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

NACCHO Aboriginal Health #SocialDeterminants and #ClimateChange : How the @Walgett_AMS community members and market garden are at risk from high sodium in water in drought-stricken NSW town

Unfortunately in our community and particularly Aboriginal people, they have a high incidence of chronic disease,

I believe we are going to have an increase in chronic disease here, particularly from the water consumption,

In my life here in Walgett for 40 odd years, it’s the first time I’ve never drank straight from the tap.

I just worry for people who have to drink straight from the tap.”

Chief Executive of the Walgett Aboriginal Medical Service, Christine Corby, said high blood pressure, heart disease, kidney disease and diabetes were common health issues:

The Australian guidelines do state that medical practitioners who are concerned about people with hypertension should advise that people drink water with no more than 20 milligrams of sodium per litre. The Walgett drinking water is about 15 times that amount … so we need to be thinking about action to address that

Salt of the earth see Part 2 below

” It’s part of good health, it’s part of healthy living, it’s part of prevention and treatment of chronic disease.

For now, the garden has an exemption from the town’s level-5 water restrictions, I’m not sure how long that would last. And even with the exemption, the bore water on offer may not be suitable for gardens.

The research that we’ve received from the University of New South Wales has indicated the long-term effects, the quality of the plants, they will deteriorate, the nutrients will be reduced so it doesn’t work,

“In the long term we can’t sustain the garden.”

The Walgett Aboriginal Medical Service runs a community garden which provides fresh produce for its chronic-disease clients.

Christine Corby said the garden was crucial to these people

The Garden was featured recently in our #refreshtheCTGrefresh campaign

Part 1 : Walgett has always been a river town, perched near the junction of the Barwon and the Namoi rivers.

But with the drought biting hard, the water from those rivers isn’t making it to this northern New South Wales town.

See original ABC post here

With nothing to pump from the local weir, Walgett is the latest town forced to go underground for water.

It is now on an emergency supply of bore water, and many locals are worried it is damaging their health.

PHOTO: The Barwon River at Walgett is just a series of stagnant pools at the moment. (ABC: Danielle Bonica)

Dharriwaa Elder, Thomas Morgan, said the water was no good for drinking.

“Too much salt in it,” he said. “The kids, my grandkids, they’re starting to spit it out, they don’t like it.”

Elder Rick Townsend lives near the water treatment plant.

“I get the smell of it every morning and it’s the foulest smell,” he said.

“I don’t drink it, not at all. I drink the water at the hospital, tank water. Or I’ll buy the water in the supermarkets.”

Dharriwaa Elders Clem Dodd, Thomas Morgan, Rick Townsend and Richard Lake are concerned that the town’s emergency bore water isn’t healthy for people to drink.

Another local, Chantelle Kennedy, said most people were avoiding the tap water. “Most of us go to IGA and buy packs of 24 bottles for $20. It’s dear,” she said.

“A lot of people have been buying fizzy drinks because of the water. Some of them come out and buy hot drinks, which is cheaper than buying water.”

Part 2 : Salt of the earth

The bore water is from the Great Artesian Basin, and tests have shown the sodium levels in the water exceeded Australian Drinking Water Guidelines.

Associate Professor Jacqui Webster, from the George Institute for Global Health, said the sodium levels were concerning.

“The sodium levels in the Walgett water supply are at 300 milligrams per litre and the Australian drinking water guidelines are 180 milligrams per litre, so that’s substantially higher,” she said.

Dr Webster said the guidelines for sodium in drinking water were based on taste rather than health.

But she said high sodium levels did pose serious health risks, particularly for people with underlying health problems.

“The Australian guidelines do state that medical practitioners who are concerned about people with hypertension should advise that people drink water with no more than 20 milligrams of sodium per litre,” she said.

“The Walgett drinking water is about 15 times that amount … so we need to be thinking about action to address that.”

Dr Webster said those who avoided salty drinking water by drinking alternatives such as soft drinks were solving one problem and creating another.

“If they are drinking the water it’s potentially a problem but if they are substituting it with other things that is also a cause for concern,” she said.

“Indigenous communities are suffering from greater incidences of diabetes, obesity and hypertension,” she said.

“In general people get a disproportionate amount of salt from processed foods in communities where there is limited access to fresh foods, so compounding that with sodium from the water supply is a problem, and it’s something we need to be looking into.”

PHOTO: Chief Executive of the Walgett Aboriginal Medical Service, Christine Corby, says the community garden may be forced to close if the town’s water situation doesn’t improve.(ABC Western Plains: Jessie Davies)

Part 3 Community veggie garden under threat

The Walgett Aboriginal Medical Service runs a community garden which provides fresh produce for its chronic-disease clients.

Christine Corby said the garden was crucial to these people.

“It’s part of good health, it’s part of healthy living, it’s part of prevention and treatment of chronic disease,” she said.

For now, the garden has an exemption from the town’s level-5 water restrictions, but Ms Corby said she was not sure how long that would last. And even with the exemption, the bore water on offer may not be suitable for gardens.

“The research that we’ve received from the University of New South Wales has indicated the long-term effects, the quality of the plants, they will deteriorate, the nutrients will be reduced so it doesn’t work,” she said.

“In the long term we can’t sustain the garden.”

 

‘It’s going to keep everyone alive’

Walgett’s mayor, Manuel Martinez, said the shire commissioned the town bore to provide water security in the event of shortages just like this one.

“Two years ago, we had the foresight to sink a bore. We’re drought-proofing our whole shire,” Cr Martinez said.

“This is Australia. We’re in a drought and until the drought breaks, that’s the only water supply we’ve got.”

“It’s going to keep everyone alive, and that’s what we’re here to do,” he said.

“The sodium level is a bit high, higher than normal, higher than preferred, but it’s within the guidelines and it’s the same level it is with other bores.

“I’ve lived in Lightning Ridge for the last 32 years with only bore water. Most of outback Queensland is on the Artesian Basin.”

Cr Martinez said that as soon as there was water in the rivers again, Walgett would be back on river water — or at least on a mixture of river and bore water.

He said the bore water was a short-term emergency supply.

“I’m not doubting what they say, long-term effects of anything can be harmful, especially sodium or salt in the water system,” he said.

Part 4 The upstream imbalance

PHOTO: Elders in Walgett say locals are sad and sorry that pastimes like fishing and swimming in the river are no longer possible. They’re concerned the river is dry not just because of drought but because of mismanagement and water use upstream. (ABC: Danielle Bonica)

Many residents in Walgett believe it is not just the drought that is to blame for the dry rivers.

They say the waterways have not being managed properly and that too much water is being taken out upstream.

Chairman of the Walgett Aboriginal Medical Service, Bill Kennedy, said it was hard when people saw so much water in the rivers not far up the road.

“We’ve lived through droughts before but there was always some water, and some running water,” he said.

