NACCHO Aboriginal Health #SDoH News: Delivering better health is about more than healthcare


” The social determinants of health include the obvious physical things such as clean water and air, healthy workplaces, adequate housing, transportation services and safe communities.

Education and employment provide income and make housing, food and healthcare affordable. Equally important are less tangible factors such as social support networks, culture and beliefs, stress and exposure to violence, discrimination and racism

The strong associations between these factors and health outcomes mean that providing for the health and wellbeing of the population requires more than hospitals, doctors and prescription pads and tackling the wicked issues such as obesity, ageing, mental health reforms and Closing the Gap on Indigenous disadvantage requires government involvement beyond the Department of Health.

There can be no question that government involvement is essential for two reasons: many of the determining factors for health lie beyond the ability of individuals and communities to influence and population health contributes to national productivity and prosperity.”

Dr Lesley Russell is adjunct associate professor at the Menzies Centre for Health Policy at the University of Sydney. From Canberra Times

Last month it was announced that the 2016 Boyer lecture series would be delivered by Sir Michael Marmot, a leading researcher on health inequality. He will explore how health is not simply a matter of genetics and access to healthcare but is intrinsically linked to economic and social factors. This lecture series comes at a time of growing recognition of the increasing inequalities in income and wealth and the subsequent impacts on health.

Life expectancy is the traditional way we measure population health, the effectiveness of our healthcare system and the value we get for the healthcare dollars we spend. By international comparisons Australia, with an average life expectancy of about 83 years, rates well. But this statistic hides many different stories for many different groups.

On average: men die five years earlier than women; Indigenous Australians die up to 17 years earlier than non-Indigenous Australians; people living in rural areas die up to seven years earlier than those in urban areas; and people with mental illness die up to 20 years earlier. Between one-third and one-half of these life expectancy gaps are explained by differences in the social determinants of health.

Health disparities have a devastating impact on individuals and families, and there are substantial costs involved to both the healthcare and welfare budgets and to the economy as a whole.

The National Centre for Social and Economic Modelling estimated that in 1998, $3 billion in healthcare costs and $1.2 billion in disability pensions a year would have been saved if the health status of the whole population was equal to that of the most advantaged 20 per cent.

Almost 20 years on, those figures must have at least doubled. How much money could be saved if our least healthy population groups were brought up to the healthiest level?

The case that Sir Michael Marmot will present will highlight why the education and economic policies of the new Turnbull government will have a direct impact on national healthcare costs.

There is a very strong link between education and health. It is not just that better educated people get better jobs, housing and healthcare. It is also about making better life decisions and the positive effects on health of having greater control over your lifestyle.

Australian data show there is a five-year difference in life expectancy between people with 12 years of education and those with more than 12 years of education.

Poverty has a major impact on health and premature death. The greater the length of time that people live in disadvantaged circumstances, the greater the risk for ill health. People who are unemployed, and the families of those who are unemployed, experience a much greater risk of premature death. The adverse health effects begin when people first feel their jobs are under threat, before becoming unemployed.

As a warning sign of what could happen here, a recent study showed that life expectancy for White Americans with less than a high school diploma is decreasing. This population group has high rates of unemployment and has seen wages decline over the past two decades. They also have many of the risk factors for poor health such as obesity, smoking and stress.

Low income has less impact if basic needs such as housing, food and healthcare are met through strong social policies. A recent study suggests that social spending, not medical spending, is the key to health. The United States has a ragged social safety net and spends only 56¢ on social services for every health dollar. The major OECD countries spend about $1.70 for every $1 spent on health.

In Australia we are seeing housing costs rise and the erosion of both welfare income and the affordability of healthcare. A report last year from ACOSS found that increasing inequality of income and wealth is dividing the country. Once thought of as the archetypal egalitarian society, Australia has been slipping over the past two decades and is now the 11th most unequal of the 34 OECD members.

We are already a country where good health and access to life’s opportunities come down to postcode. Growing inequalities will make this worse and we will all pay, directly and indirectly, the associated costs. We must hope that senior government ministers will be listening carefully to the Boyer lectures and that lessons learnt play out in budget policies.

Dr Lesley Russell is adjunct associate professor at the Menzies Centre for Health Policy at the University of Sydney.


NACCHO Aboriginal Health Heart Map : Our Indigenous Community Hurting in the Heart


“Aboriginal and Torres Strait Islander peoples are two-and-a-half times more likely to be admitted to hospital for heart events than non-Indigenous Australians.

For both sexes, Aboriginal and Torres Strait Islander peoples are more likely to have high blood pressure, be obese, smoke and a poor diet.

“Many of the hospital admissions for Aboriginal and Torres Strait Islander peoples are preventable and the Heart Foundation is committed to closing the gap in health outcomes for Aboriginal and Torres Strait Islander peoples.”

Heart Foundation National Chief Executive Officer Adjunct Professor John Kelly said these maps brought together for the first time a national picture of hospital admission rates for heart-related conditions at a national, state and regional level.

Or Download report and press release

Australian Heart Maps Report 2016

Australia’s Indigenous Community Hurting in the Heart

Aboriginal and Torres Strait Islander peoples are two-and-a-half times more likely to be admitted to hospital for heart events than non-Indigenous Australians.

Of all the four heart events (STEMI and NSTEMI, unstable angina and heart failure), admission rates for Aboriginal and Torres Strait Islander peoples is at least double that of non-Indigenous Australians.

“For all separations, Aboriginal and Torres Strait Islander peoples have a rate of 117.9 compared to non-Indigenous of 48.9,” Adj Prof John Kelly said.

“If Aboriginal and Torres Strait Islander peoples had the same rate of admissions, there would be 2300 fewer hospital admissions each year including close to 900 fewer admitted for a heart attack.

“For both sexes, Aboriginal and Torres Strait Islander peoples are more likely to have high blood pressure, be obese, smoke and a poor diet.

“Adding to the risk is they’re more likely to have comorbidities, which is having at least two or more conditions/illnesses such as heart disease, respiratory disease and kidney disease.

For almost every social indicator (education, income, housing security etc) Aboriginal and Torres Strait Islander peoples fare worse than their non-indigenous counterparts.

“These poorer social and economic conditions lead to higher rates of smoking, hypertension, and obesity for Aboriginal and Torres Strait Islander peoples.

“Yet, for historical, geographic and cultural reasons, primary healthcare services remain under-used by Aboriginal and Torres Strait Islander peoples.

“As a result, poorer health and lower quality of life becomes the “norm” until a critical event like a heart attack happens.

“Many of the hospital admissions for Aboriginal and Torres Strait Islander peoples are preventable and the Heart Foundation is committed to closing the gap in health outcomes for Aboriginal and Torres Strait Islander peoples.”

Mapping Out Australia’s Heart Health



View and Engage with Heart Map Here

New heart-related hospital admissions data mapped by the Heart Foundation reveals disturbing gaps between those living in the city and those in regional Australia.

A concerning trend among the hotspots was the correlation between access to services, particularly for those considered disadvantaged, and the rates of heart-related hospital admissions.

Heart Foundation has launched Australian Heart Maps, which is an online service highlighting how indicators for heart disease are distributed throughout Australia’s hospital network.

Queensland dominates the list of hotspots with 12 regions included in the top 20.

This compared to four from New South Wales, two from Northern Territory and one each from Western Australia and Victoria.

“This contrasts to areas with the lowest rates – particularly the northern suburbs of Sydney, where there is little disadvantage of the community.

“There is a five-fold difference of hospital admissions between Northern Territory Outback and the region with the lowest admission rates North Sydney & Hornsby, which highlights the association between remoteness, disadvantage and our heart health.

“The lowest rate we see in the northern suburbs of Sydney tells us what is possible, what we should be striving for across the country.”

Adj Prof Kelly added that the Heart Maps would serve as a valuable tool for health professionals, health services, local governments, researchers and policy makers to be used to set strategy, plan services and target prevention initiatives to areas of greatest need.

“What we need is a greater focus on prevention and management of heart disease in rural and remote Australia and in areas of disadvantage,” he said.

“For those with established heart disease, we want to work with health planners to ensure everyone has good access to co-ordinated cardiac services to reduce hospital readmissions and the development of further chronic disease.”

The Heart Foundation Heart Maps display hospital admission rates for two years of hospital separation data, with a separation defined as a completed episode of patient care in hospital resulting in discharge, death, transfer or change in type of care (ie: acute to rehabilitation).

The Heart Maps display separations for four key heart diagnosis – NSTEMI, STEMI, Unstable Angina and Heart Failure, with data for all heart-related admissions presented.

