at least a few puffs of a cigarette than those in major cities (~18%).

While 20% of young people in Major cities had smoked more than 100 cigarettes in their lifetime, 26%, 44% and 45% of young people in Inner regional, Outer regional and remote areas had done so.

People outside Major cities were as likely or slightly more likely to have attempted to quit smoking, but were less likely to be successful (and more likely to be unsuccessful).

A higher proportion of secondary students outside Major cities were weekly or monthly smokers (6%, 5% and 7% in IR, OR and remote areas versus 5% in Major cities weekly, 9%, 7%, and 10% in IR, OR and remote areas versus 7% in Major cities monthly).

Table 3: Current daily smoker, Aboriginal and Torres Strait Islander people 15+ years, by Remoteness, 2012-13

MC

IR

OR

R

VR

Crude Percent

Current daily smoker

36.2

40.9

39.8

47.4

51.1

Source: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument Table 2 (sighted 12/7/17)

Prevalence of smoking amongst Aboriginal and Torres Strait Islander people 15 years and older is around 35%-40% in Major cities and regional/rural areas, and close to 50% in remote areas. Note that while the pattern is similar in Table 2 and Table 3 above, the figures for 18+ and 15+ year olds are slightly different.

Smoking Trends

Table 4: Comparison of declines in smoking rate estimates across remoteness areas, people 18+, based on ABS NHS surveys, 2001 to 2011-12

Survey year

MC

IR

OR/Rem

Australia

Crude percent daily smokers

2001

21.9

21.9

26.5

22.4

2004-05

19.9

23.0

26.2

21.3

2007-08

17.5

20.1

26.1

18.9

2011-12

14.7

18.3

22.2

16.1

2014-15

13.0

16.7

20.9

14.5

Source: ABS National Health Surveys

From Table 4 above, rates of smoking have clearly declined in Major cities areas, but have been slower to decline in Inner regional and Outer regional/Remote areas. Rates of smoking in rural areas, apparently static last decade, now appear to be declining. Rates in Major cities and Inner regional areas have declined to 0.59 and 0.76 times the 2001 rates in these areas. The 2014-15 rate in Outer regional areas is 0.79 times the 2001 rate.

Figure 1: Daily smokers 18 years and older, 2007-08, 2011-12 and 2014-15, NHS

Figure 1: Daily smokers 18 years and older, 2007-08, 2011-12 and 2014-15, NHS

Source: ABS NHS http://www.aihw.gov.au/alcohol-and-other-drugs/data/ established tables, Table 3.3 (sighted 11/7/17)

Figure 2: Smokers 14 years and older, 2007, 2010 and 2013, NDSHS

Figure 2: Smokers 14 years and older, 2007, 2010 and 2013, NDSHS

Source: AIHW NDSHS http://www.aihw.gov.au/alcohol-and-other-drugs/data/ tobacco smoking table S3.12 (sighted 11/7/17)

Note: Smokers include daily, weekly and less frequent smokers.

Figures 1 and 2 above both show clear declines in Major cities and Inner regional areas, but the trend in Outer regional and Remote areas is less clear, with ABS data showing a decline in daily smoking rates for people aged 18+ between 2007-8 and 2014-15, but NDSHS data showing little change in smoking rates for people 14+ between 2007 and 2013.

Alcohol

Table 5: Alcohol risk status, by remoteness, 2013 and 2014-15

Alcohol consumption

MC

IR

OR/Rem

Exceeded 2009 NHMRC lifetime risk guidelines, people 18+, crude %, 2014-15 (a)

16.3

18.4

23.4

Exceeded 2009 NHMRC lifetime risk guidelines, people 15+, age standardised %, 2014-15 (b)

15.7

17.4

22.0

Exceeded 2009 NHMRC single occasion risk guidelines, people 18+, crude %, 2014-15 (a)

42.7

48.5

46

MC

IR

OR

R/VR

Abstainer/ex-drinker, crude %, 14+, 2013 (c)

23.1

18.9

20.5

17.5

Low lifetime risk, crude %, 14+, 2013 (c)

