Aboriginal Health and the @AusLawReform inquiry into the incarceration rate of Aboriginal peoples

 

” The Terms of Reference for this Inquiry ask the ALRC to consider laws and legal frameworks that contribute to the incarceration rate of Aboriginal and Torres Strait Islander peoples and inform decisions to hold or keep Aboriginal and Torres Strait Islander people in custody.

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Download this 236 page discussion paper

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Full Terms of reference part B below

The ALRC was asked to consider a number of factors that decision makers take into account when deciding on a criminal justice response, including community safety, the availability of alternatives to incarceration, the degree of discretion available, and incarceration as a deterrent and as a punishment

The Terms of Reference also direct the ALRC to consider laws that may contribute to the rate of Aboriginal and Torres Strait Islander peoples offending and the rate of incarceration of Aboriginal and Torres Strait Islander women.

Submissions close on 4 September 2017.

Make a submission

Part A Proposals and Questions

1. Structure of the Discussion Paper

1.40     The Discussion Paper is structured in parts. Following the introduction, Part 2 addresses criminal justice pathways. The ALRC has identified three key areas that influence incarceration rates: bail laws and processes, and remand; sentencing laws and legal frameworks including mandatory sentencing, short sentences and Gladue-style reports; and transition pathways from prison, parole and throughcare. These were the focus of stakeholder comments and observations in preliminary consultations.

1.41     Part 3 considers non-violent offending and alcohol regulation. It provides an overview of the detrimental effects of fine debt on Aboriginal and Torres Strait Islander peoples, including the likelihood of imprisonment in some jurisdictions. Fine debt can be tied to driver licence offending, and the ALRC asks how best to minimise licence suspension caused by fine default. Part 3 also looks at ways laws and legal frameworks can operate to decrease alcohol supply so as to minimise alcohol-related offending in Aboriginal and Torres Strait Islander communities.

1.42     Part 4 discusses the incarceration of Aboriginal and Torres Strait Islander women. It contextualises Aboriginal and Torres Strait Islander female offending within experiences of trauma, including isolation; family and sexual violence; and child removal. It outlines how proposals in other chapters may address the incarceration rates of Aboriginal and Torres Strait Islander women, and asks what more can be done.

1.43     Part 5 considers access to justice, and examines ways that state and territory governments and criminal justice systems can better engage with Aboriginal and Torres Strait Islander peoples to prevent offending and to provide better criminal justice responses when offending occurs. The ALRC places collaboration with Aboriginal and Torres Strait Islander organisations at the centre of proposals made in this Part, and suggests accountability measures for state and territory government justice agencies and police. The remoteness of communities, the availability of and access to legal assistance and Aboriginal and Torres Strait Islander interpreters are also discussed. Alternative approaches to crime prevention and criminal justice responses, such as those operating under the banner of ‘justice reinvestment’, are also canvassed.

2. Bail and the Remand Population

Proposal 2–1        The Bail Act 1977 (Vic) has a standalone provision that requires bail authorities to consider any ‘issues that arise due to the person’s Aboriginality’, including cultural background, ties to family and place, and cultural obligations. This consideration is in addition to any other requirements of the Bail Act.

Other state and territory bail legislation should adopt similar provisions.

As with all other bail considerations, the requirement to consider issues that arise due to the person’s Aboriginality would not supersede considerations of community safety.

Proposal 2–2        State and territory governments should work with peak Aboriginal and Torres Strait Islander organisations to identify service gaps and develop the infrastructure required to provide culturally appropriate bail support and diversion options where needed.

3. Sentencing and Aboriginality

Question 3–1        Noting the decision in Bugmy v The Queen [2013] HCA 38, should state and territory governments legislate to expressly require courts to consider the unique systemic and background factors affecting Aboriginal and Torres Strait Islander peoples when sentencing Aboriginal and Torres Strait Islander offenders?

If so, should this be done as a sentencing principle, a sentencing factor, or in some other way?

Question 3–2        Where not currently legislated, should state and territory governments provide for reparation or restoration as a sentencing principle? In what ways, if any, would this make the criminal justice system more responsive to Aboriginal and Torres Strait Islander offenders?

Question 3–3        Do courts sentencing Aboriginal and Torres Strait Islander offenders have sufficient information available about the offender’s background, including cultural and historical factors that relate to the offender and their community?

Question 3–4        In what ways might specialist sentencing reports assist in providing relevant information to the court that would otherwise be unlikely to be submitted?

Question 3–5        How could the preparation of these reports be facilitated? For example, who should prepare them, and how should they be funded?

4. Sentencing Options

Question 4–1        Noting the incarceration rates of Aboriginal and Torres Strait Islander people:

(a)     should Commonwealth, state and territory governments review provisions that impose mandatory or presumptive sentences; and

(b)     which provisions should be prioritised for review?

Question 4–2        Should short sentences of imprisonment be abolished as a sentencing option? Are there any unintended consequences that could result?

Question 4–3        If short sentences of imprisonment were to be abolished, what should be the threshold (eg, three months; six months)?

Question 4–4        Should there be any pre-conditions for such amendments, for example: that non-custodial alternatives to prison be uniformly available throughout states and territories, including in regional and remote areas?

Proposal 4–1        State and territory governments should work with peak Aboriginal and Torres Strait Islander organisations to ensure that community-based sentences are more readily available, particularly in regional and remote areas.

Question 4–5        Beyond increasing availability of existing community-based sentencing options, is legislative reform required to allow judicial officers greater flexibility to tailor sentences?

5. Prison Programs, Parole and Unsupervised Release

Proposal 5–1        Prison programs should be developed and made available to accused people held on remand and people serving short sentences.

Question 5–1        What are the best practice elements of programs that could respond to Aboriginal and Torres Strait Islander peoples held on remand or serving short sentences of imprisonment?

Proposal 5–2        There are few prison programs for female prisoners and these may not address the needs of Aboriginal and Torres Strait Islander female prisoners. State and territory corrective services should develop culturally appropriate programs that are readily available to Aboriginal and Torres Strait Islander female prisoners.

Question 5–2        What are the best practice elements of programs for Aboriginal and Torres Strait Islander female prisoners to address offending behaviour?

Proposal 5–3        A statutory regime of automatic court ordered parole should apply in all states and territories.

Question 5–3        A statutory regime of automatic court ordered parole applies in NSW, Queensland and SA. What are the best practice elements of such schemes?

Proposal 5–4        Parole revocation schemes should be amended to abolish requirements for the time spent on parole to be served again in prison if parole is revoked.

6. Fines and Driver Licences

Proposal 6–1        Fine default should not result in the imprisonment of the defaulter. State and territory governments should abolish provisions in fine enforcement statutes that provide for imprisonment in lieu of unpaid fines.

Question 6–1        Should lower level penalties be introduced, such as suspended infringement notices or written cautions?

Question 6–2        Should monetary penalties received under infringement notices be reduced or limited to a certain amount? If so, how?

Question 6–3        Should the number of infringement notices able to be issued in one transaction be limited?

Question 6–4        Should offensive language remain a criminal offence? If so, in what circumstances?

Question 6–5        Should offensive language provisions be removed from criminal infringement notice schemes, meaning that they must instead be dealt with by the court?

Question 6–6        Should state and territory governments provide alternative penalties to court ordered fines? This could include, for example, suspended fines, day fines, and/or work and development orders.

Proposal 6–2        Work and Development Orders were introduced in NSW in 2009. They enable a person who cannot pay fines due to hardship, illness, addiction, or homelessness to discharge their debt through:

  • work;
  • program attendance;
  • medical treatment;
  • counselling; or
  • education, including driving lessons.

State and territory governments should introduce work and development orders based on this model.

Question 6–7        Should fine default statutory regimes be amended to remove the enforcement measure of driver licence suspension?

Question 6–8        What mechanisms could be introduced to enable people reliant upon driver licences to be protected from suspension caused by fine default? For example, should:

(a)     recovery agencies be given discretion to skip the licence suspension step where the person in default is vulnerable, as in NSW; or

(b)     courts be given discretion regarding the disqualification, and disqualification period, of driver licences where a person was initially suspended due to fine default?

Question 6–9        Is there a need for regional driver permit schemes? If so, how should they operate?

Question 6–10      How could the delivery of driver licence programs to regional and remote Aboriginal and Torres Strait Islander communities be improved?

7. Justice Procedure Offences—Breach of Community-based Sentences

Proposal 7–1        To reduce breaches of community-based sentences by Aboriginal and Torres Strait Islander peoples, state and territory governments should engage with peak Aboriginal and Torres Strait Islander organisations to identify gaps and build the infrastructure required for culturally appropriate community-based sentencing options and support services.

8. Alcohol

Question 8–1        Noting the link between alcohol abuse and offending, how might state and territory governments facilitate Aboriginal and Torres Strait Islander communities, that wish to do so, to:

(a)     develop and implement local liquor accords with liquor retailers and other stakeholders that specifically seek to minimise harm to Aboriginal and Torres Strait Islander communities, for example through such things as minimum pricing, trading hours and range restriction;

(b)     develop plans to prevent the sale of full strength alcohol within their communities, such as the plan implemented within the Fitzroy Crossing community?

Question 8–2        In what ways do banned drinkers registers or alcohol mandatory treatment programs affect alcohol-related offending within Aboriginal and Torres Strait Islander communities? What negative impacts, if any, flow from such programs?

9. Female Offenders

Question 9–1        What reforms to laws and legal frameworks are required to strengthen diversionary options and improve criminal justice processes for Aboriginal and Torres Strait Islander female defendants and offenders?

10. Aboriginal Justice Agreements

Proposal 10–1       Where not currently operating, state and territory governments should work with peak Aboriginal and Torres Strait Islander organisations to renew or develop Aboriginal Justice Agreements.

Question 10–1      Should the Commonwealth Government develop justice targets as part of the review of the Closing the Gap policy? If so, what should these targets encompass?

11. Access to Justice Issues

Proposal 11–1       Where needed, state and territory governments should work with peak Aboriginal and Torres Strait Islander organisations to establish interpreter services within the criminal justice system.

Question 11–1      What reforms to laws and legal frameworks are required to strengthen diversionary options and specialist sentencing courts for Aboriginal and Torres Strait Islander peoples?

Proposal 11–2       Where not already in place, state and territory governments should provide for limiting terms through special hearing processes in place of indefinite detention when a person is found unfit to stand trial.

Question 11–2      In what ways can availability and access to Aboriginal and Torres Strait Islander legal services be increased?

Proposal 11–3       State and territory governments should introduce a statutory custody notification service that places a duty on police to contact the Aboriginal Legal Service, or equivalent service, immediately on detaining an Aboriginal and Torres Strait Islander person.

12. Police Accountability

Question 12–1      How can police work better with Aboriginal and Torres Strait Islander communities to reduce family violence?

Question 12–2      How can police officers entering into a particular Aboriginal or Torres Strait Islander community gain a full understanding of, and be better equipped to respond to, the needs of that community?

Question 12–3      Is there value in police publicly reporting annually on their engagement strategies, programs and outcomes with Aboriginal and Torres Strait Islander communities that are designed to prevent offending behaviours?

Question 12–4      Should police that are undertaking programs aimed at reducing offending behaviours in Aboriginal and Torres Strait Islander communities be required to: document programs; undertake systems and outcomes evaluations; and put succession planning in place to ensure continuity of the programs?

Question 12–5      Should police be encouraged to enter into Reconciliation Action Plans with Reconciliation Australia, where they have not already done so?

Question 12–6      Should police be required to resource and support Aboriginal and Torres Strait Islander employment strategies, where not already in place?

13. Justice Reinvestment

Question 13–1      What laws or legal frameworks, if any, are required to facilitate justice reinvestment initiatives for Aboriginal and Torres Strait Islander peoples?

Part B The Term of reference

ALRC inquiry into the incarceration rate of Aboriginal and Torres Strait Islander peoples

I, Senator the Hon George Brandis QC, Attorney-General of Australia, refer to the Australian Law Reform Commission, an inquiry into the over-representation of Aboriginal and Torres Strait Islander peoples in our prisons.

It is acknowledged that while laws and legal frameworks are an important factor contributing to over‑representation, there are many other social, economic, and historic factors that also contribute. It is also acknowledged that while the rate of imprisonment of Aboriginal and Torres Strait Islander peoples, and their contact with the criminal justice system – both as offenders and as victims – significantly exceeds that of non‑Indigenous Australians, the majority of Aboriginal and Torres Strait Islander people never commit criminal offences.

