NACCHO #ABS Aboriginal Health Download Report : Consumption of Food Groups from the Australian Dietary Guidelines, 2012-13

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Aboriginal and Torres Strait Islanders consume too little of the five major food groups and too much sugar and other discretionary foods, according to figures released by the Australian Bureau of Statistics (ABS) today.

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Like the rest of the population, Aboriginal and Torres Strait Islander peoples’ diets fail to meet the 2013 Australian Dietary Guidelines, which recommend minimum serves for vegetables, fruit, dairy products, lean meats and alternatives, and grain-based foods.

ABS Director of Health, Louise Gates said the latest results showed Aboriginal and Torres Strait adults consumed an average of 2.1 serves of vegetables per day, which is less than half of the 5-6 serves recommended by the Guidelines.

“Aboriginal and Torres Strait Islander adults consumed almost one serve (or 30 per cent) less vegetables than non-Indigenous people,” said Ms Gates.

“They also consumed just one serve of fruit on average, half the recommended two serves per day.”

In remote Australia, Aboriginal and Torres Strait Islander people consumed less than one serve (0.9) of fruit (e.g. less than one medium sized apple) and less than one serve (0.9) of dairy products (e.g. less than one cup of milk) per day, which was lower than those living in urban areas (1.3 serves for both fruit and dairy products).

However, Aboriginal and Torres Strait Islander people living in remote areas consumed around half a serve more of grain foods and lean meats and alternatives than people living in urban areas.

“The data also shows that 41 per cent of the population’s total daily energy intake came from energy-dense, nutrient-poor ‘discretionary foods’, such as sweetened beverages, alcohol, cakes, confectionery and pastry products,” said Ms Gates.

On average, this equates to over six serves of discretionary foods per day, triple the number of vegetable serves consumed. The Australian Dietary Guidelines recommend limiting discretionary foods to occasional, small amounts.

KEY FINDINGS

The 2013 Australian Dietary Guidelines (ADG or the Guidelines) recommend that Australians “Enjoy a wide variety of nutritious foods from the Five Food Groups every day and drink plenty of water”.1

This publication provides analysis on the consumption of the Five Food groups from the Australian Dietary Guidelines using nutrition data collected in the 2012-13 National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (NATSINPAS).

FIVE FOOD GROUPS

In 2012-13, Aboriginal and Torres Strait Islander people consumed an average total of 10 serves of foods from the Five Food Groups per day.

Vegetables and legumes/beans group

    • Aboriginal and Torres Strait Islander people aged two years and over consumed an average of 1.8 serves of vegetables and legumes/beans per day compared with 2.7 among non-Indigenous people.
    • The number of vegetable serves consumed increased with age, with children aged 2-18 years consuming 1.4 serves per day on average compared with 2.1 among adults aged 19 years and over.
    • The average daily consumption of vegetable and legumes/beans serves for each age-sex group of Aboriginal and Torres Strait Islander people was considerably less than the respective recommendations.

Fruit group

    • Around 1.2 serves of fruit (including fruit juice and dried fruit) were consumed per day on average by Aboriginal and Torres Strait Islander people aged two years and over, compared with 1.5 serves per day in the non-Indigenous population.
    • Fresh or canned fruit made up 62% and one-third (34%) came from fruit juice.
    • Children consumed more serves of fruit than adults, averaging 1.6 serves per day compared with 1.0 respectively.
    • Aboriginal and Torres Strait Islander people living in non-remote areas consumed more serves of fruit on average than those living in remote areas (1.3 serves compared with 0.9).
    • The average daily consumption of 1.0 serves of fruit by Aboriginal and Torres Strait Islander adults was half the recommended two serves.

Milk, yoghurt, cheese and alternatives group

    • Aboriginal and Torres Strait Islander people aged two years and over consumed an average of 1.2 serves of milk, yoghurt, cheese and alternatives per day, compared with 1.5 serves among non-Indigenous people.
    • Dairy milk made up almost two-thirds (65%) of this food group, followed by cheese (30%).
    • The average daily consumption of milk, yoghurt, cheese and alternatives for each age-sex group of Aboriginal and Torres Strait Islander people, with the exception of children aged 2-3 years and girls 4-8 years, was considerably lower than the respective recommend number of serves.

Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans group

    • The average consumption of lean meats and poultry, fish, eggs, tofu, nuts and seeds and legumes/beans was around 1.6 serves per day for Aboriginal and Torres Strait Islander people aged two years and over, slightly less than for non-Indigenous Australians (1.7 serves).
    • People living in remote areas consumed more serves of lean meats and poultry, fish, eggs, tofu, nuts and seeds and legumes/beans than those living in non-remote areas (2.0 serves compared with 1.4).
    • Lean red meats made up almost half (49%) of the serves of lean meats and poultry, fish, eggs, tofu, nuts and seeds and legumes/beans. The contribution of lean red meats was higher for people living in remote areas compared with non-remote (61% compared with 44%)
    • The average daily consumption of lean meats and poultry, fish, eggs, tofu, nuts and seeds and legumes/beans for each age-sex group of Aboriginal and Torres Strait Islander people, with the exception of girls 2-3 years, was considerably less than the respective recommendations.


Grain (Cereal) foods group

    • On average, Aboriginal and Torres Strait Islander people aged two years and over consumed around 4.1 serves of grain (cereal) foods per day, compared with 4.5 serves among non-Indigenous Australians.
    • Aboriginal and Torres Strait Islander people in remote areas consumed more serves of grain (cereal) foods on average than those in non-remote areas (4.6 serves compared with 4.0 serves)
    • One-quarter (25%) of grain (cereal) foods consumed were from wholegrain and/or high fibre varieties.
    • The average number of serves of grain (cereal) foods consumed by Aboriginal and Torres Strait Islander boys aged 4-13 years and girls aged 4-11 was equal to or greater than the recommendation.

WATER

The Guidelines also include the recommendation that Australians drink plenty of water. In 2012-13, the average amount of plain water, including both bottled and tap, consumed by Aboriginal and Torres Strait Islander people was around one litre per day (997 ml), 76 ml less than the average for non-Indigenous people (1,073 ml). An additional 262 ml of water was consumed from other non-discretionary beverages such as tea and coffee. Plain water contributed just under half (48%) of Aboriginal and Torres Strait Islander peoples’ total beverage consumption, slightly less than that of non-Indigenous Australians (50%).

UNSATURATED SPREADS AND OILS

The Guidelines also recommend a daily allowance for unsaturated fats, oils and spreads. In 2012-13, Aboriginal and Torres Strait Islander people aged 2 years and over consumed an average 1.4 serves of unsaturated spreads and oils from non-discretionary sources.