60.2

62

56.9

47.6

High lifetime risk, crude %, 14+, 2013 (c)

16.7

19.1

22.6

34.9

low single occasion risk, crude %, 14+, 2013 (c)

40.4

41.8

38.1

30.8

Single occasion risk less than weekly, crude %, 14+, 2013 (c)

23.5

24.4

23.6

22.8

Single occasion risk at least weekly, crude %, 14+, 2013 (c)

13

14.9

17.8

28.9

Sources:

Table 6: Alcohol consumption against 2009 NHMRC guidelines, Aboriginal and Torres Strait Islander people 15+ years, by Remoteness 2012-13

MC

IR

OR

R

VR

Percent

Exceeded lifetime risk guidelines

18.0

18.7

18.2

22.5

14.3

Exceeded single occasion risk guidelines

56.7

57.4

50.7

59.0

41.4

Source: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument Table 2 (sighted 12/7/17)

The figures in Table 6 are not strictly comparable with those for the total population in Table 5, because  Table 6 refers to people who are 15 years and older, while Table 5 refers to people who are 18 years and older.

The percentage of the 15+ ATSI population exceeding 2009 NHMRC Lifetime risk guidelines is around 15-20% with little apparent inter-regional variation, compared with, for the total population 18+,  16% in Major cities, increasing to 23% in Outer regional/remote areas.

The percentage of the 15+ ATSI population exceeding the 2009 single occasion risk guidelines is around 50-60%, and around 40% in Very remote areas, compared with, for the total population 18+,  40-50% in Major cities, rural and regional areas.

Alcohol trends

Table 7: Type of alcohol use and treatment for alcohol, by remoteness area (per 1,000 population)

MC

IR

OR

R/VR

single occasion risk (monthly) 2004

287

304

321

370

2007

285

292

312

437

2010

274

312

329

413

2013

250

273

315

422

lifetime risk 2004

200

215

234

262

2007

199

210

238

314

2010

189

225

251

310

2013

167

191

226

349

very high risk – yearly 2004

167

185

206

243

2007

172

183

206

288

2010

161

183

218

266

2013

151

166

194

258

very high risk – monthly 2004

77

84

104

130

2007

78

89

100

153

2010

79

94

113

154

2013

70

70

100

170

very high risk – weekly 2004

21

27

41

38

2007

24

28

24

50

2010

37

43

54

78

2013

27

28

38

70

Closed treatment episodes 2004–05

61

72

60

58

2007–08

76

84

80

129

2010–11

69

96

87

135

2013–14

68

79

93

155

Source: NDSHS,  http://www.aihw.gov.au/alcohol-and-other-drugs/data/  alcohol -supplementary data tables, Table S18

Notes:
Single occasion risk (monthly): Had more than 4 standard drinks at least once a month
Lifetime risk: On average, had more than 2 standard drinks per day
Very high risk (yearly): Had more than 10 standard drinks at least once a year
Very high risk (monthly): Had more than 10 standard drinks at least once a month
Very high risk (weekly): Had more than 10 standard drinks at least once a week

There is a clear increase in the prevalence of people who drink alcohol in such a way as to increase their single occasion risk (eg from car accident, assault, fall, etc) and their lifetime risk (eg from chronic disease – liver disease, dementia, cancer etc) as remoteness increases.

In 2013, single occasion risk ranged from 25% of people 14 years or older in major cities to 42% of people in remote areas, while lifetime risk increased from 17% in major cities to 35% in remote areas.

In 2013, The prevalence of people who drank more than 10 standard drinks in one sitting at least once per week, increased from just under 3% in Major cities to 7% in remote areas.

In 2013-14, there were just under 70 closed treatment episodes per 1,000 people living in Major cities, increasing to around 80 and 90 per 1,000 population in Inner and Outer regional areas, to 155 per 1,000 people living in remote Australia.

