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 Community Control and #Justice Health : @NACCHOChair Donnella Mills full speech at the @_PHAA_   #JusticeHealth2019 Conference #ClosingtheGap #justicereinvestment

” Given ACCHOs commitment to providing services based on community identified needs, it is not surprising, then, to learn that we are starting to address justice inequities by developing innovative partnerships with legal services.

Health justice partnerships are similar to justice reinvestment in that they target disadvantaged population groups and are community led. They differ in that funding is not explicitly linked to correctional budgets and secondly, the primary population groups targeted through these partnerships are those people at risk of poor health.[i]

Health justice partnerships in the ACCHO context address people’s fears and distrust about the justice system, by providing a culturally safe setting in which to have conversations about legal matters.

I believe that the development of collaborative, integrated service models such as Law Yarn can provide innovative and effective solutions for addressing not only the overrepresentation of Aboriginal and Torres Strait Islander peoples in the justice system, but also the health gaps between Indigenous and non-Indigenous Australians.

Selected extracts from Donnella Mills Acting Chair of NACCHO keynote speaker 9 April 

See PHAA #JusticeHealth2019 Website

Aboriginal community control and justice health

A justice target has been proposed to focus government efforts towards closing the gap on Aboriginal and Torres Strait Islander peoples’ overrepresentation in the justice system.

Discussion of the role of community leadership to address this serious issue must begin with a commitment to self-determination, community control, cultural safety and a holistic response. Aboriginal community controlled health services understand the interplays between intergenerational trauma, the social determinants of health, family violence, institutional racism and contact with the justice system.

As trusted providers within their communities, they deliver services based on community identified needs.

The presentation explores how the principles, values and beliefs underpinning the Aboriginal community controlled health service model provide the foundations for preventing and reducing Aboriginal and Torres Strait Islander peoples’ exposure to the justice system

I would like to acknowledge that the land we meet on today is the traditional lands for the Gadigal people of the Eora Nation, and that we respect their spiritual relationship with their Country.

I also acknowledge the Gadigal people as the traditional custodians of this place we now call Sydney. Their cultural and heritage beliefs are still as important to the living Gadigal people today.

This is also true for all Aboriginal and Torres Strait Islander peoples that are here this morning. We draw on the strength of our lands, our Elders past and on the lived experience of our community members.

For those who don’t know me, I am a proud Torres Strait Islander woman with ancestral and family links to Masig and Nagir.

I thank the Public Health Association of Australia for welcoming me here so warmly. I am delighted to be here today to share ideas with you on a topic that I care so deeply about.

Scene setting

Some of you may be aware that, late last month, a Partnership Agreement on Closing the Gap was signed between the Council of Australian Governments and the Coalition of Aboriginal and Torres Strait Islander Peak Bodies.

The agreement sets out how governments and Aboriginal and Torres Strait Islander representatives will work together on targets, implementation and monitoring arrangements for the Close the Gap strategy.

NACCHO and almost 40 other peak Aboriginal and Torres Strait Islander bodies negotiated the terms and conditions of this historic agreement on the understanding that when Aboriginal and Torres Strait Islander peoples are included and have a real say in the design and delivery of services that impact on them, the outcomes are far better. This understanding informs the premise of my presentation.

I am here to talk to you about how the principles, values and beliefs underpinning the Aboriginal community controlled service model provide the foundations for preventing and reducing Aboriginal and Torres Strait Islander peoples’ exposure to the justice system.

But first, a little bit about NACCHO, for those of you who are unfamiliar with our work.

NACCHO, which stands for the National Aboriginal Community Controlled Health Organisation, is the national peak body representing 145 Aboriginal Community Controlled Health Organisations – ACCHOs – across the country, on Aboriginal health and wellbeing issues.

Our members provide about three million episodes of holistic primary health care per year for about 350,000 people.

In very remote areas, our services provide about one million episodes of care in a twelve-month period. Collectively, we employ about 6,000 staff (56 per cent whom are Indigenous), which makes us the single largest employer of Indigenous people in the country.

SLIDE 2: Rates of representation in prisons and youth detention facilities

It is timely to come together and consider justice health issues in Aboriginal and Torres Strait Islander communities. It is likely that, for the first time, a justice target may be included in the Close the Gap Refresh strategy.

I am heartened to know that, for the first time, Aboriginal and Torres Strait Islander peak bodies will guide the finalisation of targets and oversee the strategy’s implementation, monitoring and evaluation. I am hopeful that, for the first time, we can begin to address the issues and see some improvements.

All of you hear today will have read and heard the shocking statistics, the increasing rates of incarceration among Indigenous Australians.

Last month it was reported that Aboriginal and Torres Strait Islander men are imprisoned at a rate 14.7 times greater than non-Indigenous men, and for women the rate is even higher, 21.2 times higher than non-Indigenous women.[ii]

Our women represent the fastest growing population group in prisons; their imprisonment rate is up 148% since 1991.[iii]

Imprisoning women affects the whole community. Children may be removed and placed in out-of-home care. Research has found there are links between detainees’ children being placed into out-of-home care and their subsequent progression into youth detention centres and adult correctional facilities.[iv] Communities suffer, and the cycle of intergenerational trauma and disadvantage is perpetuated.

Figures on the incarceration of Aboriginal and Torres Strait Islander children and young people in detention facilities reveal alarmingly high trends of overrepresentation:

  • On an average night in the June quarter 2018, nearly 59% of young people aged 10–17 in detention were Aboriginal and Torres Strait Islander, despite Aboriginal and Torres Strait Islander young people making up only 5% of the general population aged 10–17.
  • Indigenous young people aged 10–17 were 26 times as likely as non-Indigenous young people to be in detention on an average night.[v]

A concerning factor is the link between disability and imprisonment. A Senate Inquiry found that about 98% of Aboriginal and Torres Strait Islander prisoners also have a cognitive disability.[vi]

People living with physical disabilities such as hearing loss, and people with undiagnosed cognitive or psycho-social disabilities may struggle to negotiate the justice system and their symptoms are likely to be correlated with their offending behaviours, and receive punitive responses rather than treatment and care.

SLIDE 3: Overrepresentation – causal factors

Our experiences of incarceration are not only dehumanising. They contribute to our ongoing disempowerment, intergenerational trauma, social disadvantage, and burden of disease at an individual as well as community level. Indeed, ‘imprisonment compounds individual and community disadvantage.’[vii]

The question – why Aboriginal and Torres Strait Islander peoples are overrepresented in prisons – is complex. It can partly be explained by exploring how structural, geographic, historic, social and cultural factors intersect and impact individuals’ lives.

While people have some agency in how they respond to the circumstances they are born into, they are also constrained by many generations’ experiences of marginalisation, discrimination, poverty and disadvantage. This is particularly relevant and disturbing when one considers Aboriginal and Torres Strait Islander peoples’ experiences in navigating the justice system.[viii]

Issues of access and equity also disadvantage Aboriginal and Torres Strait Islander peoples in their dealings with the justice system. Some of these may relate to their geographical location – remote and very remote regions have limited legal services. Given the limited service infrastructure available in remote settings, geography also determines people’s access to community based options.

Some of the other barriers faced by our people relate to the lack of language interpreters and inappropriate modes and technologies of communication. People have different levels of English language literacy and IT capacities. These factors can result in peoples’ experiences of structural discrimination in the justice system and result in miscarriages of justice.[ix]

We have heard of the over-policing of Indigenous Australians and how this impacts on their exposure to the justice system. In his submission to the Senate Inquiry into Aboriginal and Torres Strait Islander experiences of law enforcement and justice services, Chief Justice Martin referred to ‘systemic discrimination’ through over-policing:

Aboriginal people are much more likely to be questioned by police than non-Aboriginal people. When questioned they are more likely to be arrested rather than proceeded against by summons. If they are arrested, Aboriginal people are much more likely to be remanded in custody than given bail. Aboriginal people are much more likely to plead guilty than go to trial, and if they go to trial, they are much more likely to be convicted. If Aboriginal people are convicted, they are much more likely to be imprisoned … and at the end of their term of imprisonment they are much less likely to get parole … So at every single step in the criminal justice process, Aboriginal people fare worse than non-Aboriginal people.[x]

There are other contributing factors that explain the overrepresentation of Aboriginal and Torres Strait Islander people in the justice system. The inadequate resourcing of Aboriginal community controlled legal services plays a major role in the growing level of unmet need in communities.[xi] As noted by the National Aboriginal and Torres Strait Islander Services:

Aboriginal and Torres Strait Islander people don’t just need access to more legal services; they need greater access to culturally appropriate legal services. … Cultural competency is essential for effective engagement, communication, delivery of services and the attainment of successful outcomes.[xii]

Aboriginal and Torres Strait Islander peoples’ experiences of institutional racism and discrimination, the trauma caused to members of the Stolen Generations and entire families and communities, which continues today with increasing numbers of children being placed in out-of-home care, contribute to the distrust, fear and unwillingness of many people to engage with legal services.

The Senate Inquiry into Aboriginal and Torres Strait Islander experiences of law enforcement and justice services heard that ‘for Aboriginal people in particular, there is this historical fear of about walking into a legal centre’.[xiii]

Governments’ inertia and lack of commitment to genuinely addressing the issues have contributed to a worsening situation. The National Indigenous Law and Justice Framework 2009-2015 was never funded, attracted no buy in from state and territory governments, and the review findings of the Framework were never made public.

SLIDE 4: Justice reinvestment

Increasing funding for the corrective service sector will not and does not address the issue of Aboriginal and Torres Strait Islander peoples’ exposure to the justice system. As Allison and Cunneen note, ‘the solutions to offending are found within communities, not prisons.’[xiv] They are referring to justice reinvestment, a strategy and an approach, whereby correctional funds – a portion of money for prisons – are diverted back into disadvantaged communities.

The concept of justice reinvestment centres on the belief that imprisoning people does not address the causal factors that give rise to their exposure to the justice system. Ignoring the causal factors leads not only to recidivism and repeat incarceration, it also reproduces intergenerational cycles of disadvantage and exposure to the justice system.

Reinvesting the money into community identified and led solutions not only addresses causation; it also strengthens communities. Depending on the project, justice reinvestment may not only help to reduce people’s exposure to the justice system; it may also improve education, health, and employment outcomes for Aboriginal and Torres Strait Islander peoples.

Allison and Cunneen’s analysis of justice reinvestment projects in Northern Australia shows how the underpinning principles of this approach reaffirm self-determination and strengthen cultural authority and identity. Justice reinvestment projects address the driving factors of many Aboriginal and Torres Strait Islander peoples’ interactions with the justice system: their historical experiences of colonisation, discrimination, dispossession and disempowerment.[xv]

It is encouraging to note that in its 2016 report of the inquiry into Aboriginal and Torres Strait Islander experience of law enforcement and justice services, the Finance and Public Administration References Committee recommended that the Commonwealth Government support Aboriginal led justice reinvestment projects.[xvi] In December 2017, the Australian Law Reform Commission recommended that Commonwealth, state and territory governments should provide support for:

  • the establishment of an independent justice reinvestment body; and
  • justice reinvestment trials initiated in partnership with Aboriginal and Torres Strait Islander communities.[xvii]

SLIDE 5: Closing the gap on justice outcomes: best practice approach

Emerging out of these inquiries is a growing understanding that closing the gap on justice outcomes must begin with a commitment to self-determination, community control, cultural safety and a holistic response.

Appropriately resourced, culturally safe, community controlled services are essential for addressing these barriers. Best practice approaches for developing solutions to preventable problems of Aboriginal and Torres Strait Islander peoples’ exposure to the justice system must begin with enabling their access to trusted services that are governed by principles and practices of self-determination, community control, cultural safety and a holistic response.[xviii]

NACCHO’s member services – the ACCHOs – embody these principles. The cultural safety in which ACCHOs’ services are delivered is a key factor in their success. They provide comprehensive primary care consistent with clients’ needs.

This includes home and site visits; provision of medical, public health and health promotion services; allied health, nursing services; assistance with making appointments and transport; help accessing child care or dealing with the justice system; drug and alcohol services; and providing help with income support.

The Aboriginal Community Controlled Health model of care recognises that Aboriginal and Torres Strait Islander peoples require a greater level of holistic care due to the trauma and dispossession of colonisation, dispossession and discrimination, which are linked to our poor health outcomes and over-representation in prisons.

ACCHOs understand the interplays between intergenerational trauma, the social determinants of health, family violence, and institutional racism, and the risks these contributing factors carry in increasing Aboriginal and Torres Strait Islander peoples’ exposure to the criminal justice system. We understand the importance of comprehensive health services that are trauma informed; and providing at risk families with early support. Within the principles, values and beliefs of the Aboriginal community controlled service model lie the groundwork for our communities’ better health outcomes.

SLIDE 6: Health justice partnerships

Given ACCHOs commitment to providing services based on community identified needs, it is not surprising, then, to learn that we are starting to address justice inequities by developing innovative partnerships with legal services.

Health justice partnerships are similar to justice reinvestment in that they target disadvantaged population groups and are community led. They differ in that funding is not explicitly linked to correctional budgets and secondly, the primary population groups targeted through these partnerships are those people at risk of poor health.[xix]

Health justice partnerships in the ACCHO context address people’s fears and distrust about the justice system, by providing a culturally safe setting in which to have conversations about legal matters.

In testimony given to a Senate Inquiry, an ACCHO representative describes how:

We form relationships with the health services and actually provide a legal service, for example, within the Aboriginal medical service. We have a lawyer embedded in the Aboriginal medical service in Mount Druitt so that when the doctor sees the person and they mention they have a housing issue – ‘I’m about to get kicked out of my place’ – they can say, ‘Go and see the lawyer that is in the office next door.’[xx]

ACCHOs are increasingly recognising the benefits of working with legal services to develop options that enable services to be delivered seamlessly, safely, and appropriately for their communities. Lawyers may be trained to work as part of a health care team or alternatively, health care workers may be upskilled to start a non-threatening, informal conversation about legal matters with the clients, which results in referrals to pro bono legal services.

 Case study: Law Yarn

As a lawyer and Chair of the Cairns-based Wuchopperen Health Service, I was aware of the need to provide better legal supports for my community. In conversations with local Elders and LawRight, Wuchopperen entered into a justice health partnership in 2016. LawRight is an independent, not-for-profit, community-based legal organisation which coordinates the provision of pro bono legal services for individuals and community groups.

The aim of the partnership was to improve health outcomes by enhancing access to legal rights and early intervention. Initially, it was decided that, as community member and lawyer employed by LawRight, I would provide the free legal services at Wuchopperen’s premises.

One of the challenges of justice health partnerships is ongoing funding, and in 2017 we were forced to close our doors for several months. We knew the partnership was addressing a real need in our community, so we submitted a funding proposal to the Queensland Government, and received funding of $55,000 to trial ‘Law Yarn’.

Law Yarn is a unique resource that supports good health outcomes in Aboriginal and Torres Strait Islander communities. It helps health workers to yarn with members of remote and urban communities about their legal problems and connect them to legal help. A handy how-to guide includes conversation prompts and advice on how to capture the person’s family, financial, tenancy or criminal law legal needs as well as discussing and recording their progress.

Representatives from LawRight, Wuchopperen Health Service, Queensland Indigenous Family Violence Legal Service and the Aboriginal Torres Strait Islander Legal Services came together and created a range of culturally safe resources based on LawRight’s successful Legal Health Check resources.

SLIDE 8: Law Yarn – your law story

SLIDE 9: Four aspects of Law

These symbols have been created to help identify and represent the four aspects of law that have been identified as the most concerning for individuals when presenting with any legal issues. If these four aspects can be discussed, both the Health worker and Lawyer can establish what the individual concerns are and effectively action a response.

Each symbol is surrounded by a series of 10 dots; these dots can be coloured in on both the artwork and the referral form by the Health worker to help establish what areas of law their clients have concerns with.

SLIDE 11: Launch of Law Yarn

Law Yarn was officially launched at Wuchopperen Health Service, Cairns, on 30 May 2018 by the Queensland Attorney General as a Reconciliation Week Event.

The trial has been funded to 30 June 2019 and will be comprehensively evaluated by independent academic researchers who specialise in this field.

Legal and health services throughout Australia have expressed interest in this holistic approach to the health and wellbeing of Aboriginal and Torres Strait Islander peoples. And we are hopeful that the evaluation findings will support the rollout of our model to ACCHOs across Australia.

In conclusion, I believe that the development of collaborative, integrated service models such as Law Yarn can provide innovative and effective solutions for addressing not only the overrepresentation of Aboriginal and Torres Strait Islander peoples in the justice system, but also the health gaps between Indigenous and non-Indigenous Australians.

Address the legal problems, and you will have better health outcomes. Justice health partnerships provide a model of integrated service delivery that go to the heart of the social determinants of health, key causal factors contributing to Aboriginal and Torres Strait Islander peoples’ over-exposure to the justice system.[xxi] With Aboriginal community control at the front and centre of service design, these partnerships are able to deliver both preventive law and preventive health for Aboriginal and Torres Strait Islander peoples.