The data is shown on interactive online maps that drill down into each region looking at the number of hospital admissions as well as identify the risk factors for heart problems by high blood pressure, high cholesterol, obesity, smoking and physical inactivity.

Further Away You’re Closer to a Heart Related Hospital Visit

Living in a very remote area, you’re nearly twice as likely to need to visit a hospital for a heart event.

In figures available as part of the Heart Foundation Australian Heart Maps, the further a person lives from a major city the greater the rate of heart related hospitalisations.

Those living in major cities had an ASR of 47.1, with rates increasing for people living in regional areas (inner regional 53.1; outer regional 57.6; remote 62.2; very remote 92.5).

“If Australians in outer regional and beyond had the same hospital admissions rate as those in major cities, there would be more than 3400 avoidable hospital visits for a serious heart event each year,” Adj Prof John Kelly said.

“That would mean 1700 fewer admissions for a heart attack, which is more than four a day.

“The Heart Foundation urges regional service providers and State and local governments to use this information to ensure all Australians have access to preventative health care and facilities to reduce the risk factors.”

“Along with higher rates of smoking, obesity and physical inactivity, remote Australia experiences higher levels of disadvantage, has poorer access to health services and the conditions needed for health such as an environment that supports physical activity, access to affordable healthy food, access to education and secure employment.”

see report in full Australian Heart Maps Report 2016

About the Maps

The Heart Foundation’s Australian Heart Maps bring together for the first time a national picture of hospital admission rates for heart-related conditions at a national, state, regional and where possible, at a local government level.

The Heart Maps show how rates of heart related admissions compare across Australia. Importantly, the Heart Maps also highlight the association between socioeconomic disadvantage and remoteness with heart health outcomes.

The Heart Maps can act as a valuable tool for health professionals, health services, local governments, researchers and policy makers. The Heart Maps can be used to establish health related strategies, to plan for health services and to develop/implement targeted prevention initiatives. Specifically, the Heart Maps show:

  1. The rate of hospital admissions (per 10,000 people) for “All Heart Admissions” at a Local Government level. Local Governments can be compared against the national average and are ranked from highest to lowest admission rate across Australia.
  2. The rate of admissions (per 10,000 people) for “All Heart Admissions”, Heart Attack (both STEMI and Non-STEMI), Heart Failure, and Unstable angina for states/territories and SA4 regions.
  3. Australian Health Survey data (2011/12) for the prevalence of smoking, obesity, insufficient physical activity, hypertension and total high cholesterol for states/territories and SA4 regions.

The Heart Maps provide a national context for the more detailed state level maps available for Victoria and South Australia.

About the Data

Two years of hospital separation data (2012/13 and 2013/14) is presented in the Heart Maps. The separation (admission) data excludes admissions where a patient has been transferred from another hospital.

The admission data was accessed from State and Territory Health departments via the Australian Institute of Health and Welfare (AIHW). Suppression rules have been applied to the Heart Maps, in accordance with the State and Territory Conditions of Data Release. That is, admission rates are suppressed for any population smaller than 1,000 or where there are fewer than five admissions.

A full technical report describing the data and analysis is now available.


The Heart Foundation would like to acknowledge the following organisations:

  • The Australian Institute of Health and Welfare (AIHW): in seeking clearance from the State/Territory Data custodians and for undertaking the preliminary data analysis.
  • State/Territory Health departments: for providing initial feedback and recommendations relating to the project.
  • Statistical Consultant and Epidemiologist, Stephen Vander Hoorn: for undertaking comprehensive statistical analysis and for developing the online mapping tool.



NACCHO #PCHCH Health Care Homes News : What can #PCHCH learn from our #ACCHO model ?


“Learning from Aboriginal Community Controlled Health Organisations:

ACCHOs have very successfully looked beyond the biomedical approach to health and reduced cultural and financial barriers to primary care. We should not ignore local examples of what works but rather look to implement them more widely.

Building the take-up of evidence-based models: A commitment to the continued development and implementation of the PCHCH model beyond the three-year pilot is essential. What is needed is an embedded commitment to innovation and a culture of continuous improvement, rather than the stop-start approach of a limited pilot program.”

Lesley Russell is an Adjunct Associate Professor at the Menzies Centre for Health Policy at the University of Sydney.

Originally published INSIDE STORY


Copyright Congress

Earlier this week a diverse panel of healthcare stakeholders – including medical professionals, academics and consumer representatives – released a report spelling out how a “patient-centred health care home” model, or PCHCH, should develop in Australia.

The “home” in this case is a healthcare practice of primary care providers (usually headed by GPs), and the aim is to provide care that is patient-centred, team-based, comprehensive, and coordinated. These characteristics are what we all want; they are especially important for people with complex medical problems.

The panel was responding to sketchy details the Turnbull government has released in recent months about its Health Care Homes plan, which was originally proposed in a report by its own Primary Health Care Advisory Group in December last year. That group had been asked to examine opportunities for better management of people with complex and chronic diseases, and had put forward just one option: an Australian version of the PCHCH scheme operating in the United States. (It’s not clear whether the group was asked to focus on this option and, if so, why use wasn’t made of earlier work on such a proposal commissioned by the Department of Health when Tanya Plibersek was health minister.)

Reflecting the push for change, the April meeting of the Council of Australian Governments, or COAG, coupled an increased federal government focus on primary care services with extra funding for hospitals as a way of preventing unnecessary hospitalisations for people with complex and chronic diseases. The accompanying heads of agreement contained the first mention of Health Care Homes, providing details of a pilot program that would begin in July 2017 and run for three years. A contemporaneous media release from the prime minister and the health minister made the broad details public.

In May, the initiative was funded to the tune of $21.3 million in the 2016–17 budget, but no further details were released. Although the proposal was positively received, important questions remained about how the model (or models) would be developed, implemented, funded, evaluated, adjusted and expanded. Those questions are still unanswered. What we do know is that whatever the federal health department has in mind has been developed with minimal public consultation. The timelines for the pilot are unreasonably short, and the process of getting stakeholders involved is now urgent.

It’s this sequence of events that drove the panel to hold its roundtable in early July and produce this week’s report. Clear definitions and goals will be essential if we are to know whether this new model of care is working, and perhaps the most important thing the panel did was to define the core elements of an Australian PCHCH. This model of care is already operating elsewhere, especially in the United States, but the approach must be adapted to Australian needs.

The roundtable saw the key elements as:

  • patient-focused care with patients as informed and active partners,
  • comprehensive multi-disciplinary team-based care,
  • coordination of care across the care delivery system,
  • accessibility for patients using multiple communication modes,
  • evidence-based care and data-driven quality improvement,
  • payment models that support all of these elements.

Given that none of these elements exists comprehensively at the moment, the task of transforming general practices to PCHCHs will be significant. New infrastructure and improved e-health services are needed, as are additional staff with better training and skills in multidisciplinary care, increased patient and community involvement, and new Medicare payment mechanisms. The model/s to be tested should be sufficiently flexible to meet local needs, and increased resources will be needed in underserved areas.

The size of the task is greater than the federal government might imagine because the panel made important recommendations about the scope of the scheme. It recommended that PCHCH should be available to all Australians, not just those with chronic and complex conditions. This is sensible: it makes no sense for practices to wait until patients are really sick before offering them the best model of care.

The panel also highlighted the need to go beyond simply providing clinical services, and to ensure that patients have access to the social determinants of health: safe housing, good nutrition, home-based care as needed, transport and social interactions. And it argued that PCHCHs should be embedded in the local healthcare systems, with strong links to the Primary Health Networks and hospitals.

Delivering this new model of care will require fundamental changes. PCHCHs are not just general practices with add-ons. The two biggest barriers are likely to be finding a payment system that works and is acceptable to providers, and driving the necessary changes in culture.

The roundtable panel argued that a new payment system must reward quality, comprehensiveness and continuity of care, respond to context, and safeguard against cost-shifting and other perverse incentives such as under-treatment and “cherry picking” patients. Regrettably, it didn’t take the next step and outline the details of such a scheme. While there is a willingness on the part of medical professionals to look beyond fee-for-service, in reality there will be many challenges and barriers – and there are no great success stories to draw on from earlier Australian trials or from overseas.

All of which highlights how important cultural change will be. Partly, it will be a matter of developing a common language that is relevant to patients. Innovative leaders in the clinical world and the community must be used to be exemplars and advocates, and the government will need to invest additional resources to assist those areas where there are low levels of change readiness.

