NACCHO Aboriginal Health and @sistaquit Smoking : Smoking rates among pregnant Indigenous women tackled in major research project

 ” In 2014 it was reported 45 per cent of surveyed Indigenous mothers smoked during pregnancy, compared to 13 per cent of non-Indigenous pregnant women.

Those figures have spurred University of Newcastle associate professor Gillian Gould to study what can be done to help reduce rates of Indigenous women smoking while pregnant.

It’s not only that they may be born with low birth rate, or have risks of premature birth, but it can set them up for things like obesity, diabetes, a higher risk of heart disease, and lots of respiratory illnesses.”

Smoking rates among pregnant Indigenous women tackled in major research project 

See full ABC report here or Part 2 below

Part 1 Project update 26 September

Currently we have received EOIs from about 20 ACCHS in 5 states that we are targeting for the SISTAQUIT study. These states are NSW, QLD, SA, WA and NT.

These sites will now undergo a two-way discussion for mutual interest, and to find out what protocols we need to go through to get their communities signed up.

We are aiming for 30 services to be signed up to SISTAQUIT by end of the year.

We will have a trade table at the NACCHO AGM, so interested CEOs and managers of ACCHS can get more information,  meet with Joley Manton face-to-face, and sign up their interest or consent.

Our pilot study “ICAN QUIT in Pregnancy” has been successful wrapped up, and we are applying our learnings to go forward to this larger SISTAQUIT trial.

We would like to thank pilot ACCHS services in NSW, SA and QLD for their tremendous support in making this happen.

What does the SISTAQUIT™ in Pregnancy study aim to do?

Our study aims to improve the provision of timely, evidence-based smoking cessation support to pregnant women attending Aboriginal Medical Services (AMS), by training health providers such as GPs, Aboriginal Health Workers and midwives in culturally appropriate smoking cessation care.

The SISTAQUIT intervention (culturally appropriate smoking cessation training for health providers) has been developed over a decade. We most recently explored the feasibility and acceptability of the SISTAQUIT intervention through the ICAN QUIT in Pregnancy pilot study with six Aboriginal Community Controlled Health services.

We aim to increase the proportion of health providers offering assistance in quitting to pregnant smokers and to improve the quit rates of pregnant smokers, measured by carbon monoxide testing during pregnancy and after birth. We also aim to improve birth weights and respiratory outcomes of the babies in the first six months of life.

We are currently seeking EOIs from AMS interested in participating in the trial. Funding is available to cover AMS trial participation costs, and pregnant mothers will be offered a voucher for their time for each study visit.

Contact Details

School of Medicine and Public Health, University of Newcastle:

Assoc. Prof. Gillian Gould: gillian.gould@newcastle.edu.au

Ms Joley Manton: sistaquit@newcastle.edu.au;  Phone: (02) 4033 5720

Website: www.newcastle.edu.au/SISTAQUIT

Part 2

 

SISTAQUIT project aiming to help 450 Indigenous women quit smoking.

 “We want to show that SISTAQUIT works, and that women are able to quit with our approach.

We wanted to be able to reach out eventually to any service in Australia through the internet, so we decided to do that through interactive webinars.

We know now that quite a few chronic diseases are set up by babies being exposed to smoking when they’re in the womb,”

Associate Professor Gould said

It is hoped a large-scale research project will help provide clearer solutions for tackling smoking rates among pregnant Indigenous women across the country.

In 2014 it was reported 45 per cent of surveyed Indigenous mothers smoked during pregnancy, compared to 13 per cent of non-Indigenous pregnant women.

Those figures have spurred University of Newcastle associate professor Gillian Gould to study what can be done to help reduce rates of Indigenous women smoking while pregnant.

It’s not only that they may be born with low birth rate, or have risks of premature birth, but it can set them up for things like obesity, diabetes, a higher risk of heart disease, and lots of respiratory illnesses.

“From that point of view, it is important.

“We know that one of the problems is that women are not given enough help to quit smoking.”

Associate Professor Gould has been working on the multi-phase research project for a number of years.

In the first phase of the study, the research team worked with Indigenous communities in the NSW Hunter Valley to develop a suite of resources to train health providers in supporting women while they quit smoking.

Many of those resources have been digitally focused.

Phase two involved a pilot project using those resources, and was implemented in NSW, South Australia and Queensland.

“We had trained all of the health providers at those services,” Associate Professor Gould said

Project aiming to give health workers effective tools

With the pilot study finished, the research is now expanding into 30 Aboriginal medical centres around the country, with the SISTAQUIT project aiming to help 450 Indigenous women quit smoking.

“We will link up with the services, and we’re conducting three one-hour webinars, which will be live and interactive,” Associate Professor Gould said.

“We [also] have this booklet that women receive, and within that booklet are embedded different videos.

“The women can use an app on their phone, and when they scan the little screenshot of the video that’s in the booklet, they can hear [information] from Aboriginal and Torres Strait Islander health professionals which is going to help them quit smoking.

“We’re mainly aiming it at the health professionals — GPs, midwives, Aboriginal health workers — to give them training, and then they have these resources that are going to, in consultation with women, help them quit.

“By doing it this way and being able to do it in enough women, we will get the answer — ‘is this approach the best approach?’ — and therefore, can the Government then scale-up our approach to make those webinars and resources available across the whole of Australia?”

Cultural sensitivities are observed in the training materials, and Associate Professor Gould said that helped build trust.

“We’re talking to women, giving them accurate, factual messages, but in a way that’s delivered by people they would trust,” she said.

“We’ve developed the whole approach with Aboriginal medical services, and we’ve had Aboriginal investigators on our team guiding us and working very closely with us

“By doing it this way and being able to do it in enough women, we will get the answer — ‘is this approach the best approach?’ — and therefore, can the Government then scale-up our approach to make those webinars and resources available across the whole of Australia?”

Cultural sensitivities are observed in the training materials, and Associate Professor Gould said that helped build trust.

“We’re talking to women, giving them accurate, factual messages, but in a way that’s delivered by people they would trust,” she said.

“We’ve developed the whole approach with Aboriginal medical services, and we’ve had Aboriginal investigators on our team guiding us and working very closely with us

Hopes smoking rates will drop

The study is set to last until 2021, and Associate Professor Gould was optimistic the approach would help reduce rates of smoking.

“This is the real world; it’s a real-world study, so this is what life is like,” she said.

“In our pilot study so far, we’ve had four women quit out of 22, which means we’ve already got a quit rate of almost 25 per cent. The usual quit rate is about 3 per cent. So, we think we’re doing pretty good.

“We’re aiming in the bigger trial to improve the quit rate from the baseline of 3 per cent up to 11 per cent, but already in our pilot we’ve exceeded our aim.

“You never know if this is going to work or not, and that’s why [we’re] doing the study

 

NACCHO Aboriginal Health and #Obesity : Download #TippingtheScales Report Leading health orgs set out 8 urgent actions for Federal Government

“Sixty-three per cent of Australian adults and 27 per cent of our children are overweight or obese.

This is not surprising when you look at our environment – our kids are bombarded with advertising for junk food, high-sugar drinks are cheaper than water, and sugar and saturated fat are hiding in so-called ‘healthy’ foods. Making a healthy choice has never been more difficult.

The annual cost of overweight and obesity in Australia in 2011-12 was estimated to be $8.6 billion in direct and indirect costs such as GP services, hospital care, absenteeism and government subsidies.1 “

 OPC Executive Manager Jane Martin 

Download the report HERE  tipping-the-scales

Read over 30 + NACCHO Obesity articles published last 5 years

Read over 30+ NACCHO Nutrition and Healthy foods published last 5 years

Thirty-four leading community, public health, medical and academic groups have today united for the first time to call for urgent Federal Government action to address Australia’s serious obesity problem.

In the ground-breaking new action plan, Tipping the Scales, the agencies identify eight clear, practical, evidence-based actions the Australian Federal Government must take to reduce the enormous strain excess weight and poor diets are having on the nation’s physical and economic health.

Led by the Obesity Policy Coalition (OPC) and Deakin University’s Global Obesity Centre (GLOBE), Tipping the Scales draws on national and international recommendations to highlight where action is required. Areas include:

  1. Time-based restrictions on TV junk food advertising to kids
  2. Set clear food reformulation targets
  3. Make the Health Star Rating mandatory by July 2019
  4. Develop a national active transport strategy
  5. Fund weight-related public education campaigns
  6. Introduce a 20% health levy on sugary drinks
  7. Establish a national obesity taskforce
  8. Develop and monitor national diet, physical activity and weight guidelines.

OPC Executive Manager Jane Martin said the eight definitive policy actions in Tipping the Scales addressed the elements of Australia’s environment which set individuals and families up for unhealthy lifestyles, rather than just focusing on treating the poor health outcomes associated with obesity.

