NACCHO Aboriginal Health Research Alert : @HealthInfoNet releases Summary of Aboriginal and Torres Strait Islander health status 2019 social and cultural determinants, chronic conditions, health behaviours, environmental health , alcohol and other drugs

The Australian Indigenous HealthInfoNet has released the Summary of Aboriginal and Torres Strait Islander health status 2019

This new plain language publication provides information for a wider (non-academic) audience and incorporates many visual elements.

The Summary is useful for health workers and those studying in the field as a quick source of general information. It provides key information regarding the health status of Aboriginal and Torres Strait Islander people across the following topics:

  • social and cultural determinants
  • chronic conditions
  • health behaviours
  • environmental health
  • alcohol and other drugs.

The Summary is based on HealthInfoNet‘s comprehensive publication Overview of Aboriginal and Torres Strait Islander health status 2019. It presents statistical information from the Overview in a visual format that is quick and easy for users to digest.

The Summary is available online and in hardcopy format. Please contact HealthInfoNet by email if you wish to order a hardcopy of this Summary. Other reviews and plain language summaries are available here.

Here are the key facts

Please note in an earlier version sent out 7.00 am June 15 a computer error dropped off the last word in many sentences : these are new fixed 

Key facts

Population

  • In 2019, the estimated Australian Aboriginal and Torres Strait Islander population was 847,190.
  • In 2019, NSW had the highest number of Aboriginal and Torres Strait Islander people (the estimated population was 281,107 people, 33% of the total Aboriginal and Torres Strait Islander population).
  • In 2019, NT had the highest proportion of Aboriginal and Torres Strait Islander people in its population, with 32% of the NT population identifying as Aboriginal and/or Torres Strait Islanders
  • In 2016, around 37% of Aboriginal and Torres Strait Islander people lived in major cities
  • The Aboriginal and Torres Strait Islander population is much younger than the non-Indigenous population.

Births and pregnancy outcomes

  • In 2018, there were 21,928 births registered in Australia with one or both parents identified as Aboriginal and/or Torres Strait Islander (7% of all births registered).
  • In 2018, the median age for Aboriginal and Torres Strait Islander mothers was 26.0 years.
  • In 2018, total fertility rates were 2,371 births per 1,000 for Aboriginal and Torres Strait Islander women.
  • In 2017, the average birthweight of babies born to Aboriginal and Torres Strait Islander mothers was 3,202 grams
  • The proportion of low birthweight babies born to Aboriginal and Torres Strait Islander mothers between 2007 and 2017 remained steady at around 13%.

Mortality

  • For 2018, the age-standardised death rate for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT was 1 per 1,000.
  • Between 1998 and 2015, there was a 15% reduction in the death rates for Aboriginal and Torres Strait Islander people in NSW, Qld, WA, SA and the NT.
  • For Aboriginal and Torres Strait Islander people born 2015-2017, life expectancy was estimated to be 6 years for males and 75.6 years for females, around 8-9 years less than the estimates for non-Indigenous males and females.
  • In 2018, the median age at death for Aboriginal and Torres Strait Islander people in NSW, Qld, WA, SA and the NT was 2 years; this was an increase from 55.8 years in 2008.
  • Between 1998 and 2015, the Aboriginal and Torres Strait Islander infant mortality rate has more than halved (from 5 to 6.3 per 1,000).
  • In 2018, the leading causes of death among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT were ischaemic heart disease (IHD), diabetes, chronic lower respiratory diseases and lung and related cancers.
  • For 2012-2017 the maternal mortality ratio for Aboriginal and Torres Strait Islander women was 27 deaths per 100,000 women who gave birth.
  • For 1998-2015, in NSW, Qld, WA, SA and the NT there was a 32% decline in the death rate from avoidable causes for Aboriginal and Torres Strait Islander people aged 0-74 years

Hospitalisation

  • In 2017-18, 9% of all hospital separations were for Aboriginal and Torres Strait Islander people.
  • In 2017-18, the age-adjusted separation rate for Aboriginal and Torres Strait Islander people was 2.6 times higher than for non-Indigenous people.
  • In 2017-18, the main cause of hospitalisation for Aboriginal and Torres Strait Islander people was for ‘factors influencing health status and contact with health services’ (mostly for care involving dialysis), responsible for 49% of all Aboriginal and Torres Strait Islander seperations.
  • In 2017-18, the age-standardised rate of overall potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people was 80 per 1,000 (38 per 1,000 for chronic conditions and 13 per 1,000 for vaccine-preventable conditions).

Selected health conditions

Cardiovascular health

  • In 2018-19, around 15% of Aboriginal and Torres Strait Islander people reported having cardiovascular disease (CVD).
  • In 2018-19, nearly one quarter (23%) of Aboriginal and Torres Strait Islander adults were found to have high blood pressure.
  • For 2013-2017, in Qld, WA, SA and the NT combined, there were 1,043 new rheumatic heart disease diagnoses among Aboriginal and Torres Strait Islander people, a crude rate of 50 per 100,000.
  • In 2017-18, there 14,945 hospital separations for CVD among Aboriginal and Torres Strait Islander people, representing 5.4% of all Aboriginal and Torres Strait Islander hospital separations (excluding dialysis).
  • In 2018, ischaemic heart disease (IHD) was the leading specific cause of death of Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT

Cancer

  • In 2018-19, 1% of Aboriginal and Torres Strait Islander people reported having cancer (males 1.2%, females 1.1%).
  • For 2010-2014, the most common cancers diagnosed among Aboriginal and Torres Strait Islander people living in NSW, Vic, Qld, WA and the NT were lung cancer and breast (females) cancer.
  • Survival rates indicate that of the Aboriginal and Torres Strait Islander people living in NSW, Vic, Qld, WA, and the NT who were diagnosed with cancer between 2007 and 2014, 50% had a chance of surviving five years after diagnosis
  • In 2016-17, there 8,447 hospital separations for neoplasms2 among Aboriginal and Torres Strait Islander people
  • For 2013-2017, the age-standardised mortality rate due to cancer of any type was 238 per 100,000, an increase of 5% when compared with a rate of 227 per 100,000 in 2010-2014.

Diabetes

  • In 2018-19, 8% of Aboriginal people and 7.9% of Torres Strait Islander people reported having diabetes.
  • In 2015-16, there were around 2,300 hospitalisations with a principal diagnosis of type 2 diabetes among Aboriginal and Torres Strait Islander people
  • In 2018, diabetes was the second leading cause of death for Aboriginal and Torres Strait Islander people.
  • The death rate for diabetes decreased by 0% between 2009-2013 and 2014-2018.
  • Some data sources use term ‘neoplasm’ to describe conditions associated with abnormal growth of new tissue, commonly referred to as a Neoplasms can be benign (not cancerous) or malignant (cancerous) [1].

Social and emotional wellbeing

  • In 2018-19, 31% of Aboriginal and 23% of Torres Strait Islander respondents aged 18 years and over reported high or very high levels of psychological distress
  • In 2014-15, 68% of Aboriginal and Torres Strait Islander people aged 15 years and over and 67% of children aged 4-14 years experienced at least one significant stressor in the previous 12 months
  • In 2012-13, 91% of Aboriginal and Torres Strait Islander people reported on feelings of calmness and peacefulness, happiness, fullness of life and energy either some, most, or all of the time.
  • In 2014-15, more than half of Aboriginal and Torres Strait Islander people aged 15 years and over reported an overall life satisfaction rating of at least 8 out of 10.
  • In 2018-19, 25% of Aboriginal and 17% of Torres Strait Islander people, aged two years and over, reported having a mental and/or behavioural conditions
  • In 2018-19, anxiety was the most common mental or behavioural condition reported (17%), followed by depression (13%).
  • In 2017-18, there were 21,940 hospital separations with a principal diagnosis of International Classification of Diseases (ICD) ‘mental and behavioural disorders’ identified as Aboriginal and/or Torres Strait Islander
  • In 2018, 169 (129 males and 40 females) Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA, and the NT died from intentional self-harm (suicide).
  • Between 2009-2013 and 2014-2018, the NT was the only jurisdiction to record a decrease in intentional self-harm (suicide) death rates.

Kidney health

  • In 2018-19, 8% of Aboriginal and Torres Strait Islander people (Aboriginal people 1.9%; Torres Strait Islander people 0.4%) reported kidney disease as a long-term health condition.
  • For 2014-2018, after age-adjustment, the notification rate of end-stage renal disease was 3 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people.
  • In 2017-18, ‘care involving dialysis’ was the most common reason for hospitalisation among Aboriginal and Torres Strait Islander people.
  • In 2018, 310 Aboriginal and Torres Strait Islander people commenced dialysis and 49 were the recipients of new kidneys.
  • For 2013-2017, the age-adjusted death rate from kidney disease was 21 per 100,000 (NT: 47 per 100,000; WA: 38 per 100,000) for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and NT
  • In 2018, the most common causes of death among the 217 Aboriginal and Torres Strait Islander people who were receiving dialysis was CVD (64 deaths) and withdrawal from treatment (51 deaths).

Injury, including family violence

  • In 2012-13, 5% of Aboriginal and Torres Strait Islander people reported having a long-term condition caused by injury.
  • In 2018-19, 16% of Aboriginal and Torres Strait Islander people aged 15 years and over had experienced physical harm or threatened physical harm at least once in the last 12 months.
  • In 2016-17, the rate of Aboriginal and Torres Strait Islander hospitalised injury was higher for males (44 per 1,000) than females (39 per 1,000).
  • In 2017-18, 20% of injury-related hospitalisations among Aboriginal and Torres Strait Islander people were for assault.
  • In 2018, intentional self-harm was the leading specific cause of injury deaths for NSW, Qld, SA, WA, and NT (5.3% of all Aboriginal and Torres Strait Islander deaths).

Respiratory health

  • In 2018-19, 29% of Aboriginal and Torres Strait Islander people reported having a long-term respiratory condition .
  • In 2018-19, 16% of Aboriginal and Torres Strait Islander people reported having asthma.
  • In 2014-15, crude hospitalisation rates were highest for Aboriginal and Torres Strait Islander people presenting with influenza and pneumonia (7.4 per 1,000), followed by COPD (5.3 per 1,000), acute upper respiratory infections (3.8 per 1,000) and asthma (2.9 per 1,000).
  • In 2018, chronic lower respiratory disease was the third highest cause of death overall for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT

Eye health

  • In 2018-19, eye and sight problems were reported by 38% of Aboriginal people and 40% of Torres Strait Islander people.
  • In 2018-19, eye and sight problems were reported by 32% of Aboriginal and Torres Strait Islander males and by 43% of females.
  • In 2018-19, the most common eye conditions reported by Aboriginal and Torres Strait Islanders were hyperopia (long sightedness: 22%), myopia (short sightedness: 16%), other diseases of the eye and adnexa (8.7%), cataract (1.4%), blindness (0.9%) and glaucoma (0.5%).
  • In 2014-15, 13% of Aboriginal and Torres Strait Islander children, aged 4-14 years, were reported to have eye or sight problems.
  • In 2018, 144 cases of trachoma were detected among Aboriginal and Torres Strait Islander children living in at-risk communities in Qld, WA, SA and the NT
  • For 2015-17, 62% of hospitalisations for diseases of the eye (8,274) among Aboriginal and Torres Strait Islander people were for disorders of the lens (5,092) (mainly cataracts).

Ear health and hearing

  • In 2018-19, 14% of Aboriginal and Torres Strait Islander people reported having a long-term ear and/or hearing problem
  • In 2018-19, among Aboriginal and Torres Strait Islander children aged 0-14 years, the prevalence of otitis media (OM) was 6% and of partial or complete deafness was 3.8%.
  • In 2017-18, the age-adjusted hospitalisation rate for ear conditions for Aboriginal and Torres Strait Islander people was 1 per 1,000 population.

Oral health

  • In 2014-15, the proportion of Aboriginal and Torres Strait Islander children aged 4-14 years with reported tooth or gum problems was 34%, a decrease from 39% in 2008.
  • In 2012-2014, 61% of Aboriginal and Torres Strait Islander children aged 5-10 years had experienced tooth decay in their baby teeth, and 36% of Aboriginal and Torres Strait Islander children aged 6-14 years had experienced tooth decay in their permanent teeth.
  • In 2016-17, there were 3,418 potentially preventable hospitalisations for dental conditions for Aboriginal and Torres Strait Islander The age-standardised rate of hospitalisation was 4.6 per 1,000.