The panel’s report did not address a number of areas where more work will be needed. These include:

Encouraging enrolment: The government’s original proposal was to allow voluntary enrolment in a Health Care Home. To achieve the goals of coordinated and continuous care, though, there needs to be a formal doctor–patient relationship. This could be achieved by giving patients incentives to enrol rather than making it compulsory.

Outlining the full range of services to be provided, and dealing with out-of-pocket costs: If the focus of the PCHCH is to be on the whole patient, then integrating mental health and substance-abuse services is essential. Other needed services include pharmacy, dental, eye and hearing and a range of allied health care. These need not be co-located, but must be readily accessible and affordable. The roundtable report doesn’t mention the need to link in community-based specialist services, and it fails to address the consequences for the effective implementation of the PCHCH model if patients’ out-of-pocket costs for primary and specialist care continue to grow at the current rate.

Working with the wider health and social welfare system: The panel recognises the need to provide these services but doesn’t detail how this could be facilitated. One approach is to use Community Health Workers: these frontline public health workers have a close understanding of the communities in which they work and generally share the language and culture. Because they have trust and relationships, they can act as advocates and intermediaries between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.

Learning from Aboriginal Community Controlled Health Organisations:

ACCHOs have very successfully looked beyond the biomedical approach to health and reduced cultural and financial barriers to primary care. We should not ignore local examples of what works but rather look to implement them more widely.

Building the take-up of evidence-based models: A commitment to the continued development and implementation of the PCHCH model beyond the three-year pilot is essential. What is needed is an embedded commitment to innovation and a culture of continuous improvement, rather than the stop-start approach of a limited pilot program.

Using data effectively and measuring success: The Australian healthcare system is notorious for collecting data and failing to use it to maximum effect. In designing the PCHCH model/s it will be imperative to have agreement on the most appropriate performance indicators. The data can then measure improved patient outcomes, indicate where efforts should be targeted, and benchmark quality and safety. This information can be fed back into the system at all levels.

Meeting reasonable expectations about funding and the time needed to deliver results: The roundtable didn’t comment on the government’s unrealistic funding and timing expectations. Even given the limited scope of the proposed trial (65,000 patients in 200 practices), $21 million over four years is minimal. A draft version of the COAG agreement, which doesn’t appear to be publicly available, stated that the Commonwealth would keep back $70 million annually for efforts to reduce avoidable hospitalisations and improve quality and safety, and intimated that the states and territories and private health insurers would also make contributions. This has not been further discussed, however.

The federal government expects to have an evaluation of the PCHCH pilot available to inform the next agreement on public hospital funding in 2018. That’s far too soon for any meaningful results. Done well, this is a more expensive model of primary care and the investment will be returned through reductions in costs in other sectors, especially in acute care. Moreover, the American experience shows that changes in outcomes and savings in costs will take time.

While it is essential that this initiative has a solid and evidential foundation, there is no need to start this work anew – and clearly no time to waste. The foundations have been laid by the roundtable report, by the work of the Primary Health Care Advisory Group, by the Royal Australian College of General Practitioners and other groups, and, as far back as 2009, by the National Health and Hospital Reform Commission. The health department’s archives contain other relevant papers, some of them specifically commissioned on this topic.

It’s time for engaged leadership at the top and enthusiastic healthcare workers at the coalface to get started on this much-needed project to transform Australian healthcare. •

NACCHO #Dondalekids : Refugees in their own land: how Indigenous people are still homeless


” Ultimately, health outcomes – including frequent presentation to hospital – are reflective of social conditions, especially homelessness.

Health, as we are witnessing in remote Indigenous Australia, is a reflection of individual, community and life circumstances.

By taking a socially-focused and compassionate approach to medicine, Katherine Hospital staff hope to alleviate unnecessary presentations to an already overburdened “

Geordan Shannon PhD Candidate, Institute of Global Health, UCL

Without anywhere that is home, Indigenous people have been without a physical space to reinvent themselves and their culture in modern Australia.

Since colonisation, Aboriginal people have been internally displaced from their country. The doctrine of terra nullius – a land without people – was established under British colonial government and persisted in Australian law until 1992). It served to reinforce the concept that Indigenous land was “empty”; it belonged to no one and so could rightly be claimed for Western exploitation or settlement. This doctrine arguably still persists in the collective Australian psyche, evidenced by social policies and government interventions which impact harmfully on Indigenous people and their connection to their land.

The Stolen Generation, in which Aboriginal children were forcibly removed from their families between the 1900s and the 1960s, is one government policy that led to Indigenous dispossession in the broadest sense of the word. Important Indigenous constructs around family, culture, community and the physical land were affected, and the impact was inter-generational . The Northern Territory Emergency Response Act (NTER) 2007 – often referred to as “The Intervention” – represented a suit of legislation that was enacted to address child abuse in remote communities through mandatory changes to welfare provision, land tenure, child health checks and law enforcement. It has been criticised nationally and internationally for ineffectual, non-consensual and mandatory measures, impacting on the autonomy of Indigenous people and causing humiliation, fear, and confusion among Indigenous communities. Evidence suggests that the intervention has also “increased levels of itinerancy and homelessness among Aboriginal people who have left their home communities in order to avoid the punitive and paternalistic aspects of the NTER”.

Town Camps

Warlpiri Transient Camp, established near the town of Katherine in the Northern Territory, has an interesting history that reflects Indigenous dispossession. In 1949, Lajamanu was forcibly established as an Aboriginal settlement on land that traditionally belonged to the Gurindji. Several hundred Warlpiri people – Australia’s largest tribal group – were trucked there against their will due to government concerns about overcrowding in Yuendemu, 600km to the south. Many simply walked back, with multiple walk-backs happening until 1968. Amid this, a large number of transient Warlpiri “mob” began coming to Katherine to camp, disconnected from their land.

A large number of homeless and itinerant Indigenous people now live in Katherine in town camps such as Warlpiri Transient Camp. These camps serve as a halfway house in towns, away from dilapidated and overcrowded housing and social decline in remote communities.

Conditions are unhealthy, overcrowded, and, at times, dangerous. Violence is common: cases such as the murder of a mother of five occurred in 2014 in Warlpiri Camp. Infrastructure is severely limited and neglected. This led to legal action by residents of Santa Teresa earlier this year.

Lack of a future

Imagine being a young person in Ngukurr, on the Roper River in Arnhem Land. There are very few employment opportunities and limited community infrastructure and housing. If you want a way out, Katherine is your next stop. However, there is a prolonged waiting time for public housing. According to the Northern Territory Department of Housing, the wait is now at least five years – that is to say, if you know how to apply. In reality, if you are a young person wanting to move to Katherine, then you are likely to end up homeless.

The situation has become so normalised that this is exactly what young people do on a regular basis. And while such issues are widely known, they are rarely spoken about.

Between neglected housing in remote communities and dangerous town camps, Aboriginal people live displaced from their land and culture. As Simon Quilty, head physician at Katherine Hospital, put it: “Indigenous people are like long-term refugees displaced on their own land. Nothing has changed and nothing has been done about it.” The staff also found that Indigenous people were attending the hospital with worrying regularity.

Katherine Hospital

Under the leadership of Quilty, Katherine Hospital is addressing homelessness as a health issue using a socially oriented approach. A team of doctors, nurses, social workers and Aboriginal liaison officers are looking at the factors behind why people are driven to attend the hospital so frequently. Using retrospective emergency department admission data, a recent paper published by the team found that some people attended the emergency department for non-medical conditions as frequently as every two weeks.

Such people were driven by issues such as homelessness, alcohol use, weather (including rainfall) and Indigenous identity. The study showed that people who frequently presented to the emergency department were more than 16 times more likely to live in temporary accommodation or be homeless. They were 2.2 times more likely to identify as Aboriginal, and 2.7 times more likely to have alcohol linked to their admission.

Although alcohol is commonly labelled as responsible for “the problems” in the town of Katherine, the study clearly showed that the fundamental issue was homelessness. Other recent research demonstrated that homelessness was a profound problem across the Northern Territory. Homelessness rates in the territory are 15 times the national average: 12% of all people in the Katherine region are homeless; six of the ten regions with the highest homeless rates in Australia are in the Northern Territory, regions that cover almost the entire state. An astonishing 28% of the population of East Arnhem are considered homeless.

Following these findings, the Katherine team is now implementing a social care pathway that provides a culturally appropriate intervention that addresses the whole range of problems experienced by those who present to the emergency department. The programme builds on existing evidence that social interventions for frequent presenters and homeless people, including housing provision and case management, reduces the number of people who attend emergency departments.