Watch video HERE : How does junk food marketing influence kids

“Sixty-three per cent of Australian adults and 27 per cent of our children are overweight or obese. This is not surprising when you look at our environment – our kids are bombarded with advertising for junk food, high-sugar drinks are cheaper than water, and sugar and saturated fat are hiding in so-called ‘healthy’ foods. Making a healthy choice has never been more difficult,” Ms Martin said.

“The annual cost of overweight and obesity in Australia in 2011-12 was estimated to be $8.6 billion in direct and indirect costs such as GP services, hospital care, absenteeism and government subsidies.1 But Australia still has no strategy to tackle our obesity problem. It just doesn’t make sense.

“Without action, the costs of obesity and poor diet to society will only continue to spiral upwards. The policies we have set out to tackle obesity therefore aim to not only reduce morbidity and mortality, but also improve wellbeing, bring vital benefits to the economy and set Australians up for a healthier future.”

Professor of Epidemiology and Equity in Public Health at Deakin University, Anna Peeters, said the 34 groups behind the report were refusing to let governments simply sit back and watch as growing numbers of Australians developed life-threatening weight and diet-related health problems.

“For too long we have been sitting and waiting for obesity to somehow fix itself. In the obesogenic environment in which we live, this is not going to happen. In fact, if current trends continue, there will be approximately 1.75 million deaths in people over the age of 20 years caused by diseases linked to overweight and obesity, such as type 2 diabetes, cancer heart disease, between 2011-20501,” Professor Peeters said.

“Obesity poses such an immense threat to Australia’s physical and economic health that it needs its own, standalone prevention strategy if progress is to be made. There are policies which have been proven to work in other parts of the world and have the potential to work here, but they need to be implemented as part of a comprehensive approach by governments. And they need to be implemented now.

“More than thirty leading organisations have agreed on eight priorities needed to tackle obesity in Australia. We would like to work with the Federal Government to tackle this urgent issue and integrate these actions as part of a long-term coordinated approach.”

In addition to the costs to society, the burden of obesity is felt acutely by individuals and their families.

As a Professor of Women’s Health at Monash University and a physician, Professor Helena Teede sees mothers struggle daily with trying to achieve and sustain healthy lifestyles for themselves and their families, while having to deal with the adverse impact of unhealthy weight, especially during pregnancy.

“As a mother’s weight before pregnancy increases, so does the substantive health risk to both the mother and baby. Excess weight gain during pregnancy further adds to these risks and is a key driver of infertility, long-term obesity, heart disease and type 2 diabetes, while for the child, their risk of becoming overweight or obese and developing chronic diseases in later life greatly increases,” Professor Teede said.

“The women I see are generally desperate for help to improve their lifestyle and that of their families. They want to set themselves and their families up for healthy, long lives.

“Currently, there is a lot of blame placed on individuals with unhealthy diets and lifestyles seen as being due to individual and family discipline. Women from all backgrounds and walks of life struggle with little or no support to achieve this. It is vital that we as a community progress beyond placing all responsibility on the individual and work towards creating a policy context and a society that supports healthy choices and tips the scales towards obesity prevention to give Australian families a healthy start to life.”

The calls to action outlined in Tipping the Scales are endorsed by the following organisations: Australian Chronic Disease Prevention Alliance (which includes the Heart Foundation, Cancer Council Australia, Kidney Health Australia, Diabetes Australia and the Stroke Foundation), Australian Health Policy Collaboration (AHPC), Australian Medical Students’ Association (AMSA), Australian & New Zealand Obesity Society (ANZOS), Australasian Society of Lifestyle Medicine, Baker Heart & Diabetes Institute, CHOICE, Consumers Health Forum of Australia, Deakin University’s Global Obesity Centre (GLOBE), Institute For Physical Activity and Nutrition (IPAN), Monash Centre for Health, Research and Implementation (MCHRI), LiveLighter, Menzies School of Health Research, The University of Melbourne’s Melbourne School of Population & Global Health, Melbourne Children’s (which includes The Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute and the University of Melbourne), the National Rural Health Alliance Inc, Nutrition Australia, Obesity Australia, Obesity Policy Coalition, Obesity Surgery Society of Australia & New Zealand, Parents’ Voice, Public Health Association of Australia and Sugar By Half.

Download the Tipping the Scales action plan and snapshot at opc.org.au/tippingthescales


1. Obesity Australia. Obesity: Its impact on Australia and a case for action. No time to Weight 2. Sydney, 2015.

Aboriginal #MentalHealth and #RUOKDay 14 Sept Advanced Speeches : The cause bringing Turnbull and Shorten together

 ” The truth is that mental health is enormously costly, in every respect.

It’s costly for individuals who suffer, its costly to their families but it’s especially costly when people take their own lives.

So we all have a vested interest in each others’ mental health. The most important thing we can do is to look out for each other.

Yes, governments and parliaments and health professionals spend money and trial new approaches and use digital technologies more effectively and we’re doing all these things and we’ll no doubt do much more in the future.

But you know, just four letters ‘R U OK?’ can make a difference. Because they represent another four letters, ‘L O V E’ – love. That’s what it’s about; showing that love and care for the people with whom you are with, whether they are your families, your friends or your workmates. Reach out to them, ask are you okay, show you care.

You could not just change a life, you could save a life.

Prime Minister Malcolm Turnbull addressing the RUOK Breakfast 12 September

Download his speech or read in full Part 2 Below PM Malcolm Turnbull RUOK

Read over 150 Aboriginal Mental Health articles published by NACCHO over 5 years

” We know that suicide is the scourge of rural and regional communities.

It takes a shocking toll on our people in the bush.

We know the suicide rate is twice as high amongst our First Australians, Pat Dodson has written movingly about those nights when his phone rings with the tragic news that another young person in the Kimberley has taken their life.

There is always time to start a conversation.

I think about all the people that I have known – and I am not sure I could have done anything then to change something.

But I wish that I knew then what I know now, and was able to ask these people: ‘Are you ok?’ “

Opposition Leader  Bill Shorten addressing the RUOK Breakfast 12 September

Download his speech or read in full Part 3 Below Bill Shorten RUOK

Part 1 The cause bringing Turnbull and Shorten together

From SBS Report

When Bill Shorten sat down to prepare some remarks for a parliamentary breakfast on suicide, he reflected on how many people he knew who had taken their own life.

He stopped at about seven.

“The thing about these people I thought about is that they remain forever young,” the opposition leader told an ‘R U Ok?’ gathering at Parliament House in Canberra on Tuesday.

Mr Shorten said he questioned what he could have done to help them or whether people didn’t see a sign.

He’s not alone. Seven people commit suicide on average every day in Australia.

“It is a silent crisis at the heart of our nation,” he said.

“These are preventable deaths.”

Mr Shorten reflected on veterans who feel let down by the nation they served and young people who feel like they don’t fit in.

The world of social media had created a form of emotional distance, a world of exotic holidays and glamorous events, he noted.

“The challenge is to look beyond the superficial snapshots of endless good times. To go further than simply clicking ‘like’.”

Mr Shorten believes MPs and senators are actually well placed to understand the message of the suicide prevention charity.

“In this very large building with thousands of people it can be a hard and isolating experience.”

“Suicide knows no boundaries, we are all in this together” Professor Gracelyn Smallwood in Townsville

Prime Minister Malcolm Turnbull said suicide prevention was about people but the high statistics demand everyone do much better.

He believes a reluctance to talk about mental health issues – whether because of stigma or taboo – has been a barrier.

“You can’t deal with a problem that you don’t acknowledge,” he said.

Mr Turnbull noted the work of the late Watson’s Bay resident Don Ritchie who invited anxious people at The Gap nearby in for a chat and a cuppa.

“He would gently lure them back from the brink by doing no more than showing that he cared for them,” he said.

“That is why ‘R U Ok?’ day is so important.”

Mr Shorten was glad the event brought the two leaders together.

“It’s a galling thing when you’re leader of the opposition and the prime minister yells slogans at you,” he said.

“But then occasionally sometimes he gives a speech like that and I think ‘you’re not too bad after all’.”

Both agreed the mutual feeling would be over by question time.

Readers seeking support and information about suicide prevention can contact Lifeline on 13 11 14.

Part 2 Prime Minister Malcolm Turnbull addressing the RUOK Breakfast 13 September

Well good morning. It’s great to be here with Andrew Wallace who is standing in for Julian Leeser, who together with Mike Kelly are Co-Chairs of the Friendship Group.

I acknowledge Greg Hunt, the Minister for Health and Sport, Bill Shorten, Julie Collins the Shadow Minister for Ageing and Mental Health, Murray Bleach, the Chairman Suicide Prevention Australia, Mike Connaghan – Chairman of RUOK? and Mike and I were reflecting on how many decades it is since we first met and worked together in advertising but there it is. You’re looking very youthful. That’s what happens if you don’t go into politics.