DISCRETIONARY FOODS

The Guidelines recommend that discretionary foods (i.e. those not necessary for nutrients but are often high in saturated fat, salt, sugar or alcohol) are only consumed sometimes and in small amounts. However, over two-fifths (41%) of total daily energy in 2012-13 came from foods and beverages classified as discretionary. 2

According to the Guidelines, a serve of discretionary food is around 500-600 kJ. Based on this, Aboriginal and Torres Strait Islander people consumed an average of 6.1 serves of discretionary foods per day, which was higher than the non-Indigenous population average of 5.5 serves. The leading contributors to serves of from discretionary foods were alcoholic beverages (10%), soft drinks (9.1%), potato products such as chips and fries (8.2%), pastries (7.1%), cakes and muffins (6.4%) and confectionary (6.3%).

This graph shows the mean serves consumed from the five Australian Dietary Guidelines food groups and unsaturated spreads and oils from non-discretionary sources plus serves of discretionary foods for Australians aged 2 years and over by Indigenous status

(a) Based on Day 1. See Glossary for definition.
(b) From non-discretionary sources unless otherwise specified.
(c) A discretionary serve is defined as 500-600 kJ. Discretionary serves were derived by summing energy from discretionary foods and dividing by 550 kJ. Does not include meats that do not meet the ADG criteria but are not flagged as discretionary.
Sources: National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey, 2012-13 and the National Nutrition and Physical Activity Survey, 2011-12.

ENDNOTES

1. National Health and Medical Research Council, 2013, Australian Dietary Guidelines. Canberra: Australian Government. <https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n55_australian_dietary_guidelines_130530.pdf >, Last accessed 27/10/2016

2. See discussion of Discretionary foods from 4364.0.55.007 – Australian Health Survey: Nutrition First Results – Foods and Nutrients, 2011-12, <http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.007~2011-12~Main%20Features~Discretionary%20foods~700 >

More details are available in Australian Aboriginal and Torres Strait Islander Health Survey: Consumption of food groups from Australian Dietary Guidelines (cat. no. 4727.0.55.008), available for free download from the ABS website, http://www.abs.gov.au.

partnerships-naccho

1. Call to action to Present
at the 2016 Members Conference closing 8 November
See below or Download here

2.NACCHO Partnership Opportunities

3. NACCHO Interim 3 day Program has been released

4. The dates are fast approaching – so register today

 

NACCHO #ABS Aboriginal Health Report : Indigenous Australians consuming too much added sugar

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In 2012-13, Aboriginal and Torres Strait Islander people 2 years and over consumed an average of 75 grams of free sugars per day (equivalent to 18 teaspoons of white sugar)1. Added sugars made up the majority of free sugar intakes with an average of 68 grams (or 16 teaspoons) consumed and an additional 7 grams of free sugars came from honey and fruit juice.

ABS Report abs-indigenous-consumption-of-added-sugars

Aboriginal and Torres Strait Islander people consume around 14 per cent of their total energy intake as free sugars, according to data from the Australian Bureau of Statistics (ABS).

The World Health Organization (WHO) recommends that free sugars contribute less than 10 per cent of total energy intake.

Director of Health, Louise Gates, said the new ABS report showed Aboriginal and Torres Strait Islander people are consuming an average of 18 teaspoons (or 75 grams) of free sugars per day (almost two cans of soft drink), four teaspoons more than non-Indigenous people (14 teaspoons or 60 grams).

OTHER KEY FINDINGS

    • Aboriginal and Torres Strait Islander people derived an average of 14% of their daily energy from free sugars, exceeding the WHO recommendation that children and adults should limit their intake of free sugars to less than 10% of dietary energy.
    • Free sugars made the greatest contribution to energy intakes among older children and young adults. For example, teenage boys aged 14-18 years derived 18 per cent of their dietary energy from free sugars as they consumed the equivalent of 25 teaspoons (106 grams) of free sugars per day. This amount is equivalent to more than two and a half cans of soft drink. Women aged 19-30 years consumed 21 teaspoons (87 grams) of free sugars, which contributed 17 per cent to their total energy intake.
    • The majority (87%) of free sugars were consumed from energy dense, nutrient-poor ‘discretionary’ foods and beverages. Two thirds (67%) of all free sugars consumed by Aboriginal and Torres Strait Islander people came from beverages, led by soft drinks, sports and energy drinks (28%), followed by fruit and vegetable juices and drinks (12%), cordials (9.5%), and sugars added to beverages such as tea and coffee (9.4%), alcoholic beverages (4.9%) and milk beverages (3.4%).
    • Intakes were higher for Aboriginal and Torres Strait Islander people living in non-remote areas where the average consumption was 78 grams (18.5 teaspoons), around 3 teaspoons (12 grams) higher than people living in remote areas (65 grams or 15.5 teaspoons).
    • Aboriginal and Torres Strait Islander people consumed 15 grams (almost 4 teaspoons) more free sugars on average than non-Indigenous people. Beverages were the most common source of free sugars for both populations, however Aboriginal and Torres Strait Islander people derived a higher proportion of free sugars from beverages than non-Indigenous people (67% compared with 51%).

ENDNOTES

1 A level teaspoon of white sugar contains 4.2 grams of sugar.

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“Free sugars include the sugars added by consumers in preparing foods and beverages plus the added sugars in manufactured foods, as well as honey and the sugar naturally present in fruit juice,” said Ms Gates.

“The data shows that Aboriginal and Torres Strait Islander people living in urban areas derived more energy from free sugars than those living in remote areas (14 per cent compared with 13 per cent).”

Free sugars contributed 18 per cent to dietary energy intake for teenage boys aged 14-18 years, who consumed 25 teaspoons (106 grams) of free sugars per day. This amount is equivalent to more than two and a half cans of soft drink.

Women aged 19-30 years consumed 21 teaspoons (87 grams) of free sugars, which contributed 17 per cent to their total energy intake.

“Beverages were the source of two thirds of free sugars, with soft drinks, sports and energy drinks providing 28 per cent, followed by fruit and vegetable juices with 12 per cent, cordials (9.5 per cent), sugars added to beverages such as tea and coffee (9.4 per cent), alcoholic beverages (4.9 per cent) and milk drinks (3.4 per cent),” said Ms Gates.

More details are available in Australian Aboriginal and Torres Strait Islander Health Survey: Consumption of Added Sugars (cat. no. 4727.0.55.009), available for free download from the ABS website, http://www.abs.gov.au.

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This year’s theme: Strengthening Our Future through Self Determination

As you are aware, the  2016 NACCHO Members’ Meeting and Annual General Meeting will be in Melbourne this year 6-8 December

1. Call to action to Present
at the 2016 Members Conference closing 8 November
See below or Download here

2.NACCHO Partnership Opportunities

3. NACCHO Interim 3 day Program has been released

4. The dates are fast approaching – so register today

 

NACCHO #NNW2016 Aboriginal Health and Nutrition : What works to keep our mob healthy and strong?

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” More effective action is urgently required in order to reduce the unacceptable health inequalities experienced by Aboriginal and Torres Strait Islander peoples.

During National Nutrition Week, 16-22 October 2016 NACCHO highlights food insecurity and nutrition-related chronic conditions are responsible for a large proportion of the ill-health experienced by Australia’s First Peoples who, before colonisation, enjoyed physical, social and cultural wellbeing for tens of thousands of years. Food and nutrition programs, therefore, play an important role in the holistic approach to improving health outcomes for Aboriginal and Torres Strait Islander peoples.