Patients who present themselves at the emergency department on more than five occasions within a year will trigger a “frequent presenter pathway”, where social, medical, drug and alcohol problems will be identified and addressed by trained professionals prior to discharge. This model of care has been investigated in urban, predominantly non-Indigenous settings only and this will be the first time such an investigation takes place in a rural Indigenous setting, with a large randomised trial planned for later in 2016.

Ultimately, health outcomes – including frequent presentation to hospital – are reflective of social conditions, especially homelessness. Health, as we are witnessing in remote Indigenous Australia, is a reflection of individual, community and life circumstances. By taking a socially-focused and compassionate approach to medicine, Katherine Hospital staff hope to alleviate unnecessary presentations to an already overburdened system, and focus on the drivers of overall health and community well-being.

NACCHO Opinion The Australian : Aboriginal self-determination key to life-saving health efforts


” Malcolm Turnbull’s decisive response, in the form of a royal commission into the unforgivable treatment of young Aboriginal detainees, shows that action can be taken quickly where needed.

Let’s hope this speed is the starting point for a wider inquiry — one that looks not just at what’s happening in Northern Territory detention centres, but why young Aboriginal people are 25 times more likely to end up in detention centres than non-Aboriginal youth, and what is going so wrong in regions such as the Kimberley that Aboriginal children left behind are up to six times more likely to commit suicide than non-Aboriginal children.

The fact that our children are living in a world where suicide and incarceration are so familiar is a national disgrace that should break the heart of every parent, politician and decent human being.”

Matthew Cooke is chairman of the National Aboriginal Community Controlled Health Organisation.

The Australian 1 August 2016


With the swift leadership shown by the Prime Minister, echoed by strong bipartisan support, this year must be the year that Australian government works with Aboriginal people to make a strong commitment to reverse policies that until now have hindered efforts to meet Close the Gap targets.

A new cabinet is a new beginning and the onus is on Health Minister Sussan Ley, Indigenous Affairs Minister Nigel Scullion and others to follow up on Turnbull’s response with a commitment to empowering and resourcing Aboriginal organisations in our own communities.

Now more than ever, self-determination must feature front and centre. It is imperative that Aboriginal communities and indigenous-controlled medical services are empowered to develop and run programs for Aboriginal people that are culturally appropriate and reach those who desperately need support. We know it’s the only model that works.

The Productivity Commission’s progress report from last November on the implementation of the National Indigenous Reform Agreement illustrates this in two statements: first, that inadequate progress is being made in Closing the Gap; second, more than 80 per cent of investments under the NIRA implementation have gone to non-indigenous organisations.

Unless investments under the NIRA — and in all indigenous-­focused programs — support self-determination and are channelled through reputable Aboriginal organisations, we will not make any gains. Aboriginal people need to be central to decision-making — their leadership as well as participation must be welcomed.

Better progress is being made in the area of Aboriginal health than in the other five NIRA target areas because successive Australian governments have channelled some of their Aboriginal grant funds through National Aboriginal Community Controlled Health Organisations — often referred to as Aboriginal Medical Services.

NACCHOs are Australia’s largest single national and preferred primary healthcare system for Aboriginal people. The importance of the sector is widely and formally acknowledged across the Australian health and social sectors — from GPs to hospital emergency facilities.

Importantly, the NACCHO sector is held accountable to national key performance indicators — which means it can demonstrate that it is a model that is showing the most health gains. NACCHOs increased the proportion of clients who received care in 10 out of 16 indicators. The sector also made the biggest contribution to achieving a 66 per cent reduction in child mortality rates and a 33 per cent reduction in overall mortality rates. NACCHOs are tangible evidence of the benefits of Aboriginal self-determination.

Crucially, the NACCHO sector is also the only nationwide network of service providers accountable to Aboriginal communities. NACCHO directors are elected by Aboriginal people from communities in urban, rural and remote locations all across Australia.

Last year all major political parties supported the 10-year implementation plan for the National Aboriginal and Torres Strait Islander Health Plan.

The plan communicates the ­integral role of the NACCHO ­sector, and the role it will play in more than 30 areas to improve the health and wellbeing of Aboriginal people. We are still to see any outline of how it will be fully funded.

During this new term of government, the complex set of policy and funding relationships that underpin the NACCHO sector must be acknowledged in a permanent and secure partnership, to reflect the glowing statements from current and former government ministers about the performance and value of the sector.

The royal commission needs to look at what’s happening in detention centres.

It also needs to look at why so many of our Aboriginal young people are ending up there in the first place and what’s broken in a system that is causing so many of our young people to despair.

Investing in non-indigenous services and organisations to deliver indigenous health and social services is widely acknowledged as failed policy — the solution must come from the indigenous community itself.

Matthew Cooke is chairman of the National Aboriginal Community Controlled Health Organisation.

NACCHO Aboriginal Health News : Roadmap for Regional and Remote Aboriginal Communities launched


 “The roadmap outlined new approaches to support families to succeed, including working collaboratively with Aboriginal communities and focusing resources on prevention, earlier intervention, capacity building and family empowerment.

“The Government will also engage with Aboriginal communities that want to reduce alcohol-related harm by introducing or strengthening restrictions on alcohol supply and consumption,”

Regional Development Minister Terry Redman and Child Protection Minister Andrea Mitchell released the ‘Resilient Families: Strong Communities’ roadmap, which sets out 10 actions the State Government will undertake in partnership with Aboriginal people to strengthen families, improve living conditions, increase job prospects and accelerate education outcomes.

The ministers launched the roadmap in Kununurra after more than 12 months of discussions with Aboriginal leaders and communities about their aspirations for the future.

The WA Government has laid out its plan to overhaul the servicing of Aboriginal communities, with Indigenous leaders involved in the process describing it as a “once-in-a-lifetime” opportunity for change.

The future of WA’s 274 Aboriginal communities has been under the microscope following Premier Colin Barnett’s comments that the State Government could no longer afford to keep funding all communities, and some would have to close.


The unit formed eight months ago to review the future of Aboriginal communities will today release details of the changes planned.

The report — described as a “roadmap for Regional and Remote Aboriginal Communities” — outlines a focusing of funding and support on larger communities, and a withdrawal of the minor services currently delivered to more than 1

Mr Redman said the roadmap was a milestone in the Government’s regional services reform and was a long-term commitment to change, supported by immediate actions and engagement with Aboriginal people on specific focus areas.

“The poor living conditions and general lack of opportunities for Aboriginal people in regional WA are not acceptable and must change,” he said.

“The status quo is unacceptable.  This roadmap marks the beginning of a transition to a new way of working – one which builds opportunities and strengthens outcomes, while maintaining access to country, culture and kin.”

Ms Mitchell said the roadmap outlined new approaches to support families to succeed, including working collaboratively with Aboriginal communities and focusing resources on prevention, earlier intervention, capacity building and family empowerment.

“The Government will also engage with Aboriginal communities that want to reduce alcohol-related harm by introducing or strengthening restrictions on alcohol supply and consumption,” she said.

The 10 priority actions are:

  • creation of a $175 million fund for extra housing for Aboriginal families in the Kimberley and Pilbara over four years, tied to greater participation in school and work
  • a three-year $25 million Kimberley Schools Project targeting improved attendance, engagement and learning in Kimberley schools and communities
  • ensuring residents of Aboriginal town-based reserves receive the same services and have the same responsibilities as other residents of nearby towns, starting with a $20 million project in the Pilbara
  • creating work opportunities for Aboriginal people by changing how the Western Australian public sector recruits staff, lets contracts and buys goods and services in the regions
  • identifying up to 10 communities by the end of 2016 with which to work to upgrade essential and municipal infrastructure, and introduce commensurate charges
  • working with community leaders and organisations in Roebourne in 2016–17 to co-design a reorientation of Government-funded services to respond better to local needs and achieve better local outcomes
  • publishing mapping of Government-funded services in the Kimberley and Pilbara during 2016–17 to support work between government agencies, other organisations and communities on developing place-based service systems
  • commencing an initiative in Kununurra in 2016–17 with community leaders and organisations to co-design a family-centred, earlier intervention service delivery model to support and enable better outcomes for local families
  • continuing to support the trial and evaluation of the Australian Government’s cashless debit card in the East Kimberley
  • working with the Australian Government to implement the Compulsory Rent Deduction Scheme in WA.