Disability

  • In 2018-19, 27% of Aboriginal and 24% of Torres Strait Islander people reported having a disability or restrictive long-term health
  • In 2018-19, 2% of Aboriginal and 8.3% of Torres Strait Islander people reported a profound or severe core activity limitation.
  • In 2016, 7% of Aboriginal and Torres Strait Islander people with a profound or severe disability reported a need for assistance.
  • In 2017-18, 9% of disability service users were Aboriginal and Torres Strait Islander people, with most aged under 50 years (82%).
  • In 2017-18, the primary disability groups accessing services were Aboriginal and Torres Strait Islander people with a psychiatric condition (24%), intellectual disability (23%) and physical disability (20%).
  • In 2017-18, 2,524 Aboriginal and Torres Strait Islander National Disability Agreement service users transitioned to the National Disability Insurance Scheme.

Communicable diseases

  • In 2017, there were 7,015 notifications for chlamydia for Aboriginal and Torres Strait Islander people, accounting for 7% of the notifications in Australia
  • During 2013-2017, there was a 9% and 9.8% decline in chlamydia notification rates among males and females (respectively).
  • In 2017, there were 4,119 gonorrhoea notifications for Aboriginal and Torres Strait Islander people, accounting for 15% of the notifications in Australia.
  • In 2017, there were 779 syphilis notifications for Aboriginal and Torres Strait Islander people accounting for 18% of the notifications in Australia.
  • In 2017, Qld (45%) and the NT (35%) accounted for 80% of the syphilis notifications from all jurisdictions.
  • In 2018, there were 34 cases of newly diagnosed human immunodeficiency virus (HIV) infection among Aboriginal and Torres Strait Islander people in Australia .
  • In 2017, there were 1,201 Aboriginal and Torres Strait Islander people diagnosed with hepatitis C (HCV) in Australia
  • In 2017, there were 151 Aboriginal and Torres Strait Islander people diagnosed with hepatitis B (HBV) in Australia
  • For 2013-2017 there was a 37% decline in the HBV notification rates for Aboriginal and Torres Strait Islander people.
  • For 2011-2015, 1,152 (14%) of the 8,316 cases of invasive pneumococcal disease (IPD) were identified as Aboriginal and Torres Strait people .
  • For 2011-2015, there were 26 deaths attributed to IPD with 11 of the 26 deaths (42%) in the 50 years and over age-group.
  • For 2011-2015, 101 (10%) of the 966 notified cases of meningococcal disease were identified as Aboriginal and Torres Strait Islander people
  • For 2006-2015, the incidence rate of meningococcal serogroup B was 8 per 100,000, with the age- specific rate highest in infants less than 12 months of age (33 per 100,000).
  • In 2015, of the 1,255 notifications of TB in Australia, 27 (2.2%) were identified as Aboriginal and seven (0.6%) as Torres Strait Islander people
  • For 2011-2015, there were 16 Aboriginal and Torres Strait Islander people diagnosed with invasive Haemophilus influenzae type b (Hib) in Australia
  • Between 2007-2010 and 2011-2015 notification rates for Hib decreased by around 67%.
  • In 2018-19, the proportion of Aboriginal and Torres Strait Islander people reporting a disease of the skin and subcutaneous tissue was 2% (males 2.4% and females 4.0%).

NACCHO Aboriginal #CoronaVirus News Alert No 39 : April 16 #KeepOurMobSafe : #OurJobProtectOurMob : Anyinginyi ACCHO partners in new report “Fix housing and you’ll reduce risks of coronavirus and other disease in remote Indigenous communities “

” Remote Indigenous communities have taken swift and effective action to quarantine residents against the risks of COVID-19.

Under a plan developed by the Aboriginal and Torres Strait Islander Advisory Group, entry to communities is restricted to essential visitors only.

This is important, because crowded and malfunctioning housing in remote Indigenous communities heightens the risk of COVID-19 transmission.

High rates of chronic disease mean COVID-19 outbreaks in Indigenous communities may cause high death rates. ” 

Originally published in the Conversation

 ” Rapid-testing machines that detect COVID-19 in 45 minutes are being sent to 83 indigenous communities where remote health clinics are currently waiting up to 10 days to find out whether an Aboriginal resident has coronavirus.

Health Minister Greg Hunt has announced the Australian government was investing $3.3m to establish the rapid coronavirus testing program for remote and rural ­Aboriginal and Torres Strait Islander communities.

The commonwealth is choosing the sites in most need and most at risk with help from state and territory governments and health services, and aims to have 83 ­machines in place by mid-May.”

See full story Part 2 below :  Coronavirus: Rapid tests on way to remote Indigenous communities.

Read full release Here

The “old story” of housing, crowding and health continues to be overlooked. A partnership between the University of Queensland and Anyinginyi Health Aboriginal Corporation, in the Northern Territory’s (NT) Tennant Creek and Barkly region, re-opens this story. A new report from our work together is titled in Warumungu language as Piliyi Papulu Purrukaj-ji – “Good Housing to Prevent Sickness”. It reveals the simplicity of the solution: new housing and budgets for repairs and maintenance can improve human health.

Infection risks rise in crowded housing

Rates of crowded households are much higher in remote communities (34%) than in urban areas (8%). Our research in the Barkly region, 500km north of Alice Springs, found up to 22 residents in some three-bedroom houses. In one crowded house, a kidney dialysis patient and seven family members had slept in the yard for over a year in order to access clinical care.

Many Indigenous Australians lease social housing because of barriers to individual land ownership in remote Australia. Repairs and maintenance are more expensive in remote areas and our research found waiting periods are long. One resident told us:

Houses [are] inspected two times a year by Department of Housing, but no repairs or maintenance. They inspect and write down faults but don’t fix. They say people will return, but it doesn’t happen.

Better ‘health hardware’ can prevent infections

The growing populations in communities are not matched by increased housing. Crowding is the inevitable result.

Crowded households place extra pressure on “health hardware”, the infrastructure that enables washing of bodies and clothing and other hygiene practices.


Read more: Homelessness and overcrowding expose us all to coronavirus. Here’s what we can do to stop the spread


We interviewed residents who told us they lacked functioning bathrooms and washing machines and that toilets were blocked. One resident said:

Scabies has come up a lot this year because of lack of water. We’ve been running out of water in the tanks. There’s no electric pump … [so] we are bathing less …

[Also] sewerage is a problem at this house. It’s blocked … The toilet bubbles up and the water goes black and leaks out. We try to keep the kids away.

A lack of health hardware increases the transmission risk of preventable, hygiene-related infectious diseases like COVID-19. Anyinginyi clinicians report skin infections are more common than in urban areas, respiratory infections affect whole families in crowded houses, and they see daily cases of eye infections.

Data that we accessed from the clinic confirmed this situation. The highest infection diagnoses were skin infections (including boils, scabies and school sores), respiratory infections, and ear, nose and throat infections (especially middle ear infection).

These infections can have long-term consequences. Repeated skin sores and throat infections from Group A streptococcal bacteria can contribute to chronic life-threatening conditions such as kidney disease and rheumatic heart disease (RHD). Indigenous NT residents have among the highest rates of RHD in the world, and Indigenous children in Central Australia have the highest rates of post-infection kidney disease (APSGN).


Read more: The answer to Indigenous vulnerability to coronavirus: a more equitable public health agenda


Reviving a vision of healthy housing and people

Crowded and unrepaired housing persists, despite the National Indigenous Reform Agreement stating over ten years ago: “Children need to live in accommodation with adequate infrastructure conducive to good hygiene … and free of overcrowding.”

Indigenous housing programs, such as the National Partnership Agreement for Remote Indigenous Housing, have had varied success and sustainability in overcoming crowding and poor housing quality.

It is calculated about 5,500 new houses are required by 2028 to reduce the health impacts of crowding in remote communities. Earlier models still provide guidance for today’s efforts. For example, Whitlam-era efforts supported culturally appropriate housing design, while the ATSIC period of the 1990s introduced Indigenous-led housing management and culturally-specific adaptation of tenancy agreements.

Our report reasserts the call to action for both new housing and regular repairs and maintenance (with adequate budgets) of existing housing in remote communities. The lack of effective treatment or a vaccine for COVID-19 make hygiene and social distancing critical. Yet crowding and faulty home infrastructure make these measures difficult if not impossible.

Indigenous Australians living on remote country urgently need additional and functional housing. This may begin to provide the long-term gains described to us by an experienced Aboriginal health worker:

When … [decades ago] houses were built, I noticed immediately a drop in the scabies … You could see the mental change, could see the difference in families. Kids are healthier and happier. I’ve seen this repeated in other communities once housing was given – the change.


Trisha Narurla Frank contributed to the writing of this article, and other staff from Anyinginyi Health Aboriginal Corporation provided their input and consent for the sharing of these findings.

Part 2 :  Coronavirus: Rapid tests on way to remote Indigenous communities

Rapid-testing machines that detect COVID-19 in 45 minutes are being sent to 83 indigenous communities where remote health clinics are currently waiting up to 10 days to find out whether an Aboriginal resident has coronavirus.

There are no known cases of COVID-19 in indigenous communities but health authorities are on high alert for a breakout, particularly in Western Australia, where 11 health workers in the far north Kimberley region tested positive. After a doctor in the Kimberley town of Halls Creek saw Aboriginal patients while he was potentially infectious, those ­patients have been deemed not to be close contacts.

Health Minister Greg Hunt has announced the Australian government was investing $3.3m to establish the rapid coronavirus testing program for remote and rural ­Aboriginal and Torres Strait Islander communities.

The commonwealth is choosing the sites in most need and most at risk with help from state and territory governments and health services, and aims to have 83 ­machines in place by mid-May.

The test, called the Xpert SARS-CoV-2 test, uses rapid ­technology to detect COVID-19 infections by using a nasal swab polymerase chain reaction test in the early phases of the illness.

“It’s vital we do all we can to protect our rural and remote ­Aboriginal and Torres Strait ­Islander communities,” Mr Hunt said.

“This world-first testing response means that we can continue to stay ahead of the curve when it comes to fighting this virus.

“If an outbreak is detected, local health services can move quickly to protect the community and activate established evacuation procedures.”

Indigenous Australians Minister Ken Wyatt said indigenous people were more vulnerable if they contracted coronavirus.

“There are higher rates of chronic conditions and other health issues in these communities and it can be hard to access healthcare,” Mr Wyatt said

“This means that an outbreak of COVID-19 in an Aboriginal or Torres Strait Islander community has the potential to be very serious.

“This testing program will help protect indigenous Australians against the virus.”

The program is an initiative of the Kirby Institute, in partnership with Flinders University.

NACCHO Aboriginal Health and #SocialDeterminants : #MovetoTown Housing bureaucrats are in talks with Aboriginal organisations to convert all town camps into proper suburbs with metered water and electricity

” The suspension of services comes as part of a slow but significant change.

The McGowan government is investing heavily in 10 of the state’s largest remote communities, including by installing sewerage and water systems that residents will for the first time be billed for.

It is also helping Aboriginal families move off dilapidated town camps into new or refurbished homes in the suburbs in a program called Move To Town.

The changes could mean the end of town camps that have been marred by violence and anti-­social behaviour.

Housing bureaucrats are in talks with Aboriginal organisations to convert all town camps into proper suburbs with metered water and electricity.” 

From the Australian 9 March 2020

Read all NACCHO Aboriginal Health and Housing Articles HERE

Read all NACCHO Aboriginal Health and Social Determinant Articles HERE

The West Australian Labor government has quietly suspended essential services at 25 remote Aboriginal communities five years after their Liberal predecessors suffered a political backlash for proposing the closure of most of the settlements.

The Australian has obtained a list of 25 settlements across the far north Kimberley where ­essential services such as maintaining bores and generators are “suspended” because the communities were considered abandoned or inhabited too infreq­uently to justify the cost to the taxpayer.