“I guess progress has changed all that with irrigators, farming, and especially cotton further up the river.

“I was driving to Tamworth, Newcastle last week and there’s water in the rivers further up at Gunnedah, Narrabri, Wee Waa.

PHOTO: Chairperson of Walgett Aboriginal Medical Service Bill Kennedy. (ABC Western Plains: Jessie Davies )

The mayor agreed, and said it was frustrating to see so much water upstream in both rivers.

“Even in this present time now you’ll see irrigators spraying all their crops,” Cr Martinez said.

“You’ve got a town with no water supply and you go 30kms up the road and irrigators are pumping”

Cr Martinez said the last two water releases from Lake Keepit were supposed to flow down as far as Walgett but they never made it.

“It’s beyond council’s control … we can only apply to push, to get another release, and try and get water to make it down to us.”

He said there was another water release from Lake Keepit on its way and hopefully this one will make it all the way to Walgett.

Spirits at low ebb

Many people in this community were deeply saddened by the state of the two rivers here.

Elder Rick Townsend says it was the worst dry spell anyone could remember.

“It’s a pretty bad state of affairs,” he said.

“It’s the worst I’ve ever seen it in all my life that I’ve lived here.”

For countless generations, the rivers have been a place to meet, fish and swim. But locals said at the moment that was simply not possible.

“There’s no fish or anything in the river any more,” says another Elder, Thomas Morgan.

“People used to come down here and fish every day, catch heaps of fish and crayfish. [They would] come with their kids and spend a good day here with them and be happy, and now they can’t do that.”

PHOTO: Dharriwaa Elders Group chairperson Clem Dodd. (ABC Western Plains: Jessie Davies )

For Clem Dodd, a spokesman for the Dharriwaa Elders Group, the implications for the community were dire.

“This place will be a ghost town before long,” he said.

“If there’s no water, everything’s going to die. There’ll be nothing here for people — they’ll all be moving out.”

 

NACCHO Aboriginal Health and #SocialDeterminants #refreshtheCTGRefresh @TonyAbbottMHR Statement to parliament with 6 key recommendations on remote school attendance and performance

” Why don’t the objective outcomes for Aboriginal Australians match those of everyone else – and what can be done to close this gap?

Amidst all our glittering successes as a nation, this is the one question that’s haunted us, almost since the very first Australia Day; and it always will, until it’s fixed.”

The Hon Tony Abbott MP address to Parliament 6 December 

Download a copy of Improving education outcomes for Indigenous children

Watch speech HERE

Watch SkyNews Interview HERE

Back when prime minister, I used to observe, that to live in Australia is to have won the lottery of life – and that’s true – unless you happen to be, one-of-those whose ancestors had been here for tens of thousands of years.

That’s the Australian paradox. Vast numbers of people from around the world would literally risk death to be here, yet the first Australians often live in the conditions that people come to Australia to escape. We are the very best of countries; except for the people who were here first.

And this gnaws away, a standing reproach to idealists and patriots of all stripes. As long as many Aboriginal people have third world lives, and are on average poorer, sicker, and worse housed by-a-vast-margin than the rest of us, we can indeed be – as we boast – the most successful immigrant society on earth; except, ahem, for those who have been here the longest.

You can appreciate my reservations, then, when the Prime Minister asked me to be his “special envoy” on indigenous affairs. How could a backbench MP make a-difference-in-six-months to a problem that had been intractable for two hundred years? Yet perhaps someone who’s been wrestling with this for a quarter century, and may have spent more time in remote Australia than any other MP, except the few who actually live there – but isn’t dealing with every lobby and vested interest as the PM, the minister and the relevant local member invariably are – can bring fresh eyes to an old problem and perhaps distinguish the wood from the trees.

Amidst all the generally depressing indicators on indigenous Australia, this one stands out. Indigenous people who finish school and who complete a degree have much the same employment outcomes and life expectancies as other comparable Australians. And it stands to reason…that to have a decent life, you’ve got to have a job; and to have a job, you’ve got to have a reasonable education. As prime minister for indigenous affairs this, always, was my mantra: get the kids to school, get the adults to work, and make communities safe.

So the Prime Minister and I soon agreed: that as special envoy, my task was to promote better remote school attendance and performance because this is our biggest challenge.

Around the country, school attendance is about 93 per cent. That’s 93 per cent of all enrolled students, on average, are there on any given day. But for Aboriginal kids, school attendance is just 83 per cent. In very remote schools – where the pupils are mostly indigenous – attendance is only 75 per cent, and only 36 per cent of remote students are at school at-least-90-per-cent-of-the-time, which is what educators think is needed for schooling to be effective. Not surprisingly, in remote schools, only 60 per cent of pupils are meeting the national minimum standards for reading.

Now, it’s not lack of money that’s to blame. On average, spending on remote students is at least 50 per cent higher than in metropolitan schools. A key factor is the high turnover of teachers, who are often very inexperienced to start with. In the Northern Territory’s remote schools, for instance, most teachers have less than five years’ experience and the average length of stay in any one school is less than two years.

Of course, every teacher in every school is making a difference. Even a transient teacher in a poorly-attended school is better than leaving Aboriginal people without the means of becoming successful citizens in their own country. And even attending a struggling school is better than missing out on an education. Our challenge as a government, as a parliament, as a nation, is to-do-more-to-ensure that kids in remote schools are getting the best possible education, because it’s only once we’re doing our job that we can expect parents to do theirs and send their children to school.

Posing this simple question – how do we get every child to go to school every day – prompted one teacher, an elder, who’d been at Galiwinku School since the 1970s, to sigh that she’d been asked the same question for 40 years…. And pretty obviously, that’s because after-all-that-time the answer still eludes us.

And yes, if there were more local jobs and a stronger local economy; if housing wasn’t as overcrowded; if family trauma weren’t as prevalent, and sorry business so frequent; if the sly grogging and all night parties stopped; if there were more indigenous teachers and other successful role models; if pupils didn’t have hearing problems or foetal alcohol syndrome; and maybe if indigenous recognition had taken place; and land claims had been finalised….it might be easier.

In their own way, these all feed into the issue; but if we wait for everything to be addressed, little will ever be achieved. There are all sorts of reasons why a particular child might not be at school on any one day but there’s really nothing that can justify (as opposed, sometimes, to explain) the chronic non-attendance of so many remote indigenous children.

After this latest round of visits and discussions, I can readily understand the despondency people in this field sometimes wrestle with; but there are more grounds for optimism and less reason to be resigned-to-failure than ever before. Yes, some of the federal government’s remote school attendance teams are a glorified bus service; but others are deeply embedded in the school and in the community and can explain almost every absence. Yes, too many remote schools still have very high staff and principal turnover; but there are also hundreds of dedicated remote teachers who have made their work a calling or a mission, rather than just a job or even a career.