And of course Professor Batterham is our guest speaker this morning – and so many other leaders in health and in suicide prevention, and of course all my Parliamentary colleagues here as well.

Now we’re all united here behind Suicide Prevention Day and R U OK? Day. Suicide Prevention Day was on Sunday and R U OK? Day is later this week.

Each year, around one in every five Australians experience mental illness and in 2015, more than 3,000 took their own life.

Now, suicide is about people, it’s about families, not numbers. But the statistics confront us all and call on us to do much better.

I am firmly of the view that our reluctance to talk about mental health issues – whether you call it a stigma or a taboo – has been a very real barrier to addressing this issue. You can’t deal with a problem that you do not acknowledge.

So we have started to talk about suicide and mental health and in an open and honest way, as we have not done in the past.

Now my own electorate of Wentworth includes one of the most beautiful yet tragic places in Australia, The Gap. It is a place where many, many Australians take their lives. A part of The Gap story until he died in 2012 was an extraordinary man called Don Ritchie who was an old sailor and also very tall, I might add.

For the best part of half a century, he lived near The Gap and when he would go for walks and he saw somebody there – anxious, perhaps standing on the wrong side of the fence – he would talk to them.

He would say: “Are you OK? How are you going? Do you want to have a chat? Do you want to come in and have a cup of tea?” He would gently lure them back from the brink by doing no more than showing that he cared for them.

That is why ‘R U OK? Day?’ is so important. Because what it is all about, is showing that we do care. Four letters ‘R U O K’ import so much. They send a message of love, they send a message of care. Critically important and what could be more Australian than looking out for your mates? Or looking out for people you don’t even know? Looking out for somebody who seems anxious, worried, or someone at work that isn’t quite themselves. It is a caring and a loving question. And it raises very prominently this issue of awareness, to the forefront.

At Gap Park for example, as the local Member, I’ve pushed for more funding and support for suicide prevention. Since 2010 there has been implemented a ‘Gap Master Plan’ and I want to acknowledge the support that Julia Gillard provided as Prime Minister to support the local government, the Woollahra Council, towards that funding.

It was a series of measures of signs, telephones, obviously of cameras so that the police can keep an eye on what’s going on there and also a very innovative design in defences that are hard to get over, but easier to get back over, if you know what I mean.

So all of this makes a difference and since 2010 the local police tell me there has been a significant increase in the number of successful interventions at The Gap. But still, far, far too many people die there and in many other places around Australia.

Now, we’re working better to understand the factors that have contributed to rising suicide rates and to support communities to respond to their own unique circumstances.

We’re committed to reducing suicide rates through regional trials, research and building the evidence base with flexible models that address regional needs and work in our local communities.

This includes the implementation of 12 regional suicide prevention trial sites in Townsville, the Kimberley and Darwin and other places. Digital innovation trials and ten lead sites to trial different care models. All looking to see what actually works.

We’re also investing a great deal more in mental health and making services more effective, accessible and tailored to local needs.

Since 2016, we’ve invested an additional $367.5 million in mental health and suicide prevention support.

That includes a $194.5 million election package towards building a modern 21st century mental health system and our $173 million in new funding in the 2017‑18 Budget and $58.6 million to expand mental health and suicide prevention services for current and ex-serving ADF members and their families.

So we’re putting existing resources to work. But you know, the most important resource is you, is all of us. You know my very good friend and a good friend of all of yours, I know, Ian Hickie has got a great concept. He talks about the ‘mental wealth of nations’, sort of elaborating from Adam Smith.

The truth is that mental health is enormously costly, in every respect.

It’s costly for individuals who suffer, its costly to their families but it’s especially costly when people take their own lives.

So we all have a vested interest in each others’ mental health. The most important thing we can do is to look out for each other.

Yes, governments and parliaments and health professionals spend money and trial new approaches and use digital technologies more effectively and we’re doing all these things and we’ll no doubt do much more in the future.

But you know, just four letters ‘R U OK?’ can make a difference. Because they represent another four letters, ‘L O V E’ – love. That’s what it’s about; showing that love and care for the people with whom you are with, whether they are your families, your friends or your workmates. Reach out to them, ask are you okay, show you care. You could not just change a life, you could save a life.

Thank you very much.

Part 3 Opposition Leader  Bill Shorten addressing the RUOK Breakfast 13 September

Good morning everybody.

I’d like to acknowledge the traditional owners of this land, I pay my respect to their elders both past and present.

I’m actually going to spend a moment on what the Prime Minister said and thank him for his words.

It’s a galling thing when you’re Leader of the Opposition that the Prime Minister yells slogans at you one day, and you think oh why did he do that?

But then occasionally he gives a speech like that and I think, you’re not too bad after all.

It really was a good set of words.

Mind you, by Question Time that thought will be erased.

I’d like to thank Mike Kelly and Andrew Wallace filling in for Julian Leeser for bringing all of us here today.

We’ve got the Shadow Minister Julie Collins and we’ve got the Minister Greg Hunt.

Yesterday afternoon when I was preparing my words for this morning, I stopped to think about people I’d known who’d taken their own lives. And you start to construct that list.

I’m sure I’m not unique. I think most Australians find out after the event, someone they liked or loved has taken their own life.

As I got thinking about it, I could think of about seven people I knew. I actually stopped there. Because I knew the longer I thought, I could think of families with their kids and other people.

The thing about these people I thought about, is that they remain forever young.

You can still imagine them. You can remember not everything that you should, but you can remember some of their jokes perhaps, some of their ideas, some of their abilities.

I think about RUOK and I thought what could we have done then, what could I have done then?

And what has been done today to help this be prevented in the future.

I think about each of these people, and I went through the process of writing down their names just to start reconstructing.

Because you don’t always think about the people who have passed, you move on, the events move on.

And I think, was there some sign that they weren’t well? Was there some signal, some marker?

Is there something you could have done differently?

Some of the people I think of were teenagers, highly-talented. They seemed to be very successful at everything they did. But inside they were battling illness and great, great depression.

And when I thought about seven people I could think of I was reminded that seven Australians take their life on average every day, and possibly seven more will today. Every single day.

It is a silent crisis at the heart of our nation.

I’m sure all of you have sat with parents at their table when they’re numb with incomprehension, when they’re shattered by grief.

When they’re trying to write words to say farewell to their child or their adult child, taken too soon.

I still recall a school assembly where the school captain or someone very senior in the school said he died on a train, that’s what we were told. It was only years after that I found out that was the way the school dealt with the fact that he had taken his own life.

And you do think about what you could have done.

I think about veterans who are let down by the nation that they served.

Seven Australians – every day.

And what I wanted to say is that these are preventable deaths – we are not talking about a terminal condition, some dreadful metastasising cancer spread throughout a human body.

These deaths are preventable, there is nothing inevitable about suicide.

And we know that expert assistance can make the difference but it is in short supply.

Our emergency departments work very well. If you turn up with say chest pains, terrible chest pains I reckon nearly all of the time you’ll get the right diagnosis and the care is there.

When I was talking to Professor Pat McGorry who is here today, you know and he worries that you can turn up to an emergency department and you’ve got a very serious case of potential self-harm, or as a suicide risk.

Do we have the resources there to the same proportion as a medical condition, another medical condition? I don’t think we do.

And I know every Member of Parliament here regardless of their political affiliation will have constituents who come to them desperate, red-eyed saying I’ve got a child, an adult child who really needs that sub-acute care. And the search for the beds that aren’t there.

We know that suicide is the scourge of rural and regional communities.

It takes a shocking toll on our people in the bush.

We know the suicide rate is twice as high amongst our First Australians, Pat Dodson has written movingly about those nights when his phone rings with the tragic news that another young person in the Kimberley has taken their life.

We know, as Mike Kelly alluded to, that suicide is more common and more frequently attempted by young LGBTI Australians grappling with their sexuality, fearing rejection.

Completely alienated and unsure of where they fit in.

And we all do have a responsibility to call-out that hateful discrimination and language, particularly in the weeks ahead.

The simple truth is no part of our nation has a wall tall enough to keep the scourge of suicide from that postcode. Suicide is no respecter of ethnicity, of income.

It does not care which god you pray to, or who you love, it affects every Australian and therefore it is within the power of every Australian to do something about it.

We live in a world where it has been easier than ever to see what our friends and our family are up to.

I remember when I was a backpacker 25 years ago, I could be back home before any of the postcards which I had sent to Mum and Dad.

These days you feel like you’re on everybody else’s holiday half the time, as soon as you turn on the computer.

Australians aged between 15 and 24 spend an average of around 18 hours a week online.

And while social media has a tremendous ability to bring us closer together, Instagram,

Facebook and Snapchat also create emotional distance. A carefully-curated view of each other’s lives: exotic holidays, glamorous events, fun nights out, fancy meals.