SLIDE 12: Thank you

[i] Health Justice Australia. 2017. Integrating services; partnering with community. Submission to national consultation on Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023.

[ii] https://www.lawcouncil.asn.au/media/media-releases/recommendations-to-reduce-disproportionate-indigenous-incarceration-must-not-be-ignored

[iii] Law Council of Australia. 2018. The Justice Project, Final Report – Part 1. Aboriginal and Torres Strait Islander People.

[iv]. Law Council of Australia. 2018. The Justice Project, Final Report – Part 1. Aboriginal and Torres Strait Islander People.

[v] Australian Institute of Health and Welfare. 2018. Youth detention population in Australia. AIHW Bulletin 145.

[vi] Ibid., 2010 Senate Inquiry into hearing health in Australia.

[vii] Australian Human Rights Commission. 2009. Social Justice Report, pp. 53-54, cited in Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House.

[viii] Law Council of Australia. 2018. The Justice Project, Final Report – Part 1. Aboriginal and Torres Strait Islander People.

[ix] Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House; Law Council of Australia. 2018.

[x] Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House. Testimony from Chief Justice Martin.

[xi] Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House; Law Council of Australia. 2018. The Justice Project, Final Report – Part 1. Aboriginal and Torres Strait Islander People.

[xii] National Aboriginal and Torres Strait Islander Legal Service, Submission No. 109 to ALRC, 60, cited in Law Council of Australia. 2018. The Justice Project, Final Report – Part 1. Aboriginal and Torres Strait Islander People.

[xiii] Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House, p. 31. Testimony from Ms Porteous, NACLC, Committee Hansard, 23 September 2015, p. 28.

[xiv] Allison, Fiona and Chris Cunneen. 2018. Justice Reinvestment in Northern Australia. The Cairns Institute Policy Paper Series, p. 5.

[xv] Allison, Fiona and Chris Cunneen. 2018. Justice Reinvestment in Northern Australia. The Cairns Institute Policy Paper Series, p. 8.

[xvi] Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House.

[xvii] Australian Law Reform Commission. 2017. Pathways to Justice—An Inquiry into the Incarceration Rate of Aboriginal and Torres Strait Islander Peoples, Final Report No 133, p. 17.

[xviii] Thorburn, Kathryn and Melissa Marshall. 2017. The Yiriman Project in the West Kimberley: an example of justice reinvestment? Indigenous Justice Clearinghouse, Current Initiatives Paper 5; McCausland, Ruth, Elizabeth McEntyre, Eileen Baldry. 2017. Indigenous People, Mental Health, Cognitive Disability and the Criminal Justice System. Indigenous Justice Clearinghouse. Brief 22; AMA Report Card on Indigenous Health 2015. Treating the high rates of imprisonment of Aboriginal and Torres Strait Islander peoples as a symptom of the health gap: an integrated approach to both; Richards, Kelly, Lisa Rosevear and Robyn Gilbert. 2011. Promising interventions for reducing Indigenous juvenile offending Ibid. Indigenous Justice Clearinghouse, Brief 10.

[xix] Health Justice Australia. 2017. Integrating services; partnering with community. Submission to national consultation on Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023.

[xx] Finance and Public Administration References Committee. 2016. Aboriginal and Torres Strait Islander experience of law enforcement and justice services. The Senate: Australian Parliament House, p. 31. Testimony from Ms Hitter, Legal Aid NSW, Committee Hansard, 23 September 2015, p.28

[xxi] Ibid., p. 4; Chris Speldewinde and Ian Parsons. 2015. Medical-legal partnerships: connecting services for people living with mental health concerns. 13th National Rural Health Conference, Darwin; Barry Zuckerman, Megan Sandel, Ellen Lawton, Samantha Morton. Medical-legal partnerships: transforming health care. 2008. The Lancet, Vol 372.

NACCHO Aboriginal Health and #Housing #SocialDeterminants @2019wihc News : @AIHW report Our #housing situation of #IndigenousAustralians has improved – with rises in #homeownership and housing provided through the private rental market, and falling levels of #homelessness.

 ” Stable and secure housing is fundamentally important to health and well-being.

Historically, Aboriginal and Torres Strait Islander people have experienced much higher rates of homelessness and have been overrepresented among clients seeking homelessness and social housing services than non-Indigenous Australians.

These higher rates of unstable housing relate to complex and interrelated factors including the lasting impacts of colonisation on Indigenous Australians, exposure to family violence, substance disorders, unemployment, low education levels and poor health—which are both contributors to, and outcomes of, insecure housing circumstances (Flatau et al. 2005; Keys Young 1998; Silburn et al. 2018).

Even though there is still much progress to be made, the findings in this report covering the last 15 years demonstrate the housing situation of Indigenous Australians has improved—with rises in home ownership and housing provided through the private rental market, and falling levels of homelessness. “

From AIHW Report March 2019 see Part 1 Below and Download the Report

aihw-housing Report

“The Territory Labor Government has fought long and hard for the housing funding that was promised to us 9 months ago. We’ve now won that fight.

“When you invest in housing and address indigenous disadvantage, you are investing in generational change – and saving money in the long term.

“Since coming to Government the Territory Labor Government has built and upgraded more than 1350 homes. The Federal Government’s contribution to our Government’s trail-blazing remote housing program will allow us to continue to make tangible and sustainable differences to the lives of Territorians.

Local Decision Making is at the core of our work in remote communities where we are building new homes, improving living conditions and creating jobs and generational change.

“People from the bush have told us that having jobs and better homes gives them a sense of pride and dignity. We know our remote housing program is working. It is changing the housing landscape and improving social outcomes in communities across the Territory.”

The Territory Labor Government has secured a $550 million investment from the Federal Government to continue to deliver remote housing in the NT. The deal comes nine months after the funding was first committed by the Commonwealth. 

The NT Government will work with the Federal Government and Land Councils to continue the delivery of remote housing.

The deal will see the Federal Government add $550 million to the NT Government’s investment of $1.1 billion for remote housing. In return, the NT Government will accept responsibility for remote housing leases until 2023

NT Chief Minister Michael Gunner

Download Full Press Release 

Territory Govt Housing Win

20 -24 May 2019 World Indigenous Housing Conference. Gold Coast

Thank you for your interest in the 2019 World Indigenous Housing Conference.

The 2019 World Indigenous Housing Conference will bring together Indigenous leaders, government, industry and academia representing Housing, health, and education from around the world including:

  • National and International Indigenous Organisation leadership
  • Senior housing, health, and education government officials Industry CEOs, executives and senior managers from public and private sectors
  • Housing, Healthcare, and Education professionals and regulators
  • Consumer associations
  • Academics in Housing, Healthcare, and Education.

The 2019 World Indigenous Housing Conference #2019WIHC is the principal conference to provide a platform for leaders in housing, health, education and related services from around the world to come together. Up to 2000 delegates will share experiences, explore opportunities and innovative solutions, work to improve access to adequate housing and related services for the world’s Indigenous people.

Key event details as follows:
Venue: Gold Coast Convention and Exhibition Centre
Address: 2684-2690 Gold Coast Hwy, Broadbeach QLD 4218
Dates: Monday 20th – Thursday 23rd May, 2019 (24th May)

PLEASE NOTE: The Trade Exhibition is open Tuesday 21st May – Thursday 23rd May 2019

Please visit www.2019wihc.com for further information on transport and accommodation options, conference, exhibition and speaker updates.

Part 1

Read full AIHW Report Online HERE

More Indigenous households own their home or rent privately

Across the 4 most recent Censuses, there has been a steady rise in Indigenous home ownership, with 38% of Indigenous households (or around 100,000) owning a home (with or without a mortgage) in 2016, compared with 32% in 2001. The opposite trend was observed for other Australian households (69% home ownership in 2001, 66% in 2016).

For both Indigenous and other Australians, there was a steady fall in the proportion of households in social housing between 2001 and 2016, offset by a rise in the proportion of private renters. Indigenous households were consistently more likely than other households to be renting in private housing (32% compared with 25% in 2016) over the period. The largest difference between Indigenous and other households remains the proportion of households renting in social housing (21% compared with 4% in 2016), however, this gap has been narrowing over time.

Fewer households in mortgage stress, more in rental stress

Increasing home ownership levels are a positive sign, particularly when considered in combination with data about households in mortgage stress. The proportion of Indigenous households with a mortgage considered to be in mortgage stress has dropped from a peak of 30% in 2011 to 21% in 2016. In 2016, 68,000 Indigenous home owners had a mortgage (26% of Indigenous households).

In contrast, of those Indigenous households renting, the proportion considered to be in rental stress increased from 22% in 2001 to 39% in 2016. In private rental housing, rental stress for Indigenous households increased similarly in both urban and rural areas over this period (from 34% to 43% in urban areas and 29% to 38% in rural areas in 2016).

Indigenous households in public housing

While the proportion of the Indigenous household population living in social housing has decreased, the number of households has increased. There are three main types of social housing available to eligible Australians. In 2016–17, of the 66,700 Indigenous households in social housing:

  1. Half (50%, or 33,300) were in public housing, with this number rising by one-third (8,200 households) since 2008–09.
  2. The number of Indigenous households in community housing more than doubled from 2,700 households in 2008–09 to 5,800 in 2016–17.
  3. In contrast, the numbers of households in Indigenous-specific housing programs remained relatively stable over the period (around 10,000 for state owned and managed housing (SOMIH) and 18,000 for Indigenous community housing).

Fall in wait times for social housing

Waiting times for Indigenous Australians are generally shorter compared with other applicants. For both public housing and SOMIH housing programs there were improvements from 2013–14 to 2016–17. A larger proportion of clients waited less than 3 months (35% in 2013–14 and 42% in 2016–17 for public housing and 38% and 48% for SOMIH), and a smaller proportion waited more than 2 years to be housed. However, up to 1 in 6 (17%) Indigenous households waited more than 2 years for public housing.

Conditions in social housing have also improved over the 6 years to 2018. Data show a fall in overcrowding among Indigenous households, and a rise in the proportion of Indigenous tenants who rated their dwellings at an ‘acceptable’ standard.

1 in 28 Indigenous people are homeless

One in 28 Indigenous people (23,000) were homeless on Census night in 2016—representing more than 1 in 5 (22%) homeless Australians. More than half of Indigenous people experiencing homelessness lived in Very remote areas.

The rate of Indigenous homelessness decreased from 571 per 10,000 population in 2006 to 361 in 2016. The decline in Indigenous homelessness since 2006 is due predominantly to the decrease in Indigenous people living in ‘severely’ crowded dwellings (75% in 2006 to 70% in 2016). However, the 2016 Indigenous homelessness rate is 10 times that of non-Indigenous Australians. The differences in the rates of homelessness for Indigenous and non-Indigenous Australians were higher in Remote and Very remote areas than in Major cities.

The main type of homelessness experienced by Indigenous Australians was living in ‘severely crowded’ dwellings; that is, dwellings that need 4 or more extra bedrooms. Of those homeless on Census night 2016, Indigenous Australians (70%) were much more likely than non-Indigenous Australians (42%) to be living in severely crowded dwellings, yet the gap has narrowed over the past decade. Indigenous Australians were 68 times more likely to live in severely crowded dwellings in 2006; decreasing to 16 times more likely in 2016.

1 in 4 specialist homelessness services clients are Indigenous

Indigenous clients made up a quarter (25%) of all clients assisted by specialist homelessness services (SHS) in 2017–18; a rate 9 times that of non-Indigenous clients (803 per 10,000 population compared with 86). Most Indigenous people using these services were at risk of homelessness (53%), with the remainder homeless (47%), when they sought assistance.

Since 2011–12, SHS have assisted more Indigenous clients (43,600 in 2011–12; 65,200 in 2017–18). Of the Indigenous SHS clients in 2017–18:

  • 1 in 8 (13% or 8,500) were aged under 5, reflecting that families often seek assistance
  • 4 in 10 had experienced domestic and family violence (domestic and family violence was a reason they sought help and/or they required domestic or family violence assistance).

Homelessness services help clients keep tenancies and find homes

In 2017–18, more than half of Indigenous SHS clients (53% or 32,400 people) sought help when they were in unstable housing situations (at risk of homelessness)—more than 1 in 2 (16,400 clients) were living in social housing (either renting or rent free) when they sought assistance, while another third (12,100 clients) were in private or other housing (renting, rent free or owning). Most clients at risk of homelessness (89%) maintained their tenancies with SHS support.

Of the 20,700 Indigenous clients who were homeless when they sought help from SHS and had ended support in 2017–18, 38% (or 7,200 clients) were assisted into stable housing; an increase from 29% in 2012–13. In 2017–18 most Indigenous homeless clients who were assisted into housing ended support in social housing (around 3,800) with a further 3,100 clients in private rentals.

NACCHO Aboriginal Health and #SelfDetermination : Our CEO Pat Turner pays tribute to her Uncle Charlie Perkins at opening of new Canberra building named in his honour

“ Even though Uncle Charlie is gone and I have left the Public Service, I can tell you that his vision of self-determination is what I have sought to achieve every day of my life.

I know that fulfilling that vision is what will Close the Gap more than anything else.

It has driven me to lead a Coalition of Aboriginal and Torres Strait Islander peak organisations to seek a partnership with the Commonwealth and State and Territory Governments to jointly decide the next phase of Closing the Gap.

If he was here, I know Uncle Charlie would be standing with me in making sure that our peoples have to be at the table and make decisions about Closing the Gap and take responsibility for them alongside Governments.

This is a very powerful legacy of Uncle Charlie.”

NACCHO CEO Pat Turner speaking at the opening of Charles Perkins House In Canberra : See Full Speech Part 2 Below

Read yesterday Closing the Gap announcement by Prime Minister Morrison 

In 1966, Dr Charles Nelson Perkins AO was the first Aboriginal man to graduate from a university in Australia.

 Importantly Aboriginal people should be aware of this false economy which forms the basis of Aboriginal affairs in this country.

The economic lifeline is maintained only at the discretion of politicians and a fickle public.

We must therefore develop and consolidate a viable economy for our various communities and organisations that will sustain us into the future.

We must create short and long-term economic strategies now and thus create a more independent and secure base for ourselves and our children. The reality is that Aboriginal people under utilise, to put it kindly, their current economic and personnel resources. The potential for economic viability for our people is available now if only we could awake to the opportunity and not be blinded largely by employment survival economics ”

Unless the approaches to Aboriginal health are broadened to include greater attention to the health problems of adults, and are matched by broad ranging strategies aimed at redressing Aboriginal social and economic disadvantages, it is likely that overall mortality will remain high.

Dr Charles Perkins opening the Australia’s First National /International Indigenous and Economic Conference (NIBEC 1993) Alice Springs. 1993 International Year of the World’s Indigenous Peoples and Paul Keating was Prime Minister :

Read his full speech here Aboriginal people and a healthy economy

In a fitting tribute, the building where Indigenous affairs policy is developed was renamed Charles Perkins House last week, in honour of the celebrated anti-discrimination campaigner and former Department of Aboriginal Affairs secretary.

From The Madarin 

The late Dr Charles Perkins  became the first Indigenous Commonwealth secretary in 1984, after being appointed to the top job at the department where he started as a research officer in 1969. Before, during and after his career as a public servant, however, Perkins remained an activist first and foremost.

He was a major figure in the struggle for equal rights, arguing powerfully and publicly on behalf of Aboriginal and Torres Strait Islander people and leaving a towering legacy.

If Perkins had a choice between playing the role of the mild-mannered public servant to stay in the good books or speaking his mind, he chose the latter. He was famously suspended from his government job after publicly labelling the Western Australian government racist rednecks, and countless other anecdotes tell of a man whose life’s work was speaking truth to power, and never giving up on a fair go for the first Australians, above all else.

Staff of the Department of the Prime Minister and Cabinet’s Indigenous affairs group have long worked out of the south Canberra office block, described as “the home of Indigenous affairs” by PM&C, since prior to 2013 when they were brought together into a single structure within the central agency.

Charles Perkins House replaced the much blander “Centraplaza” at a ceremony last week, attended by relatives of Perkins and “other significant names in Indigenous Affairs” according to a brief report from the department.

A spokesperson said the new name would stand as “a reminder of his significant contribution to the Australian Public Service, Indigenous Affairs, and to Australia’s national identity”.

While it’s not a stand-alone department, the creation of the IA group marked a move back towards centralisaton from the arrangements it superseded. It has slightly more autonomy than most comparable groupings as it works under an associate secretary, the former vice-chief of the Australian Defence Force, Ray Griggs. This is one of only two such positions that currently exist in the Australian Public Service and has higher status than deputy secretaries.

Perkins’ niece Patricia Turner, a former APS deputy secretary herself and chief executive of the National Aboriginal Community Controlled Health Organisation, did the honours with PM&C secretary Martin Parkinson and deputy secretary for Indigenous affairs, Ian Anderson.

