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

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

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

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

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

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

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

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

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

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

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

She was desperate and broken.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

From Natasha Robinson The Australian October 24 Continued Part 1 below

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

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

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

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

From the AIHW Report see Part 2 Below

Download full report HERE

Rural & remote health

Part 1 The Australian media report 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Part 2

Profile of rural and remote Australians

See AIHW Online version HERE

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

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

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

72% in Major cities

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

President of the AMA Dr Tony Bartone opening speech

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

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

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

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

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

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

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

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

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

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

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

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

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

We all know that this approach does not work.

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

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

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

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

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

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

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

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

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

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

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

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

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

This is demonstrated through:

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

 See all NACCHO and AMA Articles HERE 

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

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

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

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

See Coalition of Peaks Press Release this week

But this is not enough.

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

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

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

This must change. It has to change.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Findings from this report:

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

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

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

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

See AIHW detailed Interactive site locations map HERE

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

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

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

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

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

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

Read full report and all data HERE

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

Indigenous primary health services

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

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

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

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

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

At a glance

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

Key messages

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

See this AIHW detailed Interactive site locations map HERE

  1. Organisations made on average nearly 13 contacts per client

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

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

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

Nurses and midwives were the most common type of health worker (14% of employed staff), followed by Aboriginal and Torres Strait Islander health workers and practitioners (13%) and doctors (7%). Nurses and midwives represented a higher proportion of employed staff in Very remote areas (22%).

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

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

 

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

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

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

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

Download aihw-bod-22

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

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

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

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

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

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

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

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

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

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

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

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

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

Reports

Table of contents

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

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

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

 

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

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

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

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

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

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

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

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

Written by Melissa Sweet for The Guardian

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

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

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

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

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

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

Renee Blackman interviewed by NACCHO TV in 2016

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More info HERE 

NACCHO Acting Chair, Donnella Mills

A multiplier effect

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

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

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

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

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

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

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

An unfair burden

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

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

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

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

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

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

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

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

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

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

A big silent killer’

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NACCHO Aboriginal #Vote1RuralHealth #VoteACCHO #AusVotesHealth : Major health groups @NRHAlliance @amapresident @RuralDoctorsAus express concern over lack of #Election2019 focus on #RuralHealth #RemoteCommunities

“ We have a crisis in rural Australia – health outcomes have not improved and we continue to see measurable disparities in levels of access to health care and health outcomes.

I note that yesterday the Australian Medical Association and the Rural Doctors Association of Australia raised similar concerns. They’re concerned about the lack of a comprehensive plan to boost the rural medical workforce and staffing levels in hospitals and health services.”

Mark Diamond  CEO National Rural Health Alliance See full press release PART 1

“It is inconceivable that millions of Australians who experience higher incidence of the drivers of chronic disease could be overlooked.

People in rural, regional, and remote Australia face many obstacles when they require access to the full range of quality medical and health services.

There are shortages of doctors and other health professionals.

It is harder to access specialist services such as maternity and mental health.

And country people often have to travel to capital cities and large regional centres for vital services such as major surgery or cancer care.”

We need to see tailored and targeted policies to address these inequities.

Rural Australians deserve nothing less.”

AMA President, Dr Tony Bartone, said today that rural Australians are still waiting to hear major announcements from the major parties to address the serious and specific health needs of rural and remote communities. See Part 2 Below

“ With less than two weeks left to go until polling day, rural doctors are calling out the major parties on their absence of a comprehensive plan to boost the rural medical workforce.

This is a cone of silence that Maxwell Smart would be proud of

There continues to be a massive maldistribution of doctors and other health professionals between urban Australia and the bush, yet this critical issue remains largely overlooked. “

President of the Rural Doctors Association of Australia (RDAA), Dr Adam Coltzau

NACCHO has developed a set of policy  10 #Election2019 recommendations that if adopted, fully funded and implemented by the incoming Federal Government, will provide a pathway forward for improvements in our health outcomes.