Yes, there’ve been plenty of policy flip-flops over-the-years as new governments and new ministers try to reinvent the wheel; but in most states and territories there are now ten-year strategies in place with a stress on staff continuity, on closely monitoring each pupil’s progress and movement, on back-to-basics teaching, on community involvement, and on getting mothers and their new babies straight into the school environment: strategies that have outlived changes of government and minister.

In other words, there’s finally broad agreement on what needs to be done – at least for schools – and a collective official determination to see-it-through for the long term, rather than be blown-off-course by each you-beaut-new-idea.

In all the remote schools that I’ve just visited, culture is respected – and in many of them teaching is bi-lingual, at least in the early years – while teachers still strive to enable proud indigenous people to flourish in the wider world, not just the community they’re born into.

Many fret that progress is stalled or even in reverse – because the world only changes for the better, person-by-person, school-by-school, and community-by-community; and, at this level, there can often be two steps back for every step forward. But while little ever improves as fast as we’d like, it was gratifying to see that the Opal fuel, I introduced as health minister, has all-but-eliminated petrol sniffing in remote Australia. And the larger communities of the APY Lands, with just one exception, now have what-they-all-lacked-a-decade-ago, the permanent police presence that I’d tried to achieve as the relevant federal minister. The Lands are still off-limits-without-a-permit to most Australians, but at least Pukatja now has a roadhouse!

And at least some remote community leaders haven’t shirked the “tough love” conversation that’s needed with their own people; and have accepted restrictions on how welfare can be spent, with the debit card in Kununurra, Ceduna and Kalgoorlie; and the Family Responsibilities Commission in many of the communities of Cape York.

On my recent swing through remote schools, all classrooms – every one of them – were free of the defeated teachers, the structure-less lessons and the distracted pupils that were all-too-prevalent some years back on my stints as a stand-in teacher’s aide; even if actual attendance rates still left much to be desired.

In all the bigger schools, there’s now the Clontarf “no-class-no-footy” programme for the boys and, increasingly, a comparable Girls Academy too. Who would have thought that Kununurra, Coen and Hope Vale schools would have concert bands that any school could be proud of! In Coober Pedy, I helped to wrap books as gifts for the children who regularly attended school; and in Aurukun, handed out satchels to the students going on excursion to the Gold Coast as a reward being at school all the time.

I’m much-more-confident-than-I-expected-to-be that, left to their own devices, the states and territories will manage steady if patchy progress towards better attendance and better performance. But what will be hard to overcome, I suspect, is communities’ propensity to find excuses for kids’ absences; and school systems’ reluctance to tailor-make credentials and incentives for remote teachers. This is where the federal government could come in: to back strong local indigenous leadership ready to make more effort to get their kids to school; and to back state and territory governments ready for further innovation to improve their remote schools.

While all states and territories provide incentives and special benefits for remote teachers, sometimes these work against long-term retention. In one state, for instance, the incentives cease once a teacher has been in a particular school for five years. In others, a remote teaching stint means preferential access to more sought-after placements, so teachers invariably leave after doing the bare minimum to qualify.

There should be special literacy and numeracy training (as well as cultural training) before teachers go to remote schools, where English is often a second or third language. And there should be substantially higher pay in recognition of these extra professional challenges. And because it can take so long to gain families’ trust, there should be substantial retention bonuses to keep teachers in particular remote locations.

We need to attract and retain better teachers to remote schools. And we need to empower remote community leadership that’s ready to take more responsibility for what happens there. The objective, is not to dictate to the states their decisions about teacher pay and staffing but to work with them so that whatever they do is more effective. It’s not to impose new rules on remote communities but to work in partnership with local leaders who want change for the better.

Where local leaders are prepared to accept measures that should create a better environment for school attendance, like the debit card or the Family Responsibilities Commission, the government should be ready to offer extra economic opportunity or better amenities. If local communities have a project, and would like federal government support, and are prepared to accept that with rights come responsibilities, they should make contact to explore what we might all do better.

For instance, at Borroloola, when I wanted to talk school attendance, locals only wanted to talk housing. And I well and truly got their point, once I’d seen the near-shanties that people were living in; and new houses, I’m pleased to say, are now on their way. On future visits, no one should have poor housing as an on-going reason for kids missing school; because if government wants communities to lift their game, we have to be ready to lift ours too.

As the national government, we should be prepared to make it easier for state and territory action to attract and retain better teachers; and we should reinforce the self-evident maxim that every kid should go to school every day: not by taking away the states’ and territories’ responsibility for managing schools; and not by imposing a “punishment agenda” but by making good policy and strong local leadership more effective.  After all, good government – certainly good, sensible small-c conservative government – means a clear objective, plus reasonable, do-able means of moving towards it.

As envoy, my job is to make recommendations rather than decisions: recommendations with a good chance of success because they’re consistent with the government’s values and its policy direction.

6 Major Recommendations 

First, the government should work with the states and territories (whose responsibility it is to pay teachers) to increase substantially the salary supplements and the retention bonuses (if any) currently paid to teachers working in very remote areas.

Second, and this is just a federal responsibility, the government should waive the HECS debt of teachers who, after two years’ experience in other schools, teach in a very remote school and stay for four years.

Third, communities ready to consider the debit card or arrangements akin to it, in order to boost local pupils’ capacity to attend school, should have fast-tracked Indigenous Advancement Strategy projects as a reciprocity measure – a form of mutual obligation, if you like, between government and communities.

Fourth, the Remote School Attendance Strategy should be funded for a further four years, but with some refinements to obtain more local school “buy-in” and better community “intelligence”, and to encourage engagement with local housing authorities and police, where needed.

Fifth, the Good-to-Great-Schools programme, that’s reintroduced phonics and disciplined learning to quite a few remote schools, should be funded for another year to enable further evaluation and emulation.

And sixth, the government should match the Australian Indigenous Education Foundation’s private and philanthropic funding on an on-going basis. Officialdom never likes selective schemes that send people to elite schools, but this one is undoubtedly working to lift people’s horizons, to open people’s hearts and to create an indigenous middle class with the kinds of networks that people in this parliament, for instance, can invariably take for granted.

These recommendations will now be considered through the government’s usual policy making processes and I look forward to ministers’ announcements in due course; and, in some cases, before Christmas.

In every state and territory, it’s compulsory for school age children to be enrolled and not to miss school without a good excuse. For a host of understandable reasons: such as schools’ reluctance to be policemen, the disruption that unwilling students can create in class, the difficulty of holding parents responsible for teenagers’ behaviour, and the cost to family budgets, these truancy laws are rarely enforced, even though there should be direct consequences for bad behaviour – not just the long-term cost to society of people who can’t readily prosper in the modern world.

Most jurisdictions are once-more ready to impose fines on consistently delinquent parents and guardians but fines are often ineffective when gaol is the only mechanism for making people pay. Hence my final recommendation is that all debts-to-government, including on-the-spot fines – and not just those to the Commonwealth – should be deductible from welfare payments.