The West Australian Department of Communities, which is responsible for remote housing, said the suspensions followed consultation with Aboriginal people. It is part of a policy of ­investing in larger remote settlements while razing town camps and moving residents to suburbs in larger communities.

Former Liberal premier Colin Barnett sparked mass protests, a rebuke from the UN and was criticised by the state Labor ­opposition when he announced in November 2014 that most of Western Australia’s 274 remote communities would close.

Read NITV Article HERE

Opposition Treasury and ­Aboriginal affairs spokesman Ben Wyatt asked the state’s lower house to condemn Mr Barnett for “ongoing uncertainty, confusion and fear that he has created in remote Aboriginal communities”. The policy crisis was largely a result of a federal ­decision that states and the Northern Territory would bear the full cost of remote housing, ending an arrangement in which the federal government paid half.

Mr Barnett said there was no way Western Australia could carry that cost. While WA Labor wanted the federal government to reverse or delay its decision, Mr Barnett became the target of anger when he linked community closures to child-sex abuse. “They cannot look anyone in the eye and guarantee the safety of little boys and girls,” he told parliament.

Prime minister Tony Abbott was also criticised when he ­described the decision to live in remote settlements as a lifestyle choice.

The list of communities that have had services suspended by the McGowan Labor government includes Osmond Valley at the foot of the Bungle Bungles where flood then fire drove residents away several years ago.

The Australian understands Warmun Community Incorporated uses its own budget to carry out basic maintenance at ­Osmond Valley amid hopes it can one day become a tourist destination that generates income for Aboriginal people.

Other communities on the state government’s “suspended” list include Kurlku in the Great Sandy Desert, which was established by the late artist Jimmy Pike in the 1980s. It has no permanent residents though rangers had in recent years camped there when carrying out work. Some other remote communities on the list are outstations that had previously been recorded as having small permanent populations or were seasonally occupied.

The suspension of services comes as part of a slow but significant change. The McGowan government is investing heavily in 10 of the state’s largest remote communities, including by installing sewerage and water systems that residents will for the first time be billed for. It is also helping Aboriginal families move off dilapidated town camps into new or refurbished homes in the suburbs in a program called Move To Town.

The changes could mean the end of town camps that have been marred by violence and anti-­social behaviour. Housing bureaucrats are in talks with Aboriginal organisations to convert all town camps into proper suburbs with metered water and electricity.

But the department has shown it is prepared to raze those town camps if that is what traditional owners want. So far, one camp called One Mile on the outskirts of Broome has been bulldozed and all residents of the Kennedy Hill town camp in the centre of Broome have opted to move to better housing elsewhere in the town. One boarded-up house ­remains at Kennedy Hill and will be demolished within a week.

Paul Isaachsen, assistant ­director of general strategy and transformation at the Department of Communities, said the West Australian government was maintaining services in remote places where people lived.

“When the state government establishes that a remote community it supports is no longer ­occupied, which can be the case with very small outstations, the maintenance of essential and ­municipal service assets is suspended pending any return of residents,” he said. “For example, the regular inspection (and, if necessary, ­repair) of generators and bores does not occur during the suspension period. Currently, ­services are suspended in 25 remote communities following ­numerous visits to the communities and consultation with community members, service providers and other relevant stakeholders.”

WA Housing Minister Peter Tinley said he hoped the Labor government’s collaborative approach could succeed where the former Liberal government failed. “Aboriginal people are the most marginalised and vulnerable in Australia — even more so when they live in remote communities, out of sight and generally out of mind to the vast majority of us,” he said.

“The McGowan government does not believe that people should be denied access to basic services based on where they live.

“Everyone has the right to ­expect running water, proper sewerage systems, power supplies, education and health services and suitable housing.

“The challenge to providing such services arose when the state government’s long-term funding partner in the joint arrangement that used to deliver those same services — the commonwealth government — walked away from its responsibilities, axed its funding contribution and laid the entire financial burden on the state government.

“The result is an ongoing ­annual $100m hole in the state’s budget.”

NACCHO Aboriginal Health and #SocialDeterminants “Poor housing is not an issue of indigeneity; it is an issue of poverty” – Dr Paul Torzillo

Aboriginal health, more specifically, is often characterised as wicked.

But when it comes to the link between housing and Indigenous health at least, Dr Paul Torzillo says emphatically,

“This is not some issue about cultural dissonance. This is not a wicked problem.”

Dr Paul Torzillo is a founding director of Healthabitat. A non-profit company that has been working for more than three decades to identify a quantifiable link between housing and health in remote Aboriginal communities, and to offer solutions to clearly articulated, fixable problems.

Drawing above showing Healthabitat’s nine Healthy Living Practice

This article by Habititat and Tracey Clement

“It’s going to get too hard for ngurraritja to live in the desert soon. I might shift somewhere when the desert dries up – up north, down south.”

Without action to stop climate change, people may be forced to leave their country,”

Climate change is a clear and present threat to the survival of our people and their culture,”

Living in “unbearable concrete hot boxes” doesn’t help.

People resort to sleeping outside, or cramming everybody into the coolest room, with all the well-known consequences for the spread of diseases.

It’s also common for people to sleep in shifts, with young people roaming the streets at night where they get into trouble, and sleeping during the day when they should beat school.

You can sometimes see people in communities hosing the outside of their Besser brick walls with garden hoses to keep cool despite the water shortages – that’s how desperate they are.”

” Too hot for our mob ” From Central Land Council’s Head of Policy, Josie Douglas

Download Land Rights News 

Land-Rights-News-March-2020_(2)

Read all NACCHO Aboriginal Health and Housing Articles HERE

Read all NACCHO Aboriginal Health and Social Determinant Articles HERE

Drawing above showing Healthabitat’s nine Healthy Living Practice

The company applies a scientific approach to what some have seen as a social and cultural problem.

Some problems are so complex we label them ‘wicked.’ As the Australian Public Service Commission (APS) explains, “The term ‘wicked’ in this context is used, not in the sense of evil, but rather as an issue highly resistant to resolution.”

In a document titled, ‘Tackling wicked problems: A public policy perspective,’ the APS, a policy unit within the Department of the Prime Minister and Cabinet, cites climate change, obesity, land degradation and Indigenous disadvantage as examples.

In 1985, Torzillo was working as a medical officer for the Nganampa Health Council at the Pukatja (Ernabella) health clinic in the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in South Australia. There he met architect Paul Pholeros (1953–2016) and anthropologist Stephan Rainow.

They began working together at the invitation of elder Yami Lester, who could see that people in the community were still getting sick, despite improved health services. In 1987, the trio released a report known as the Uwankara Palyanku Kanyintjaku (UPK) – a plan to “stop people getting sick”, in the local Pitjantjatjara language.

In the UPK, Torzillo, Pholeros and Rainow – who would become the founding directors of Healthabitat – identified a clear link between deficiencies in the built environment and the poor health of community members.

The report outlined nine Healthy Living Practices: washing people, washing clothes and bedding, removing wastewater safely, improving nutrition through the ability to store prepare and cook food, reducing the negative impact of over-crowding; reducing the negative effects of animals, insects and vermin; reducing the impact of dust; controlling temperature in the living environment; and reducing hazards that cause physical trauma.

These practices are still at the core of what Healthabitat does today.

Healthabitat primarily works on projects that focus on improving health by fixing what Dr Fred Hollows (1929–1993) called “health hardware,” in this case the physical infrastructure in a home that enables occupants to undertake the nine Healthy Living Practices. Since 1985, licensed contractors overseen by Healthabitat have completed some 287,919 repair jobs, mostly in remote Indigenous communities. But recently they also conducted projects in densely populated urban areas in both Australia and the USA. “And those projects have provided data to support the important thesis that poor housing is not an issue of indigeneity,” Torzillo says, “it is an issue of poverty.”

While a common misconception persists that occupants in remote Aboriginal communities have destroyed their own homes, Healthabitat’s extensive collection of data has demonstrated that vandalism (or even unsuccessful repair work) accounts for only seven percent of damaged health hardware.

Overwhelmingly, poor design, poor material choices, shoddy or incomplete initial construction (19%), and lack of routine maintenance (74%) are the factors that lead to substandard infrastructure in the homes that they have worked on.

As Torzillo puts it, “We have found that you can improve health hardware in these communities for an affordable cost. And we have also shown that the key reasons that these houses aren’t performing are not reasons which are philosophical, or race related, or even occupant dependent. They are issues that are fixable.”

Small teams of local people undertake Survey-Fix work as part of Healthabitat’s “yellow caps” house repair program.

This all seems fairly straightforward. After all, the link between sanitation and health has been widely accepted since at least the Victorian era. A functioning toilet, kitchen and shower should be standard in all homes, and yet the problem of healthy housing in Indigenous communities is ongoing.

Which is not to say that Healthabitat has not had some success. “I think what we have done is we have unequivocally changed the language and the rhetoric around housing in Australia. So at every housing conference somebody talks about the nine Healthy Living Practices, and at every conference people talk about housing for health, and most bureaucratic statements include language that would suggest that they are adopting the principles,” Torzillo explains. “The difficulty is in the implementation.”

Despite clearly defined solutions and quantifiable evidence that its projects work, Healthabitat’s methodology has yet to be meaningfully translated into Federal and State government policy within Australia. When asked why, Torzillo admits that there is no easy answer. For him, “the hard question”, as he puts it, is why do those in authority insist on labelling the problem as ‘wicked’?

Tackling this question is one of the reasons Healthabitat became an industry partner on a Housing for Health Incubator, led by Professor Tess Lea and facilitated by the Henry Halloran Trust. Beyond the big, complex ‘why’ questions, Lea and her team are also examining the interactions between politics and bureaucracy and probing the ‘how.’

They are asking questions, Torzillo says, such as: “How is it that we are still building houses that don’t perform? How is it that we are losing housing stock because we don’t have sustainable maintenance systems? How does that happen?” Their research, which will conclude later this year, also addresses another apparently wicked problem: climate change.

As Torzillo explains, “Our work started with me thinking predominantly about child health, predominantly about infectious disease and the impact of washing and waste disposal in the 1980s. Most of that still stands, but now there is a whole other set of issues.” Climate change is perhaps the issue of our times, and it is already hitting hard in the communities Healthabitat works with. “Lots of remote communities now have temperatures in the high 40s and low 50s centigrade. And they are not going to have the money to afford the energy to control temperature. So communities are going to be threatened by that,” Torzillo says. “This is a big issue right now. So we want to bring that into the centre of what we’re doing.”

With this in mind, the Henry Halloran Trust Incubator is looking at updating, modernising, and refocusing Healthabitat’s work with an emphasis on the impact of the climate crisis on housing for poor people.

As Torzillo points out. “It’s not a future issue, it’s a here-and-now issue.”

Tracey Clement is an artist and writer based in Sydney, Australia.

NACCHO Aboriginal Health Resources Alert : Download @HealthInfoNet Overview of Aboriginal and Torres Strait Islander health status 2019 : Continuing to show important positive developments for our mob

In the Overview we strive to provide an accurate and informative summary of the current health and well-being of Aboriginal and Torres Strait Islander people.

In doing so, we want to acknowledge the importance of adopting a strengths-based approach, and to recognise the increasingly important area of data sovereignty.

To this end, we have reduced our reliance on comparative data in favour of exploring the broad context of the lived experience of Aboriginal and Torres Strait islander people and how this may impact their health journey “

HealthInfoNet Director, Professor Neil Drew

The Overview of Aboriginal and Torres Strait Islander health status (Overview) aims to provide a comprehensive summary of the most recent indicators of the health and current health status of Australia’s Aboriginal and Torres Strait Islander people.

Download HERE 

Overview+of+Aboriginal+and+Torres+Strait+Islander+health+status+2019

The annual Overview contains updated information across many health conditions.

It shows there has been a range of positive signs including a decrease in death rates, infant mortality rates and a decline in death rates from avoidable causes as well as a reduction in the proportion of Aboriginal and Torres Strait Islander people who smoke.

It has also been found that fewer mothers are smoking and drinking alcohol during pregnancy meaning that babies have a better start to life.

The initial sections of the Overview provide information about:

  • the context of Aboriginal and Torres Strait Islander health
  • social determinants including education, employment and income
  • the Aboriginal and Torres Strait Islander population
  • measures of population health status including births, mortality and hospitalisation.