The current health outcomes for Aboriginal and Torres Strait Islander people are unacceptable. 65% of Indigenous people live in rural Australia.

We are calling on all political parties to include these 10 recommendations in their election platforms and make a real commitment to improving the health of Aboriginal and Torres Strait Islander peoples and help us Close the Gap.

Our ACCHO TOP 10 key asks of a new Federal Government

Read all the 10 Recommendations HERE

Part 1

A chorus of concern over the major parties’ failure to focus on rural health issues in the election campaign is growing, the National Rural Health Alliance says.

The peak body for rural, regional and remote health says the 7 million people living in rural Australia have been unable to discern what the big health policy announcements mean for them.

“Nor has there been a specific focus by the Liberal-Nationals Coalition and Labor on how access to health and preventive health services will be improved for them,” CEO Mark Diamond said.

“We have a crisis in rural Australia – health outcomes have not improved and we continue to see measurable disparities in levels of access to health care and health outcomes.

“I note that yesterday the Australian Medical Association and the Rural Doctors Association of Australia raised similar concerns. They’re concerned about the lack of a comprehensive plan to boost the rural medical workforce and staffing levels in hospitals and health services.

“The Greens have acknowledged that they recognize the significance of health care in rural areas and have issued a specific rural health statement which I commend them for.

“And yesterday, the Independent candidate for Indi, Helen Haines, joined the call for a boost to the allied health professions taskforce.

“Getting more allied health professionals into rural Australia is vital to address the chronic inequality of access to health services.

“This is a key part of the National Rural Health Alliance’s 2019 Election Charter.” (See www.ruralhealth.org.au/election19)

The NRHA is calling for

  • An additional 3000 Aboriginal Health Workers and practitioners
  • Increased funding for Aboriginal Community Controlled Health Organisations (Labor has committed some funds for this)
  • An additional 3000 allied health positions
  • Trials created in 20 rural and remote sites to test for the best workforce models
  • A community grants program that communities can apply to for funds for better digital infrastructure so they can access healthcare online
  • Medicare rebates for online or telehealth consults to people in outer regional, remote and very remote areas
  • A special Mission for Rural Health created in the Medical Research Future Fund that is allocated a share of the fund proportionate to the population in rural Australia (28% = $360m)
  • A commitment to endorse the Uluru Statement and establish a Makarrata Commission for the sake of the nation’s wellbeing

Mr Diamond said parties must show they can govern for all of Australia, not just cities.

With 28% of the population and 7 million people, it’s important that all parties represent the interests of people in country areas. Rural health matters.

Part 2

AMA President, Dr Tony Bartone, said today that rural Australians are still waiting to hear major announcements from the major parties to address the serious and specific health needs of rural and remote communities.

Dr Bartone said it is surprising and disappointing that rural health remains largely neglected this far into the election campaign.

“It is inconceivable that millions of Australians who experience higher incidence of the drivers of chronic disease could be overlooked,” Dr Bartone said.

“People in rural, regional, and remote Australia face many obstacles when they require access to the full range of quality medical and health services.

“There are shortages of doctors and other health professionals.

“It is harder to access specialist services such as maternity and mental health.

“And country people often have to travel to capital cities and large regional centres for vital services such as major surgery or cancer care.

“We need to see tailored and targeted policies to address these inequities. Rural Australians deserve nothing less.”

Dr Bartone said that there will be some flow-on to rural Australia from the policies already announced by the major parties, including public hospital funding, new PBS drugs, the Government’s Rural Generalist Pathway medical training initiatives, and Labor’s cancer and seniors’ dental plans, but there are still major gaps.

“It is staggering that there was very little mention of rural health during last week’s Health Debate at the National Press Club,” Dr Bartone said.

“The situation is critical.

“Rural communities need real investment in medical infrastructure and incentives to attract more permanent doctors.

