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

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

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

Download the PC issues paper HERE mental-health-issues

See Productivity Commission Website for More info 

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

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

NACCHO Chairperson, Matthew Cooke 2015 Read in full Here 

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

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

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

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

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

Background

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

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

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

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

Scope of the inquiry

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

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

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

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

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

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

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

Key inquiry dates

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

Submissions and brief comments can be lodged

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

Contacts

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

Subscribe for inquiry updates

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

 

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

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

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

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

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

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

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

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

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

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

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

Assessing the consequences of mental ill-health

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

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

 

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

 

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

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

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

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

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

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

Donate at the the GOFUNDME PAGE

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

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

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

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

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

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

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

Read full speaking notes HERE

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

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

Australie: une cagnotte pour faire libérer des femmes aborigènes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Call for income-appropriate fines

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

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

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

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

ABC NEWS: SARAH COLLARD

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

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

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

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

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

“It’s a terrible, terrible thing

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

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

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

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

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

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

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

Salt of the earth see Part 2 below

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

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

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

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

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

Christine Corby said the garden was crucial to these people

The Garden was featured recently in our #refreshtheCTGrefresh campaign

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

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

See original ABC post here

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

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

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

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

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

Elder Rick Townsend lives near the water treatment plant.

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

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

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

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

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

Part 2 : Salt of the earth

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

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

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

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

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

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

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

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

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

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

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

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

Part 3 Community veggie garden under threat

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

Christine Corby said the garden was crucial to these people.

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

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

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

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

 

‘It’s going to keep everyone alive’

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

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

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

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

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

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

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

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

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

Part 4 The upstream imbalance

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Spirits at low ebb

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

The Hon Tony Abbott MP address to Parliament 6 December 

Download a copy of Improving education outcomes for Indigenous children

Watch speech HERE

Watch SkyNews Interview HERE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

6 Major Recommendations 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Many people feel unsafe accessing the care they need.

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

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

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

See the #RefreshtheCTGRefresh Campaign post HERE

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

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

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

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

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

Summer May Finlay writes Part 2 below for Croakey 

Part 1 : Why an urgent need for action

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

Aboriginal control

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

Healing

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

A public policy crisis

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

 .

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

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

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

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


 

Healing and support crew on hand should the be needed 

Summer May Finlay writes:

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

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

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

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

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

Representation matters

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

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

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

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

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

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

Safe spaces needed

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

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

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

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

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

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

Culture is key

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

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

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

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

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

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

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

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

Listening with heart

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Minister Indigenous Health Ken Wyatt see full speech Part 2 below

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

Part 1 NACCHO Keynote by John Havnen Senior Policy Officer 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 Part 2 Minister Indigenous Health Ken Wyatt keynote 

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

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

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

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

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

To form new partnerships.

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

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

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

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

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

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

But there is still much work to be done.

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

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

Alcohol and drug abuse has a broad and insidious impact.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

These range from alcohol restrictions to treatment and rehabilitation.

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

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

Alcohol is a particular problem in the Northern Territory.

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

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

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

It is equally high on our Government’s agenda.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But there is one big lesson from that success.

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

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

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

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

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

NACCHO Aboriginal Health and #SocialDeterminants #Housing : Why do we need another study to evaluate the impact of housing policies on the health and wellbeing of our mob ?

 ” A new study will evaluate the impact of housing policies on the health and wellbeing of First Nations people thanks to a $250,000 grant from the Australian Government.

Shelter WA will lead this work around the country to assess environmental health impacts, short term versus long term policy vision and how we manage the construction and maintenance of housing for Aboriginal and Torres Strait Islander people.”

Minister Ken Wyatt Press Release See in full Part 1

A recent Senate Estimates have highlighted the failure of Indigenous Affairs Minister Nigel Scullion to negotiate a new remote Indigenous housing agreement with the states and territories.

In its May Budget, the Coalition effectively axed the National Partnership Agreement on Remote Indigenous Housing (NPARIH), which had invested $5.4 billion over the previous decade to address severe overcrowding.

The Government’s own independent review clearly states that “high levels of overcrowding and poor housing condition negatively impact on outcomes in health, education, employment and safety.

 The decision left Western Australia, Queensland and South Australia without any ongoing funding arrangement for remote Indigenous housing.

Shadow Housing and Homelessness Minister, Senator Doug Cameron, said the hearing also exposed the scale of the Coalition’s cuts to remote housing.

” Houses that are not well-maintained fall out of commission quickly and do not provide their basic function of supporting the health and wellbeing of tenants. While overcrowding is present, the need for maintenance is even greater.

Future funding is needed from governments as the costs of housing cannot be covered by rental income or other forms of investment due to market factors. Governments should work together to set a target for reducing the taxpayer subsidy for running social housing in remote Indigenous communities.

Ongoing funding, at least to maintain housing created, will protect the $5.4 billion investment already made under the Strategy. Without this funding, the Panel is confident houses will quickly fall out of commission, wasting the Strategy’s progress.”

See all the recommendations from 2017 Remote Housing Review Part 3 below

WA’s peak housing body has been angered enough to wade into a toxic fight over WA’s remote Indigenous communities, after Prime Minister Scott Morrison commented in Perth that the 10-year Commonwealth-state funding agreement was for “a couple of years” only, and that remote housing was a WA responsibility.