Mr Redman said the State Government would invest over time to upgrade essential and municipal infrastructure such as power, water and roads, starting in larger remote communities that had the most potential to grow and be sustainable.

Fact File

  • About 12,000 Aboriginal people live in remote communities in WA
  • Regional services reform is focused initially on the Kimberley and Pilbara and will expand to other regions over time
  • The $175 million housing program, $25 million Kimberley Schools Project and $20 million town-based reserves project are supported by the Royalties for Regions program
  • ‘Resilient Families: Strong Communities: A roadmap for regional and remote Aboriginal communities’ is available at

However Regional Development Minister Terry Redman has emphasised no-one will be forced to leave the smaller bush out-stations, even though small government contributions, such as fuel subsidies, will be withdrawn. 

“One of the not-negotiables in the work we did, was that we’re not going to remove, or force Aboriginal people to be removed from land, and access to their culture and heritage, access to their kin,” he said.

“So what’s imperative in this, is if someone wants to stay living on the land, living where they’ve always lived, they can do so.”

The 120 communities that have less than 10 residents, or which are only occupied occasionally, will therefore be required to be self-sufficient, while resources are focused on larger centres.

“By the end of the year, we’ll identify 10 of the larger communities and sequentially start coordinating investment into key municipal infrastructure, to give them much better service delivery around water, power, sewerage and the like going forward,” Mr Redman said.

“It may even be some of the bigger centres, where there is access to employment and good quality education, that they could get transitioned into a town.”

Tough decisions needed to ensure future success

The Premier’s comments in December 2012 prompted a widespread backlash, with protests held in capital cities across the country to emphasise the rights of Aboriginal people to remain living on their traditional country.

But Aboriginal leaders who helped develop the remote reform roadmap being released today have urged communities to come on board with the process.

Putijurra woman Kate George, who has been providing feedback from communities in the Pilbara, said the proposed changes are a once-in-a-lifetime opportunity for Aboriginal people.

“I’m optimistic, because the principles in the roadmap document are the things we’ve been advocating for a long time,” she told the ABC.

“So here is an opportunity, but we’ve actually got to go for it. And for me as an Aboriginal woman, I’m saying to the Aboriginal leadership we actually have to grab this, because I don’t think the sushi train’s going to come along too often.

“When you look at our culture and our communities, and the way we’ve lived in the past, there have always been rules. We’ve just been caught up in chaos for the last 55-plus years, and I think everyone wants some order.

“There will have to be some tough decisions made, but ultimately we need to get back to a situation of peace and prosperity.”

Reform process still a mystery to many

But those sitting outside the process appear far more ambivalent about the reform process that will change their lives over the next few years.

The ABC this week visited the community of Pandanus Park, 60 kilometres south of Derby and home to about 100 people.

Local woman Patricia Riley, who runs the community office, said neither she nor the other local families knew anything about the remote reform process.

“I don’t know if it will benefit our community, not just our community but the remote communities,” she said.

“We’d love to have more funding allocated back to our remote communities, and have employment for a proper CEO.

“I’m doing my best trying to get childcare funding up and running, a telecentre to have literacy and numeracy programs, and have the internet services running properly.

“Because now, the majority of people are on Centrelink, and we’d like to get them off Centrelink and get proper employment for them.”

Patricia Riley

Pandanus Park’s size and location means it will continue to receive funding, as it sits just off the region’s main highway and is only half an hour’s drive from the town of Derby.

But Ms Riley said many people had already started leaving small bush communities in the area as Government funding dried up.

“It makes me feel sad, heartbroken,” she said.

“The majority of people have moved out through lack of funding and communication, no support, so they’ve moved because they have to look for a job, so they move into towns or a bigger community that’s got jobs and they leave the little places which is their home.

“We are all struggling, especially the smaller ones. All the service providers that are supposed to be out here helping us, I don’t know what they’re there for, probably just window-dressers.

“The bigger communities, they’ve got the majority of people who got educated and got all these skills, but some of us are still left in the Stone Age.

“We’re still trying to pick things up and trying to keep the community going with whatever knowledge or education we got.”

Opportunity to support a special edition #HealthElection16 NACCHO Aboriginal Health Newspaper PUBLISH DATE June 29



    Opportunity to send your Aboriginal Health issue message to Canberra for



Advertising and editorial is invited from

  • All political parties
  • NACCHO 150 Members and Affiliates
  • Stakeholders/ Aboriginal organisations
  • Peak Health bodies

Closing 17 June for publishing election week 29 June



Response to our NACCHO Aboriginal Health Newspaper from our members, community, stakeholders and Government  has been nothing short of sensational over the past 3 years , with feedback from around the country suggesting we really kicked a few positive goals for Aboriginal health.

NACCHO is the national peak body for Aboriginal health. It is entrusted to represent the needs and interests of Aboriginal health on behalf of its members in the national arena.

NACCHO has and continues to be a living embodiment of the aspirations of Aboriginal people

10 good reasons to advertise in the NACCHO Aboriginal Health Newspaper :

  1. Highly targeted health sector from CEO’s to all staff audience
  2. Quality production and guaranteed national distribution in partnership with the award-winning Koori Mail 14,000 printed copies
  3. Spend any surplus dollars before the end of the financial year
  4. Article space offered with ad bookings
  5. Newspaper also distributed at NACCHO events and workshops
  6. 1500 copies posted to the CEO’s of Australia’s top Aboriginal health organisations and NGO’s and Government departments
  7. Thank you ‘burst’ through NACCHO’s social media network naming all advertisers
  8. Over 100,000 audited readers
  9. Targeted at Aboriginal consumer / clients
  10. Support NACCHO vision to Close the Gap

Our media partner Koori Mail Turns 25 this week

The Koori Mail is an Australian media institution, 100% owned and controlled by Aboriginal people. The fortnightly newspaper circulates all states and covers the issues that matter the most to black Australians. 25 years since its first print, the Indigenous paper is still breaking ground for Indigenous journalism.




Editorial Proposals  10 June 2016
Final Ads artwork 17 June 2016
Publication date 29 June 2016

Editorial Opportunities

New Microsoft Word Document (2)

We are now looking to all our members, programs and sector stakeholders for advertising, compelling articles, eye-catching images and commentary for inclusion in our next edition.

Maximum 600 words (word file only) with image

Please Note: All submitted advertising and editorial content is subject to space availability and review by the NACCHO Newspaper editorial committee

Advertising opportunities

NEW VERSION A3poster_Aboriginal_2_nocropsExample full Page Ad April and June edition

This 24-page newspaper is produced and distributed as an insert in the Koori Mail, circulating 14,000 full-colour print copies nationally via newsagents and subscriptions.

Our audited readership (Audit Bureau of Circulations) is 100,000 readers!

Our target audience also includes over 1,500 NACCHO member and affiliate health organisations, relevant government departments, subsidiary indigenous health services and suppliers, as well as the end-users of Australian Indigenous health services nationally.

Your advertising support means we can build this newspaper to a cost-neutral endeavour, thereby guaranteeing its future.

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Note: the earlier you book your ad or submit an article for consideration, the better placement we can offer in the printed newspaper. All prices are GST inclusive. Discounts are available to not-for-profits, NACCHO member organisations and industry stakeholders. All prices include artwork if required.

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Download the April 6th Edition of the NACCHO Aboriginal Health Newspaper – click here!

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NACCHO #HealthElection16 : AMA launches Key Health Issues / Aboriginal Health policy for 2016 Federal Elections


” The gap in health and life expectancy between Aboriginal and Torres Strait Islander people and other Australians is still considerable, despite the commitment to closing the gap.

The AMA sees progress being made, particularly in reducing early childhood mortality rates, and in addressing major risk factors for chronic disease, such as smoking. However, to close the gap in Indigenous health, Government must commit to improving resourcing for culturally appropriate primary health care for Aboriginal and Torres Strait Islander people, and the health workforce.

Including increased investment in Aboriginal and Torres Strait Islander community controlled health organisations. Such investment must support services to build their capacity and be sustainable over the long term;

Brian Owler AMA President pictured above Matthew Cooke Chair of NACCHO at recent NACCHO Event Parliament House Canberra : The Aboriginal Policy is part of a 16 Page AMA Health Issues Document  

“The Medicare freeze is not just a co-payment by stealth – it is a sneaky new tax that punishes every Australian family,”

Professor Owler said, with the elderly and chronically ill among those most affected see press release here AMA LAUNCHES NATIONAL CAMPAIGN AGAINST THE MEDICARE REBATE FREEZE (FED)

Putting Health First

Download the 16 Pages here AMA Key Health Issues Federal Election 2016

Health policy will be at the core of the 2016 Federal Election.