“Dr Perkins was a proud Arrernte and Kalkadoon man and laid the foundation for the type of forward-thinking Indigenous Affairs policy we aspire to at PM&C,” Parkinson said in the statement.

Anderson said Perkins was “an inspiration to public servants and the Indigenous community alike” and noted he was one of the first Aboriginal people to receive a university degree, leader of the 1965 Australian Freedom Ride, and an influential advocate of the yes-vote in the 1967 referendum that essentially created the policy area where he would later become the chief administrator.

We’re told PM&C “worked closely with the owner of the building to secure its agreement” to rename the building and that no money changed hands with the owner, the evri group.

“The Department also engaged Dr Perkins’ family as well as key Indigenous stakeholders in the naming of the building and design of the tribute to Dr Perkins,” a spokesperson added.

Part 2 OFFICIAL LAUNCH OF CHARLES PERKINS HOUSE THURSDAY 21 MARCH 2019 PAT TURNER SPEECH

Introduction

I too want to thank Matilda for the warm welcome.  Of course I also want to pay my respects to the traditional owners and elders, past and present.

This is our national capital, which we are all proud of but it is also the traditional lands of Aboriginal people who lived here for many generations.  That they have survived and are here should also be a source of pride for all of us.

I should point out that Matilda and her family also lived in Pearce and became close personal lifetime friends with my aunty and uncle.

Can I also greet the Perkins family formally, and I am very proud that they are part of my family and that Charles Perkins was my uncle.

Uncle Charlie

My uncle Charlie was an extraordinary man.

He had many roles throughout his life and none more important than being a husband, a father, a son, a brother, an uncle, a grandfather and a part of the Arrente and Kalkadoon First Nations.

His family and his wider extended family and cultural responsibilities were at the essence of his life.

It’s important I think to say that because often the focus is on his career in the public service and the influence that he has brought to bear on Australia over the course of the 20th century.

However, he was an Aboriginal man first and foremost.  That he was so successful at that is obvious – just take a look at his family and his children.  They have been such a success and I take this opportunity to pay tribute to them.

Soccer

Uncle Charlie had other family of course and I am referring to those who lived at St Frances House in Adelaide.

Soccer was the springboard for his international travel and the experiences of living in another country.

Going overseas and, after returning to Australia, playing soccer with teams of different ethnic backgrounds, opened Uncle Charlie’s eyes to how he was viewed as an Aboriginal man among equals in this setting.

But we know, sadly, that if he was treated as an equal when he was playing soccer and recognised for being an Aboriginal man, the society in which he lived discriminated against him.

Strengths

We also know, however, that this Aboriginal man decided to do something about it.  Uncle Charlie was strong and proud.  He had many strengths

-a strong work ethic and was very disciplined in fulfilling all his roles and responsibilities.

-Because he worked hard, he expected everyone else around him to do the same.

-I also remember personally his generosity and acts of kindness to me and others.

-At work, he focused on meeting and talking directly with Aboriginal and Torres Strait Islander peoples right around the country.

-He had the most extensive network of contacts that I have ever seen, from people living in the Central Australian desert through to the Prime Minister’s office and heads of corporate Australia.  He was never afraid to pick up the phone.

-Of course his leadership qualities were displayed in the Freedom Rides which others have referred to today.

Priorities for Uncle Charlie

Uncle Charlie was a successful kidney transplant recipient and it made him more driven to get a better deal for Aboriginal people throughout Australia.

In the 1960s as a University student he held a mirror up so that Australian people could see how racist they were and forced them to look at themselves.

Uncle Charlie forced our country to start taking a good hard look at itself.

Sure, many considered him controversial and a stirrer, but we loved him and applauded him for his leadership, his strength of character and his undying commitment to achieve a much better quality of life for First Nations peoples throughout this country and a full suite of our specific rights as First Nations peoples.

We know that his spirit guides us today, and that during his lifetime he taught us a great deal.

Today we all stand on his shoulder as a giant of a man whose legacy we must build upon and bring his vision into reality.

Self-Determination

That vision more than anything else was self-determination for Aboriginal and Torres Strait Islander peoples.

By self-determination, Uncle Charlie never meant that we should be able to decide if we are part of Australia or that our development ought to be separate.

I can assure you that Uncle Charlie was a proud Australian and also saw the benefits of mainstream economic development.

What Uncle Charlie meant by self-determination was that;

  • Aboriginal and Torres Strait Islander peoples had to be fully involved in decision making about the policies and programs of governments that affected them,
  • while we had to co-exist with non-Indigenous Australians, we had to have our own structures that allowed us the opportunity to make decisions about our priorities for development;
  • racism in all its forms against us had to be defeated; and
  • while we had to live and succeed in Australia we also had the right to have our culture and identity.

This vision became central to the outlook of a whole generation of public servants who worked in Indigenous Affairs including me.

Even though Uncle Charlie is gone and I have left the Public Service, I can tell you that his vision of self-determination is what I have sought to achieve every day of my life.

I know that fulfilling that vision is what will Close the Gap more than anything else.

It has driven me to lead a Coalition of Aboriginal and Torres Strait Islander peak organisations to seek a partnership with the Commonwealth and State and Territory Governments to jointly decide the next phase of Closing the Gap.

If he was here, I know Uncle Charlie would be standing with me in making sure that our peoples have to be at the table and make decisions about Closing the Gap and take responsibility for them alongside Governments.

This is a very powerful legacy of Uncle Charlie.

Burn Baby Burn!

Reflections on the life of my Uncle Charlie, however, should not end without some other significant moments which many seem to have forgotten.

He had a love/hate relationship with the media, and he certainly knew how and when to cause a storm.

In some cases, I can’t help but laugh even though they were very serious at the time.  Remember the threats of protests in the lead up to the Sydney 2000 Olympics.

Uncle Charlie made a highly controversial declaration in April 2000 that Sydney would “Burn Baby Burn” during the event.

Who can forget the nationwide ruckus this caused.  Funny that we should be naming a building after the Aboriginal man who said it.

As I was walking up the steps just now, I was looking at the new sign “Charles Perkins House” and thinking to myself that I would like to spray paint in brackets “Burn Baby Burn”.

Other anecdotes

My uncle would read the press coverage every morning, and the executive soon learnt we also had to. At times I would walk into his office if I was concerned about a particular emerging issue covered in the press and indicate high level briefing may need to be prepared, and he had a very keen sense of when that was necessary and when it wasn’t. He would often say to us “Today’s news – tomorrow’s fish and chips wrapping”.

One morning we walked into his office in the executive meeting and he exclaimed the headline “Woman crawls 500m to escape croc attack”. “Geez”, he said “fancy that, crawling 500 miles!” I replied “Can’t be, must be 500 metres because she would be dead from exhaustion if she crawled 500 miles!”

Before the age of the mobile, my uncle was addicted to the phone and at home the phone and his personal phone book were forever on his side. He would flick through the phone book to decide who to ring today, and when someone answered he would say “Hello mate, Charlie here, just touching base”. Of course we all knew he was just keeping his finger on the pulse.

He always had a fire in his belly and held is back bone straight, a determination he instilled in us all. I am so proud he was my uncle.

In closing, I want to thank you personally Ian Anderson for all the effort you put into bringing this event to fruition.

It’s fantastic that Australia’s headquarters for Indigenous Affairs has been named after Uncle Charlie and well done to the Australian Government and thank you very much.

 

NACCHO #SaveaDate : This week features #WorldDayofSocial Justice @Galambila #Culture and @awabakalltd #Youth ACCHO @DjirraVIC Plus @CongressMob International Conference #HousingCrisis #WIHC2019 #Homelessness

20 February World Day of Social Justice

Download the 2019 Health Awareness Days Calendar 

21 February Galambila ACCHO Gumbaynggirr Cultural Show for Coffs Harbour Pharmacists 

22 February Awabakal ACCHO Strong Youth Launch

6 March AIATSIS Culture and Policy Symposium

9 March  Bush to Beach Project Grazing Style Light Indigenous Marathon Fundraiser

12- 13 March Overcoming Indigenous Family Violence 

14 – 15 March 2019 Close the Gap for Vision by 2020 – National Conference 2019

21 March National Close the Gap Day

21 March Indigenous Ear Health Workshop Brisbane

24 -27 March National Rural Health Alliance Conference

20 -24 May 2019 World Indigenous Housing Conference. Gold Coast

18 -20 June Lowitja Health Conference Darwin

2019 Dr Tracey Westerman’s Workshops 

7 -14 July 2019 National NAIDOC Grant funding round opens

24 -26 September 2019 CATSINaM National Professional Development Conference

5-8 November The Lime Network Conference New Zealand 

20 February World Day of Social Justice

Social justice is an underlying principle for peaceful and prosperous coexistence within and among nations.

We uphold the principles of social justice when we promote gender equality or the rights of indigenous peoples and migrants.

We advance social justice when we remove barriers that people face because of gender, age, race, ethnicity, religion, culture or disability.

For the United Nations, the pursuit of social justice for all is at the core of our global mission to promote development and human dignity.

The adoption by the International Labour Organization of the Declaration on Social Justice for a Fair Globalization is just one recent example of the UN system’s commitment to social justice.

The Declaration focuses on guaranteeing fair outcomes for all through employment, social protection, social dialogue, and fundamental principles and rights at work.

2019 theme: If You Want Peace & Development, Work for Social Justice

Social justice is an underlying principle for peaceful and prosperous coexistence within and among nations. The ILO estimates that currently about 2 billion people live in fragile and conflict-affected situations, of whom more than 400 million are aged 15 to 29.

Job creation, better quality jobs, and better access to jobs for the bottom 40 per cent have the potential to increase incomes and contribute to more cohesive and equitable societies and thus are important to prevent violent conflicts and to address post-conflict challenges.

Download the 2019 Calendar Health Awareness Days

For many years ACCHO organisations have said they wished they had a list of the many Indigenous “ Days “ and Aboriginal health or awareness days/weeks/events.

With thanks to our friends at ZockMelon here they both are!

It even has a handy list of the hashtags for the event.

Download the 53 Page 2019 Health days and events calendar HERE

naccho zockmelon 2019 health days and events calendar

We hope that this document helps you with your planning for the year ahead.

Every Tuesday we will update these listings with new events and What’s on for the week ahead

To submit your events or update your info

Contact: Colin Cowell www.nacchocommunique.com

NACCHO Social Media Editor Tel 0401 331 251

Email : nacchonews@naccho.org.au

21 February Galambila ACCHO Gumbaynggirr Cultural Show for Coffs Harbour Pharmacists 

Please join us in the evening on Thursday the 21st of February 2019 for a Gumbaynggirr Cultural Show.

Through the QUMAX program (Quality Use of Medicines for Maximised for Aboriginal and Torres Strait Islander people), Galambila AHS will be hosting a cultural event for pharmacists, pharmacy assistants and health professionals in Coffs Harbour to learn more about our local indigenous culture. QUMAX Cultural Awareness activities aim to improve culturally sensitive care for Aboriginal clients and enhance the working relationship between Galambila and local pharmacies.

The event will be run by Clark Webb and his team at Bularri Muurlay Nyanggan Aboriginal Corporation (BMNAC). BMNAC recently won a Bronze Medal at the 2018 NSW Tourism Awards for Excellence in Aboriginal Tourism. To see more information on what this great organisation is all about, visit their website at the following link: https://bmnac.org.au/

The night will include the following:

– Traditional Welcome to Country

– Traditional fire making

– Introductory Gumbaynggirr Language Lesson

– Sharing of traditional Gumbaynggirr dreaming stories that connect participants to our local landscape

– Uses of various varieties of plants, including medicinal

– Damper and tea will be provided on the night

Please RSVP by COB on Monday 18th of February 2019 via Eventbrite. Get in quick as places will be limited!

BOOK HERE 

21 February Winyarr Dreaming Creations, Marngrook workshop 

 

The wonderful Bernadette Atkinson will be leading the way, sharing her knowledge and creativity.

To avoid missing out, please contact the Koori Women’s Place team on 03 9244 3333 or kwp@djirra.org.au

22 February Awabakal ACCHO Strong Youth Launch

Featuring MC Sean Choolburra and performances by Koori Rep, Shanelle Dargan (as seen on X-Factor) and Last Kinnection.

RSVP: 0457 868 980 or zkhan@awabakal.org by February 15.

6 March AIATSIS Culture and Policy Symposium 

Info and Register

9 March  Bush to Beach Project Grazing Style Light Indigenous Marathon Fundraiser

The Port Macquarie Running Festival is happening over the weekend of the 9th-10th March 2019. As a part of this event we are running a fundraiser to support the important work being undertaken by Charlie & Tali Maher as a part of the Indigenous Marathon Project Running And Walking group. Come along to hear from Olympians Nova Peris, Steve Moneghette & Robert de Castella while meeting members of the Indigenous Marathon Project over lunch. We hope to see you there.

All funds raised will go towards the Bush to Beach Project. The project aims
to develop a strong relationship between the Northern Territory community of
Ntaria and the coastal community of Port Macquarie, with an exchange program
occurring several times throughout the year. This will include young Indigenous
people visiting the communities and participating in running and walking events
to promote healthy living. We thank you for your support.

Guest Speakers: Olympians Nova Peris, Steve Moneghetti & Robert de Castella.

Any enquiries please get in touch with Nina Cass or Charlie Maher (ninacass87@gmail.com / charles.maher@det.nsw.edu.au)

Tickets $59 Register HERE 

12- 13 March Overcoming Indigenous Family Violence 

Djirra has been chosen to be the charity partner of the next Overcoming Indigenous Family Violence conference organised by Aventedge in Melbourne on the 12th and 13th of March.

On the first day, Tuesday 12th of March, Marion Hansen, Djirra’s chairperson, will give the opening and closing address. At 10.30am, Djirra’s CEO Antoinette Braybrook will share her experience and knowledge on Supporting Aboriginal women, their children and communities to be safe, culturally strong and free from violence.

Family violence against Aboriginal and Torres Strait Islander people, predominantly women and their children, is a national crisis.

Aboriginal and Torres Strait Islander communities and their organisations hold the solutions to ending the disproportionate rates of family violence. However this requires the support and involvement of a range of stakeholders around the country.

The 5th annual Overcoming Indigenous Family Violence Forum (Melbourne & Perth) has partnered with Djirra and brings together representatives from Aboriginal and Torres Strait Islander Community Controlled Organisations, specialist family violence support and prevention services, community legal services, government, police and not-for-profit organisations.

During the course of this conference and 1-day workshop, we will explore critical issues in working to end family violence against Aboriginal and Torres Strait Islander people, including state and federal government initiatives; how frontline services are engaging in prevention, early intervention and response; learning from the stories and experiences of survivors of family violence; working more effectively with people who use violence towards accountability and behaviour change and the impacts of family violence on children and young people.

For more information on these events, pricing and discounts click below:
Melbourne | 12th-14th March 2019
Event homepage – www.ifv-mel.aventedge.com
Register here – http://elm.aventedge.com/ifv-mel-register

Perth | 5th-6th March 2019
Event homepage – www.ifv-per.aventedge.com
Register here – http://elm.aventedge.com/ifv-per/register

 

14 – 15 March 2019 Close the Gap for Vision by 2020 – National Conference 2019

Indigenous Eye Health (IEH) at the University of Melbourne and co-host Aboriginal Medical Services Alliance Northern Territory (AMSANT), are pleased to invite you to register for the Close the Gap for Vision by 2020:Strengthen & Sustain – National Conference 2019 which will be held at the Alice Springs Convention Centre on Thursday 14 and Friday 15 March 2019 in the Northern Territory. This conference is also supported by our partners, Vision 2020 Australia, Optometry Australia and the Royal Australian and New Zealand College of Ophthalmologists.

The 2019 conference, themed ‘Strengthen & Sustain’ will provide opportunity to highlight the very real advances being made in Aboriginal and Torres Strait eye health. It will explore successes and opportunities to strengthen eye care and initiatives and challenges to sustain progress towards the goal of equitable eye care by 2020. To this end, the conference will include plenary speakers, panel discussions and presentations as well as upskilling workshops and cultural experiences.

Registration (including workshops, welcome reception and conference dinner) is $250. Registrations close on 28 February 2019.

Who should attend?

The conference is designed to bring people together and connect people involved in Aboriginal and Torres Strait Islander eye care from local communities, Aboriginal Community Controlled Health Organisations, health services, non-government organisations, professional bodies and government departments from across the country. We would like to invite everyone who is working on or interested in improving eye health and care for Aboriginal and Torres Strait Islander Australians.

Speakers will be invited, however this year we will also be calling for abstracts for Table Top presentations and Poster presentations – further details on abstract submissions to follow.

Please share and forward this information with colleagues and refer people to this webpage where the conference program and additional informationwill become available in the lead up to the conference. Note: Please use the conference hashtag #CTGV19.