Twelve thousand outback residents wait in limbo, some suffering illnesses including leprosy, tuberculosis and trachoma – which has been described as a “national disgrace”, and is directly related to overcrowded, inadequate housing. ”

Read full media coverage Here 

 ” Indigenous affairs envoy Tony Abbott appears to be trying to make amends with the Borroloola community, who were less than impressed with his first visit, by giving them second hand RAAF base houses, some of which may already be over forty years old.

The NT News understands that the houses may only be liveable for two to five years and the NT Government provided feedback that they were not a suitable option.

The secretive process that the federal indigenous affairs envoy and NT Senator Nigel Scullion undertook in plucking 12 houses from beside the Stuart Hwy has come under scrutiny and questions have been raised as to the suitability of the homes, most of which were built in the late 1970s and have been sitting roadside for over four years.

Read NT media coverage HERE 

 

Read NACCHO Press release HERE

Part 1 Housing Study Aims to Improve Health of First Australians

The 2017 national My Life My Lead report highlighted housing’s importance, finding better housing conditions would improve First Australians’ health and were also linked to increased participation in education, employment and the community.

The Commonwealth’s investment through the National Partnership Agreement on Remote Indigenous Housing has delivered significant results.

Our Remote Housing Review, completed in partnership with leading Indigenous Australians, found that there had been a significant decrease in the proportion of overcrowded households in remote and very remote areas, falling from 52.1 per cent to 37.4 per cent by 2018.

Read or download the report HERE 

review-of-remote-housing

The Commonwealth remains committed to future investment in remote Indigenous housing and has agreed to provide $550 million for future remote housing investment in the Northern Territory.

Offers for further investment in Western Australia, Queensland and South Australia remain on the table for state governments to consider.

Shelter WA will work closely with project partners the National Aboriginal Congress and National Shelter to deliver this study, helping to ensure there is a strong First Nations voice and national perspective in future housing policy.

Work will commence immediately with the results of the study expected to be concluded by mid-2019.

 

Part 2 Labor Press Release October 2018

A recent Senate Estimates have highlighted the failure of Indigenous Affairs Minister Nigel Scullion to negotiate a new remote Indigenous housing agreement with the states and territories.

Shadow Housing and Homelessness Minister, Senator Doug Cameron, said today’s hearings also exposed the scale of the Coalition’s cuts to remote housing.

In its May Budget, the Coalition effectively axed the National Partnership Agreement on Remote Indigenous Housing (NPARIH), which had invested $5.4 billion over the previous decade to address severe overcrowding.

The Government’s own independent review clearly states that “high levels of overcrowding and poor housing condition negatively impact on outcomes in health, education, employment and safety.”

The decision left Western Australia, Queensland and South Australia without any ongoing funding arrangement for remote Indigenous housing. Evidence today from the Department of Prime Minister and Cabinet revealed that contrary to claims by Minister Scullion that “there are no cuts to housing”, no new Commonwealth funds have being delivered this year.

“As a matter of urgency, Minister Scullion must establish a program of negotiations with state and territory governments to resolve future

Commonwealth funding arrangements for remote Indigenous housing,” Senator Cameron said.

“Priority must be given to a building program that assists in reducing the negative health implications of severe overcrowding.”

Reports by the ABC just this week have drawn attention to the prevalence of Rheumatic Heart Disease in remote Indigenous communities. RHD is a preventable illness affecting about 6,000 Australians, with Indigenous children 55 times more likely to die from the disease than their non-Indigenous peers.

The causes can be as common as repeated throat and skin infections, caused by living in overcrowded housing conditions, but the consequences can be devastating, leading to permanent heart damage and even death.

“Despite the seriousness of the issues, Minister Scullion’s performance today was aggressive, amateurish and incompetent,” Senator Cameron said.

“It’s clear that if the Minister is unable to reach agreements with the states and territories he will be responsible for the ongoing poor health outcomes in remote communities.”

Labor believes a committed, ongoing partnership from all levels of government is essential to meet the scale of the need in remote communities.

The Morrison Government should be working cooperatively with Indigenous communities to ensure services are delivered as efficiently and effectively as possible. Senator Cameron said that in light of Minister’s performance, Prime Minister

Morrison should seriously consider whether he has confidence in his ability to carry out his responsibilities in the portfolio.

Part 3 8.3 Key Findings

Continued investment by governments will be required beyond 2018, at least in the maintenance of existing tenancies, where there are limited opportunities to recover costs through rent or other charges.

Governments should work together to set a target for reducing the minimum cost of taxpayer subsidy for the operational expense of running social housing in remote Indigenous communities.

High costs prohibit financial returns and mean funding is required for a remote housing program to be sustainable, even with improvements to PTM.

Government funding could be used to develop impact investment financing models, but this needs further exploration and trialling in less unfavourable markets, before it would be sensibly trialled in a remote context.

Future Directions – Panel recommendations

The Strategy has made a significant difference to the lives of many families in remote Indigenous communities. A long-term investment in remote Indigenous housing is needed for additional houses and to maintain existing stock.

Our recommendations build on the lessons learned from the Strategy and previous investment.

Recommendation: A recurrent program must be funded to maintain existing houses, preserve functionality and increase the life of housing assets

Houses that are not well-maintained fall out of commission quickly and do not provide their basic function of supporting the health and wellbeing of tenants. While overcrowding is present, the need for maintenance is even greater.