 

Illicit drug use 2013

Table 8: Illicit drug use, “recent users” 14+, 2013

MC IR OR remote

Crude percent

Cannabis

9.8

10.0

12.0

13.6

Ecstasy

2.9

1.5

1.6

*1.8

Meth/amphetamine

2.1

1.6

2.0

*4.4

Cocaine

2.6

0.8

*1.1

*2.5

Any illicit drug

14.9

14.1

16.7

18.7

Source: AIHW National Drug Strategy Household Survey, 2013. http://www.aihw.gov.au/alcohol-and-other-drugs/data/  Illicit drug use (supplementary) tables S5.6, S5.11, S5.17, S5.21, S5.26.

Note: * indicates large standard error (therefore some degree of uncertainty)

Illicit drug use appears to be higher in Outer regional and remote areas compared with Major cities and Inner regional areas, in large part due to higher rates of cannabis use in these areas, but with apparent lower use of ecstasy and cocaine in regional areas compared with Major cities.

 

Physical activity

Table 9: Physical inactivity, people 18+, 2014-15

MC

IR

OR/Remote

Percentage of people aged 18+ who undertook no or low exercise in the previous week (crude) (a)

64.3

70.1

72.4

Percentage of people aged 18+ who undertook no or low exercise in the previous week (age standardised) (b)

64.8

68.6

71

Sources:
(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) PHIDU (ABS NHS data) (http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas) sighted 18/7/2017

Note that level of exercise is based on exercise undertaken for fitness, sport or recreation in the last week.

Physical inactivity appears to be more prevalent with remoteness, increasing from 65% of people in Major cities to 71% in Outer regional/remote areas.

Table 10: Average daily steps, 2011-12

MC

IR

OR/Rem

Average daily steps, 18+ years, 2011-12 (a)

7,393

7,388

7,527

Average daily steps, 5-17years, 2011-12 (b)

9,097

9,266

9,160

Sources:

In 2011-12, adults living in Outer regional/Remote areas took slightly more steps than those living in Major cities or Inner regional areas, while the number of steps taken by children and adolescents in regional/Remote areas was slightly greater compared with those in Major cities.

Table 11: Average time spent on physical activity and sedentary behaviour by persons aged 18+, 2011-12

MC

IR

OR/Remote

Australia

Hours

Physical activity(a)

3.9

3.4

3.9

3.8

Sedentary behaviour (leisure only)(b)

29.3

28.0

27.9

28.9

Sedentary behaviour (leisure and work)(b)

40.2

35.2

36.0

38.8

Notes:
(a) Includes walking for transport/fitness, moderate and vigorous physical activity.
(b) Sedentary is defined as sitting or lying down for activities.

Source: ABS 2011-12 Australian Health Survey (Physical activity) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0042011-12?OpenDocument  Table 5.1

Adults living in Inner regional and Outer regional/Remote areas were about as likely as (or very slightly less likely than) those in Major cities to be sedentary in their leisure time, but appeared to be slightly less likely to be sedentary overall (ie their work involved a greater level of physical activity).

Table 12: Whether children aged 2-17 years met physical and screen-based activity recommendations, 2011-12

MC

IR

OR/Rem

Crude percentage

Met physical activity recommendation on all 7 days(a)(b)

27.5

34.3

34.2

Met screen-based activity recommendation on all 7 days(b)(c)

28.0

29.7

31.0

Met physical activity and screen-based recommendations on all 7 days (a)(b)(c)

9.7

10.9

14.2

Notes:
(a) The physical activity recommendation for children 2–4 years is 180 minutes or more per day, for children 5-17 years it is 60 minutes or more per day. See Physical activity recommendation in Glossary.
(b) In 7 days prior to interview.
(c) The screen-based recommendation for children 2–4 years is no more than 60 minutes per day, for children 5-17 years it is no more than 2 hours per day for entertainment purposes.

Source:
ABS 2011-12 Australian Health Survey (Physical activity) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0042011-12?OpenDocument  Table 14.3

Children in rural and regional Australia appeared more likely (34% vs 28%) to meet physical activity recommendations and slightly more likely (30%vs 28%) to meet screen-based activity recommendations than their Major cities counterparts.