“Country towns are seeing medical services closed on them with no other options provided.

“Rural maternity services are deteriorating. Earlier this year, expectant mothers in Queensland were sent DIY birthing kits because their nearest birthing unit was too far to get to.

“Many communities are struggling with few or no doctors, and many doctors will be looking to retire in the coming years with no one there to take over for them.

“In a recent AMA poll, the top priority for our rural doctors was extra funding and resources for hospitals to support improved staffing levels, including core visiting medical officers, to allow workable rosters.

“The pressure on public hospital staff and resources is felt even more acutely in rural, regional, and remote areas.

“Training the next generation of rural doctors is a major priority. We need strategic policies that support students from rural backgrounds to study medicine.

“We want to see investment in programs that create positive training experiences for prevocational doctors in rural areas.

“We need to support these students to complete their training rurally so that they can choose to stay to live and work in rural areas and deliver the care these communities need.

“Rural Australian families need the confidence and comfort of being able to see a doctor or other health professional when they need care or advice, and to be able to get to hospital when they are sick or injured.

“It is not too late for the major parties to provide rural Australians with that security.”

The AMA’s Key Health Issues for the 2019 Federal Election calls on the major parties to:

  • provide funding and resources to support improved staffing levels and workable rosters for rural doctors, including better access to locum relief and investment in hospital facilities, equipment, and practice infrastructure;
  • expand the successful Specialist Training Program to 1,400 places by 2021, with higher priority being given to training places in regional and rural areas, generalist training, and specialties that are undersupplied;
  • fund a further 425 rural GP infrastructure grants of up to $500,000 each;
  • provide additional funding/grants to individual GPs and practices to support nonvocationally registered doctors to attain fellowship through the More Doctors for Rural Australia Program; and
  • support further reforms to medical school selection criteria for Commonwealth supported students; and introduce changes to the structure of courses so that the targeted intake of medical students from a rural background is lifted from 25 per cent of all new enrolments to one-third of all new enrolments, and the proportion of medical students required to undertake at least one year of clinical training in a rural area is lifted from 25 per cent to one-third.

The AMA’s health policy wish list – Key Health Issues for the 2019 Federal Election – is available at https://ama.com.au/article/keyhealthissues2019federalelection

 

Part 3 Rural doctors urge parties to “Get Smart”  on rural health workforce plan

With less than two weeks left to go until polling day, rural doctors are calling out the major parties on their absence of a comprehensive plan to boost the rural medical workforce.

“This is a cone of silence that Maxwell Smart would be proud of”

President of the Rural Doctors Association of Australia (RDAA), Dr Adam Coltzau, said.

“There continues to be a massive maldistribution of doctors and other health professionals between urban Australia and the bush, yet this critical issue remains largely overlooked.

“Yes, there has been funding committed by both the Coalition and Labor to kick-start a National Rural Generalist Pathway, and this is very welcome – but if the major parties think that the Pathway will be the panacea for the shortage of doctors and other health professionals in the bush, they are sadly mistaken.

“The Pathway needs to be just one component of a much wider rural health workforce strategy – one that not only delivers more Rural Generalist doctors to the bush, but also more GPs, specialists, nurses, midwives and allied health professionals.

“The challenges of accessing health services in rural areas have not been resolved, and will require the incoming government to ‘get smart’ in improving this.

“It will require a practical, big picture strategy, not just tinkering at the edges.

“It will require the incoming government to invest in more training places in the bush, so newly-minted doctors are able to access the training they need in their intern and junior doctor years.

“There is real opportunity for rural hospitals, rural general practices and other rural health settings to meet the growing demand for junior doctor training, and to keep these doctors in the bush – but the right supports will be needed to make this happen.

“More also needs to be done to increase the capacity for regional training opportunities in non-GP Specialist training and Advanced Skills posts.

