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.

 

NACCHO Aboriginal Health #ClosingtheGap Download @AIHW Australia’s Welfare Report 2019 : Our mobs welfare is closely linked to health and is influenced by #socialdeterminants such as education, employment, housing, access to services, and community safety.

Indigenous wellbeing is shaped by the wellbeing of the community. In recent years there have been improvements in a range of areas of wellbeing for Aboriginal and Torres Strait Islander Australians.

Indigenous home ownership has risen over the past decade, from 34% in 2006 to 38% in 2016, household overcrowding has decreased, and fewer Indigenous Australians rely on government payments.

Education remains important in helping to overcome Indigenous disadvantage.

The employment gap between Indigenous and non-Indigenous Australians narrows as education levels increase.

There is no gap in the employment rates between Indigenous and non-Indigenous Australians with a university degree.

Despite these improvements, some Indigenous Australians experience widespread social and economic disadvantage.

One in 5 Indigenous Australians live in remote areas and fare worse than those in non-remote areas. They had lower rates of school attendance and employment, and were more likely to live in overcrowded conditions and in social housing.

Members of the Stolen Generations are another particularly disadvantaged group.

They were more likely than other Indigenous Australians to have been incarcerated, receive government payments as their main source of income, experience actual or threatened physical violence or experience homelessness.”

AIHW spokesperson Mr. Dinesh Indraharan.

” Many factors contribute to the welfare of Aboriginal and Torres Strait Islander Australians.

Welfare is closely linked to health and is influenced by social determinants such as education, employment, housing, access to services, and community safety. Contextual and historical factors are particularly important for understanding the welfare of Indigenous Australians.”

” Home ownership has an opportunity to formulate the next wave of transformative success for indigenous people.

Home ownership is a key pillar on the journey to economic independence for indigenous Australians, providing not only stable housing but also an anchor from which to build an asset base for current and future generations and equity for other investment and business opportunities.”

Dagoman-Wardaman man and chairman of Indigenous Business Australia Eddie Fry oversees a home loan program that is helping increasing numbers of Aboriginal and Torres Strait Islander people into home ownership. See Part 2 Below

The latest two-yearly snapshot of national wellbeing uses high-quality data to show how Australians are faring in key areas, including housing, education and skills, employment, social support and justice and safety.

The Australian Institute of Health and Welfare report Australia’s welfare 2019 was launched today in Canberra by Senator the Hon. Anne Ruston, Minister for Families and Social Services.

The report shows that record employment and an increase in education levels are contributing to Australia’s wellbeing but challenges facing the nation include housing stress among low-income earners.

Download the Report and Snapshot

aihw-aus-227

Australias-welfare-snapshots-2019

‘Australia’s welfare 2019 demonstrates the value in continuing to build an evidence base that supports the community, policy makers and services providers to better understand the varying and diverse needs of Australians,’ said AIHW spokesperson Mr. Dinesh Indraharan.

‘Australia is in the top third of Organisation for Economic Co-operation and Development (OECD) countries for a range of measures, including life satisfaction and social connectedness.

‘In 2018, 74% of people aged 15–64 were employed—the highest annual employment rate recorded in Australia. In July 2019 the female and total employment rates remain at record levels.’

The proportion of Australians working very long hours (50 or more per week) declined from 16% to 14% and more Australians are using part-time work to balance work with other activities including caring responsibilities.

However, in December 2018, about 9% of workers were underemployed, or unable to find as many hours of work as they would like. One in 9 families with children had no one in the family who was employed.

Generally, the higher a person’s level of education, the more opportunities they have in their working life.

‘Between 2008 and 2018 the proportion of students staying in school until Year 12 rose from 69% to 81% for males and from 80% to 89% for females,’ Mr Indraharan said.

‘In 2018, 65% of Australians aged 25–64 had a non-school qualification at Certificate III level or above. This is up from 55% in 2009.’