Finally, I thank the Prime Minister for the opportunity he’s given me. I thank the Ministers for Indigenous Affairs and for Education (who’ve magnanimously put up with an intruder on their patch); and the Prime Minister and Cabinet staff I’ve been working with (in Canberra and in the regional networks) for the past three months. I thank the Northern Territory, South Australian and Western Australian education ministers and their officials, and Queensland officials for their discussions and for facilitating community visits. And I thank the schools and communities of Warruwi, Galiwinku, Nhulunbuy, Yirrkala, Borroloola, Koonibba, Yalata, Coober Pedy, Pukatja, Broome, Kununurra, Coen, Aurukun, Hope Vale, Palm Island and Cherbourg for making me welcome.

However long my public life lasts; in government, or out of it; in the parliament, or out of it; I intend to persevere in this cause. Some missions, once accepted, can never really cease. Of course, the future for Aboriginal people lies much more in their own hands than in mine; but getting more of them to school, and making their schooling more useful, is a duty that government must not shirk. An ex-PM has just one unique trait, and that’s a very big megaphone, that I will continue to use, to see this done. This is my first statement to parliament on remote school attendance and performance…but it certainly won’t be my last word on this absolutely vital subject.

NACCHO Aboriginal Health and #SuicidePrevention : #ATSISPC18 #refreshtheCTGRefresh Pat Turner CEO NACCHO Setting the scene panel : Health led solutions through Aboriginal Community Controlled Health #Leadership

” It is well established that Aboriginal led solutions deliver better outcomes.

Aboriginal community-controlled health services should be funded based on need and so that they can develop comprehensive suicide prevention initiatives with the communities they service. 

The Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project identifies successful Indigenous community led health led responses including providing positive health messages and mental health support underpinned by a cultural framework and tackling harmful drug and alcohol use.

These initiatives can be delivered by properly funded and supported Aboriginal Community Controlled Health Organisations.

I also believe in regular full health checks for at risk people so that critical issues that can impact on a persons wellbeing, like poor hearing, can be picked up and addressed early. 

We also know that mainstream mental health service provision for Aboriginal and Torres Strait Islander people across the country is inadequate and inappropriate.

Many people feel unsafe accessing the care they need.

Aboriginal Community Controlled Health Organisations should be priortised for funding to support our own people.” 

Pat Turner AM CEO NACCHO who is working with Aboriginal and Torres Strait Islander peak bodies across Australia to ask COAG for a seat at the table on the Closing the Gap Refresh: so that we get that policy right : Part 1 Below

Picture above @CroakeyNews : Prof Pat Dudgeon kicks off the keynote panel session: “Setting the scene”. #ATSISPC18. Prof Tom Calma, Prof Helen Milroy, and our CEO Pat Turner

See the #RefreshtheCTGRefresh Campaign post HERE

Read over 120 NACCHO Aboriginal Health and #SuicidePrevention articles published over last 6 years 

Suicide among Aboriginal and Torres Strait Islander communities is regularly in the media and public conversations. Often the focus is on an individual completed or attempted suicide or the negative statistics.

The second National Aboriginal and Torres Strait Islander Suicide Prevention Conference, to be held in Perth on November 20-21, will shift the focus to solutions identified by Indigenous people themselves. The program consists of only Indigenous people from Australia and internationally.

Our voices are important because it is our mob who understand what is going on in our communities best. We live and breathe it, with many of us either having considered taking our own lives, making an attempt or having had family members who have.

This is why the program includes a focus on community-based solutions. “

Summer May Finlay writes Part 2 below for Croakey 

Part 1 : Why an urgent need for action

  • Our people are more than twice as likely to commit suicide than other Australians.
  • Young Aboriginal and Torres Strait Islander men are the most at risk of suicide in Australia.
  • Those in remote area are more disproportionately affected
  • Suicide and self-inflicted injuries was the greatest burden of disease for our young people in 2011.
  • If, Western Australia’s Kimberley region was a country, it would have the worst suicide rate in the world, according to World Health Organisation statistics.
  • Rate of suicide for Aboriginal people in the Kimberley is seven times the rest of Australia.
  • This is not news to us: but it is unacceptable and it is why we are here today.

Aboriginal control

  • At the heart of suicide is a sense of hopelessness and powerlessness.
  • Our people feel this powerlessness at multiple levels, across multiple domains of our lives.
  • It is why we have the Uluru Statement from the Heart: a cry from Aboriginal and Torres Strait Islander peoples across the nation to have a say over matters that impact on us.
  • At the national level, it means a Voice to the Commonwealth Parliament and a full partnership between Indigenous people and governments on the Closing the Gap Refresh with COAG.
  • At the regional level, it is about the formation of partnerships – like in the Kimberley one on suicide prevention – working together and advocating as a region.
  • At the local level, it is about Aboriginal people being in control of the design and delivery of programs to their own people.
  • The importance of Aboriginal control or Indigenous led is highlighted consistently as a way to achieve better outcomes for our people.
  • This is also reinforced at the Kimberley Roundtable and in the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project.
  • Community-led actions are the most effective suicide prevention measure for our people. This fundamental point cannot be ignored if the situation is to change.

Healing

  • Aboriginal suicide rates have been accelerating since 1980.
  • Aboriginal people did not have a word for “suicide” before colonisation.
  • To go forward, we must go back and identify and draw on those aspects of our culture that gives us strength and identity.
  • We also must heal by acknowledging and addressing the effects of intergenerational trauma.
  • Part of healing must include challenging the continuing impacts of colonisation on Indigenous peoples’ contemporary lives.
  • Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project identifies the success of Elder-driven, on-country healing for youth which has the dual effect of strengthening intergenerational ties as well as increasing cultural connection.
  • Red Dust Healing is another example of cultural reconnection achieving positive outcomes with people at risk.
  • The Healing Foundation also achieves similar outcomes with the same principles of empowerment and connection to culture.

A public policy crisis

  • Almost all Aboriginal people who commit suicide are living below the poverty line.
  • Other common factors are:
    • Aboriginal people who have been incarcerated and come out of prison with little to no hope on the horizon.
    • Aboriginal people who are homeless.
    • Aboriginal people who have been recently evicted from their public housing rentals.
    • Aboriginal people who are exposed to violence and alcohol misuse and suffer domestic abuse.
    • Aboriginal people who have multiple underlying health and metal health issues.
    • Aboriginal people who are young; males; and those who live in remote areas.
  • This tells us that we need a comprehensive public policy response to address suicide rates in our people – that suicide in our people is linked to our status and situation more broadly in Australia.
  • It is therefore unacceptable that the National Partnership Agreement on Remote Indigenous Housing has been allowed to lapse and no further investment has been agreed.
  • We must overturn and replace the Community Development Program that is leaving our young people completely disengaged.
  • We must also tackle the issues that lead to the greater incarceration of our peoples, with greater investment in ear health programs, employment and education.
  • It is why we must join the call for Newstart to be raised, so that our people who cannot find work, are not living in poverty.
  • And it is why myself and NACCHO are working with Aboriginal and Torres Strait Islander peak bodies across Australia to ask COAG for a seat at the table on the Closing the Gap Refresh: so that we get that policy right.
  • Whilst these matters can be overlooked in our efforts to respond to suicide in our people, and because it is difficult for governments, but they are fundamental drivers.