 

Fruit and vegetable consumption

Table 13: Fruit and vegetable consumption, people 18+ years, by remoteness, 2014-15

MC

IR

OR/Remote

Crude Percentage

Inadequate fruit consumption(a)

50.0

50.6

51.2

Inadequate fruit consumption(b)

50.4

48.3

48.0

Inadequate vegetable consumption(a)

93.4

93.5

89.3

Inadequate vegetable consumption(b)

n.p.

n.p.

n.p.

Sources:
(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) PHIDU (ABS NHS data) (http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas) sighted 18/7/2017

Note that adequacy of consumption is based on comparison with 2013 NHMRC guidelines.

Half of adult Australians eat insufficient fruit, with little clear difference between major cities and regional/rural areas.

Around 90% of adult Australians ate insufficient vegetables, with little clear difference between major cities and regional/rural areas.

Table 14: Fruit and vegetable consumption, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

MC

IR

OR

R

VR

Crude Percent

Inadequate daily fruit consumption (2013 NHMRC Guidelines)

59.0

60.6

56.9

54.9

49.1

Inadequate daily fruit consumption (2003 NHMRC Guidelines)

62.1

63.6

59.8

58.3

51.6

Inadequate daily vegetables consumption (2013 NHMRC Guidelines)

95.9

93.5

93.6

94.5

97.9

Inadequate daily vegetables consumption (2003 NHMRC Guidelines)

93.8

90.6

90.5

91.2

96.1

Source: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument Table 2 (sighted 12/7/17)

Roughly 60% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate fruit intake, closer to 50% in remote areas (compared with around 50% of all Australians 18+ in major cities and regional/rural areas).

Roughly 95% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate vegetable intake, perhaps higher (98%) in Very remote areas (compared with around 90%-94% of all Australians 18+ in major cities and regional/rural areas).

 

 

Overweight and Obesity

Table 15: Overweight and Obesity, people 18+ years, by remoteness, 2014-15

MC

IR

OR/Remote

Crude Percentage

Persons, overweight/obese (a)

61.1

69.2

69.2

Age standardised percentage

Males overweight (b)

43.8

41.1

34.3

Males obese (b)

25.8

33.1

38.2

Females overweight (b)

28.9

28.3

30.1

Females obese (b)

25.0

32.4

33.7

People  overweight (b)

36.2

34.4

31.4

People obese (b)

25.4

32.6

35.8

Sources:
(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) ABS NHS http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas

Adults in rural/regional areas are more likely to be overweight or obese than people in Major cities (69% vs 61%).

However, there were inter-regional BMI and gender differences:

  • Compared with those in Major cities, males in Inner regional and especially Outer-regional areas were less likely to be overweight (41% and 34%, vs 44%) but much more likely to be obese (33% and 38% vs 26%).
  • Compared with those in Major cities, females in Inner regional and Outer-regional areas were about as likely to be overweight (~29%) but much more likely to be obese (~33% vs 25%).

 

Table 16: Overweight and Obesity, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

MC

IR

OR

R

VR

Crude Percent

Overweight

27.5

28.8

30.1

32.5

26.4

Obese

37.9

41.3

36.2

33.1

32.3

Overweight/obese

65.4

70.1

66.2

65.6

58.8

Aboriginal and Torres Strait Islander people in rural/regional and Remote areas (29%-33%) were a little more likely to be overweight than those in Major cities (28%), with those in Very Remote areas (26%) least likely to be overweight.

Aboriginal and Torres Strait Islander people in Inner regional areas (41%) were more likely to be obese than those in Major cities (38%), but those in Outer regional (36%) and remote areas (~33%) were less likely to be obese.

Overall, Aboriginal and Torres Strait Islander people in Inner Regional areas were most likely to be overweight/obese (70%), those in Major cities, Outer Regional and Remote areas were less likely to be overweight/obese (~66%), while those in Very Remote areas were the least likely to be overweight/obese (59%).