Australia has high levels of civic engagement with 97% of eligible people enrolled to vote in 2019—up from 90% in 2010 and strong rates of volunteering (contributing 743 million hours a year). But an estimated 1 in 4 Australians are currently experiencing an episode of loneliness – with people who live alone, young adults, males and people with children more likely to feel lonely.

Finding affordable housing remains a challenge for many Australians, with more people spending a higher proportion of their incomes on housing than in the past and fewer younger people owning their own homes.

‘More than 1 million low-income households were in housing stress in 2017-18, where they spent more than 30% of their income on rent or mortgage repayments,’ Mr Indraharan said.

There has been little change in income inequality since the mid-2000s—though it is higher now than it was in the 1980s—and wealth is more unequally distributed than income.

Most crime rates have fallen in recent years but Australia ranked in the bottom third of countries for people feeling safe walking alone at night.

‘Survey data shows rates of partner and sexual violence have remained relatively stable since 2005, while rates of total violence have fallen. However, the number and rate of sexual assault victims recorded by police has risen each year since 2011,’ Mr. Indraharan said.

Welfare services and support for people in need

Australian governments spent nearly $161 billion on welfare services and support in 2017-18, including $102 billion on cash payments to specific populations, $48 billion on welfare services and $10 billion on unemployment benefits. Per person spending on welfare increased an average of 1.3% a year—from $5,287 per person in 2001–02 to $6,482 in 2017–18.

Over the past 2 decades, there has been a notable fall in the number of people aged 18–64 receiving income support—down from 2.6 million in 1999 to 2.3 million in 2018. Put another way, in 1999, 22% of Australians aged 18–64 received income support, but this fell to 15% in 2018.

In 2017-18:

  • 1.2 million people (or 3 in 10 older people) received aged care services
  • 803,900 people were in social housing
  • 288,800 people were supported by Specialist Homeless Services
  • 280,000 people used specialist disability support services under the National Disability Agreement
  • 172,000 people were active participants in the National Disability Insurance Scheme (at June 2018)
  • 159,000 (or 1 in 35) children aged 0–17 received child protection services.

incarcerated, receive government payments as their main source of income, experience actual or threatened physical violence or experience homelessness.

Aboriginal and Torres Strait Islander Survey #HaveYourSay :

Pat Turner Lead Convener of the Coalition of Peaks invites community to share their voice on #ClosingtheGap

Part 2 From today’s Australian

More indigenous Australians than ever are homeowners, fewer live in overcrowded accommodation and Aboriginal and Torres Strait Islander people who rent are slowly shifting away from social housing in favour of private properties.

Figures to be published on Wednesday by the Australian Institute of Health and Welfare show almost two in five indigenous Australians were homeowners at the last census — of those, 12 per cent owned their home outright and 26 per cent had a mortgage. The number of indigenous households where the home is paid off or mortgaged has reached an estimated 263,000.

The rate of home ownership among indigenous Australians has gradually increased since 2006, while the home ownership rate among non-indigenous Australians has decreased slightly over the same period.

In 2006, 34 per cent of indigenous Australians owned their home or were paying it off.

By 2011 that figure had climbed to 36 per cent and at the 2016 census, 38 per cent of indigenous Australians either owned their homes outright or were paying off a mortgage.

In contrast, the percentage of non-indigenous Australians who either owned their home or were paying it off declined from 68 per cent in 2006 to 66 per cent in 2016.

Dagoman-Wardaman man and chairman of Indigenous Business Australia Eddie Fry oversees a home loan program that is helping increasing numbers of Aboriginal and Torres Strait Islander people into home ownership.

IBA approved more than $1bn in home loans to indigenous Australians over the past five years.

In 2014-15, IBA approved 517 home loans to Aboriginal and Torres Strait Islander people. In 2017-18, the number of home loans approved by IBA was a record 917.

“Home ownership has an opportunity to formulate the next wave of transformative success for indigenous people,” Mr Fry said.