 .

Part 2 Follow #ATSISPC18 for news from National Aboriginal and Torres Strait Islander Suicide Prevention Conference : From Croakey 

The second National Aboriginal and Torres Strait Islander Suicide Prevention Conference will take place in Perth this week.

Summer May Finlay, who will cover the discussions for the Croakey Conference News Servicetogether with Marie McInerney, writes below that the focus will be on community-based solutions, as well as listening to young people and LGBTIQ+ sistergirls and brotherboys.

For news from the conference on Twitter, follow #ATSISPC18@SummerMayFinlay@mariemcinerney and @CroakeyNews.


 

Healing and support crew on hand should the be needed 

Summer May Finlay writes:

Suicide among Aboriginal and Torres Strait Islander communities is regularly in the media and public conversations. Often the focus is on an individual completed or attempted suicide or the negative statistics.

The second National Aboriginal and Torres Strait Islander Suicide Prevention Conference, to be held in Perth on November 20-21, will shift the focus to solutions identified by Indigenous people themselves. The program consists of only Indigenous people from Australia and internationally.

Our voices are important because it is our mob who understand what is going on in our communities best. We live and breathe it, with many of us either having considered taking our own lives, making an attempt or having had family members who have. This is why the program includes a focus on community-based solutions.

While the term “Aboriginal and Torres Strait Islander” is used as a collective term for the Indigenous nations in Australia, each community within each nation is unique – culturally, socially and historically. This means that solutions need to be tailored to each community. Again, this focus is reflected in the conference program.

That’s not to say everyone in each community has the same needs and concerns. Within communities there are sub-groups who also have distinct needs, such as young people and LGBTQI+ sister girls and brother boys.

Representation matters

Our young people and community of LGBTIQ+ sistergirls and brotherboys experience disproportionate rates of suicide. Their voices on how to address the situation are important to hear, which is why these groups are well represented at the conference, with sessions where people will share their stories of ways forward.

Dion Tatow, a conference presenter, says the focus needs to be on ways forward because being “LGBTIQ+ sistergirls and brotherboys isn’t the cause of suicide, it is the discrimination and exclusion that are the cause”.

He says: “The shame [and] secrecy. You have to hide it, so it’s not good for your own health and wellbeing.”

Tatow is an Iman and Wadja man from Central Queensland and South Sea Islander (Ambrym Island, Vanuatu) and chairperson of gar’ban’djee’lum, a Brisbane-based, independent, social and support network for Aboriginal & Torres Strait Islander people with diverse genders, bodies, sexualities and relationships.

He believes that Aboriginal and Torres Strait Islander people and organisations like Aboriginal Community Controlled Health Organisations (ACCHOs) and cisgender people and mainstream organisations have a role to play in improving the health and wellbeing of LGBTIQ+ sistergirls and brotherboys.

However, many health services “staff aren’t trained to deal with some LGBTIQ+ sistergirls and brotherboys’ health concerns such as gender reassignment.” This can mean LGBTIQ+ sistergirls and brotherboys can feel uncomfortable accessing a service.

Safe spaces needed

Tatow believes that ACCHOs need to step up and become “safe spaces” for LGBTIQ+ sister girls and brother boys. He says that there is a perception among LGBTIQ+ sistergirls and brotherboys that ACCHOs may be unsafe, with concerns particularly around confidentiality.

According to Tatow, the program Safe and Deadly Spaces run by Aboriginal and Torres Strait Islander Community Health Service in Brisbane (ATSICHS) is a great example of what ACCHOs can do to offer appropriate services to LGBTIQ+ sister girls and brother boys.

ATSICHS is “committed to being inclusive of all sexual orientations, gender identities and intersex variations to ensure every member our community feels safe, accepted and valued when they access our services and programs”.

Young Aboriginal and Torres Strait islander people also have a strong presence at the conference.

Culture is Life, led by the Chief Executive Officer Belinda Duarte, has taken charge of the youth program. Culture is Life backs Aboriginal-led solutions that deepen connection and belonging to culture and country, and supports young Aboriginal and Torres Strait Islander people to thrive. This includes allowing young Aboriginal and Torres Strait Islander people to take on leadership roles.

Will Austin, 22, a Gunditjmara man, from South West Victoria who is the Community Relations manager for Culture is Life, was charged with leading development of the youth program. He believes that young people being part of the program was important because “Aboriginal leadership and expertise needs to be shared in a really inclusive way with young people through listening and reciprocity across the generations.”

Culture is key

Culture is Life, as the name implies, places culture at the centre of the work they do, and Austin sees culture as key to health and wellbeing for our young people, connecting to cultural practice in traditional and modern ways. He says:

Modern culture is marching down the street and finding the balances in different ways such as art, dance and contemporary dance, poems, song writing, music.

Our culture has been around for thousands of years and shared through our Elders. It will evolve. There is no better feeling than going out on country, dancing on country, feeling your feet on the earth your ancestors have walked on. Connecting to the ancient knowledge and using modern ways to communicate it.”

Katie Symes, Culture is Life General Manager – Marketing and Communications, also believes Culture is a key “protective factor” for Aboriginal and Torres Strait Islander young people.

Will Austin and Katie Symes encourage young people at the conference to have their voices heard.

Austin said: “Don’t be shame. Make sure you step up. Make sure you contribute to the conversations…young Indigenous people are the heartbeat of the nation.”

Symes said: “It’s important for young people to be supported to cut their teeth in a really safe space.”

And the conference is designed to be just that, a safe space.

Listening with heart

Culture is Life is promoting the importance of “Listening with our hearts to the lived experiences of First Nations young people, their friends, families and communities” through its LOVE and HOPE campaign, which aims to aims to raise awareness through communicating the evidence, lived experiences and Aboriginal-led solutions. This aim is echoed through the conference.

You can watch the two campaign videos featuring young Aboriginal and Torres Strait Islander people and Professor Pat Dudgeon, chair of the conference organising committee, here and here. Also follow the campaign on social media using the hashtags #loveandhope  #culturesquad  #cultureislife.

The conference showcases evidence from research and lived experience from Aboriginal and Torres Strait Islander people and Indigenous brother and sisters from other countries. The uniqueness of the program will lend itself to a unique experience for attendees.

This conference follows the first conference held in Alice Springs in 2016 as part of the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project funded by the Commonwealth Government (see this Croakey report compiling coverage of the conference).