We have now got a situation where before teenagers will eat the food, they will photograph it.

But the challenge for us is to look beyond the superficial snapshots of endless good times, to go further than simply clicking ‘like’ and scrolling on down the feed.

It’s about digging a bit deeper.

And in conclusion, that’s why we are here.

It’s time to make that call, to send a message, to drop-in for a visit – to really see how someone is going.

I actually think Parliamentarians are well placed to understand RUOK Day.

We’ve all seen our own challenges with mental health, I think previously in this parliament.

In this very large building with thousands of people, it can be hard and isolating experience.

It is important that RUOK day occurs because it is a reminder that we need to distinguish and not let the urgent distract us from the important.

There is always time to

  • Ask
  • Listen
  • Encourage action
  • And check-in

There is always time to start a conversation.

I think about all the people that I have known – and I am not sure I could have done anything then to change something.

But I wish that I knew then what I know now, and was able to ask these people: ‘Are you ok?’

NACCHO Aboriginal Health #Strokeweek : #Fightstroke Aboriginal people are up to three times more likely to suffer a stroke than non-Indigenous

 

” Aboriginal and Torres Strait Islander people are up to three times more likely to suffer a stroke than non-Indigenous Australians and almost twice as likely to die, according to the Australian Bureau of Statistics. It’s an alarming figure and one that  prompted the National Stroke Foundation in 2016 to urge the Federal Government to fund a critical $44 million awareness campaign in a bid to close the gap .

The good news is most strokes are preventable and treatable.

However communities need to be empowered to protect themselves from this insidious disease.”

Sharon McGowan, Stroke Foundation CEO ( see full Aboriginal Stroke statistics part 2 below

Download the 48 Page support guide :

journeyafterstroke_indigenous_0

Read over 75 Stroke related articles published by NACCHO over past 5 years

“Never had I ever come across one ( stroke ) or heard much about them. I had nothing to do with them,”

When I woke up, I didn’t know what was going on. I couldn’t communicate. I couldn’t tell anyone I was still here. It was really scary. I’d never seen the effects of a stroke.

First, I lost my voice, then my vision, my [ability to] swallow and my movement of all my body parts. I lost all my bowel and bladder function. I’ve still got bad sight but I can see again. My speech took about six months.

With help from the Aboriginal Disability Network, they advocated to get me out and get the right support equipment at home “

For Tania Lewis, an Awabakal woman, stroke was something that only happened to older people. But in 2011, Tania suffered a severe stroke at the age of 39 that would leave her with permanent right-sided hemiplegia – paralysis of one side of the body.

Pictured above : Editor of NACCHO Communique and Stroke Foundation Consumer Council Board Member Colin Cowell (left ) with fellow stroke survivor Tania Lewis at an NDIS workshop in Coffs Harbour conducted by Joe Archibald (right )

Part 1 Stroke Foundation in 2016 called on government to close the gap

Originally published here

A stroke occurs when supply of blood to the brain is disturbed suddenly. The longer it remains untreated, the heightened the risk of stroke-related brain damage.

Medical treatment during the first onset of symptoms can significantly improve a sufferer’s chance of survival and of successful rehabilitation.

In Australia, stroke is the leading cause of long-term disability in adults, accounting for 25 per cent of all chronic disability. The NSF reports that roughly 50,000 strokes occur per year with over 437,000 people living with stroke across the country. While severity varies, two thirds of victims, like Tania, are left with impeding disabilities

But in 2011, Tania suffered a severe stroke at the age of 39 that would leave her with permanent right-sided hemiplegia – paralysis of one side of the body.

The burden of stroke doesn’t just fall on the patient, but can take a significant toll on family and carers.

“The doctor at the hospital tried to take Power of Attorney and Guardianship away from me and give it to the Guardianship Board, because he didn’t believe that [my husband] Len or anyone could look after me,” Tania recalls.

“I was put through hell. I figured life wasn’t worth living anymore because they took everything away from me. I couldn’t go home to my family. So I tried to off myself.

“Then all of a sudden, one day the doctor said, ‘You can go home. We can’t rehabilitate you anymore’. At home, I was having seizures for a while. My hubby wouldn’t sleep. He and his mum would take shifts looking after me. We tried to get assistance but there was nothing for young people. So one day, my husband collapsed on the lounge room floor from exhaustion. It was just a nightmare. That’s how I ended up in aged care.”

Tania spent the next two and a half years between three aged care facilities.

“I wouldn’t wish it upon nobody,” she says.

It was during her nightly ritual of chatting with her daughter via Facebook that Tania typed “young people in nursing homes” into Google. The search engine’s results would lead to her life-changing encounter with the YPINH.

“With help from the Aboriginal Disability Network, they advocated to get me out and get the right support equipment at home. Whatever I need, physio, OT – they’ve got my back. I can’t thank them enough for what they’ve done for me.”

Today, Tania is working with the Aboriginal Disability Network, helping Indigenous Australians navigate their way through the National Healthcare System.

It has long been recognised that Aboriginal and Torres Strait Islander people have a life expectancy that is approximately 20 years less than non-Indigenous Australians (Australian Bureau of Statistics). Recent data from the ABS shows that up to 80 per cent of the mortality gap can be attributed to chronic diseases such as heart disease, stroke, diabetes and kidney disease.

For many Aboriginal communities, especially those in remote regions, socio-economic factors play an important role. Kerin O’Dea from Darwin’s Menzies School of Health Research cites unemployment, poor education outcomes and limited access to fresh foods as key factors in her paper, Preventable chronic diseases among Indigenous Australians.

Lifestyle related risks such as smoking, alcohol misuse, stress, poor diet, and inadequate physical activity also need to be addressed, according to the Australian Institute of Health and Welfare .

But the first step, McGowan says, is for indigenous stroke sufferers to recognise the signs of a stroke in themselves and their family members. The NSF recommends the F.A.S.T. test as the most effective way to remember the most common signs of a stroke.

Face: Check their face. Has their mouth drooped?
Arms: Can they lift both arms?
Speech: Is their speech slurred? Do they understand you?
Time: Is critical. If you see any of these signs call 000 straight away.

“If I had known that because I’d lost my vision I had suffered a stroke, I could’ve put two and two together and got help, but I didn’t know anything,” Tania says.

“I was a heavy smoker, but not anymore – no way. Life’s too important. I didn’t ever know anything about a stroke – I was more thinking when you smoke, you can have lung problems and lose your fingers, like on the packets. But they don’t say anything about a stroke – they don’t advertise that stuff.”

The Stroke Foundation called on the Federal Government to fund an urgent $44 million campaign to address the gap in stroke care. For more information on stroke and the campaign, visit strokefoundation.com.au.

Part 2 Aboriginal Stroke Facts

From here

  • The incidence rate of stroke for Aboriginal and Torres Strait Islander Australians has been found to be 2.6 times higher for men and 3.0 for women (Australian Institute of Health and Welfare, 2008; Katzenellenbogan et al. 2010) compared to non-Aboriginal and Torres Strait Islander Australians and many suggest that these figures may in fact be underestimates (Thrift et al 2011).
  • Aboriginal and Torres Strait Islander Australians are known to experience stroke at a younger age than their non-Aboriginal and Torres Strait Islander counterparts, (Katzenellenbogen et al., 2010; Australian Institute of Health and Welfare, 2004) with 60% of Aboriginal and Torres Strait Islander non-fatal stroke burden occurring in the 25-54 year age-group compared to 24% in the non-Aboriginal and Torres Strait Islander group (Katzenellenbogen et al., 2010).
  • The prevalence of stroke is similarly significantly higher at younger ages among Aboriginal and Torres Strait Islander people (Katzenellenbogen 2013), with a significantly higher prevalence of co-morbidities among Aboriginal and Torres Strait Islander patients under 70 years of age, including heart failure, atrial fibrillation, chronic rheumatic heart disease, ischaemic heart disease, diabetes and chronic kidney disease. This reflects the increased clinical complexity among Aboriginal and Torres Strait Islander stroke patients compared with non-Aboriginal/Torres Strait Islander patients.
  • Aboriginal and Torres Strait Islander stroke patients aged 18–64 years have a threefold chance of dying or being dependent at discharge compared to non-Aboriginal and Torres Strait Islander patients (Kilkenny et al., 2012).

NACCHO Aboriginal Health and @MHPNOnline free webinar : Reducing the mental health impact of Indigenous incarceration

NACCHO Member Alert speaker update August 30

 ” Our CEO Pat Turner and NACCHO staff would like to invite all health workers to be a part of this free webinar: Reducing the mental health impact of Indigenous incarceration on people, communities and services.
 
Developed by NACCHO and produced by Mental Health Professionals’ Network (MHPN) the webinar features Q&A with a panel of experts and will explore the key issues and the impact that incarceration has on individuals, families and communities.”