Scope of the reference

  1. In developing its law reform recommendations, the Australian Law Reform Commission (ALRC) should have regard to:
    1. Laws and legal frameworks including legal institutions and law enforcement (police, courts, legal assistance services and prisons), that contribute to the incarceration rate of Aboriginal and Torres Strait Islander peoples and inform decisions to hold or keep Aboriginal and Torres Strait Islander peoples in custody, specifically in relation to:
      1. the nature of offences resulting in incarceration,
      2. cautioning,
      3. protective custody,
      4. arrest,
      5. remand and bail,
      6. diversion,
      7. sentencing, including mandatory sentencing, and
      8. parole, parole conditions and community reintegration.
    2. Factors that decision-makers take into account when considering (1)(a)(i-viii), including:
      1. community safety,
      2. availability of alternatives to incarceration,
      3. the degree of discretion available to decision-makers,
      4. incarceration as a last resort, and
      5. incarceration as a deterrent and as a punishment.
    3. Laws that may contribute to the rate of Aboriginal and Torres Strait Islander peoples offending and including, for example, laws that regulate the availability of alcohol, driving offences and unpaid fines.
    4. Aboriginal and Torres Strait Islander women and their rate of incarceration.
    5. Differences in the application of laws across states and territories.
    6. Other access to justice issues including the remoteness of communities, the availability of and access to legal assistance and Aboriginal and Torres Strait Islander language and sign interpreters.
  2.  In conducting its Inquiry, the ALRC should have regard to existing data and research[1] in relation to:
    1. best practice laws, legal frameworks that reduce the rate of Aboriginal and Torres Strait Islander incarceration,
    2. pathways of Aboriginal and Torres Strait Islander peoples through the criminal justice system, including most frequent offences, relative rates of bail and diversion and progression from juvenile to adult offending,
    3. alternatives to custody in reducing Aboriginal and Torres Strait Islander incarceration and/or offending, including rehabilitation, therapeutic alternatives and culturally appropriate community led solutions,
    4. the impacts of incarceration on Aboriginal and Torres Strait Islander peoples, including in relation to employment, housing, health, education and families, and
    5. the broader contextual factors contributing to Aboriginal and Torres Strait Islander incarceration including:
      1. the characteristics of the Aboriginal and Torres Strait Islander prison population,
      2. the relationships between Aboriginal and Torres Strait Islander offending and incarceration and inter‑generational trauma, loss of culture, poverty, discrimination, alcohol and drug use, experience of violence, including family violence, child abuse and neglect, contact with child protection and welfare systems, educational access and performance, cognitive and psychological factors, housing circumstances and employment, and
      3. the availability and effectiveness of culturally appropriate programs that intend to reduce Aboriginal; and Torres Strait Islander offending and incarceration.
  3. In undertaking this Inquiry, the ALRC should identify and consider other reports, inquiries and action plans including but not limited to:
    1. the Royal Commission into Aboriginal Deaths in Custody,
    2. the Royal Commission into the Protection and Detention of Children in the Northern Territory (due to report 1 August 2017),
    3. Senate Standing Committee on Finance and Public Administration’s Inquiry into Aboriginal and Torres Strait Islander Experience of Law Enforcement and Justice Services,
    4. Senate Standing Committee on Community Affairs’ inquiry into Indefinite Detention of People with Cognitive and Psychiatric impairment in Australia,
    5. Senate Standing Committee on Indigenous Affairs inquiry into Harmful Use of Alcohol in Aboriginal and Torres Strait Islander Communities,
    6. reports of the Aboriginal and Torres Strait Islander Social Justice Commissioner,
    7. the ALRC’s inquiries into Family violence and Family violence and Commonwealth laws, and​
    8. the National Plan to Reduce Violence against Women and their Children 2010-2022.

The ALRC should also consider the gaps in available data on Aboriginal and Torres Strait Islander incarceration and consider recommendations that might improve data collection.

  1. In conducting its inquiry the ALRC should also have regard to relevant international human rights standards and instruments.

Consultation

  1. In undertaking this inquiry, the ALRC should identify and consult with relevant stakeholders including Aboriginal and Torres Strait Islander peoples and their organisations, state and territory governments, relevant policy and research organisations, law enforcement agencies, legal assistance service providers and the broader legal profession, community service providers and the Australian Human Rights Commission.

Timeframe

  1. The ALRC should provide its report to the Attorney-General by 22 December 2017.

 

NACCHO NEWS ALERT: COAG Health Ministers Council Communique acknowledge the importance #ACCHO’s advancing Aboriginal health

 

  Included in this NACCHO Aboriginal Health News Alert

  1. All issues 11 included in  Communique highlighting ACCHO health
  2. Health Ministers approve Australia’s National Digital Health Strategy
  3. Transcript Health Minister Hunt Press Conference

” The Federal Minister for Indigenous Health, Ken Wyatt, attended the COAG Health Council discussed the Commonwealth’s current work on Indigenous health priorities.

In particular this included the development of the 2018 iteration of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 that will incorporate strategies and actions to address the social determinants and cultural determinants of health.

Ministers also considered progress on other key Indigenous health issues including building workforce capability, cultural safety and environmental health, where jurisdictions can work together more closely with the Commonwealth to improve outcomes for Aboriginal and Torres Strait Islander peoples.

Ministers acknowledged the importance of collaboration and the need to coordinate activities across governments to support a culturally safe and comprehensive health system.

Ministers also acknowledge the importance of community controlled organisations in advancing Aboriginal and Torres Strait Islander health. ”

1.Development of the next iteration of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 COAG Health Council 

Read over 50 NACCHO NATSIHP Articles published over past 50 years

INTRODUCTION

The federal, state and territory Health Ministers met in Brisbane on August 4 at the COAG Health Council to discuss a range of national health issues.

The meeting was chaired by the Victorian Minister for Health, the Hon Jill Hennessy MP.

Health Ministers welcomed the New South Wales Minister for Mental Health, the Hon Tanya Davies MP, the Victorian Minister for Mental Health, the Hon Martin Foley MP, the ACT Minister for Mental Health Mr Shane Rattenbury and the Minister for Aged Care and Minister for Indigenous Health, the Hon Ken Wyatt AM, MP who participated in a joint discussion with Health Ministers about mental health issues.

Major items discussed by Health Ministers today included:

2.Andrew Forrest and the Eliminate Cancer Initiative

Mr Andrew Forrest joined the meeting to address Health Ministers in his capacity as Chairman of the Minderoo Foundation to discuss the Eliminate Cancer Initiative. The Minderoo Foundation is one of Autralia’s largest and most active philanthropic groups. It has established the Eliminate Cancer Initiatve (the Initiative), a global initiative dedicated to making cancer non-lethal with some of the world’s leading global medicine and anti-cancer leaders.

The Initiative is a united effort to convert cancer into a non-lethal disease through global collaboration of scientific, medical and academic institutes, commercially sustained through the support of the philanthropic, business and government sectors worldwide.

Australia has a critical role to play in this highly ambitious and thoroughly worthwhile goal.

3.Family violence and primary care

Today, Health Ministers discussed the significant health impacts on those people experiencing family violence.

Health Ministers acknowledged that health-care providers, particularly those in a primary care setting, are in a unique position to create a safe and confidential environment to enable the disclosure of violence, while offering appropriate support and referrals to other practitioners and services.

Recognising the importance of national leadership in this area, Ministers agreed to develop a plan to address barriers to primary care practitioners identifying and responding to patients experiencing family violence.

Ministers also agreed to work with the Royal Australian College of General Practitioners to develop and implement a national training package.

Further advice will be sought from Primary Health Networks on existing family violence services, including Commonwealth, State and NGO service providers in their regions, with a view to developing an improved whole-of-system responses to the complex needs of clients who disclose family violence

4.Fifth National Mental Health and Suicide Prevention Plan

Health Ministers endorsed the Fifth National Mental Health and Suicide Prevention Plan 2017-2022 and its Implementation Plan.

The Fifth Plan is focused on improvements across eight targeted priority areas:

1. Achieving integrated regional planning and service delivery

2. Effective suicide prevention

3. Coordinated treatment and supports for people with severe and complex mental illness

4. Improving Aboriginal and Torres Strait Islander mental health and suicide prevention

5. Improving the physical health of people living with mental illness and reducing early mortality

6. Reducing stigma and discrimination

7. Making safety and quality central to mental health service delivery

8. Ensuring that the enablers of effective system performance and system improvement are in place

The Fifth Plan also responds to calls for a national approach to address suicide prevention and will be used to guide other sectors and to support health agencies to interact with other portfolios to drive action in this priority area.

Ongoing collaboration and engagement across the sector and with consumers and carers is required to successfully implement the Fifth Plan and achieve meaningful reform to improve the lives of people living with mental illness including the needs of children and young people.

Health Ministers also agreed that mental health workforce issues would be considered by the Australian Health Ministers’ Advisory Council.

5.The National Psychosocial Supports Program

Health Ministers agreed to establish a time-limited working group to progress the Commonwealth’s National Psychosocial Supports program. This will have the objective of developing bilateral agreements to support access to essential psychosocial supports for persons with severe mental illness resulting in psychosocial disability who are not eligible for the NDIS.

Those bilateral agreements will take into account existing funding being allocated for this purpose by states and territories.

6.Strengthened penalties and prohibition orders under the Health Practitioner Regulation National Law

Health Ministers agreed to proceed with amendments to the Health Practitioner Regulation National Law (the National Law) to strengthen penalties for offences committed by people who hold themselves out to be a registered health practitioner, including those who use reserved professional titles or carry out restricted practices when not registered.

Ministers also agreed to proceed with an amendment to introduce a custodial sentence with a maximum term of up to three years for these offences.

These important reforms will be fast tracked to strengthen public protection under the National Law. Preparation will now commence on a draft amendment bill to be brought forward to Ministers for approval, with a view to this being introduced to the Queensland Parliament in 2018. The Western Australian Parliament is also expected to consider legislative changes to the Western Australian National Law.

7.Amendment to mandatory reporting provisions for treating health practitioner

Health Ministers agree that protecting the public from harm is of paramount importance as is supporting practitioners to seek health and in particular mental health treatment as soon as possible.

Health Ministers agreed that doctors should be able to seek treatment for health issues with confidentiality whilst also preserving the requirement for patient safety.

A nationally consistent approach to mandatory reporting provisions will provide confidence to health practitioners that they can feel able to seek treatment for their own health conditions anywhere in Australia.

Agree for AHMAC to recommend a nationally consistent approach to mandatory reporting, following discussion paper and consultation with consumer and practitioner groups, with a proposal to be considered by COAG Health Council at their November 2017 meeting, to allow the amendment to be progressed as part of Tranche 1A package of amendments and related guidelines.

8.National Digital Health Strategy and Australian Digital Health Agency Forward Work Plan 2018–2022

Health Ministers approved the National Digital Health Strategy and the Australian Digital Health Agency Work Plan for 2018-2022.

Download Strategy and work plan here  

The Strategy has identified the priority areas that form the basis of Australia’s vision for digital health.

This Strategy will build on Australia’s existing leadership in digital health care and support consumers and clinicians to put the consumer at the centre of their health care and provide choice, control and transparency.

Expanding the public reporting of patient safety and quality measures

Health Ministers supported Queensland and other interested jurisdictions to collaboratively identify options in relation to aligning patient safety and quality reporting standards across public and private hospitals nationally.

Ministers agreed that the Australian Commission on Safety and Quality in Health Care (ACSQHC) would undertake work with other interested jurisdictions to identify options in relation to aligning public reporting standards of quality healthcare and patient safety across public and private hospitals nationally.

The work be incorporated into the national work being progressed on Australia’s health system performance information and reporting frameworks.

 

9.National human biomonitoring program

Health Ministers noted that human biomonitoring data can play a key role in identifying chemicals which potentially cause adverse health effects and action that may need to be taken to protect public health.

Health Ministers agreed that a National Human Biomonitoring Program could be beneficial in assisting with the understanding of chemical exposures in the Australian population.

Accordingly, Ministers agreed that the Australian Health Ministers’ Advisory Council will explore this matter in more detail by undertaking a feasibility assessment of a National Human Biomonitoring Program.

Clarification of roles, responsibilities and relationships for national bodies established under the National Health Reform Agreement

States and territories expressed significant concern that the proposed Direction to IHPA will result in the Commonwealth retrospectively not funding activity that has been already delivered by states and territories but not yet funded by the Commonwealth.

States and territories were concerned that this could reduce services to patients going forward as anticipated funding from the Commonwealth will be less than currently expected.

The Commonwealth does not agree with the concerns of the states and territories and will seek independent advice from the Independent Hospital Pricing Authority (IHPA) to ensure hospital service activity for 2015-2016 has been calculated correctly. The Commonwealth committed to work constructively and cooperatively with all jurisdictions to better understand the drivers of increased hospital services in funding agreements.

10.Legitimate and unavoidable costs of providing public hospital services in Western Australia

Health Ministers discussed a paper by Western Australia on legitimate and unavoidable costs of providing public hospital services in Western Australia, particularly in regional and remote areas, and recognised that those matters create a cumulative disadvantage to that state. Health Ministers acknowledged that Western Australia will continue to work with the Commonwealth Government and the Independent Hospital Pricing Authority to resolve those matters.

11.Vaccination

Health Ministers unanimously confirmed the importance of vaccination and rejected campaigns against vaccination.

All Health Ministers expressed their acknowledgement of the outgoing Chair, the Hon Ms Jill Hennessy and welcomed the incoming Chair Ms Meegan Fitzharris MLA from the Australian Capital Territory.

Health Ministers approve Australia’s National Digital Health Strategy

Digital information is the bedrock of high quality healthcare.

The benefits for patients are signicant and compelling: hospital admissions avoided, fewer adverse drug events, reduced duplication of tests, better coordination of care for people with chronic and complex conditions, and better informed treatment decisions. Digital health can help save and improve lives.

To support the uptake of digital health services, the Council of Australian Governments (COAG) Health Council today approved Australia’s National Digital Health Strategy (2018-2022).

Download Strategy and work plan here  

In a communique issued after their council meeting in Brisbane August 4 , the Health Ministers noted:

“The Strategy has identified the priority areas that form the basis of Australia’s vision for digital health. It will build on Australia’s existing leadership in digital health care and support consumers and clinicians to put the consumer at the centre of their health care and provide choice, control, and transparency.”

Australian Digital Health Agency (ADHA) CEO Tim Kelsey welcomed COAG approval for the new Strategy.

“Australians are right to be proud of their health services – they are among the best, most accessible, and efficient in the world.

Today we face new health challenges and rapidly rising demand for services. It is imperative that we work together to harness the power of technology and foster innovation to support high quality, sustainable health and care for all, today and into the future,” he said.

The Strategy – Safe, seamless, and secure: evolving health and care to meet the needs of modern Australia – identifies seven key priorities for digital health in Australia including delivery of a My Health Record for every Australian by 2018 – unless they choose not to have one.

More than 5 million Australians already have a My Health Record, which provides potentially lifesaving access to clinical reports of medications, allergies, laboratory tests, and chronic conditions. Patients and consumers can access their My Health Record at any time online or on their mobile phone.

The Strategy will also enable paper-free secure messaging for all clinicians and will set new standards to allow real-time sharing of patient information between hospitals and other care professionals.

Australian Medical Association (AMA) President Dr Michael Gannon has welcomed the Strategy’s focus on safe and secure exchange of clinical information, as it will empower doctors to deliver improved patient care.

“Doctors need access to secure digital records. Having to wade through paperwork and chase individuals and organisations for information is

archaic. The AMA has worked closely with the ADHA on the development of the new strategy and looks forward to close collaboration on its implementation,” Dr Gannon said.

Royal Australian College of General Practitioners (RACGP) President Dr Bastian Seidel said that the RACGP is working closely and collaboratively with the ADHA and other stakeholders to ensure that patients, GPs, and other health professionals have access to the best possible data.