Future funding is needed from governments as the costs of housing cannot be covered by rental income or other forms of investment due to market factors. Governments should work together to set a target for reducing the taxpayer subsidy for running social housing in remote Indigenous communities.

Ongoing funding, at least to maintain housing created, will protect the $5.4 billion investment already made under the Strategy. Without this funding, the Panel is confident houses will quickly fall out of commission, wasting the Strategy’s progress.

To avoid creating two classes of housing in communities, a future agreement should include repairs and maintenance of all dwellings in remote Indigenous communities, not just those built or refurbished under the Strategy.

Recommendation: Investment for an additional 5,500 houses by 2028 is needed to continue efforts on Closing the Gap on Indigenous Disadvantage

The investment under the Strategy has improved the life outcomes of many Aboriginal and Torres Strait Islander families, but problematic overcrowding still exists and the population is growing.

An additional 5,500 dwellings are needed, to address current levels and the potential for a return to higher overcrowding levels due to population growth if efforts are not maintained.

An additional 5,500 dwellings are projected to further reduce overcrowding to a level of 25-30 per cent by 2028 and as such will continue to support efforts for Aboriginal and Torres Strait Islander people and Closing the Gap.

Recommendation: The costs of a remote Indigenous housing program should be shared 50:50 between the Commonwealth and the jurisdictions

Under the Strategy the Commonwealth was the sole funder of the program which meant jurisdictions lacked skin in the game and the Commonwealth reacted to protect its interest by introducing a series of processes that had unintended consequences.

A genuine financial partnership between the Commonwealth and jurisdictions would focus the attention of both levels of government to the delivery of outcomes, not outputs. Shared responsibility for funding would establish a partnership that works toward shared goals.

If responsibility for funding is shared, then both levels of government have incentives to run an efficient program.

Recommendation: Establish a regional governance structure to facilitate better administration of the program

Commonwealth and jurisdiction governments need a way of working with each other and with communities that facilitates management of an inherently complex program. All parties should be able to contribute information and perspective to help guide sound decision making.

A regional governance framework would facilitate more effective collaboration between Commonwealth, jurisdiction and local governments, and communities. It would have the added benefit of bringing planning and decision making closer to the ground and would create a more responsive program. In addition, communities that can organise themselves will have a formal mechanism for input.

Bringing local government into the governance structure means the community and region would have a greater stake in the success of the program.

Recommendation: A higher level of transparency is required: a sound performance framework and information processes that are relevant to individuals and communities, and derivative of the information that is needed for regional governance of the program

One of the key failures of the Strategy was its information collection.

Improved transparency would foster mutual responsibility for all parties to identify problems and share solutions. It is important the reasons for decisions are known and all parties are incentivised to find innovative solutions to local problems.

By focusing on collecting data that is needed for decision making to serve overarching policy, performance indicators for the program as a whole can be developed that have real meaning in terms of the achievement of better and sustained housing amenity for Aboriginal and Torres Strait Islander people living in remote Australia.

Recommendation: Best practice fora should be established to share information across the Commonwealth, jurisdictions, regional governance bodies and service providers

To improve housing delivery, best practice, challenges and experience need to be shared. Multilateral fora between the Commonwealth and jurisdictions to share experiences are important. There should also be opportunities for regional governance bodies, service providers and community leaders to share their learnings.

Best practice fora should consider housing experiences outside communities and jurisdictions funded by the Strategy. Other jurisdictions, and urban and regional housing providers should be included in broader discussions for best practice in social and Indigenous housing.

Recommendation: A minimum five year rolling plan for the program should be established

The two year timeframes introduced as part of the competitive bids were too short for proper planning and undermined the effectiveness and efficiency of jurisdictions’ efforts to deliver the Strategy particularly for housing construction.

A minimum five year rolling plan for the program should be established with proper mechanisms for performance management and information systems as outlined in the previous recommendations.

A program that retains the intended long planning cycles in practice would enable better decision making and flexibility to respond to local conditions, incentivise investment in better systems, improve coordination between service providers and administrators, achieve economies of scale, and support the development of additional capacity and training of local workforces and businesses.

Recommendation: Regional sample surveys (using the survey–and–fix methodology of the Fixing Houses for Better Health program) must form a core part of the regional governance and monitoring strategy

A recurrent, proactive maintenance program is fundamental to preserve functionality and increase the life of existing housing assets in remote Indigenous communities. Cyclical maintenance programs must be developed more consistently across the program.

This should be reinforced by a requirement for regional sample surveys using the survey-and-fix methodology of the Fixing Houses for Better Health program.

The long-term cost of property management is decreased by having a cyclical maintenance program in place. Data from the surveys would enable the governance structure to make sound and evidence based policy decisions about delivery of the program and to develop long-term plans for additional construction, conduct repairs, and establish a recurrent and proactive maintenance program.

Recommendation: Details about certification of properties (at all stages of building, and for life after acceptance and tenanting) should be reported to the governance structure to ensure construction in remote communities is compliant with the appropriate building and certification standards and sub-standard builders are eliminated

Housing in remote communities must be built and upheld to the same effective standard as in urban areas. Compliance with existing Commonwealth and jurisdiction legislation for housing standards and the National Indigenous Housing Guide (that lifts the standard to that appropriate for remote areas) is not negotiable. Regulation of housing standards needs more assertive management across the project management life cycle – planning, project delivery, acceptance and post-acceptance functioning.