Key Recommendations

  1. Consistent incorporation of nutrition and breastfeeding advice into holistic maternal and child health care services.
  2. Creation of dedicated positions for Aboriginal or Torres Strait Islander people to be trained and supported to work with their local communities to improve food security and nutrition.
  3. Development of strategies which increase access to nutritious food, such as meal provision or food subsidy programs, should be considered for families experiencing food insecurity.
  4. Adoption of settings-based interventions (e.g. in schools, early childhood services and sports clubs) which combine culturally-appropriate nutrition education with provision of a healthy food environment.

The evidence suggests that the most important factor determining the success of Aboriginal and Torres Strait Islander food and nutrition programs is community involvement in (and, ideally, control of) program development and implementation.

Working in partnership with Aboriginal or Torres Strait Islander health professionals and training respected community members to deliver nutrition messages are examples of how local strengths and capacities can be developed. Incorporation of Aboriginal and Torres Strait Islander knowledge and culture into program activities is another key feature of strength-based practice which can be applied to food and nutrition programs.”

Food and nutrition programs for Aboriginal and Torres Strait Islander Australians: what works to keep people healthy and strong?

Download full report food-and-nutrition-programs-aboriginal-what-works

The authors would also like to acknowledge the National Aboriginal Community Controlled Health Organisation (NACCHO) for their contribution to this work.

Deeble Institute for Health Policy Research, Australian Healthcare and Hospitals Association (AHHA), Canberra.

Nutrition Australia, the country’s leading non-profit nutrition organisation and creators of the Healthy Eating Pyramid, is challenging all Australians to take the pledge to eat more veg during National Nutrition Week, 16-22 October 2016.

With an alarming 96% of Australians failing to eat their recommend daily intake of vegetables, Nutrition Australia’s Try For 5 theme encourages all Australians to discover new ways to add veg to their day.

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The recommended daily intake for people over 4 years of age is around 5 serves of vegetables and legumes a day (75g per serve), yet data from the Australia Bureau of Statistics shows that the average Australian eats around half that amount.

“It’s the food group that we eat the least, yet it’s the one we should eat from the most!” said Lucinda Hancock, Accredited Nutritionist and CEO of Nutrition Australia Vic Division.

“Whether they’re fresh, frozen or canned, eating a rainbow of vegetables every day is one of the easiest things we can do to improve our health and wellbeing.”

“Vegetables are full of vitamins, minerals, fibre and antioxidants which all help keep our minds and bodies working day-to-day, and reduce our risk of chronic disease in the future.”

President of Nutrition Australia, Rob Rees said “Our Healthy Eating Pyramid has been advising Australians to eat a diet of mostly plant foods, including vegetables and legumes, for over 30 years. Sadly, we know that most Australians don’t eat the balanced diet that’s recommended by the Pyramid, and this is why we’re seeing such high rates of diet-related diseases.”

“In fact the average Australian gets over a one third of their daily kilojoules (energy) from ‘junk foods’, like biscuit and cakes, confectionery, take away foods, sugary drinks and alcohol,“ said Mr Rees .

Nutrition Australia is supporting the Try For 5 goal with 3 key strategies to boost vegetable intake:

 

eatarainbow  

Eat a rainbow

Eating a variety of vegetables each day exposes us to a wide range of nutrients for better health. We should eat different coloured vegetables every day because each colour carries its own set of unique health-promoting properties called ‘phytochemicals’ that give vegetables their colour, flavour, taste and even smell.

nnwiconnew  

Try something new

Trying new things is a great strategy to boost your vegetable intake. Whether that’s trying new vegetables, a new recipe, or trying vegetables in a way that you normally don’t consume them like at breakfast or in a snack. Experimenting with vegetables and preparing foods can give you the knowledge, skills and confidence to easily prepare vegetables to suit your tastes, which makes you more likely to buy, cook and consume them.

 nnwiconlegumes  

Love your legumes

2016 is International Year of the Pulse (another term for legumes) and they are a cheap and versatile source of fibre, protein plus many other important nutrients. We should have 2–3 serves of legumes a week for health benefits.

Sibylla Stephen is one half of children’s band, Teeny Tiny Stevies, who are ambassadors for National Nutrition Week 2016.

Mum-of-two Sibylla and her bandmate and sister, Beth, are releasing the animated video for their song “I Ate A Rainbow” during National Nutrition Week, which was written as a tool to help parents teach their children about why we should eat different coloured vegetables every day.

And it’s a perfect match with the storybook, I’m having a rainbow for dinner published by Nutrition Australia’s Queensland Division.

“I’m thrilled to be an ambassador for National Nutrition Week because I think we can all do with learning some new quick and easy ways to feed ourselves and our families with vegetables,” Sibylla said.

“My children are four and one, and their relationship with food changes as they get older. It can be incredibly frustrating to get them to eat their veggies, but I always encourage them to try different veggies cooked in different ways, and learn what they do and don’t like.

“As parents we try so hard to make sure our kids are well nourished, but the stats show that we’re not taking our own advice. I think ‘eating a rainbow’ is a great message for children and adults alike!”

Report continued

The National Aboriginal and Torres Strait Islander Health Plan takes a “whole-of-life” approach to improving health outcomes. Priority areas include maternal health and parenting; childhood health and development; adolescent and youth health; healthy adults and healthy ageing.

This Policy Issues Brief provides a synthesis of the evidence for food and nutrition programs at each of these life stages. It answers questions such as, what kind of food and nutrition programs are most effective for Aboriginal and Torres Strait Islander peoples? And, how should these food and nutrition programs be developed and implemented?

Nutrition research has been criticised for focusing too much on quantifying dietary risks and deficits, without offering clear solutions.

Increasingly, Aboriginal organisations are calling for strength-based approaches, which utilise community assets to promote health and wellbeing.

Evidence-based decision-making must consider not only what should be done, but also how food and nutrition policies and programs can be developed to support the existing strengths of Aboriginal and Torres Strait Islander communities.

National Nutrition Week runs from 16-22 October 2016. Click here for recipes, tips and resources to discover new ways to add veg to your day.

How you can share positive health messages and  stories about Aboriginal Community Controlled Health issues ? Closing this week for advertising and editorial

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NACCHO Aboriginal Health and Smoking : New #AIHW report Indigenous smoking rates gap is widening

smoking

 ” While improvements were seen across all population groups, some achieved greater progress than others.

For example, despite the fact that Indigenous smoking rates are improving, they are not improving at the same rate as non-Indigenous Australians, so the gap is widening across a number of indicators.

Factors influencing smoking behaviours among Aboriginal and Torres Strait Islander (Indigenous) people are complex and interrelated.

As with other populations, some Indigneous people experience multiple levels of disadvantage, for example, low socioeconomic position, unemployment, low educational attainment and a single-parent household type.

There were significant declines in the proportion of Indigenous people smoking tobacco daily and being exposed to tobacco smoke between baseline and midpoint.