• If you or someone you know needs help or support, call Lifeline on 13 11 14 (24 hours-a-day), contact your local Aboriginal Community-Controlled Organisation, call Beyondblue on 1300 22 4636 or call Q Life: 1800 184 527.

• Further reading: On World Suicide Prevention Day, calls for the Federal Government to invest in Indigenous suicide prevention.

• The feature image above is detail from an artwork on the conference website: Moortang Yoowarl Dandjoo Yaanginy: Families (Cultures) Coming Together for a Common Purpose (Sharing) Shifting SandsThe website says: “This artwork represents our people doing business on country that is recovering from colonisation; our lands taken over, our cultures decimated, and our families separated, causing hardship, despair, and loss of hope

Aboriginal Health Alcohol and Other Drugs : Minister @KenWyatt and John Havnen #NACCHO deliver #NIDAC18 keynotes : What is currently being done to reduce the high levels of alcohol and other drug use within Aboriginal communities? 

 ” All of us want to see better health for First Nations Australians. 

We know that the excessive consumption of drugs and alcohol is associated with health problems in all societies.

It has been linked to chronic conditions such as cancer and liver disease, the spread of hepatitis and HIV, injuries and deaths from motor vehicle accidents and assaults, increased encounters with the law, deaths in custody, suicides and family breakdown.

The reasons why First Nations’ people engage in high risk drug and alcohol consumption are indeed, complex.

When families, communities, local organisations and governments join hands, we are powerful together.

Alcohol and other drugs, tobacco, lifestyle risk factors and social determinants represent more than half of the quest for health and life equality.

It’s now been 10 years since the launch of the Closing the Gap initiative.

The agenda is being refreshed and it’s time to refresh our approach – including by acknowledging the complexity of the drug and alcohol challenge and making even greater efforts to address it.

This conference NIDAC18 will be an important part of that solution – and I look forward to hearing the outcomes. ” 

Minister Indigenous Health Ken Wyatt see full speech Part 2 below

Read over 200 NACCHO Aboriginal Health Alcohol and Other Drugs articles we have published over past 6 years 

Part 1 NACCHO Keynote by John Havnen Senior Policy Officer 

The harmful use of alcohol is a problem for the Australian community as a whole – alcohol misuse and alcohol-related disease remains a recognised as a nationwide problem.

It is estimated that in 2011 alcohol misuse caused 5.1% of the total burden of disease in Australia.

Alcohol related harm has clear social and economic determinants and it is closely related to disadvantage.

As such Aboriginal and Torres Strait Islander communities, which as we all know rate disproportionately in all measures of disadvantage, experience higher rates of alcohol misuse and alcohol-related harm than non-indigenous Australians.

This discrepancy leads to Aboriginal and Torres Strait Islander people experiencing significant health and social problems in a rate unequal to non-Indigenous Australians. But not all of us drink, in the 2016 National Drug Strategy Household Survey, Indigenous Australians aged 14 and over were more likely to abstain from drinking alcohol than non-Indigenous Australians.

This abstinence rate has been increasing over the last decade with more and more of us deciding not to drink.

So although there are proportionately more Indigenous people than non-Indigenous people who refrain from drinking, those of us who do drink are more likely to do so at high-risk levels.

In 2014-15 the National Aboriginal and Torres Strait Islander Social Survey found 19% of Indigenous Australians over the age of 15 exceeded the lifetime risk guidelines for alcohol consumption.

This is no more than 2 standard drinks per day on average or no more than 4 drinks per occasion.

Even though the rate of harmful drinking has declined in recent years, this has been mainly in non-remote areas, so there is still high rates of harmful drinking in remote areas and drinking at risky levels puts a person at risk of medical and social problems.

Due to these high levels of risky drinking, Aboriginal and Torres Strait islanders are more likely to be hospitalised for alcohol-related conditions and accidents than non-Indigenous Australians including acute intoxication, liver disease, injuries, suicide or self-harm and cancer.

There is big differences in the rates with Indigenous males over 9 times more likely to need hospitalisation and Indigenous females 13 times more than non-Indigenous Australians.

These drinking patterns highlight that it is possible that risky drinking and binge drinking has been normalised within some communities and this could potentially act as a barrier to seeking treatment when needed.

However, alcohol is not the only substance that presents a major concern for in Aboriginal and Torres Strait Islander people.

In 2014-15, the National Aboriginal and Torres Strait Islander Social Survey stated that 30% of Indigenous Australians over the age of 15 years reported using an illicit substance in the previous 12-months.

This was an increase from 23% in 2008. The substances most commonly used by Aboriginal and Torres Strait islanders were cannabis with 19% reporting, non-prescription analgesics and sedatives (such as painkillers, sleeping pills and tranquillisers) at 13%, and amphetamines or speed with a rate of 5%.

Smoking has overtime become common place in Aboriginal and Torres Strait islander communities and whilst tobacco smoking is declining in Australia, rates remain disproportionately high among Aboriginal and Torres Strait Islander people.

Indigenous Australians more than twice as likely to be current daily smokers as non-Indigenous Australians.

Despite declines in rates of smoking in Aboriginal and Torres Strait Islander people in the last 20 years there appears to have been no change to the gap in smoking prevalence between the Indigenous and non-Indigenous Australian adult population.

Tobacco-related disease is responsible for between 1.5 and 8 times more deaths in the Aboriginal and Torres Strait islander community than in non-Indigenous Australians.

The harmful use of alcohol, in addition to tobacco and other drugs, are both the cause and effect of serious harm to physical health.

The health status of Aboriginal and Torres Strait Islander people is considerably lower than for non-Indigenous Australians with 71.0% of Indigenous Australians reporting having a long-term health condition compared with 55.3% of non-Indigenous Australians.

Those with long-term health conditions are also more likely to be a daily smoker or misuse alcohol and other drugs. Aboriginal and Torres Strait Islander people who experience multiple diagnoses are more likely to have more difficulty accessing treatment and have poorer outcomes when they do receive treatment than either a physical health condition or an alcohol or other drug disorder alone.

There is a well-known high rate of co-morbidity of substance use disorders with other mental health / social and emotional wellbeing issues, and medical conditions in particular chronic diseases.

These issues tend to cluster in individuals and communities along with other markers of social, economic and intergenerational disadvantage.

These high rates of comorbidity contribute to complexities in the treatment and causality of disorders and remains a significant challenge for the delivery of effective healthcare services for our people.

This is in part due to the complexity of the mental and physical health issues individuals display, and in part because of the burden of multiple disadvantages including; poverty and intergenerational disadvantage and this can reduce the capacity to engage consistently and meaningfully in treatment.

So, what is currently being done to reduce the high levels of alcohol and other drug use within Aboriginal and Torres Strait Islander communities?