Certification of houses should be robust and require a level of compliance appropriate to remote environments, delivering the same amenity as applies for houses in urban areas. All non-arm’s length certification arrangements should be eliminated and independent scrutiny that houses meet standards post acceptance and for years after tenanting would add rigour.

This rigour will ultimately improve conditions for Aboriginal and Torres Strait Islander people, improve health and other social outcomes and will ultimately reduce costs and protect governments’ investment over the longer term.

Recommendation: The regional governance bodies should work with local employers to plan how to develop the local work force and create more local employment

The employment opportunities that arise from housing construction and maintenance activities have provided positive outcomes for communities in some areas. There is scope to increase efforts and derive benefits more broadly.

Where possible, local employment opportunities should be maximised and the local labour force developed in partnership with local businesses and councils. A regional governance body should work with local businesses or councils as potential employers, and with regional training organisations, to develop a plan to train and develop the local labour force and businesses.

Where local people are employed by local businesses or councils to do the work, it can reduce the cost of delivering PTM and improve the timeliness of response.

Recommendation: Comprehensive planning across governments, involving local communities, is essential for the next remote Indigenous housing national program

Town and community planning are important to ensure that communities are developing in ways that meet the aspirations of local people. Plans need to assess whether housing is appropriate for its location and local cultural requirements.

Governments should link and develop plans for infrastructure and housing together, under town and community planning principles. Plans should include housing-related infrastructure in parallel with housing delivery, and coordinate municipal and essential services requirements and infrastructure needs including the need for new land development or upgrades of essential services.

Plans should be completed to the same quality standard as applies for urban environments.

Governments should focus on resolution of land tenure in communities with significant need that have not received investment.

A long-term, coordinated effort between governments would avoid duplication in effort and wasted investment.

Recommendation: Tenancy education programs should be implemented. Outreach services for tenancy tribunals to improve access in remote communities should be funded

Consequences and enforcement of rights and responsibilities are important for both tenants and landlords. Tenants and landlords (jurisdictions) have frustrations in enforcing their rights and ensuring compliance with responsibilities.

Clear understanding of rights and responsibilities by tenants would assist. Better access to tenancy tribunals in remote communities could assist both tenants and landlords resolve complaints and enforce compliance. There are opportunities for sharing and replication of best practice in the creation of incentives for householders to look after and preserve their housing.

Activities that continue to support better application of PTM will assist tenants in managing their rights and responsibilities under the program.

 

NACCHO Aboriginal Health News : #NACCHOagm2018 Delegates agree unanimously to motion that the #CDP is discriminatory and is causing significant harm, hardship , distress and they call on cross bench senators to reject the Bill in its entirety

” The National Association of Aboriginal Controlled Community Health Services, in its submission, warned that extending the four-week payment cutoff penalty to CDP and requiring recipients to reapply would be much more difficult for people in remote areas who may have language barriers, lack access to a phone or have underlying cognitive or health impairments and will likely mean that Aboriginal people in CDP regions will have less access to income support payments than other Australians”.

The Australian 

 ” NACCHO is deeply concerned by the Community Development Program (CDP) and its impact on Aboriginal people living in remote areas or CDP regions. We believe that the CDP is discriminatory and is causing significant harm, hardship and distress to Aboriginal people across Australia. NACCHO does not support the CDP nor does it support the proposed Bill. We believe the proposed Bill will only worsen the impact of the current CDP.

The Senate must recognise the unanimous voice of Aboriginal and Torres Strait Islander people and reject this Bill.”

Background : Extracts from NACCHO submission  post 15 October Read in full

We haven’t come here to bash the government or criticise, we’ve come here with a solution and the solution is here and we’re willing to work with all government at all levels,” he said.

What it reminds me of is a modern day Wave Hill situation- where Aboriginal people were paid sugar, flour and tea,

Those sorts of conditions and that sort of wage offer and assistance for Aboriginal Australians should not be offered in this day and age.”

John Paterson, CEO of Aboriginal Peak Organizations said the current program is “not an effective piece of work” and claims it puts “so many breaches on Aboriginal people” 

Picture below speaking at Parliament House September 2018 see NITV SBS Article

Motion below by John Paterson on CDP to the NACCHO 2018 Conference, 1 Nov 2018

Moved: Tim Agius, Durri ACMS, Kempsey NSW

Seconded: Vicki O’Donnell, KAMS

Agreed unanimously.

That the NACCHO 2018 Conference endorses the following:

NACCHO member services are deeply concerned by the Community Development Program (CDP) and its impact on Aboriginal people living in remote areas or CDP regions.

We believe that the CDP is discriminatory and is causing significant harm, hardship and distress to CDP participants and their families and deepening poverty in communities.

We do not support the Social Security Legislation Amendment (Community Development Program) Bill 2018 (CDP Bill) currently before the Parliament. We believe the Bill will only worsen the impact of the current CDP.

In particular, the proposed application of the mainstream Targeted Compliance Framework (TCF) is inappropriate for remote community conditions and will result in a worsening of already unacceptable rates of serious breaches and penalties applied to participants and an increase in disengagement from the scheme.

Other proposed changes, such as reducing the number of hours that CDP participants must Work for the Dole and offering wage subsidies, can be achieved without the Bill.

