NACCHO Aboriginal Health : Coniston NT massacre 1928 descendants reunite to push for national truth-telling process , a theme of the #UluruStatement from the Heart.

We expect up to 400 people to join us for a chance to share the truth about our colonial past with the families of the victims and the murderers.

We want everyone to know that these massacres didn’t happen during some distant past but 10 years after the end of the First World War.

We remember those who lost their lives in that war every year, in every town around Australia. We have a special public holiday for it and lots of memorials everywhere.

What about our fallen loved ones?

Truth telling, along with agreement making and an Aboriginal voice to parliament, is a theme of the Uluru Statement from the Heart.

Central Land Council chair Francis Kelly.

Download the 12 Page PDF 

Coniston-Brochure-2018

Families affected by the Coniston Massacre from around Australia have gathered at a meeting of the Central Land Council outside Yuendumu, getting ready to remember the innocent men, women and children killed during a series of massacres in 1928.

Today they will travel to the remote outstation of Yurrkuru (Brooks Soak), approximately three hours north west of Alice Springs, to commemorate with songs, dances, speeches and prayers the 90th anniversary of the killings.

Yurrkuru is the site of the murder of the dingo trapper Fred Brooks which triggered the revenge parties led by Police Constable George Murray between August and October 1928 that have become known as the Coniston Massacre.

The families of an estimated 100 murder victims are planning to speak at the event, alongside members of Constable Murray’s family and political leaders such as Senator Patrick Dodson and NT Chief Minister Michael Gunner.

Their families unveiled a plaque at Yurrkuru in 2003 and plan to call for annual events commemorating the massacres and for interpretive signs at the many massacre locations.

They also want all school children to be taught about the frontier wars.

Mr Kelly, one of the creators of the documentary Coniston which will be shown at the CLC meeting tonight, said he is particularly pleased to welcome students from surrounding Aboriginal communities to the commemoration.

“Until all Australians know about the crimes committed against our families we can’t move forward as one mob, one country,” he said.

“Other countries with murderous pasts have managed to come together by speaking the truth. If they can do it, why can’t we?”

The Aboriginal man on the 2 dollar coin.His name was Gwoya Jungarai and he was one of the only survivors of one of the last recognised massacres of Aboriginal people, the 1928 Coniston Massacre in Central Australia.

Almost every Australian has seen his face, held his likeness in their hands but how many know his story?

Today Friday the 24th of August 2018 will mark the 90th anniversary of that atrocity. We will remember him as well as those others who did not survive.Lest we forget the Frontier Wars.

Minister for Indigenous Affairs Nigel Scullion Press Release

The anniversary was a solemn commemoration from or the families and descendants of the victims as well as for the entire Central Australian community.

Today community members from Central Australia gathered at Yurrkuru to commemorate 90 years since the Coniston massacre.

The Coniston massacre was a series of killings between August and October 1928, with large numbers of Aboriginal people from the Warlpiri, Anmatyerre and Kaytetye nations killed.

Minister for Indigenous Affairs Nigel Scullion said that the anniversary was a solemn commemoration for the families and descendants of the victims as well as for the entire Central Australian community.

“It is important that we remember the Aboriginal men, women and children who were killed during this dark chapter of Australian history and acknowledge the impact on families and communities that these crimes have on First Nations peoples,” said Minister Scullion.

“Today we also reflect on the resilience of the local Traditional Owners in more recent history. In 2014 I was honoured to join Traditional Owners and deliver a deed of grant to the Yurrkuru Aboriginal Land Trust – handing back land which was central to the Coniston massacre.

The Central Land Council hosted an event to commemorate the massacre at Yurrkuru (Brooks Soak), approximately 60 kilometres from Yuendumu.  The event brought together Aboriginal families from across Central Australia, as well as descendants of those responsible.

“I commend the Central Land Council for this work to ensure that the Coniston massacre is never forgotten.”

NACCHO Aboriginal Health #selfdetermination #International day of the #WorldsIndigenousPeople 9 August : #WeAreIndigenous and we Walk for Makarrata –  One Message, One Goal, Many Voices #ulurustatement

On this annual observance, let us commit to fully realizing the United Nations Declaration on the Rights of Indigenous Peoples, including the rights to self-determination and to traditional lands, territories and resources.”