These figures compare with 61% – the prevalence of overweight/obesity for (predominantly non-Indigenous) people living in Major cities.

 

High blood pressure

Table 17: High blood pressure, people 18+, by Remoteness, 2014-15

MC

IR

OR/Remote

Percentage

Crude % (a)

21.9

27.1

24

Age standardised % (b)

22.7

24.6

22.1

Sources:

(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) ABS NHS http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas

Age for age, people in rural/regional Australia appeared to be as likely, or very slightly more likely to have high blood pressure than their counterparts in Major cities (~23% vs ~24%). However, because people in rural/regional areas are older (on average), the prevalence of people with high blood pressure is higher (~26% vs 22%) than

Updated 31/07/2017
To view archived Risk Factors click here

NACCHO Aboriginal Remote Health : Governments urged to fund dialysis treatment in remote communities

 ” The premature death of Dr G Yunupingu could have been prevented if recommended funding models for dialysis services were already in place, his doctor has said.

With a new funding model to increase the service in remote communities currently under consideration, Dr Paul Lawton urged swift government action to assist in Yunupingu leaving a legacy.

He had been in Darwin for dialysis services because there was no service for him in his home community of Galiwink’u, on Elcho Island. His situation was a high profile example of the growing urgent circumstances for remote-living Indigenous renal patients.

Lawton said there had been a lot of work done in recent years – particularly by Miwatj Health and central Australia’s Purple House – to increase on-country dialysis support, including self-operated dialysis on Elcho Island.

The kidney specialist said G Yunupingu – like Dr M Yunupingu who died in 2013 – advocated for better health outcomes and options for Indigenous people, and both would be proud to leave a legacy if their stories prompted change. ”

Reports Helen Davidson from Darwin writing in the Guardian  See Full report Part 1 Below

The case for change

Aboriginal and Torres Strait Islander people experience disproportionate levels of CKD regardless of urban, region or rural locality. Compared with the general population, Aboriginal and Torres Strait Islanders are four times more likely to have CKD and develop ESKD

In remote and very remote areas of Australia, the incidence of ESKD for Aboriginal and Torres Strait Islander people is especially high with rates almost 18 times and 20 times higher than those of comparable non-Indigenous peoples.

The greater prevalence of CKD in some Aboriginal and Torres Strait Islander communities is due to the high incidence of risk factors including diabetes, high blood pressure and smoking, in addition to increased levels of inadequate nutrition, alcohol abuse, streptococcal throat and skin infection and poor living conditions.

See Kidney Health Australia Recommendation

Download full Budget submission Kidney Health Australia

3. Investing in appropriate patient support services in remote and regional locations

In remote areas, 78% of patients have to relocate to access dialysis or transplant services, compared with 39% of those who live in rural areas and 15% of urban Indigenous ESKD patients.

Separation from country creates significant biological, psychological, social and economic consequences on the health and wellbeing of consumers, their families, communities the wider health and welfare system.

At present, there is inadequate support for Aboriginal and Torres Strait Islander patients to assist and support the renal pathway journey, including emotional and social support.

Incidence of new Indigenous patients starting kidney replacement therapy. 2010-2014

A Patients Opinion

” One possible solution is to explore the possibility of using the Kimberley Aboriginal Medical Services (KAMS) plane which arrives every Friday from Broome with medicines for the clinic, and transports nurses in and out.

Why can’t some of our mob go on that plane for appointments, so avoiding all those hours of travel, especially for our elderly?

My wife also suffers from serious kidney issues. We have been told that renal dialysis is the next step. This will involve twice weekly dialysis which would be done in Broome. For this treatment, we will be expected to leave our family, “country” and home to live in Broome, over 1000 kilometres away.”

I am an Aboriginal man living in the remote desert area of Mulan Aboriginal Community in the Tanami Desert. see Health Authority responses below part 2 

See also :  Indigenous health organisations unite to improve remote dialysis treatment 

Part 1 :Dialysis funding could have prevented Dr G Yunupingu’s death, says doctor

The musician’s doctor says his premature death would have been prevented if he could have been cared for on his home island

The 46-year-old Gumatj musician and singer from remote Arnhem Land died in Royal Darwin hospital last Tuesday, after battling kidney and liver illnesses.