We look forward to you joining us in the Territory in 2019 for learning and sharing within the unique beauty and cultural significance of Central Australia.

Additional Information:

If you have any questions or require additional information, please contact us at indigenous-eyehealth@unimelb.edu.au or contact IEH staff Carol Wynne (carol.wynne@unimelb.edu.au; 03 8344 3984 email) or Mitchell Anjou (manjou@unimelb.edu.au; 03 8344 9324).

Close the Gap for Vision by 2020: Strengthen & Sustain – National Conference 2019 links:

– Conference General Information

– Conference Program

– Conference Dinner & Leaky Pipe Awards

– Staying in Alice Springs

More information available at: go.unimelb.edu.au/wqb6 

21 March National Close the Gap Day

 

Description

National Close the Gap Day is a time for all Australians to come together and commit to achieving health equality for Aboriginal and Torres Strait Islander people.

The Close the Gap Campaign will partner with Tharawal Aboriginal Aboriginal Medical Services, South Western Sydney, to host an exciting community event and launch our Annual Report.

Visit the website of our friends at ANTaR for more information and to register your support. https://antar.org.au/campaigns/national-close-gap-day

EVENT REGISTER

21 March Indigenous Ear Health Workshop Brisbane 

The Australian Society of Otolaryngology Head and Neck Surgery is hosting a workshop on Indigenous Ear Health in Brisbane on Thursday, 21 March 2019.

This meeting is the 7th to be organised by ASOHNS and is designed to facilitate discussion about the crucial health issue and impact of ear disease amongst Indigenous people.

The meeting is aimed at bringing together all stakeholders involved in managing Indigenous health and specifically ear disease, such as:  ENT surgeons, GPs, Paediatricians, Nurses, Audiologists, Speech Therapists, Allied Health Workers and other health administrators (both State and Federal).

Download Program and Contact 

Indigenous Ear Health 2019 Program

24 -27 March National Rural Health Alliance Conference

Interested in the health and wellbeing of rural or remote Australia?

This is the conference for you.

In March 2019 the rural health sector will gather in Hobart for the 15th National Rural Conference.  Every two years we meet to learn, listen and share ideas about how to improve health outcomes in rural and remote Australia.

Proudly managed by the National Rural Health Alliance, the Conference has a well-earned reputation as Australia’s premier rural health event.  Not just for health professionals, the Conference recognises the critical roles that education, regional development and infrastructure play in determining health outcomes, and we welcome people working across a wide variety of industries.

Join us as we celebrate our 15th Conference and help achieve equitable health for the 7 million Australians living in rural and remote areas.

Hobart and its surrounds was home to the Muwinina people who the Alliance acknowledges as the traditional and original owners of this land.  We pay respect to those that have passed before us and acknowledge today’s Tasmanian Aboriginal community as the custodians of the land on which we will meet.

More info 

20 -24 May 2019 World Indigenous Housing Conference. Gold Coast

Thank you for your interest in the 2019 World Indigenous Housing Conference.

The 2019 World Indigenous Housing Conference will bring together Indigenous leaders, government, industry and academia representing Housing, health, and education from around the world including:

  • National and International Indigenous Organisation leadership
  • Senior housing, health, and education government officials Industry CEOs, executives and senior managers from public and private sectors
  • Housing, Healthcare, and Education professionals and regulators
  • Consumer associations
  • Academics in Housing, Healthcare, and Education.

The 2019 World Indigenous Housing Conference #2019WIHC is the principal conference to provide a platform for leaders in housing, health, education and related services from around the world to come together. Up to 2000 delegates will share experiences, explore opportunities and innovative solutions, work to improve access to adequate housing and related services for the world’s Indigenous people.

Event Information:

Key event details as follows:
Venue: Gold Coast Convention and Exhibition Centre
Address: 2684-2690 Gold Coast Hwy, Broadbeach QLD 4218
Dates: Monday 20th – Thursday 23rd May, 2019 (24th May)

Registration Costs

  • EARLY BIRD – FULL CONFERENCE & TRADE EXHIBITION REGISTRATION: $1950 AUD plus booking fees
  • After 1 February FULL CONFERENCE & TRADE EXHIBITION REGISTRATION $2245 AUD plus booking fees

PLEASE NOTE: The Trade Exhibition is open Tuesday 21st May – Thursday 23rd May 2019

Please visit www.2019wihc.com for further information on transport and accommodation options, conference, exhibition and speaker updates.

Methods of Payment:

2019WIHC online registrations accept all major credit cards, by Invoice and direct debit.
PLEASE NOTE: Invoices must be paid in full and monies received by COB Monday 20 May 2019.

Please note: The 2019 WIHC organisers reserve the right of admission. Speakers, programs and topics are subject to change. Please visit http://www.2019wihc.comfor up to date information.

Conference Cancellation Policy

If a registrant is unable to attend 2019 WIHC for any reason they may substitute, by arrangement with the registrar, someone else to attend in their place and must attend any session that has been previously selected by the original registrant.

Where the registrant is unable to attend and is not in a position to transfer his/her place to another person, or to another event, then the following refund arrangements apply:

    • Registrations cancelled less than 60 days, but more than 30 days before the event are eligible for a 50% refund of the registration fees paid.
    • Registrations cancelled less than 30 days before the event are no longer eligible for a refund.

Refunds will be made in the following ways:

  1. For payments received by credit or debit cards, the same credit/debit card will be refunded.
  2. For all other payments, a bank transfer will be made to the payee’s nominated account.

Important: For payments received from outside Australia by bank transfer, the refund will be made by bank transfer and all bank charges will be for the registrant’s account. The Cancellation Policy as stated on this page is valid from 1 October 2018.

Terms & Conditions

please visit www.2019wihc.com

Privacy Policy

please visit www.2019wihc.com

 

18 -20 June Lowitja Health Conference Darwin


At the Lowitja Institute International Indigenous Health and Wellbeing Conference 2019 delegates from around the world will discuss the role of First Nations in leading change and will showcase Indigenous solutions.

The conference program will highlight ways of thinking, speaking and being for the benefit of Indigenous peoples everywhere.

Join Indigenous leaders, researchers, health professionals, decision makers, community representatives, and our non-Indigenous colleagues in this important conversation.

More Info 

2019 Dr Tracey Westerman’s Workshops 

More info and dates

7 -14 July 2019 National NAIDOC Grant funding round opens 

The opening of the 2019 National NAIDOC Grant funding round has been moved forward! The National NAIDOC Grants will now officially open on Thursday 24 January 2019.

Head to www.naidoc.org.au to join the National NAIDOC Mailing List and keep up with all things grants or check out the below links for more information now!

https://www.finance.gov.au/resource-management/grants/grantconnect/

https://www.pmc.gov.au/indigenous-affairs/grants-and-funding/naidoc-week-funding

24 -26 September 2019 CATSINaM National Professional Development Conference

 

 

The 2019 CATSINaM National Professional Development Conference will be held in Sydney, 24th – 26th September 2019. Make sure you save the dates in your calendar.

Further information to follow soon.

Date: Tuesday the 24th to Thursday the 26th September 2019

Location: Sydney, Australia

Organiser: Chloe Peters

Phone: 02 6262 5761

Email: admin@catsinam.org.au

 

5-8 November The Lime Network Conference New Zealand 

This years  whakatauki (theme for the conference) was developed by the Scientific Committee, along with Māori elder, Te Marino Lenihan & Tania Huria from .

To read about the conference & theme, check out the  website. 

 

NACCHO Aboriginal Health Pre- #Budget2019 -2020 : #RefreshTheCTGRefresh :The following #ClosingTheGap policy proposals are informed by NACCHO’s consultations with its Affiliates and our 145 Aboriginal Community Controlled Health Services:

 

The proposals included in this submission are based on the extensive experience NACCHO member services have of providing many years of comprehensive primary health care to Aboriginal and Torres Strait Islander peoples.

We have long recognised that closing the gap on Aboriginal and Torres Strait Islander health and disadvantage will never be achieved until primary health care services’ infrastructure hardware is fit for purpose; our people are living in safe and secure housing; culturally safe and trusted early intervention services are available for our children and their families; and our psychological, social, emotional and spiritual needs are acknowledged and supported.=

If these proposals are adopted, fully funded and implemented, they provide a pathway forward where improvements in life expectancy can be confidently predicted. “  

Pat Turner AM NACCHO CEO on behalf of our State and Territory Affiliates and 145 Aboriginal Community Controlled Health Services operating 302 ACCHO Clinics

Download this 20 Page NACCHO Submission

NACCHO Budget Submission 2019-20 FINAL

NACCHO is the national peak body representing 145 ACCHOs across the country on Aboriginal health and wellbeing issues.

In 1997, the Federal Government funded NACCHO to establish a Secretariat in Canberra, greatly increasing the capacity of Aboriginal peoples involved in ACCHOs to participate in national health policy development. Our members provide about three million episodes of care per year for about 350,000 people. In very remote areas, our services provide about one million episodes of care in a twelve-month period.

Collectively, we employ about 6,000 staff (56 per cent whom are Indigenous), which makes us the single largest employer of Indigenous people in the country.

The following policy proposals are informed by NACCHO’s consultations with its Affiliates and Aboriginal Community Controlled Health Services:

  1. Increase base funding of Aboriginal Community Controlled Health Services;
  2. Increase funding for capital works and infrastructure;
  3. Improve Aboriginal and Torres Strait Islander housing and community infrastructure;
  4. Reduce the overrepresentation of Aboriginal and Torres Strait Islander children and young people in out-of-home care and detention; and
  5. Strengthen the Mental Health and Social and Emotional Wellbeing of Aboriginal and Torres Strait Islander peoples.

NACCHO is committed to working with the Australian Government to further develop the proposals, including associated costings and implementation plans and identifying where current expenditure could be more appropriately targeted.

1. Increase base funding of Aboriginal Community Controlled Health Services

Proposal:

That the Australian Government:

  • Commits to increasing the baseline funding for Aboriginal Community Controlled Health Services to support the sustainable delivery of high quality, comprehensive primary health care services to Aboriginal and Torres Strait Islander people and communities.
  • Works together with NACCHO and Affiliates to agree to a new formula for the provision of comprehensive primary health care funding that is relative to need.

Rationale: 

The Productivity Commission’s 2017 Indigenous Expenditure Report found that per capita government spending on Indigenous services was twice as high as for the rest of the population. The view that enormous amounts of money have been spent on Indigenous Affairs has led many to conclude a different focus is required and that money is not the answer. Yet, the key question in understanding the relativities of expenditure on Indigenous is equity of total expenditure, both public and private and in relation to need.

The Commonwealth Government spends $1.4 for every $1 spent on the rest of the population, while Aboriginal and Torres Strait Islander people have 2.3 times the per capita need of the rest of the population because of much higher levels of illness and burden of disease. In its 2018 Report Card on Indigenous Health, the Australian Medical Association (AMA) states that spending less per capita on those with worse health, is ‘untenable national policy and that must be rectified’.1 The AMA also adds that long-term failure to adequately fund primary health care – especially Aboriginal Community Controlled Health Services (ACCHSs) – is a major contributing factor to failure in closing health and life expectancy gaps.

Despite the challenges of delivering services in fragmented and insufficient funding environments, studies have shown that ACCHSs deliver more cost-effective, equitable and effective primary health care services to Aboriginal and Torres Strait Islander peoples and are 23 per cent better at attracting and retaining Aboriginal and Torres Strait Islander clients than mainstream providers.2 ACCHSs continue to specialise in providing comprehensive primary care consistent with clients’ needs.

This includes home and site visits; provision of medical, public health and health promotion services; allied health, nursing services; assistance with making appointments and transport; help accessing child care or dealing with the justice system; drug and alcohol services; and providing help with income support.

                                                        

1https://ama.com.au/system/tdf/documents/2018%20AMA%20Report%20Card%20on%20Indigenous%20Heal th_1.pdf?file=1&type=node&id=49617, page 6.

2 Ong, Katherine S, Rob Carter, Margaret Kelaher, and Ian Anderson. 2012. Differences in Primary Health Care

Delivery to Australia’s Indigenous Population: A Template for Use in Economic Evaluations, BMC Health

Services Research 12:307; Campbell, Megan Ann, Jennifer Hunt, David J Scrimgeour, Maureen Davey and

Victoria Jones. 2017. Contribution of Aboriginal Community Controlled Health Services to improving Aboriginal

There are limits, however, to the extent that ACCHSs can continue to deliver quality, safe primary health care in fragmented and insufficient funding environments. This is particularly challenging to meet the health care needs of a fast-growing population.3 There is an urgent need to identify and fill the current health service gaps, particularly in primary health care, and with a focus on areas with high preventable hospital admissions and deaths and low use of the Medical Benefits Scheme and the Pharmaceutical Benefits Scheme.

An appropriately resourced Aboriginal Community Controlled Health sector represents an evidence-based, cost-effective and efficient solution for addressing the COAG Close the Gap and strategy and will result in gains for Aboriginal and Torres Strait Islander peoples’ health and wellbeing.

Strengthening the workforce

NACCHO welcomes COAG’s support for a National Aboriginal and Torres Strait Islander Health and Medical Workforce Plan. A long-term plan for building the workforce capabilities of ACCHSs is overdue. Many services struggle with the recruitment and retention of suitably qualified staff, and there are gaps in the number of professionals working in the sector.

NACCHO believes that the plan will be strengthened by expanding its scope to include:

  • metropolitan based services;
  • expanding the range of workforce beyond doctors and nurses; and
  • recognising that non-Indigenous staff comprise almost half of the workforce. While Aboriginal and Torres Strait Islander health staff are critical to improving access to culturally appropriate care and Indigenous health outcomes, consideration to the non-Indigenous workforce who contribute to improving Aboriginal and Torres Strait Islander Health outcomes should also be given.

An increase in the baseline funding for Aboriginal Community Controlled Health Services, as set out in this proposal will enable our sector to plan for and build workforce capabilities in line with the Health and Medical Workforce Plan objectives.

2. Increase funding for capital works and infrastructure upgrades

Proposal:

That the Australian Government:

  • Commits to increasing funding allocated through the Indigenous Australians’ Health Programme for capital works and infrastructure upgrades, and  Telehealth services; noting that at least $500m is likely to be needed to address unmet needs, based on the estimations of 38.6 per cent of the ACCHO sector, and we anticipate that those needs may be replicated across the sector (see Table A below).

Rationale: 

There is a current shortfall in infrastructure with a need for new buildings in existing and outreach locations, and renovations to increase amenities including consultation spaces. Additional funding is required for additional rooms and clinics mapped against areas of highest need with consideration to establishing satellite, outreach or permanent ACCHSs.

Many of the Aboriginal health clinics are 20 to 40 years old and require major refurbishment, capital works and updating to meet increasing population and patient numbers. The lack of consulting rooms and derelict infrastructure severely limits our services’ ability to increase MBS access.

Further, whilst there may be some scope to increase MBS billing rates for Aboriginal and Torres Strait Islander peoples, this cannot be achieved without new services and infrastructure. A vital priority is seed funding for the provision of satellite and outreach Aboriginal Community Controlled Health Services that Aboriginal and Torres Strait Islander people will access, and which provide the comprehensive services needed to fill the service gaps, to boost the use of MBS and PBS services to more equitable levels, and to reduce preventable admissions and deaths.

Improvements to the building infrastructure of ACCHSs are required to strengthen their capacity to address gaps in service provision, attract and retain clinical staff, and support the safety and accessibility of clinics and residential staff facilities. However, the level of funding of $15m per annum, under the Indigenous Australians’ Health Programme allocated for Capital Works – Infrastructure, Support and Assessment and Service Maintenance, is not keeping up with demand.

In our consultations with Affiliates and ACCHSs, NACCHO is increasingly hearing that

Telehealth services,[1] including infrastructure/hardware and improved connectivity, is required to support the provision of NDIS, mental health and health specialist services. A total of 22 out of 56 survey responses (see Table A below) identified the need for Telehealth to support service provision.

NACCHO believes that insufficient funding to meet capital works and infrastructure needs is adversely impacting the capacity of some ACCHSs to safely deliver comprehensive, timely and responsive primary health care; employ sufficient staff; to improve their uptake of Medicare billing; and to keep up with their accreditation requirements. In January 2019, we surveyed ACCHSs about their capital works and infrastructure needs, including Telehealth services. We received 56 responses, representing a response rate of 38.6 per cent.

 

Survey respondents estimated the total costs of identified capital works and infrastructure upgrades (see Table A below). The estimated costs have not been verified; however, they do

suggest there is a great level of unmet need in the sector. Please note that not all respondents were able to provide estimates.