Download FLYER HERE and share /promote this free webinar

No need to travel to benefit from this free PD opportunity.
Simply register and log in to participate from your home, work or anywhere you have a computer or tablet with a high speed internet connection.
 
Register now to attend this free webinar for health practitioners on
Wednesday 13 September 2017, from 4:30pm – 5:45pm AEST.
 
NACCHO also invites all Member services to ask staff to register now to access a free Mental Health Professionals’ Network webinar for their own professional development.
 
The Indigenous interdisciplinary panel will explore and discuss ways of reducing the mental health impact of Indigenous incarceration on people, communities and services.
 
This professional development opportunity is free and the previous webinar conducted by the MHPN had 680 participants across Australia.
 
The webinar features a Q&A with a panel of experts and will explore the key issues and the impact that incarceration has on Aboriginal and Torres Strait Islander peoples.
The panel will discuss strategies to enhance cultural awareness and develop responsive services for Indigenous communities affected by incarceration.

WHO’S ON THE PANEL?
 
Julie Tongs OAM : CEO Winnunga Nimmityjah Aboriginal Health Service ACT
Dr Louis Peachy : QLD-based rural medical advisor
Dr Marshall Watson : SA-based psychiatrist
Dr Jeff Nelson : QLD-based psychologist
 
Facilitator: Dr Mary Emeleus (QLD-based general practitioner and psychotherapist).
 
Simply register and log in to participate from your home, work or anywhere you have a computer or tablet with a high speed internet connection.
Registrations close at midnight on Tuesday 12th September, 2017.
 
Please find attached a flyer about the updated webinar and it would be appreciate if you could distribute this to your local network.
 
 

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

 

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

ALRC Home page

Download this 236 page discussion paper

discussion_paper_84_compressed_no_cover

Full Terms of reference part B below

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

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

Submissions close on 4 September 2017.

Make a submission

Part A Proposals and Questions

1. Structure of the Discussion Paper

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

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

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

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

2. Bail and the Remand Population

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

Other state and territory bail legislation should adopt similar provisions.

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

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

3. Sentencing and Aboriginality

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

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

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

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

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

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

4. Sentencing Options

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

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

(b)     which provisions should be prioritised for review?

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

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

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

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

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

5. Prison Programs, Parole and Unsupervised Release

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

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

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

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

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

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

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

6. Fines and Driver Licences

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

8. Alcohol

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

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

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

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

9. Female Offenders

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

10. Aboriginal Justice Agreements

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

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

11. Access to Justice Issues

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

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

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

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

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

12. Police Accountability

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

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

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

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

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

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

13. Justice Reinvestment

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

Part B The Term of reference

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

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

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

Scope of the reference

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

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

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

Consultation

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

Timeframe

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

 

Aboriginal #Nutrition Health and #Sugar : @healthgovau Health Star Rating System review closes 17 August

 ” The Health Star Rating System has been marred by anomalies. Milo powder (44% sugar) increased its basic 1.5 Stars to 4.5 by assuming it will be added to skim milk. About one in every seven products bearing health stars goes against the Department of Health’s own recommendations.

Those of us working in public health question why obvious junk foods get any stars at all.”

See Sugar, sugar everywhere MJA insight article in full Part 3 below

  ” 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 

See Part 1 below for Aboriginal sugar facts

The Health Star Rating (HSR) Advisory Committee (HSRAC), responsible for overseeing the implementation, monitoring and evaluation of the HSR system is undertaking a five year review of the HSR system.

The five year review of the system is well underway, with a public submission process opening on 8 June 2017 on the Australian Department of Health’s online Consultation Hub.

Since the consultation period has been opened there has been strong interest in the system from stakeholders representing a diverse range of views.

To ensure that as much evidence as possible is captured, along with stakeholders’ views on the system, a further two week extension to the consultation period has been agreed and it will now close on 17 August 2017

See full survey details Part 2 Below

Part 1 Aboriginal sugar facts

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%).

Part 2 @healthgovau Health Star Rating System review closes 17 August

Introduction

The Health Star Rating (HSR) Advisory Committee (HSRAC), responsible for overseeing the implementation, monitoring and evaluation of the HSR system, is undertaking a five year review of the HSR system. The HSR system is a front-of-pack labelling (FoPL) scheme intended to assist consumers in making healthier diet choices. The findings of the review will be provided to the Australia and New Zealand Ministerial Forum on Food Regulation (Forum) in mid‑2019.

In parallel with this consultation on the HSR system five year review, the HSRAC is conducting a dedicated investigation of issues and concerns raised about the form of the food (‘as prepared’) rules in the Guide for Industry to the HSR Calculator. These enable additional nutrients to be taken into account when calculating star ratings based on foods prepared according to on-label directions. A specific consultation process seeking input into this investigation opened on 19 May 2017 and will close at 11.59 pm 30 June 2017. The form of the food (‘as prepared’) consultation can be viewed on the Australian Department of Health’s Consultation Hub.

The HSR system

The HSR system is a public health and consumer choice intervention designed to encourage people to make healthier dietary choices. The HSR system is a voluntary FoPL scheme that rates the overall nutritional profile of packaged food and assigns it a rating from ½ a star to 5 stars. It is not a system that defines what a ‘healthy’ or ‘unhealthy’ food is, but rather provides a quick, standardised way to compare similar packaged foods at retail level. The more stars, the healthier the choice. The HSR system is not a complete solution to assist consumers with choosing foods in line with dietary guidelines, but should be viewed as a way to assist consumers to make healthier packaged food choices.  Other sources of information, such as the Australian Dietary Guidelines and the New Zealand Eating and Activity Guidelines, also assist consumers in their overall food purchasing decisions.

The HSR system aims to:

1. Enable direct comparison between individual foods that, within the overall diet, may contribute to the risk factors of various diet related chronic diseases;

2. Be readily understandable and meaningful across socio-economic groups, culturally and linguistically diverse groups and low literacy/low numeracy groups; and

3. Increase awareness of foods that, within the overall diet, may contribute positively or negatively to the risk factors of diet related chronic diseases.

The HSR system consists of the graphics, including the words ‘Health Star Rating’, the rules identified in the HSR system Style Guide, the algorithm and methodology for calculating the HSR identified in the Guide for Industry to the HSR Calculator, and the education and marketing associated with the HSR implementation.

The HSR system is a joint Australian, state and territory and New Zealand government initiative developed in collaboration with industry, public health and consumer groups. The system is funded by the Australian government, the New Zealand government and all Australian jurisdictions during the initial five year implementation period.

From June 2014, food manufacturers started to apply HSRs to the front of food product packaging. Further information on the HSR system is available on the HSR website. The New Zealand Ministry for Primary Industries (MPI) website also provides information on the HSR system in New Zealand.

Purpose and scope of the review
The five year review of the HSR system will consider if, and how well, the objectives of the HSR system have been met, and identify options for improvements to and ongoing implementation of the system (Terms of reference for the five year review).

With a focus on processed packaged foods, the objective of the HSR system is:

To provide convenient, relevant and readily understood nutrition information and /or guidance on food packs to assist consumers to make informed food purchases and healthier eating choices.

The HSRAC has agreed that the areas of communication, system enhancements, and monitoring and governance will be considered when identifying whether the objectives of the HSR system have been achieved.

Although HSRAC will need to be a part of the review process, a degree of independence is required and independent management and oversight of the review is an important factor to ensure credible and unbiased reporting. An independent consultant will be engaged to undertake the review. Specific detail about the scope of the review will be outlined in the statement of requirement for the independent consultant. A timeline for the five year review of the HSR system has been drafted and will be updated throughout the review.

Next steps in the review process

As part of the five year review, HSRAC is seeking evidence based submissions on the consultation questions provided in this discussion paper.

This consultation is open to the public, state and territory governments, relevant government agencies, industry and public health and consumer groups.

Making a submission

The HSRAC is seeking submissions on the merits of the HSR system, particularly in response to the consultation questions below. The aim of the questions is to assist respondents in providing relevant commentary. However, submissions are not limited to answering the questions provided.  Please provide evidence or examples to support comments. Some areas of this review are technical in nature therefore comments on technical issues should be based on scientific evidence and/or supported by research where appropriate. Where possible, please provide citations to published studies or other sources.

While the HSRAC will consider all submissions and proposals put forward, those that are not well supported by evidence are unlikely to be addressed as part of the five year review.

Enquiries specifically relating to this submission process can be made via email to: frontofpack@health.gov.au. Please DO NOT provide submissions by email.

After the consultation period closes the HSRAC will consider the submissions received and will prepare a summary table of the issues raised which will be published on the HSR website. All information within the summary table will be de-identifiable and will not contain any confidential material.

HSRAC will treat information of a confidential nature as such. Please ensure that material supplied in confidence is clearly marked ‘IN CONFIDENCE’ and is provided in a separate attachment to non-confidential material. Information provided in the submissions will only be used for the purpose of the five year review of the HSR system and will not be used for any other purpose without explicit permission.