The AMA is non-partisan. It is our role during election campaigns, as it is throughout the terms of governments, to highlight the issues we think will be of greatest benefit to the health system, the medical profession, the community, and patients.

As is customary, the AMA will focus on the respective health policy platforms presented by the major parties in the coming weeks.

The next Government must invest significantly in the health of the Australian people.

Investment in health is the best investment that governments can make.

We must protect and support the fundamentals of the health system.

The two major pillars of the system that mean most to the Australian people are quality primary health care services, led by general practice, and well-resourced public hospitals.

The AMA has advocated strongly and tirelessly on these issues for the term of the current Government.

General practice and public hospitals are the priority health issues for this election.

The AMA is calling on the major parties to lift the freeze on the Medicare Benefits Schedule (MBS) patient rebate. The freeze was extended until 2020 in the recent Budget. The freeze means that patients will pay more for their health care. It also affects the viability of medical practices.

We also need substantial new funding for public hospitals. The Government provided $2.9 billion in new funding in the Budget, but this is well short of what is needed for the long term.

We must build capacity in our public hospitals. Funding must be better targeted, patient-focused, and clinician led.

The AMA is also calling for leadership and effective policy from the major parties on Indigenous health, medical workforce and training, chronic disease management, and a range of important public health measures.

The AMA will release a separate Rural Health Plan, responding to the unique health needs of people in rural and regional Australia, later in the election campaign.

Elections are about choices. The type of health system we want is one of those crucial decisions.

In this document, Key Health Issues for the 2016 Federal Election, the AMA offers wide-ranging policies that build on what works. We offer policies that come from the experience of doctors who are at the coalface of the system – the doctors who know how to make the system work best for patients.

The AMA urges all political parties to engage in a competitive and constructive health policy debate ahead of the election on 2 July.

Indigenous Health Policy Continued

Despite the recent health gains, progress remains frustratingly slow and much more needs to be done. A life expectancy gap of around 10 years remains between Aboriginal and Torres Strait Islander people and other Australians, with recent data suggesting that Indigenous people experience stubbornly high levels of treatable and preventable conditions, high levels of chronic conditions at comparatively young ages, high levels of undetected and untreated chronic conditions, and higher rates of co-morbidity in chronic disease. This is completely unacceptable.

It is not credible that Australia, one of the world’s wealthiest nations, cannot address health and social justice issues affecting just three per cent of its citizens. The Government must deliver effective, high quality, appropriate and affordable health care for Aboriginal and Torres Strait Islander people, and develop and implement tangible strategies to address social inequalities and determinants of health.

Without this, the health gap between Indigenous and non-Indigenous Australians will remain wide and intractable.

The AMA calls on the major parties to commit to:

  • correct the under-funding of Aboriginal and Torres Strait Islander health services;
  • establish new and strengthen existing programs to address preventable health conditions that are known to have a significant impact on the health of Aboriginal and Torres Strait Islander people such as cardiovascular diseases (including rheumatic fever and rheumatic heart disease), diabetes, kidney disease, and blindness;
  • increase investment in Aboriginal and Torres Strait Islander community controlled health organisations. Such investment must support services to build their capacity and be sustainable over the long term;
  • develop systemic linkages between Aboriginal and Torres Strait Islander community controlled health organisations and mainstream health services to ensure high quality and culturally safe continuity of care;
  • identify areas of poor health and inadequate services for Aboriginal and Torres Strait Islander people and direct funding according to need;
  • institute funded national training programs to support more Aboriginal and Torres Strait Islander people to become health professionals to address the shortfall of Indigenous people in the health workforce;
  • implement measures to increase Aboriginal and Torres Strait Islander people’s access to primary health care and medical specialist services;
  • adopt a justice reinvestment approach to health by funding services to divert Aboriginal and Torres Strait Islander people from prison, given the strong link between health and incarceration;
  • appropriately resource the National Aboriginal and Torres Strait Islander Health Plan to ensure that actions are met within specified timeframes; and
  • support for a Central Australia Academic Health Science Centre. Central Australia faces many unique and complex health issues that require specific research, training and clinical practice to properly manage and treat, and this type of collaborative medical and academic research, along with project delivery and working in remote communities, is desperately needed.

Australian Medical Association joins campaign against Medicare rebate freeze


Download the AMA Press Release


Article below originally published here

Tens of thousands of specialist doctors are joining GPs’ war against the Turnbull government’s extended freeze on Medicare rebates, increasing pressure on the Coalition’s health record ahead of the federal election.

The Australian Medical Association has distributed posters to its members, warning patients that they will be out of pocket because the cost of running the medical practice will continue to rise as Medicare rebates stay frozen until 2020.

“You will pay a new or higher co-payment every time you visit your GP, every time you visit other medical specialists, every time you need a blood test, and every time you need an X-ray or other imaging,” it says, alongside a photo of a woman comforting a crying child.

It comes a week after the Royal Australian College of General Practitioners announced its 32,000 members would urge their patients to lobby local MPs against the move. The groups share about 8000 members, adding about 22,000 more specialist doctors to the campaign.

The AMA’s campaign similarly encourages patients to contact their local MPs and election candidates, but goes further to directly blame the Turnbull government for the extra cost: “The government has cut Medicare and wants you to pay for it.”

While pathologists on Friday agreed to retain bulk-billing rates in exchange for reduced regulatory pressure on rents under a deal with Health Minister Sussan Ley, the AMA maintains that they and diagnostic imaging services will remain under pressure to charge patients, with the government’s cuts to bulk-billing incentive payments deferred till later in the year.

The AMA’s president, Professor Brian Owler, said many doctors had absorbed costs but the extension “has pushed them over the edge”. They may charge patients a $30 co-payment to cover costs associated with moving to a private billing system, more than triple the Abbott government’s failed and deeply unpopular $7 GP co-payment, he said.

“The Medicare freeze is not just a co-payment by stealth – it is a sneaky new tax that punishes every Australian family,” Professor Owler said, with the elderly and chronically ill among those most affected.

While most specialists (about 70 per cent) already charged patients a co-payment, having had their rebates frozen for decades, the extended freeze could reduce the bulk-billing rate further, an AMA spokesman said.

Labor froze indexation for eight months in 2013, lifting it briefly for GPs in 2014-15. The Coalition extended it for four years in 2014, and this year extended it a further two years to 2020, to save $925.3 million.

Opposition Leader Bill Shorten said Labor opposed the extended freeze at the leaders’ debate on Friday, but would not say whether it would commit to lifting it if elected.

Thirty per cent of 400 GPs surveyed by the College said they would stop all bulk-billing, including for concession card holders, due to the extended freeze. Another 18 per cent said the practice would start charging a co-payment, but cap annual out-of-pocket fees for concession card holders.

Thirty per cent said they would maintain a mixed billing policy, and 10 per cent would continue to bulk bill all patients. Twelve per cent said they were already privately billing all their patients.

The Turnbull government plans to cut bulk-billing incentives for pathology and diagnostic imaging services to save $650 million over four years. Pathology Australia, which had warned this would lead more doctors to charge patients for pap smears, blood and urine tests, has agreed to drop its public campaign against the cuts.

Ms Ley said: “The Coalition will increase Medicare investment to $26 billion per year by 2020-21, while introducing revolutionary reforms such as Health Care Homes that cement a GP’s role at the centre of patient care.”

While she appreciated many GPs’ efforts to keep costs down during the indexation freeze, she was disappointed that “there’s no reciprocal offer to assist taxpayers with the immediate financial challenges our budget faces while [Health Care Homes are] implemented”.


            Send your Aboriginal Health issue message to Canberra for


Advertising and editorial is invited from

All political parties

NACCHO 150 Members and Affiliates

Stakeholders/ Aboriginal organisations

Peak Health bodies

Closing 17 June for publishing election week 29 June

Contact for Advertising rate cards/bookings/editorial

NACCHO Aboriginal Male Health News : Shame’ deters males from sexual health help

Ingkintja Male Health Congress Alice Springs

“The sexual health of men in remote Indigenous communities would likely improve if they had access to “male safe areas” in health clinics .If Indigenous men are reluctant to present to clinics because the service does not feel appropriate to them, we would argue that the health service is inequitable.