UN Secretary-General António Guterres See Part 2 below 

Our desire for Makarrata is about self-determination, genuine partnership and moving beyond survival.  It’s about putting our future into our own hands,

Makarrata was needed because the Apology and successive reforms from both sides of politics have not on their own delivered healing and unity for the nation, or enough progress for Aboriginal people.” 

NSWALC Chairman, Cr Roy Ah-See Part 1 Below 

What is the UN Declaration on the Rights of Indigenous Peoples?

A declaration is a statement adopted by governments from around the world. Declarations are not legally binding, but they outline goals for countries to work towards.

The United Nations Declaration on the Rights of Indigenous Peoples (the Declaration) represents 20 years of negotiation between Indigenous peoples, governments and human rights experts, and argues that Indigenous peoples all around the world are entitled to all human rights, including collective rights.

The rights within the Declaration, which was formally adopted by Australia in 2009, set standards for the survival, dignity and well-being of Indigenous peoples.

Why have a Declaration for Indigenous peoples?

The Declaration is necessary to combat the policies of assimilation and integration employed by colonisers throughout the world that have uprooted, marginalised and dispossessed First Nation peoples. This common history of dispossession created many circumstances that remain unique to Indigenous cultures. These groups bear similar marks of colonisation, while continuing to practice their incredibly diverse cultures and traditions.

The rights of all people are protected through international law mechanisms. However, what these fail to provide to Indigenous peoples are the “specific protection of the distinctive cultural and group identity of indigenous peoples as well as the spatial and political dimension of that identity, their ways of life.”[1] Prior to the Declaration there was a lack of a legal guarantee of Indigenous communities to their collective rights, such as ownership of traditional lands, the return of sacred remains, artefacts and sites, and the guarantee of governments to honour treaty obligations.

What does the Declaration mean for Australia?

The Declaration sets out rights both for individuals and collective groups. This reflects the tendency of Indigenous groups around the world, to organise societies as a group (a clan, nation, family or community). An example of these group rights is the acknowledgment that Aboriginal and Torres Strait Islander communities have the right to own country, hold cultural knowledge as a group and the right to define their groups.

Some other rights secured in the document include, the right to equality, freedom from discrimination, self-determination and self-government. Many of these rights are already secured through Commonwealth and State legislation. However, the Declaration is Australia’s promise that mechanisms will be put in place to ensure that Aboriginal and Torres Strait Islander peoples will be able to benefit from these rights.

The significant disadvantages currently faced by Aboriginal and Torres Strait Islander people in Australia only serve to highlight the ongoing relevance and importance of the Declaration.

What is self-determination and why is it important?

Self-determination is a key part of the Declaration, and is a right unique to Indigenous communities around the world. Self-determination can only be achieved through the consultation and participation of Aboriginal and Torres Strait Islander communities in the formation of all policies and legislation that impacts upon them. Self-determination is characterised by three key elements that require Aboriginal and Torres Strait Islander peoples to have:
 Choice to determine how their lives are governed and the paths to development
 Participation in decisions that affect the lives of First Nation peoples.
 Control over their lives and futures, including economic, social and cultural development.

A campaign for Makarrata launches in Sydney today Thursday August 9, when Aboriginal people and their supporters will walk from Hyde Park to the NSW Parliament.

Led by the NSW Aboriginal Land Council (NSWALC) and Coalition of Aboriginal Peak Organisations (CAPO), the walk will call on Parliamentarians to join a movement for a better future for Aboriginal people, and all Australians.

NSWALC Chairman, Cr Roy Ah-See said that the walk will promote a positive alternative agenda for Aboriginal affairs in the state. .

Makarrata is gift from the Yolngu language. It means coming together after a struggle. It has been used nationally since the National Aboriginal Conference in the late 1970’s and featured prominently in the historic Uluru Statement from the Heart.

 

“What we have seen to date are disconnected stepping stones towards a vague future focused on survival. What we need is a clear pathway for Aboriginal people to thrive, and for all Australians to walk with us on this journey.

“Our successes have been many, but we still face significant challenges.  We want to see increased prosperity for Aboriginal families across the state, with more of our people going to university and getting better jobs.

“We want to see our children flourishing; walking proudly and successfully in two worlds. Taking part in the economy and enriching the country with their culture.