He had been in Darwin for dialysis services because there was no service for him in his home community of Galiwink’u, on Elcho Island. His situation was a high profile example of the growing urgent circumstances for remote-living Indigenous renal patients.

Media reports aired questions about how Yunupingu spent his last days before being hospitalised, but his doctor Paul Lawton said Yunupingu was in control of his health decisions even if they weren’t always on his doctor’s terms, and suffered being away from home.

The kidney specialist said G Yunupingu – like Dr M Yunupingu who died in 2013 – advocated for better health outcomes and options for Indigenous people, and both would be proud to leave a legacy if their stories prompted change.

“Of course he would have been much happier not to have to have a legacy but to be home supported by family on Elcho Island. He may be alive today if that were possible,” he said.

“It could have been possible if there was a funding model that allowed that to happen. Such a funding model has been proposed, and it needs to be supported and agreed to by the minister forthwith.”

Indigenous Australians suffer kidney disease at rates up to 50 times that of non-Indigenous people. The rate of end-stage kidney disease is seven times higher for Indigenous people, and in very remote communities it is 30 times higher.

The number of people at end-stage is growing annually, forcing large numbers to travel into town centres for care, away from family, country, and culture.

“Every person from a remote community … when they end up in renal failure and have to start dialysis, the first thing people want to know is when and if they can get home and if they can receive treatment close to home,” Lawton said. “Dr Yunupingu was no different.”

In 2015 the federal government launched a review of more than 5,700 items on the Medicare Benefits Scheme to determine how they can be “aligned with contemporary clinical evidence and practice and improve health outcomes for patients”.

The review is led by expert panels exploring different areas of health, and has no mandate to find savings.

The expert panel on renal health has published its recommendations, including a new MBS item to provide dialysis in very remote areas by nurses, Aboriginal health practitioners and health workers.

The report noted the likelihood of direct costs of providing staffed dialysis services in very remote areas being much higher, but said no studies so far had considered the broader impact of relocating for treatment.

“It has undeniable social, economic and health consequences,” the report countered. “As a result of these social and economic costs, relocated patients often miss treatments, which has a negative impact on health outcomes.

“As requirements for dialysis can extend over many years, it makes sense to provide services where people live, have support and can continue to contribute to their communities.”

The report is open for public comment, and according to the department of health a final report will be delivered to the minister in December this year.

“It’s a big step forward potentially but one of the challenges in bureaucracies is that sometimes these things spend a lot of time going around in circles,” Lawton said.

Lawton said there had been a lot of work done in recent years – particularly by Miwatj Health and central Australia’s Purple House – to increase on-country dialysis support, including self-operated dialysis on Elcho Island.

“But unfortunately we weren’t able to get him home to Elcho Island because supported dialysis is not available. And clearly a blind man can’t do dialysis themselves.”

PART 2

Access To Specialist Healthcare in the Kimberley For Desert People.

I am an Aboriginal man living in the remote desert area of Mulan Aboriginal Community in the Tanami Desert. I live with my elderly wife and extended family. Mulan is our home.

For people living in very remote communities such as ours, English is a second or third language. Communication with mutual understanding is vital.

I’m sharing this story about our recent healthcare experiences so that frail persons don’t suffer as my wife did.

Recently my wife required a cardiac appointment in Broome.

This involved a morning flight from Mulan to Halls Creek; waiting for the Greyhound bus; then leaving at 10pm that evening to ride to Broome (8 hours to the west). All this was booked through the Patient Assisted travel Scheme office (PATS).

After her appointment my wife was left in Broome with no money, no return bus fare and no accommodation. She spent the night homeless. My wife was rescued by the local police who recognised she was hypoglycaemic and took her to Broome Hospital where she was stabilised.

With the help and intervention of a friend, PATS was contacted and a return bus fare was organised for that evening to Halls Creek where my wife was hospitalised for three days waiting for a flight back to Mulan. This could have been avoided with better planning, travel, accommodation and effective communication.