However, they were generally more likely to be exposed to tobacco smoke, to have tried and transitioned to established smoking patterns and were less likely to succeed at quitting smoking than non-Indigenous people.

Between baseline and midpoint, the difference in rates (the gap) among these groups narrowed for some indicators but widened for others. The gap widens despite the fact that Indigenous smoking rates are declining because the non-Indigenous rate is declining faster than the Indigenous rate. The gap closes when the Indigenous rate is declining faster than the non-Indigenous rate.

Tobacco Indicators: measuring mid-point progress: reporting under the National Tobacco Strategy 2012-2018

Table 3.1: Smoking phases, per cent change (Indigenous)

Download report here

national-tobacco-strategy-mid-point-report

Read 85 NACCHO Smoking Stories HERE

Tobacco smoking remains a major cause of many health problems, but according to a new report from the Australian Institute of Health and Welfare (AIHW), Australians’ smoking behaviours are improving-with some groups improving more than others.

The report, Tobacco Indicators: measuring mid-point progress: reporting under the National Tobacco Strategy 2012-2018, measures smoking behaviours in Australia against a range of indicators, and shows that across most, Australia is progressing well.

The report’s indicators look at a range of smoking phases-including exposure to tobacco smoke, initial uptake of tobacco smoking, established smoking patterns and quitting-and measure progress since the baseline report, released in 2015.

‘Since the baseline report, we’ve seen improvements when it comes to people taking up smoking, with fewer secondary school students and adults trying cigarettes-and those who do, are taking up tobacco smoking at older ages than in the past,’ said AIHW spokesperson Tim Beard.

Falls were also recorded in the number of secondary students and adults who smoked regularly with a decline of almost a quarter for both groups.

‘Our report also shows a significant fall in the number of children and non-smokers who are exposed to tobacco smoke in the home,’ Mr Beard said.

While improvements were seen across all population groups, some achieved greater progress than others.

‘For example, despite the fact that Indigenous smoking rates are improving, they are not improving at the same rate as non-Indigenous Australians, so the gap is widening across a number of indicators.’

Similar findings were seen for people living in Remote and Very remote areas (compared to Major cities).

Daily smoking rates significantly improved among people living in the lowest and second-lowest socioeconomic areas, but not at the same rate as those living in the highest socioeconomic area.

The report showed unclear results when it came to quitting, but some positive results were recorded among people who had smoked more than 100 cigarettes in their lifetime (referred to in the report as ‘ever-smokers’).

Since the baseline report, the proportion of adult ever-smokers who have now quit smoking has risen from 47% to 52%.’

In 2013, more than half (52%) of adult ever-smokers had quit smoking (they had not smoked in the last 12 months). This was an increase from 47% in 2010.

How you can share positive good news stories about Aboriginal Community Controlled Health ?

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Editorial Opportunities

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NACCHO Aboriginal Health News Alert : Five ways that the $160m same sex plebiscite could be spent in health

phaa

PHAA chief executive Michael Moore said the money should be funnelled into areas that would benefit the community such as health and education instead.

“Essentially this is a waste of money at a time when governments are cutting health budgets – and particularly slashing prevention,” Mr Moore said.

Reporting in todays The Age

Photo Above Some in the health industry name Indigenous health as the top area worthy of investment. Photo: Michael Amendolia

The growing cost of health – powered by an ageing population and more expensive technology – presents an ongoing challenge to the federal government, but there is no shortage of people willing to offer Health Minister Sussan Ley some unsolicited advice on how to better spend her portion of the budget.

If the $160 million was diverted to health, here is where some health advocates believe it could be better invested, in no particular order.

  1. Preventative health

The latest Australian Institute of Health and Welfare report showed the proportion of health expenditure devoted to prevention had decreased to 1.4 per cent in 2013-14, down from 2.2 per cent in 2007-2008.

Although much of the preventative health dollar in that peak year went towards introducing the HPV vaccine, other evidence suggests a disinvestment in preventative health, including the termination of funding to the Australian National Preventative Health Agency [ANPHA].

Michael Moore said the re-opening of that agency and all the programs that it ran would be one good use of the funds, or campaigns on the harms associated with tobacco, alcohol or obesity.

“You could easily spend all of the money on this as we cannot hope to compete with industry bombardment,” he said.

The Heart Foundation has called for $35 million to be spent annually on addressing physical inactivity, which is estimated to cause 14,000 deaths every year.

General manager advocacy Rohan Greenland said Australia was in the bottom third of OECD nations in terms of the amount it spent on preventative health.

“While we are doing well on tobacco control, we should be putting the same, sustained effort into preventing obesity, tackling physical inactivity and addressing poor nutrition,” Mr Greenland said.

A Department of Health spokeswoman said the activities of ANPHA had been taken over by the department.

Preventative programs included projects centred on chronic conditions, a National Asthma Strategy, a National Diabetes Strategy, activities addressing healthy eating, physical activity, obesity, tobacco, alcohol, research, immunisation,  mental health initiatives and cancer screening, she said.

  1. Aged care

Nurses nominate aged care as the sector in most dire requirement of funding.

Aged care providers have long been predicting a shortage of places and qualified nurses as baby boomers move into their dotage, with lack of staffing blamed on an increase in violent incidents.

The Australian Nursing and Midwifery Federation federal secretary Lee Thomas said $160 million could replace some of the money that has been taken out of the sector in recent years.

“Currently, there is a shortage of 20,000 nurses in aged care,” Ms Thomas said.

“This needs to be fixed as a matter of urgency, given Australia’s rapidly ageing population.

“The restoration of funding for the health sector would also go toward supporting public hospitals in the states and Territories and allowing more graduate nurses to be employed.”

  1. Indigenous health

Australian Healthcare and Hospitals Association chief executive Alison Verhoeven has a wishlist that lasts pages (“Oh there’s so much you could do”) but indigenous health tops her list.

As a start, the money could be invested in closing the gap in diseases such as rheumatic heart disease and trachoma or addressing the high rates of suicide, drug and alcohol abuse.

“We could be looking beyond that at things like how we incorporate investment in safe housing and safe food supplies and ensure that kids growing up in indigenous, particularly remote and rural, communities actually get a good start in life,” Ms Verhoeven said.

  1. Chronic disease

The Heart Foundation has argued that there is an economic and social argument to address chronic disease, which cause 90 per cent of all deaths and 85 per cent of the burden of disease.

“The health minister has rightly said that chronic disease is our greatest health challenge,” Mr Greenland said.

“We need to be better at early detection of those at risk of having heart attacks, strokes or developing diabetes and kidney disease.”

The federal government unveiled in March a trial of “Health Care Homes”, whereby people with chronic disease would have all their care managed from a single GP practice, but Ms Verhoeven says the $21 million package would only cover education and training.

“It’s not enough to make a real change across Australia in the way we deliver primary care.”

A Department of Health spokeswoman said the $21 million was in addition to $93 million that would be redirected from the Medicare Benefits Schedule in 2017-18 and 2018-19 to support the management of patients with chronic conditions.