“These places are largely controlled by the specialist colleges, and it is virtually impossible for young doctors to access this training outside metropolitan areas or very large regional centres.

“This makes it very difficult for those doctors who want a career as a non-GP specialist in rural Australia to follow that path.

“The lack of commitment from the major parties to fix the rural health workforce crisis is a major black hole in the election campaign – and it needs urgent attention before polling day.”

 

 

NACCHO Aboriginal #Rural #Remote Health #VoteACCHO  #Vote1RuralHealth #AusVotesHealth : With 65% of Indigenous people living in rural Australia @NRHAlliance prioritises our mobs health

” The National Rural Health Alliance (NRHA) has named four key areas an incoming Federal Government must address to help rural Australians get healthier and live longer.

The nation’s peak body for rural, regional and remote health has also listed in detail what needs to be done in each area.

The four areas are:

1.Improving the health of Indigenous Australians

2.Boosting the supply and distribution of allied health care workers in rural, regional and remote areas

3.Creating a greater research focus on factors affecting rural health;

4.Developing a new National Rural Health Strategy.

NRHA CEO Mark Diamond says much needs to be done so everyone in Australia enjoys better health. Currently those living beyond major cities carry 1.3 times the cost, mortality and disability associated with illness and disease. See full Press Release Part 1 below

 ” The body representing 37 rural health organisations has urged the next government to endorse the Uluru Statement from the Heart and establish a “voice” to federal parliament as its No 1 priority to improve Indigenous health.

Launching its election charter at Parliament House, National Rural Health Alliance chair Tanya Lehmann said Australia needed to start tackling problems impacting on people’s health — problems that would not be fixed by more doctors or technology.

Connection to country, spiritual wellbeing, overcoming intergenerational trauma are central to the health of indigenous Australians,”

NRHA Chair Tanya Lehmann told The Australian. see full article Part 4 below

Download the NRHA 9 Page PDF #Election2019 Charter Document HERE

Rural Health Matters 2019 Election Charter FINAL_1

Part 1 Priority 1. Improve Indigenous health

The current health outcomes for Aboriginal and Torres Strait Islander people are unacceptable. (65% of Indigenous people live in rural Australia.)

We seek a commitment from an incoming government to

  1. Endorse the Uluru Statement from the Heart and the Makarrata, ie establish a First Nations Voice in the Australian Constitution and establish a Makarrata Commission to supervise a process of agreement-making between governments and First Nations and truth-telling about our history.
  2. Fund an additional 3000 Aboriginal Health Workers and practitioners. ($180m over 4 years; $180m per year ongoing)
  3. Increase base funding of Aboriginal Community Controlled Health Organisations.
  4. Eliminate Rheumatic Heart Disease. Get serious about meeting targets set under the END RHD program. ($170m over 4 years.)

See Rationale Part 3 Below  

Fund an additional 3000 Aboriginal Health Workers and practitioners. ($180m over 4 years; $180m per year ongoing)

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

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

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

NACCHO Acting Chair, Donnella Mills

Visit NACCHO for more info

Part 2 :  NRHA CEO Mark Diamond says much needs to be done so everyone in Australia enjoys better health. Currently those living beyond major cities carry 1.3 times the cost, mortality and disability associated with illness and disease.

“We are looking for commitments from all sides of politics as we go into this election not only to fund immediate needs but to take a long-term strategic view for the sake of the future of the seven million people living outside major cities.

“We need a new National Rural Health Strategy. The previous strategy was based on a framework endorsed by the COAG Health Council in 2011.

“It’s use and effectiveness has not been evaluated since and we need to understand how widely that framework or guide for decision-making in planning and delivering effective and better health care and health promotion services is being used and what, if anything, needs to change.

“In short, we need to prepare a new National Rural Health Strategy for the approaching third decade of the 21st century to ensure all governments and health care service providers are pulling in the same direction when it comes to rural health.”