“By walking with us we are asking all political parties to commit to genuine partnership, to face our challenges together, and grow and support our successes.

“NSW is where the struggle started, and it is right that the largest state, with the largest population of Aboriginal people in the country takes genuine steps towards Makarrata,

“We are looking for all Australians to join us on our journey towards Makarrata,” Cr Ah-See said.

Walk with us, join us at www.makarrata.org.au

 

Part 2

There are an estimated 370 million indigenous people in the world, living across 90 countries. They make up less than 5 per cent of the world’s population, but account for 15 per cent of the poorest. They speak an overwhelming majority of the world’s estimated 7,000 languages and represent 5,000 different cultures.

Indigenous peoples are inheritors and practitioners of unique cultures and ways of relating to people and the environment. They have retained social, cultural, economic and political characteristics that are distinct from those of the dominant societies in which they live. Despite their cultural differences, indigenous peoples from around the world share common problems related to the protection of their rights as distinct peoples.

Indigenous peoples have sought recognition of their identities, way of life and their right to traditional lands, territories and natural resources for years, yet throughout history their rights have always been violated. Indigenous peoples today, are arguably among the most disadvantaged and vulnerable groups of people in the world. The international community now recognizes that special measures are required to protect their rights and maintain their distinct cultures and way of life.

2018 Theme: Indigenous peoples’ migration and movement

As a result of loss of their lands, territories and resources due to development and other pressures, many indigenous peoples migrate to urban areas in search of better prospects of life, education and employment.

They also migrate between countries to escape conflict, persecution and climate change impacts. Despite the widespread assumption that indigenous peoples live overwhelmingly in rural territories, urban areas are now home to a significant proportion of indigenous populations. In Latin America, around 40 per cent of all indigenous peoples live in urban areas — even 80 per cent in some countries of the region. In most cases, indigenous peoples who migrate find better employment opportunities and improve their economic situation but alienate themselves from their traditional lands and customs. Additionally, indigenous migrants face a myriad of challenges, including lack of access to public services and additional layers of discrimination.

The 2018 theme will focus on the current situation of indigenous territories, the root causes of migration, trans-border movement and displacement, with a specific focus on indigenous peoples living in urban areas and across international borders. The observance will explore the challenges and ways forward to revitalize indigenous peoples’ identities and encourage the protection of their rights in or outside their traditional territories.

The observance of the International Day will take place on Thursday 9 August 2018 from 3:00 pm to 6:00 pm in the ECOSOC Chamber at the United Nations Headquarters in New York. The programme can be found in Events. More information in the Department of Economic and Social Affairs (DESA) page.

International Year of Indigenous Languages

View above interactive map HERE

Languages play a crucially important role in the daily lives of all peoples, are pivotal in the areas of human rights protection, peace building and sustainable development, through ensuring cultural diversity and intercultural dialogue. However, despite their immense value, languages around the world continue to disappear at an alarming rate due to a variety of factors. Many of them are indigenous languages.

Indigenous languages in particular are a significant factor in a wide range of other indigenous issues, notably education, scientific and technological development, biosphere and the environment, freedom of expression, employment and social inclusion.

In response to these threats, the United Nations General Assembly (UNGA) adopted a Resolution (A/RES/71/178) on ‘Rights of Indigenous Peoples’, proclaiming 2019 as the International Year of Indigenous Languages.

On Twitter, follow #WeAreIndigenous#IndigenousDay#IndigenousPeoplesDay, and #UNDRIP

NACCHO Aboriginal Health #COAG meeting Alice Springs : Time for COAG Health Council to address the Indigenous funding myth & ‘market failure’ says Ian Ring

 ” COAG Health Ministers will discuss Aboriginal and Torres Strait Island health at their meeting in Alice Springs this week.

There is much to discuss. Ten years on from the start of Closing the Gap, progress is mixed, limited and disappointing, and the life expectancy gap is widening.

This is hardly surprising.

The National Partnership Agreements on Indigenous health, which spelt out the roles, responsibilities and funding of the Commonwealth and state and territory jurisdictions, have not yet been replaced by bilateral agreements.

Formal regional structures and agreements to bring together Aboriginal community controlled health and mainstream services have yet to be formalised nationally. On the broader front, culture, racism and social, political and economic issues cry out for attention.