“The Strategy will help facilitate the sharing of high-quality commonly understood information which can be used with confidence by GPs and other health professionals. It will also help ensure this patient information remains confidential and secure and is available whenever and wherever it is needed,” Dr Seidel said.

Pharmacy Guild of Australia National President George Tambassis said that technology would increasingly play an important role in supporting sustainable healthcare delivery.

“The Guild is committed to helping build the digital health capabilities of community pharmacies and advance the efficiency, quality, and delivery of healthcare to improve health outcomes for all Australians.

“We are working with the ADHA to ensure that community pharmacy dispensing and medicine-related services are fully integrated into the My Health Record – and are committed to supporting implementation of the National Digital Health Strategy as a whole,” George Tambassis said.

Pharmaceutical Society of Australia (PSA) President Dr Shane Jackson said that the Strategy would support more effective medicationmanagement, which would improve outcomes for patients and improve the efficiency of health services.

“There is significant potential for pharmacists to use digital health records as a tool to communicate with other health professionals, particularly during transitions of care,” Dr Jackson said.

The Strategy will prioritise development of new digital services to support newborn children, the elderly, and people living with chronic disease. It will also support wider use of telehealth to improve access to services, especially in remote and rural Australia and set standards for better information sharing in medical emergencies – between the ambulance, the hospital, and the GP.

Consumers Health Forum (CHF) Leanne Wells CEO said that the Strategy recognises the importance of empowering Australians to be makers and shapers of the health system rather than just the users and choosers.

“We know that when consumers are activated and supported to better self-manage and coordinate their health and care, we get better patient experience, quality care, and better health outcomes.

“Digital health developments, including My Health Record, are ways in which we can support that to happen. It’s why patients should also be encouraged to take greater control of their health information,” Leanne Wells said.

Medical Software Industry Association (MSIA) President Emma Hossack said that the Strategy distils seven key themes that set expectations at a national level.“The strategy recognises the vital role industry plays in providing the smarts and innovation on top of government infrastructure.

This means improved outcomes, research, and productivity. Industry is excited to work with the ADHA to develop the detailed actions to achieve the vision which could lead to Australia benefitting from one of the strongest health software industries in the world,” Emma Hossack said.

Health Informatics Society of Australia (HISA) CEO Dr Louise Schaper welcomed the Strategy’s focus on workforce development.

“If our complex health system is to realise the benefits from information and technology, and become more sustainable, we need clinical leaders with a sound understanding of digital health,” Dr Schaper said.

The Strategy was developed by all the governments of Australia in close partnership with patients, carers and the clinical professionals who serve them – together with leaders in industry and science.

The Strategy draws on evidence of clinical and economic benefit from many sources within Australia and overseas, and emphasises the priority of patient confidentiality as new digital services are implemented.

The ADHA has established a Cyber Security Centre to ensure Australian healthcare is at the cutting edge of international data security.

The ADHA, which has responsibility for co-ordinating implementation of the Strategy, will now be consulting with partners across the community to develop a Framework for Action. The framework will be published later this year and will detail implementation plans for the Strategy.

The National Digital Health Strategy Safe, seamless and secure: evolving health and care to meet the needs of modern Australia is available on

https://www.digitalhealth.gov.au/australias-national-digital-health-strategy (https://www.digitalhealth.gov.au/australias-national-digital-health-strategy)

Greg Hunt Press Conference

Topics: COAG Health Council outcomes; The Fifth National Mental Health and Suicide Prevention Plan; support for doctors and nurses mental health; hospital funding; same-sex marriage

GREG HUNT:
Today was a huge breakthrough in terms of mental health. The Fifth National Mental Health Plan was approved by the states.

What this is about is enormous progress on suicide prevention. It has actually become the Fifth National Mental Health and Suicide Prevention Plan, so a real focus on suicide prevention.

In particular, the focus on what happens when people are discharged from hospital, the group in Australia that are most likely to take their own lives.

We actually know not just the group, but the very individuals who are most at risk. That’s an enormous step.

The second thing here is, as part of that plan, a focus on eating disorders, and it is a still-hidden issue. In 2017, the hidden issue of eating disorders, of anorexia and bulimia, and the prevalence and the danger of it is still dramatically understated in Australia.

The reality is that this is a silent killer and particularly women can be caught up for years and years, and so there’s a mutual determination, a universal determination to progress on eating disorders, and that will now be a central part of the Fifth National Mental Health and Suicide Prevention Plan.

And also, as part of that, we’ve included, at the Commonwealth’s request today, a real focus on early intervention services for young people under 16. Pat McGorry has referred to it as CATs for Kids, meaning Crisis Assessment Teams, and the opportunity.

And this is a really important step because, for many families, when they have a crisis, there’s nowhere to turn. This is a way through. So those are all enormous steps forward.

The other mental health area where we’ve made big, big progress is on allowing doctors to seek routine mental health treatment.

There’s an agreement by all of the states and territories to work with the Commonwealth on giving doctors a pathway so as they can seek routine mental health treatment without being reported to the professional bodies.

JOURNALIST:
What has led to the increased focus on eating disorders? Has there been an uptick in the number of suicides resulting from that, or has there been an uptick in the number of cases?

GREG HUNT:
No, this has been silently moving along. It’s a personal focus. There are those that I have known, and then when we looked the numbers shortly after coming in, and dealt with organisations such as the Butterfly Foundation, they explained that it’s been a high level issue with the worst rate of loss of life amongst any mental health condition.

And so that’s a combination both of suicide, but also of loss of life due to physical collapse. And so it’s what I would regard as a personal priority from my own experience with others, but then the advocacy of groups like Butterfly Foundation has finally landed. It should’ve happened earlier, but it’s happening on our watch now.

JOURNALIST:
That would be my next question, is that I’m sure advocacy groups will say this is great that it’s happened, but it’s taken the Government so long. Why is it that you’re focussing on it now as opposed to…?

GREG HUNT:
I guess, I’ve only just become Minister. So from day one, this is one of the things I’ve wanted to do, and I’m really, personally, deeply pleased that we’ve made this enormous progress.

So I would say this, I can’t speak for the past, it is overdue, but on our watch collectively we’ve taken a huge step forward today.

Then the last thing is I’ve seen some reports that Queensland and Victoria may have been upset that some of their statistical anomalies were referred to what’s called IHPA (Independent Hospital Pricing Authority).

The reason why is that some of their figures simply didn’t pass the pub test.

The independent authority will assess them, but when you have 4000 per cent growth in one year in some services, 3300 per cent growth in some years in other services, then it would be negligent and irresponsible not to review them.

It may be the case that there was a more than 40-fold increase in some services, but the only sensible thing for the Commonwealth to do is to review it.

But our funding goes up each year every year at a faster rate than the states’ funding, and it’s gone up by $7.7 billion dollars since the current health agreement with the states was struck.

JOURNALIST:
Is that, sorry, relating to private health insurance, or is that something separate?

GREG HUNT:
No, that’s just in relation to, a couple of the states lodged claims for massive growth in individual items.

JOURNALIST:
Thank you. So was there a directive given today regarding private health policies to the states? Was that something that was discussed or something that …?

GREG HUNT:
Our paper was noted, and the states will respond. So we’ve invited the states to respond, they’ll respond individually.

JOURNALIST:
And regarding that mental health plan, besides their new focus on eating disorders, how is it different from previous mental health plans?

GREG HUNT:
So, a much greater focus on suicide prevention, a much greater focus on eating disorders, and a much greater focus on care for young children under 16.

JOURNALIST:
Is that something that you can give more specific details about? You’re saying there’s a much greater focus, but is there any specific information about what that would mean?

GREG HUNT:
As part of the good faith, the Commonwealth, I’ve written to the head of what’s called the Medical Benefits Schedule Review, so the Medicare item review, Professor Bruce Robinson and asked him and their team to consider, for the first time, specific additional treatment, an additional treatment item and what would be appropriate for eating disorders.

NACCHO Research Alert : @NRHAlliance Aboriginal health risk factors #rural and #remote populations

 ” Health risk factors like smoking, excessive drinking, illicit drug use, lack of physical activity, inadequate fruit and vegetable intake and overweight have powerful influences on health, and there are frequently clear inter-regional differences between the prevalence of these.

While it can be argued that there is some degree of personal choice involved in whether individuals have a poor health risk profile, there is clear evidence that external factors such as environment, opportunity, and community culture each have very strong influences.

For example, access to affordable healthy food can often be poor in smaller communities and this, coupled with lower incomes in these areas, adversely affects the quality of peoples’ diets, the prevalence of overweight, and consequently the prevalence of chronic disease.”

From the National Rural Health Alliance Research View HERE

National data pertaining to personal health risk factors typically comes from the ABS National Health Survey and the AIHW National Drug Strategy Household Survey (NDSHS). Some State and Territory Health Departments run their own health surveys (which cannot be aggregated nationally with each other or with the ABS survey because of the different methodologies and definitions used (think different State rail gauges). Consequently data describing aspects of health in regional and especially remote areas can be thin (ie with imprecise estimates in some or all areas).

Example 1

Table 14: Fruit and vegetable consumption, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

Roughly 60% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate fruit intake, closer to 50% in remote areas (compared with around 50% of all Australians 18+ in major cities and regional/rural areas).

Roughly 95% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate vegetable intake, perhaps higher (98%) in Very remote areas (compared with around 90%-94% of all Australians 18+ in major cities and regional/rural areas).

Example 2

NACCHO provided graphic

Table 16 Below : Overweight and Obesity, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

Aboriginal and Torres Strait Islander people in rural/regional and Remote areas (29%-33%) were a little more likely to be overweight than those in Major cities (28%), with those in Very Remote areas (26%) least likely to be overweight.

Aboriginal and Torres Strait Islander people in Inner regional areas (41%) were more likely to be obese than those in Major cities (38%), but those in Outer regional (36%) and remote areas (~33%) were less likely to be obese.

Overall, Aboriginal and Torres Strait Islander people in Inner Regional areas were most likely to be overweight/obese (70%), those in Major cities, Outer Regional and Remote areas were less likely to be overweight/obese (~66%), while those in Very Remote areas were the least likely to be overweight/obese (59% )

At the time of writing, the most recent National Health Survey was conducted in 2014-15[1], while the most recent AIHW NDSHS[2] was conducted in 2016, with most recently available results from the 2013 NDSHS. The most recent ABS Australian Aboriginal and Torres Strait Islander Health Survey[3] was conducted in 2012-13.

Some organisations (eg the Public Health Information Development Unit (PHIDU)) have calculated modelled estimates for small areas (eg SLA’s and PHN’s), where the prevalence of some risk factors has been predicted based on the age, sex and socioeconomic profile of the population living there.

Some sites (eg ABS) present risk factor data as crude rates, other sites (eg PHIDU) present risk factor data as age-standardised rates.  The advantage of the age-standardised rates is that the effect of age is largely removed from inter-population comparisons.

For example, older populations (eg those in rural/regional areas) would be expected to have higher average blood pressure than younger (eg Major cities) populations even though the underlying age-specific rates happened to be identical in both populations (because older people tend to have higher blood pressure than younger people).

While crude rates for the older population will be higher, the age-standardised rates in such a comparison would be the same – indicating a higher rate that is entirely explainable by the older age of one of the populations.

Both crude and age standardised rates are useful in understanding the health of rural and remote populations.

 


[1] http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001

[3] http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocumentSmoking

Table 1: Smoking status, by remoteness, 2013 and 2014-15

MC

IR

OR/Remote

Percentage

Current daily smoker (18+) (crude) 2014-15 (a)

13.0

16.7

20.9

Current smoker (18+) (Age standardised) 2014-15 (b) (includes daily, weekly, social etc smoking)

14.6

19.0

22.4

MC

IR

OR

Remote+ Very Remote

Current smoker (daily, weekly, or fortnightly) 14+ (crude) 2013 (c)

14.2

17.6

22.6

24.6

Current smoker (daily, weekly, or fortnightly) 14+ (Age standardised) 2013 (d)

14.2

18.6

23.6

24.4

Mean number of cigarettes smoked per week, smokers aged 14 years or older 2013 (e)

85.9

113.1

109.4

126.2

Sources:

Compared with Major cities (13%), the prevalence of daily smoking by people 18 years and older in Inner regional (17%) and Outer regional/Remote areas (21%) is higher.

The NDSH survey reflects these trends albeit with a slightly different age group (14+) and a different definition of smoking (daily plus less frequently), but the NDSH survey adds detail for remote areas where smoking rates are higher again (around 25% versus around 23% in Outer regional).

In addition, the average number of cigarettes smoked by each smoker is higher in regional/rural areas (~110/week) than in Major cities (86/week), and higher again (126/week) in remote areas.