We are heartened by the opposition to the Bill expressed by Labor and the Greens and the support for Aboriginal concerns expressed by cross bench members of the Senate.

We urge cross bench Senators to reject the Bill in its entirety.

We call for urgent and fundamental reform of the program to be achieved through direct engagement and collaboration with Aboriginal peak and community organisations.

We propose the Fair Work and Strong Communities scheme proposed by APO NT and a coalition of Aboriginal organisations and national peak bodies as the appropriate basis for this discussion.

 NACCHO Aboriginal Health and Food security #IndigenousNCDs : Welfare reform is targeting many remote-living Aboriginal people impoverishing them and resulting in the consumption of unhealthy foods that are killing them prematurely from non-communicable diseases

What national and average Closing the Gap figures do not tell us is just how badly the estimated 170,000 Indigenous people in remote and very remote Australia are faring. This region where I focus my work covers 86 per cent of the Australian continent.

In the last decade new race-based instruments have been devised to regulate Indigenous people including their forms of expenditure (via income management), forms of working via the Community Development Programme (CDP) and their places of habitation, where they might access basic citizenship services.

All these measures have implications for consumption of market commodities, including food from shops, and of customary non-market goods, including food from the bush.

Owing to deep poverty, many people can only purchase relatively cheap and unhealthy takeaway foods that are killing them prematurely from non-communicable diseases, like acute heart and kidney disorders, followed by lung cancer from smoking.

With income management Aboriginal people are being coerced to shop at stores according to the government’s rhetoric for their ‘food security’. Before the introduction of this regime many more people were exercising their ‘food sovereignty’ right to harvest far healthier foods from the bush.

Extracts from Jon Altman a research professor in anthropology at the Alfred Deakin Institute for Citizenship and Globalisation at Deakin University, Melbourne.

From New Matilda Read and subscribe HERE

A version of this article was first published in the Land Rights News

READ over 5 Articles NACCHO Aboriginal Health and Nutrition 

READ Articles NACCHO Aboriginal Health and Welfare Card 

” NACCHO is strongly opposed to the current cashless debit card trials as well as any proposal to expand. We also note that Aboriginal people are disproportionately affected by the trials and that they are in and proposed for locations where the majority participants are Aboriginal. Whilst it is not the stated intent of the trials, its impact is discriminatory.

NACCHO knows that some Aboriginal people and communities need additional support to better manage their lives and ensure that income support funds are used more effectively.

However, NACCHO is firmly of the view that there are significantly better, more cost efficient, alternative approaches that support improvements in Aboriginal wellbeing and positive decision making.

Aboriginal Community Controlled Health Services would be well placed to develop and implement alternative programs. We firmly believe that addressing the ill health of Aboriginal people, including the impacts of alcohol, drug and gambling related harm, can only be achieved by local Aboriginal people controlling health care delivery.

We know that when Aboriginal and Torres Strait Islander people have a genuine say over our lives, the issues that impact on us and can develop our own responses, there is a corresponding improvement in wellbeing. This point is particularly relevant given that the majority of trial participants are Aboriginal. “

Selected extracts from Submission to the Senate Community Affairs Legislation Committee Inquiry into the Social Services Legislation Amendment (Cashless Debit Card Trial Expansion) Bill 2018 

Download HERE 

NACCHO submission on cashless debit card final

As is the case in many countries, Indigenous people in Australia, New Zealand, United States of America and Canada are disproportionately affected by NCDs.

Diabetes, cardiovascular disease, cancer,  smoking related lung disease and mental health conditions are the five main NCDs identified by the World Health Organisation (WHO), and these are almost uniformly experienced by Indigenous peoples at higher rates than other people.

Indigenous people globally are disproportionately affected by diabetes. In Australia, Aboriginal and Torres Strait Islander peoples are 6 times more likely than the non-Indigenous population to die from diabetes. In Canada, Indigenous peoples are 3-5 times more likely to have diabetes than other citizens.

Indigenous people are also more likely to have Cardiovascular disease. Cardiovascular disease accounts for almost a quarter of the mortality gap between Aboriginal and Torres Strait Islander peoples and other Australians. Maori people are 3-4.2 times more likely to die from cardiovascular disease than other people in New Zealand.

These numbers are not improving, despite national rates of smoking decreasing, and increased social marketing aimed at reducing sugar consumption and increasing physical activity.

Mainstream solutions do little to reduce the burden of NCDs for Indigenous populations. The broader social determinants of health have a huge role to play, and until these are addressed in a meaningful way, Indigenous peoples will continue to experience an inequitable burden.

With colonisation having had a devastating impact on Indigenous peoples, and mainstream solutions unable to significantly reduce the rates of NCDs experienced by Indigenous peoples, a new paradigm is urgently required.

What is required is not more state based solutions but Indigenous led solutions.

Summer May Finlay Croakey 

Welfare reform is targeting many remote-living Aboriginal people impoverishing them and resulting in the consumption of unhealthy foods that are killing them prematurely from non-communicable diseases

Rome (Canberra) continues to fiddle while Black Australia burns. Professor Jon Altman weighs in on the ongoing disasters of government policy that have a tight grip on remote living Indigenous people.

In the last month I participated in two workshops. I used what I observed on my latest visit to Arnhem Land and what people were telling me to inform what I presented at the workshops.