  1. Mental health

Many in the health sector are concerned that the angst caused by the plebiscite could actually contribute to its overall cost.

Michael Moore said the mental health impact of the plebiscite was estimated to cost $20 million and already there was more demand for counselling services.

The Royal Australian and New Zealand College of Psychiatrists has called for employment support for people with mental illness and improved services for people with borderline personality disorder, aged care residents, children and adolescents and Aboriginal and Torres Strait Islanders.

 

NACCHO #fightstroke Aboriginal Health News : New smartphone APP to treat atrial fibrillation and prevent strokes.”

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“A lot of the time, you’ll get a machine that has a lot of connections and you’re there for about 10 to 15 minutes setting up, whereas the iECG is in a comfortable position in your hands and it’s just two fingers on the back of a probe on the back on a phone,” he said.

“People are quite happy to do it, they’re quite surprised that a screening tool can be so small and so mobile.”

At the heart of the research is community consultation.

The programs and rollout have been designed with local people on the ground because they are more in touch with what the community needed.”

Daniel Kelly is an Aboriginal Health Education Officer at the hospital in Brewarrina in north-west NSW and said it was less daunting for patients who were sometimes scared of hospitals

NACCHO Articles about strokes and recovery

A new smartphone app could revolutionise the way health care is delivered in the outback Brooke Boney from ABCNews Reports

The iECG replaces a traditional ECG machine to detect atrial fibrillation, which is responsible for one third of all strokes in Australia.

A pilot at the University of Sydney is trialling the technology in far western New South Wales to create the first snapshot of atrial fibrillation rates in Aboriginal people.

One of the benefits is that it can be carried out by local healthcare workers with minimal training and effort.

‘Oh go away, it’s only a phone’

One of the Aboriginal health officers, Helen Ferguson, said it was so easy, some of the patients thought they were joking.

The smartphone app iECG

“It was so funny because when we first got the little machine we would say to the people, ‘now we’ve just come to have a little yarn to you, this is a machine that we’ve got and it’s like a little ECG machine and instead of having all the cords on and it’ll give you a reading of either normal or AF [atrial fibrillation]’,”she said.

“And then they’d say ‘oh go away, it’s only a phone’, and they thought we were pretending.”

The patient places their fingers on connectors and holds on for 30 seconds.

The file is processed by an app on the phone which gives results almost immediately.

Once an abnormality is picked up, the patient is referred to a specialist in Sydney or they can book an appointment with visiting specialists who come to the area about once a month.

One of those specialists, Dr John Watson, is a leading neurologist and said that stroke, as a result of atrial fibrillation, could be among the most severe — but it can also be easily treated with anti-coagulant medications.

“A lot of the time, the stroke can be the presenting feature of the atrial fibrillation,” he said.

“One of the worst things is to see someone who’s just had a stroke to find out that they are in atrial fibrillation and that was the cause of the stroke, and then to hear that the chance to detect it earlier was missed or ignored or it was detected and not enough was done to try to treat the atrial fibrillation and prevent the stroke.”

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More info about F.A.S.T. and Stroke Foundation HELP

Telehealth to transform outback care

It is the beginning of a new way of treating people in remote and inaccessible areas.

As a concept, telehealth has been around for a while but new technology is helping to push that along.

Dr Watson said new equipment, which included satellite technology and medical instruments, could send information back to specialists in real time — meaning consultations could take place more frequently and for less cost.

“We may have a cardiologist in Sydney who says, ‘every Thursday morning, for three hours, I’m free, I’m available to help run a clinic anywhere else in the country’,” he said.

Treating Indigenous people in communities rather than sending people to cities for treatment, where possible, could be more successful and more cost effective.

Dr Susannah Tobin  said culturally appropriate health care was not just important, but vital if patients were to see the benefits.

“If we can deliver them where they feel comfortable … then they’re more likely to be able to take advantage of it and to see the benefit,” she said.

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NACCHO Aboriginal health : #AIHW #AustraliasHealth2016 : What are the health experts saying about the report ?

aus-2016

” The report has also pointed out ongoing areas of health inequality in Australia, driven by socioeconomic factors and social determinants.

Communities suffering socioeconomic disadvantage continued to have systematically poorer health including lower life expectancy, higher rates of chronic disease and higher smoking rates.

Aboriginal and Torres Strait Islander peoples recorded improved health indicators in some areas, including lower rates for smoking and infant mortality.

However, the report found life expectancy was shorter by 10 years than for non-Indigenous Australians, and Aboriginal and Torres Strait Islander peoples continued to suffer higher rates of diseases such as diabetes, coronary heart disease and end-stage kidney disease.

The impact of risk factors such as smoking, physical inactivity, poor nutrition and harmful alcohol use have been emphasised as significant contributors to Australia’s rising rates of chronic disease.

This is an opportunity for health leaders and the Commonwealth Government to heed the report’s message that lifestyle factors and social determinants are significant contributors to ill-health, and to address the issues of health inequality and the importance of reform across all of our care systems “

AHHA Chief Executive Alison Verhoeven

Download the report here australias-health-2016

 #AIHW and Minister Sussan Ley press releases from launch #AustraliasHealth2016 report

Life expectancy gap between Indigenous and non-Indigenous Australians remains about one decade

The life expectancy gap between Indigenous and non-Indigenous Australians remains about one decade, according to new statistics.

The latest report from the Australian Institute of Health and Welfare (AIHW) said that while health outcomes had improved for Aboriginal and Torres Strait Islander people, they still remain below those of non-Indigenous Australians.

The biennial report, published today, shows Indigenous males born between 2010 and 2012 have a life expectancy of 69.1 years, a decade less than their non-Indigenous counterparts.

The gap for women was slightly lower at 9.5 years.

Between 2009 and 2013, 81 per cent of all Indigenous deaths were of people under 75. This is more than twice the rate of non-Indigenous Australians, which stands at 34 per cent.

The latest statistics come 10 years after the establishment of the Closing the Gap campaign, which aims to end the disparity on life expectancies.

Earlier this year, Prime Minister Malcolm Turnbull pledged that the Government would better engage with Indigenous people in “hope and optimism rather than entrenched despair”.

Indigenous sobriety rate higher than non-Indigenous Australians

While smoking rates have been falling nationally, they remain high among Indigenous Australians, with 44 per cent of Aboriginal and Torres Strait Islander people aged 15 and over describing themselves as a current smoker.

The report states that 42 per cent smoke daily, 2.6 times the rate of their non-Indigenous counterparts.

However, Indigenous Australians drink less alcohol than non-Indigenous counterparts — 26 per cent of Aboriginal and Torres Strait Islander people aged 15 and over had not consumed alcohol in past 12 months.

This equates to a sobriety rate 1.6 times that of non-Indigenous Australians.

Potentially avoidable deaths — categorised as deaths that could have been avoided given timely and effective health care — accounted for 61 per cent of deaths of Indigenous Australians aged up to 74 years between 2009 to 2013.

This was 10 per cent more than their non-Indigenous counterparts.

Australians are living longer than ever but with higher rates of chronic disease, the latest national report card shows.