One possible solution is to explore the possibility of using the Kimberley Aboriginal Medical Services (KAMS) plane which arrives every Friday from Broome with medicines for the clinic, and transports nurses in and out.

Why can’t some of our mob go on that plane for appointments, so avoiding all those hours of travel, especially for our elderly?

My wife also suffers from serious kidney issues. We have been told that renal dialysis is the next step. This will involve twice weekly dialysis which would be done in Broome. For this treatment, we will be expected to leave our family, “country” and home to live in Broome, over 1000 kilometres away.

Kidney disease is a major health concern in our communities. My point is why can’t we have a dialysis machine in Balgo – our biggest community in the desert, 30 minutes from my community? This would reduce the number of patients and their carers travelling to a major town, so avoiding a lot of financial and other social situations. I know there are renal machines in other communities – it makes sense! In the long run, the money spent on transferring our mob across the Kimberley would surely pay for a machine and staff.

My wife will require ongoing medical care. Yet her experience is part of a much larger story where our younger people (who escort loved ones to towns for treatment) are subject to the vices a town offers. In going to town, many of them get lost from their cultural identity. Having services in country closer to home and keeping our families in community helps to avoid these social issues.

I hope that sharing our story will result in more effective planning and improved services in the future.

Response 1 to Mulan Man

Dear Mulan Man,

Firstly I want to apologise again for your wife’s experience in Broome. It was very good of your friend to notify us of your wife’s situation at the time, and I am pleased the PATS officer on the day was able to make contact with your wife and her escort to provide them with some refreshments and return tickets to Halls Creek. You are right, there was a communication issue in the arrangement of this trip, as the PATS staff had expected your wife to return to the PATS office directly after her appointment to retrieve her return ticket, but this was clearly not your wife’s expectation. We will work to improve this communication.

I would also like to thank you very much for engaging with us in this forum to share your story, which was clearly distressing, and yet also includes suggestions for improvement. Your story is a great example of what a forum like this can bring to the planning and delivery of health services.

The WA Country Health Service aims to provide care closer to home, where this is safe and feasible. We need to hear from the people living in communities like yours to be able to gain a real appreciation of the challenges you face, and work to ease your access to our services, either by better travel arrangements, or bringing the care closer to you.

Where possible, in new remote clinic builds or funded remote clinic refurbishments, we are ensuring there is the capacity for a dialysis room to accommodate home dialysis therapy on country. Examples of this are Wangkatjunka and Looma remote clinics. There are Renal Dialysis Hostels being built or already built in Kununurra, Fitzroy Crossing, Derby and Broome, to ease the burden of accommodation when people do need to attend the dialysis centres in those towns. WA Country Health Service is also developing a Renal Health Strategy, and will continue to work in close partnership with our renal service delivery providers.

I agree there are also opportunities for us to work more cohesively with other agencies in the Kimberley in undertaking the logistics of moving our consumers, equipment and those delivering care around the region. You have provided some very logical suggestions to resolve the issues you raised, and we would like to arrange to meet with you, and members of your community, to further identify the barriers you face accessing health care and your suggested solutions to those barriers.

You can contact me to discuss how to arrange this meeting. The other signatories to this reply will also attend to engage with you and your community.

Margi Faulkner, Broome Hospital Operations Manager

Dr David Gaskell, Kimberley Regional Medical Director

Carmen Morgan, Kimberley Regional Director of Nursing and Midwifery

Response 2

Dear Mr Mulan Man

We’ve had opportunity to talk together recently which I’ve valued.

Thanks to your help, I want to share here some of the changes we’ve made in improving our health services.

As you know, the Patient Assisted Travel Scheme (PATS) provides travel and accommodation subsidies to patients for whom specialist care is not locally available.

PATS is State-funded with one policy for all WA. All PATS staff are required to follow these State-wide rules. They seek to ensure a safe and planned journey when transporting clients from home to a health service and back.