The remaining sections are about selected health conditions and risk and protective factors that contribute to the overall health of Aboriginal and Torres Strait Islander people.

These sections include an introduction and evidence of the extent of the condition or risk/protective factor. Information is provided for state and territories and for demographics such as sex and age when it is available and appropriate.

The Overview is a resource relevant for the health workforce, students and others requiring access to up-to-date information about the health of Aboriginal and Torres Strait Islander people.

This year, the focus will be mainly on the Aboriginal and Torres Strait Islander data and presentation is within the framework of the strength based approach and data sovereignty (where information is available).

As a data driven organisation, the HealthInfoNet has a publicly declared commitment to working with Aboriginal and Torres Strait Islander leaders to advance our understanding of data sovereignty and governance consistent with the principles and aspirations of the Maiam nayri Wingara Data Sovereignty Collective (https://www.maiamnayriwingara.org).

As we have done in previous years, we continue our strong commitment to developing strengths based approaches to assessing and reporting the health of Aboriginal and Torres Strait Islander people and communities.

It is difficult to make comparisons between Aboriginal and Torres Strait Islander people and non- Indigenous Australian populations without consideration of the cultural and social contexts within which people live their lives.

As in past versions, we still provide information on the cultural context and social determinants for the Aboriginal and Torres Strait Islander population.

However, for the selected health topics and risk/protective factors we have removed many of the comparisons between the two populations and focused on the analysis of the Aboriginal and Torres Strait Islander data only.

In an attempt to respond to the challenge issued by Professor Craig Ritchie at the 2019 AIATSIS conference to say more about the ‘how’ and the ‘why’ not just the ‘what’ where comparisons are made and if there is evidence available, we have provided a brief explanation for the differences observed.

Accompanying the Overview is a set of PowerPoint slides designed to help lecturers and others provide up-to-date information.

  • In 2019, the estimated Australian Aboriginal and Torres Strait Islander population was 847,190.
  • In 2019, NSW had the highest number of Aboriginal and Torres Strait Islander people (the estimated population was 281,107 people, 33% of the total Aboriginal and Torres Strait Islander population).
  • In 2019, NT had the highest proportion of Aboriginal and Torres Strait Islander people in its population, with 32% of the NT population identifying as Aboriginal and/or Torres Strait Islander.
  • In 2016, around 37% of Aboriginal and Torres Strait Islander people lived in major cities.
  • The Aboriginal and Torres Strait Islander population is much younger than the non-Indigenous population.

Download the PowerPoint HERE

Overview+of+Aboriginal+and+Torres+Strait+Islander+health+status+2019_+key+facts

NACCHO Aboriginal Children’s Health : Download @AIHW releases its first comprehensive report on the health and wellbeing of our kids since 2012 : #Health #Education #SocialSupport #Housing #JusticeandSafety

 ” Children in Australia are generally happy, healthy and safe, according to a new report from the Australian Institute of Health and Welfare (AIHW).

But children’s experiences and outcomes can vary depending on where they live and their families’ circumstances.

The report, Australia’s children, brings together data about children and their experiences at home, school and in their communities, along with statistics on important influences such as parental health, family support networks and household finances.

The report focuses generally on children aged 0–12, spanning infancy, early childhood and primary school years. ” 

Download the PDF Report and link to all contents HERE

NACCHO Announcement 2020

After 2,800 Aboriginal Health Alerts over 7 and half years from www.nacchocommunique.com NACCHO media will cease publishing from this site as from 31 December 2019 and resume mid January 2020 with posts from www.naccho.org.au

For historical and research purposes all posts 2012-2019 will remain on www.nacchocommunique.com

Your current email subscription will be automatically transferred to our new Aboriginal Health News Alerts Subscriber service that will offer you the options of Daily , Weekly or Monthly alerts

For further info contact Colin Cowell NACCHO Social Media Media Editor

Download the NACCHO Annual Report

‘From an early age, most Australian children have the foundations to support good health and wellbeing as they grow up,’ said AIHW spokesperson Louise York.

Aboriginal and Torres Strait Islander children

Click on this links for 

1.Health  Smoking ,Teenage Mothers ,Birth weight ,Immunisation ,Injury Deaths

2.Education

3.Social Support

4. Housing

5. Justice and Safety

How are Australia’s children faring on national indicators?

Doing well

  • Death rates among Australia’s infants and children have dropped substantially. Between 1998 and 2017, infant deaths dropped from 5.0 to 3.3 deaths per 1,000 live births. Child deaths halved from 20 to 10 deaths per 100,000 children.
  • Less mothers are smoking during the first 20 weeks of pregnancy. Between 2011 and 2017, the proportion of mothers smoking fell from 13% to 9.5%.
  • The proportion of Year 5 students achieving at or above the national minimum standard for reading and numeracy increased between 2008 and 2018. Reading increased from 91% to 95% and numeracy from 93% to 96%.
  • The rate of children aged 10–14 under youth justice supervision decreased between 2008–09 and 2017–18, from 95 to 73 per 100,000 children.

Could be better

  • Around 1 in 4 children aged 5–14 are overweight or obese, with the proportion remaining relatively stable between 2007–08 (23%) and 2017–18 (24%).
  • Most children (96%) aged 5–14 do not eat enough vegetables, with the proportion meeting the guidelines for vegetable consumption only increasing slightly between 2014–15 (2.9%) and 2017–18 (4.4%).
  • In 2016–17, there were around 66,500 hospitalised injury cases for children aged 0–14, slightly higher than 10 years earlier. The rate was relatively stable between  2007–08 and 2016–17 (1,419 and 1,445 per 100,000, respectively).
  • Around 19,400 (0.4%) of children aged 0–14 were homeless on Census night in 2016, similar to the proportion in 2006 (0.5%).

What do Australia’s children say?

  • Most children (91%) aged 12–13 felt safe in their neighbourhood in 2015–16.
  • 1 in 5 Year 4 students experienced bullying on a weekly basis in 2015.
  • Most children (94%) in years 4, 6 and 8 spent quality time doing at least one of talking, having fun or learning with their family most days in the week in 2014.
  • 97% of children aged 12–13 had someone to talk to if they have a problem in 2016.
  • Almost 9 in 10 children aged 12–13 would talk to their mum and/or dad if they had a problem in 2016.
  • For children in years 4, 6 and 8, health ranked as the second most important domain, after family, for having a good life in 2014.

In 2017, just under 1 in 10 mothers smoked during their pregnancy, compared to 1 in 8 mothers in 2011. In 2016

35% of women drank alcohol during pregnancy, down from 42% in 2013. In 2018, about 9 in 10 children aged 2 were fully immunised.

Deaths among infants and children are uncommon, having fallen markedly over the past 2 decades. Injury and cancer are the leading causes of death for children aged 1-14 years—however, the death rates for both have reduced significantly.

Most parents share stories with their infants, with almost 4 in 5 children aged 0–2 read to or told stories by a parent regularly in 2017, and 90% of eligible children enrolled in a preschool program in the year before they entered full- time school.

In some areas, children in Australia show signs of healthy lifestyles—for example, in 2017–18, almost three- quarters (72%) of children aged 5–14 eat enough fruit every day. Despite this, very few (4%) eat enough vegetables and almost half (42%) usually consumed sugar sweetened drinks at least once a week.

Around 65% of children aged 5–8, 78% of children aged 9–11 and 72% of children aged 12–14 participated in organised physical activities outside of school hours at least once per week in 2018. However, other data sources included in the report suggest that in 2011–12, less than one-quarter (23%) of children aged 5–14 undertook the recommended 60 minutes of physical activity every day and less than one-third (32%) met the screen-based activity guidelines (to limit screen-based activity to no more than 60 minutes per day). Planned updates to these data under the Intergenerational Health and Mental Health Study will be useful.

‘In 2017–18, about a quarter of children aged 5–14 were overweight or obese, similar to 2007–08. The likelihood of a child being overweight or obese is greater if they live outside major cities, in one-parent families, or if they have a disability,’ Ms York said.

Literacy and numeracy are fundamental building blocks for children’s educational achievement, lives outside school, engagement with society and future employment prospects. In 2018, almost all Year 3, 5 and 7 students achieved at or above the minimum standards for reading and numeracy. However, results were lower among some groups of children. For example, Year 5 students in more remote areas of Australia were less likely to meet the minimum standards, as were Indigenous students.

Between 2008 and 2018, the proportion of Indigenous students in Year 5 at or above national minimum standards for reading rose from 63% to 77%, and for numeracy rose from 69% to 81%.

While school years can provide positive experiences for children, bullying is an issue for many. In 2015, almost 3 in 5 Year 4 students reported that they experienced bullying monthly or weekly during the school year. The rise of the internet has also enabled bullying to spread online.

‘In 2016–17, receiving unwanted contact and content was the most commonly reported negative online experience for children aged 8–12, experienced by about a quarter of all children,’ Ms York said.

Most children say they look to their parents for support in difficult times—in 2016, 9 in 10 children aged 12–13 said they would talk to their mum and/or dad if they had a problem.

In 2013–14, an estimated 314,000 children aged 4–11 (almost 14%) experienced a mental disorder, with boys more commonly affected than girls (17% compared with 11%).

‘Attention Deficit Hyperactivity Disorder (ADHD), was the most common mental disorder for children (8.2%), followed by Anxiety Disorders (6.9%),’ said Ms York.

Household finances—including whether adults in the household have a job—can affect a child’s health, emotional wellbeing, education and ability to take part in social activities. In 2017–18, there were 2 million low-income households in Australia, about a quarter of which had at least 1 dependent child aged 0–14.

Ms York said there is always more to learn about children and their experiences, including how children transition through major developmental stages and how longer-term outcomes may vary depending on childhood circumstances.

‘In particular, it is important to learn more about how certain groups of children are faring, including those with a disability, those from culturally or linguistically diverse backgrounds, and those who identify as lesbian, gay, bisexual, trans and gender diverse, or children who have intersex variations,’ Ms York said.

‘It is also important to gather more evidence about children’s own perspectives on issues affecting their lives and development, to ensure children’s views are heard.’

This is the AIHW’s first comprehensive report on children since 2012. It updates and extends data about Australia’s children and provides suggestions for how to fill known information gaps.

NACCHO Aboriginal Environmental Health : With #ClimateChange contributions from @RACGP Dr @timseniorand @climatecouncil @CroakeyNews and @HealthInfoNet What are the environmental factors that impact on the health of our Aboriginal and Torres Strait Islander communities?

“We’ve had more people coming in the last few weeks, with the smoke coming down from the bushfires in New South Wales, presenting with coughs, difficulty breathing – more than you’d usually expect,” he says.

I’ve been aware increasingly of people coming in with symptoms that could be put down to climate change. The other doctors are seeing the same things; we’re all seeing that ” 

Dr Tim Senior, who works at the Tharawal Aboriginal Corporation in south-west Sydney, is always busy, but the practice has been getting even more traffic lately. Like other GPs across the country, Dr Senior has a front-row seat to the growing impact of the climate crisis on the health of Australians : Read full RACGP article Part 3 Below 

 ” A NEW CLIMATE COUNCIL report has found this summer is shaping up as a terrible trifecta of heatwaves, droughts and bushfires, made worse by climate change. “Dangerous Summer: Escalating Bushfire, Heat and Drought Risk” finds the catastrophic events unfolding across Australia are not normal.“
Climate change is supercharging the extreme weather events we are witnessing. We have seen temperature records smashed, bushfires in winter and a prolonged drought.
Climate change is influencing all of these things,” said Climate Councillor and report author, Professor Will Steffen.“It is only the beginning of summer, which means the biggest danger period may yet be to come,” he said.
Report Key Findings

  • If greenhouse gas emissions continue to rise, the unusually hot weather currently experienced will become commonplace, occurring every summer across the country. Sydney and Melbourne could experience unprecedented 50°C summer days by the end of the century.
  • The current prolonged drought across eastern Australia is threatening crops for a third year in a row, and national summer crop production is forecast to fall by 20 percent to 2.1 million tonnes.
  • The period from January 2017 to October 2019 have been the driest on record for the Murray-Darling Basin as a whole.
  • Wildlife has been badly affected by the ongoing bushfires, with reports of at least 1,000 koala deaths in important habitats in New South Wales, Queensland and South Australia.
  • Australia must contribute to the global effort to deeply and rapidly reduce greenhouse gas emissions and we must prepare our emergency and fire services and communities for worsening extreme weather events.