Reports below from the Conversation

According to the Australian Institute of Health and Welfare’s Australia’s Health 2016 report, released today, Australian boys can now expect to live into their 80s (80.3), while the life expectancy for girls has reached the mid-80s (84.4).


A boy born and girl born in 1890 could only expect to live to 47.2 and 50.8 years respectively. AIHW

The single leading cause of death in Australia is coronary heart disease, followed by:

Grouped together, cancer has overtaken cardiovascular disease (heart disease and stroke) as Australia’s biggest killer. Cancer is also the largest cause of illness, followed by cardiovascular disease:


Burden of disease, by disease group, Australia, 2011 AIHW

Chronic diseases are becoming more common, due to population growth and ageing. Half of Australians (more than 11 million) have at least one chronic disease. One quarter have two or more.

The most common combination of chronic diseases is arthritis with cardiovascular disease (heart disease and stroke):


AIHW

Australians have high rates of the biomedical risk factors that increase the risk of heart disease and stroke. Almost a quarter (23%) of Australian adults have high blood pressure and 63% have abnormal levels of cholesterol.


Lifestyle choices

Fron Jackson-Webb, Health + Medicine Editor, The Conversation

The good news is Australians are less likely to smoke and drink at risky levels than in the past.

Australia now has the fourth-lowest smoking rate among 34 OECD countries, at 13% in 2013. This is almost half that of 1991 (24%).


AIHW

The volume of alcohol Australians consume fell from 10.8 litres per person in 2007–08 to 9.7 litres in 2013–14. This is the lowest level since 1962–63. But 16% of Australians are still drinking to very risky levels: consuming 11 or more standard drinks on one occasion in the past 12 months.


AIHW

Around eight million Australians have tried illicit drugs in their lifetime, including 2.9 million in the last 12 months. The most commonly used illicit drugs are cannabis (10%), ecstasy (2.5%), methamphetamine (2.1%) and cocaine (2.1%).

Use of methamphetamine has remained stable in recent years. However, more methamphetamine users are opting for crystal (ice) rather than powder (speed).

The bad news is Australians are still struggling with their weight. Around 63% are overweight or obese, up from 56% in 1995. This equates to an average increase of 4.4kg for men and women. One in four children are overweight or obese.

Junk foods high in salt, fat and sugar account for around 35% of adults’ energy intake and around 39% of the energy intake for children and young people.

Most Australians (93%) don’t consume the recommended five serves of vegetables a day and only half eat the recommended two serves of fruit. Just 3% of children eat enough vegetables, though 70% consume the recommended amount of fruit.

Almost half (45%) of adults aged 18 to 64 and 23% of children aren’t meeting the national physical activity recommendations. These are for adults to accumulative 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous intensity physical activity each week. Children are advised to accumulate at least 60 minutes of moderate to vigorous physical activity every day.

Lifestyle choices have a huge impact on the risk of chronic disease; an estimated 31% of the burden of disease in Australia could have been prevented by reducing risk factors such as smoking, excess weight, risky drinking, physical inactivity and high blood pressure.

Proportion of the burden attributable to the top five risk factors


AIHW

Preventing chronic disease

Rob Moodie, Professor of Public Health, University of Melbourne

This report outlines a number of positives in Australia’s health – our life expectancy, the health services at our beck and call, major declines in tobacco and road deaths. We’re doing well, it says, but we could do better.

If we took prevention and health promotion far more seriously, we could do a lot better.

The report nominates tobacco use, alcohol, high body mass and physical inactivity as the chief causes of preventable illness and the chief causes of our increasing level of chronic illnesses. Yet national investment in prevention is declining.


Further reading: Focus on prevention to control the growing health budget


Tobacco use is rapidly declining because of really effective measures (plain packaging, advertising bans and increasing price through taxes) that save lives and enormous amounts of money over a lifetime for people who used to smoke.

However, we can’t seem to make any major dent in the commercial, industrial and lifestyle diseases related to junk food and drinks, harmful consumption of alcohol and car dependency.

We’ve known what will work for many years but the power of some of these unhealthy industries is still overwhelming – a situation in which our politicians fear these industries and their associations more than they fear the voters.

Our collective health would have been much better if we’d been able to follow the guidance of our own national task forces and learnt from other countries. The report card should read, “Doing well, but could have done a lot better”.


Inequities

Fran Baum, Matthew Flinders Distinguished Professor and Foundation Director at the Southgate Institute for Health, Society & Equity, Flinders University

Australia’s Health 2016 shows many Australians are not getting a fair go at health. There is a gradient across society whereby the richer the area you live in, the longer you can expect to live. The difference between the highest and lowest is four years.

Deaths by socioeconomic group: 1 = lowest; 5 = highest


AIHW

The gradient is evident from early life. Children most at risk of exclusion – those from poor areas who experience problems with education, housing and connectedness – are most likely to die before they reach 15 years from potentially preventable or treatable causes.


Further reading: Want to improve the nation’s health? Start by reducing inequalities and improving living conditions


Our most glaring inequity is the ten-year life gap between Aboriginal and Torres Strait Islander Australians and others. Indigenous life expectancy is 69.1 years for males and 73.7 years for females.

Compared with the non-Indigenous population, Indigenous Australians are:

  • 3.5 times as likely to have diabetes and four times as likely to be hospitalised with it or to die from it
  • five times as likely to have end-stage kidney disease
  • twice as likely to die from an injury
  • twice as likely to have heart disease.

Australians living outside major cities have higher rates of disease and injury. They also live in environments that make healthy lifestyles choices harder (such as more difficulties buying fresh fruit and vegetables) and so their risk of chronic diseases is increased.


AIHW

The data on who has private health insurance coverage points to the emergence of a two-tiered health system, where those who can afford to pay receive better access and quality of care. Just 26% of those in the lowest socioeconomic group have cover compared to about 80% of the top group.

Coverage with private health insurance and government health-care cards


AIHW

Cost of care

Professor Stephen Duckett, Director of the Health Program at Grattan Institute

Over the last decade, health expenditure grew about 5% each year, above the 2.8% average growth in Gross Domestic Product (GDP). As a result, health took up an increasing share of GDP.

Spending more on health means Australia spent less on other things. This is not necessarily bad, as long as the benefits from that increased expenditure – such as increasing life expectancy or increased quality of life – are worth the increased costs.

But spending above GDP growth cannot continue indefinitely. And the last few years saw an increase in rhetoric about health spending increases being “unsustainable” from so-called “futurists” and politicians.

Informed commentators have generally rejected the unsustainability claim, some labelling it a “myth”, while others take a more nuanced view.

Australia’s Health 2016 shows a slowing of the real growth rate in the most recent two years to about half that of the previous decade – 1.1% from 2011-12 to 2012-13 and 3.1% from 2012–13 to 2013–14.


Annual growth rates in health expenditure AIHW

This suggests the “unsustainability” rhetoric is at least overblown and potentially prompting budget decisions which are counter-productive, such as introducing a co-payment for general practice.