PATS policy ensures that vulnerable patients can choose a family member as escort to accompany them. This escort is responsible for assisting the patient throughout the journey. Roles include assistance in communication, physical support, need for encouragement, and help with cultural needs. You have pointed out that some aboriginal people speak other languages more fluently than English (like Kukutja). PATS staff seek to identify need for a translator and so make necessary arrangements.

Yet there are many variables beyond our control which create uncertainty – like phone coverage, bus and plane operations, timings, the conduct of the escort and other people, or the weather. For the patient, navigating all this uncertainty only compounds the stress of suffering and separation from home. Of all this, I am mindful.

So, in response to the first part of your story, have we done anything to improve the provision and quality of our PATS services?

Yes, we have made several improvements. Here’s the current situation:

The PATS booking service has been increased from 5 days to every day of the week, from 0800hrs to 1600hrs, by phone or email. This ensures that, every day, a PATS officer is able to make a booking or assist a patient with their journey. We have extended the Aboriginal Liaison Officer (ALO) service from 5 days to every day of the week. ALO hours have been extended also. Broome now has 5 positions. Between them, they work every day, including weekends, from 0630 to 2200 hours. As this period covers the arrival and departure times of all scheduled Greyhound bus and plane services, an Aboriginal Liaison Officer is present to meet clients from their plane or bus and assist them with their onward journey. So transport home can be booked, our Aboriginal Liaison Officers inform all transiting clients to present to the PATS Front Office. With arrangements in place, patients return to and wait in the transit lounge. From there, an officer takes them to the bus or plane on time. Remoter health facilities do not have a PATS Office, of course, so the PATS team works closely with local staff to ensure that travel planning and documentation are explained clearly and in person to clients. A spare seat on the KAMS (Kalamunda Aeronautical Model Society) plane, when available, has been allocated to PATS clients and will be used for this purpose in the future. A major development just pre-dating your post was that WACHS Kimberley secured the Skippers Charter Plane service from Broome to Halls Creek via Fitzroy Crossing, 3 times weekly. This flight schedule had been at risk of closure.

Thanks for your engagement on and off line. I think that being in closer touch makes so much difference. I’m aware that your wife had an awful experience not long ago. I hope that she gains some peace of mind in knowing that you sharing her story has led to improvements which will help other patients on their travels to and from health care.

Regarding the need for dialysis care closer to home, we have spoken together. I need to post this now yet I wish to reassure you here that the ‘bigger picture’ is being looked at by all the key agencies – WA Department of Health, WA Country Health Service, Kimberley Aboriginal Medical Services overseeing the Kimberley Renal Service, and our visiting specialists from Royal Perth Hospital. Much thought and planning are going in to improving the delivery of quality-assured services closer to home. In the township of Fitzroy Crossing, for example, a new Renal Health Centre is soon to open with 4 dialysis chairs. Yet there are many communities (as in your desert community of Mulan in the Kutjungka) without access to a haemodialysis service nearby. We are acutely aware. All of us Kimberley Health providers want to deliver the State Government’s commitment to have a mobile dialysis unit operate here in the dry season, as soon as possible. This will allow dialysis patients to go home for a while so they can re-connect with family and friends on Country. Given the right resources, this will be delivered. I will keep in touch.

Would it be helpful if we meet together? If you would like this, if privileged to be invited, I will come to your Country soon.

With best wishes to you and your wife,

David

Dr David Gaskell

a/Regional Director, Regional Medical Director

WA Country Health Service, Kimberley

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Northern Territory to improve antenatal care in the Aboriginal population.

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

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

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

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

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

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

1.Chronic Conditions

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

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

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

2.Health Determinants and Risk Factors

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

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

3.Health Services Research

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

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

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

4.Policy Research and Evaluation

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

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

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

5.Workforce and Capacity Building

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

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

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

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

Part 2 World-class focus on boosting remote health

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

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

From the Australian July 5

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

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

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

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

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

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

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

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

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

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

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

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

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

Part 3 Alice Springs: the Red Centre of medical innovation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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