“Home ownership is a key pillar on the journey to economic independence for indigenous Australians, providing not only stable housing but also an anchor from which to build an asset base for current and future generations and equity for other investment and business opportunities.”

The Australian Institute of Health and Welfare report used census data to show that, between 2006 and 2016, the proportion of indigenous households living in social housing fell from 29 per cent to 21 per cent.

The proportion of indigenous Australians renting privately increased from 27 per cent to 32 per ce

NACCHO Aboriginal #MentalHealth #SuicidePrevention @NMHC Communique : @GregHuntMP roundtable meeting to review investment to date in mental health and suicide prevention : #TimeToFixMentalHealth #TomCalma @AUMentalHealth @FrankGQuinlan @PatMcGorry @amapresident @headspace_aus

” Minister for Health, Greg Hunt, hosted a Government-led roundtable this week to review investment to date in mental health and suicide prevention, to hear from the sector on current gaps and priorities, to understand what is and is not working, and to advise on the upcoming national forum on youth mental health and suicide prevention.

Minister Hunt and Prime Minister Scott Morrison are committed to working towards zero-suicide for all Australians, including our youth.

From the National Mental Health Commission 6 June 

( The Indigenous ) Suicide rates are an appalling national tragedy that is not only depriving too many of our young people of a full life, but is wreaking havoc among our families and communities.

As anyone who has experienced a friend or family member committing suicide will know, the effects are widespread and devastating and healing can be elusive for those left behind.

It is time that we draw a line under this tragic situation that is impacting so significantly on Aboriginal and Torres Strait Islander communities  “

Noting Professor Tom Calma AO was a participant in the meeting via telephone link and opened the meeting with a discussion on Indigenous suicide. 

See this quote and 140 Plus Aboriginal Health and Suicide Prevention articles published by NACCHO in last 7 Years 

Those in attendance welcomed the Government’s commitment, with a number noting that suicide prevention needs to be a priority across all age groups, especially those groups with the highest suicide rates.

The conversation covered a range of key issues, challenges and opportunities for reform and action. Particular discussion points included:

  • Social determinants of mental health: there is a fundamental need to focus on the social determinants of mental health for all Australians, noting and emphasising the range of factors that contribute to distress in young Australians. This is an important factor for all young people and communities, with particular reference to the factors impacting on Aboriginal and Torres Strait Islander children and youth.
  • The impact of trauma and disadvantage: conversation centred on the impacts of trauma and disadvantage and the importance of supporting, for example, young people in out-of-home care, those living in poverty and individuals who are in the justice system.
  • Support for children and families: in order to improve the lives of young Australians, there is a need to better support children and families in the early years. This includes support for neurodevelopmental disorders. In the same way headspace has been developed for young people, there was a suggestion that mental health services focused on children and families could show real benefits.  There is strong support for a focus on prevention
  • Support for Schools: a continued need was highlighted around the role of, and support for, schools, including primary schools and early learning centres. Schools are a critical component of a ‘whole of community’ approach in building supportive environments for children and young people.   It was suggested that for families who may not seek services but who were in need a way of ‘connecting’ may be through digital tools, to identify and support children and parents in those families.
  • Impact on youth: young people can be seriously impacted and influenced by the suicide death of other young people who are their friends, peers, family members or celebrities. More timely and sophisticated data and comprehensive local responses are needed to assist in the reduction of risk for further lives being lost following a suicide.
  • Data: The importance of being able to collect, analyse and provide accurate data was highlighted.  This data is significant across mental health services and particularly for suicide prevention, treatment and support services.
  • Service reform: there is a need for service reform to better respond to people with mental health concerns that are too complex to be managed by a GP at a primary health care level but not so acute as to require specialist tertiary mental health services. While there are some good programs and services to build upon, there is a lack of equity across all regions and access remains a key issue for those requiring psychological and other services. We also need to integrate mental health services with drug and alcohol services.
  • Workforce development: there is an urgent need to focus on training and supporting the diverse professionals working with those at risk of or with mental health issues – health and allied health staff, drug and alcohol workers, school counsellors, psychologists, peer workers and many others. The role of peer workers was recognised as being a critical one and this must be included in all workforce development strategies and initiatives.
  • Peer and carer support: many families and peers supporting those who are in suicidal distress and/or living with challenging mental health and drug and alcohol concerns needed immediate and quality support themselves as they are also at risk for mental ill-health. Families and friends are the largest non-clinical workforce providing care and support for Australians and there is an immediate need to provide better supports for them.
  • Regional and national leadership: while attendees were supportive of regional planning and action, it was suggested that stronger guidance at a national level was needed in order to ensure equity and quality of service responses across the country, with a recognition of the importance of the role of Primary Health Networks.  Further work is needed to ensure that the roles and responsibilities of all governments were clarified, together with accountability. The Fifth National Mental Health and Suicide Prevention Plan, and particularly the Suicide Prevention Implementation Plan, are key drivers for clearer accountability and integrated and coordinated responses.
  • Funding models: there was discussion on how best to fund services across the range of needs, including the current review of Medicare and the role of private health insurance.