Table A. Estimated costs of capital works and infrastructure upgrades identified by ACCHSs

Type Number of respondents Percentage of respondents Total estimated costs
Replace existing building 43 76.7% 207,559,043
New location/satellite clinic 21 37.5% 53,480,000
Extension 24 42.8% 18,310,000
Refurbishment 29 51.7% 35,251,000
Staff accommodation 25 44.6% 39,450,000
Telehealth services 22 39.2% 6,018,763
Total estimated costs of capital works and infrastructure upgrades $361,068,806

 

37 survey respondents applied for funding for infrastructure improvements from the Australian Government Department of Health during 2017 and/or 2018. Of the 11 that were successful, four respondents stated that the allocated funds were not sufficient for requirements.

ACCHSs believe that the current state of their service infrastructure impedes the capacity of their services as depicted in Table B, below:

Table B: Impact of ACCHSs’ infrastructure needs on service delivery

Infrastructure impeding service delivery Highly affected Somewhat affected
Safe delivery of quality health care 48.1% 51.9%
Increase client numbers 74.1% 25.9%
Expand the range of services and staff numbers 83.3% 16.7%
Increase Medicare billing 66% 34%

 

An extract of feedback provided by ACCHSs relating to their capital works and infrastructure needs is at Appendix A.

3. Improve Aboriginal and Torres Strait Islander housing and community infrastructure

Proposals:

That the Australian Government:

  • Expand the funding and timeframe of the current National Partnership on Remote Housing to match AT LEAST that of the former National Partnership Agreement on Remote Indigenous Housing.
  • Establish and fund a program that supports healthy living environments in urban, regional and remote Aboriginal and Torres Strait Islander communities, similar to the Fixing Houses for Better Health program. Ensure that rigorous data collection and program evaluation structures are developed and built into the program, to provide the Commonwealth Government with information to enable analysis of how housing improvements impact on health indicators.[2]
  • Update and promote the National Indigenous Housing Guide, a best practice resource for the design, construction and maintenance of housing for Aboriginal and Torres Strait Islander peoples.[3]

Rationale: 

Safe and decent housing is one of the biggest social determinants of health and we cannot overlook this when working to close the gap in life expectancy.

1. Remote Indigenous Housing

The National Partnership Agreement on Remote Indigenous Housing 2008-2018 was a COAG initiative that committed funding of $5.4b towards new builds, refurbishments, housing quality, cyclical maintenance, and community engagement and employment and business initiatives.

In 2016, the National Partnership Agreement on Remote Indigenous Housing was replaced by the National Partnership on Remote Housing. Under this new partnership, the Commonwealth Government committed:

  • $776.403m in 2016, to support remote housing in the Northern Territory, Queensland, South Australia, Western Australia, and the Northern Territory over a two-year period; and
  • $550m in 2018, to support remote housing in the Northern Territory, over a five-year period.

New South Wales, Victoria and Tasmania are not part of discussions with the Commonwealth Government on housing needs.

A review of the National Partnership Agreement on Remote Indigenous Housing (2018) found that:

  • An additional 5,500 homes are required by 2028 to reduce levels of overcrowding in remote areas to acceptable levels
  • A planned cyclic maintenance program, with a focus on health-related hardware and houses functioning, is required.
  • Systematic property and tenancy management needs to be faster.
  • More effort is required to mobilise the local workforces to do repairs and maintenance work.[4]

There is currently a disconnect between the levels of government investment into remote housing and the identified housing needs of remote communities. This disconnect is increasingly exacerbated by population increases in Aboriginal communities.[5]

There is a comprehensive, evidence-based literature which investigates the powerful links between housing and health, education and employment outcomes.[6] Healthy living conditions are the basis from which Closing the Gap objectives may be achieved. Commonwealth Government leadership is urgently needed to appropriately invest into remote housing.

2.Environmental health

The importance of environmental health to health outcomes is well established. A healthy living environment with adequate housing supports not only the health of individuals and families; it also enhances educational achievements, community safety and economic participation.10

Commonwealth and State and Territory Governments have a shared responsibility for housing. Overcrowding is a key contributor to poor health of Aboriginal and Torres Strait Islander peoples. In addition to overcrowding, poor and derelict health hardware (including water, sewerage, electricity) leads to the spread of preventable diseases for Aboriginal and Torres Strait Islander peoples. Healthy homes are vital to ensuring that preventable diseases that have been eradicated in most countries do not exist in Aboriginal and Torres Strait Islander communities and homes.

4. Reduce the overrepresentation of Aboriginal and Torres Strait Islander children and young people in out-of-home care and detention

Proposals:

That the Australian Government:

  • Establishes an additional elective within the existing Aboriginal Health Worker curriculum, that provides students with early childhood outreach, preventative health care and parenting support skills
  • Waives the upfront fees of the first 100 Indigenous students to undertake the Aboriginal Health Worker (Early Childhood stream) Certificate IV course.
  • Funds an additional 145 Aboriginal Health Worker (early childhood) places across ACCHSs.

Rationale:

The overrepresentation of Aboriginal and Torres Strait Islander children and young people in the child protection system is one of the most pressing human rights challenges facing Australia today.[7]

Young people placed in out-of-home care are 16 times more likely than the equivalent general population to be under youth justice supervision in the same year.[8]

Government investment in early childhood is an urgent priority to reduce the overrepresentation of Aboriginal and Torres Strait Islander children in out of home care and youth detention. Research reveals that almost half of the Aboriginal and Torres Strait Islander children who are placed to out of home care are removed by the age of four[9] and, secondly, demonstrates the strong link between children and young people in detention who have both current and/or previous experiences of out of home care.[10] There is also compelling evidence of the impact of repetitive, prolonged trauma on children and young people and how, if left untreated, this may lead to mental health and substance use disorders, and intergenerational experiences of out-of-home care and exposure to the criminal justice system.15

Despite previous investments by governments, the Aboriginal and Torres Strait Islander children and young people remain overrepresented in the children protection and youth detention systems. The Council of Australian Governments (COAG) Protecting Children is Everyone’s Business National Framework for Protecting Australia’s Children 2009–2020 (‘National Framework’) was established to develop a unified approach for protecting children. It recognises that ‘Australia needs a shared agenda for change, with national leadership and a common goal’.

One of the six outcomes of the National Framework is that Aboriginal and Torres Strait Islander children are supported and safe in their families and communities, with this overarching goal:

Indigenous children are supported and safe in strong, thriving families and communities to reduce the over-representation of Indigenous children in child protection systems. For those Indigenous children in child protection systems, culturally appropriate care and support is provided to enhance their wellbeing.16

Findings presented in the 2018 Family Matters Report reveal, however, that the aims and objectives of the National Framework have failed to protect Aboriginal and Torres Strait Islander children:

Aboriginal and Torres Strait Islander children make up just over 36 per cent of all children living in out-of-home care; the rate of Aboriginal and Torres Strait Islander children in out-ofhome care is 10.1 times that of other children, and disproportionate representation continues to grow (Australian Institute of Health and Welfare [AIHW], 2018b). Since the last Family Matters Report over-representation in out-of-home care has either increased or remained the same in every state and territory.17

Furthermore, statistics on the incarceration of Aboriginal and Torres Strait Islander children and young people in detention facilities reveal alarmingly high trends of overrepresentation:

  • On an average night in the June quarter 2018, nearly 3 in 5 (59%) young people aged 10– 17 in detention were Aboriginal and Torres Strait Islander, despite Aboriginal and Torres Strait Islander young people making up only 5% of the general population aged 10–17.
  • Indigenous young people aged 10–17 were 26 times as likely as non-Indigenous young people to be in detention on an average night.
  • A higher proportion of Indigenous young people in detention were aged 10–17 than non-Indigenous young people—in the June quarter 2018, 92% of Aboriginal and Torres

Strait Islander young people in detention were aged 10–17, compared with 74% of non-

Indigenous Islander young people.18

towardtraumainfo/Orygen_trauma_and_young_people_policy_report.aspx?ext=.; https://www.facs.nsw.gov.au/__data/assets/pdf_file/0016/421531/FACS_SAR.pdf

NACCHO believes an adequately funded, culturally safe, preventative response is needed to reduce the number and proportion of Aboriginal and Torres Strait Islander children in child protection and youth detention systems. It is vital that Aboriginal and Torres Strait Islander families who are struggling with chronic, complex and challenging circumstances are able to access culturally appropriate, holistic, preventative services with trusted service providers that have expertise in working with whole families affected by intergenerational trauma. The child protection and justice literature are united in that best practice principles for developing solutions to these preventable problems begin with self-determination, community control, cultural safety and a holistic response.[11] For these reasons, we are proposing that the new Aboriginal Health Worker (Early Childhood) be based within the service setting of the Aboriginal Community Controlled Health Service.

The cultural safety in which ACCHSs’ services are delivered is a key factor in their success. ACCHSs have expert understanding and knowledge of the interplays between intergenerational trauma, the social determinants of health, family violence, and institutional racism, and the risks these contributing factors carry in increasing Aboriginal and Torres Strait Islander peoples’ exposure to the child protection and criminal justice systems.

Our services have developed trauma informed care responses that acknowledge historical and contemporary experiences of colonisation, dispossession and discrimination and build this knowledge into service delivery.

Further, they are staffed by health and medical professionals who understand the importance of providing a comprehensive health service, including the vital importance of regular screening and treatment for infants and children aged 0-4, and providing at risk families with early support. Within the principles, values and beliefs of the Aboriginal community controlled service model lay the groundwork for children’s better health, education, and employment outcomes. The addition of Aboriginal Health Workers with early childhood skills and training will provide an important, much needed role in preventing and reducing Aboriginal and Torres Strait Islander children and young peoples’ exposure to child protection and criminal justice systems.

 

Aboriginal Peak Organisations of the Northern Territory, Submission to the Royal  

Commission into the Protection and Detention of Children in the Northern Territory, 2017

NACCHO supports the position and recommendations of Aboriginal Peak Organisations in the NT, that:

•        Aboriginal community control, empowerment and a trauma informed approach should underpin the delivery of all services to Aboriginal children and their families. This applies to service design and delivery across areas including early childhood, education, health, housing, welfare, prevention of substance misuse, family violence prevention, policing, child protection and youth justice.

•        The Australian Government develops and implements a comprehensive, adequately resourced national strategy and target, developed in partnership with Aboriginal and Torres Strait Islander peoples, to eliminate the over-representation of Aboriginal and Torres Strait Islander children in out-of-home care.

•        There is an urgent need for a child-centred, trauma-informed and culturally relevant approach to youth justice proceedings which ultimately seeks to altogether remove the need for the detention of children.

•        Early childhood programs and related clinical and public health services are provided equitably to all Aboriginal children (across the NT) through the development and implementation of a three-tiered model of family health care – universal, targeted and indicated – to meet children’s needs from before birth to school age. Services should be provided across eight key areas:  o quality antenatal and postnatal care;

o clinical and public health services for children and families; o a nurse home visiting program; o parenting programs; o child development programs; o two years of preschool; o targeted services for vulnerable children and families; and o supportive social determinants policies.

•        These services need to be responsive to, and driven by, the community at a local level.

5. Strengthen the mental health and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples

Proposal:

That the Australian Government:

  • Provide secure and long-term funding to ACCHSs to expand their mental health, social and emotional wellbeing, suicide prevention, alcohol and other drugs services, using best practice trauma informed approaches.
  • Urgently increase funding for ACCHSs to employ staff to deliver mental health and social and emotional wellbeing services, including psychologists, psychiatrists, speech pathologists, mental health workers and other professionals and workers; and
  • Urgently increase the delivery of training to Aboriginal health practitioners to establish and/or consolidate skills development in mental health care and support, including suicide prevention; and
  • Return funding for Aboriginal and Torres Strait Islander suicide prevention, health and wellbeing and alcohol and other drugs from the Indigenous Advancement Strategy to the Indigenous Australians’ Health Programme.

Rationale: 

The Australian Institute of Health and Welfare has estimated that mental health and substance use are the biggest contributors to the overall burden of disease for Aboriginal and Torres Strait Islander peoples. Indigenous adults are 2.7 times more likely to experience high or very high levels of psychological distress than other Australians.[12] They are also hospitalised for mental and behavioural disorders and suicide at almost twice the rate of non-Indigenous population and are missing out on much needed mental health services.

Suicide is the leading cause of death for Aboriginal people aged 5-34 years, the second leading cause of death for Aboriginal and Torres Strait Islander men. In 2016, the rate of suicide for Aboriginal and Torres Strait Islander peoples was 24 per 100,000, twice the rate for non-Indigenous Australians.[13] Aboriginal people living in the Kimberley region are seven times more likely to suicide than non-Aboriginal people.

Many Aboriginal Community Controlled Health Services deliver culturally safe, trauma informed services in communities dealing with extreme social and economic disadvantage that are affected and compounded by intergenerational trauma and are supporting positive changes in the lives of their members. The case study provided by Derby Aboriginal Health Service demonstrates not only the impact that this ACCHS is having on its community. It also illustrates the rationale for each of the proposals described in this pre-budget submission.

Case Study: Derby Aboriginal Health Service, WA

Derby Aboriginal Health Service’s Social and Emotional Wellbeing Unit (SEWB) have partnered with another organisation to employ someone in our SEWB unit to work directly with families on issues that contribute to them losing their children to Department of Child Protection (DCP). This program is designed to help prevent the children from being removed by DCP by working one to one with families on issues such as budgeting, education, substance misuse, a safe and healthy home etc.

Our SEWB unit has a community engagement approach which involves working directly with clients and their families, counselling with the psychologist and mental health worker, the male Aboriginal Mental Health Worker taking men out on country trips as part of mental health activities for men, the youth at risk program (Shine), the Body Clinic, the prenatal program working directly with mums, dads and bubs around parenting, relationships between mums, dads and children etc. The team work directly with the community.

We are now introducing a new SEWB designed program into the Derby prison which focuses on exploring men and women’s strengths and abilities rather than looking at their deficits. Using a strengths based program was very successfully delivered with a group of 22 Aboriginal men and 16 Aboriginal women where, for many of the participants, they were told for the first time in their lives that they matter and that they have good things about them and they are strong men and women (this naturally brought in some behavior modification that they could attempt in making changes in their lives; e.g. one participant said that when he went home, he was going to make his wife a cup of tea instead of expecting her to make him tea – he said he had never thought of that before). The SEWB team presented this at the National Mental Health Conference in Adelaide, August last year.

Given the deep and respectful footprint the SEWB team has in the town and surrounding communities, they, and the people, deserve and need a new building in which to continue their important work. If we can help people deal with the issues above, then they will be much more empowered to prevent/deal with their own health issues – perhaps then we can Close the Gap.

Given the burden of mental, psychological distress and trauma that our communities are responding to and the impact this has on Aboriginal and Torres Strait Islander peoples’ life expectancy, educational outcomes, and workforce participation, NACCHO believes it is imperative that a funded implementation plan for the National Strategic Framework for Aboriginal and Torres Strait Islander Mental Health and Social and Emotional Wellbeing

2017-2023 (‘the Framework’) be developed as a priority. The following Action Areas of the Framework relate to this proposal:

  • Action Area 1 – Strengthen the foundations (An effective and empowered mental health and social and emotional wellbeing workforce);
  • Action Area 2 – Promote wellness (all outcome areas);[14] and
  • Action Area 4 – Provide care for people who are mildly or moderately ill (Aboriginal and Torres Strait Islander people living with a mild or moderate mental illness are able to access culturally and clinically appropriate primary mental health care according to need).

As the above case study suggests, our trusted local Aboriginal community controlled services are best placed to be the preferred providers of mental health, social and emotional wellbeing, and suicide prevention activities to their communities. Australian Government funding should be prioritised to on the ground Aboriginal services to deliver suicide prevention, trauma and other wellbeing services. Delivering these much-needed services through ACCHSs, rather than establishing a new service, would deliver economies of scale and would draw from an already demonstrated successful model of service delivery.

Further, NACCHO believes that the current artificial distinction between separating mental health, social and emotional wellbeing and alcohol and drug funding from primary health care funding, must be abolished. Primary health care, within the holistic health provision of ACCHS, provides the sound structure to address all aspects of health care arising from social, emotional and physical factors. Primary health care is a comprehensive approach to health in accordance with the Aboriginal holistic definition of health and arises out of the practical experience within the Aboriginal community itself having to provide effective and culturally appropriate health services to its communities.

The current artificial distinction, as exemplified by program funding for ACCHS activities being administered across two Australian Government Departments, does not support our definition of health and wellbeing. It also leads to inefficiencies and unnecessarily increases red tape, by imposing additional reporting burdens on a sector that is delivering services under challenging circumstances.     