The way forward is within the reach of the COAG Health Council.

If there is to be a point in retaining the goal to close the life expectancy gap, the hope is that COAG will now grasp that opportunity.”

Ian Ring AO Honorary Professorial Fellow Research and Innovation Division
University of Wollongong

Originally published in Croakey 

Much remains to be done in housing, the justice system is a debacle, and the question of an Aboriginal voice, one of the main priorities of the Uluru Statement from the Heart, remains unresolved.

Critically, the National Aboriginal and Torres Strait islander Health Implementation Plan, which was supposed to be the game changer for health, has become an unfunded plan of words not action and, after almost three years, basic core tasks such as defining service models and filling service gaps remain unfulfilled.

Misleading money myths

While money isn’t the only factor, money myths are playing an important role in the failure to close the gap.

A recent Productivity Commission report found that per capita government spending on Aboriginal and Torres Strait Islander people was twice as high as for the rest of the population.

The view that enormous amounts of money have been spent on Indigenous Affairs has led many to conclude a different focus is required and that money is not the answer.

But higher spending on Aboriginal and Torres Strait Islander people should hardly be a surprise.

We are not surprised, for example, to find that per capita health spending on the elderly is higher than on the healthier young because the elderly have higher levels of illness.

Nor is it a surprise that welfare spending is higher for Indigenous people who lag considerably in education, employment and income. There would be something very wrong with the system if it were otherwise.

The key question in understanding the relativities of expenditure on Aboriginal and Torres Strait Islander people is equity of total expenditure, both public and private, in relation to need, but the Productivity Commission’s brief is simply to report on public expenditure, and that can be misleading.

Massive market failure

For health services, while state and territory governments spend on average $2 per capita on Indigenous people for every $1 spent on the rest of the population, the Commonwealth spends $1.20 for every $1 spent on the rest of the population, notwithstanding that the burden of disease and illness for Indigenous Australians is 2.3 times the rate of the rest of the population. And total government expenditure on Aboriginal and Torres Strait Islander health is only about 60 per cent of the needs based requirements.

This is massive market failure.

The health system serves the needs of the bulk of the population very well but the health system has failed to meet the needs of the Indigenous population.

Mortality for the Indigenous population has flatlined since 2008 and the inevitable result is that the life expectancy gap is widening rather than closing.

This is not surprising since the Federal Government’s own reports clearly show that preventable admissions for Indigenous people, funded by the states and territories, are three times as high as for the rest of the population (see graphs below, and sources at the bottom of the post) yet use of the Medical Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS), funded by the Commonwealth, appears at best to be a half and a third respectively of the needs based requirements for Indigenous people.

It is simply impossible for the mortality gaps to close under these conditions.

It is not that the Commonwealth is deliberately underfunding health services for Aboriginal and Torres Strait Islander people. However there are decades of experience establishing beyond all doubt that demand driven services designed to meet the needs of the bulk of the population will not adequately meet the needs of a very small minority of the population with very special needs.

In recognition of that, for over 40 years, the Commonwealth has been funding Aboriginal Community Controlled Health Services (ACCHS), which evidence shows better meet those needs, but the coverage of those services is patchy and needs to be expanded.

It has been shown that the nonviolent death rate for at risk Aboriginal people can be halved in just over three years by systematic application of knowledge we already have. It really is within the grasp of the current government to turn things around and now is the time to do it.

Priorities to address

A key requirement is to address the shortfall in Commonwealth funding for out of hospital services, which is contributing to excessive preventable admissions funded by the states and territories, and to avoidable deaths.

A vital priority is seed funding for the provision of satellite and outreach ACCHSs that Indigenous people will access, and which provide the comprehensive services needed to fill the service gaps, to boost the use of MBS and PBS services to more equitable levels, and to reduce preventable admissions and deaths.

Additional funding is also required for mental health and social and emotional wellbeing services which are neglected in the Closing the Gap initiative.

And much more attention needs to be paid to the quality of services, with much needed investment in the training of clinicians, managers and public servants for the difficult and complex roles they have to play.

The ‘Refresh’: resource-free targets

The danger is that action will be put on hold in the belief that somehow the Closing the Gap ‘Refresh’ is going to solve everything!