A collective agreement and strong commitment was reached that a collaborative approach is vital to achieving improved mental health outcomes for all Australians, including children and youth.

There is significant support for a 2030 Vision for mental health and suicide prevention, to be led by the Commission and to ensure that the systematic changes required to best service the community can be identified, prioritised and achieved. This Vision would be look beyond the current plans and strategies.

Attendees acknowledged the commitment to mental health and quality program responses in recent years, together with the increased funding in the 2019/20 federal budget for expanded youth and adult mental health services in the community, together with initiatives to strengthen the collection of critical data around suicide and mentally healthy workplaces.  They also noted the current enquiries being undertaken by the Productivity Commission and the Victorian Royal Commission.  However, there needs to be an increased focus on longer term systems reform.  The Commission has been tasked with taking a leading role in this and will work closely with the sector to develop a reform pathway.

Participants embraced the importance of hope, recognising not only the significant investment to date but that youth mental health services in Australia have been copied by other nations.  There is strong support for improvements in mental health and suicide prevention across all levels of government and community.

As outlined by the Minister for Health, this was an opportunity to review the current status and continue this important discussion.  It is one of many conversations that will continue with the sector at organisational, group and individual levels.

The Commission will provide updates in sector engagement and discussions as they occur.

Lucy Brogden

Chair, National Mental Health Commission

Christine Morgan

CEO, National Mental Health Commission

 

NACCHO Aboriginal Health and #Ice #ClosingTheGap : Some call it an epidemic, others call it the “Ice Age”. What ever you call it , it is destroying families, and Indigenous culture

“You need to trust us to be able to deliver a service to our own people linked in with culture. Who are the right people to deliver that? Our people.

I have seen it a thousand times over. Once they are addicted to ice, culture’s gone, you don’t care about your kids, your primary focus is ‘I need this drug.’ It is worse than heroin.

Ice has a terrible impact on the family. Yet there was nothing to explain to families “why all your stuff is being sold at the pawn shop” and how to get help “

Tanya Bloxsome, a Waddi Waddi woman of the Yuin, who is chief executive of a residential rehabilitation service for men, Oolong House

Read over 60 Aboriginal Health and Ice articles published by NACCHO

Originally published SMH Julie Power

It makes Nowra grandmother Janelle Burnes’ day when her grandson Lucas* says, “Nanny, you’ve got a beautiful smile. I love you.”

The Wiradjuri woman has been punched and kicked by eight-year-old Lucas, who hears voices and suffers psychosis.

Janelle Burnes had to give up work to care for her eight-year-old grandson. He suffers from a range of mental illnesses, including psychosis, attributed to his parents’ ice addictions.

Abandoned by his mother as a baby, Lucas has fetal alcohol and drug syndrome attributed to his parents’ ice use when he was conceived.