Please see the Terms of Use and Privacy pages at the bottom of this page for further information on maintaining the security of your data.

For further information about the HSR system, including its resources and governance structure, please refer to the Australian HSR website and the New Zealand MPI website.

Part 3 Sugar Sugar MJA Insights

Originally published Here

IT’S hard to escape sugar, not only in what we eat and drink, but also in the daily news and views that seep into so many corners of our lives.

There’s nothing new about concern over sugar. I can trace my own fights with the sugar industry back to the 1960s, and since their inception in 1981, the Australian Dietary Guidelines have advised limiting sugary foods and drinks. The current emphasis in many articles in newspapers, magazines, popular books and online blogs, however, go further and recommend eliminating every grain of the stuff from the daily diet.

Taking an academic approach to the topic, the George Institute for Global Health has published data based on the analysis of 34 135 packaged foods currently listed in their Australian FoodSwitch database. They found added sugar in 87% of discretionary food products (known as junk foods in common parlance) and also in 52% of packaged foods that can be described as basic or core foods.

The George Institute’s analysis is particularly pertinent to the Department of Health’s Health Star Rating System, and found that some of the anomalies in the scheme could be eliminated by penalising foods for their content of added sugars rather than using total sugars in the product, as is currently the case.

The definition of “added sugars” used in Australia also needs attention, a topic that has been stressed in the World Health Organization’s guidelines. I will return to this later.

In Australia, the nutrition information panel on the label of packaged foods must include the total sugars present. This includes sugars that have been added (known as extrinsic sugars) as well as any sugars present naturally in ingredients such as milk, fruit or vegetables (intrinsic sugars).

There is no medical evidence to suggest that intrinsic sugars are a problem – at least not if they occur in “intact” ingredients. If you consume fruit, for example, the natural dietary fibre and the bulk of the fruit will limit the amount of the fruit’s intrinsic sugars you consume. However, if the sugar is extracted from the structure of the fruit, it becomes easy to consume much larger quantities. Few people could munch their way through five apples, but if you extract their juice, the drink would let you take in all the sugar and kilojoules of five apples in less than a minute.

The Australian Dietary Guidelines do not include advice to restrict fruit itself because there is high level evidence of its health value. The guidelines do, however, recommend that dried fruit and fruit juice be restricted – the equivalent of four dried apricot halves or 125 mL juice consumed only occasionally.

Contrary to the belief of some bloggers, Australia’s dietary guidelines have never suggested replacing fat with sugar. That was a tactic of some food companies who marketed many “low” or “reduced” fat foods where the fat was replaced with sugars or some kind of refined starch.

The wording of Australia’s guideline on sugar has changed. The initial advice to “avoid too much sugar” led to the sugar industry’s multimillion dollar campaign “Sugar, a natural part of life”. This included distributing “educational” material to the general public, politicians, doctors, dentists, pharmacists and other health professionals discussing the importance of a “balanced diet”.

In spite of fierce lobbying by the sugar industry, the next revision of the guidelines retained a sugar guideline, although it was watered down to “eat only moderate amounts of sugars”. Some school canteen operators reported that they had been confronted by sweet-talking sellers of junk foods omitting the word “only” from this guideline.

The evidence for sugar’s adverse effects on dental health have long been known, but the evidence against sugar and its potential role in obesity and, consequently, in type 2 diabetes and other health problems has grown stronger. The most recent revision of the National Health and Medical Research Council’s Dietary Guidelines, therefore, emphasises the need to “limit” added sugars and lists the foods that need particular attention.

Sugary drinks have been specifically targeted because the evidence against them is strong and extends beyond epidemiological studies. Double-blind trials now clearly link sugary drinks with weight gain, the only exceptions being a few trials funded by the food industry.

Added sugar is not the only topic for public health concern, and hence the government’s Health Star Rating System was set up to introduce a simple front-of-pack labelling scheme to assist Australians reduce their intake of saturated fat, salt and sugars from packaged foods.

A specially commissioned independent report (Evaluation of scientific evidence relating to Front of Pack Labelling by Dr Jimmy Chun Yu Louie and Professor Linda Tapsell of the School of Health Sciences, University of Wollongong) found that added sugars were the real problem, but the food industry argued that the scheme should include total sugars because this was already a mandatory inclusion on food labels and routine chemical analysis couldn’t determine the source of sugars.

This was a strange argument since food manufacturers know exactly how much sugar they add to any product, just as they know how many “offset” points the Health Star Rating System allows for the inclusion of fruit, vegetable, nuts or legumes. The content of these ingredients is only disclosed on the food label if used in the product’s name.

The Health Star Rating System has been marred by anomalies. Milo powder (44% sugar) increased its basic 1.5 Stars to 4.5 by assuming it will be added to skim milk. About one in every seven products bearing health stars goes against the Department of Health’s own recommendations.

Those of us working in public health question why obvious junk foods get any stars at all.

How can caramel topping or various types of confectionery, such as strawberry flavoured liquorice, each get 2.5 stars? Why do some chocolates sport 3.5 stars, while worthy products such as Greek yoghurt without any added sugars get 1.5 and a breakfast cereal with 27% sugar gets four stars?

The fact that over a third of Australian’s energy intake comes from discretionary products (40% for children) is the elephant in the room for excess weight. We need to reduce consumption of these products and allotting them health stars is not helping.

It’s clearly time to follow our dietary guidelines and limit both discretionary products and added sugar. Of the nutrients used in the current algorithm for health stars, the George Institute’s analysis shows that counting added rather than total sugars has the greatest individual capacity to discriminate between core and discretionary foods.

However, in moving to mandate added sugars on food labels and using added sugars in health stars, it’s vital to define these sugars. The World Health Organization has done so: “Free sugars refer to monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) added to foods and drinks by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates”.

Regular sugar in Australia could be described as cane juice concentrate. It has no nutrients other than its carbohydrate. Fruit juice concentrates are also just sugars with no nutrients other than carbohydrates. At present the Health Star Rating System allows products using apple or pear juice concentrate to be counted as “fruit” and used to offset the total sugars. This is nonsense, and gives rise to confectionery, toppings and some breakfast cereals scoring stars they do not deserve.

Other ways to boost health stars also need attention. Food technologists boast they can manipulate foods to gain extra stars (Health Star Rating Stakeholders workshop, Sydney, 4 August 2016). For example, adding wheat, milk, soy or other protein powder, concentrated fruit purees or a laboratory-based source of fibre such as inulin will all give extra “offset” points to reduce adverse points from saturated fat, sugar or salt. Indeed, some food technologists have even suggested they could revert to using the especially nasty trans (but technically unsaturated) fatty acid from partially hydrogenated vegetable oils to replace naturally occurring saturated fat.

My alternative is to go for fresh foods and minimise packaged foods. If the stars look too good to be true, check the ingredient list. But remember that Choice found sugar may go by more than 40 different names. Buyer beware!

NACCHO @TheAHCWA Aboriginal Health and the Cashless Welfare card debate

 

 ” Graphic video footage played recently to Prime Minister Malcolm Turnbull and other influential politicians cuts to the core. It is horrific, sickening and gut-wrenching, and would affect any compassionate human being.

But the intent behind the carefully edited emotive video – further pushing a ( Cashless Welfare ) card to supposedly tackle every imaginable social problem in vulnerable communities – is ill-conceived and ideologically driven.

Michelle Nelson-Cox Chair  : Aboriginal Health Council of Western Australia press release Opinion piece (part 2 Below )

 

 ” We need to recognise that the best way of dealing with problems is with respect, working together, and focussed on commonly agreed goals. We do not need a new generation of community members under the control of those who want to use punitive measures to coerce and control them. When has this approach ever been shown to work?

We need to ask why we are not doing it differently, treating the very causes of the dislocation and alienation of our communities — facing up to and turning around the hopelessness and despair that beleaguers them.

The Rural Doctors have made it clear when they said: “Those that do have problems will not be helped by measures that feel punitive, such as switching them to a cashless debit card, rather than payments. Tough love is rarely successful in treating substance abuse – particularly when it’s from the Government.”

I support the Rural Doctors and our community organisations working with families dealing with these issues. This is where we have to take this debate.”

Shadow assistant minister for Indigenous affairs and Aboriginal and Torres Strait Islanders Senator for Western Australia, Patrick Dodson responds to article portraying the state as a ‘war zone’ .Full article HERE

” Senator Rachel Siewert has criticised a new video campaign showing graphic depictions of violence in Indigenous communities as shock tactics designed to scare the Federal Government into rolling out more cashless welfare cards in remote Western Australia.

Using violent imagery then offering a one-dimensional, paternalistic and previously failed approach to a complex problem shows that Andrew Forrest is more concerned about furthering his ideologies than looking at what works.