The fear is that we have entered the world of magical targets – the kind where you just say what you would like to happen and that’s it, it just magically comes to pass without actually specifying, let alone actually doing all the things that are required to achieve the targets. It’s a bit like painting pictures in the sky: let’s put an end to war and famine without any thought or action about what would need to be done for those desirable things to come to pass.

With the Refresh target setting process, there seems to be a lot of emphasis on data issues while more or less completely overlooking consideration of the investment or services required to achieve the targets.

In an orthodox sensible planning process, target setting is an important element. Targets need to be directly related to overarching goals, and need to relate directly to the services, actions and investments that will be made to achieve the targets.

Timeframes setting out what is to be achieved in say 1 year, 5 years, 10 years etc are crucial, and both process and outcome targets need to be set. In the absence of this kind of process a belief that the Refresh will somehow turn things around may well be illusory.

It is extraordinary that the only response to the finding on the life expectancy target – that it not only won’t be met but is going backwards – is an apparent intent to freeze Commonwealth funding for Indigenous health services!

There is little point in having mortality goals which are clearly in jeopardy – and when the causes are not hard to define and the remedies clear – if there is insufficient action taken to actually achieve them.

The funds required for satellite and outreach ACCHS services to fill the service gaps, together with the other priorities described above, spread over a carefully prepared five year plan, are likely to be modest and would make a real and substantial improvement to the health of Indigenous people.

There is no call for some kind of special deal, but simply the same level of expenditure from both Commonwealth and state and territory governments for Australia’s Indigenous peoples that anyone else in the population with equivalent need would receive.

The way forward is within the reach of the COAG Health Council.

If there is to be a point in retaining the goal to close the life expectancy gap, the hope is that COAG will now grasp that opportunity.

Sources:

 

NACCHO Aboriginal Health, #UluruStatement and Referendum : Download : Joint Select Committee on Constitutional Recognition release interim report, putting calls for a Voice for First Nations people back on the national agenda

 ” The Labor-initiated Joint Select Committee on Constitutional Recognition has today released its interim report, putting calls for a Voice for First Nations people back on the national agenda.

 More than a year after the Uluru Statement from the Heart and the Final Report of the Referendum Council, the overwhelming evidence to this Committee is that First Nation’s people want a Voice, and a more meaningful say in the issues that impact their lives.

Nine months ago the Prime Minister rejected the Uluru Statement and the proposal for a Voice to Parliament through the Referendum Council, labelling it ‘undesirable’ and ‘unwinnable’ – characterising the Voice as a ‘third chamber of Parliament’.

Despite this, Labor fought to establish the Committee to keep the issue of constitutional recognition on the agenda of the Parliament. Labor has worked hard through the committee to get cross party support for an Indigenous Voice to Parliament. Labor is pleased the interim report puts all options back on the table, including constitutional change and the establishment of regional Voices “

Senator Dodson’s Labor Party Press Release in Full Part 2

Download Joint Select Committee on Constitutional Recognition HERE

 Interimreport

The Joint Select Committee on Constitutional Recognition relating to Aboriginal and Torres Strait Islander Peoples has presented its interim report to the Parliament.

The report centres on the proposal for a First Nations Voice, which arose from the Uluru Statement from the Heart.

The report considers evidence in relation to the constitutionality, structure, function, and establishment of The Voice, and examines past and existing advisory bodies and new proposals that might inform the design of The Voice.

The report also considers other proposals for constitutional change and proposals for truth-telling and agreement making.

The Committee acknowledges the high level of interest in its inquiry, and wishes to thank the many individuals and organisations who made submissions and met with the Committee. The Committee will continue to consult with Aboriginal and Torres Strait Islander peoples and the broader community.

The Committee is seeking additional submissions examining the principles and models outlined in the report, and addressing the questions posed in the final chapter. Additional submissions should be received by 17 September 2018.

The Committee acknowledges the frustration caused by the length of time taken to advance constitutional recognition of Aboriginal and Torres Strait Islander peoples. The Committee is hopeful that, through this inquiry, it can play a constructive role in developing proposals for the recognition of Aboriginal and Torres Strait Islander peoples.

The Committee is due to present its final report to the Parliament on 29 November 2018.

The interim report is also  on the Committee’s website at: www.aph.gov.au/jsccr.

Part 2 Senator Dodsons Press Releases

The Labor-initiated Joint Select Committee on Constitutional Recognition has today released its interim report, putting calls for a Voice for First Nations people back on the national agenda.