 

Smoking – exposure, uptake, establishment, quitting

Table 2: Smoking characteristics by Remoteness, 2013, 2014 and 2014-15

MC

IR

OR

remote

8.8

17.8

19.3

27.8

Proportion of pregnant women who gave birth and smoked at any time during the pregnancy (2013, crude, National Perinatal Data Collection, exposure tables, Table 5.1.2 )

8.5

17.0

18.9

27.5

Proportion of pregnant women who gave birth and smoked in the first 20 weeks of pregnancy (2013, crude, National Perinatal Data Collection) exposure tables, Table 5.2.2)

3.6

3.1

4.1

*9.4

Proportion of dependent children (aged 0–14) who live in a household with a daily smoker who smokes inside the home (2013, crude, NDSHS exposure tables, Table 6.3)

2.5

2.0

2.7

*2.9

Proportion of adults aged 18 or older who live in a household with a daily smoker who smokes inside the home (2013, crude, NDSHS, exposure tables, Table 7.3)

16.2

15.4

14.7

15.5

Average age at which people aged 14–24 first smoked a full cigarette (2013, crude, NDSHS, uptake tables, Table 9.3)

17.8

22.7

17.8

28.3

Proportion of 12–17 year old secondary school students smoking at least a few puffs of a cigarette (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, uptake tables, Table 10.3

54.7

61.1

64.9

67.2

Proportion of persons (aged 18 or older) who have smoked a full cigarette (2013, crude,  NDSHS, uptake tables, Table 10.8)

2.5

3.4

2.5

3.7

Proportion of secondary school students (aged 12–17) who have smoked more than 100 cigarettes in their lifetime (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, transition tables, Table 2.3)

20.2

25.9

44.1

45.2

Proportion of young people (aged 18–24) who have smoked more than 100 cigarettes in their lifetime (2013, crude, NDSHS, transition tables, Table 2.6)

21.3

16.8

19.0

15.5

Quitting: Proportion successfully gave up for more than a month (2013, crude, NDSHS, cessation tables, Table 4.3)

29.2

34.2

31.7

32.9

Quitting, Proportion unsuccessful (2013, crude, NDSHS, cessation tables, Table 4.3)

46.3

48.0

47.4

45.2

Quitting: Proportion any attempt (2013, crude, NDSHS, cessation tables, Table 4.3)

35.2

36.3

36.1

36.0

Mean age at which ex-smokers aged 18 or older reported no longer smoking (2013, crude, NDSHS, cessation tables, Table 11.2)

53.1

51.5

46.3

45.0

The proportion of ever smokers aged 18 or older who did not smoke in the last 12 months (2013, crude, NDSHS, cessation tables, Table 12.3)

4.9

6.0

4.8

7.0

Proportion of secondary school students (aged 12–17) who were weekly smokers (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, established tables, Table 1.3)

6.9

9.3

6.8

10.4

Proportion of secondary school students (aged 12–17) who were monthly smokers (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, established tables, Table 13.3)

13.0

16.7

21.2

18.8

Proportion of adults aged 18 or older who are daily smokers (2014-15, crude, ABS NHS, established tables, Table 3.3)

10.9

7.8

2.9

n.p.

Proportion of smokers aged 18 or older who are occasional smokers (smoke weekly or less than weekly) (2014-15, crude, ABS NHS, established tables, Table 14.3)

40.1

44.7

42.3

52.7

Proportion of Aboriginal and Torres Strait Islander people aged 18 or older who are daily smokers (2012-13, crude, ABS Australian Aboriginal and Torres Strait Islander Health Survey 2012–13, established tables, Table 8i.3)

Source: http://www.aihw.gov.au/alcohol-and-other-drugs/data/ (sighted 11/7/17)
Note: Those estimates above with asterix have large standard errors and should be treated carefully.

Women in rural and remote areas were much more likely to smoke during pregnancy, with 28% of women in remote areas smoking during pregnancy, compared with 18-19% in regional/rural areas, and 9% in Major cities.

It is unclear whether exposure to environmental tobacco smoke varies by remoteness.

Young people outside major cities appeared to have their first cigarette at an earlier age (~15 years as opposed to ~16 years in Major cities.

Secondary school students in Inner regional (~23%) and remote (~28%) areas were more likely to have had at least a few puffs of a cigarette than those in major cities (~18%).

While 20% of young people in Major cities had smoked more than 100 cigarettes in their lifetime, 26%, 44% and 45% of young people in Inner regional, Outer regional and remote areas had done so.

People outside Major cities were as likely or slightly more likely to have attempted to quit smoking, but were less likely to be successful (and more likely to be unsuccessful).

A higher proportion of secondary students outside Major cities were weekly or monthly smokers (6%, 5% and 7% in IR, OR and remote areas versus 5% in Major cities weekly, 9%, 7%, and 10% in IR, OR and remote areas versus 7% in Major cities monthly).

Table 3: Current daily smoker, Aboriginal and Torres Strait Islander people 15+ years, by Remoteness, 2012-13

MC

IR

OR

R

VR

Crude Percent

Current daily smoker

36.2

40.9

39.8

47.4

51.1

Source: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument Table 2 (sighted 12/7/17)

Prevalence of smoking amongst Aboriginal and Torres Strait Islander people 15 years and older is around 35%-40% in Major cities and regional/rural areas, and close to 50% in remote areas. Note that while the pattern is similar in Table 2 and Table 3 above, the figures for 18+ and 15+ year olds are slightly different.

Smoking Trends

Table 4: Comparison of declines in smoking rate estimates across remoteness areas, people 18+, based on ABS NHS surveys, 2001 to 2011-12

Survey year

MC

IR

OR/Rem

Australia

Crude percent daily smokers

2001

21.9

21.9

26.5

22.4

2004-05

19.9

23.0

26.2

21.3

2007-08

17.5

20.1

26.1

18.9

2011-12

14.7

18.3

22.2

16.1

2014-15

13.0

16.7

20.9

14.5

Source: ABS National Health Surveys

From Table 4 above, rates of smoking have clearly declined in Major cities areas, but have been slower to decline in Inner regional and Outer regional/Remote areas. Rates of smoking in rural areas, apparently static last decade, now appear to be declining. Rates in Major cities and Inner regional areas have declined to 0.59 and 0.76 times the 2001 rates in these areas. The 2014-15 rate in Outer regional areas is 0.79 times the 2001 rate.

Figure 1: Daily smokers 18 years and older, 2007-08, 2011-12 and 2014-15, NHS

Figure 1: Daily smokers 18 years and older, 2007-08, 2011-12 and 2014-15, NHS

Source: ABS NHS http://www.aihw.gov.au/alcohol-and-other-drugs/data/ established tables, Table 3.3 (sighted 11/7/17)

Figure 2: Smokers 14 years and older, 2007, 2010 and 2013, NDSHS

Figure 2: Smokers 14 years and older, 2007, 2010 and 2013, NDSHS

Source: AIHW NDSHS http://www.aihw.gov.au/alcohol-and-other-drugs/data/ tobacco smoking table S3.12 (sighted 11/7/17)

Note: Smokers include daily, weekly and less frequent smokers.

Figures 1 and 2 above both show clear declines in Major cities and Inner regional areas, but the trend in Outer regional and Remote areas is less clear, with ABS data showing a decline in daily smoking rates for people aged 18+ between 2007-8 and 2014-15, but NDSHS data showing little change in smoking rates for people 14+ between 2007 and 2013.

Alcohol

Table 5: Alcohol risk status, by remoteness, 2013 and 2014-15

Alcohol consumption

MC

IR

OR/Rem

Exceeded 2009 NHMRC lifetime risk guidelines, people 18+, crude %, 2014-15 (a)

16.3

18.4

23.4

Exceeded 2009 NHMRC lifetime risk guidelines, people 15+, age standardised %, 2014-15 (b)

15.7

17.4

22.0

Exceeded 2009 NHMRC single occasion risk guidelines, people 18+, crude %, 2014-15 (a)

42.7

48.5

46

MC

IR

OR

R/VR

Abstainer/ex-drinker, crude %, 14+, 2013 (c)

23.1

18.9

20.5

17.5

Low lifetime risk, crude %, 14+, 2013 (c)

60.2

62

56.9

47.6

High lifetime risk, crude %, 14+, 2013 (c)

16.7

19.1

22.6

34.9

low single occasion risk, crude %, 14+, 2013 (c)

40.4

41.8

38.1

30.8

Single occasion risk less than weekly, crude %, 14+, 2013 (c)

23.5

24.4

23.6

22.8

Single occasion risk at least weekly, crude %, 14+, 2013 (c)

13

14.9

17.8

28.9

Sources:

Table 6: Alcohol consumption against 2009 NHMRC guidelines, Aboriginal and Torres Strait Islander people 15+ years, by Remoteness 2012-13

MC

IR

OR

R

VR

Percent

Exceeded lifetime risk guidelines

18.0

18.7

18.2

22.5

14.3

Exceeded single occasion risk guidelines

56.7

57.4

50.7

59.0

41.4

Source: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument Table 2 (sighted 12/7/17)

The figures in Table 6 are not strictly comparable with those for the total population in Table 5, because  Table 6 refers to people who are 15 years and older, while Table 5 refers to people who are 18 years and older.

The percentage of the 15+ ATSI population exceeding 2009 NHMRC Lifetime risk guidelines is around 15-20% with little apparent inter-regional variation, compared with, for the total population 18+,  16% in Major cities, increasing to 23% in Outer regional/remote areas.

The percentage of the 15+ ATSI population exceeding the 2009 single occasion risk guidelines is around 50-60%, and around 40% in Very remote areas, compared with, for the total population 18+,  40-50% in Major cities, rural and regional areas.

Alcohol trends

Table 7: Type of alcohol use and treatment for alcohol, by remoteness area (per 1,000 population)

MC

IR

OR

R/VR

single occasion risk (monthly) 2004

287

304

321

370

2007

285

292

312

437

2010

274

312

329

413

2013

250

273

315

422

lifetime risk 2004

200

215

234

262

2007

199

210

238

314

2010

189

225

251

310

2013

167

191

226

349

very high risk – yearly 2004

167

185

206

243

2007

172

183

206

288

2010

161

183

218

266

2013

151

166

194

258

very high risk – monthly 2004

77

84

104

130

2007

78

89

100

153

2010

79

94

113

154

2013

70

70

100

170

very high risk – weekly 2004

21

27

41

38

2007

24

28

24

50

2010

37

43

54

78

2013

27

28

38

70

Closed treatment episodes 2004–05

61

72

60

58

2007–08

76

84

80

129

2010–11

69

96

87

135

2013–14

68

79

93

155

Source: NDSHS,  http://www.aihw.gov.au/alcohol-and-other-drugs/data/  alcohol -supplementary data tables, Table S18

Notes:
Single occasion risk (monthly): Had more than 4 standard drinks at least once a month
Lifetime risk: On average, had more than 2 standard drinks per day
Very high risk (yearly): Had more than 10 standard drinks at least once a year
Very high risk (monthly): Had more than 10 standard drinks at least once a month
Very high risk (weekly): Had more than 10 standard drinks at least once a week

There is a clear increase in the prevalence of people who drink alcohol in such a way as to increase their single occasion risk (eg from car accident, assault, fall, etc) and their lifetime risk (eg from chronic disease – liver disease, dementia, cancer etc) as remoteness increases.

In 2013, single occasion risk ranged from 25% of people 14 years or older in major cities to 42% of people in remote areas, while lifetime risk increased from 17% in major cities to 35% in remote areas.

In 2013, The prevalence of people who drank more than 10 standard drinks in one sitting at least once per week, increased from just under 3% in Major cities to 7% in remote areas.

In 2013-14, there were just under 70 closed treatment episodes per 1,000 people living in Major cities, increasing to around 80 and 90 per 1,000 population in Inner and Outer regional areas, to 155 per 1,000 people living in remote Australia.

 

Illicit drug use 2013

Table 8: Illicit drug use, “recent users” 14+, 2013

MC IR OR remote

Crude percent

Cannabis

9.8

10.0

12.0

13.6

Ecstasy

2.9

1.5

1.6

*1.8

Meth/amphetamine

2.1

1.6

2.0

*4.4

Cocaine

2.6

0.8

*1.1

*2.5

Any illicit drug

14.9

14.1

16.7

18.7

Source: AIHW National Drug Strategy Household Survey, 2013. http://www.aihw.gov.au/alcohol-and-other-drugs/data/  Illicit drug use (supplementary) tables S5.6, S5.11, S5.17, S5.21, S5.26.

Note: * indicates large standard error (therefore some degree of uncertainty)

Illicit drug use appears to be higher in Outer regional and remote areas compared with Major cities and Inner regional areas, in large part due to higher rates of cannabis use in these areas, but with apparent lower use of ecstasy and cocaine in regional areas compared with Major cities.

 

Physical activity

Table 9: Physical inactivity, people 18+, 2014-15

MC

IR

OR/Remote

Percentage of people aged 18+ who undertook no or low exercise in the previous week (crude) (a)

64.3

70.1

72.4

Percentage of people aged 18+ who undertook no or low exercise in the previous week (age standardised) (b)

64.8

68.6

71

Sources:
(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) PHIDU (ABS NHS data) (http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas) sighted 18/7/2017

Note that level of exercise is based on exercise undertaken for fitness, sport or recreation in the last week.

Physical inactivity appears to be more prevalent with remoteness, increasing from 65% of people in Major cities to 71% in Outer regional/remote areas.

Table 10: Average daily steps, 2011-12

MC

IR

OR/Rem

Average daily steps, 18+ years, 2011-12 (a)

7,393

7,388

7,527

Average daily steps, 5-17years, 2011-12 (b)

9,097

9,266

9,160

Sources:

In 2011-12, adults living in Outer regional/Remote areas took slightly more steps than those living in Major cities or Inner regional areas, while the number of steps taken by children and adolescents in regional/Remote areas was slightly greater compared with those in Major cities.

Table 11: Average time spent on physical activity and sedentary behaviour by persons aged 18+, 2011-12

MC

IR

OR/Remote

Australia

Hours

Physical activity(a)

3.9

3.4

3.9

3.8

Sedentary behaviour (leisure only)(b)

29.3

28.0

27.9

28.9

Sedentary behaviour (leisure and work)(b)

40.2

35.2

36.0

38.8

Notes:
(a) Includes walking for transport/fitness, moderate and vigorous physical activity.
(b) Sedentary is defined as sitting or lying down for activities.

Source: ABS 2011-12 Australian Health Survey (Physical activity) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0042011-12?OpenDocument  Table 5.1

Adults living in Inner regional and Outer regional/Remote areas were about as likely as (or very slightly less likely than) those in Major cities to be sedentary in their leisure time, but appeared to be slightly less likely to be sedentary overall (ie their work involved a greater level of physical activity).

Table 12: Whether children aged 2-17 years met physical and screen-based activity recommendations, 2011-12

MC

IR

OR/Rem

Crude percentage

Met physical activity recommendation on all 7 days(a)(b)

27.5

34.3

34.2

Met screen-based activity recommendation on all 7 days(b)(c)

28.0

29.7

31.0

Met physical activity and screen-based recommendations on all 7 days (a)(b)(c)

9.7

10.9

14.2

Notes:
(a) The physical activity recommendation for children 2–4 years is 180 minutes or more per day, for children 5-17 years it is 60 minutes or more per day. See Physical activity recommendation in Glossary.
(b) In 7 days prior to interview.
(c) The screen-based recommendation for children 2–4 years is no more than 60 minutes per day, for children 5-17 years it is no more than 2 hours per day for entertainment purposes.