Commonwealth government expenditure was more or less stable over these most recent two years, declining 2.5% initially then increasing 2.4% in the last year.

Health expenditure by area (adjusted for inflation)


AIHW

Savings to the government came from shifting costs to consumers, by slowing the growth in government subsidies to private health insurers, and also by slowing spending on pharmaceuticals.

This latter slowdown was achieved through tighter controls on payments to drug manufacturers and because some big-selling drugs came off patent, resulting in falls in prices.

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NACCHO Aboriginal Health #strokeweek : “No more stroke for our mob “: rap spreads awareness

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Aboriginal and Torres Strait Islander are between two and three times as likely to have a stroke than non-Indigenous Australians which is why increasing stroke awareness is crucial.

Too many Australians couldn’t spot a stroke if it was happening right in front of them. We know that in Aboriginal and Torres Strait Islander communities this awareness is even lower. This Stroke Week we want all Australians, regardless of where they live or what community they’re from, to learn the signs of stroke.

Naomi and Rukmani’s stroke rap runs through vital stroke awareness messages, such as lifestyle advice, learning the signs of stroke, and crucially the need to seek medical advice when stroke strikes.

Music is a powerful tool for change and we hope that people will listen to the song and remember the FAST message – it could save their life,”

Stroke Foundation Queensland Executive Officer Libby Dunstan 

Naomi Wenitong  pictured with her father Dr Mark Wenitong Public Health Officer at  Apunipima Cape York Health Council  in Cairns:

Share the stroke rap with your family and friends on social media and celebrate Stroke Week in your community.

Listen to the new rap song HERE

                                       or Hear

A new rap song promoting stroke awareness and prevention is set to hit the airwaves across the country during National Stroke Week (12-18 September).

The song, written by Cairns speech pathologist Rukmani Rusch (pictured below)and performed by leading Indigenous artist Naomi Wenitong, was created to boost low levels of stroke awareness in Aboriginal and Torres Strait Islander communities.

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This year National Stroke Week centres on the theme Speed Saves in recognition of the impact time has on stroke. Many stroke treatments can only be administered within a short time after stroke, which is why knowing the signs of stroke is so critical.

Read 34 Aboriginal Stroke related NACCHO Articles Here

Ms Dunstan said too many Australians continue to lose their lives to stroke each year.

“There will be more than 50,000 strokes in Australia this year and sadly many people miss out on accessing life-saving treatment as they don’t get to hospital on time,” Ms Dunstan said.

“We want the community to be aware that stroke is always a medical emergency. When you have a stroke, your brain cells start to die at a rate of almost two million per minute.

“Being aware of the signs of stroke and knowing to call 000 as soon as it strikes is crucial in the fight against this terrible disease.

“Aboriginal and Torres Strait Islander are between two and three times as likely to have a stroke than non-Indigenous Australians which is why increasing stroke awareness is crucial.

“This National Stroke Week you can help us make a difference.

Share the stroke rap with your family and friends on social media and celebrate Stroke Week in your community.

“It is all about bringing people together to have fun, while raising awareness of stroke.”

Think FAST this National Stroke Week and raise awareness of stroke.

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Find out more, register your event at www.strokefoundation.com.au.

Free resource packs and information are available to assist with events; including posters fundraising ideas and information about stroke awareness.

National Stroke Week runs from September 12 to 18. It is an annual event which aims to raise the awareness of stroke within the community and encourage Australians to take action to prevent stroke.

Declaration of Interest Colin Cowell

acted F.A.S.T. and saved his life

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Please note : The Editor of NACCHO News is a stroke survivor and is currently a board member of the Stroke Foundation and chair of the National Stroke Consumer Council Read his story

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NACCHO Aboriginal Health and Obesity : Should Doctors be taught how to discuss their patients’ excess weight ?

ATSI Obesity

” Being overweight or obese increases the risk of a range of health conditions, including coronary heart disease, Type 2 diabetes, some cancers, respiratory and joint problems, sleep disorders and social problems. The excess burden of obesity in the Indigenous population is estimated to explain 1 to 3 years (9% to 17%) of the life expectancy gap in the NT .

Obesity is estimated to contribute 16% of the health gap between Aboriginal and Torres Strait Islander peoples and the total Australian population

Obesity is associated with risk factors for the main causes of morbidity and mortality among Aboriginal and Torres Strait Islander peoples. It impacts largely through diabetes (half of the obesity burden) and ischaemic heart disease (40%) “

Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report

Download the report ATSI Overweight and Obesity

Download ANPHA Obesity Prevalence Trends

 “With 80% of adults and close to one-third of children expected to be overweight or obese by 2025, doctors are increasingly likely to be working with people who are overweight or obese.

An individual’s weight is a complex and sensitive issue, which may be related to many factors that are not only medical but social, environmental and emotional. The skills to address the issue in a way that communicates the health risks of being overweight without judgement and without inciting negative responses are not easy to acquire or universally taught.”

From The Conversation Adrienne Gordon  Neonatal Staff Specialist, NHMRC Early Career Research Fellow, University of Sydney and Kirsten Black Associate Professor & Joint Head of Discipline Obstetrics, Gynaecology and Neonatology, University of Sydney see full article below (2)

The 2012–13 Health Survey included height and weight measurements to allow body mass index (BMI) scores to be calculated. In 2012–13, 66% of Indigenous Australians aged 15 years and over had a BMI score in the overweight or obese range (29% overweight and 37% obese). Indigenous adults were 1.6 times as likely to be obese as non-Indigenous Australians (after adjusting for differences in the age structure of the two populations).

Indigenous obesity rates varied geographically. Obesity was highest in inner regional areas (40%) and lowest in very remote areas (32%). Rates were similar in major cities (37%) and in outer regional and remote areas (38%). By jurisdiction, obesity rates ranged from 41% in NSW to 29% in the NT. Indigenous women had higher rates of obesity (40%) and lower rates of overweight (26%) compared with Indigenous men (34% and 31% respectively). Of those adult Indigenous women who had an underweight or normal measured BMI, 44% had a waist circumference of 80cm or more, indicating increased risk of developing chronic disease. For both Aboriginal and Torres Strait Islander males and females, the rates for overweight/obesity increased with age, with 80% of the population aged 55 years and over being overweight or obese. Higher proportions of Torres Strait Islanders were overweight/obese than in the Aboriginal population (73% versus 65%).

The 2012–13 Health Survey showed obesity was strongly associated with chronic disease biomarkers (being obese increased the risk of abnormal test results for nearly every chronic disease tested for in the survey). Indigenous obese adults were 7 times more likely to have diabetes than those of normal weight/ underweight (17% compared with 2%). Those who did not meet the physical activity guidelines were more likely to be obese (44%) than those who met the guidelines (36%).