Our findings may also have implications for other important areas of men’s health, such as chronic disease of mental health management if a sex disparity in screening, testing and treatments is found in these areas

School of Health Associate Professor Suzanne Belton Charles Darwin University ” Gendered sexual health services are needed in remote communities “

“Sexual health programs need to be conducted in appropriate settings for males, and it is notable that while women may be screened opportunistically at several convenient events (Ante natal Clinic, Pap smear and breast check, while bringing kids in to the Primary Health Care Centre) there are fewer opportunities for adult males.
For adolescent males there are even less opportunities, so targeted interventions will be necessary at times. Aboriginal men occupy a range of sexualities and all should have appropriate unbiased access to primary health care including, gay males, men who have sex with men (MSM) and sister-girls (transgender)

NACCHO Blueprint for Aboriginal Male Health: Sexual and Reproductive Health (see full Blueprint below )

Photo Above : Ingkintja Male Health Congress Alice Springs

The sexual health of men in remote Indigenous communities would likely improve if they had access to “male safe areas” in health clinics or male-specific outreach services, a Charles Darwin University academic says in the May edition of an international health journal.

School of Health Associate Professor Suzanne Belton said men’s sense of shame from being seen by women while visiting a clinic was one of several factors that contributed to high rates of sexually transmitted infections in remote communities.

“Some men do not seek testing for sexually transmitted infections because they cannot see a male clinician, which is particularly important in this type of clinical encounter,” Dr Belton said.

“If Indigenous men are reluctant to present to clinics because the service does not feel appropriate to them, we would argue that the health service is inequitable.

“Until culturally and gender appropriate approaches to sexual health services are implemented, sexually transmitted infection (STI) rates in Indigenous Australians are likely to remain high.”

Dr Belton and co-authors Dr Jiunn-Yih Su and Dr Nathan Ryder posed the question “Why are men less tested for sexually transmitted infections in remote Australian Indigenous communities” in an article published this month in Culture, Health and Sexuality.

“To our knowledge, this is the first study in Australia to investigate the reasons for disparity in STI testing rates between men and women in remote Indigenous communities,” Dr Belton said.

The study in a remote Northern Territory community confirmed a low level of health literacy among some Indigenous men.

“Culturally appropriate sexuality education and health promotion to men and boys would improve understanding of their own sexual health needs. “Men and boys require sexuality knowledge to be able to look after themselves and their sexual partners.”

Dr Belton said Indigenous men and women deserved the highest standard of health care that a country was able to provide and if men’s sexual and reproductive health remained poor this impacted on women’s and infants’ health.

NACCHO Blueprint for Aboriginal Male Health:

(this document contains an area that deals with Sexual, Reproductive Health)

NACCHO’s position paper on Aboriginal male health (2010) describes the key policy areas and programs NACCHO has documented should be developed in male health.

These include physical health, strong minds, brother care, healing and men’s business, as well as Aboriginal male health workforce development. It summarises that Aboriginal male health should be a core primary health care service provided by Aboriginal Community Controlled Health Organisations (ACCHOs). NACCHO as a cultural organisation has always supported the proper gender based approaches to health service provision, which fits within the current approaches of primary health care service quality and research and evaluation.

Aboriginal Males have a unique and important role in their communities.

All too often Aboriginal male health is approached negatively, with programs only aimed at males as perpetrators. Examples include alcohol, tobacco and other drug Services, domestic violence, prison release, and child sexual abuse programs. These programs are vital, but are essentially aimed at the effects of males behaving badly to others, not for promoting the value of males themselves as an essential and positive part of family and community life.
To address the real social and emotional needs of males in our communities, NACCHO proposes a positive approach to male health and wellbeing. We need to celebrate Aboriginal masculinities, and uphold our traditional values of respect for our laws, respect for elders, culture and traditions, responsibility as leaders and men, teachers of young males, holders of lore, providers, warriors and protectors of our families, women, old people, and children.

The NACCHO approach is to support Aboriginal males to live longer healthier lives as males for themselves. The flow-on effects will hopefully address the key effects of poor male behaviour by expecting and encouraging Aboriginal males to be what they are meant to be.
In many communities, males have established and are maintaining men’s groups, and attempting to be actively involved in developing their own solutions, to the well documented men’s health and wellbeing problems, though almost all are unfunded and lack administrative and financial support.

Health and Wellbeing
Aboriginal males have arguably the worst health outcomes of any population group in Australia.
Key health issues continue to be
•       Injury and suicide
•       Cardiovascular disease
•       Respiratory disease
•       Diabetes.
There are however, a number of male specific health issues not identified here which are poorly documented, this includes mental health and wellbeing issues.

Social determinants relating to identity culture, language and land, as well as violence, alcohol, employment and education remain significant issues.
In considering the health and wellbeing of Aboriginal males, it is important also to take into account the construction of ‘masculinity’, the relationships between Aboriginal males and females, and concepts of health which may differ from Anglo-European ways of thinking.

Integration of Aboriginal male health in targeted strategies
Male health should be identified and prioritised (as appropriate) in all health strategies developed for Aboriginal Community Controlled Health Organisations (ACCHOs) including that all relevant programs being progressed in these services will be expected to ensure Aboriginal male health is considered in the planning phase or as the program progresses.
Specialised Aboriginal male health programs and targeted interventions should be developed to address male health intervention points across the life cycle continuum.

This may include
•       Community specific adolescent programs
•       Adult male health and include men as boyfriends, schoolchildren, partners, fathers, grandfathers, and children
•       Men’s business programs should be developed as appropriate
Male (Men’s Business) camps may be the most appropriate context for group education and information sessions on specific male health issues such as sexual health and sexually transmitted infections, These camps may also be the most appropriate forum for males to develop their own responses to address domestic violence, alcohol and substance abuse as well as child sexual abuse and neglect.

Improving Access to health care

Accessibility of health services to males has been identified as an issue in numerous male health conferences and summits This includes access to Primary Health Care in all contexts, but especially the clinical services.
Wherever possible males should have access to
•       male Aboriginal Health Workers,
•       Registered Nurses,
•       GPs and male specialists as required.
Accessibility within the Primary Health Care Centre may mean restructuring clinics to accommodate male specific areas, or off-site areas, and may include specific access (back door entrance) to improve attendance and cultural gender issues. For men that work, services should investigate the potential for holding regular after hour’s clinics to accommodate their needs. This need not be onerous, and could be additional 5-6 pm clinics to be held fortnightly.

Sexual and Reproductive Health
Sexual health programs need to be conducted in appropriate settings for males, and it is notable that while women may be screened opportunistically at several convenient events (Ante natal Clinic, Pap smear and breast check, while bringing kids in to the Primary Health Care Centre) there are fewer opportunities for adult males.
For adolescent males there are even less opportunities, so targeted interventions will be necessary at times. Aboriginal men occupy a range of sexualities and all should have appropriate unbiased access to primary health care including, gay males, men who have sex with men (MSM) and sister-girls (transgender)

While there are obvious funding constraints on these innovations there is much that can be achieved within current primary health care practice as well.

A key element in providing appropriate services for males is the development of a sufficient quantity and quality of male health workforce. This includes both Aboriginal and non-Aboriginal males in the health workforce. Every service should have accessible male clinical staff for males.  Where there are deficiencies in male health workforce, recruitment should note gaps and target male recruitment.  Male Aboriginal Health Workers should be able to have access to specialist male health training and male health career opportunities, including subspecialist status as per child health and women’s health. Any service specific male health strategy and appropriate workforce should be supported by a full time male health coordinator.

A healthier generation
Male health outcomes are affected from conception to old age and insults to the body at any time, such as chemical, physical, emotional all have an effect.
Interventions to minimise risk therefore start at preconception with the health and wellbeing of the new mother having an impact on the developing foetus. This may include nutritional status, smoking cigarettes, alcohol intake and emotional stress amongst others. Males have a role to play even at this early stage, and can assist their sons and nephews by ensuring the mother is supported and help her to minimise risks.
At each life stage there are intervention points, though some are more difficult than others. Adolescence is a significant time for young males, but also a time when they least engage with health services. Services need to target this group and each service should develop strategies with Men’s Groups to engage this population.

The Boomerang Method
NACCHO encourages all Aboriginal males (of all ages) to ensure that they have an Aboriginal Community Controlled Health Service where they can go regularly for their health check, for monitoring and review of ongoing health problems,  for a consultation when new problems arise, and to co-ordinate their ongoing health care. NACCHO also encourages and supports all Aboriginal males who do not have ready access to a culturally safe primary health care service which is able to address all the health needs of Aboriginal males, to take appropriate action with other Aboriginal people and their organisations to overcome these access problems.