” Aboriginal and Torres Strait Islander people in Australia are especially vulnerable to the impacts of climate change 

 For those Aboriginal and Torres Strait Islanders in remote parts of Australia, increases in temperature will reduce the amount of bush tucker and other native foods available. For people in coastal areas, rises in sea levels may force people off their land .

This is especially concerning considering the connection that Aboriginal and Torres Strait Islander people have to their Country, and may result in poor mental health and other social issues .

Extreme weather events such as cyclones and floods will affect the infrastructure in remote Aboriginal and Torres Strait Islander communities, and these communities may be cut-off from services for long periods of time .

To address some of the issues associated with climate change, a process called ‘adaptation’ is being used. Adaptation refers to the practical changes that individuals and communities can make to help them manage the issues that climate change will bring, and to protect their communities 

A key part of the Australian strategy on climate change is adaptation .

From Healthinfonet  : For some of the ways communities are adapting to climate change : See Part 2 Below 

” In mainstream settings, there is no battle for recognition or resources for environmental health from finance departments. There is nothing more to prove and a fully resourced framework is in place.  But Aboriginal environmental health is something else again.

Aboriginal environmental health combines deep cultural knowledge of how things work in Aboriginal communities with these hard scientific facts about disease. Aboriginal environmental health must forge high-trust partnerships with community. Aboriginal environmental health is a community asset. And Aboriginal environmental health is needed now more than ever.   Why is this so?

Public housing and public utilities have largely been taken out of Aboriginal control. In some locations, funding for the Aboriginal Environmental Health workforce has evaporated.

Sometimes, the power to make the simplest decision on the ground has been ripped away from local communities.

Instead, this power is with someone far away who doesn’t even know us. This is nowhere more manifest than in Aboriginal housing.  

Effective Aboriginal environmental health programs must be in Aboriginal hands.

 Community controlled organisations must drive the necessary knowledge exchange between those who hold technical expertise and those who have been denied it.

The very nature of this work means that Aboriginal communities must retain the reins – and retain the knowledge ” 

Selected extracts NACCHO CEO Pat Turner addressing the National Aboriginal and Torres Strait Islander Environmental Health Conference

Read full Speech HERE

Croakey : Reaching out to community members who are most at-risk during extreme heat events

Part 1 What are the environmental factors that impact on the health of Aboriginal and Torres Strait Islander communities?

The environments in which Aboriginal and Torres Strait Islander people live have a significant impact on their health. It is important to recognise healthy practices and identify and fix the risks present in Aboriginal and Torres Strait Islander communities.

The key factors in the physical environment which impact on the health and wellbeing of Aboriginal and Torres Strait Islander communities include:

  • water treatment and supply
  • access to affordable and healthy food and food safety
  • adequate housing and maintenance and minimisation of overcrowding
  • rubbish collection and disposal
  • sewage disposal
  • animal control (including insects)
  • dust control
  • pollution control
  • personal hygiene.

Examples of the types of health problems associated with the environment include; respiratory, cardiovascular and renal diseases, cancers and skin infections. Diseases can be spread as a result of overcrowding, pollution, poor animal management and gastrointestinal illnesses can be due to poor water quality, contaminated food or poor hygiene.

Preventing health problems by ensuring healthy environment standards reduces suffering and treatment costs.

What strategies are in place for the environmental health of Aboriginal and Torres Strait Islander communities?

The enHealth Council was responsible for the implementation of The National Environmental Health Strategy: 1999 .

The enHealth Council provides national leadership on environmental health issues, for example, by setting environmental health priorities and coordinating national policies and programs.

The council is made up of representatives from government and public health agencies, the environmental health profession and the community, including the Aboriginal and Torres Strait Islander community. Aboriginal and Torres Strait Islander environmental health is seen as a priority for the council and the National Environmental Health Strategy acknowledges the need to improve the health status of Aboriginal and Torres Strait Islander communities in rural, remote and urban areas, ‘through the development of appropriate environmental health standards commensurate (matching) with the wider Australian population’.

Who is responsible for healthy environments?

The responsibility for environmental health lies primarily with individuals and communities. However, communities often need to work with a range of government and non-government organisations to put into operation plans for improving environmental health standards in a community, evaluation of strategies and risk management.

Individuals and organisations who work in environmental health may differ between states and territories and between Aboriginal and Torres Strait Islander communities and include the following:

  • Environmental Health Officers and Workers
  • the Community Government Council, and its employees, for example, Essential Services Officers
  • electricity and water authorities
  • government housing departments
  • Aboriginal and Torres Strait Islander housing authorities
  • government departments responsible for land, planning and the environment
  • private consultants and contractors, for example, electricians, plumbers, builders
  • other non-government service providers, for example, land care agencies.

Many Aboriginal and Torres Strait Islander communities have an Environmental Health Worker based in their community who plays a vital role in reducing the day to day environmental risks which can affect the health and wellbeing of the communities’ residents. The Environmental Health Workers job is varied and often challenging as they are required to undertake a number of tasks including:

  • attending to day to day repairs and maintenance of infrastructure (e.g., housing and rubbish tips)
  • attending to urgent environmental health problems (e.g., sewage overflow)
  • planning and implementing programs
  • gaining the support of the community members and managers for community based programs

Part 2

Select from all the above Healthinfonet environmental factors 

Climate change

Climate change refers to a change in weather patterns because of a rise in the earth’s temperature [1][2]. Some of this change is natural, but some changes in climate have also been caused by human actions, such as the burning of fossil fuels (oil, gas and coal) [1]. Climate change has a negative impact on:

  • the Australian coastline (rising sea levels and potential flooding)
  • cities and other built environments
  • farming (an increase in temperature and droughts)
  • water (rainfall levels are decreasing)
  • natural ecosystems (increases in non-native species and decreases in native species)
  • health and wellbeing (increased risk of injury, disease and death due to rising temperatures)
  • extreme weather events such as floods and fires [3].

Aboriginal and Torres Strait Islander people in Australia are especially vulnerable to the impacts of climate change [4]. For those Aboriginal and Torres Strait Islanders in remote parts of Australia, increases in temperature will reduce the amount of bush tucker and other native foods available. For people in coastal areas, rises in sea levels may force people off their land [1].

This is especially concerning considering the connection that Aboriginal and Torres Strait Islander people have to their Country, and may result in poor mental health and other social issues [4]. Extreme weather events such as cyclones and floods will affect the infrastructure in remote Aboriginal and Torres Strait Islander communities, and these communities may be cut-off from services for long periods of time [1].

To address some of the issues associated with climate change, a process called ‘adaptation’ is being used. Adaptation refers to the practical changes that individuals and communities can make to help them manage the issues that climate change will bring, and to protect their communities [5]. A key part of the Australian strategy on climate change is adaptation [6]. Some of the ways communities are adapting to climate change are:

  • setting up good evacuation and early warning processes
  • upgrading and strengthening buildings
  • managing energy use
  • teaching people about the importance of staying healthy [1].

There are also ways that Aboriginal and Torres Strait Islander people and communities can lessen some of the risks associated with climate change [1]. These include:

  • planting trees
  • managing feral animals
  • reducing the number of bushfires by undertaking planned burning initiatives, such as the

Tiwi Carbon Study: Managing Fire for Greenhouse Gas Abatement

  • switching to renewable energy sources, like solar power [1].

Part 3 RACGP

Read the RACGP Climate Change policy HERE 

The health impacts of climate crisis-related events have never been more apparent in Australia, with recent catastrophic fire conditions visibly contributing to respiratory and cardiovascular problems. But medical professionals warn that the climate emergency is likely to have a far wider reach.

The Royal Australian College of General Practitioners (RACGP) put out a climate change and human health position statement this year, recognising the climate crisis as a key public health issue.

The position statement cites a long list of health effects that could result from higher temperatures and increased heatwaves, bushfires, droughts and storms. These include risk of stroke and heat stress, worsening chronic respiratory, cardiac and kidney conditions, and psychiatric illness.

Dr Tim Senior, who works at the Tharawal Aboriginal Corporation in south-west Sydney, is always busy, but the practice has been getting even more traffic lately. Like other GPs across the country, Dr Senior has a front-row seat to the growing impact of the climate crisis on the health of Australians.

“We’ve had more people coming in the last few weeks, with the smoke coming down from the bushfires in New South Wales, presenting with coughs, difficulty breathing – more than you’d usually expect,” he says.

“I’ve been aware increasingly of people coming in with symptoms that could be put down to climate change. The other doctors are seeing the same things; we’re all seeing that.”

Brace for impact: it’s going to get worse

The RACGP’s concerns are wide ranging, and cover the short and long term. Dr Senior says changing environmental impacts, such as air pollution, water access, and nutrition, will have flow-on effects for people’s health.

There are also concerns specific to different regions.

“Some GPs in southern Queensland will see more dengue fever coming through,” Dr Senior says. “Where I live it might be more Ross River or Barmah Forest virus.”

Then there are the indirect impacts, such as the effect of drought on food production, resulting in a poorer quality diet. Vulnerable patients, who already struggle to afford adequate housing, heating or cooling, will be the first affected and least able to deal with weather extremes.

The mental load

Drought, bushfires and floods have been shown to have severe and long-term effects on mental health. They can also make existing problems worse.

“If you’re already struggling for money or work, having other difficulties piled on top – such as drought, going through a flood, or seeing your children get unwell because of the effect of a heatwave – that adds stress,” Dr Senior says.

Instead of drinking water, “yellow sludge” came out of the taps on the day that Dr Senior visited Walgett, a town in northern NSW. Residents had to boil it or wait for bottled supplies.

“You can imagine the [mental] impact of having to do that for something that we take for granted – it is terrifying.”

Born into a heating world

Older Australians, children, and those with pre-existing conditions are likely to feel the health effects of the climate crisis earlier than the general population, but children have the most to lose, according to a report by Doctors for the Environment Australia. Research has found that globally, 88% of disease due to climate change is borne by children under the age of five, the report says.

“It’s hard to get your head around that,” Dr Senior says. “They will live through climate change in a way that no other generation has had to. They won’t know anything but chaotic climate.

“And we know from a lot of the research into health inequality that the first five years of life, as well as pregnancy, are crucial in terms of future health. They have a massive impact.”

Managing your health in a changing environment

Dr Senior says GPs understand what communities are going through, because it’s affecting them, too. GPs are best placed to help patients understand how changing temperatures and environment can affect their current conditions, or potentially spark new health concerns.

“We’ve always been advising behavioural change, and it’s based on having a therapeutic relationship with people,” he says.

“The behaviours that keep us well – walking more, driving less, eating less meat and less processed food, for example – also protect the environment.

“Our patients come first, which means our interventions are based on good science and evidence, along with a good understanding of the people we’re working with.”

That can entail advising individual patients at risk from heat or smoke to stay indoors at particular times, or advocating for those with respiratory illnesses to get better housing (as Dr Senior does).

It can also mean discussing interventions – such as diet, transport, energy usage, and community initiatives – to limit the effects of the climate crisis.

“We treat people and then we send them back to the circumstances that made them unwell,” Dr Senior says, “but it’s much better for all of us if we’re able to be kept well.”

GPs see 84% of the Australian population each year.

“That’s a massive reach. It’s a real opportunity to talk about the ways of mitigating climate change, the effects on their health.”

The Royal Australian College of General Practitioners (RACGP) is Australia’s largest professional general practice organisation – our mission is to improve the health and wellbeing of all people in Australia by supporting GPs, general practice registrars and medical students.

NACCHO Aboriginal Health #IYIL2019 and Early Childhood Development #ClosingTheGap : @theALNF shines on the world stage for its innovative use of technology to help solve the literacy challenges facing our Indigenous communities

 

“Language gives us a sense of identity and, for many Indigenous peoples globally, storytelling is the way our culture and history is shared through the generations. With the loss of language therefore comes the loss of identity.