Childhood is a critical period in which inequalities in health determinants such as socio-economic status and overweight/ obesity emerge (Jansen et al. 2013). In 2012–13, Aboriginal and Torres Strait Islander children aged 2–14 years were more likely than non-Indigenous children to be underweight (8% compared with 5%); were less likely to be in the normal weight range (62% compared with 70%); and more likely to be overweight or obese (30% compared with 25%). Obesity rates for Indigenous children increased from the age of 5, with the highest rates at 10–14 years of age (12%). High BMI is found to be a predictor of short sleep duration for children (Magee et al. 2014), which impacts on school performance (measure 2.04) and engagement in physical activity (measure 2.18). It is not possible to compare 2012–13 Health Survey results with previous surveys as the latest results are based on measured BMI rather than self-reported height and weight (as was done before). Research shows rates of overweight/ obesity have increased more rapidly in Aboriginal than non-Aboriginal school-aged children in NSW (Hardy et al. 2014).

In December 2013, national Key Performance Indicators data provided by Australian Government-funded Indigenous primary health care organisations, found that 27% of clients aged 25 years and over were overweight, and 41% were obese (AIHW 2014w).

Obesity is associated with other health risk factors and social determinants of health. One example is prolonged financial stress, which is a predictor of obesity (Siahpush et al. 2014) (see measure 2.08). Low income is associated with food security problems (Markwick et al. 2014) and subsequent dietary behaviour (see measure 2.19). Evidence also shows that incarceration is associated with weight gain and obesity in Indigenous youth (Haysom et al. 2013) (see measure 2.11).

Implications

Given the health risks associated with being obese or overweight, the situation for Aboriginal and Torres Strait Islander peoples requires urgent attention. It is second only to tobacco consumption in terms of contribution of modifiable risk factors to the health gap experienced by Aboriginal and Torres Strait Islander peoples (Voset al. 2007).

An evaluation of a school-based health education programme for urban Indigenous youth found promising results in physical activity, breakfast intake and fruit and vegetable consumption (Malseed et al. 2014), all of which are core components of healthy weight management. Likewise, opportunities exist for obesity prevention in young children through practice-nurse brief interventions (Denney-Wilson et al. 2014).

Reversal of obesity is difficult even in the absence of environmental and social barriers. Therefore, early intervention to prevent the onset of excessive weight gain is likely to be the most effective strategy (Thurber et al. 2014). Studies reporting success in reducing obesity have a number of common characteristics, including: a focus on physical activity and diet opposed to diet alone; the ability to accommodate the preferences of participants; a group focus; and choice between a number of physical activities. Programmes must also be culturally acceptable, conveniently located, easily incorporated into the daily schedule and show goal attainment that is realistic and appropriate (Canuto et al. 2011).

The Australian Government’s Indigenous Australians’ Health Programme aims to actively promote healthier lifestyle choices with culturally secure community education, health promotion and social marketing activities. A Healthy Weight Guide consisting of an interactive website and printed resources is currently being developed to provide guidance and information for consumers to help them achieve and maintain a healthy weight. The guide includes information for Aboriginal and Torres Strait Islander peoples.

Doctors need to be taught how to discuss their patients’ excess weight

Health professionals repeatedly report a lack of confidence in knowing how to address obesity in their patients. They report minimal, if any, training on obesity as well as limited resources for effective conversations and insufficient clinical time to be able to do this well.

Starting a conversation about weight requires not only empathy but awareness of strategies people can use to manage weight issues and an understanding of the range of local services available to assist. It has been shown that although behavioural and medical strategies can be effective, uninformed discussion in the clinic can disengage, stigmatise or shame patients, which then has negative impacts on the outcomes.

Many patients do expect weight-loss guidance from health professionals and the discussion can influence outcomes. In fact, having the conversation and formally diagnosing and documenting excess weight or obesity is the strongest predictor of having a treatment plan and weight-loss success.

Choice of language is crucial

Research has identified the terms “fat” and “fatness” are the least preferred terms. The words “obese” and “obesity” have also been found to arouse negative responses. The National Institute of Clinical Excellence in the UK suggests patients may be more receptive if the conversation is about achieving or maintaining a “healthy weight”.

The STOP Obesity Alliance in the US suggests using “people first” language such that a person “has” obesity rather than “is” obese, similar to “having” cancer or diabetes.

This is part of a debate about whether obesity should be labelled as a disease rather than a risk factor.

Regardless of how this issue is classified, doctors and patients both require the knowledge to understand effective therapies do exist and obesity treatment is not futile. Losing 5-10% of body weight can have a significant impact on risk factors such as blood pressure and can lower the risks of later health problems such as heart disease or type 2 diabetes.

This sort of weight loss also often improves other factors more immediately beneficial to the patient, such as energy levels, mood and mobility.

 

A communication style that encourages shared decision-making and helps people change their behaviour is key. The objective is not to solve the problem but to help the patient begin to believe change is possible and develop a plan about health goals.

Let’s take the case of a woman who presents with urinary incontinence. The woman may describe the problem of needing to wear sanitary pads because of daily leaking of urine. Factors such as obesity will worsen the problem, but the woman may not be aware of this.

The doctor might say:

I hear you’re concerned about your loss of urine, is that correct? Let’s talk about that; and would it be OK to discuss your weight too, as that may be related?

The practitioner might listen for a willingness to have further discussion and then pose a goal-orientated question:

If, as part of our plan to help your urinary symptoms, you decide to work on getting to a healthier weight, what might be a first step?

Repercussions for our kids

For men and women of reproductive age the conversation is potentially not just about their own health but also about that of their children. Women who have higher pre-conception weight and pregnancy weight gain are at increased risk of developing diabetes and heart disease in later life and are less likely to lose weight after they give birth.

This vicious cycle results in larger babies that are predisposed to short-term risks as newborns, longer-term risks of increased childhood obesity and an increased lifetime risk of obesity, diabetes and heart disease.

Between 1985 and 1995 the rate of excess weight and obesity in childhood increased by 50% and obesity tripled in Australia. Animal studies also suggest obesity in the male parent can increase the chance of their offspring developing obesity or diabetes.

The intergenerational nature of obesity therefore means until we address overweight and obesity in adults who are planning a pregnancy, it may be impossible to lower rates of childhood obesity.

The framing of the issue as a problem for patients’ own health as well as for the health of their children is even more complex. However, unless there is a greater understanding of this risk and more training of doctors in talking to patients about obesity this will be difficult to tackle.

Currently, many health professionals remain uncomfortable and unsure in this area of practice. Ensuring the workforce is skilled will also mean there is the ability to discuss weight when it is not the primary issue a patient presents with, but where an important conversation at a critical life stage may actually have lasting effects on patients’ health and that of their children.


Adrienne Gordon will be online for an Author Q&A between 4 and 5pm AEST on Wednesday, 17 August, 2016. Post any questions you have in the comments below.

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

Heart

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

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

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

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

Or Download report and press release

Australian Heart Maps Report 2016

Australia’s Indigenous Community Hurting in the Heart

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

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

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

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

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

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

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

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

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

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

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

Mapping Out Australia’s Heart Health

MAP

 

View and Engage with Heart Map Here

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

see report in full Australian Heart Maps Report 2016

About the Maps

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

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

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

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

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

About the Data

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

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

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

Acknowledgments

The Heart Foundation would like to acknowledge the following organisations:

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