Mr Diamond says that if people living in rural, regional and remote areas had the same mortality rates as people living in major cities, there would have been almost 20,000 fewer deaths, according to Australian Institute of Health and Welfare data for 2009-2011.

“In these areas, coronary heart disease, chronic obstructive pulmonary disease, transport accidents, diabetes, lung cancer and suicide – all preventable conditions – killed 11 more people a day compared with metropolitan areas.

“This situation is unfair and untenable. All that is required is the political will to fix it. In the lead up to this 2019 Federal election we are keen that voters, candidates and political parties understand what it will take for an incoming government to provide good healthcare and health promotion for all regardless of where they live.”

Over the next four weeks the NRHA will roll out more detail on what it is asking of Australia’s next Federal Government. To learn more, check www.ruralhealth.org.au/election19

The NRHA represents all professions and services dedicated to helping rural Australians get health care and health promotion services. Among them are nurses, physiotherapists, doctors, pharmacists, paramedics, surgeons and other allied health professionals. Its 37 members include national organisations representing those professions and other bodies such as NACCHO ,the Country Women’s Association of Australia, the Isolated Children’s Parents’ Association and the Royal Flying Doctor Service of Australia.

Part 3 Indigenous Health Rationale

  1. More than 1,100 delegates from around Australia voted at the 15thNational Rural Health Conference in March to seek government endorsement for the Uluru Statement from the Heart as a key priority. Poorer health outcomes in non-metropolitan Australia reflect the widening gap that Aboriginal and Torres Strait Islander people experience in their health care compared with non-Indigenous people. It is only when we listen to Aboriginal and Torres Strait Islander voices that we will be able to deliver health solutions that will succeed.
  2. Aboriginal Health Workers and health practitioners are critical to achieving better health outcomes for Aboriginal and Torres Strait Islander people through culturally safe preventative health and treatment services. Aboriginal and Torres Strait Islander people have three-fold higher levels of preventable hospital admissions and deaths than other Australians and the burden of disease for the Aboriginal and Torres Strait Islander population is 2.3 times higher. A significant driver behind these numbers is that Aboriginal and Torres Strait Islander people can often feel unsafe in accessing the health care they need. 2016 data from the National Aboriginal and Torres Strait Islander Health Worker Association shows the number of Indigenous workers in health professions was 1347.A ratio of one for every 150 Indigenous people would require 4328 practitioners – this would mean putting 3000 more Aboriginal Health Workers and practitioners on the ground.
  3. Increasing the baseline funding for Aboriginal Community Controlled Health Organisations will remove funding insecurity that threatens their programs and services.
  4. Young Indigenous Australians are 55 times more likely to die of rheumatic heart disease than their non-Indigenous peers, yet it is preventable. Priorities have been established under the END RHD program – these need to be implemented immediately.

Updated Part 4 Indigenous voice key to wellbeing

The body representing 37 rural health organisations has urged the next government to endorse the Uluru Statement from the Heart and establish a “voice” to federal parliament as its No 1 priority to improve indigenous health.

Launching its election charter at Parliament House, National Rural Health Alliance chair Tanya Lehmann said Australia needed to start tackling problems impacting on people’s health — problems that would not be fixed by more doctors or technology.

“Connection to country, spiritual wellbeing, overcoming intergenerational trauma are central to the health of indigenous Australians,” she told The Australian.

“Recognising indigenous Australians appropriately in the ­Constitution is an important symbol but it’s more than a symbol, it’s ­actually essential to changing the trajectory of the health and wellbeing of Aboriginal people. It’s ­essential to closing the gap.”

Bill Shorten plans to hold a ­referendum on indigenous recognition in the first term of his prime ministership if he wins the ­election.

Scott Morrison committed $7.3 million in the budget to investigate a model for an advisory body such as a “voice to parliament”.

In its charter, the NRHA said: “It is only when we listen to Aboriginal and Torres Strait Islander voices that we will be able to deliver health solutions that will succeed.”