The importance of First Language, particularly to early childhood development, has been recognised by the United Nations and it’s especially exciting for us to win this award during the International Year of Indigenous Languages ‘

Professor Tom Calma AO, Co-Chair of ALNF and Reconciliation Australia 

“ Language is more than a mere tool for communicating with other people. People simply don’t speak words. We connect, teach and exchange ideals. Indigenous languages allows each of us to express our unique perspective on the world we live in and with the people in which we share it with.

Unique words and expressions within language, even absence of, or taboos on certain words, provide invaluable insight to the culture and values each of us speaks.

Our Language empowers us.

It is a fundamental right to speak your own language, and to use it to express your identity, your culture and your history. For Indigenous people it lets us communicate our philosophies and our rights as they are within us, our choices and have been for our people for milleniums “

Minister Ken Wyatt sharing Australia’s story on preserving and revitalising #IndigenousLanguages at @UNHumanRights Council

Read full speech Here 

Australian technology innovation shone on the world stage today when the Australian Literacy and Numeracy Foundation (ALNF) won the MIT Solve Challenge for ‘Early Childhood Development’ in New York.

The Australian charity was selected out of 1400 entrants, and was one of 61 finalists for the global accolade which recognises innovative technology solutions for global challenges.

ALNF was awarded for its ground-breaking ‘Living First Language Platform’ (LFLP), a highly accessible, cross- platform multi-media app that preserves and revitalises Indigenous First Languages, empowering speakers with best-practice literacy tools to learn to read, write and teach in their mother tongue

The award recognises ALNF’s innovative use of technology to help solve the literacy challenges facing Indigenous communities and will see MIT Solve deploy its global community of private, public, and non-profit leaders to help ALNF build the partnerships needed to scale their work nationally and internationally.

ALNF seeks to address the lack of linguistically inclusive early education, which is recognised by communities and leaders as a major factor in low levels of attainment and engagement of Indigenous children and families in early education.

In remote areas of Australia, around two-thirds of Indigenous children speak some words of an Indigenous language, and in some communities, almost 100% of children encounter English for  the first time when they enter school. Globally, around 221 million children do not have access to education in their First Language.

See a demonstration of the ‘Living First Language Platform’ in action here

Importantly, the platform also aims to stem the rapid and ever-increasing loss of Indigenous languages. There are more than 4,000 Indigenous languages in the world and devastatingly, one is lost approximately every 14 days.

The support from the MIT Solve network will help us to continue to develop and grow the platform’s capability, ensuring a robust Early Childhood Development resource. Additional funding received from investors and donors will go directly to ALNF to enable us to work with more communities in Australia to record our own Indigenous languages and improve literacy levels.”

ALNF is currently working with five Australian Indigenous language groups on the platform, in some instances recording ancient languages for the first time.

One of these languages, Erub Mer from the Torres Strait, has only a few fluent speakers remaining. Thanks to the Living First Language Platform, more than 2000 Erub Mer words have been added to ALNF’s teaching tool by an enthusiastic community, passionate about passing their language on to the next generation.

Photos from Erub Mer workshop Kenny Bedford 

The six global challenges in the MIT Solve Challenge were determined via consultation with more than 500 leaders and experts and workshops with communities around the world. ALNF was among 61 global finalists invited to New York city to pitch their technology solution to the MIT Solve Challenge Leadership Group — a judging panel of cross-sector leaders and MIT faculty —during U.N. General Assembly Week.

In addition to today’s MIT Solve win, the ‘Living First Language Platform also won in its category of ‘Innovation in Connecting People’ at the South by Southwest (SXSW) Innovation Awards in Austin, Texas earlier this year.

For more information or to donate go to alnf.org/program/firstlanguages/.

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

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

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

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

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

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

NACCHO Aboriginal #Environmental Health ClosingtheGap #HaveYourSay : Our CEO Pat Turner’s speech to the National Aboriginal and Torres Strait Islander Environmental Health Conference in Perth this week

” In mainstream settings, there is no battle for recognition or resources for environmental health from finance departments. There is nothing more to prove and a fully resourced framework is in place. 

But Aboriginal environmental health is something else again.

Aboriginal environmental health combines deep cultural knowledge of how things work in Aboriginal communities with these hard scientific facts about disease.

Aboriginal environmental health must forge high-trust partnerships with community. 

Aboriginal environmental health is a community asset.

And Aboriginal environmental health is needed now more than ever.   Why is this so?

Public housing and public utilities have largely been taken out of Aboriginal control. In some locations, funding for the Aboriginal Environmental Health workforce has evaporated.\

Sometimes, the power to make the simplest decision on the ground has been ripped away from local communities. 

Instead, this power is with someone far away who doesn’t even know us.

This is nowhere more manifest than in Aboriginal housing. 

Effective Aboriginal environmental health programs must be in Aboriginal hands. 

Community controlled organisations must drive the necessary knowledge exchange between those who hold technical expertise and those who have been denied it.

The very nature of this work means that Aboriginal communities must retain the reins – and retain the knowledge

Selected extracts NACCHO CEO Pat Turner addressing the National Aboriginal and Torres Strait Islander Environmental Health Conference in Perth this week

As an Aboriginal woman of Gudanji-Arrernte heritage, I wish to acknowledge the Whadjuk people of the Noongar nation as traditional owners of the land where we meet today.

I also acknowledge our continuing and vibrant First Nations cultures.  I am grateful for the contributions of our past, present and emerging leaders.

Our cultures, our leaders and our country give us collective strength and resilience as Aboriginal and Torres Strait Islander peoples.

Just a note for about language conventions in Western Australia. I tend to use the term Aboriginal in recognition that Aboriginal people are the original inhabitants here. This is not out of any disrespect to Torres Strait Islander colleagues and communities.

I have discovered that the first NATSIEH conference was held in 1998. Every second year or so since, the aim of these national conferences is to increase the understanding and awareness of environmental health issues in our communities.

This year, your theme is ONE GOAL: MANY PATHS.  There must be a huge diversity of backgrounds, professions and experiences in the room.   I am delighted to be here.  I hope I have something for everyone in my address to you today.

I will begin with recent CHANGES in the way governments must now work with Aboriginal and Torres Strait Islander people.

Then I’ll cover some CHALLENGES that we can no longer ignore.

And finally, I’ll explain how Aboriginal LEADERSHIP will show the right path that we must take together.

How has our political landscape changed?

Please cast your minds back to 2008 when the original Closing the Gap policy was agreed by the Council of Australian Governments – known as COAG.

There was never full ownership of Closing the Gap from Aboriginal and Torres Strait Islander peoples. CLOSING the Gap was always considered to be an initiative of Governments.  Frankly, it was governments talking to other governments ABOUT us.  WITHOUT us.

Many Aboriginal and Torres Strait Islander Peak bodies supported Closing the Gap in good faith, particularly with new funding given to specific issues including housing, health and education.

But was Closing the Gap ever going to work with its genesis in the bureaucratic backrooms of Canberra?

Our people were always going to be configured as ‘the problem’.  Not as allies, not as experts, not as partners, not as equals.  It was not surprising to Aboriginal people to see that progress was patchy.

As Prof Marcia Langton, a leading Aboriginal academic of Yiman and Bidjara heritage, said in February this year at the Australian and New Zealand School of Government Indigenous conference:

“You can’t have administration of very complex matters from the Canberra bubble. It’s not working and lives are being lost. 

… We must push for policies that give formal powers to the Indigenous sector and remove incompetent, bureaucratic bungling.”

Marcia made a specific request of those who were listening:

“Please do not feel personally offended by what I have to say to you” she said.

I also ask this of you today.  And as Marcia continued to say:

‘… we must all take responsibility and be courageous enough to take action, to put an end to the policies and programs that disempower Aboriginal and Torres Strait Islander people, not just causing a decline in their living standards, but accelerating them into permanent poverty.

Especially the vulnerable. The children and youth are victims of a failed view of the Indigenous world and Indigenous people. This is a dystopian nightmare. We must imagine a future in which Indigenous people thrive and we must do whatever it takes to reach that future. This is urgent.”

It is not surprising then, that after 10 years, not much progress against the Closing the Gap targets had been made.

As the Closing the Gap targets were expiring, COAG announced a “Refresh” of Closing the Gap.  This “refresh” kicked in during 2017.  As various conversations took place however, it became clear that governments were still not listening properly or engaging in a genuine way, and they only wanted to talk about new targets.

Many Aboriginal Peak bodies wanted more time to test the options being put before us in these conversations. Most importantly, Peak bodies needed to be sure that THEIR voices were truly being heard. There was a real concern – AGAIN – that governments had already decided what they wanted to do. That governments were now negotiating behind closed doors to decide new priorities and targets without our input.

As Aboriginal peak bodies, we had to call this out before the country made another momentous mistake. We were very insistent.  We formed a Coalition.  The Prime Minister and his COAG colleagues had to adopt a better way of working.  Without a radical change in approach, the next ten years would be more of the same lack luster approach.

To his credit, Prime Minister Morrison listened.

He opened the door to a new way of working, giving his personal authority to change.

An historic Partnership Agreement on Closing the Gap was signed this year in March between COAG and the Coalition of Peaks.  This means that now, for the first time, Aboriginal and Torres Strait Islander people, through their peak body representatives, will share decision making with governments on Closing the Gap.

How is this to be done?

This Partnership Agreement has created a high-level COAG Joint Council.  This Joint Council is made up of 22 members.  That means a Minister from the Commonwealth Government, a Minister from each State and Territory Governments, and a representative for local government. This makes up ten members.

But significant success was realized when the Coalition of Aboriginal Peak Bodies ensured TWELVE Aboriginal or Torres Strait Islander representatives were on the Joint Council.  Chosen by us, in the majority, working for our mobs.

The Joint Council is co-chaired by the current Commonwealth Minister for Indigenous Australians and a representative of the Coalition of Peaks chosen by the Peaks. Currently, that representative is me.

The Partnership Agreement embodies the belief of all signatories that:

  • When Aboriginal and Torres Strait Islander peoples are included and have a real say in the design and delivery of services that impact on them, the outcomes are far better;
  • Aboriginal and Torres Strait Islander peoples need to be at the centre of Closing the Gap policy: the gap won’t close without our full involvement; and
  • COAG cannot expect us to take responsibility and work constructively with them to improve outcomes if we are excluded from the decision making.

So to those public servants in the audience, whether you work in Commonwealth, state, territory or local government institutions, I say this.

If the Director-General, Secretary or CEO of your department or agency is not enabling you to do your work differently and act in accordance with the Partnership Agreement, Principles, then you need to join the movement and shake the tree.

I encourage you to:

  • Initiate co-design that looks entirely different to the way your department worked two years ago.
  • Give power of veto to communities on priorities. Listen to what THEY say.
  • Double the number of Indigenous people on your committees.
  • Forget ‘one size fits all’ … because it doesn’t.
  • Immerse yourself in this unprecedented opportunity for true equity in our country.

Trust me, your change of practice will be noticed, commended and supported.

Within the Joint Council, we will continue to lead the structural reform that will make your change of practice easier.  At our recent meeting in Adelaide, the Joint Council significantly agreed to develop a new National Agreement on Closing the Gap centred on three reform priorities.

The reform priorities seek to change the way Australian Governments work with Aboriginal and Torres Strait Islander peoples and organisations, and accelerate life outcomes for Aboriginal and Torres Strait Islander peoples, these are:

  1. Establishing shared formal decision making between Australian governments and Aboriginal and Torres Strait Islander people at the State/Territory, regional and local level to embed ownership, responsibility and expertise on Closing the Gap.
  2. Building and strengthening Aboriginal and Torres Strait Islander community-controlled organisations to deliver services and programs in priority areas.
  3. Ensuring all mainstream government agencies and institutions undertake systemic and structural transformation to contribute to Closing the Gap.

The Joint Council also agreed to the Coalition of Peaks leading engagements with Aboriginal and Torres Strait Islander people over the next two months to ensure others can have a say on the new National Agreement on Closing the Gap.

The Coalition of Peaks want to hear views from across the country on what is needed to make the reform priorities a success.

 

I encourage you all to contribute and have your say.