More than a year after the Uluru Statement from the Heart and the Final Report of the Referendum Council, the overwhelming evidence to this Committee is that First Nation’s people want a Voice, and a more meaningful say in the issues that impact their lives.

Nine months ago the Prime Minister rejected the Uluru Statement and the proposal for a Voice to Parliament through the Referendum Council, labelling it ‘undesirable’ and ‘unwinnable’ – characterising the Voice as a ‘third chamber of Parliament’. Despite this, Labor fought to establish the Committee to keep the issue of constitutional recognition on the agenda of the Parliament. Labor has worked hard through the committee to get cross party support for an Indigenous Voice to Parliament. Labor is pleased the interim report puts all options back on the table, including constitutional change and the establishment of regional Voices.

The Committee is an opportunity for the Parliament to work together to give First Nations people a Voice to Parliament and push forward a Makarrata commission to oversee truth-telling and agreement-making.

Labor remains committed to working with First Nations people, the broader community and the Parliament on this task. Labor has always supported the Uluru Statement and remains committed to working with First Nations people to ensure their voices are heard – including through a voice to Parliament. It is time for the Prime Minister to reverse his position and back these calls.

Over the next few months the committee will be undertaking further consultations, traveling to other parts of Australia to speak with both First Nations and the broader community before delivering a final report in November.

In the absence of cross party support necessary to achieve constitutional change Labor has promised in government to legislate for a voice to honour the aspirations held in the Uluru statement, whilst not losing sight of the need for constitutional guarantee.

We will work to build support for a referendum. For the honour of our Nation, for the respect of all Australians, for the sake of equality and fair treatment – constitutional recognition of First Nations people must happen.

It will happen

NACCHO Aboriginal Health : @theMJA Publishes special @naidocweek #IndigenousHealth #CloseTheGap #Ulurustatement #FirstNations open access edition

 ” While Closing the Gap has become an iconic representation of Indigenous advocacy, it remains essential to maintain focus on the individual components of disease processes, epidemiology, intervention delivery, and cultural mechanisms that influence the achievement of significant change.

The MJA will ensure it strengthens its role in delivering the relevant data to clinicians, policy developers, and the Australian community.

Indigenous health: One gap is closed See Part 1 Below

“DESPITE a slight narrowing over the past decade, the life expectancy gap between Aboriginal and Torres Strait Islander Australians and the general population remains significant.

On average, the lives of Aboriginal and Torres Strait Islander people are around a decade shorter than those of non-Aboriginal Australians – a shocking statistic for a high income country.

This gap has been attributed to many factors, most of which relate to high levels of socio-economic disadvantage.

Now, new research points to multimorbidity as a significant driver of higher mortality rates in Aboriginal and Torres Strait Islander populations.”

See Part 2 Below Multimorbidity as a significant driver of higher mortality rates

  ” Aboriginal people are under stress and we need to take some of that away by recognising their existence and their self-determination. The Uluru Statement is a good place to start.”

He says that he’s no hand wringer and he’s optimistic that the cultural change can happen.

The government won’t take constitutional recognition to a referendum yet because it doesn’t think the public has come around to it. But I think the public is ahead of the government here, just as it was for same-sex marriage. There’s an enormous willingness in the public to embrace First Nations people. I think there’s a huge capacity for change.”

The Uluru Statement is a good place to start SEE Part 3 Below

Read full edition Here

Part 1 Indigenous health: one gap is closed

The 2017 MJA Indigenous health issue explored the social determinants of health that are essential to closing the gap between health outcomes for Indigenous and non-Indigenous Australians, specifically targeting cultural awareness and communication.1

The issue also placed recent gains in the life expectancy of Indigenous Australians in perspective,2 and recognised achievements by an often silent yet dedicated clinical community.

The Journal has continued to develop these themes. In this year’s Indigenous health issue, four research papers and the accompanying editorials underline the progress we are making as a journal and as a medical community in bringing about meaningful change.

In this respect, the report by Hendry and colleagues,3 documenting the effective closure of the gap in vaccination rates, is particularly heartening. Vaccination is recognised by the World Health Organization as one of the most cost-effective interventions in public health.4 Hendry and her co-authors describe a program in which Aboriginal Immunisation Healthcare Workers identify and follow up Indigenous children due or overdue for vaccinations, a program that has achieved equality of full vaccination coverage for Indigenous and non-Indigenous children in New South Wales at 9, 15 and 51 months of age.