The Uluru Statement from the Heart, released in 2017, called for a First Nations voice to be enshrined in the Constitution, with a Makarrata commission to supervise “a process of agreement-making between governments and First ­Nations people and truth-telling about our history”.

NACCHO Aboriginal Health #refreshtheCTGRefresh @jackietrad Queensland Minister for Aboriginal and Torres Strait Islander Partnerships : How Queensland reform will #ClosetheGAP

 ” We asked the Queensland Productivity Commission to examine how res­ources devoted to service delivery in remote Aboriginal and Torres Strait Islander communities could be best used to meet their needs. It was clear from those findings, delivered in June, that we must reform and reframe the way we work with the state’s 19 remote communities.

They have given us a clear message: “Stop consulting us. Stop engaging us. Stop doing things to us and start doing things with us. Start to hear what we’re saying, and make us equal partners and key enablers in turning around the disadvantage our people face.”

Jackie Trad is Queensland Deputy Premier, Treasurer and Minister for Aboriginal and Torres Strait Islander Partnerships. see extracts from Health Report here

Download all reports HERE

Or Download Health report here

Chapter-17-Health-and-wellbeing

This year marked 10 years since the release of the landmark report Closing the Gap, which for the first time held governments accountable for addressing the endemic inequality that exists between indigenous and non-indigenous Australians. There has been significant progress in areas such as Year 12 completion, employment and reducing infant mortality, but in some areas the gap has widened.

Does that mean we have been too ambitious? Of course not. It is incumbent on this generation to be ambitious in pursuing a better future for First Nations people and to right the wrongs of the past by tackling injustice, poverty and disadvantage. We cannot hope to achieve this unless we learn from mistakes, build on good work and acknowledge what doesn’t work.

In 2016, the Productivity Commission was scathing in its assessment of 1000 government programs to tackle indigenous disadvantage, finding that just 34 of them had been properly evaluated. It recommended more robust evaluation and publication of results.

These requests are central to achieving real change. We must stop punishing people and start empowering them. I am steadfast in my desire to make this happen. I want the Palaszczuk government’s response to be more than just a shopping list of things we are providing communities. We must throw away the bureaucratic playbook that has hampered change, and must work together to give real meaning to local authority, local decision-making and self-determin­ation.

I have tasked my director-general, Chris Sarra, to work with communities to test and work through the QPC recommendations and to put in place a framework that will enable commun­ities to thrive. It’s an agenda not devised and proselytised from Brisbane but shaped by the people who live in the unique communities across our state — communities such as Cherbourg, Yarrabah, Doomadgee and Thursday Island.

Thriving Communities will build on past successes and acknowledge failures. There is a clear place for the policy agenda advanced by Noel Pearson’s welfare reform trial and the Families Responsibilities Commission. For 10 years the FRC has been fac­ilitating behavioural change through conditional access to welfare payments in five communities in Cape York. Like Closing the Gap, the program has had mixed success.

Despite its protestations, the federal government knows this too. In June 2015, Indigenous Affairs Minister Nigel Scullion wrote to the Queensland government seeking support for a new “lower cost approach” to the FRC, citing the current model as expensive and with limitations. Consequently, for two years, all parties have been engaged in a review of the model — a fact notice­ably absent from Scullion and special envoy Tony Abbott’s recent commentary. There also has been no mention of their failure to allocate funds to the program beyond this month.

While the federal government remains distracted by internal turbulence, we are committed to working with communities to give them the self-determination they need.

About the Inquiry

In September 2016, the Queensland Government announced the Queensland Productivity Commission (QPC) would inquire into service delivery in remote and discrete Aboriginal and Torres Strait Islander communities. The Inquiry was announced in response to concerns expressed by Indigenous leaders that the level of investment in all services (federal, State and non-government) was not delivering higher outcomes for members of their communities.