You can find out more on the NACCHO website. Step up and join in!

I know these priorities, especially the first two, are critical to our success as Aboriginal  people. And I know this from a lifetime of advocacy and service for my people, including my current role as CEO of NACCHO.

NACCHO is the living embodiment of the aspirations of Aboriginal and Torres Strait Islander communities and our struggle for self-determination.  NACCHO is the national peak body representing 143 Aboriginal Community Controlled Health Services or “ACCHOs” across the country.   NACCHO has a history stretching back to a meeting in Albury in 1974 in country New South Wales.

For those who don’t know, an “ACCHO” is a primary health care service initiated and operated by the local Aboriginal community to deliver holistic, comprehensive, and culturally appropriate health care to the community which controls it, through a locally elected Board of Management.

As a sector, we are especially proud that ACCHOs are the largest employer of Aboriginal and Torres Strait Islanders in the country.  Not even the mining sector compares. We also have evidence that ACCHOs are demonstrably better than mainstream in providing culturally responsive, clinically effective primary health care.

At this year’s AMSANT conference, Donna Ah Chee, a Bundgalung woman from NSW and CEO of Central Australian Aboriginal Congress, said precisely what community control means in this context.

Read full speech HERE

It means:

  • The right to set the agenda and determine what the issues are
  • The right to determine which programs or approaches are best suited to tackle the problems in the community
  • The right to determine how a program is run, its size and resources
  • The right to determine when a program operates, its pace and timing
  • The right to say where a program will operate, its geographic coverage and its target groups
  • The right to determine who will deliver the program its staff and advisers.

This commitment to equal partnership through COAG has brought us to the table.  There’s no going back.

I’d now like to cover some CHALLENGES in environmental health. 

Environmental health is a science-based, technical practice.  Environmental health takes scientific knowledge to people. It focuses on disease risk and finds the way to limit disease in modern society. Environmental Health Practitioners draw the connection between environmental factors and health outcomes.

Environmental health practitioners take this science and fix environmental hazards to prevent risk. They nip outbreaks in the bud.

They influence and draft legislation, and monitor compliance with public health laws and the regulations to protect people’s health.

Of course, in mainstream Australia, hardly anyone recognizes the role that environmental health plays.  For the majority of the population, environmental health is silently present. Water, sanitation, rubbish, housing standards, food safety, everything … it is all taken for granted.

In mainstream settings, there is no battle for recognition or resources for environmental health from finance departments. There is nothing more to prove and a fully resourced framework is in place.

But ABORIGINAL environmental health is something else again.

Aboriginal environmental health combines deep cultural knowledge of how things work in Aboriginal communities with these hard scientific facts about disease. Aboriginal environmental health must forge high-trust partnerships with community.

Aboriginal environmental health is a community asset.

And Aboriginal environmental health is needed now more than ever.   Why is this so?

Public housing and public utilities have largely been taken out of Aboriginal control. In some locations, funding for the Aboriginal Environmental Health workforce has evaporated. Sometimes, the power to make the simplest decision on the ground has been ripped away from local communities.  Instead, this power is with someone far away who doesn’t even know us.

This is nowhere more manifest than in Aboriginal housing.

First, the evidence.  A recent systematic review of the scientific literature has summarized the known causal links between the home environment and health.  Here are some examples:

  • Skin-related diseases are associated with crowding
  • Viral conditions such as influenza are also associated with crowding.
  • Ear infections are associated with crowding, lack of functioning facilities for washing people, bedding and sewerage outflow.
  • Gastro infections are associated with poorly maintained housing and the state of food preparation and storage.

These are not hypothetical claims yet to be proved.  These have academic weight and the verdict is in.

In mainstream Australia, these causal links between the housing and health have been actioned.  In mainstream Australia, sustained progress in the social and environmental determinants of health has permanently reduced the rates of preventable infectious diseases.  One look at the disease burden tells us that.

BUT … because of the state of OUR environmental conditions, Aboriginal people are denied the health outcomes that non-Indigenous people now enjoy.

The challenge is huge.

  • Let’s consider clinic presentations for Aboriginal children for their first year of life. Did you know that research has found that the median number of clinic presentations per child in the first year of life was 21.  Twenty-one! Per child!   Children in this NT study would typically have six clinic presentations for diarrhea in any one year!  SIX! An infectious ear disease known as Otitis Media and skin infections were also high on the list of most frequent reasons for Aboriginal children coming to the clinic in their first year of life. These infectious diseases are NOT caused by bad parents.  They are caused by poor living conditions, overcrowding and poverty imposed on our people.
  • In the Fitzroy Valley in the Kimberley here in Western Australia, 70% of Aboriginal children have been admitted to hospital at least once before they turn seven years of age. A closer look at the reasons why is shocking.  The researchers concluded that most of these admissions would not have happened at all if household disadvantage, poor quality housing and access to primary health care had been addressed.
  • Another example comes from the Western Desert region here in Western Australia. This looked at clinic presentations of all children aged 0 to 5 years of age.  These children had on average more than 30 clinic visits each per year to their clinic. ………  Think about what that means to the morale of the parents, the attitudes of the clinicians, the health budget bottom line. Infectious diseases explained half of these presentations:
    • Ear infections were 15%
    • Upper respiratory tract infections, 13%
    • Skin sores were 12% of the total.
    • And 25% needed treatment for scabies.
  • These statistics aren’t just confined to remote communities. Aboriginal children in Western Sydney in homes with 3 or more housing problems were two and a half times more likely than others to have recurrent gastro-enteritis. For every additional housing problem, the odds of infectious disease significantly increased.

But is this all NEWS?  What about the year of your first NATSIEH conference in 1998?

1998 was the year a study was published showing that admissions to hospital for skin disease of Aboriginal children under five years of age was ten times higher than that of their non-Indigenous counterparts.

It was also the year that deaths among Aboriginal men from infectious diseases were calculated to be some 15 times higher than deaths among non-Indigenous men.

1998 was also the year a study measured the precise “wear and tear” on washing machines installed in seven remote communities.

1998 was a year AFTER a study had already been published showing that over one-third of Aboriginal remote communities had water supply or sanitation problems. Seventy percent had housing problems.  In the words of the researchers, overcrowding and substandard housing were “commonplace”.

So there we have it.   Even this brief snapshot shows we have a disconnect between data and decisions.

From your first conference in 1998 to this one in 2019 …

….  Aboriginal people, their children and now their children’s children have NOT been afforded their DUE HUMAN RIGHTS in response to these “repeat plays” of research data.

Should we have mobilised a more strategic response at the time these research studies were published?

Perhaps data sovereignty is another challenge we need to face.

I regret thinking of the number of children growing up since 1998 who should have been safe from preventable infections IF THERE HAD BEEN ACTION.  I think of how many children need not have gone to hospital.  Who should NOT have ended up with permanent damage for life from rheumatic heart disease or deafness …

… and would NOT have ended up with these conditions if their houses had been safe, healthy and affordable.

I have been told even mental health problems – including suicide – get worse in overcrowded houses not fit for social purpose.

And please don’t tell me we can’t find the money.  My colleagues in the Kimberley estimate that one third of the entire cost of hospital admissions of Aboriginal children is DIRECTLY due to the environmental conditions in which these children live.  Let me repeat that. One third of the entire cost.

In one year alone, $16.9 million is the estimated cost for hospitalisations of Aboriginal people directly due to the environment. And that was just the Kimberley.

Maybe all those departments of housing really don’t have the money BUT their colleagues in health departments are spending it hand over fist.

The Australian Indigenous Governance Institute affirms that Aboriginal people have the right to:

  • Exercise control of the data “ecosystem” including creation, development, stewardship, analysis, dissemination and infrastructure.

We also have the right to:

  • Data structures that are accountable to Aboriginal and Torres Strait Islander peoples and their governance structures.

And the right to

  • Data that is protective and respects our individual and collective interests.

AND

  • Data that is relevant and empowers sustainable self-determination and effective self-governance.

In my view, Aboriginal people must more clearly set the agenda for the health data story.

As Aboriginal people, WE are vested in the outcomes.  WE are accountable to each other, our families and communities.  These research studies represent OUR families, OUR loved ones, OUR LOST ones.

I believe the character and foresight of Aboriginal leadership will show the right path. 

Should you need convincing, I can think of no better example in environmental health than Yami Lester and the Nganampa Health Council in the APY lands.

Decades ago, these leaders knew that health improvement required medical services AND a healthy living environment.  In 1986, they initiated a collaborative project between local Anangu people and technical experts to ‘stop people getting sick’. Some of you may recognise this as the UKP project.

These Aboriginal leaders engaged Paul Pholeros and Dr Paul Torzillo to work together to develop a codified schedule for home assessments and repairs.  When assessments were finished, simple repairs to health hardware that could be fixed, WERE fixed.  Immediately, over 75% of these assessment and repair teams were local Aboriginal and Torres Strait Islander people trained and assisted by skilled managers and team leaders.

Any requirements for major repairs that were the responsibility of the landlord were submitted, logged and monitored. As this program expanded, data from different locations showed that the reasons for poor housing conditions were shoddy building materials in the first place (22%); inadequate maintenance schedules by the landlord (70%) and less than 8% was due to damage by occupants.

As relevant today, Yami Lester and his Council knew the importance of sharing with their people knowledge about disease transmission and supporting households to adopt new habits to sustain health in circumstances none of us would find easy.

And they succeeded.

Their legacy is the framework of nine Healthy Living Practices about washing, clothes, wastewater, nutrition, crowding, animals, dust, temperature and safety against injury.

Today, housing audits and home hardware assessments conceived by Aboriginal leaders in this UKP project MUST be permanently funded everywhere and combined with culturally responsive support directed by communities to re-build THEIR knowledge about disease transmission.

Every home is different.  Every environmental risk assessment is unique.  In one, there might be an issue with food-borne diseases. In another, passive smoking that affects the children’s ears, lungs and eyes.  In another, it could be …

– a blocked toilet,

– a shower dislodged from a poorly laid wet floor, or

– a washing machine that has collapsed under the pressure from multiple loads and hard water every single day.

Resources enable Aboriginal environmental health workers and families to work together over time to build the household’s confidence and knowledge.  The shared goal is self-management in healthy habits ….. AND an assertiveness as tenants to report poor quality building materials, housing problems and urgent repairs to the respective housing landlord.

Effective Aboriginal environmental health programs must be in Aboriginal hands.  Community controlled organisations must drive the necessary knowledge exchange between those who hold technical expertise and those who have been denied it. The very nature of this work means that Aboriginal communities must retain the reins – and retain the knowledge.

What Yami Lester envisaged is our unrealized obligation.

Housing programmes will have limited impact UNLESS they are controlled in their design and delivery by Aboriginal organisations with sustained visibility, authority and relationships in the community.  Communities have ideas on how to manage overcrowding, maintain housing stock and build new housing through local entrepreneurship. It is time once again for Aboriginal leaders to be heard.

You may know about extensive consultations conducted across the country in 2017 known as “My Life My Lead”.

The purpose of these consultations was to provide an opportunity to shape the next update of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan released originally in 2013.

At these consultations, Aboriginal people spoke up about the fundamental significance of social, economic and environmental determinants affecting their health and wellbeing.

Environmental health was identified as one of seven top priorities for the next Implementation Plan.

I quote:

Addressing the underlying environmental health conditions that contribute to poor health outcomes in many Aboriginal and Torres Strait islander communities will lead to long-term improved health, education and employment outcomes. 

This is why I hope my message to you today is clear. We will get better health by improving housing and environmental health programs. Regaining control over decisions about housing will also lead to better health.  Returning authority for decision-making to communities about resources and program design reinvigorates empowerment, autonomy and more equitable power arrangements.  Self-determination promotes health.

With a decent investment in Aboriginal housing alongside genuine shifts in who makes decisions about resource allocation, I am prepared to guarantee to you today that the impact on Aboriginal health outcomes will be large, positive and permanent.

If those estimates of the costs from hospital admissions hold true nationally, I am also prepared to guarantee a significant reduction in healthcare budgets.

Our Prime Minister is inclined to miracles … so I think this would be the next miracle he’d very much like to see!