The first workshop explored issues around excessive consumption by industrialised societies globally and how this is harming human health and destroying the planet. Workshop participants asked how such ‘consumptogenic’ systems might be regulated for the global good? My job was to provide a case study from my research on consumption by Indigenous people in remote Australia.

The second workshop looked at welfare reform in the last decade in remote Indigenous Australia. In this workshop I looked at how welfare reform by the Australian state after the NT Intervention was creatively destroying the economy and lifeways of groups in Arnhem Land who are looking to live on their lands and off its natural resources.

Here I want to share some of what I said.

BROADLY speaking Indigenous policy in remote Australia is looking to do two things.

The first is to Close the Gaps so that Indigenous Australians can one future day have the same socio-economic status as other Australians. In remote Australia this goal is linked to the project to ‘Develop the North’ via a combination of opening Aboriginal communities and lands to more market capitalism and extraction, purportedly for the improvement of disadvantaged Indigenous peoples and land owners.

While remote-living Indigenous people have economic and social justice rights to vastly improved wellbeing, in such scenarios of future economic equality based on market capitalism, the downsides of what I think of as ‘consumptomania’ are never mentioned.

The second aim of policy is the extreme regulation of Indigenous people and their behaviour, when deemed unacceptable. In a punitive manifestation of neoliberal governmentality, the Australian state, and its nominated agents, are looking to morally restructure Indigenous people to transform them into model citizens: hard-working, individualistic, highly educated, nationally mobile at least in pursuit of work (not alcohol), and materially acquisitive.

This paternalistic project of improvement makes no concessions whatsoever to cultural difference, colonial history of neglect, connection to country, discrimination, and so on.

In the last decade new race-based instruments have been devised to regulate Indigenous people including their forms of expenditure (via income management), forms of working via the Community Development Programme (CDP) and their places of habitation, where they might access basic citizenship services.

All these measures have implications for consumption of market commodities, including food from shops, and of customary non-market goods, including food from the bush.

We have all heard the bad news, year after year, report after report, that the government-imposed project of improvement, called ‘Closing the Gap’ and introduced by Kevin Rudd in 2008, is failing.

Using the government’s own statistics, after 10 years only one target, year 12 attainment, might be on track. I say ‘might’ because ‘attainment’ is open to multiple interpretations: is attainment just about attendance or about gaining useful life skills?

What national and average Closing the Gap figures do not tell us is just how badly the estimated 170,000 Indigenous people in remote and very remote Australia are faring. This region where I focus my work covers 86 per cent of the Australian continent.

What we are seeing in this massive part of Australia according to the latest census are the very lowest employment/population ratios of about 30 per cent for Indigenous adults (against 80% for non-Indigenous adults) and the deepest poverty, more than 50 per cent of people in Indigenous households currently live below the poverty line.

This is also paradoxically where Indigenous people have most land and native title rights, a recent estimate suggests that 43 per cent of the continent has some form of indigenous title; and is dotted with maybe 1000 small Indigenous communities with a total population of 100,000 at most.

Native title rights and interests give people an unusual and generally unregulated right to use natural resources for domestic consumption.

This form of consumption might include hunting kangaroos or feral animals like the estimated 100,000 wild buffalo in Arnhem Land.

Such hunting is good for health because the meat is lean and fresh; it is also good for the environment because buffalo eat about 30kg of vegetation a day and are environmentally destructive; and it is good for global cooling because each buffalo emits methane with a carbon equivalent value of about two tonnes per annum.

The legal challenge of gaining native title rights and interests is that claimants must demonstrate continuity of customs and traditions and connection to their claimed country. But in remote Australia, culture and tradition have been identified as a key element of the problem that is exacerbating social dysfunction. (That is unless tradition appears as fine art ‘high culture’ which is imagined to be unrelated to the everyday culture and is a favourite item for consumption by metropolitan elites.)

Hence the project of behavioural modification to eradicate Indigenous cultures that exhibit problematic characteristics, like sharing and a focus on kinship and reciprocity, to be replaced by western culture with its high consumption, individualistic and materially acquisitive characteristics.

Connection to country, at least if it involves living on it, is also deemed highly problematic by the Australian state if one wants to produce western educated, home-owning, properly disciplined neoliberal subjects — terra nulliusis now to be replaced by terra vacua, empty land.

Such empty land would be ripe for resource extraction and capitalist accumulation by dispossession Despite all the talk of mining on Aboriginal land, there are currently very few operating mines on the Indigenous estate. This is imagined as one means to Develop the North, but recent history suggests that the long-term benefits to Aboriginal land owners from such development will be limited.

MUCH of what I describe above in general terms resonates with what I have observed in Arnhem Land where I have visited regularly since the Intervention; and what I hear from Aboriginal people and colleagues working elsewhere in remote Indigenous Australia.

From 2007 to 2012 all communities in Arnhem Land were prescribed under NT Intervention laws. Since 2012, under Stronger Futures laws legislated in force until 2022, the Aboriginal population has continued to be subject to a new hyper-regulatory regime: income management, government-licenced stores, modern slavery-like compulsory work for welfare, enhanced policing, unimaginable levels of electronic and police surveillance, school attendance programs and so on.

The limited availability of mainstream work in this region as elsewhere means that most adults of working age receive their income from the new Community Development Program introduced in 2015. Weekly income is limited to Newstart ($260) for which one must meet a work requirement of five hours a day, five days a week if aged 18-49 years and able-bodied.