The QPC was asked to consider investment in remote and discrete Indigenous communities and what works well, and why, with a view to improving outcomes for Aboriginal and Torres Strait Islander people.

The QPC has released its final report which is available on the QPC website.

The QPC Inquiry Recommendations

The QPC Inquiry final report and recommendations are based on extensive consultation with more than 500 stakeholders and remote and discrete Indigenous communities in Queensland.

The QPC Inquiry final report shows examples of good service delivery that can be built upon but most stakeholders agree that there are opportunities to improve how services are designed, funded and delivered that will work towards better outcomes for Aboriginal and Torres Strait Islander Queenslanders.

The QPC Inquiry final report provides 22 recommendations and proposes a substantial reform agenda for policy and service delivery that includes structural reform, service delivery reform and economic reform, to be supported by capacity and capability building of all stakeholders, and timely and transparent transfer of data to measure performance and evaluation.

The Queensland Government Response to the QPC Inquiry

The Queensland Government makes a long-term commitment to work with the 19 remote and discrete Aboriginal and Torres Strait Islander communities, their leaders and Mayors and other stakeholders to implement the intent of the reform agenda proposed by the QPC.

The Queensland Government has provided its response to the final report (PDF, 521 KB).

Key points Health Delivery (text added by NACCHO ) 

􀁸 Indigenous people in remote Queensland experience a burden of disease and injury 2.4 times the non-Indigenous rate—mainly chronic disease, mental disorders, cancers and intentional injuries.

􀁸 Socioeconomic determinants (education, income, overcrowding), racism and discrimination play a significant role in the health gap, along with behavioural and environmental risk factors.

􀁸 The health system is a multifaceted network of services and settings, involving a variety of public and non-government providers, funding arrangements, participants and regulatory mechanisms.

System issues

􀁸 The ‘silo’ approach to service delivery is problematic for communities. It is difficult to ensure services are adequate, appropriate, coordinated and not unnecessarily duplicated, and meet community priorities and user needs.

􀁸 Mainstream mental health services do not meet the cultural needs of Indigenous people, who view social and emotional wellbeing as incorporating individuals, their families and communities.

􀁸 Service providers and institutions are not well-equipped to respond effectively to the distress Stolen

Generations can experience when using those services—distress that arises from the role of those institutions in past injustices.

􀁸 Anecdotally, Foetal Alcohol Spectrum Disorder is prevalent, and access to diagnosis limited.

􀁸 Access to healthcare can be problematic—issues include ineffective, nil or confusing referral pathways, lower screening rates and limited access to renal care and rehabilitation centres. There are significant gaps in the Indigenous health workforce.

What is working

􀁸 Aboriginal and Torres Strait Islander community-controlled health services provide effective, culturally appropriate and multidisciplinary models of comprehensive primary healthcare.

􀁸 Family Wellbeing is an example of a cultural healing program that has been found to increase the capacity of participants to exert greater control over their health and wellbeing.

The reforms proposed by this inquiry can provide an enabling environment for stakeholders to develop collaborative and flexible solutions to these challenges.

 

NACCHO Aboriginal Health and #ElderCare funding up to $46 million : Applications close on 26 Nov 2018: Donna Ah Chee CEO @CAACongress welcomes @KenWyattMP announcement of increased funding to assist Aboriginal people growing old with their families in their own communities


Improvements in Aboriginal health have more of our people living into old age than there were even a decade ago and necessitates a need to meet the increasing demand for these types of services.

Being on country as you grow old is a very strong cultural obligation for Aboriginal people and for too long our people have had to move into population centres to access services.

We now have two major recent initiatives that will help our older people stay on country. Firstly, the announcement of the new Medicare item for nurse assisted dialysis on country and now this announcement from Minister Wyatt.

This continuing connection to country is vital for the spiritual foundation and quality of life of Aboriginal people.

It is a key part of keeping our older people healthy and happy.