Source:
ABS 2011-12 Australian Health Survey (Physical activity) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0042011-12?OpenDocument  Table 14.3

Children in rural and regional Australia appeared more likely (34% vs 28%) to meet physical activity recommendations and slightly more likely (30%vs 28%) to meet screen-based activity recommendations than their Major cities counterparts.

 

Fruit and vegetable consumption

Table 13: Fruit and vegetable consumption, people 18+ years, by remoteness, 2014-15

MC

IR

OR/Remote

Crude Percentage

Inadequate fruit consumption(a)

50.0

50.6

51.2

Inadequate fruit consumption(b)

50.4

48.3

48.0

Inadequate vegetable consumption(a)

93.4

93.5

89.3

Inadequate vegetable consumption(b)

n.p.

n.p.

n.p.

Sources:
(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) PHIDU (ABS NHS data) (http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas) sighted 18/7/2017

Note that adequacy of consumption is based on comparison with 2013 NHMRC guidelines.

Half of adult Australians eat insufficient fruit, with little clear difference between major cities and regional/rural areas.

Around 90% of adult Australians ate insufficient vegetables, with little clear difference between major cities and regional/rural areas.

Table 14: Fruit and vegetable consumption, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

MC

IR

OR

R

VR

Crude Percent

Inadequate daily fruit consumption (2013 NHMRC Guidelines)

59.0

60.6

56.9

54.9

49.1

Inadequate daily fruit consumption (2003 NHMRC Guidelines)

62.1

63.6

59.8

58.3

51.6

Inadequate daily vegetables consumption (2013 NHMRC Guidelines)

95.9

93.5

93.6

94.5

97.9

Inadequate daily vegetables consumption (2003 NHMRC Guidelines)

93.8

90.6

90.5

91.2

96.1

Source: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument Table 2 (sighted 12/7/17)

Roughly 60% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate fruit intake, closer to 50% in remote areas (compared with around 50% of all Australians 18+ in major cities and regional/rural areas).

Roughly 95% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate vegetable intake, perhaps higher (98%) in Very remote areas (compared with around 90%-94% of all Australians 18+ in major cities and regional/rural areas).

 

 

Overweight and Obesity

Table 15: Overweight and Obesity, people 18+ years, by remoteness, 2014-15

MC

IR

OR/Remote

Crude Percentage

Persons, overweight/obese (a)

61.1

69.2

69.2

Age standardised percentage

Males overweight (b)

43.8

41.1

34.3

Males obese (b)

25.8

33.1

38.2

Females overweight (b)

28.9

28.3

30.1

Females obese (b)

25.0

32.4

33.7

People  overweight (b)

36.2

34.4

31.4

People obese (b)

25.4

32.6

35.8

Sources:
(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) ABS NHS http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas

Adults in rural/regional areas are more likely to be overweight or obese than people in Major cities (69% vs 61%).

However, there were inter-regional BMI and gender differences:

  • Compared with those in Major cities, males in Inner regional and especially Outer-regional areas were less likely to be overweight (41% and 34%, vs 44%) but much more likely to be obese (33% and 38% vs 26%).
  • Compared with those in Major cities, females in Inner regional and Outer-regional areas were about as likely to be overweight (~29%) but much more likely to be obese (~33% vs 25%).

 

Table 16: Overweight and Obesity, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

MC

IR

OR

R

VR

Crude Percent

Overweight

27.5

28.8

30.1

32.5

26.4

Obese

37.9

41.3

36.2

33.1

32.3

Overweight/obese

65.4

70.1

66.2

65.6

58.8

Aboriginal and Torres Strait Islander people in rural/regional and Remote areas (29%-33%) were a little more likely to be overweight than those in Major cities (28%), with those in Very Remote areas (26%) least likely to be overweight.

Aboriginal and Torres Strait Islander people in Inner regional areas (41%) were more likely to be obese than those in Major cities (38%), but those in Outer regional (36%) and remote areas (~33%) were less likely to be obese.

Overall, Aboriginal and Torres Strait Islander people in Inner Regional areas were most likely to be overweight/obese (70%), those in Major cities, Outer Regional and Remote areas were less likely to be overweight/obese (~66%), while those in Very Remote areas were the least likely to be overweight/obese (59%).

These figures compare with 61% – the prevalence of overweight/obesity for (predominantly non-Indigenous) people living in Major cities.

 

High blood pressure

Table 17: High blood pressure, people 18+, by Remoteness, 2014-15

MC

IR

OR/Remote

Percentage

Crude % (a)

21.9

27.1

24

Age standardised % (b)

22.7

24.6

22.1

Sources:

(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) ABS NHS http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas

Age for age, people in rural/regional Australia appeared to be as likely, or very slightly more likely to have high blood pressure than their counterparts in Major cities (~23% vs ~24%). However, because people in rural/regional areas are older (on average), the prevalence of people with high blood pressure is higher (~26% vs 22%) than

Updated 31/07/2017
To view archived Risk Factors click here

NACCHO Aboriginal Health and #LiteracyforLife @NITV In My Own Words screens nationally, July 30

 

 ” In My Own Words is an uplifting new documentary on the work of the Literacy for Life Foundation in the small New South Wales town of Brewarrina.

Watch on as a group of Aboriginal adults pick up pen and paper for the first time and begin to learn to read and write.

It is a heartwarming story that shows what is possible through lifting literacy.”

In My Own Words screens nationally, July 30, on NITV (8:30pm) and SBS It is directed by Erica Glynn and produced by Blackfella Films.

Trailer for Sydney Film Festival 2017  VIEW HERE

There’s a large adult-sized hole in Australia’s approach to boosting literacy levels among Indigenous children and young people.

For several decades, the focus has been on increasing investment in schools and refining the ways we engage Indigenous children.

But what if the most effective way to get more kids reading and writing was to give their parents those same skills?

The Literacy for Life Foundation is exploring this idea through the Aboriginal Adult Literacy Campaigns the organisation has been running in western New South Wales since 2012, in partnership with the University of New England.

The Foundation uses a campaign model known as Yes, I Can!, originally developed in Cuba. It has been used in 30 countries in the global south, including Timor-Leste where it reached 200,000 people.

Each campaign is led by local Aboriginal leaders and their organisations, supported by a small team from the Literacy for Life Foundation. So far, it has run in five western NSW communities, with completion rates over 65%.

This is five times higher than Indigenous students’ completion rates for formal, accredited Foundations Skills courses run through the national vocational education and training (VET) system, which aim to get students to a similar level on the Australian Core Skills Framework.

Nationally, the completion rate for VET Certificate One courses is only 13%, and lower in rural and remote areas. These courses are mainly funded for registered job-seekers aged 15-65, missing a large number of adults who have very low literacy.

A key difference identified in a recent NCVER study is that Yes, I Can! is taught in community, by community members, with a non-formal community education approach.

Struggle to complete everyday tasks

While adults are the focus, boosting literacy levels across an entire community creates a flow-on effect into other areas, including health, employment, justice and school education.

In initial household surveys, over 50% of adults said they did not have the literacy they needed for everyday tasks such as filling in forms.

The consequences of this can be quite dire.

Law and justice officials and community leaders in these locations report that people with low literacy are less likely to go for their drivers licences, resulting in multiple instances of fines, arrest and incarceration for unlicensed driving.

People with very low literacy also struggle to understand and respond to the official communications from Centrelink and job network agencies, which determine their continued eligibility for income support.

The lack of control that people with low literacy have over their circumstances brings with it a range of health problems. At the same time, they are less likely to access primary health care services, and to follow the instructions they are given for managing medications and treatments.

A way to get more kids reading and writing is to give their parents those same skills. Literacy for Life Foundation/Adam Sharman, Author provided (No reuse)

Impact on children

When the adults in a community experience these problems, they have obvious consequences for their children, including on their ability to participate in school.

Most importantly, parents and other adult relations who struggle with literacy are unlikely to be able to support their children at school, in the way that parents with more literacy can.

This includes reading to children when they are very young; being able to understand and respond to notes that come home from school; taking part in parent-teacher meetings; and advocating for their children when they are having trouble at school.

It should therefore come as no surprise that children who are least likely to attend regularly and do well in school are those who grow up in households where few adults, if any, have had a good education.

When Literacy for Life Foundation ran an adult literacy campaign in the small New South Wales community of Enngonia, the local school principal was one of the biggest supporters. She said:

More parents are talking to me about school and asking for their kids to be given homework. Our pre-schoolers are using the library more, too. It’s been a great thing for the community: it’s given the adults who did miss out on their schooling a chance to catch up and have a way to relate to their children.

An ARC-funded longitudinal study of the impact of the campaigns is now underway and due for completion in 2019. This will provide more detailed evidence of the links between lifting adult literacy across a community and better school outcomes for children.

In the meantime, there is plenty of evidence already in the public domain that indicates Indigenous adult literacy levels are alarmingly low and require immediate attention.

Aboriginal community leaders began calling for action on adult literacy nearly 30 years ago, and these calls were supported in the recommendations of the 1991 Royal Commission into Aboriginal Deaths in Custody.

If we are serious about getting more Indigenous kids reading and writing, we must tackle low adult literacy at the same time. If we don’t, the gap will only continue to widen.


Read more articles in this series.

NACCHO Aboriginal Health #SocialDeterminants : #Indigenous education represented a “potent, practical and achievable road to change life expectancy by 12 years

 “Improvements in educational attainment could boost Indigenous life expectancy by as much as 12 years.

While clinicians focus on medical advances to benefit health care, real improvement in Indigenous health will come through attention to factors such as education, gender, power, racism and employment conditions,

These daily living factors constitute the social determinants of health, which are responsible for major health inequalities between population groups.”

 Researchers say Writing in the MJA

Read over 80 NACCHO articles over 5 years about Social Determinants

Dr Michael B Hart of the Social Determinants of Health Alliance, and co-authors, said that education represented a “potent, practical and achievable road to change” that had been overlooked as a force for health improvement.

They pointed to an analysis of evidence that contrasted a difference in life expectancy of 10–12 years between people with less than a high school education and people with an advanced degree, compared with a life expectancy difference of 6 months between people with elevated low-density lipoprotein cholesterol levels versus normal cholesterol levels.

While the MJA authors noted that a causal link between education and health had yet to be found, they said that the estimation that life expectancy could be increased by up to 12 years by improving educational attainment was “too compelling to ignore”.

Professor Steven Larkin, Pro Vice-Chancellor of Indigenous Education and Research at the University of Newcastle, said that the article presented a sophisticated analysis of the problem, but that the lack of evidence regarding causation made it difficult to draw firm conclusions.

“Consequently, we may well ask: does improving education lead to improved health outcomes? Or is it because of your improved health outcomes that you achieve better educational outcomes?” said Professor Larkin, who is also a former CEO of the National Aboriginal Community Controlled Health Organisation and a former adviser to the Australian Medical Association.

He said that it may also be that health and education were more likely to be a part of a broader range of macro socio-economic determinants that had an impact on the holistic quality of life and status of health.

The MJA article noted encouraging trends in education, with the proportion of Indigenous 20–24-olds who had achieved schooling to Grade 12 or equivalent increasing from 45.4% in 2008 to 61.5% in 2014–15.

However, they added, concerns remained, with 2013 Northern Territory data showing that less than half of Indigenous children had reached the Grade 3 minimum reading standard, compared with the national figure of about 90%.

In May of 2017, in acknowledgement of the 50th anniversary of the 1967 referendum, the federal government announced a raft of Indigenous education programs. The $138 million education package includes scholarships and mentoring programs for secondary students, a scholarship fund for students in STEM (science, technology, engineering and mathematics) degrees, as well as a program to raise the aspirations for tertiary studies.

Professor Larkin said that a key barrier to educational attainment was the lack of recognition of the depth of cultural difference.

“There is an underlying assumption of cultural homogeneity in operation here, and that’s one of the major issues for the lack of success and lower levels of Indigenous engagement and participation,” Professor Larkin told MJA InSight. “We basically have teachers who are trained in the Western educational paradigm. They are using Western curricula materials and pedagogy, and they are expecting people who are culturally different and for whom English is a second or third language to automatically be able to comprehend and study effectively under those imposed conditions.”

Professor Larkin said that seeking out more versatile, heterogenous curricula and teaching methods could help improve educational outcomes.

“We have had a pedagogy that has been designed around what constitutes best quality teaching, rather than how do people learn better. It’s a subtle but significant shift.”

He said that underperformance in measures such as NAPLAN (National Assessment Program – Literacy and Numeracy) showed a clear need for a rethink of the assumptions underpinning the delivery of education to Indigenous children.

“It’s not about dispensing with Western education, it’s just saying, can’t we do this in different ways to achieve better outcomes?”

Professor Larkin that said a lack of Indigenous leadership in both education and health was another factor that needed closer consideration.

He said that there was a need for more Indigenous Australians in the roles of employers, managers, decision makers and thought leaders.

“As much as we need non-Indigenous leadership on this, it has to be complemented by Indigenous leadership,” Professor Larkin said. “Non-Indigenous people may have the experience in the field, and they may have a developed understanding, but they are never going to be able to see the reality and understand that reality from an Indigenous point of view.”

From #Mabo25 to #UluruStatement and #Treaty : Mabo Commemoration Oration : Senator Patrick Dodson

 ” Aboriginal and Torres Strait Islander people will continue to call for a treaty and a strong Indigenous voice if nothing is done.

These calls only highlight the need for constitutional reform.

Australia cannot move forward while our founding document, our birth certificate, embodies our racist past. The stubborn stains in our racist Constitution must be erased.

  • Eddie Koiki Mabo would expect nothing less.
  • Eddie Koiki Mabo was a great Australian.

We can find the Mabo spirit within each of us, and work together to build a great Australia, free from racism, honorable and just.”

Part 2

 “Last month at Uluru, in the spirit of constitutional conventions from which we had previously been excluded, many Aboriginal and Torres Strait Islander people gathered.

Their one page document, Uluru Statement from the Heart, issues a series of challenges to the Parliament and the people of Australia.