Experts told the NSW special commission of inquiry into ice in Nowra last week that they were increasingly seeing multiple generations of users living together, exposing children to violence, neglect, abuse and witnessing sex and drug use by intoxicated adults.

Some call it an epidemic, others call it the “Ice Age”.

When Lucas hit his grandmother over the head with a guitar, she didn’t yell at him. Determined to stop the boy from becoming part of another generation broken by ice, Ms Burnes ignored the blood running down her face and the waiting ambulance.

“I walked back to him, I hugged him, I cuddled him, I told him, ‘You are going to hurt Nanny if you do stuff like that.’ And I gave him a kiss and I told him I still loved him.”

Ice is a stronger and more addictive stimulant than speed, the powder form of methamphetamine, the Alcohol and Drug Foundation says. It causes aggression, psychosis, stroke, heart attacks and death. It causes confusion, making it nearly impossible to get a rational response from someone under the drug’s influence.

Tanya Bloxsome, chief executive of Oolong House, a residential rehabilitation service where more than 90 per cent of its male residents have been addicted to ice. CREDIT:LOUISE KENNERLEY

Ms Burnes doesn’t blame Lucas for his behaviour, but ice. It is destroying Indigenous and non-Indigenous families across the Shoalhaven region. It is also destroying Indigenous culture.

To recover, Indigenous leaders say they have to develop role models and restore pride in their identity.

“You need to trust us to be able to deliver a service to our own people linked in with culture. Who are the right people to deliver that? Our people,” said Tanya Bloxsome, a Waddi Waddi woman of the Yuin, who is chief executive of a residential rehabilitation service for men, Oolong House.

“I have seen it a thousand times over. Once they are addicted to ice, culture’s gone, you don’t care about your kids, your primary focus is ‘I need this drug.’ It is worse than heroin.

“Ice has a terrible impact on the family,” she said. Yet there was nothing to explain to families “why all your stuff is being sold at the pawn shop” and how to get help.

Nearly two-thirds of 52 Indigenous and non-Indigenous children placed in out-of-home care in the Nowra region in the past year were removed because of ice use by their parents. It was also a “risk factor” in about 40 per cent of the 124 families working with Family and Community Services’ case managers.

When Indigenous groups met the commission last week, they said they needed more culturally appropriate programs, rehabilitation places and detoxification units (the closest are in Sydney, Canberra and Dubbo).

Indigenous Australians are more than 2.2 times as likely to take meth/amphetamine than other Australians.

In the opening address to the commission, Sally Dowling, SC, said the impacts of colonisation and dispossession, intergenerational trauma and socio-economic disadvantage had continued to contribute to high levels of amphetamine use in Indigenous communities.

Ice use in Nowra is not as bad as out west. But the region has seen the biggest year-on-year growth in arrests for possession and use since 2014, with a 31 per cent increase compared with 6 per cent across the state.

Cheaper than Maccas

Getting high on ice was “cheaper than going for Maccas”, said Nowra’s Aboriginal Medical Corporation’s substance abuse counsellor Warren Field, who runs a weekly men’s group for recovering addicts.

Ice had also become a “rite of passage” for some young people after they had received their first Centrelink payment or wage.

Mr Field said “99 per cent” of ice users had suffered some form of trauma. Nearly all had other mental health problems, including anxiety and depression.

“Everyone says there is nothing [like it] that will numb the pain and take the grief and loss away,” he said. It also makes women lose weight and gives men incredible sexual prowess.

“Most people are vulnerable when they go through a traumatic event and the Aboriginal community has had more than its fair share of that,” he said.

He argues they know what works – culturally appropriate rehabilitation which develops strong role models and a sense of identity. But there had to be more support when people came out of rehabilitation to stop them from relapsing.

The first year of rehabilitation was particularly hard. People in recovery were often depressed and their ability to feel happiness or pleasure without the drug was dulled.