This remarkable outcome is especially significant given the high background susceptibility of Indigenous children to vaccine-preventable diseases. While it is not clear whether the improvement in vaccination rates is attributable to the dedicated program structure or to the deployment of culturally aware health workers, it is certain that partnerships between modern clinical methods and traditional cultural awareness will continue to be the model of choice for improving Indigenous health.

Also noteworthy is the authors’ combination of high quality research with statistically sound methodology in a culturally appropriate setting, a mix essential to the Journal, as detailed in the 2017 Indigenous health issue.1,5 Banks and colleagues6 applied similarly robust and culturally appropriate methodology to draw attention to the substantial undertreatment with lipid-lowering therapies of Aboriginal and Torres Strait Islander people at high risk of cardiovascular disease.

They found that 4.7% of Indigenous people aged 25–34 years are at high primary risk, but this age group is not assessed for cardiovascular disease risk under current national guidelines. The accompanying editorial7 summarises a suite of targeted interventions that build on these and other findings published in the Journal.8 While these approaches are no doubt important, adapting the successful approach of Hendry and colleagues’ to vaccination,3 to provide a similarly structured intervention for lipid-lowering therapy, could be a game-changing strategy for closing the gap in cardiovascular disease.

The MJA recognises the power of big data and data linkage studies. Randall and colleagues9 analysed linked hospital and mortality data to explore in depth multimorbidity in Indigenous patients in NSW.

The necessary policy and clinical responses are placed in perspective by Broe and Radford10 in their editorial. They note the especially higher level of comorbidities among Aboriginals in mid-life age groups than in non-Aboriginals of the same age, and that this difference is correlated with the age-group peak in the mortality gap between Indigenous and non-Indigenous Australians, highlighted in this Journal last year.2 While the wealth of information made available by big data-based research can sometimes be overwhelming, the MJA prioritises analyses that can change practice..

Finally, Gunasekera and colleagues11 report the high degree of agreement between diagnoses by audiologists and otolaryngologists of otitis media in Aboriginal children, suggesting that audiologists could triage cases in areas where specialist services are limited.

The false negative rate was low — in 3.0% of children, audiologists did not diagnose otitis media subsequently detected on image review by an experienced otolaryngologist — and the most serious form, tympanic membrane perforation, was never missed. These findings may open pathways for children in high risk settings — where otitis media is common (prevalence of 29% in this study) but otolaryngologists are few — to more efficiently receive specialist care.

The articles in this issue show that progress in medical and research methodology can be meaningfully combined with cultural sensitivity. The Journal welcomes submissions that further develop these approaches. More broadly, the MJA will continue to highlight emerging issues of significance to Indigenous health, and is leading a global collaboration with major overseas medical journals to publish a joint issue on the health of indigenous peoples around the world in 2019.

While Closing the Gap has become an iconic representation of Indigenous advocacy, it remains essential to maintain focus on the individual components of disease processes, epidemiology, intervention delivery, and cultural mechanisms that influence the achievement of significant change. The MJA will ensure it strengthens its role in delivering the relevant data to clinicians, policy developers, and the Australian community.

Part 2

Published in the MJA, the study linked hospital and mortality data for around five and half million New South Wales residents, from 2003 to 2013.

The authors from the University of New South Wales, led by Dr Deborah Randall, found a much higher prevalence of multimorbidity (defined as two or more medical conditions) among people with an Aboriginal and Torres Strait Islander background than among the non-Indigenous population.

After adjusting for age, sex and socio-economic status, the rate of multimorbidity in Aboriginal and Torres Strait Islander people was more than 2.5 times that of the non-Aboriginal population.

The relatively higher rates were found across all age groups, and peaked at around the age of 40 years. In younger Aboriginal and Torres Strait Islander people, this was largely driven by mental health issues, while in those aged over 60 years, it was mostly due to physical conditions.

A secondary endpoint for the study was one-year all-cause mortality after 2013. The rate for this was also around 2.5 times greater for Aboriginal and Torres Strait Islander people, and was significantly associated with multimorbidity.