  • It calls for constitutional reforms to empower our people and take a rightful place in our own country.
  • It calls for the establishment of a First Nations Voice enshrined in the Constitution.
  • It calls for a Makarrata Commission to supervise a process of agreement-making between governments and First Nations and truth-telling about our history.

A treaty or agreement, whether one or many, would be an acknowledgment flowing from the Mabo decision that terra nullius is a discredited, outmoded legal fiction and that this land was taken from Aboriginal people.”

Senator Patrick Dodson on June 16 delivered  this year’s 2017 ANU Mabo Commemoration Oration at University House. The Mabo Commemoration Oration was held to recognise the 25th anniversary of the Mabo ruling.

In June 1992, the High Court of Australia recognised that a group of Torres Strait Islanders, led by Eddie Mabo, held ownership of Mer (Murray Island). In acknowledging the traditional rights of the Meriam people to their land, the Court also held that native title existed for all Indigenous people. This landmark decision gave rise to important native title legislation the following year and rendered terra nullius a legal fiction.

Senator Patrick Dodson is a Yawuru man from Broome in Western Australia. He has dedicated his life work to being an advocate for constructive relationships between Indigenous and non-Indigenous peoples based on mutual respect, understanding and dialogue. He is a recipient of the Sydney International Peace prize

Image above : On display at Parliament House Canberra in a careful hand with coloured pencils, Eddie Mabo drew this map in the shape of the Island of Mer, noting the family names associated with tracts of the Island, including his own family name.

Full Oration

Thank you very much Vice-Chancellor Professor Brian Schmidt and thank you for the Welcome to Country. I too join in the appreciation of the Ngunnawal and Ngambri people for their welcome to their lands.

It is a great honour for me to be here at the Australian National University tonight to deliver a speech in honour of the late Eddie Koiki Mabo.

  • Mr Mabo was a man of history.
  • He celebrated his Mer and Torres Strait Islander history.
  • He made Australian history.

So it is to history that I will turn to start my remarks.

On 26 January 1788, the British flag was raised at Botany Bay.

The land, now part of the City of Sydney, was the territorial property of the Gadigal and Bidigal people of the Eora nation. It was held and looked after by them, for countless generations.

With a cheer and a tot of rum, to the sounds of fife and drums, the colony of New South Wales was proclaimed.

Over time, other colonies were established in other parts of Australia or by separation of their territory from New South Wales.

• Queensland was one of those.

Over time, the boundaries of the Queensland colony were stretched to include offshore northern islands around 1859.

The lines on the map between Papua New Guinea and Australia included the Murray Islands, the largest of which is Murray Island or Mer.

  • In 1912, the Island of Mer was declared a Reserve under the Land Act 1910 (Qld).
  • In 1936, Eddie Mabo was born in Mer.
  • In 1982, Eddie Koiki Mabo and four other Murray Islanders commenced proceedings against the State of Queensland.

They claimed ownership of parcels of land on Mer as the holders of native title under their customary law.

This litigation, bearing the name of the man we commemorate tonight, transformed the modern Australian common law.

• The case changed our History.

• For the good. On the first floor of our Parliament, I walk past a display of foundation documents of  Australia’s law and society.

This week I watched a group of school children walk through the area on their tours of Parliament House, under a banner that reads, “Parliament is the law-making body which determines the rules of the society by which people live.”

A couple of young boys were looking at a case where a page out of an old-school notebook was on display.

In a careful hand with coloured pencils, Eddie Mabo had drawn the shape of the Island of Mer, noting the family names associated with tracts of the Island, including his own family name.

On the same floor, there are other important documents and paintings on display: The Yirrkala bark petition, the Barunga petition, the Kevin Rudd apology.

Each of these artefacts talks to our most significant national historical challenge.

How can we recognise and acknowledge the fact of Aboriginal and Torres Strait Islander prior ownership of this land we now call Australia?

Mr Mabo’s map and the petitions call for all of us to recognise and acknowledge the fact  of occupation.

• to re-think the received colonial settler narrative. They remind us of the exertion of force by and on behalf of the British authorities.

  • The fact is: the British did not ask permission to settle.
  • The fact is: no-one consented, no-one ceded.
  • The fact is: the judiciary and the legislature have become less generous since The Mabo ruling.
  • The fact is: we need an agreement or treaty to settle not only the ongoing legacy of terra nullius but also the legacy of its existence.

The first peoples were in this land as owners and governors of their respective countries before and when the colonists ‘arrived’ and began to gradually occupy their territories and rule over them. Today those native title holders under the Native Title Act are evidence of their descent from their ancestors and are the living testimony of their prior occupation of their lands and waters.

They and their people proclaim continuing occupation. This land was not, and is not, terra nullius.

The only thing that threatens this is the application of extinguishment written into the Native Title Act. It is more sinister than its existence as a legal mechanism, because in most cases it requires the consent of the very people that hold the Native Title.

This is neither honourable, nor generous.

This is treachery and brings shame to the Mabo name. It belittles the vision and motives of Mr Mabo and the other families who fought and won a seminal victory in the High Court.

The Chief Justice of Australia who heard the Mabo case, Justice Sir Gerard Brennan made this determination on 3rd June 1992 :

  • The common law of Australia rejects the notion that, when the Crown acquired sovereignty over territory which is now part of Australia it thereby acquired the absolute beneficial ownership of the land therein, and
  • accepts that the antecedent rights and interests in land possessed by the indigenous inhabitants of the territory survived the change in sovereignty.
  • Those antecedent rights and interests thus constitute a burden on the radical title of the Crown.

His decision in the Mabo case ruled that:

• the Meriam people are entitled as against the whole world to possession, occupation, use and enjoyment of the island of Mer.

Rejecting the notion of “terra nullius”, native title was found to have survived the acquisition of sovereignty.

Of course the High Court as an instrument of our Constitution cannot rule on the issue of sovereignty.

It took ten long years to resolve the Mabo claim. It is a poignant tragedy that Koiki Mabo did not live long enough to hear the decision of the High Court.

  • To celebrate the recognition of what he knew in his heart and mind to be the truth
  • His country was in Mer.

From our viewpoint in history, we see the Case that bears his name as a major landmark, a signpost for our future. But the road is long and at times the travelling is hard going.

The Mabo decision led to an eruption of controversy and alarm, in much of mainstream Australia.

Mabo was an affront to the security provided by the lie of terra nullius.

The Commonwealth Parliament, in 1993, under the Labor Government of Paul Keating, enacted the Native Title Act.

The Act sought to build on the common law as defined in the Mabo case.The integrity around this today raises serious questions.

In my own State of Western Australia, in which more than half of the land was legally unalienated and mineral rich, the Government objected. The State Parliament in Perth passed a law to extinguish native title from the moment of colonisation and challenged the Commonwealth Act.

The High Court upheld the validity of the Native Title Act and found the Western Australian law to be invalid.

On a personal note, that decision enabled the Yawuru people to pursue our own native title interests and reclaim our country. My brother Mick and I have good reason to be forever grateful to Koiki Mabo and his pioneering vision and courage.

Another major milestone took place in 1996. The High Court in the Wik case found that Native Title and pastoral leases could co-exist.

The pastoral leases were a feature of the colonial period, trying to reign in the peacocking of the best lands by squatters.

  • There was at least some consideration by the Colonial authorities of the rights of Aboriginal people to travel over the leases.
  • Such rights themselves became caveats on the pastoral lease until gradually modified.

The Wik case was a simple matter of concurrent and co-existing rights but with the Native Title rights yielding to the leaseholder if there is a conflict. The public reaction by some sectors was ill informed and disgraceful.

So the generosity of the Court already had begun to harden somewhat in the qualification they put on the notion of “concurrent and coexistent” rights.

The Government of Prime Minister John Howard, could have used this decision as a positive step, as an opportunity for advancing reconciliation.

The Howard “Ten Point Plan” led to the 1996 amendments to the Native Title Act, and in the words of his Deputy Tim Fischer, delivered ‘bucket-loads of extinguishment’.

That legislation was in my view intended to reinstate terra nullius or to remove what Justice Brennan called the ‘burden on the radical title of the Crown’.

As a sweetener they also delivered opportunity previously denied except under a statutory land rights Act.

They opened the opportunity for Agreement Making, which unfortunately is too often structurally tied to extinguishment. Indigenous Land Use Agreements could be negotiated under the Act whereby Native Title Holders and other parties could agree on the use of Native Title lands, for mutual benefit and economic development.

Far too often, the price of that opportunity has been too high, in my view, leading to the extinguishment of Native Title, forever and a day, leaving a lingering burden on the shoulders of the native title holders.

Nevertheless, hundreds of agreements have been negotiated and signed across the nation, especially in Queensland, but also in my state of Western Australia, where an ILUA Agreement for the Noongar people, had been hailed as a major landmark, a Treaty in all but name for the people of the South West.

In the Senate this week, the validation of Indigenous Land Use Agreements has been under debate. There is a tension between law-making in the Parliament, the decisions of the Courts and the aspirations of Aboriginal people to negotiate agreements that retain their rights.

The concept of separation of powers is not always empathetic to the sense of justice held by Aboriginal people.

The Noongar agreement came unstuck with the McGlade decision. With the recent amendments in the Parliament this Agreement will go back to the process of registration, for the Noongars to settle.

At every step, the Labor Party has pushed for consultation on these Bills, through a Senate Committee, through submissions and through consultations with representatives of the Native Title Representative bodies.

At every step, we have remembered the legacy of Koiki Mabo and understand the fact that Native Title rights, now recognised in the common law, should not be changed, extinguished or modified at the whim of Government.

They do not exist as a gift of the Parliament, or an act of largesse by the Government of the day.

Native Title rights are ongoing rights, with deep roots into our common law held exclusively by Native Title holders. Amending legislation should always require the ‘free, prior and informed consent of Native Title holders.

The Native Title Act, much amended over time, has evolved in complexity and function. Koiki Mabo would probably have some difficulty understanding how his vision has become brutalised by Parliament.

The Australian Law Reform Commission, in its 2015 review, Connection to Country, has identified key areas of reform that are yet to be implemented by the Government. Indeed, we still await a formal response from the Government to its recommendations.

From my own perspective, as a native title holder, and now as a legislator, I see five key areas where the functioning of the Act requires rework, not least to better align it to the vision of Eddie Koiki Mabo. These are, in summary:

  • The need to rethink the presumption that an Agreement for alternative uses of native title land requires extinguishment of native title rights;
  • The need to rethink the decision-making process required under the Act;
  • The need to improve the fungibility for native title land without needing extinguishment or loss of communal title;
  • The need to address the rights of compensation for the loss of enjoyment, access and use of Native Title lands.
  • The need to change the onus of proof burden from native title applicants to the Crown
  • The Native Title Act can be refashioned to shift the point of balance towards the ongoing rights, interest, needs and concerns of Indigenous Australians. Doing so would restore the Act to its fundamental purpose: to recognise and protect native title, in the interests of Indigenous Australians, and our shared national future.

Last month at Uluru, in the spirit of constitutional conventions from which we had previously been excluded, many Aboriginal and Torres Strait Islander people gathered.

They set out to deliberate and report back to the Prime Minister and the Leader of the Opposition, through the Referendum Council, on Constitutional recognition.

Their one page document, Uluru Statement from the Heart, issues a series of challenges to the Parliament and the people of Australia.

  • It calls for constitutional reforms to empower our people and take a rightful place in our own country.
  • It calls for the establishment of a First Nations Voice enshrined in the Constitution.
  • It calls for a Makarrata Commission to supervise a process of agreement-making between governments and First Nations and truth-telling about our history.

From a Parliamentary perspective, we look forward to the report on those consultations from the Referendum Council at the end of the month. Hopefully working through these issues in the Parliament, in the time ahead, will take place in the spirit of constructive optimism.

To formulate a successful referendum outcome, especially in the next year a bipartisan, indeed, cross party consensus will need to be carefully shaped.

In my personal view, Constitutional reform, a treaty and a strong Indigenous voice have never been mutually exclusive—one does not come at the expense of the others.

• Of course I support an Agreement making process

A treaty or agreement, whether one or many, would be an acknowledgment flowing from the Mabo decision that terra nullius is a discredited, outmoded legal fiction and that this land was taken from Aboriginal people.

It would also pick up the opportunity that was lost when the Native Title negotiations focused solely upon land tenure.

I have never held the view that Mabo was only about land tenure. In fact when my views clashed with the then negotiators I was asked to discontinue any involvement in the process and dutifully left it to those who settled the issues with Prime Minister Keating.

There was no treaty when this land was colonized. In the future a treaty will be a strong step for a mature and harmonious nation. The work of Labor Governments in our States of Victoria and South Australia show it can be done.

Of course we need a strong Indigenous voice.

For too long Aboriginal and Torres Strait Islander people have been denied a voice, excluded from decision making processes about their own lives.

Indigenous people want to reset our relationship with government.

  • We want to be heard.
  • We have been calling for this for a long time.

Working to make a Voice effective within the processes of Parliament and capable of support from the whole Australian population in a referendum is a key challenge. A challenge Labor will consider carefully.

We look forward to more information on how the idea of an entrenched Voice can become a systemic, secure and successful legislative reality.

• We need to address the systemic racism that exists in our nation’s founding document, Australia’s Constitution.

We want our past to be acknowledged and we want to be involved in decisions about our future.

The Uluru Statement called for a First Nations Voice enshrined in the Constitution and a Makarrata Commission to supervise a process of agreement-making between governments and First nations and truth-telling about our history.

Many rejected the  idea of any ‘symbolic’ acknowledgement in what they saw as a racist document, the  Constitution.

This may well have been a statement from the heart.

It is time we acknowledged that Indigenous people were not included in the Constitutional Conventions that were held all over Australia in the lead up to Federation.

The Australian Constitution was written by people who thought Indigenous people were lesser beings; a dying race with no sense of land use and development.

  • The dynamic of racism in Australia is institutional and it is structural.
  • The foundations of racism are entrenched, persistent, in this nation’s founding  document.

The question we need to work through is not about choosing between a treaty, a voice or constitutional recognition.

The question is whether Australia is able to move forward towards reconciliation —be that in the form of a Treaty, or an Indigenous voice enshrined in the Constitution —while the nation’s foundation document remains, in its DNA, a flawed and racist document.