APPENDIX A

Qualitative feedback from Aboriginal Community Controlled Health Services  capital works and infrastructure needs 

The following comments from ACCHSs have been extracted from a survey administered by NACCHO in January 2019:

  • Currently at capacity and as the government focusses more on Medicare earnings and less on funding we need the ability to expand into this area as well as the NDIS in order to meet our client service needs and build sustainability.
  • The facility that our service currently occupies is state government owned, on state crown land, is over 40 years old and is ‘sick’ – it is not fit for purpose with an irreparable roof, significant asbestos contamination, water ingress, mould and recurrent power outages. The maintenance costs are an unsustainable burden, it is unreliable, unsuitable and unsafe for clients and staff, and there is no room for expansion for program and community areas. We applied for funding from the Australian Government Department of Health, but the application was not successful. This figure is inclusive of early works transportable – temporary accommodation, building works, demolition works, services infrastructure, external works, design development contingency, construction contingency, builder preliminaries and margin, loose furniture and equipment, specialist/medical equipment, ICT & PABX, AV equipment, professional including.

disbursements (to be confirmed), statutory fees, locality loading, and goods and services tax.

  • We are in need of kitchen renovations to each of our community care sites that do meals on wheels. The WA Environmental Health unit has informed us that we need to upgrade all our kitchens to meet Food Safety requirements or they will enforce closure of some of our kitchens, which would then mean we are unable to do our Meals on Wheels service in some communities
  • Currently limited by space to employ support staff and increase our GP’s, our waiting room is around 3x4m and we are always having clients standing up or waiting outside until there is space for them. We currently have three buildings in the one township with two being rentals, if we could co-locate all services, we could offer a higher level of integrated care and save wasted money on rent.
  • Not currently enough space to house staff and visiting clinicians.
  • Have been applying for grants in infrastructure and included in Action Plan for quite a few years and still not successful.
  • We need a multi-purpose building to bring together our comprehensive range of services in a way that enables community to gather, express their culture and feel safe and welcome whilst receiving a fully integrated service delivery model of supports. We have more than doubled in staffing and program delivery and are still trying to operate out of the same space. The need for further expansion is inevitable and the co-operative welcomes the opportunity to bring more services to our community, but infrastructure

is a barrier and we have taken the strategic decision to acquire vacant land near our main headquarters with the view to obtaining future infrastructure funding – it is much needed.

  • The three sites we currently lease are all commercial premises and we have to make our business fit, the buildings are not culturally appropriate nor are they designed for a clinical setting.
  • For eight years we have struggled to grow in line with our community service needs and the requirement to become more self-sufficient in the face of a funding environment which is declining in real terms (not keeping pace with CPI and wages growth). Further to this, every time we add a building our running costs go up so even capital expansion comes at a cost to the organisation as it takes time to build up to the operating capacity that the new/improved buildings provide. This is the ongoing struggle in our space.
  • Our service was established in 1999 and has been operating from an 80 year old converted holiday house, with a couple of minor extensions. The clinic does not meet the contemporary set up for an efficient clinic from viewpoint of staff, medical services and for community members. Space is very limited, and service delivery is also limited due to room availability. Demand for services both for physical and mental health/SEWB is growing strongly. We have 425 Community Members (with 70 currently in prisons in our region) and our actual patient numbers accessing services over 12 months have increased 50%.
  • We never received support or funding to acquire a purpose-built facility from the outset and as there was no suitable accommodation for rent or lease, we acquired two small houses to deliver our services from. These were totally inadequate but all we could acquire at the time. We have 31 staff accommodated through three locations and require a purpose-built facility to deliver quality primary health care to our Community.
  • Over the last two years we have been able to purchase the site it is currently located on. This site is based on five contiguous residential properties, with each property containing a 2-3 bedroom, approximately 40 year old house. Two of these houses have been joined together to form the Medical Clinic, the other three houses have all been renovated and upgraded to various levels in order to make them usable by the service. The next step in the plan is to redevelop the entire site to build an all-in-one centre to replace the current four separate buildings. In our 12 years of service we have moved from renting at a number of locations to being able to purchase our current site. The current site of old, converted residential buildings while viable in the short term, does not allow for efficient use of the site nor capacity for growth. Parking is scattered around the site, staff are scattered and continually moving from building to building to serve clients. There is no excess accommodation capacity to allow for growth of services. Our intention is to re-develop the site to house all staff in one building, which will be configured for growth over the long term and allow efficient use of the available grounds for parking, an Elders shed, and so on.
  • We have run out of room. Every office is shared, including the CEO’s office. We can’t hire any staff – nowhere to house them. Whenever a visiting service is operating – GP clinic, podiatry, optometry, audiology, chiropractor etc, offices have to be vacated to house

them, displaced staff basically have nowhere to go. Fine balancing act to schedule things to displace as few people as possible.

  • We are currently located in two refurbished community buildings as there is no suitable accommodation for lease. Our organisation is growing very quickly, and we need all services located under one roof – one identity, one culture.
  • Rapidly reaching the point where services will be diminished because of failing infrastructure or insufficient housing for the nursing staff required.
  • Some clinical rooms are not fit for purpose. Clinicians working from rooms without hand washing facilities. Medical Clinic is old, out of date, some rooms not fit for purpose, ineffective air conditioning, clinical staff sharing rooms, no room for expansion, difficult to house students due to lack of appropriate space.
  • We have made a number of applications to improve infrastructure, and to replace current infrastructure, all have been unsuccessful, in some cases we have purchase buildings & land to try and demonstrate a commitment to ongoing growth and servicing of clients. We get little feedback in relation to funding applications.
  • Spread across three sites with some providers having to share rooms and staff being required to work outside on laptops at times. Desperately needing to build a purposebuilt facility in order to stop paying high amounts of rent and allow effective primary health care to an increasing client number.

Derby Aboriginal Health Service

The Derby Aboriginal Health Service (DAHS) Social and Emotional Wellbeing (SEWB) unit is housed in a 60+ year old asbestos building that was originally a family home. It has an old and small transport unit connected to the house by an exposed verandah. There are 6 staff working from the house who provide individual and family counselling and support. The clients who come to SEWB experience mental health issues, family violence, poverty, Department of Child Protection (DCP) issues around removal of children, alcohol and other drug issues and supporting those released from the Derby local Prison (approx. 200 prisoners). It is difficult to safely secure SEWB to the extent it is required given the age and asbestos nature of the building (security alarms etc). In the photos, you can see the buildings are old and are of asbestos. The transportable out the back houses the manager who is also the psychologist – this means she is in a vulnerable position when counselling should the session not go as planned (potential for a violent situation – see photo showing external verandah connecting to the donga).

The size of the house means that counselling clients privately is difficult as everything happens in close quarters. The number of clients the team work with exceeds the capacity of the building which impacts on the number of Aboriginal clients the team can help. The SEWB building has been broken into a number of times the last being during the long weekend in September 2018 where significant damage was done. Given the age of the house, during the past 18 months, parts of the internal ceiling including cornices have been falling away from the structures creating potential issues of asbestos fibre being released into the air. In addition, there are plumbing problems and the wooden floor is becoming a safety issue in one area of the building.

SEWB runs a vulnerable youth programme (the Shine Group) and a Body Shop clinic for youth who will not attend the main clinic for shame and fear reasons (special appointments are made with a doctor so that the young person doesn’t have to wait in the waiting area. In addition, a doctor runs a monthly session at the SEWB building with youth around health education and also sees them if there is a clinical need). These programmes run out of another 60+ year old asbestos family house some distance from the main SEWB house. Not only is the house not suitable but there may be security risks for the staff member working with vulnerable youth.  The Shine House was also broken into in September 2018 where significant damage was done (see photos).

The DAHS main building has no further office or other space to house staff.  This is particularly the case for 2019 as DAHS takes on new programmes (e.g. 2 staff for the new Syphilis Programme).  DAHS is acutely aware of the need to source funding to build new administration offices in order to release current admin offices for clinical and programme purposes.

DAHS requires a new or upgraded SEWB building. DAHS first applied for service maintenance funding in March 2017 but were unsuccessful. DAHS applied in June 2018 for Capital Works but were unsuccessful because it didn’t fit in with IAHP Primary Health Care as it was about mental health. DAHS also paid for an Architect to draw up the plans for a new SEWB building.  It is my view that one of the main issues is that the government separates SEWB from primary health care.

Social and emotional wellbeing issues CANNOT be separated from primary health care.  As is well known, a person’s SEWB impacts on the physical health of an individual.  Physical illhealth is frequently caused by the SEWB condition of an individual (i.e. historical and current experiences of trauma frequently commencing in the pre-natal phase of a child’s life, family violence, alcohol and other drug use, smoking, anxiety, removal of children, mental health issues etc). Aboriginal people suffer greatly from SEWB issues which impacts on their overall physical health.  Mental health in all its forms is part and parcel of physical health so it must be included in primary health care.

However, both state and commonwealth governments do not seem to prioritise or even support funding for SEWB (such as service and maintenance work, capital works or funding to continue key positions in the SEWB team – in fact, the government actively separates funding for SEWB and primary health care).  DAHS also provides clinical services to 7 remote communities most of whom are up to 400 kms away with Kandiwal Community 600kms away where we supply a fly in/fly out clinical service. There are many demands placed on a team of SEWB workers stationed in a working environment that does not allow them to function to the best of their abilities or offer increased services to our clients. Passion for the cause alone does not help in Closing the Gap. Working with one hand tied behind one’s back is not effective in reducing mental health issues and chronic diseases.

Part of an upgrade we requested was to renovate reception to make it safer for receptionist staff and to increase confidentiality when clients speak with reception staff (it also doesn’t meet the needs of disabled clients). There are a number of times throughout the year when receptionist staff are verbally abused with threats of physical harm. The current reception was designed prior to more recent events of aggression exhibited by clients under the influence of drugs.  The design now enables abusive clients to quite easily reach across the reception counter and hurt staff or can jump over the same counter to gain access to staff.  In addition, given there is no screen and the current open nature of the reception area, sharing confidential information can be compromised. DAHS applied for services and maintenance funding to make the changes but were unsuccessful.

[1] ACCHSs may apply for Telehealth funding through the Indigenous Australians’ Health Programme, Governance and System Effectiveness: Sector Support activity.

[2] https://www.anao.gov.au/work/performanceaudit/indigenoushousinginitiativesfixinghousesbetterhealthprogram  

[3] http://web.archive.org/web/20140213221536/http://www.dss.gov.au/sites/default/files/documents/05_201 2/housing_guide_info_intro.pdf  

[4] https://www.pmc.gov.au/resourcecentre/indigenousaffairs/remotehousingreview, page 3.

[5] https://www.caac.org.au/uploads/pdfs/CongressHousingandHealthDiscussionPaperFinalMarch2018.pdf

[6] https://www.pmc.gov.au/resourcecentre/indigenousaffairs/healthperformanceframework2017report; https://www.mja.com.au/journal/2011/195/11/closinggapandindigenoushousing;  https://probonoaustralia.com.au/news/2016/02/housingkeyclosinggap/; https://ama.com.au/positionstatement/aboriginalandtorresstraitislanderhealthrevised2015; https://www.caac.org.au/uploads/pdfs/CongressHousingandHealthDiscussionPaperFinalMarch2018.pdf. 10 https://www.anao.gov.au/work/performanceaudit/indigenoushousinginitiativesfixinghousesbetterhealthprogram  

[7] Australia Human Rights Commission Social Justice and Native Title Report 2015, cited in the Australian Law

Reform Commission publication, Pathways to JusticeInquiry into the Incarceration Rate of Aboriginal and Torres Strait Islander Peoples (ALRC Report 133)https://www.alrc.gov.au/publications/crossoverouthomecaredetention.

[8] https://www.alrc.gov.au/publications/crossoverouthomecaredetention; https://www.aihw.gov.au/getmedia/06341e00a08f4a0b9d33d6c4cf1e3379/aihwcsi025.pdf.aspx?inline=true  

[9] https://www.snaicc.org.au/ensuring-fair-start-children-need-dedicated-funding-stream-aboriginal-torresstrait-islander-early-years-sector/

[10] https://www.alrc.gov.au/publications/crossoverouthomecaredetention;

https://aifs.gov.au/cfca/publications/intersectionbetweenchildprotectionandyouthjusticesystems 15 https://aifs.gov.au/cfca/sites/default/files/publicationdocuments/cfcapracticebraindevelopmentv6040618.pdf; https://www.orygen.org.au/PolicyAdvocacy/PolicyReports/TraumaandyoungpeopleMoving

[11] http://www.familymatters.org.au/wpcontent/uploads/2018/11/FamilyMattersReport2018.pdf; Thorburn, Kathryn and Melissa Marshall. 2017. The Yiriman Project in the West Kimberley: an example of justice reinvestment? Indigenous Justice Clearinghouse, Current Initiatives Paper 5; McCausland, Ruth, Elizabeth McEntyre, Eileen Baldry. 2017. Indigenous People, Mental Health, Cognitive Disability and the

Criminal Justice System. Indigenous Justice Clearinghouse. Brief 22; AMA Report Card on Indigenous Health 2015. Treating the high rates of imprisonment of Aboriginal and Torres Strait Islander peoples as a symptom of the health gap: an integrated approach to both; Richards, Kelly, Lisa Rosevear and Robyn Gilbert. 2011.

Promising interventions for reducing Indigenous juvenile offending. Indigenous Justice Clearinghouse, Brief 10.

[12] Australian Institute of Health and Welfare. 2018. Australia’s Health 2018. Australia’s health series no. 16. AUS 221. Canberra: AIHW.

[13] Ibid

[14] Outcome areas: Aboriginal and Torres Strait Islander communities and cultures are strong and support social and emotional wellbeing and mental health; Aboriginal and Torres Strait Islander families are strong and supported; Infants get the best possible developmental start to life and mental health; Aboriginal and Torres Strait Islander children and young people get the services and support they need to thrive and grow into mentally healthy adults.

NACCHO Aboriginal Health and #SocialDeterminants : Download @AIHW Report : Indicators of socioeconomic inequalities in #cardiovascular disease #heartattack #stroke, #diabetes and chronic #kidney disease @ACDPAlliance

 ” Most apparent are inequalities in chronic disease among Aboriginal and Torres Strait Islander people and non-Indigenous Australians. Social and economic factors are estimated to account for slightly more than one-third (34%) of the ‘good health’ gap between the 2 groups, with health risk factors such as high blood pressure, smoking and risky alcohol consumption explaining another 19%, and 47% due to other, unexplained factors.

 An estimated 11% of the total health gap can be attributed to the overlap, or interactions between the social determinants and health risk factors (AIHW 2018a).

Download the AIHW Report HERE aihw-cdk-12

‘By better understanding the role social inequality plays in chronic disease, governments at all levels can develop stronger, evidence based policies and programs aimed at preventing and managing these diseases, leading to better health outcomes across our community,’

AIHW spokesperson Dr Lynelle Moonn noted that these three diseases are common in Australia and, in addition to the personal costs to an individual’s health and quality of life, they have a significant economic burden in terms of healthcare costs and lost productivity

AIHW Website for more info 

Government investment is essential to encourage health checks, improve understanding of the risk factors for chronic disease, and implement policies and programs to reduce chronic disease risk, particularly in areas of socioeconomic disadvantage,

Chair of the Australian Chronic Disease Prevention Alliance Sharon McGowan said that the data revealed stark inequities in health status amongst Australians.

Download Press Release Here : australianchronicdiseasepreventionalliance

The Australian Chronic Disease Prevention Alliance is calling on the Government to target these health disparities by increasing the focus on prevention and supporting targeted health checks to proactively manage risk.

AIHW Press Release

Social factors play an important role in a person’s likelihood of developing and dying from certain chronic diseases, according to a new report from the Australian Institute of Health and Welfare (AIHW).

The report, Indicators of socioeconomic inequalities in cardiovascular disease, diabetes and chronic kidney disease, examines the relationship between socioeconomic position, income, housing and education and the likelihood of developing and dying from several common chronic diseases—cardiovascular disease (which includes heart attack and stroke), diabetes and chronic kidney disease.

Above image NACCHO Library

The report reveals that social disadvantage in these areas is linked to higher rates of disease, as well as poorer outcomes, including a greater likelihood of dying.

‘Across the three chronic diseases we looked at—cardiovascular disease, diabetes and chronic kidney disease— we saw that people in the lowest of the 5 socioeconomic groups had, on average, higher rates of these diseases than those in the highest socioeconomic groups,’ said AIHW spokesperson Dr Lynelle Moon.

‘And unfortunately, we also found higher death rates from these diseases among people in the lowest socioeconomic groups.’

The greatest difference in death rates between socioeconomic groups was among people with diabetes.

‘For women in the lowest socioeconomic group, the rate of deaths in 2016 where diabetes was an underlying or associated cause of death was about 2.4 times as high as the rate for those in the highest socioeconomic group. For men, the death rate was 2.2 times as high,’ Dr Moon said.

‘Put another way, if everyone had the same chance of dying from these diseases as people in the highest socioeconomic group, in a one year period there would be 8,600 fewer deaths from cardiovascular disease, 6,900 fewer deaths from diabetes, and 4,800 fewer deaths from chronic kidney disease.’

Importantly, the report also suggests that in many instances the gap between those in the highest and lowest socioeconomic groups is growing.