Existing mainstream models of practice in the alcohol and other drug field have been developed within Western systems of knowledge and focus on a biomedical model with an emphasis on biological factors and discounts any psychological, environmental, and social influences. As a result, it is not generalisable to Aboriginal and Torres Strait islander culture and ignores important indigenous perspectives and needs.

Including the need for access to culturally appropriate and comprehensive services to address multiple problems, and the need for local links with Indigenous services.

Western alcohol and other drug services are based on an abstinence model and focuses on residential rehabilitation which is aimed more on the needs of alcohol users and not illicit drug users.

Residential alcohol and drug programs provide care and support for people within a residential community setting and can be medium to long-term duration of anywhere from 4 weeks to 12 months and but again only supports residents’ psychological needs only.

This model also lacks consideration to the prevention and early intervention strategies of risky drinking and drug use, lacks acknowledgement of family, culture and community which we know are important aspects in the holistic model of care.

Despite a paucity of data, the knowledge of how to prevent alcohol misuse among the general population – while not consistently translated to policy and practice – is extensive.

The evidence for the effectiveness of such programs for Indigenous Australians, however, remains scant.

Racism is still present in mainstream services so many Aboriginal and Torres Strait Islanders might have limited access to mainstream health services.

Systemic racism in the health system directly influences Indigenous Australians’ quality of and access to healthcare.

The severity of this impact intensifies levels of psychological stress, which is closely linked to poorer mental and physical health outcomes.

Racism not only provides a major barrier to Aboriginal and Torres Strait Islander peoples’ access to health care but also to receiving the same quality of healthcare services available to non-Indigenous Australians.

There is also a tendency to stereotype Aboriginal and Torres Strait Islanders as ‘drunks’ or ‘alcoholics’ which, as I have previously discussed today is not necessarily the case.

So, what will work if mainstream alcohol and other drug services have limited evidence for our people?

Historically, reactions to the concerns of alcohol and other drug misuse among Aboriginal and Torres Strait Islander people were driven not by governments, but by Aboriginal and Torres Strait Islander people themselves who recognised the fact that mainstream services were non-existent or largely culturally inappropriate.

Today, Indigenous Australians are acutely aware of the impacts of alcohol and other drugs and have been actively involved in responding to alcohol and other drugs misuse in their communities.

Any initiative to reduce the harmful effects of alcohol and other drugs in Aboriginal and Torres Strait Islander communities should be developed with, and led by, those communities.

There is value in supporting these communities, including the evaluation of strategies implemented so that communities can learn from their own and from other communities’ experience.

Any action that attempts to treat alcohol and other drugs needs to come from a holistic model of care that is comprehensive and culturally appropriate.

Awareness of the land, the physical body, clan, relationships, and lore, it is the social, emotional and cultural wellbeing of the whole community and not just the individual.

This is why western models of treatment just won’t work.

Comprehensive primary health care is a key strategy for improving the health of Indigenous Australians and is an important platform from which to address the complex health and social issues associated with alcohol and drug misuse.

A holistic approach locally designed and operated by Indigenous people is favoured in its ability to be tailored to community needs and in a cultural context that is owned and supported by the community. 

Despite inadequate funding and resources, the ACCHOs sector has been identified as having a unique role in making alcohol and other drug treatment services more accessible.

One of the unique attributes of Aboriginal controlled drug and alcohol services is that they are a practical expression of Aboriginal peoples’ self-determination, reflected in their governance and treatment models.

A recent example of what works is the pilot of an integrated model of care within Central Australian Aboriginal Congress based in Alice Springs.

Congress developed an integrated non-residential treatment model for Aboriginal and Torres Strait Islanders with alcohol and other drug issues and it is based on providing care for all aspects of health through three streams of care:

Social and cultural support – which is delivered by Indigenous workers with cultural knowledge, language skills and an in-depth knowledge of the Aboriginal community alongside social workers. This stream includes case management and care coordination, advocacy on behalf of clients, social support, cultural support, access to medical care, and opportunistic alcohol and other drug counselling and brief interventions.

Psychological therapy – which is carried out by qualified therapists delivering evidence-based treatments including cognitive behaviour therapy (CBT) and related psychological therapies and access to neuropsychological assessment and treatment. And:

Medical treatment – which is provided by Congress GPs and other members of the primary health care team, and includes medical assessments of alcohol and other drug clients, management of chronic disease and prescription of pharmacotherapies where appropriate to assist with alcohol withdrawal.

This model recognises the comorbidities that occur with alcohol and other drug clients and sought to address within a holistic approach that is adaptable based on needs of individuals.

In 2016-17, in the presenting alcohol and other drug clients, 28% received only one stream of care, 59% received two-streams and the remainder, 13% received all three streams of care.

The Congress ‘three streams model’ of care for alcohol and other drug treatment has been developed over many years to provide a single, integrated multidisciplinary service organised around social and cultural support; psychological therapy; and medical care.

In doing so, it reduces demands on clients presenting with alcohol and other drug issues to navigate multiple health care providers, and attempts to address their holistic needs, including advocacy and support around the social determinants of health and wellbeing including housing, welfare and employment, criminal justice, and basic life needs.

This is a great example of how well it can work when the system is correct and can be used as a model for other ACCHOs to learn from.

The diversity of Aboriginal Australia means that no service model can be simply transferred from one place to another. Instead, the strength of Aboriginal community-controlled health services is their capacity to adapt successful models to the particular needs, strengths and histories of the communities they serve.

But funding is a barrier in implementing optimal services in many regions.

A recent report on organisations conducting Indigenous-specific alcohol and other drug services found that a lack of government commitment to funding community-controlled organisations has compromised the capacity of Indigenous Australians to address alcohol and other drug issues within their own communities.

In addition, the capacity of Aboriginal community-controlled organisations to deliver services was severely constrained by staff shortages, lack of trained and qualified staff, and very limited access to workforce development programs.

Treatment is also not the only key, continuing to increase the community awareness and education about the effects of alcohol and other drugs and the treatment options for dealing with issues is vital.

Including a range of health promotion activities and groups including exercise and nutrition programs, tobacco use treatment and preventions groups to address the holistic needs is essential and well help to reduce the levels of risky drinking and the efficacy of treatment once in treatment.

We need to enable our people to have control over their health and improve health literacy on risky behaviours to help stop the impacts of alcohol and other drugs.

 Part 2 Minister Indigenous Health Ken Wyatt keynote 

Good morning. In West Australian Noongar language I say “kaya wangju” – hello and welcome.

I acknowledge the traditional custodians of the land on which we’re meeting, the Kaurna people, and pay my respects to Elders past and present.

The 5th National Indigenous Drug and Alcohol Conference is a positive opportunity to make progress on a difficult issue.

The conference theme is Responding to Complexity – and there certainly is no one-size-fits-all solution to the challenges our people face.

This is why we have to attack the scourge of drug and alcohol dependency and abuse on multiple fronts.

To form new partnerships.