Of this paltry income, 50 per cent is quarantined for spending at stores where prices are invariably high, owing to remoteness.

The main aim of such paternalism is to reduce expenditure on tobacco and alcohol which cannot be purchased with the BasicsCard.

Shop managers that I have interviewed tell me that despite steep tax-related price rises (a pack of Winfield blue costs nearly $30) tobacco demand is inelastic and sales have not declined.

Since the year 2000, Noel Pearson has popularised his metaphor ‘welfare poison’. Pearson is referring figuratively to what he sees as the negative impacts of long-term welfare dependence. In Arnhem Land welfare is literally a form of poison because in the name of ‘food security’ people are forced to purchase foods they can afford with low nutritional value from ‘licenced’ stores.

However, paternalistic licencing to allow stores to operate the government-imposed BasicsCard is not undertaken equitably by officials from the Department of Prime Minister and Cabinet.

So one sees large, long-standing, community-owned and operated and mainly Indigenous staffed stores being rigorously regulated, managers argue over-regulated. Such stores are highly visible, as are their accounts.

But small private-sector operators (staffed mainly by temporary visa holders and backpackers) that have been established as the regional economy has been prised open to the free market appear under-regulated, even though they are also ‘licenced’ to operate the BasicsCard.

These private sector operators compete very effectively with community-owned enterprises because they only have a focus on commerce: all the profits they make and most of the wages they pay non-local staff leave the region.

Owing to deep poverty, many people can only purchase relatively cheap and unhealthy takeaway foods that are killing them prematurely from non-communicable diseases, like acute heart and kidney disorders, followed by lung cancer from smoking.

With income management Aboriginal people are being coerced to shop at stores according to the government’s rhetoric for their ‘food security’. Before the introduction of this regime many more people were exercising their ‘food sovereignty’ right to harvest far healthier foods from the bush.

This dramatic transformation has occurred as an unusual form of regional economy that involved a high level of customary activity has been effectively destroyed by the dominant government view that only prioritises engagement in market capitalism — that is largely absent in this region.

On one hand, we now see the most able-bodied hunters required to work for the dole every week day with their energies directed from what they do best.

On the other hand, the greatly enhanced police presence is resulting simultaneously in people being deprived of their basic equipment for hunting — guns and trucks — regularly impounded because they are unregistered or their users unlicenced.

People are being increasingly isolated from their ancestral lands and their hunting grounds.

Excessive policing, growing poverty, dependency and anomie are seeing criminality escalate with expensive fines for minor misdemeanours further impoverishing people and reducing their ability to purchase either more expensive healthy foods or the means to acquire bush foods.

A virtuous production cycle that until the Intervention saw much ‘bush food consumption’ has been disastrously reversed. Today, we see a vicious cycle where people regularly report hunger while living in rich Australia; people’s health status is declining.

Welfare reform and Indigeneity is indeed a toxic mix, poison, in remote regions like Arnhem Land.

I WANT to end with some more general conclusions.

On the regulation of Indigenous expenditure, we see a perverse policy intervention: the Australian government is committing what are sometimes referred to as Type 1 and Type 2 errors.

The former sees the government looking to regulate Indigenous consumption using the expensive instrument of income management that has cost over $1.2 billion to date, despite no evidence that it makes a difference.

The latter sees an absence of the proper regulation of supply in licences stores evident when stores with names like ‘The Good Food Kitchen’ sell cheap unhealthy take-aways.

In my view the racially-targeted and crude attempts to regulate Indigenous expenditure are unacceptable on social justice grounds.

Two principles as articulated by Guy Standing stand out.

‘The security difference principle’ suggests that a policy is only socially just if it improves the [food]security of the most insecure in society. Income management and work for the dole do not do this.

And ‘the paternalism test’ suggests that a policy like income management would only be socially just if it does not impose controls on some groups that are not imposed on the most-free groups in society.

Paternalistic governmentality in remote Australia is imposing tight regulatory frameworks on some people, even though the justifying ideology suggests that markets should be free and unregulated.

Sociologist Loic Wacquant in  Punishing the Poor shows how the carceral state in the USA punishes the poor with criminalisation and imprisonment; the poor there happen to be mainly black.

In Australia, punitive neoliberalism punishes those remote living Aboriginal people who happen to be poor and dependent on the state.

Once again there is a perversity in policy implementation.

Hence in Arnhem Land, people maintain strong vestiges of a hunter-gatherer subjectivity that when combined with deep poverty makes them avid consumers of western commodities that are bad for health (like tobacco that is expensive and fatty, sugary takeaway food that is relatively cheap).

At the same time commodities that might be useful to improve health, like access to guns and trucks essential for modern hunting, are rendered unavailable by a combination of poverty and excessive policing.

Australian democracy that is founded on notions of liberalism needs to be held to account for such travesties.

Long ago in 1859, John Stuart Mill, the doyen of liberals, wrote in  On Liberty: “…despotism is a legitimate form of government in dealing with barbarians, providing the end be their improvement and the means justified by actually effecting that end”.

In illiberal Australia today, authoritarian controls over remote living Indigenous people and their behaviour are again viewed as legitimate by the powerful now neoliberal state, even though there is growing evidence from remote Australia that things are getting worse.