Our people have a very strong desire to be on country when they die and announcements like this will help to make sure that people grow old and die on country and with family. We know that social isolation is very damaging to older people’s health and this will ensure people remain socially and culturally connected.

While keeping people at home with aged care packages is a key goal there are some very successful aged care facilities on country at places like Mutitjulu. This also is important for people who need this level of care

Central Australian Aboriginal Congress (Congress) Chief Executive Officer, Donna Ah Chee, welcomes the announcement of increased funding to assist Aboriginal people growing old in a well-supported way, with their families in their own communities

Originally published Talking Aged Care 

Photos above Ken Wyatt meeting with the elders from the Yindjibarndi Aboriginal Corporation in Roebourne WA 2017

Read NACCHO Aboriginal Health and Elder Care Articles HERE

Ageing First Australians living remotely will now have increased access to residential and home aged care services close to family, home or country following an announcement by Federal Government to expand their Budget initiative – the National Aboriginal and Torres Strait Islander Flexible Aged Care (NATSIFAC) program

The $105.7 million Government commitment, which will benefit more than 900 additional First Australians, is set to be expanded progressively over the next four years.

Federal Minister for Senior Australians, Aged Care and Indigenous Health Ken Wyatt announced the first round of expansion funding under the program – up to $46 million – to increase the number of home care places delivered through NATSIFAC program in remote and very remote areas.

“Aged care providers are invited to apply for funding under the expanded NATSIFAC program’s first grants round, which is designed to improve access to culturally-safe aged services in remote Aboriginal and Torres Strait Islander communities,” the Minister explains.

“The program funds service providers to provide flexible, culturally-appropriate aged care to older Aboriginal and Torres Strait Islander people close to home and community.

“Service providers can deliver a mix of residential and home care services in accordance with the needs of the community.”

Minister Wyatt reiterates the importance of home care in enabling senior Australians to receive aged care to live independently in their own homes and familiar surroundings for as long as possible, and says the initiative is all about “flexibility and stability”.

“It is improving access to aged care for older people living in remote and very remote locations, and enables more Aboriginal and Torres Strait Islander people to receive culturally-safe aged  care services close to family, home or country, rather than having to relocate hundreds of kilometres away,” he says.

“At the same time, it helps build the viability of remote aged care providers through funding certainty.”

Applicants can apply for new or additional home care places under the NATSIFAC program or approved providers can apply to convert their existing Home Care Packages, administered under the Aged Care Act 1997, to home care places under the NATSIFAC program.

Applications close on 26 November 2018 with more details about the expansion round available online.

GO ID: GO1606
Agency:Department of Health

Close Date & Time:

26-Nov-2018 2:00 pm (ACT Local Time)
Primary Category:
101001 – Aged Care

Publish Date:

4-Oct-2018

Location:

ACT, NSW, VIC, SA, WA, QLD, NT, TAS

Selection Process:

Targeted or Restricted Competitive

Description:

This Grant Opportunity is to increase the number of home care places under the NATSIFAC Program in remote and very remote Australia (geographical locations defined as Modified Monash Model (MMM) 6 and 7).

Eligibility:

To be eligible you must be one of the following:

Type A:

Existing NATSIFAC Program providers delivering services in geographical locations MMM 6-7

Type B:

Approved providers currently delivering Commonwealth funded home care services (administered under the Aged Care Act 1997) to Aboriginal and Torres Strait Islander people in geographical locations MMM 6-7, with up to 50 home care recipients per service, for conversion to the NATSIFAC Program

Type C:

Organisations not currently delivering aged care services in geographical locations MMM 6-7, however but existing infrastructure and the capability to deliver aged care services to Aboriginal and Torres Strait Islander people

Total Amount Available (AUD):

$46,000,000.00

Instructions for Lodgement:

Applications must be submitted to the Department of Health by the closing date and time.

Other Instructions:

$46 million (GST exclusive) over 4 years, 2018-2022.