To speak and to listen, with open minds and hearts.

All of us want to see better health for First Nations Australians.

We know that the excessive consumption of drugs and alcohol is associated with health problems in all societies.

It has been linked to chronic conditions such as cancer and liver disease, the spread of hepatitis and HIV, injuries and deaths from motor vehicle accidents and assaults, increased encounters with the law, deaths in custody, suicides and family breakdown.

The reasons why First Nations’ people engage in high risk drug and alcohol consumption are indeed, complex.

Working together, we are making progress, reducing binge drinking rates among our people from 38 per cent to 31 per cent between 2008 and 2014–15.

But there is still much work to be done.

As we see in the Aboriginal and Torres Strait Islander Health Performance Framework report, social determinants are estimated to make up 34 per cent of the gap in health outcomes between First Nations’ people and other Australians.

Together, with behavioural risk factors, such as alcohol, drug and tobacco use, they account for 53.2 per cent of the health gap.

Alcohol and drug abuse has a broad and insidious impact.

We have a moral and social imperative to work together to put an end to violence and dysfunction and the drug- and alcohol-driven neglect of children in our communities.

Our Government is committed to working with families and individuals to address substance misuse and to break the cycle of disadvantage that prevents children from attending school, and adults from going to work.

Particularly for the protection of children, we have invested over $10 million to provide better diagnosis and management, develop best practice interventions and services to support high-risk women.

A 10-year FASD Strategic Action Plan is in the final stage of development.

Just as important, we see outstanding examples of local warriors for health – like June Oscar and her team in Fitzroy Crossing – who have tackled alcohol in their communities, with life-changing results for children and families.

We must try harder to understand and address the underlying causes of alcohol and drug misuse.

The percentage of First Nations’ people who drink is no greater than for other Australians – in fact, there are many of our people who do not drink at all.

Equally, the impacts of trauma on the health of our communities cannot be ignored, because they add to the complexity of the challenge.

Trauma is no excuse for substance abuse, violence or neglect – but understanding its history can help us reduce its impact.

It reaches across generations of Aboriginal and Torres Strait Islander people, and must be acknowledged and addressed.

Significant health impacts have resulted from displacement from family and country, institutionalisation, racism, abuse and neglect.

This has led to increasingly high rates of incarceration and juvenile detention, suicide, family violence, children being taken into care, and poorer physical and mental health.

63 per cent of First Nations’ prisoners are incarcerated as a result of violent crimes and offences that cause harm.

First Nations’ offenders are also more likely to be under the influence of alcohol when they offend.

It’s a sad fact, that alcohol was involved in 80 per cent of cases of domestic homicide, where both the offender and the victim were First Nations’ people.

That’s more than three times the level of domestic homicides involving other Australians.

It’s also known that First Nations people who engage in alcohol-related crime are themselves more likely to be the victims of such offences.

The question is, how do we reduce high-risk levels of alcohol consumption?

Harm reduction programs can minimise the immediate danger posed by alcohol misuse; but our broader aim should be to reduce alcohol intake.

Our Government is investing in a series of activities which have been shown to be effective.

These range from alcohol restrictions to treatment and rehabilitation.

Under the Indigenous Advancement Strategy, the Government has committed around $70 million in 2017–18 to support over 80 Indigenous alcohol and other drug treatment services.

They are located in places with high First Nations’ populations, in capital cities and regional centres as well as outer regional and remote areas.

Alcohol is a particular problem in the Northern Territory.

Our Government recognises this and is providing more than $91 million over seven years for targeted local action to reduce alcohol related harm.

A significant part of our national support to reduce risk also includes primary healthcare and population health programs addressing smoking and alcohol, in urban, regional and remote locations across Australia.

Poor mental health as a result of drug and alcohol problems is a huge issue and one which I am pleased will be addressed during this important conference.

It is equally high on our Government’s agenda.

The Australian Health Ministers’ Advisory Council recently endorsed the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017–2023.

The council has prioritised development of a national Indigenous Health and Medical Workforce Plan, which aims to increase the number of Aboriginal doctors, nurses and health workers on country and in our towns and cities.

Primary Health Networks across Australia also have mental health and Aboriginal and Torres Strait Islander health among their priorities.

I am very keen to ensure Primary Health Networks provide a strong platform for culturally comfortable drug, alcohol and mental health services.

To that end, we have targeted more than $85 million to improve access for integrated, culturally appropriate and safe mental health services for First Nations people.

Our Primary Health Networks are also currently investing a further $79 million on the provision of alcohol and other drug services specifically designed to meet the needs of First Nations people, at the local level.

While the effects of alcohol and drugs can be dire, the insidious damage caused by tobacco is significant.

Statistics show that smoking is responsible for 23 per cent of the gap in health outcomes between First Nations’ people and other Australians.

That is why reducing smoking rates among Aboriginal and Torres Strait Islander people is central to our efforts to close the gap.

By supporting locally linked projects within a national campaign, we are seeing some success.

The daily smoking rate for First Nations’ people aged 15 years and over has declined from 49 per cent in 2002 to 39 per cent in 2014–15, with most of this since 2008, when targeted measures commenced.

However, the daily smoking rate in remote areas is still 47 per cent, and worryingly, the number of First Nations’ women smoking while pregnant remains far too high, at 46 per cent.

To continue supporting change for the better – through funding certainty and proven programs – we have gone to a four-year, $300 million funding commitment for the successful Tackling Indigenous Smoking program.

We are supporting Aboriginal and Torres Strait Islander specific education programs, as part of the National Tobacco Campaign.

“Don’t Make Smokes Your Story” targets First Nations’ smokers aged 15 years and over.

Since its third phase concluded at the end of June, evaluation has shown its effectiveness.

86 per cent of First Nations smokers were aware of the campaign.

7 per cent had quit and 26 per cent said they had reduced the amount they smoke.

If we can maintain this sort of momentum, I am we will see significant improvements in health in future.

We have also had significant success in reducing petrol sniffing, which can cause brain damage and even death.

Independent research undertaken since 2005 indicates that in communities with low aromatic fuel, petrol sniffing has dropped by 88 per cent.

Low aromatic fuel, subsidised by the Government, has now replaced regular unleaded in around 175 outlets in the Northern Territory, Queensland, Western Australia and South Australia.

There were special factors related to petrol sniffing which make it impractical to apply the same approach to alcohol and drug misuse.

But there is one big lesson from that success.

When families, communities, local organisations and governments join hands, we are powerful together.

Alcohol and other drugs, tobacco, lifestyle risk factors and social determinants represent more than half of the quest for health and life equality.

It’s now been 10 years since the launch of the Closing the Gap initiative.

The agenda is being refreshed and it’s time to refresh our approach – including by acknowledging the complexity of the drug and alcohol challenge and making even greater efforts to address it.

This conference will be an important part of that solution – and I look forward to hearing the outcomes.