‘For example, while the rate of death from cardiovascular disease has been falling across all socioeconomic groups, the rate has been falling more dramatically for men in the highest socioeconomic group—effectively widening the gap between groups,’ Dr Moon said.

The report also highlights the relationship between education and health, with higher levels of education linked to lower rates of disease and death.

‘If all Australians had the same rates of disease as those with a Bachelor’s degree or higher, there would have been 7,800 fewer deaths due to cardiovascular disease, 3,700 fewer deaths due to diabetes, and 2,000 fewer deaths due to chronic kidney disease in 2011–12,’ Dr Moon said.

Housing is another social factor where large inequalities are apparent. Data from 2011–12 shows that for women aged 25 and over, the rate of death from chronic kidney disease was 1.5 times as high for those living in rental properties compared with women living in properties they owned. For men, the rate was 1.4 times as high for those in rental properties.

Dr Moon noted that these three diseases are common in Australia and, in addition to the personal costs to an individual’s health and quality of life, they have a significant economic burden in terms of healthcare costs and lost productivity.

‘By better understanding the role social inequality plays in chronic disease, governments at all levels can develop stronger, evidence based policies and programs aimed at preventing and managing these diseases, leading to better health outcomes across our community,’ she said

Underlying causes of socioeconomic inequalities in health

There are various reasons why socioeconomically disadvantaged people experience poorer health. Evidence points to the close relationship between people’s health and the living and working conditions which form their social environment.

Factors such as socioeconomic position, early life, social exclusion, social capital, employment and work, housing and the residential environment— known collectively as the ‘social determinants of health’—can act to either strengthen or to undermine the health of individuals and communities (Wilkinson & Marmot 2003).

These social determinants play a key role in the incidence, treatment and outcomes of chronic diseases. Social determinants can be seen as ‘causes of the causes’—that is, as the foundational determinants which influence other health determinants such as individual lifestyles and exposure to behavioural and biological risk factors.

Socioeconomic factors influence chronic disease through multiple mechanisms. Socioeconomic disadvantage may adversely affect chronic disease risk through its impact on mental health, and in particular, on depression. Socioeconomic gradients exist for multiple health behaviours over the life course, including for smoking, overweight and obesity, and poor diet.

When combined, these unhealthy behaviours help explain much of the socioeconomic health gap. Current research also seeks to link social factors and biological processes which affect chronic disease. In CVD, for example, socioeconomic determinants of health have been associated with high blood pressure, high cholesterol, chronic stress responses and inflammation (Havranek et al. 2015).

The direction of causality of social determinants on health is not always one-way (Berkman et al. 2014). To illustrate, people with chronic conditions may have a reduced ability to earn an income; family members may reduce or cease employment to provide care for those who are ill; and people or families whose income is reduced may move to disadvantaged areas to access low-cost housing.

Action on social determinants is often seen as the most appropriate way to tackle unfair and avoidable socioeconomic inequalities. There are significant opportunities for reducing death and disability from CVD, diabetes and CKD through addressing their social determinants.

Summary

Australians as a whole enjoy good health, but the benefits are not shared equally by all. People who are socioeconomically disadvantaged have, on average, greater levels of cardiovascular disease (CVD), diabetes and chronic kidney disease (CKD).

This report uses latest available data to measure socioeconomic inequalities in the incidence, prevalence and mortality from these 3 diseases, and where possible, assess whether these inequalities are growing. Findings include that, in 2016:

  • males aged 25 and over living in the lowest socioeconomic areas of Australia had a heart attack rate 1.55 times as high as males in the highest socioeconomic areas. For females, the disparity was even greater, at 1.76 times as high
  • type 2 diabetes prevalence for females in the lowest socioeconomic areas was 2.07 times as high as for females in the highest socioeconomic areas. The prevalence for males was 1.70 times as high
  • the rate of treated end-stage kidney disease for males in the lowest socioeconomic areas was 1.52 times as high as for males in the highest socioeconomic areas. The rate for females was 1.75 times as high
  • the CVD death rate for males in the lowest socioeconomic areas was 1.52 times as high as for males in the highest socioeconomic areas. For females, the disparity was slightly less, at 1.33 times as high
  • if all Australians had the same CVD death rate as people in the highest socioeconomic areas in 2016, the total CVD death rate would have declined by 25%, and there would have been 8,600 fewer deaths.

CVD death rates have declined for both males and females in all socioeconomic areas since 2001— however there have been greater falls for males in higher socioeconomic areas, and as a result, inequalities in male CVD death rates have grown.

  • Both absolute and relative inequality in male CVD death rates increased—the rate difference increasing from 62 per 100,000 in 2001 to 78 per 100,000 in 2011, and the relative index of inequality (RII) from 0.25 in 2001 to 0.53 in 2016.

Often, the health outcomes affected by socioeconomic inequalities are greater when assessed by individual characteristics (such as income level or highest educational attainment), than by area.

  • Inequalities in CVD death rates by highest education level in 2011–12 (RII = 1.05 for males and 1.05 for females) were greater than by socioeconomic area in 2011 (0.50 for males and 0.41 for females).

The impact on death rates of socioeconomic inequality was generally greater for diabetes and CKD than for CVD.

  • In 2016, the diabetes death rate for females in the lowest socioeconomic areas was 2.39 times as high as for females in the highest socioeconomic areas. This compares to a ratio 1.75 times as high for CKD, and 1.33 for CVD. For males, the equivalent rate ratios were 2.18 (diabetes), 1.64 (CKD) and 1.52 (CVD).viii

Part 2

 

NACCHO Aboriginal Health and #AustraliaDay2019 or #InvasionDay1788 Debate : With Editorial from PM @ScottMorrisonMP, Jeff Kennett and Marion Scrymgour : On #SurvivalDay 2019 we recognise the strength and resilience of Aboriginal and Torres Strait Islander people

” Yesterday 25 January my family and I spent time with the Ngunnawal people — the first inhabitants of the Canberra region. We attended a smoking ceremony, an ancient cleansing ritual, in what I believe should become a prime ministerial tradition on the eve of Australia Day.

The timing, ahead of our national day, is entirely appropriate because the sacred custodianship of our indigenous people marked the first chapter in the story of our country.

Our First Australians walked here long before anyone else, loving and caring for these lands and waters. They still do. We honour their resilience and stewardship across 60,000 years. We pay respect to the world’s oldest continuous culture.

A culture that is alive; a culture that has survived. A culture that speaks to us no matter what our background as Australians because it is part of the living, breathing soul of our land.

Scott Morrison is the Prime Minister of Australia see full Text Published 26 January 2019 The Australian see Part 1 Below 

Watch video

 Minnie Tompkins ochreing the PM’s two Daughters at the event : Copyright Billy T.Tompkins

” We cannot celebrate 26 January when our children still face the devastating impacts of colonisation. Instead, on Survival Day we recognise the strength and resilience of Aboriginal and Torres Strait Islander people, and the survival of Aboriginal and Torres Strait Islander children.

If we are to celebrate the many great things about our nation, we need a new date that is inclusive of all Australians and ensures we can all participate in celebrations together.

For Aboriginal and Torres Strait Islander people 26 January and the colonisation of Australia is a reflection of the ongoing discrimination and violation of human rights that many Aboriginal and Torres Strait Islander children face today.”

SNAICC Press Release 26 January 2019 

It was with profound sadness that I read two stories in The Australian this week: first was the front-page piece “Conservative MPs push to protect January 26”, published on Thursday, and then yesterday, “Dutton puts pressure on PM with support for Australia Day law”. This second story was accompanied by a report on an “invasion day” rally planned for the steps of Parliament House today.

In my column in Melbourne’s Herald Sun this week, I presented the case for changing the date from January 26.

I am the first to admit the issue of the date on which we celebrate Australia Day is not the top priority for Australians. Nor is the recalibration of the way in which Australia recognises its First Peoples. But changing the date is a start in building the recognition and trust I believe is necessary in an educated country

Stop this insult to our First Peoples in the Australian 26 January 2019

Jeff Kennett was the Liberal premier of Victoria, 1992-99 see Part 2 Below

” How can Australia possibly persist in celebrating as its national day the colonial acts of a foreign country? Without even touching on the sensitivities of Indigenous people, where does that leave the majority of Australians who came to or are descended from people who came to this country since Federation (including exponentially increasing numbers of Asian Australians)?

And finally, just to return to the issue of the stake of Indigenous people in this nation. Some have suggested that because there are pressing and immediate issues which are undermining our prospects for progress and wellbeing, it is inappropriate to spend time and energy participating in the debate about our national day.

Like many others who are committed to tackling domestic violence, drug and alcohol abuse, and unemployment amongst our people, I believe we can walk and chew gum at the same time.” 

Marion Scrymgour is currently the Chief Executive Officer of the Tiwi Islands Regional Council. Prior to this she was the Chief Executive Officer of the Wurli-Wurliinjang Health Service and was Chair of the Aboriginal Medical Services Alliance of the Northern Territory.

Part 4 Invasion Day rally 2019: where to find marches and protests across Australia

Part 1 January 26, 1788 marked the birth of today’s modern Australia Scott Morrison

Today we also remember the second chapter of our country’s history that began on January 26, 1788, with the arrival of the First Fleet.

Wooden convict ships came carrying men and women who were sick, poor and destitute. Those men and women, who included my own ancestors, persevered, endured and won their freedom. They braved hardship and built lives and families. Indeed, the wonder of our country is that out of such hardship would emerge a nation as decent, as fair and as prosperous as ours.

For along with the cruelties of empire came the ideas of the Enlightenment, and Australia was the great project. Notions of liberty, enterprise and human dignity became the foundation for modern Australia.

And we embrace, too, all those who’ve come since — to make us the happy, thriving, multicultural democracy that we are. That’s the third chapter of our story: the one we’re still writing.

Across Australia, 16,212 men, women and children will become citizens today in more than 365 ceremonies. They will be endowed with the same rights, opportunities and responsibilities as every other Australian. Australia’s great bounty is that she is now made up of people from every nation on earth. Together, all these chapters make us who we are.

They’re not unblemished. We don’t have a perfect history. We’ve made mistakes, but no nation is perfect. But we have so much to be grateful for and so much to be proud of.

We’re a free nation, with an elected parliament, an independent judiciary and a free press. We believe in the equality of men and women — of all citizens no matter their creed, race, sexuality or gender. We’ve worked to create a nation that is harmonious, prosperous and safe — one where every individual matters.

That’s what today is about. Gratitude for all we have. Pride in who we’ve become together.

Australia Day is the day we come together. It’s the day we celebrate all Australians, all their stories, all their journeys. And we do this on January 26 because this is the day that Australia changed — forever — and set us on the course of the modern Australia we are today.

Our nation’s story is of a good-hearted and fair people always striving to be better. We have a go. We take risks. Occasionally we fall flat on our faces. But we get up. We always get up. After all, we know how to have a laugh. And we know how to help how mates when they’re down. Today we remember our history, we celebrate our achievements and we re-dedicate ourselves to the land and the people we love.

Happy Australia Day.

Scott Morrison is the Prime Minister of Australia.

Part 2  Stop this insult to our First Peoples

It was with profound sadness that I read two stories in The Australian this week: first was the front-page piece “Conservative MPs push to protect January 26”, published on Thursday, and then yesterday, “Dutton puts pressure on PM with support for Australia Day law”. This second story was accompanied by a report on an “invasion day” rally planned for the steps of Parliament House today.

In my column in Melbourne’s Herald Sun this week, I presented the case for changing the date from January 26.

I am the first to admit the issue of the date on which we celebrate Australia Day is not the top priority for Australians. Nor is the recalibration of the way in which Australia recognises its First Peoples. But changing the date is a start in building the recognition and trust I believe is necessary in an educated country.

Let me start with the claims of “invasion day”. This is a term used by some in the indigenous community and by activists. It has gathered some mileage because its use has not been challenged regularly.

Australia was not invaded in 1788, it was settled. The country was occupied by a people from a different community and race to those who were already here, spread in tribes throughout the land.

As those settlers spread from Sydney Cove, the First Peoples were dispossessed of their lands and, yes, as that happened atrocities were committed.

Commodore Arthur Phillip did not arrive with a military force when he settled Port Jackson in 1788. There was no intent to wage a war against the local inhabitants. In fact, the opposite was true. Phillip was commissioned to work with the inhabitants of the country. Although that did not occur, nor did an invasion.

Let me turn to those so-called conservatives mentioned earlier. Probably the closest political grouping we have in Australia that claims to be conservative is the Nationals. Members of the Liberal Party are part of a broader church that I had always taken to mean economically conservative and socially generous.

Together in government the parties and their members discuss and find consensus on issues through policy development.

It is inconceivable to me that these so-called conservatives cannot see how celebrating Australia Day on January 26 every year reinforces a sense of loss among our First Peoples.

How can they not understand that passing legislation to enshrine January 26 as Australia Day would insult our First Peoples and defer any real hope of building the recognition they deserve?

Their action in pursuing such legislation indicates yet again how out of touch and inflexible some members of parliament have become. This is in the face of the demonstrated generosity of the community on social issues such as same-sex marriage and recognition of the challenges facing our disabled and their carers.

Why can’t they see that the same social generosity should be extended to our First Peoples?

Why do they argue that we should continue to discriminate against an important section of our community who are offended by January 26 as the date of national celebration?

The only reason these so-called conservatives are doing so is because some polls suggested that 75 per cent of Australians support January 26 as the day for the celebration.

This reasoning simply continues the cowardice of so many of our federal politicians over the past two decades.

They are elected to lead. Make bold decisions. Correct areas that cause pain to the community when bold action can easily resolve such pain.

Some in the community argue the government is not conservative enough. I disagree. The issues that were relevant in the 1960s and 70s have evolved through education and extraordinary advances in technology. There is a growing recognition of individual rights.

While I respect the right of all individuals in a broad church to hold differing views, I reserve the right to disagree with them, as I do on this issue. It is in my opinion a myopic view, outdated and based on wrong motives.

I will be interested in see which conservatives put their names to any motion to put back any real advance in the recognition of our First Peoples.

As for Peter Dutton. Leader of the band? Jumping on the so-called conservative bandwagon? He has already done considerable damage to his political reputation and must accept much of the blame for the position of the government, having been instigator of the events that led to the removal of Malcolm Turnbull.

Leadership is what is required, Peter, not weakness. Leadership is what the community respects.

By the way, happy Australia Day to all. I hope today provides an opportunity for people, including politicians, to reconsider their position so that we can continue to build the respect we should be showing to our First Peoples.

Part 3 Let’s park the issues relating to Aboriginal people to one side and look at what the 26th of January represents and symbolises for Australians generally, and at how patently incompatible with our modern national identity it is as a selected national day.

Marion Scrymgour first published 2018

The debate about whether Australia Day should be changed to a date other than the 26th of January has in recent times been focussed on the offensiveness to many Indigenous Australians of using the commemoration of the establishment of an English colony in New South Wales as the foundation narrative of our national identity. The objection articulated by advocates for change is that it ignores, marginalises or diminishes Indigenous history and culture, and fails to acknowledge past injustices (some still unresolved).

Personally I think the objection is valid, but I accept that there are differing views. However, it is not necessary to even get into that argument to be persuaded conclusively that there should be a change of date. Let’s park the issues relating to Aboriginal people to one side and look at what the 26th of January represents and symbolises for Australians generally, and at how patently incompatible with our modern national identity it is as a selected national day.

The 26th of January marks the beginning of what sort of enterprise? What sort of uplifting and inspirational human endeavour? The answer is that it was a penal settlement. A remote punishment farm to warehouse the overflow from Britain’s prisons. A place of brutality and despair conceived out of a desire to keep a problem out of sight and out of mind.

Modern Australia has its flaws. Some may want to argue the toss over Don Dale or Manus Island, but the reality is that we are a civilised, enlightened and fair people. We embrace those values in ourselves and in each other. We all recognise how lucky we are to live in a tolerant society where diversity and difference are accepted and mateship and hard work are encouraged. We cherish our autonomy and freedom. A national day should resonate with and reflect those values. The way it can do that is by reminding us of something in our past which either brought out the best in our national character, or else represented a step along the path to our unique Australian identity.

Potential examples are many, but might include these: Kokoda; the first Snowy River hydro scheme (with its harnessing of migrant workers from all over Europe coming to seek a better life after the second world war); the abolition of the white Australia policy in 1966; the passage of the Australia Act in 1986 (when Australia’s court system finally became fully independent).

One thing I know for sure is that when we look into history’s mirror for some event or occasion that allows us to see ourselves as we aspire to be, the last and most alien screen we would contemplate downloading and sharing as emblematic of ourselves as Australians would be Sydney Cove in 1788. You just have to pause and think about it for a moment to be able to reject the concept as ludicrous. And yet that is the status quo that has become entrenched in our national calendar, through a process which has been more recent and less considered than most would be aware of.