If we believe in public health and preventing the preventable …

If we believe in equity and social justice …

If we believe in community control …

… then we have everything we need to turn this around.

To governments I say let Aboriginal leaders sit down with you and – together in partnership – analyse the current state of environmental health and housing in your jurisdictions.

Let’s establish the level of investment that will reduce the cost of hospitalisations of Aboriginal children, adults and elders due to poor housing and living conditions.

Let’s develop national standards for a safe house. Let’s agree to strict criteria for urgent and priority housing repairs.  Let’s audit repair performance.  Let’s publish the data.

Let’s get more accountability from public housing for proactive home maintenance schedules and repairs.

Let’s invest in environmental and building programs that will cut the demand in primary health care clinics by a quarter and let these busy staff focus on other priorities.

Let’s grow knowledge in our communities as experts in healthy living.

Let’s train, credential and employ young Aboriginal people as environmental health workers, plumbers, electricians and carpenters to keep houses safe, healthy and ready for climate change ahead.

Let’s ensure a sustainable on-the-ground workforce for effective environmental health employed by Aboriginal organisations.

Here at this conference, let’s create the cross-sectoral approach involving communities, environmental health, primary health care and governments IN PARTNERSHIP to get this moving.

In closing, I’d like to quote Senator Patrick Dodson, a Yawuru man from Broome who, in February this year, asked a very important question:

“Who actually closes the gap?”

He answered this by saying:

“It’s the people working at the grassroots, led by First Nations peoples, with a deep understanding and lived experience of the needs of their communities.”

It is in that spirit that I thank each and every Aboriginal Environmental Health Practitioner at this conference whether it is your 1st or your 12th.

I know you work hard. I know you care deeply about your communities.  I know you lead by example.

I respect your hard-earned skills and your expertise to provide a huge scope of professional services ranging from dog control to vector management.

I admire your precise and up-to-date knowledge of disease transmission routes, hazardous chemicals, sanitation and practical engineering.

I am sincerely impressed by the care you take to work with families whose circumstances are complex … and that you find THEIR strengths and work with their capacities.

You respect cultural protocols.  You deliver with few resources, a lot of ingenuity and teamwork.

It is enabling YOU to do an even better job for YOUR communities that motivates me to do mine.  And I will keep on working just as hard as you do.

It’s been a pleasure sharing my reflections with you all.

Thank you for this opportunity to kick off the second day of your 12th NATSIEH conference here in Perth.

 

NACCHO Health and #austph2019 Read full speech HERE : Acting @NACCHOChair Donnella Mills #Humanrights Panel – 48 years of Aboriginal and Torres Strait Islander Community Control’

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

Justice health partnerships provide a model of integrated service delivery that goes to the heart of the social determinants of health, key causal factors contributing to Aboriginal and Torres Strait Islander peoples’ over-exposure to the justice and health systems. In this way we are also focussing on the rights of our people.

Address the legal issues, and you will have better health outcomes.

In the health and justice areas the message is simple. Community-control works, cultural safety works and collaborative partnerships work.

With Aboriginal community control at the front and centre of service design, we can deliver both preventive law and preventive health for Aboriginal and Torres Strait Islander peoples. ”

Donnella Mills, Acting Chair NACCHO

Speaking at the Australian Public Health Conference, Adelaide Panel Plenary session titled ‘Human Rights’

I would like to acknowledge that the land on which we are meeting today is the traditional land of the Kaurna Nation. I respect the continuing culture of the Kaurna people and the contribution they make to the life of this important city.

You may wish to say ‘hello, how are you’ in the Kaurna language. If so, say:

“I understand that the traditional greeting in the Kaurna language is ‘Ninna Marni’.”

I am the Acting Chair of NACCHO, which stands for the National Aboriginal Community Controlled Health Organisation. For those of you who don’t know me, I am a Torres Strait Islander woman with ancestral and family links to Masig and Nagir islands.

You may also want to add ‘welcome’ in Meriam Mir. If so, “In the language of Masig Island, ‘Maiem’.”

Thanks are due to the Public Health Association of Australia for welcoming me here to speak today. I am delighted to be able to share ideas with you on a topic that is close to my heart. I am also honoured to be part of a panel with such two inspiring colleagues: Barri Phatarfod (Founder, Doctors for Refugees) and Mohammad Al-Khafaji (CEO, FECCA).

In this presentation I will look at Aboriginal and Torres Strait Islander justice issues and the role of NACCHO’s member organisations: the 144 Aboriginal Community-controlled health organisations (our ‘ACCHOs’).

It is always tempting to focus on problems. I could talk about the fact that our life expectancy is at the level of a Third-World nation: about ten years lower than the non-Aboriginal population.

I could talk about the unconscionably high rates of incarceration for Aboriginal and Torres Strait Islander people and our over-representation in state and territory gaols and institutions across the country. I could ask why nothing has changed since the Royal Commission into Aboriginal Deaths in Custody was initiated in 1988. But most of you are already very familiar with these topics and frustrations.

What I will focus on instead is the ACCHO model of health care, how it started and how it has evolved. Why? Because I think that our model of community control is a way forward. It gives Aboriginal and Torres Strait Islander people control. It gives our people the framework in which we can deliver our own health outcomes and develop our own solutions and are able to form genuine partnerships.

So, before we look forward, let’s look backwards for a moment, so that we can appreciate the context in which this model was forged.

NACCHO and the model of Aboriginal community control

 

The Public Health Association is celebrating 50 years since its foundation in 1969. Two years after that, in 1971, the first Aboriginal medical service was established at Redfern. It was a response to the urgent need to provide decent, accessible health services for the largely medically uninsured Aboriginal population of Redfern.

The mainstream was not working. So it was, that forty-eight years ago, Aboriginal people took control and designed and delivered our own model of health care.

Similar Aboriginal medical services quickly sprung up around the country. In 1974, a national peak organisation was formed to represent them at the national level. All this predated the huge Medibank reforms of 1975.

The ACCHO sector has been growing bigger and stronger every year since 1971. NACCHO – the national peak – now represents 144 ACCHOs across the country. Our members provide about three million episodes of care per year for about 350,000 people – that’s over half the Aboriginal and Torres Strait Islander population.

Collectively, we employ about 6,000 staff (the majority of whom are Aboriginal or Torres Strait Islander people), which makes us the single largest employer of Aboriginal or Torres Strait Islander people in the country.

It also shows the flow on effect of what we have been doing. In this case, that our health organisations are doing more to Close the Gap in Aboriginal employment than any government program or scheme.

There is a dangerous myth that Aboriginal and Torres Strait people receive ample funding. The Government’s own numbers show that, in real terms, health expenditure (excluding hospital expenditure) for Aboriginal people fell 2% from $3,840 per person in 2008 to $3,780 per person in 2016.

Over the same period, expenditure on non-Aboriginal people rose by 10%. How can Governments seriously expect to Close the Gap in health if funding is decreasing? The burden of disease for the Aboriginal and Torres Strait Island population is 2.3 times higher than for the rest of the population. The burden of disease can be six-times higher in remote areas.

Despite the funding shortfall, our ACCHOs continue to deliver excellent results.

The primary health care approach developed by Redfern and other early ACCHOs was innovative. It mirrored international aspirations at the time for accessible, effective and comprehensive health care with a focus on prevention and social justice. It even foreshadowed the WHO Alma Ata Declaration on Primary Health Care in 1978.

Just like we did in the 1970s, NACCHO has continued to play a leadership role. Some of you may be aware that, recently, NACCHO and almost 40 other peak Aboriginal and Torres Strait Islander bodies forced the nine Australian governments to get the Closing the Gap process back on track.

This is community control at the national level. It is the first time that Aboriginal and Torres Strait Islander peaks have come together in this way, to work collectively and as full partners with the nine Australian governments.

We need this sort of radical shift to the way governments work with Aboriginal and Torres Strait Islander people at all levels of policy design and implementation. We need a seat at the table and responsibility for making decisions about what governments do in our communities.

Another priority reform area is placing Aboriginal community-controlled services in all sectors – not just health – at the heart of delivering programs and services to our people. When we are in control and lead the design and implementation of services in our communities the outcomes are so much better.

We have also had some staunch allies along the way. ACOSS and the AMA, for example, continue to be a key friends in our sector. For example, the 2018 AMA Report Card was launched in November of last year. It highlighted research showing that the mortality gaps between Aboriginal and Torres Strait Islander people and other Australians are widening. NACCHO called for the immediate adoption of its recommendations.

Closing the gap on justice outcomes

Now that I have referred back to the history of the community-controlled model and where it is today, let me now switch the focus onto human rights and justice outcomes.

The World Health Organisation (WHO) sees the “highest attainable standard of health as a fundamental human right”. I agree with this statement.

Most of you here today know the shocking statistics. I have already mentioned that Aboriginal and Torres Strait Islanders have ten-years less in life expectancy than other Australians.

We must take a rights-based approach in addressing health inequities, if we are ever going to close the gap. This means that we need to address the social determinants of health, such as: education, housing, and other social and economic factors. This, of course, is a huge topic, so let’s just focus on justice outcomes.

Earlier this year it was reported that Aboriginal and Torres Strait Islander men are imprisoned at a rate almost 15-times greater than non-Aboriginal men, and for women the rate is even higher, 21-times worse than non-Aboriginal women.

Our women represent the fastest growing population group in prisons; their imprisonment rate is up 148% since 1991. Locking up our women affects the whole community. Children may be removed and placed in out-of-home care. Research has found there are links between detainees’ children being placed into out-of-home care and their subsequent progression into youth detention centres and adult correctional facilities. Communities suffer, and the cycle of intergenerational trauma and disadvantage is perpetuated.

Figures on the incarceration of our children and young people in detention facilities also reveal alarmingly high trends of overrepresentation. Our young people aged 10–17 are 26-times as likely as non-Aboriginal young people to be in detention on any given night. How can this be justified?

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

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

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

Emerging out of these inquiries is a growing understanding that an improvement in justice outcomes must begin with a commitment to self-determination, community control, and cultural safety. These are three of the most critical elements of the community-controlled model itself.

Appropriately resourced community controlled services are essential for addressing these barriers. Best-practice solutions to preventable problems of our peoples’ exposure to the justice system must begin with enabling their access to trusted services that are governed by these three principles.

But let’s see some traction on the ground with these statements. The intentions are there, but now is the time to act.

Case study – Law Yarn

As a lawyer myself and the ex-Chair of the Cairns-based Wuchopperen Health Service, I have become aware of the need to provide better legal supports for my community. In conversations with local Elders and LawRight, Wuchopperen entered into a justice health partnership in 2016.

LawRight is an independent, not-for-profit, community-based legal organisation which coordinates the provision of pro bono legal services for individuals and community groups. The aim of the partnership was to improve health outcomes by enhancing access to legal rights and early intervention. Initially, it was decided that, as community member and lawyer employed by LawRight, I would provide the free legal services at Wuchopperen’s premises.

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

Law Yarn is a unique resource that supports good health outcomes in Aboriginal and Torres Strait Islander communities. It helps health workers to yarn with members of remote, regional and urban communities about their legal problems and connect them to legal help.

Representatives from LawRight, Wuchopperen Health Service, Queensland Indigenous Family Violence Legal Service and the Aboriginal Torres Strait Islander Legal Services came together and created a range of culturally safe resources based on LawRight’s successful Legal Health Check resources. A handy how-to guide includes conversation prompts and advice on how to capture the person’s family, financial, tenancy or criminal law legal needs as well as discussing and recording their progress.

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

Conclusion

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

Justice health partnerships provide a model of integrated service delivery that goes to the heart of the social determinants of health, key causal factors contributing to Aboriginal and Torres Strait Islander peoples’ over-exposure to the justice and health systems. In this way we are also focussing on the rights of our people. Address the legal issues, and you will have better health outcomes.

If the Government really wants to help vulnerable populations, don’t punish them with cashless welfare cards, with robo-debts or by sending them off to meaningless Work for the Dole activities. Work with us, not against us.

In the health and justice areas the message is simple. Community-control works, cultural safety works and collaborative partnerships work.

With Aboriginal community control at the front and centre of service design, we can deliver both preventive law and preventive health for Aboriginal and Torres Strait Islander peoples.

Thank you.