I want to end with some suggested antidotes to the toxic mix that has resulted from welfare reform that is targeting many remote-living Aboriginal people and impoverishing them.

First, in my view despotism for some is never legitimate, so people should be treated equally irrespective of their ethnicity or structural circumstances.

Second, the Community Development Programme is a coercive disaster that is far more effective at breaching and penalising the jobless for not complying with excessive requirements than in creating jobs. CDP is further impoverishing people and should be replaced, especially in places where there are no jobs, with unconditional basic income support.

Third, people need to be empowered to find their own solutions to the complex challenges of appropriate development that accord with their aspirations, norms, values, and lifeways. Devolutionary principles of self-government and community control, not big government and centralised control, are needed.

Fourth, the native title of remote living people should be protected to ensure that they benefit from all their rights and interests. There is no point in legally allocating property rights in natural resources valuable for self-provisioning if people are effectively excluded from access to their ancestral lands and the enjoyment of these resources.

Finally, governments should support what has worked in the past to improve people’s diverse culturally-informed views about wellbeing and sense of worth.

While such an approach might not close some imposed ‘closing the gap’ targets, like employment as measured by standard western metrics, it will likely improve other important goals like reducing child mortality and enhancing life expectancy and overall quality of life.

 

 

NACCHO Aboriginal Health : Download @CSIROnews #FutureofHealth Report that provides a new path for national healthcare delivery, setting a way forward to shift the system from illness treatment, to #prevention.

Australians rank amongst the healthiest in the world with our health system one of the most efficient and equitable. However, the nation’s strong health outcomes hide a few alarming facts: 

  • There is a 10-year life expectancy gap between the health of non-Indigenous Australians and Aboriginal and Torres Strait Islander people
  • Australians spend on average 11 years in ill health – the highest among OECD countries
  • 63% (over 11 million) of adult Australians are considered overweight or obese
  • 60% of the adult population have low levels of literacy 
  • The majority of Australians do not consume the recommended number of serves from any of the five food groups.

From CSIRO Future of Health report

Download HERE full 60 Page Report NACCHO INFO FutureofHealthReport_WEB_180910

The CSIRO Future of Health report provides a list of recommendations for improving the health of Australians over the next 15 years, focussed around five central themes: empowering people, addressing health inequity, unlocking the value of digitised data, supporting integrated and precision health solutions, and integrating with the global sector.

CSIRO Chief Executive Dr Larry Marshall said collaboration and coordination were key to securing the health of current and future generations in Australia, and across the globe.

“It’s hard to find an Australian who hasn’t personally benefitted from something we created, including some world’s first health innovations like atomic absorption spectroscopy for diagnostics; greyscale imaging for ultrasound, the flu vaccine (Relenza); the Hendra vaccine protecting both people and animals; even the world’s first extended-wear contact lenses,” Dr Marshall said.

“As the world is changing faster than ever before, we’re looking to get ahead of these changes by bringing together Team Australia’s world-class expertise, from all sectors, and the life experiences of all Australians to set a bold direction towards a brighter future.”

The report highlighted that despite ranking among the healthiest people in the world, Australians spent on average of 11 years in ill health – the highest among OECD countries.

Clinical care was reported to influence only 20 per cent of a person’s life expectancy and quality of life, with the remaining 80 per cent relying on external factors such as behaviour, social and economic support, and the physical environment.

“As pressure on our healthcare system increases, costs escalate, and healthy choices compete with busier lives, a new approach is needed to ensure the health and wellbeing of Australians,” CSIRO Director of Health & Biosecurity Dr Rob Grenfell said.

The report stated that the cost of managing mental health related illness to be $60 billion annually, with a further $5 billion being spent on managing costs associated with obesity.

Health inequities across a range of social, economic, and cultural measures were found to cost Australia almost $230 billion a year.

“Unless we shift our approach to healthcare, a rising population and increases in chronic illnesses such as obesity and mental illness, will add further strain to the system,” Dr Grenfell said.

“By shifting to a system focussed on proactive health management and prevention, we have an exciting opportunity to provide quality healthcare that leaves no-one behind.

“How Australia navigates this shift over the next 15 years will significantly impact the health of the population and the success of Australian healthcare organisations both domestically and abroad.”

CSIRO has been continuing to grow its expertise within the health domain and is focussed on research that will help Australians live healthier, longer lives.

The Future of Health report was developed by CSIRO Futures, the strategic advisory arm of CSIRO.

More than 30 organisations across the health sector were engaged in its development, including government, health insurers, educators, researchers, and professional bodies.

Australia’s health challenges:

  • Australians spend on average 11 years in ill health – the highest among OECD countries.
  • 63 per cent (over 11 million) of adult Australians are considered overweight or obese.
  • There is a 10-year life expectancy gap between the health of non-Indigenous Australians and Aboriginal and Torres Strait Islander peoples.
  • 60 per cent of the adult population have low levels of health literacy.
  • The majority of Australians do not consume the recommended number of serves from any of the five food groups.

The benefits of shifting the system from treatment to prevention:

  • Improved health outcomes and equity for all Australians.
  • Greater system efficiencies that flatten the cost curve of health financing.
  • More impactful and profitable business models.
  • Creation of new industries based on precision and preventative health.
  • More sustainable and environmentally friendly healthcare practices.
  • More productive workers leading to increased job satisfaction and improved work-life balance.

More info : www.csiro.au/futureofhealth