Mr Field said “black fellas” were also unfairly targeted by police who, he argued, should spend more time closing the crack houses that “everyone” knew about.

 

At Oolong House, 21 men – 18 of whom were Indigenous – were getting themselves breakfast while 42-year-old Bobby McLeod jnr played guitar and a mate accompanied him on the didgeridoo.

More than 90 per cent of men in the program had been using ice, very often with other drugs, and increasingly with heroin, Ms Bloxsome said.

“Every addicted person who comes in here has a mental health issue,” she said. And residents addicted to ice were more psychotic than those addicted to other drugs.

Most residential programs are 12 weeks, but Oolong offers 16 weeks, and Ms Bloxsome believes even longer programs would be better. But like services up and down the South Coast, it can’t keep up with demand.

The program offered cognitive behavioural therapy, addressed mental and physical health, and encouraged the men to undertake training that would help them get work. Nearly all the men arrived with hepatitis C and those released from jail were, with few exceptions, addicted to the drug, bupe (buprenorphine).

The most powerful medicine, though, was getting back to culture by doing traditional dance, learning language and going on bush walks. After a lifetime in prison, Mr McLeod  said painting and writing songs about his life had helped his recovery.

When everything else was bad, ice had made him “feel invincible”. But it cost him his family and caused anxiety and depression, which made him feel suicidal.

His old man was a successful singer, his brother had travelled around the world with an Indigenous dance group, but he was the one who “went to jail”, Mr McLeod said.

Raising money for a funeral 

Ms Burnes lives in fear of a phone call telling her that Lucas’ 39-year-old mother is dead.

In anticipation of the inevitable – her nephew died earlier this year from a heart attack caused by his ice addiction – she is raising money for anticipated funeral costs.

Lucas’ mother has had three heart attacks caused by decades of addiction.

Janelle Byrnes is planning a funeral for her ice-addicted daughter. In a Facebook post, her 39-year-old daughter asks others to stop using ice. CREDIT:FACEBOOK

In a Facebook post, her daughter wrote about how her “huge addiction” had caused two heart attacks in two weeks.

“Now I’ve got to plan my funeral just in case I don’t make the next,” she wrote. “That’s not the saddest thing. It is listening to my mum cry and plan it with me. ”

“If U love your family reconsider having that pipe or putting that needle in your arm,” Ms Burnes’ daughter said.

In the meantime, Ms Burnes does everything she can to provide a stable home for Lucas.

She quit her job of 22 years as an Aboriginal education officer to care for her grandson, to ensure he gets to doctors’ appointments and maintain his schooling.

She’s been working with him to maintain his good results in reading and spelling, despite frequent suspensions for getting into fights, so he has a chance of fulfilling his dream of becoming a police officer.

* name changed

With additional reporting by Louise Kennerley.

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

 

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

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

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

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

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

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

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

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

Written by Melissa Sweet for The Guardian

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

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

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

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

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

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

Renee Blackman interviewed by NACCHO TV in 2016

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More info HERE 

NACCHO Acting Chair, Donnella Mills

A multiplier effect

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

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

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

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

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

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

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

An unfair burden

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

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

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

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

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

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

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

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

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

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

A big silent killer’

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

See PHAA #JusticeHealth2019 Website

Aboriginal community control and justice health

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

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

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

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

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

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

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

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

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

Scene setting

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

SLIDE 3: Overrepresentation – causal factors

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

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

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

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

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

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

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

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

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

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

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

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

SLIDE 4: Justice reinvestment

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

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

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

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

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

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

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

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

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

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

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

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

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

SLIDE 6: Health justice partnerships

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

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

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

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

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

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

 Case study: Law Yarn

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

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

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

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

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

SLIDE 8: Law Yarn – your law story

SLIDE 9: Four aspects of Law

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

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

SLIDE 11: Launch of Law Yarn

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

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

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

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

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

SLIDE 12: Thank you

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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