Contact details NACCHO OCHRE DAY



NACCHO Aboriginal #HealthElection16 : Storytelling ,leadership ,Ken Wyatt MP and healthy hearts

KW and Eddie Masina

Eddie, your story is an important story because if we’re going to change health and the health outcomes of our people, we need to hear the stories from those who’ve been affected. …the work you do – what you think is not important – it is actually absolutely critical because you are keeping our storytellers and our cultural knowledge as a part of life.

And you are perpetuating our culture through the work that you do. The work that we do collectively to keep people alive much longer, means families and the communities have the opportunity to share the knowledge. Closing the gap is a challenge to achieve that requires a concerted effort by all.

Because if we are to make a difference, then collectively we as Australians, not just governments, we as Australians, need to work very closely, but more importantly, we need to encourage people like Eddie to become the storytellers so that we develop the understanding.

The Hon. Ken Wyatt, AM, MP, Assistant Minister for Health and Aged Care, was a keynote speaker at a recent RHDA Conference in Brisbane. He paid tribute to RHD patient Eddie Masina and spoke about the need to utilise old traditions of storytelling to spread the word amongst Indigenous communities. 

 Pictured below Minister Wyatt signing the Close the Gap Statement of Intent 2008


Australia has one of the highest recorded rates of Rheumatic Heart Disease (RHD), despite the disease being almost eliminated in developed countries.

RHDAustralia, in association with the Heart Foundation and Queensland RHD Control Program, hosted the RHD Close the Gap Conference on 22 and 23 March, where over 200 Queensland healthcare professionals learnt about best practice approaches to the prevention, treatment and management of rheumatic fever and

RHD and heard the latest developments in RHD control in Australia.

Along with educating and informing healthcare workers, the Conference laid the groundwork for potential policy change and highlighted the importance of collaboration at a National and State level to address this issue.

RHD is a significant public health issue in Queensland; recent audits undertaken by Queensland Department of Health have uncovered a previously unknown burden of the disease in urban centres with approximately 380 new cases identified in the past 12 months. This is in addition to over 2,000 people already on the rheumatic heart disease register in Queensland and over 6,000 people on registers across the country.

Approximately 40% on these registers are under the age of 24 and at risk of premature death or disability.

Storytelling – finding new ways for stories to be shared

Many patients related their personal stories with rheumatic heart disease over the course of the conference, including Eddie Masina, a Djirbalngan man now living in Townsville. Eddie shared his journey, which started at age 5. He told how the disease has impacted his life, with five open-heart surgeries and a stroke. RHD has affected his family, his employment opportunities and his education. His story highlights the need for early detection and diagnosis by informed clinicians.

The Hon. Ken Wyatt, AM, MP, Assistant Minister for Health and Aged Care, was a keynote speaker at the Conference events. He paid tribute to Eddie Masina and spoke about the need to utilise old traditions of storytelling to spread the word amongst Indigenous communities.

Think ARF. Stop RHD.

“In the past our elder women and mothers taught the next generations of young women about those things that kept us healthy and strong; that enabled us for 40,000 years to live on this continent and grow in number and strength.

“We seem to have stopped that, which is a pity because I think if we start to go back to the sharing of knowledge in a way that is culturally appropriate and built around our matriarchal system, then I think we will see some changes emerge.”

The stories of those affected by RHD – patients, families, and communities – must be heard; they are a catalyst for action and they inspire and inform improved practice. Those in attendance at the Conference were motivated by Eddie Massina to do more, learn more, advocate more for those living with this disease, and to safeguard future young generations from the damage done by this devastating disease that is a marker of poverty and disadvantage.

There is a role for a broader group of champions from clinical, political and social sectors who can assist in raising the profile of RHD in multiple settings. Oral storytelling is at the heart of Aboriginal and Torres Strait culture – we should embrace this and work to find more ways for stories to be shared.

Greater Leadership

The World Heart Federation (WHF) has adopted the World Health Assembly’s goal of reducing premature non-communicable diseases mortality by 25% by 2025, developing roadmaps in priority areas. The WHF recognises that the political windows opened by governments’ coordinated efforts to meet the global goal represent a once-in-a-generation opportunity to influence policy makers and dramatically accelerate action around cardiovascular disease.

In Australia, we have many committed individuals taking action to raise awareness of ARF (Acute Rheumatic Fever) and RHD and to bring an end to this entirely preventable disease. However, there is widespread concern that in our wealthy, developed nation, more should be done to address Indigenous disadvantage and the resultant health conditions. RHDAustralia sincerely thanks the Hon. Ken Wyatt, AM, MP, (Assistant Minister for Health and Aged Care) and the Hon. Cameron Dick (Queensland Minister for Health) for being part of the RHD education and awareness raising events in Brisbane.

Senator Nigel Scullion recently noted that this year’s Closing the Gap report has highlighted there are still major challenges to eliminating Indigenous disadvantage, despite the progress that is being made. Senator

Fiona Nash recently announced a further $2.5 million for Indigenous Eye Health to ensure that Australia is able to eliminate trachoma by 2020 and close the gap in eye health between our Indigenous and non- Indigenous Australians. The RHD community applauds this and other initiatives to Close the Gap on Indigenous health outcomes, but there needs to be a more concerted effort from Governments at all levels to commit to eliminating the factors that contribute to all preventable, communicable diseases.

New opportunities, new knowledge and new technology make us optimistic that we can make a real difference. The vision is that by working collaboratively we can eliminate what is an entirely preventable condition.

RHDAustralia acknowledges the Federal Government’s commitment in the 2016-2017 Budget to extending funding to the National Partnership for the Rheumatic Fever Strategy until June 2017.

For further information please contact Catherine Halkon at RHDAustralia –

National Approach Needed for Heart Disease

Today’s burden of disease report, released by the Australian Institute of Health and Welfare – represents a major wake up call for all parties contesting the federal election, highlighting the huge impact a small number of risk factors have on the national disease burden.

The risk factors causing the most burden were tobacco use, high body mass, alcohol use, physical inactivity and high blood pressure, which are all major factors in heart disease. The report found that a third of the burden experienced by the population could be prevented by reducing the exposure to modifiable risk factors.

Heart Foundation Chief Medical Advisor Prof Garry Jennings

Today’s burden of disease report, released by the Australian Institute of Health and Welfare

Although the largest fall in the fatal burden was seen in heart disease, the Heart Foundation Chief Medical Advisor Prof Garry Jennings said there was no room for complacency.

“We need to lift our effort to reduce the impact of these risk factors if we are to continue to tackle Australia’s number one killer heart disease,” Prof Jennings said.

“This major AIHW study demonstrates the need to invest more in addressing those critical risk factors of tobacco use, high body mass, alcohol use, physical inactivity and high blood pressure.”

Heart disease was one of the five chronic diseases that dominate in terms of total burden, with this quintet accounting for 69% in males and 62% in females of the total disease burden.

“Australia performs well when it comes to tobacco control – a credit to all major parties. But we are well behind the eight-ball when it comes to other major risk factors,” he said.

“We need to see the same effort invested in addressing physical inactivity, overweight/obesity and alcohol misuse.”

Prof Jennings added that Australia needed to see much greater attention paid to early detection, especially for those at risk of heart attack, stroke and other vascular conditions such as type 2 diabetes and kidney disease.

“We would also like to see more effective treatment for people with heart disease to address treatment gaps as well as more support for heart research as the disease burden evolves.

“Both the major parties are committed to a 12.5% annual increase in tobacco tax and we must keep the pedal to the metal to maintain that progress, especially with parts of the population with high smoking prevalence.”

Some of the $4.7bn raised over the next four years should be invested in prevention, making this a cost neutral measure for government.

Sadly, Australia is in the bottom third of OECD nations when it comes to investing in public health. Australian governments invest less than 2% of total health care expenditure in prevention, well behind class leaders New Zealand, on 7%, and Canada, on 5.9%.

In Australia in 2008-09 hospital costs attributed to heart disease was nearly $1.9b, with today’s estimate at $2.5b.

“When it comes to addressing the risk factors of heart disease, we know what will work is a comprehensive approach,” Prof Jennings said.

“These include national action plans for heart disease and stroke as well as physical activity, introducing an integrated health check, improving participation in cardiac rehabilitation programs, funding for cardiovascular research and directing focus of the new Medical Research Future Fund investment on major causes of the Australian disease burden.

“By adopting the recommended actions, we can prevent premature death, improve quality of life and reduce the immense economic burden heart disease places on the health system.”

The Heart Foundation urges all major parties to read this report and take decisive action.

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