I understand this because I was a member of the Expert Panel on Constitutional Recognition of Indigenous Australians, which was tasked to report to the Government on possible options for constitutional change to give effect to indigenous constitutional recognition and to assess any legal consequence that might flow.

In 2012, the Expert Panel delivered our report , which made a series of recommendations including:

  • a statement of acknowledgment in the Constitution, relevant to the lawmaking power in indigenous affairs (new Section 51 A);
  • a modification to the wording of the Commonwealth’s lawmaking power in

Indigenous affairs (s 51 (26);

  • a constitutional prohibition on racial discrimination (new S 116A); and
  • the removal of a provision that contemplates states disqualifying people from voting based on their race (s 25).

These recommendations recognise that the Government has the power to make laws about Indigenous people, but the laws must be beneficial and give the Parliament guidance.

It would be a mistake to consider this constitutional reform as merely ‘symbolic’.

Nothing about our Constitution is symbolic. There is not even a preamble that could point us to something symbolic.

The words in the Constitution reference powers that the Parliament uses to make laws.

They are words with real power. They are words that guide the Parliament in making laws and the Courts when they judge the validity of those laws.

Changing powers in the Constitution and giving clarification around how such powers can be used is not mere symbolism, “pretty words”.

Having an Indigenous voice enshrined in the Constitution, without amending the Constitution to remove racially entrenched ideologies, is puzzling.

It seems to assume that an Indigenous voice in the Constitution could be strong enough to challenge the entrenched structural racism which shapes the policies and laws that affect the lives of Aboriginal people without removing the racist elements of the Constitution.

We know these policies and laws. They are the policies of assimilation, of forced social and cultural change. These are the policies that continue to remove Aboriginal people from their families, country and culture.

These are the policies that have caused Aboriginal and Torres Strait Islander people to  make up approximately one quarter of Australia’s prison population, despite making up  just 3 per cent of the total population.

These are the policies which have led to Indigenous Australians dying a decade earlier than non-Indigenous Australians.

  • Policies that repeatedly fail Aboriginal people.
  • Policies that Koiki Mabo challenged with his life and would do so today if he were alive.

It is no coincidence that these policies exist alongside a constitution that is the legacy of a colonial settler narrative, a narrative that saw Aboriginal and Torres Strait islander people as lesser beings and Australia as a land belonging to nobody. If we are going to clean up the mess that racism has made in Australia, in the hope that we might one day achieve reconciliation, we have to do it properly and honorably.

The report of the Referendum Council at the end of this month deserves and requires weighty consideration. If the Referendum Council’s recommendations do not get broad parliamentary support it will fail and there will be no referendum.

If there is broad support then, it requires careful consideration of a Bill and Explanatory Memorandum that can pass through this challenging and complicated parliament.

It requires a question that can be put to the Australian people that will pass the high bar of a referendum.

Aboriginal and Torres Strait Islander people will continue to call for a treaty and a strong Indigenous voice if nothing is done.

These calls only highlight the need for constitutional reform.

Australia cannot move forward while our founding document, our birth certificate, embodies our racist past. The stubborn stains in our racist Constitution must be erased.

  • Eddie Koiki Mabo would expect nothing less.
  • Eddie Koiki Mabo was a great Australian.

We can find the Mabo spirit within each of us, and work together to build a great Australia, free from racism, honorable and just.

Kaliya. Thank you.

 

Aboriginal Health : Second Atlas of Healthcare Variation highlights higher Aboriginal hospitalisation rates for all 18 clinical conditions

 

“The report, compiled by the Australian Commission on Safety and Quality in Health Care, shows us that high hospitalisation rates often point to inadequate primary care in the community, leading to higher rates of potentially preventative hospitalization

The most disturbing example of this  has been the higher hospitalisation rates for all of the 18 clinical conditions surveyed experienced by Aboriginal and Torres Strait Islander Australians, people living in areas of relative socioeconomic disadvantage and those living in remote areas.

 Chairman of Consumers Health Forum, Tony Lawson who is a member of the Atlas Advisory Group.

 “Additional priorities for investigation and action are hospitalisation rates for specific populations with chronic conditions and cardiovascular conditions, particularly:

  • Aboriginal and Torres Strait Islander Australians
  • People living in remote areas
  • People at most socioeconomic disadvantage.

Please note

  • Features of the second Atlas include: Analysis of data by Aboriginal and Torres Strait Islander status

DOWNLOAD Key-findings-and-recommendations

Mr Martin Bowles Secretary Dept of Health  launches the Second Australian Atlas of Healthcare Variation

A new report showing dramatic differences in treatment rates around Australia signals a pressing need for reforms to ensure equitable access to appropriate health care for all Australians, the Consumers Health Forum, says.

“A seven-fold difference in hospitalisation for heart failure and a 15-fold difference for a serious chronic respiratory disease depending on place of residence, are among many findings of substantial variations in treatment rates in Australia revealed in the Second Australian Atlas of Healthcare Variation,” the chairman of Consumers Health Forum, Tony Lawson, said.

“While there are a variety of factors contributing to these differences,  the variation in health and treatment outcomes is, as the report states, an ‘alarm bell’ that should make us stop and investigate whether appropriate care is being delivered.

“These findings show that recommended care for chronic diseases is not always provided.  Even with the significant funding provided through Medicare to better coordinate primary care for people with chronic and complex conditions, fragmented health services contribute to suboptimal management, as the report states.

“We support the report’s recommendation for a stronger primary health system that would provide a clinical ‘home base’ for coordination of patient care and in which patients and carers are activated to develop their knowledge and confidence to manage their health with the aid of a healthcare team.

“The Atlas provides further robust reasons for federal, state and territory governments to act on the demonstrated need for a more effective primary health system that will ensure better and more cost effective care for all Australians.

“The Atlas also examined  variations in women’s health care, and its findings included a seven-fold difference in rates of hysterectomy and  21-fold  difference in rates of endometrial ablation.  The report states that rates of hysterectomy and caesarean sections in Australia are higher than reported rates in other developed nations.  These results highlight the need for continuing support and information on women’s health issues,” Mr Lawson said.

The Second Australian Atlas of Healthcare Variation (second Atlas) paints a picture of marked variation in the use of 18 clinical areas (hospitalisations, surgical procedures and complications) across Australia.

This Atlas, the second to be released by the Commission, illuminates variation by mapping use of health care according to where people live.  As well, this Atlas identifies specific achievable actions for exploration and quality improvement.

The second Atlas includes interventions not covered in the first Atlas, such as hospitalisations for chronic diseases and caesarean section in younger women. It also builds on the findings from the first Atlas – for example, examining hysterectomy and endometrial ablation separately, and examining rates of cataract surgery using a different dataset.

Priority areas for investigation and action arising from the second Atlas include use of:

  • Hysterectomy and endometrial ablation
  • Chronic conditions (COPD, diabetes complications)
  • Knee replacement.

Additional priorities for investigation and action are hospitalisation rates for specific populations with chronic conditions and cardiovascular conditions, particularly:

  • Aboriginal and Torres Strait Islander Australians
  • People living in remote areas
  • People at most socioeconomic disadvantage.

Healthcare Variation – what does it tell us

Some variation is expected and associated with need-related factors such as underlying differences in the health of specific populations, or personal preferences. However, the weight of evidence in Australia and internationally suggests that much of the variation documented in the Atlas is likely to be unwarranted. Understanding this variation is critical to improving the quality, value and appropriateness of health care.

View the second Atlas

The second Atlas, released in June 2017, examined four clinical themes: chronic disease and infection – potentially preventable hospitalisations, cardiovascular, women’s health and maternity, and surgical interventions.

Key findings and recommendations for action are available here.

View the maps and download the data using the interactive platform.

What does the Atlas measure?

The second Atlas shows rates of use of healthcare interventions (hospitalisations, surgical procedures and complications,) in geographical areas across Australia.  The rate is then age and sex standardised to allow comparisons between populations with different age and sex structures. All rates are based on the patient’s place of residence, not the location of the hospital or health service.

The second Atlas uses data from national databases to explore variation across different healthcare settings. These included the National Hospital Morbidity Database and the AIHW National Perinatal Data Collection.

Who has developed the second Atlas?

The Commission worked with the Australian Institute of Health and Welfare (AIHW) on the second Atlas.

The Commission consulted widely with the Australian government, state and territory governments, specialist medical colleges, clinicians and consumer representatives to develop the second Atlas.

Features of the second Atlas include:

  • Greater involvement of clinicians during all stages of development
  • Analysis of data by Aboriginal and Torres Strait Islander status
  • Analysis of data by patient funding status (public or private).

Table of Contents

Chapter 1 Chronic disease and infection: potentially preventable hospitalisations

1.1 Chronic obstructive pulmonary disease (COPD)
1.2 Heart failure
1.3 Cellulitis
1.4 Kidney and urinary tract infections
1.5 Diabetes complications

Chapter 2 Cardiovascular conditions

2.1 Acute myocardial infarction admissions
2.2 Atrial fibrillation

Chapter 3 Women’s health and maternity

3.1 Hysterectomy
3.2 Endometrial ablation
3.3 Cervical loop excision or cervical laser ablation
3.4 Caesarean section, ages 20 to 34 years
3.5 Third- and fourth-degree perineal tear

Chapter 4 Surgical interventions

4.1 Knee replacement
4.2 Lumbar spinal decompression
4.3 Lumbar spinal fusion
4.4 Laparoscopic cholecystectomy
4.5 Appendicectomy
4.6 Cataract surgery
Technical Supplement
About the Atlas
Glossary

Australian Atlas of Healthcare Variation data set specifications are available at http://meteor.aihw.gov.au/content/index.phtml/itemId/674758

 

NACCHO Aboriginal Health and #childhood #obesity : How #junkfood brands befriend kids on #socialmedia

ABS Overweight and obesity

  • In 2014-15, 63.4% of Australian adults were overweight or obese (11.2 million people). This is similar to the prevalence of overweight and obesity in 2011-12 (62.8%) and an increase since 1995 (56.3%).
  • Around one in four (27.4%) children aged 5-17 years were overweight or obese, similar to 2011-12 (25.7%).

ABS National Health Survey: First Results, 2014-15  

Download this graphic as a poster HERE

LL_ATSI_junkfoodandhealth_infographic

”  We examined how six “high-fat-sugar-salt” food brands approached consumers at an interactive, direct and social level online in 2012 to 2013 (although the practice continues).

If a stranger offered a child free lollies in return for their picture, the parent would justifiably be angry. When this occurs on Facebook, they may not even realise it’s happening.

We found food brands being presented online and interactively in four main ways: as “the prize”, “the entertainer”, the “social enabler” and as “a person”.

Using Facebook, advergames and other online platforms, food marketers can create deeper relationships with kids than ever before. Going far beyond a televised advertisement, they are able to create an entire “brand ecosystem” around the child online.

The latest National Health Survey found that around one in four Australian kids aged 5-17 were overweight or obese.

Food marketers promoting unhealthy options to kids online should be held to account.”

From the Conversation Four ways junk food brands befriend kids online

” Australian households spend the majority (58 per cent) of their food budget on discretionary or ‘junk’ foods and drinks, including take-aways (14 per cent) and sugar-sweetened beverages (4 per cent), according to new research.

Ill health due to poor diet is not shared equally, with some population groups, such as Aboriginal and Torres Strait Islander people and people who are disadvantaged socioeconomically, more at risk.”

Professor Lee, an Accredited Practising Dietician see article 2 Aussies spending most of food budget on junk food

Picture above from WHO Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016-2030

Read NACCHO 20 Articles on Obesity

Read NACCHO 20 Articles on Nutrition Healthy Foods

Article 1 Four ways junk food brands befriend kids online

If a stranger offered a child free lollies in return for their picture, the parent would justifiably be angry. When this occurs on Facebook, they may not even realise it’s happening.

There was outrage after a recent report in The Australian suggesting that the social media company can identify when young people feel emotions like “anxious”, “nervous” or “stupid”. Although Facebook has denied offering tools to target users based on their feelings, the fact is that a variety of brands have been advertising to young people online for many years.

We’re all familiar with traditional print and television advertising, but persuasion is harder for children and parents to detect online. From using cartoon characters to embody the brand, to games that combine advertising with interactive content (“advergames”), kids are exposed to a pervasive ecosystem of marketing on social media.

The blurring of the line between advertising, entertainment and socialising has never been greater, or more difficult to fight.

Kids are vulnerable to junk food advertising

Junk food advertising aimed at both adults and children is nothing new, but research shows that young people are particularly vulnerable.

Their minds are more susceptible to persuasion, given that the part of their brain that controls impulsivity and decision-making is not always fully developed until early adulthood. As a result, children are likely to respond impulsively to interactive and attractive content.

While the issue of advertising junk food to children through television and other broadcast media gets a lot of attention, less is understood about how children are consuming such marketing online.

How brands interact online

We examined how six “high-fat-sugar-salt” food brands approached consumers at an interactive, direct and social level online in 2012 to 2013 (although the practice continues).

Analysing content on official Facebook pages, website advergames and free branded apps, we coded brand placements as primary, secondary, direct or implied brand mentions.

While the content may not be explicitly targeted at children, the colours, skill level of the games and the prizes are attractive to younger people. The responses on Facebook in particular show that young consumers often interact with these posts, sharing comments and reposting.

We found food brands being presented online and interactively in four main ways: as “the prize”, “the entertainer”, the “social enabler” and as “a person”.

1. The prize

The fast food company Hungry Jack’s Shake and Win app has been offered since 2012. By “shaking” the app, it tells you, using your smartphone GPS, which Hungry Jack’s outlet is closest and where you can redeem your “free” offer or discount.

In this way, it combines several interactive elements to push the user towards immediate consumption with the brand coded as a reward.

Hungry Jack’s Shake and Win app screens captured on May 17th 2017. iTunes/Hungry Jacks

2. The entertainer

Free branded video game apps or advergames are also used to engage young consumers, disguising advertising as entertainment.