In my view it is a matter of historical logic that Australia’s national day cannot be one which commemorates something which happened before Australia itself was created. That happened in 1901 when the various colonies joined together in a single federation in which each of them was transformed into an entity called a “state”.

The new Australian states were modelling themselves on the American colonies which had joined together to become the United States of America. Many of those colonies already had a long prior history since they had been established by European settlers and in most cases they were much prouder of their origins than those new Australian states which had started off as penal settlements. But if anyone, then or since, had proposed that the national day for the USA should be some day commemorating the early history of some individual colony, they would have been howled down by Americans. The American national day celebrates the independence of the unified whole, not a way-station in the history of a pre-independence colony. It should be the same with us.

If any recent event should have served to underscore the lack of fit between the date on which our national day is currently celebrated and our contemporary political reality it is the disqualifying of Federal Parliamentarians who have belatedly discovered that they are British citizens.

Just think about that for a moment. The colony of New South Wales was established on behalf of the British Crown. Then when the country called Australia was created in 1901, its people were classed as British subjects. Stand-alone citizenship came later and things have been slowly and fundamentally changing. In 2018 Britain is a foreign country and if you are a citizen of that country you are excluded from being elected to our Australian parliament. That is because it is recognised that there are conflicting interests and allegiances.

How can Australia possibly persist in celebrating as its national day the colonial acts of a foreign country? Without even touching on the sensitivities of Indigenous people, where does that leave the majority of Australians who came to or are descended from people who came to this country since Federation (including exponentially increasing numbers of Asian Australians)?

And finally, just to return to the issue of the stake of Indigenous people in this nation. Some have suggested that because there are pressing and immediate issues which are undermining our prospects for progress and wellbeing, it is inappropriate to spend time and energy participating in the debate about our national day. Like many others who are committed to tackling domestic violence, drug and alcohol abuse, and unemployment amongst our people, I believe we can walk and chew gum at the same time.

Marion Scrymgour

 

NACCHO Aboriginal #MentalHealth and #SuicidePrevention : @ozprodcom issues paper on #MentalHealth in Australia is now available. It asks a range of questions which they seek information and feedback on. Submissions or comments are due by Friday 5 April.

 ” Many Australians experience difficulties with their mental health. Mental illness is the single largest contributor to years lived in ill-health and is the third largest contributor (after cancer and cardiovascular conditions) to a reduction in the total years of healthy life for Australians (AIHW 2016).

Almost half of all Australian adults have met the diagnostic criteria for an anxiety, mood or substance use disorder at some point in their lives, and around 20% will meet the criteria in a given year (ABS 2008). This is similar to the average experience of developed countries (OECD 2012, 2014).”

Download the PC issues paper HERE mental-health-issues

See Productivity Commission Website for More info 

“Clearly Australia’s mental health system is failing Aboriginal people, with Aboriginal communities devastated by high rates of suicide and poorer mental health outcomes. Poor mental health in Aboriginal communities often stems from historic dispossession, racism and a poor sense of connection to self and community. 

It is compounded by people’s lack of access to meaningful and ongoing education and employment. Drug and alcohol related conditions are also commonly identified in persons with poor mental health.

NACCHO Chairperson, Matthew Cooke 2015 Read in full Here 

Read over 200 Aboriginal Mental Health Suicide Prevention articles published by NACCHO over the past 7 years 

Despite a plethora of past reviews and inquiries into mental health in Australia, and positive reforms in services and their delivery, many people are still not getting the support they need to maintain good mental health or recover from episodes of mental ill‑health. Mental health in Australia is characterised by:

  • more than 3 100 deaths from suicide in 2017, an average of almost 9 deaths per day, and a suicide rate for Indigenous Australians that is much higher than for other Australians (ABS 2018)
  • for those living with a mental illness, lower average life expectancy than the general population with significant comorbidity issues — most early deaths of psychiatric patients are due to physical health conditions
  • gaps in services and supports for particular demographic groups, such as youth, elderly people in aged care facilities, Indigenous Australians, individuals from culturally diverse backgrounds, and carers of people with a mental illness
  • a lack of continuity in care across services and for those with episodic conditions who may need services and supports on an irregular or non-continuous basis
  • a variety of programs and supports that have been successfully trialled or undertaken for small populations but have been discontinued or proved difficult to scale up for broader benefits
  • significant stigma and discrimination around mental ill-health, particularly compared with physical illness.

The Productivity Commission has been asked to undertake an inquiry into the role of mental health in supporting social and economic participation, and enhancing productivity and economic growth (these terms are defined, for the purpose of this inquiry, in box 1).

By examining mental health from a participation and contribution perspective, this inquiry will essentially be asking how people can be enabled to reach their potential in life, have purpose and meaning, and contribute to the lives of others. That is good for individuals and for the whole community.

Background

In 2014-15, four million Australians reported having experienced a common mental disorder.

Mental health is a key driver of economic participation and productivity in Australia, and hence has the potential to impact incomes and living standards and social engagement and connectedness. Improved population mental health could also help to reduce costs to the economy over the long term.

Australian governments devote significant resources to promoting the best possible mental health and wellbeing outcomes. This includes the delivery of acute, recovery and rehabilitation health services, trauma informed care, preventative and early intervention programs, funding non-government organisations and privately delivered services, and providing income support, education, employment, housing and justice. It is important that policy settings are sustainable, efficient and effective in achieving their goals.

Employers, not-for-profit organisations and carers also play key roles in the mental health of Australians. Many businesses are developing initiatives to support and maintain positive mental health outcomes for their employees as well as helping employees with mental illhealth continue to participate in, or return to, work.

Scope of the inquiry

The Commission should consider the role of mental health in supporting economic participation, enhancing productivity and economic growth. It should make recommendations, as necessary, to improve population mental health, so as to realise economic and social participation and productivity benefits over the long term.

Without limiting related matters on which the Commission may report, the Commission should:

  • examine the effect of supporting mental health on economic and social participation, productivity and the Australian economy;
  • examine how sectors beyond health, including education, employment, social services, housing and justice, can contribute to improving mental health and economic participation and productivity;
  • examine the effectiveness of current programs and Initiatives across all jurisdictions to improve mental health, suicide prevention and participation, including by governments, employers and professional groups;
  • assess whether the current investment in mental health is delivering value for money and the best outcomes for individuals, their families, society and the economy;
  • draw on domestic and international policies and experience, where appropriate; and
  • develop a framework to measure and report the outcomes of mental health policies and investment on participation, productivity and economic growth over the long term.

The Commission should have regard to recent and current reviews, including the 2014 Review of National Mental Health Programmes and Services undertaken by the National Mental Health Commission and the Commission’s reviews into disability services and the National Disability Insurance Scheme.

The Issues Paper
The Commission has released this issues paper to assist individuals and organisations to participate in the inquiry. It contains and outlines:

  • the scope of the inquiry
  • matters about which we are seeking comment and information
  • how to share your views on the terms of reference and the matters raised.

Participants should not feel that they are restricted to comment only on matters raised in the issues paper. We want to receive information and comment on any issues that participants consider relevant to the inquiry’s terms of reference.

Key inquiry dates

Receipt of terms of reference 23 November 2018
Initial consultations November 2018 to April 2019
Initial submissions due 5 April 2019
Release of draft report Timing to be advised
Post draft report public hearings Timing to be advised
Submissions on the draft report due Timing to be advised
Consultations on the draft report November 2019 to February 2020
Final report to Government 23 May 2020

Submissions and brief comments can be lodged

Online (preferred): https://www.pc.gov.au/inquiries/current/mental-health/submissions
By post: Mental Health Inquiry
Productivity Commission
GPO Box 1428, Canberra City, ACT 2601

Contacts

Inquiry matters: Tracey Horsfall Ph: 02 6240 3261
Freecall number: Ph: 1800 020 083
Website: http://www.pc.gov.au/mental-health

Subscribe for inquiry updates

To receive emails updating you on the inquiry consultations and releases, subscribe to the inquiry at: http://www.pc.gov.au/inquiries/current/mentalhealth/subscribe

 

 Definition of key terms
Mental health is a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

Mental illness or mental disorder is a health problem that significantly affects how a person feels, thinks, behaves and interacts with other people. It is diagnosed according to standardised criteria.

Mental health problem refers to some combination of diminished cognitive, emotional, behavioural and social abilities, but not to the extent of meeting the criteria for a mental illness/disorder.

Mental ill-health refers to diminished mental health from either a mental illness/disorder or a mental health problem.

Social and economic participation refers to a range of ways in which people contribute to and have the resources, opportunities and capability to learn, work, engage with and have a voice in the community. Social participation can include social engagement, participation in decision making, volunteering, and working with community organisations. Economic participation can include paid employment (including self-employment), training and education.

Productivity measures how much people produce from a given amount of effort and resources. The greater their productivity, the higher their incomes and living standards will tend to be.

Economic growth is an increase in the total value of goods and services produced in an economy. This can be achieved, for example, by raising workforce participation and/or productivity.

Sources: AIHW (2018b); DOHA (2013); Gordon et al. (2015); PC (2013, 2016, 2017c); SCRGSP (2018); WHO (2001).

An improvement in an individual’s mental health can provide flow-on benefits in terms of increased social and economic participation, engagement and connectedness, and productivity in employment (figure 1).

This can in turn enhance the wellbeing of the wider community, including through more rewarding relationships for family and friends; a lower burden on informal carers; a greater contribution to society through volunteering and working in community groups; increased output for the community from a more productive workforce; and an associated expansion in national income and living standards. These raise the capacity of the community to invest in interventions to improve mental health, thereby completing a positive reinforcing loop.

The inquiry’s terms of reference (provided at the front of this paper) were developed by the Australian Government in consultation with State and Territory Governments. The terms of reference ask the Commission to make recommendations to improve population mental health so as to realise higher social and economic participation and contribution benefits over the long term.

Assessing the consequences of mental ill-health

The costs of mental ill-health for both individuals and the wider community will be assessed, as well as how these costs could be reduced through changes to the way governments and others deliver programs and supports to facilitate good mental health.

The Commission will consider the types of costs summarised in figure 4. These will be assessed through a combination of qualitative and quantitative analysis, drawing on available data and cost estimates, and consultations with inquiry participants and topic experts. We welcome the views of inquiry participants on other costs that we should take into account.

 

NACCHO Aboriginal Women’s Health : The @DebKilroy #sistersinside #Freethepeople campaign to free Aboriginal women jailed for unpaid fines has raised almost $300K : We do not need to criminalise poverty.

 

“Originally the campaign asked people to give up two coffees in their week and donate $10 so we could raise $100,000.

“However less than two days later, more than a $100,000 was raised, so the target is now to hit 10,000 donors.”

Campaign organiser Debbie Kilroy, the CEO of advocacy charity Sisters Inside, told Pro Bono News the campaign now aimed to go well beyond the 6,000 donors they had currently. See Part 1 Below 

The money will be there for any woman who’s imprisoned, and the money will be spent on the community for women who have warrants for their arrest by the police.

“Every cent will be spent for the purposes of that … particularly Aboriginal mothers are the ones we want to target and prioritise to pay those fines, so those warrants are revoked, so they don’t end up in prison.”

Ms Kilroy told the ABC the money raised by donors would be spent on supporting formerly incarcerated women and ensuring any outstanding warrants were paid so the women were not at risk of jail. See Part 2 below 

Donate at the the GOFUNDME PAGE

” NACCHO supports the abolition of prisons for First Nations women. The incarceration of Aboriginal and Torres Strait Island women should be a last resort measure.

It is time to consider a radical restructuring of the relationship between Aboriginal people and the state.

Aboriginal and Torres Strait Islander people and their communities must be part of the design, decision-making and implementation of government funded policies, programs and services that aim to reduce – or abolish –the imprisonment of our women.

Increased government investment is needed in community-led prevention and early intervention programs designed to reduce violence against women and provide therapeutic services for vulnerable women and girls. Programs and services that are holistic and culturally safe, delivered by Aboriginal and Torres Strait Islander organisations.

NACCHO calls for a full partnership approach in the Closing the Gap Refresh, so that Aboriginal people are at the centre of decision-making, design and delivery of policies that impact on them.

We are seeking a voice to the Commonwealth Parliament, so we have a say over the laws that affect us. “

Pat Turner NACCHO CEO Speaking at  Sisters Inside 9th International Conference 15 Nov 2018

Read full speaking notes HERE

Part 1: The campaign was launched on 5 January with the aim of raising $100,000 – enough to clear the debt of 100 women in Western Australia who have been imprisoned or are at risk of being imprisoned for unpaid court fines.

But as of this morning 16 January the campaign has already raised $280,460, after attracting international attention.

Australie: une cagnotte pour faire libérer des femmes aborigènes

WA is the only state that regularly imprisons people for being unable to pay fines, and ALP research in 2014 found that more than 1,100 people in WA had been imprisoned for unpaid fines each year since 2010.

Under current state laws, the registrar of the Fines Enforcement Registry, who is an independent court officer, can issue warrants for unpaid court fines as a last resort.

The campaign’s crowdfunding page said this system meant Aboriginal mothers were languishing in prison because they did not have the capacity to pay fines.

“They are living in absolute poverty and cannot afford food and shelter for their children let alone pay a fine. They will never have the financial capacity to pay a fine,” the page said.

Money raised from the campaign has already led to the release of one woman from jail, while another three women have had their fines paid so they won’t be arrested.

Campaign organisers are currently working on paying the fines for another 30 women.

The success of the campaign has put pressure on the WA government to reform the law to stop vulnerable people entering jail.

Kilroy said the current law criminalised poverty and she criticised the Labor government’s inaction on the issue despite making a pledge to repeal the lawwhile in opposition.

“The government said prior to their election victory that this was one of their policy platforms, but it’s now been two years and nothing has changed,” she said.

“It’s just not good enough. It does not take that long to change the laws and so we’re calling on the government to change the law as a matter of urgency.”

A spokeswoman for WA Attorney-General John Quigley told Pro Bono News the government intended to introduce a comprehensive package of amendments to the law in the first half of 2019, so warrants could only be handed down by a court.

“These reforms are designed to ensure that people who can afford to pay their fines do, and those that cannot have opportunities to pay them off over time or work them off in other ways,” the spokesperson said.

The Department of Justice has denied the campaign’s claim that single Aboriginal mothers made up the majority of those in prison who could not pay fines.

Departmental figures provided to Pro Bono News state that on 6 January, two females were held for unpaid fines, one of whom identified as Aboriginal.

According to the department, data suggests there has not been an Aboriginal woman in jail in WA for unpaid fines since the campaign started on 5 January.

Part 2 Update from ABC Website Fewer fine defaulters now in prison: Government

The WA Department of Justice said numbers of people jailed solely for fine defaulting had fallen sharply in the past 12 months — with the average daily population falling to “single digits”.

WA Attorney-General John Quigley agreed, saying said recent figures also showed a recent drop in the number of Indigenous women in custody for fine defaulting.

Mr Quigley said the issue of fine defaulters going to prison would be addressed very soon.

“I have a whole raft of changes to the laws through the Cabinet, and [they] are currently with the Parliamentary Council for drafting to Parliament,” he said.

“I have been working assiduously with the registrar of fines … to find other ways to reduce the numbers.”

In terms of the money raised by Sisters Inside, Mr Quigley said he hoped it was being put to good use.

Ms Kilroy told the ABC the money raised by donors would be spent on supporting formerly incarcerated women and ensuring any outstanding warrants were paid so the women were not at risk of jail.

“The money will be there for any woman who’s imprisoned, and the money will be spent on the community for women who have warrants for their arrest by the police.

“Every cent will be spent for the purposes of that … particularly Aboriginal mothers are the ones we want to target and prioritise to pay those fines, so those warrants are revoked, so they don’t end up in prison.”

Call for income-appropriate fines

WA Aboriginal Legal Service chief executive Dennis Eggington said Indigenous women, and those in poverty, were disproportionately affected by the practice of jailing for fines.

“Fines do not have any correlation to someone’s income. If you get $420 on Centrelink and then face a $1,000 fine you are in real trouble and you are not going to be able to pay the fine,” he said.

A head shot of Dennis Eggington with Aboriginal colours in the background.

PHOTO Dennis Eggington for some people it’s easier to go to jail than find the money for fines.

ABC NEWS: SARAH COLLARD

“WA could lead the country at looking at a way where fines are appropriate to the income no matter the offence.”

“It’s really a matter of indirect discrimination. If women are being overrepresented in warrants of commitment, that is having a devastating impact on children and their families.”

He said there was a culture which had led to many Indigenous people feeling as though they had no choice but to go prison for fines.

“It’s much easier to do a couple of days in jail and cut your fine out than to try and find the money to pay the fine,” Mr Eggington said.

”It’s an indictment on the country; It’s an indictment on Australia as a whole that we as one of the most disadvantaged group in Australia have had to develop those ways to survive.

“It’s a terrible, terrible thing