“I share concerns about disadvantage and agree we need to be addressing severe disadvantage in communities like Port Hedland. We need a multifaceted approach including addressing alcohol supply, drug and alcohol services, and wrap around services driven by the community.

“I agree we do need to be investing in communities but in approaches that work ‘ Senator Rachel Siewert

Read Senator Rachel Siewert full press release part 4 below

Mining magnate Andrew Forrest and local leaders from the East Kimberley region, last week launched #timetoact an online anti-violence campaign in the nation’s capital. It features a video that shows disturbing scene of violence.”

Watch video HERE

” The concerted push by outgoing WA Police Commissioner Karl O’Callaghan that the cashless welfare system should be expanded to somehow protect children from sexual abuse, particularly in the north-west town of Roebourne, is fundamentally flawed.

There has been no conclusive evidence to date that cashless welfare cards play any role in reducing the impact of issues such as illicit drug use or child sexual abuse.

Instead, greater investment is needed in programs that address social determinants and build strong families and communities.

Ultimately, we need to see an increase in community programs and comprehensive support services to help address these complex social issues in Aboriginal communities.

AHCWA does not support simplistic apparent solutions imposed from outside Aboriginal communities. Rather, it advocates for greater investment in community designed and driven programs to build strong families and communities.

Our sector has been delivering positive outcomes in Aboriginal health for more than 40 years, but in that time we have often dealt with the unintended negative consequences of whatever “silver bullet” solution is politically fashionable at the time.

Extracts from Michelle Nelson-Cox Chair  : Aboriginal Health Council of Western Australia press release (part 1and 2 below)

 

Elder Ted Carlton with a card

Part 1 : AHCWA rejects Karl O’Callaghan’s call to expand cashless welfare

The Aboriginal Health Council of Western Australia has challenged outgoing Police Commissioner Karl O’Callaghan to look in his own backyard and adequately police remote communities rather than advocate for greater disempowerment of indigenous Australians.

AHCWA chairperson Michelle Nelson-Cox today rejected calls by Mr O’Callaghan, whose contract ends on August 15 after 13 years at the helm of WA Police, for an urgent expansion of the cashless welfare system to combat child sex crimes in regional WA.

“The cashless welfare card is not a panacea to complex social problems,” Ms Nelson-Cox said.

“While AHCWA supports the government’s commitment to improve the health outcomes of Aboriginal people and prevent child sexual abuse, we do not support the ill-conceived idea that cashless welfare cards can turn the tide on the abhorrent abuse of children.

“There has been no conclusive evidence to date that cashless welfare cards play any role in reducing the impact of issues such as illicit drug use or child sexual abuse.

“Instead, greater investment is needed in programs that address social determinants and build strong families and communities.

“Ultimately, we need to see an increase in community programs and comprehensive support services to help address these complex social issues in Aboriginal communities.”

Ms Nelson-Cox said Mr O’Callaghan’s admissions in The West Australian newspaper that his officers could not protect children in remote communities was gravely concerning.

“At what point does the buck stop with police and governments to keep communities safe? Over the past 13 years, how have the high instances of sexual abuse not have been addressed earlier?” she said.

“There is a large police presence in Roebourne, and admissions by Karl O’Callaghan that ‘police were not capable of protecting children in those communities’ and ‘neither the police nor government can guarantee protection of these children’ shows a lack of commitment to work with communities to effectively address these issues.

“The reality is there are a huge number of people very unhappy with the way they have been affected by the cashless welfare system imposed by the Federal Government.

“If anything, this is a failure of policing in the Roebourne area to address these crimes.

“The cashless welfare card does not need to be expanded. The solution does not lie in the disempowerment of Aboriginal people, but rather additional police resources and a greater commitment to stamp out these shocking and abhorrent crimes.”

AHCWA is the peak body for Aboriginal health in WA, with 22 Aboriginal Community Controlled Health Services (ACCHS) currently engaged as members.

Part 2 : AHCWA rejects Karl O’Callaghan’s call to expand cashless welfare

 

Graphic video footage played recentlt to Prime Minister Malcolm Turnbull and other influential politicians cuts to the core. It is horrific, sickening and gut-wrenching, and would affect any compassionate human being.

But the intent behind the carefully edited emotive video – further pushing a card to supposedly tackle every imaginable social problem in vulnerable communities – is ill-conceived and ideologically driven.

The concerted push by outgoing WA Police Commissioner Karl O’Callaghan that the cashless welfare system should be expanded to somehow protect children from sexual abuse, particularly in the north-west town of Roebourne, is fundamentally flawed.

The belief that the cashless welfare card can prevent child sexual abuse is based on nothing more than a distorted perception that quarantining income will address all social problems in remote Aboriginal communities.

To date, there has been no conclusive evidence that cashless welfare cards play any role in reducing the impact of issues such as illicit drug use or sexual abuse.

In fact, the most comprehensive review of income management in the Northern Territory has proven that this strategy will not work and will likely only create further dependence.

WA communities like Roebourne do not need the next new idea imposed by white people who live elsewhere.

Instead, they need to work with Aboriginal people and support under resourced local initiatives already being worked on.

The Aboriginal Health Council of Western Australia (AHCWA) is the peak body for Aboriginal health in WA, with 22 Aboriginal Community Controlled Health Services (ACCHSs) currently engaged as members.

AHCWA does not support simplistic apparent solutions imposed from outside Aboriginal communities. Rather, it advocates for greater investment in community designed and driven programs to build strong families and communities.

Our sector has been delivering positive outcomes in Aboriginal health for more than 40 years, but in that time we have often dealt with the unintended negative consequences of whatever “silver bullet” solution is politically fashionable at the time. These days, the cashless welfare card is seen as the quick fix.

The cashless welfare card has been delivered as part of a Cashless Debit Card Trial (CDCT), a program developed to reduce the harm associated with alcohol consumption, illicit drug use and gambling in Ceduna in South Australia and the East Kimberley in WA (Kununurra and Wyndham).

The trial began in early 2016, when participants were issued a debit card which could not be used to buy alcohol, gambling products or to withdraw cash.

The system quarantines 80 per cent of income support payments into a restricted account linked to the card, with the remainder of these payments accessible through a normal, unrestricted bank account.

Remarkably, and perhaps unsurprisingly, an evaluation of the current trial showed that the majority of people using the card, and their families, did not report gambling, using illicit drugs, or consuming alcohol in excess.

To put it simply, this trial has been socially disempowering for a huge number of community members. Strong resistance and opposition has been made clear at public meetings, strikes and petitions.

Admissions by Karl O’Callaghan in the video shown to the PM that “police can’t save them” shows a lack of commitment to work with communities to effectively address these issues.

If anything, his comments reflect a failure of policing in the Roebourne area to address these crimes and protect the town’s most vulnerable people.

We support any commitment to improve the safety and health of Aboriginal people, particularly children, in WA and turn the tide on the appalling abuse of our youngsters, but the answer is not an expansion of the cashless welfare card.

The solution does not lie in the disempowerment of Aboriginal people, which has been an ongoing tactic by governments. Instead it lies in additional police resources and a genuine commitment to work with communities to stamp out these shocking and abhorrent crimes.

We agree it is time to act – it is time for the police to act.

“Using violent imagery then offering a one-dimensional, paternalistic and previously failed approach to a complex problem shows that Andrew Forrest is more concerned about furthering his ideologies than looking at what works,” Senator Siewert said today.

“I share concerns about disadvantage and agree we need to be addressing severe disadvantage in communities like Port Hedland. We need a multifaceted approach including addressing alcohol supply, drug and alcohol services, and wrap around services driven by the community.”

Part 3  :  Graphic video campaign pushing for welfare card slammed as ‘one dimensional’  

Continued from opening                                

Mr Forrest was joined yesterday by Jean O’Reerie, Aboriginal Education Worker from Wyndham in East Kimberley- a Cashless Debit Card trial site, her colleague, local Bianca Crake, and the Mayor of Port Hedland, Mr Camillo Blanko.

Mr Forrest claims that the government’s current system to stop drug and alcohol fuelled violence against children in the Pilbara and East Kimberley region isn’t working.

Linking what he described as horrific child abuse to alcohol and drug use, Mr Forrest is pushing for the Cashless Welfare Card to be introduced into more West Australian communities.

“Elders of communities, mayors of major towns are standing up and saying enough is enough. We need the system to change. What we have had is not enough. It’s delivering our children into hell and they have to be protected,” he told a media conference yesterday.

Mr Forrest yesterday brough elders and civic leaders, from Western Australia and South Australia, to meet personally with the Prime Minister Malcolm Turnbull, the leader of the opposition Bill Shorten and his deputy leader Tanya Plibersek.