According to Professor Tony Broe, Conjoint Professor of Geriatric Medicine at the University of NSW and co-author of an editorial on the study, the research has two major implications, one for Aboriginal and Torres Strait Islander people and the other for chronic disease control in general.

“First, there’s the much higher rate of multimorbidity in Aboriginal people, which is no mystery, but what the study authors have done is to show the data and put a figure on the issue. That’s important.”

Professor Broe, whose recent research work has focused on Aboriginal health and ageing, says that the second lesson from the study is that Australia is not managing multimorbidity and chronic disease very well, whether it’s in Aboriginal and Torres Strait Islander people or across the general population.

“The current approach to chronic disease is that we treat by specific disease and specialty. So, the respiratory physician will deal with lung disease and the cardiologist will deal with heart disease et cetera. That’s the wrong approach. What those of us involved in Aboriginal health have done is to say, well, these diseases all have the same risk factors. So, we decided to look at hypertension, smoking, mental health disorders and other risk factors as a group of things to tackle.”

Professor Broe says that in order to reduce multimorbidity prevalence, there needs to be a switch of focus away from episodic medical care towards preventive medicine.

“You come in with pneumonia and they give you a treatment, but what we want to do is to prevent you coming in with pneumonia in the first place. We need more focus on preventive medicine and we should be getting the GPs to do it, not the specialists. The specialists can help out with chronic disease programs, but it should be GPs who are running them.”

But Professor Broe says that the preventive approach won’t be enough on its own to improve the health and mortality rates of Aboriginal and Torres Strait Islander people. A large part of the solution is non-medical, he says, and requires a major cultural change.

“A lot of the comorbidities of younger Aboriginal people relate to mental health issues, driven by stress and trauma. In fact, a study we’ve just published shows that even the high rates of late-life dementia in Aboriginal people are associated with childhood stress and adversity. Aboriginal people are under stress and we need to take some of that away by recognising their existence and their self-determination.

Perspectives

PODCASTS

James S Ward, Karen Hawke and Rebecca J Guy

Med J Aust 2018; 209 (1): 56 Free

John A Stevens, Garry Egger and Bob Morgan

Med J Aust 2018; 209 (1): 68 Free

Multimorbidity in Aboriginal and non-Aboriginal people

GA (Tony) Broe and Kylie Radford

Med J Aust 2018; 209 (1): 16-17 Free

Part 3 THE Medical Journal of Australia and MJA InSight endorse the Uluru Statement from the Heart.

The Statement, a consensus from the First Nations National Constitutional Convention held in May 2017, calls for “establishment of a First Nations Voice enshrined in the Constitution” and seeks “a Makarrata Commission to supervise a process of agreement-making between governments and First Nations and truth-telling about our history”.

It affirms the connection of Aboriginal and Torres Strait Islander peoples with the land, and highlights the social difficulties and ongoing suffering faced by Aboriginal and Torres Strait Islander peoples. The MJA accepts the invitation of the Aboriginal and Torres Strait Islander peoples to join with them “in a movement of the Australian people for a better future”.

The MJA has been at the forefront of striving for health equity and equality for all Australians, including our First Nations peoples. We know the legacy of the MJA over 104 years is but a tiny fraction of the history of our nation, although our contribution in this short time has helped to spotlight our First Nations peoples’ health, including, all too often, the astounding and continuing inequities.

We recognise there is an ongoing health crisis that is clearly felt in the hearts of the First Nations peoples.

The 2018 Indigenous issue of the Journal, like those before it, continues to expand knowledge of Indigenous health determinants and issues and, even more crucially, begins presenting practical solutions to improve First Nations peoples’ health by harnessing modern medical understanding integrated with uncompromising cultural awareness. The task is far from complete. The Journal commits not only to support the Uluru Statement but to continue to prioritise publications that will integrate the statement into a health care and societal movement.

Health is integral to the spirit of all cultures; it is underpinned by social determinants obligating recognition, understanding and complete cultural awareness as identified in the Uluru Statement. If health equity and equality are to be achieved for all Australians, and if Australians all agree this is a fundamental human right and that it is un-Australian to think otherwise, then we must join hands and move forward to create a better future for us all.

Laureate Professor Nick Talley, AC, is editor-in-chief of the Medical Journal of Australia.