In the 2012 Chupa Chups game Lol-a-Coaster (which is not currently available on the Australian iTunes store), for example, we found a lollipop appeared as part of game play up to 200 times in one minute. The game is simple to play, full of fun primary colours and sounds, and the player is socialised to associate the brand with positive emotion.

Chuck’s Lol-A-Coaster: an interactive game for Chupa Chups.

3. The social enabler

Brands often leverage Facebook’s “tagging” capability to spread their message, adding a social element.

When a company suggests that you tag your family and friends on Facebook with their favourite product flavour, for example, the young consumer is not only using the brand to connect with others, but letting the brand connect to their own Facebook network. For a brand like Pringles, this increases their reach on social media.

A post on the Pringles’ Facebook page on October 13th, 2016. Facebook/Pringles

4. The person

Some brands also use a humanised character, like Chupa Chups’s Chuck, to voice the brand and post messages to consumers on Facebook.

Often this character interacts with the consumer in a very human way, asking them about their everyday lives, aspirations and fears. This creates the possibility of a long-term brand relationship and brand loyalty.

A Chupa Chups post on September 2nd, 2014 showing the character, Chuck. Facebook/Chupa Chups

Brands need to clean up their act

Using Facebook, advergames and other online platforms, food marketers can create deeper relationships with kids than ever before. Going far beyond a televised advertisement, they are able to create an entire “brand ecosystem” around the child online.

The latest National Health Survey found that around one in four Australian kids aged 5-17 were overweight or obese. Food marketers promoting unhealthy options to kids online should be held to account.

In Australia, the food marketing industry is mostly self-regulating. Brands are meant to abide by a code of practice which, if breached, holds them account through a complaints-based system.

While some companies have also pledged, via an Australian Food and Grocery Council code, not to target child audiences using interactive games unless offering a healthy choice, the current system is too slow and weak to be a real deterrent. That needs to change.

While online food marketing may be cheap for the corporations, the price that society pays when it comes to issues such as childhood obesity is immeasurable.

Article 2 Aussies spending most of food budget on junk food

According to Professor Amanda Lee, who is presenting her research at the Dietitians Association of Australia’s National Conference in Hobart this week, healthy diets are more affordable than current (unhealthy) diets – costing households 15 per cent less.

But according to Australian Health Survey data, few Australians consume diets consistent with national recommendations.

“Less than four per cent of Australians eat adequate quantities of healthy foods, yet more than 35 per cent of energy (kilojoule) intake comes from discretionary foods and drinks, which provide little nutrition – and this is hurting our health and our hip pocket,” said Professor Lee, from the Sax Institute.

She said the figures are particularly worrying because poor diet is the leading preventable cause of ill health in Australia and globally, contributing to almost 18 per cent of deaths in Australia, while obesity costs the nation $58 billion a year.

Her research found that, although healthy diets cost less than current (unhealthy) diets, people in low income households need to spend around a third (31 per cent) of their disposable income to eat a healthy diet, so food security is a real problem in these households.

She added that policies that increase the price differential between healthy and unhealthy diets could further compromise food security in vulnerable groups.

“At the moment, basic healthy foods like fresh vegetables and fruit are except from the GST, but there’s been talk of extending this to all foods. If this were to happen, the cost of a healthy diet would become unaffordable for low-income families,” said Lee.

Lee said Australia needs a coordinated approach to nutrition policy – a call echoed by the Dietitians Association of Australian, the Public Health Association of Australia, the Heart Foundation and Nutrition Australia.

Aboriginal Women’s Health : Download Report : Over imprisonment of Aboriginal women is a growing national crisis

“For too long our women have been ignored by policymakers. It is time for governments at all levels to put Aboriginal and Torres Strait Islander women’s experiences and voices front and centre, and listen to what we have to say about the solutions.

The report highlights the importance of Aboriginal and Torres Strait Islander women having access to specialist, holistic and culturally safe services and supports that address the underlying causes of imprisonment,

Experiences of family violence contribute directly and indirectly to women’s offending, If we are to see women’s offending rates drop, governments must invest in Aboriginal and Torres Strait Islander organisations that work with our women to stop violence.”

Antoinette Braybrook, Co Chair of the Change the Record Coalition and Convener of the National Family Violence Prevention Legal Services Forum.

New report launched to address skyrocketing Aboriginal and Torres Strait Islander women’s imprisonment rates

Download the report here : Aboriginal Woman OverRepresented_online

The over imprisonment of Aboriginal and Torres Strait Islander women is a growing national crisis that is being overlooked by all levels of government in Australia, the Human Rights Law Centre and Change the Record said in a new report launched today.

The imprisonment rate of Aboriginal and Torres Strait Islander women has skyrocketed nearly 250 per cent since the Royal Commission into Aboriginal Deaths in Custody.

Aboriginal and Torres Strait Islander women make up around 34 per cent of the female prison population but only 2 per cent of the adult female population.

The report, Overrepresented and overlooked: the crisis of Aboriginal and Torres Strait Islander women’s growing over imprisonment, calls for system wide change and outlines 18 recommendations to redress racialised and gendered justice system outcomes.

Adrianne Walters, Director of Legal Advocacy at the Human Rights Law Centre said,

“The tragic and preventable death of Ms Dhu is a devastating example of what happens when the justice system fails Aboriginal and Torres Strait Islander women. Ms Dhu was locked up under draconian laws that see Aboriginal women in WA disproportionately locked up for fines they cannot pay. She was treated inhumanely by police and died in their care. At a time when she most needed help, the justice system punished her.”

Annette Vickery, Deputy CEO of the Victorian Aboriginal Legal Service, said, “The vast majority of Aboriginal and Torres Strait Islander women in custody are mothers. While Aboriginal and Torres Strait Islander women are often in custody for short periods, even a short time can cause devastating and long term upheaval – children taken into child protection, stable housing lost, employment denied.

“Governments should be doing everything they can to help women avoid prison to prevent the devastating rippling effects of women’s imprisonment on children and families,” added Ms Vickery.

The report calls for governments to move away from ‘tough on crime’ approaches in reality and rhetoric, and to focus on evidence based solutions that tackle drivers of offending and prevent women coming into contact with the justice system in the first place.

Ms Walters said, “Overzealous policing and excessive police powers, driven by tough on crime politics, see too many Aboriginal and Torres Strait Islander women and men fined and locked up for minor offending. Only last month, the WA Coroner recommended the removal of police arrest and detention powers for public drinking after another Aboriginal woman died in police custody.”

“Governments can act now to remove laws that disproportionately and unfairly criminalise Aboriginal and Torres Strait Islander women, like fine default imprisonment laws in WA and paperless arrest laws in the NT,” added Ms Walters

Ms Walters said, “Aboriginal and Torres Strait Islander women are also being denied bail and options to transition away from courts and prisons to more rehabilitative alternatives. Too often this is because of a lack of housing and programs designed for their social and cultural needs, particularly in regional and remote locations.’

“Rather than enacting harsher laws and barriers to women accessing rehabilitative alternatives, governments must invest in programs that are designed for and by Aboriginal and Torres Strait Islander women and that tackle the root causes of offending,” said Ms Walters.

Response from contributor to the report, Vickie Roach Vickie Roach, a former prisoner turned writer and advocate said “punitive approaches don’t work for Aboriginal and Torres Strait Islander women. They punish our women, their families and communities, for actions that are often the consequence of forced child removal and assimilation policies.”

“Governments should be getting rid of laws that unfairly criminalise our women. They should be trying to close prisons and focusing on alternatives that are healing. You need to respect women’s dignity, but in my experience, so often the criminal justice system just takes it away,” added Ms Roach.

 

NACCHO Aboriginal Health and #junkfood : Download @aihw Report Impact of overweight & obesity on health

Picture above : Nutritionists and dieticians throughout Australia have been criticizing on social media the recent Mc Donald’s  advertising during sports TV for the ” Made for Family ” of Burger , Coke and Chips recommending the #junkfood as not the preferred family meal

” Overweight and obesity, as well as many of the linked chronic diseases, is highly prevalent among Aboriginal and Torres Strait Islander people, with this also varying by socioeconomic group.

Overweight and obesity is a major public health issue, with nearly 2 in 3 adults and 1 in 4 children in Australia considered overweight or obese (AIHW 2016c).

The Australian Burden of Disease Study (ABDS) 2011 modelled the impact of overweight and obesity and showed it is one of the leading risk factors for ill health and death (AIHW 2016a).”

Download the AIHW report HERE : AIHW Obesity Burden of Disease

 ” Outcomes of the meeting included support the public health objectives to reduce chronic disease related to overweight and obesity.

This will include evaluating the effectiveness of existing initiatives and identify potential new initiatives, such as how the food regulation system can facilitate healthy food choices and positively influence the food environment.”

Australian Ministers, the New Zealand Minister responsible for food safety and the Australian Local Government Association met in Adelaide today and agreed the priority areas for the food regulation system for both countries for 2017 – 2021. They also discussed the latest updates on food labelling of sugar and fats and oils and released the two year progress review report on the implementation of the Health Star Rating system. 

The meeting was chaired by the Australian Government Assistant Minister for Health, Dr David Gillespie.

Download Communique HERE : Final Communique 28 April 2017

  • Childhood obesity has been labelled one of the most serious public health issues of the 21st century.
  • Overweight and obese children typically grow into overweight and obese adults, who are susceptible to chronic complaints such as diabetes and cardio vascular disease. These diseases place considerable burdens on national health systems and economies.
  • It can be argued therefore that policy which encourages healthy eating habits is desirable.  However, the increasing availability of foods high in fat, sugar and salt (so called junk foods) across the world has made eating healthily a challenge. 
  • This challenge, according to some research, is compounded by advertising that adversely influences people’s food preferences and consumption patterns. As a consequence of this research, there has been considerable advocacy which has urged governments to place limitations on the advertising of junk foods, particularly to children. 

 

APH : Marketing obesity? Junk food, advertising and kids

“Obesity is markedly more prevalent amongst people of Aboriginal and Torres Strait Islander descent compared to all Australians, with 25 per cent of men and 29 per cent of women being obese.

Aboriginal and Torres Strait Islander communities need information that is culturally appropriate, evidence-based, easily understood, action-oriented and motivating. There is also the need to promote healthy eating to facilitate community ownership and does not undermining the cultural importance of family social events, the role of elders and traditional preferences for some foods. Food supply in Indigenous communities needs to ensure healthy, good quality food options are available at competitive prices.

Primary health care services have a central role in promoting and improving Aboriginal and Torres Strait Islander health and the sector needs specialised training and resources to implement new initiatives and provide culturally appropriate advice.”

Department of Health Website

OBESITY – AUSTRALIA’S BIGGEST PUBLIC HEALTH CHALLENGE

Download AMA Position Statement on Obesity 2016

obesity-2016-ama-position-statement

NACCHO Articles about Obesity

“For Australia’s Aboriginal and Torres Strait Islander peoples, “diet is the single most important factor in the chronic disease epidemic facing Aboriginal communities.” The resolution commits governments “to reverse the rising trends in overweight and obesity and reduce the burden of diet-related noncommunicable diseases in all age groups.”

Dr Mark J Lock is an ARC Discovery Indigenous Research Fellow at the School of Medicine and Public Health, University of Newcastle. See Croakey article Part 2

“Jamie Oliver on behalf of the Wadeye community, I invite you to visit us and teach us to understand healthy eating and nutritious food. Our community would be pleased take you collecting bush tucker traditional way, and you can teach us new skills.

Being healthy means our kids have a better chance in life, and your visit would help make our community strong for the future and ensure our kids to grow up healthy and deadly.”

Hope to hear from you soon,
From Julie see full letter below

“We need all sides of politics to take these issues seriously, to support effective policies and water down the alcohol and junk food and junk drink industries that currently are undermining our health.

In the Medical Journal of Australia, we argue that we are losing the war against alcohol and weight-related illnesses because our nation lacks a comprehensive approach to prevention.”

By Professor Rob Moodie, Melbourne School of Population and Global Health, University of Melbourne.He worked  for NACCHO Member , Congress, the Aboriginal Community controlled health service in Central Australia from 1982-1988.

Full article

NACCHO #Worldhealthweek Obesity News: : Is diet the single most important factor in the chronic disease epidemic facing Aboriginal communities.”

Australian Healthcare Reform Alliance (AHCRA) policy proposals are not driven by ideology but have their foundations in research, evidence and broader policy review.

 ” Aboriginal communities should take advice from the fast food industry “

NACCHO’s 2013 #junkfood V Health campaign reached 20 Million + worldwide

Thus, advocacy for reducing sugar intake, support for plain packaging of tobacco and the better funding of primary and preventive care align with the basic principles of the social determinants of health in achieving better health outcomes.

To underpin this work AHCRA draws on research, aggregated data and reports from reputable sources.

A recent study published by the Australian Institute of Health and Welfare (AIHW) provides insight into the contribution of overweight and obesity to the health burden of chronic disease.

Download the AIHW report HERE : AIHW Obesity Burden of Disease

It highlights the importance of reducing overweight and obesity to prevent the onset and/or reduce the severity of associated diseases in the population.

Health impacts from being overweight or obese are not always immediate, particularly for lifestyle-related diseases, and depend on when exposure occurs and the associated disease.

In this report, only asthma was identified as a linked disease with a direct association in childhood; however, childhood obesity is a risk factor for chronic disease in adulthood and later life.

As well, being overweight and obese in mid-life is associated with increased dementia risk in late life, demonstrating a time lag from exposure to disease development. Other studies also show a reduction in cancer risk in adults who experienced weight loss 10 years prior, also suggesting a time lag.

The result is that prevention and intervention efforts focused on maintaining a healthy weight in children, as well as reducing existing overweight and obesity in all age groups, are likely to result in increased health gains in the future.

This report updates and extends estimates of the burden due to overweight and obesity reported in the Australian Burden of Disease Study 2011 to include people under 25, revised diseases linked to overweight and obesity based on the latest evidence, and estimates by socioeconomic group.

The report includes scenario modelling to assess the potential impact on future health burden if overweight and obesity in the population continues to rise or is reduced. The enhanced analysis in the report shows that 7.0% of the total health burden in Australia in 2011 is due to overweight and obesity, and that this burden increased with increasing level of socioeconomic disadvantage.