Figures from the West Australian Police Commissioner Karl O’Callaghan’s department claimed that one in three children are being abused, in a town of 500 children – 158 were sexually assaulted, 36 men face 300 charges of child abuse and in another town six children committed suicide in six months. It was not specified whether the children affected were Indigenous or Non- Indigenous.

Jean O’Reerie an Aboriginal Education Worker from Wyndham in the East Kimberley was emotional as she described the situation in her community.

“We need help, we need the government to intervene and help us out as community leaders. We can’t do it on our own. We need change for our community, our kids are hurting,” she said.

“We, the grassroots people, live with it every day. The hurt, the suffering, and the abuse.”

Part 4 : Trying to scare people into supporting the cashless card a worrying ramp up of Andrew Forrest’s campaign: Senator Rachel Siewert

Andrew Forrest is trying to use similar shock tactics to those of the previous Howard Government to scare people into supporting the cashless welfare card, Australian Greens Senator Rachel Siewert said last week

“We are seeing a worrying ramp up of Andrew Forrest’s cashless welfare card campaign that uses children, violence and fear just like the Howard Government did in 2007 over the NT Intervention.

“The Howard Government did this to justify the Northern Territory Intervention to impose income management and the Basics Card, at the time the Little Children are Sacred report was used to scare people into supporting income management.

“The final evaluation of the NT Intervention shows that it met none of its objectives. Ten years on we are still seeing the number of children going into out of home care increasing and appalling disadvantage persists.

Using violent imagery then offering a one-dimensional, paternalistic and previously failed approach to a complex problem shows that Andrew Forrest is more concerned about furthering his ideologies than looking at what works.

“I share concerns about disadvantage and agree we need to be addressing severe disadvantage in communities like Port Hedland. We need a multifaceted approach including addressing alcohol supply, drug and alcohol services, and wrap around services driven by the community.

“I agree we do need to be investing in communities but in approaches that work. The Government invested over $1.2 billion in the NT Intervention which met none of its objectives. We should stop wasting money on income management style approaches and start looking at real solutions that work”.

 

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

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

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

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

From the National Rural Health Alliance Research View HERE

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

Example 1

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

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

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

Example 2

NACCHO provided graphic

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

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

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

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

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

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

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

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

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

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

 


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

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

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

MC

IR

OR/Remote

Percentage

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

13.0

16.7

20.9

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

14.6

19.0

22.4

MC

IR

OR

Remote+ Very Remote

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

14.2

17.6

22.6

24.6

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

14.2

18.6

23.6

24.4

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

85.9

113.1

109.4

126.2

Sources:

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

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

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

 

Smoking – exposure, uptake, establishment, quitting

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

MC

IR

OR

remote

8.8

17.8

19.3

27.8

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

8.5

17.0

18.9

27.5

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

3.6

3.1

4.1

*9.4

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

2.5

2.0

2.7

*2.9

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

16.2

15.4

14.7

15.5

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

17.8

22.7

17.8

28.3

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

54.7

61.1

64.9

67.2

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

2.5

3.4

2.5

3.7

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

20.2

25.9

44.1

45.2

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

21.3

16.8

19.0

15.5

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

29.2

34.2

31.7

32.9

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

46.3

48.0

47.4

45.2

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

35.2

36.3

36.1

36.0

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

53.1

51.5

46.3

45.0

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

4.9

6.0

4.8

7.0

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

6.9

9.3

6.8

10.4

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

13.0

16.7

21.2

18.8

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

10.9

7.8

2.9

n.p.

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

40.1

44.7

42.3

52.7

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

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

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

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

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

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

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

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

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

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

MC

IR

OR

R

VR

Crude Percent

Current daily smoker

36.2

40.9

39.8

47.4

51.1

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

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

Smoking Trends

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

Survey year

MC

IR

OR/Rem

Australia

Crude percent daily smokers

2001

21.9

21.9

26.5

22.4

2004-05

19.9

23.0

26.2

21.3

2007-08

17.5

20.1

26.1

18.9

2011-12

14.7

18.3

22.2

16.1

2014-15

13.0

16.7

20.9

14.5

Source: ABS National Health Surveys

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

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

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

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

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

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

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

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

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

Alcohol

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

Alcohol consumption

MC

IR

OR/Rem

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

16.3

18.4

23.4

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

15.7

17.4

22.0

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

42.7

48.5

46

MC

IR

OR

R/VR

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

23.1

18.9

20.5

17.5

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

60.2

62

56.9

47.6

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

16.7

19.1

22.6

34.9

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

40.4

41.8

38.1

30.8

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

23.5

24.4

23.6

22.8

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

13

14.9

17.8

28.9

Sources:

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

MC

IR

OR

R

VR

Percent

Exceeded lifetime risk guidelines

18.0

18.7

18.2

22.5

14.3

Exceeded single occasion risk guidelines

56.7

57.4

50.7

59.0

41.4

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

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

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

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

Alcohol trends

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

MC

IR

OR

R/VR

single occasion risk (monthly) 2004

287

304

321

370

2007

285

292

312

437

2010

274

312

329

413

2013

250

273

315

422

lifetime risk 2004

200

215

234

262

2007

199

210

238

314

2010

189

225

251

310

2013

167

191

226

349

very high risk – yearly 2004

167

185

206

243

2007

172

183

206

288

2010

161

183

218

266

2013

151

166

194

258

very high risk – monthly 2004

77

84

104

130

2007

78

89

100

153

2010

79

94

113

154

2013

70

70

100

170

very high risk – weekly 2004

21

27

41

38

2007

24

28

24

50

2010

37

43

54

78

2013

27

28

38

70

Closed treatment episodes 2004–05

61

72

60

58

2007–08

76

84

80

129

2010–11

69

96

87

135

2013–14

68

79

93

155

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

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

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

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

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

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

 

Illicit drug use 2013

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

MC IR OR remote

Crude percent

Cannabis

9.8

10.0

12.0

13.6

Ecstasy

2.9

1.5

1.6

*1.8

Meth/amphetamine

2.1

1.6

2.0

*4.4

Cocaine

2.6

0.8

*1.1

*2.5

Any illicit drug

14.9

14.1

16.7

18.7

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

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

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

 

Physical activity

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

MC

IR

OR/Remote

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

64.3

70.1

72.4

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

64.8

68.6

71

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

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

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

Table 10: Average daily steps, 2011-12

MC

IR

OR/Rem

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

7,393

7,388

7,527

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

9,097

9,266

9,160

Sources:

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

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

MC

IR

OR/Remote

Australia

Hours

Physical activity(a)

3.9

3.4

3.9

3.8

Sedentary behaviour (leisure only)(b)

29.3

28.0

27.9

28.9

Sedentary behaviour (leisure and work)(b)

40.2

35.2

36.0

38.8

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

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

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

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

MC

IR

OR/Rem

Crude percentage

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

27.5

34.3

34.2

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

28.0

29.7

31.0

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

9.7

10.9

14.2

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

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

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

 

Fruit and vegetable consumption

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

MC

IR

OR/Remote

Crude Percentage

Inadequate fruit consumption(a)

50.0

50.6

51.2

Inadequate fruit consumption(b)

50.4

48.3

48.0

Inadequate vegetable consumption(a)

93.4

93.5

89.3

Inadequate vegetable consumption(b)

n.p.

n.p.

n.p.

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

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

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

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

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

MC

IR

OR

R

VR

Crude Percent

Inadequate daily fruit consumption (2013 NHMRC Guidelines)

59.0

60.6

56.9

54.9

49.1

Inadequate daily fruit consumption (2003 NHMRC Guidelines)

62.1

63.6

59.8

58.3

51.6

Inadequate daily vegetables consumption (2013 NHMRC Guidelines)

95.9

93.5

93.6

94.5

97.9

Inadequate daily vegetables consumption (2003 NHMRC Guidelines)

93.8

90.6

90.5

91.2

96.1

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

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

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

 

 

Overweight and Obesity

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

MC

IR

OR/Remote

Crude Percentage

Persons, overweight/obese (a)

61.1

69.2

69.2

Age standardised percentage

Males overweight (b)

43.8

41.1

34.3

Males obese (b)

25.8

33.1

38.2

Females overweight (b)

28.9

28.3

30.1

Females obese (b)

25.0

32.4

33.7

People  overweight (b)

36.2

34.4

31.4

People obese (b)

25.4

32.6

35.8

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

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

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

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

 

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

MC

IR

OR

R

VR

Crude Percent

Overweight

27.5

28.8

30.1

32.5

26.4

Obese

37.9

41.3

36.2

33.1

32.3

Overweight/obese

65.4

70.1

66.2

65.6

58.8

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

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

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

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

 

High blood pressure

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

MC

IR

OR/Remote

Percentage

Crude % (a)

21.9

27.1

24

Age standardised % (b)

22.7

24.6

22.1

Sources:

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

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

Updated 31/07/2017
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