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

 

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

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

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

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

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

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

Donate at the the GOFUNDME PAGE

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

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

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

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

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

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

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

Read full speaking notes HERE

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

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

Australie: une cagnotte pour faire libérer des femmes aborigènes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Call for income-appropriate fines

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

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

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

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

ABC NEWS: SARAH COLLARD

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

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

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

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

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

“It’s a terrible, terrible thing

NACCHO Aboriginal Health and #chronicdisease @SandroDemaio How #obesity ups your chronic disease risk and what to do about it

” Almost two in every three Australian adults are now overweight or obese, as are one in four of our children.

This rising obesity burden is the outcome of a host of factors, many of which are beyond our individual control – and obesity is linked to a number of chronic diseases.”

Dr Sandro Demaio is an Aussie medical doctor and global expert on non-communicable diseases. Co-host of the ABC TV series ‘Ask the Doctor’, author of 30 scientific papers and ‘The Doctor’s Diet’ (a cookbook based on science) see Part 2 below 

This article was originally published HERE 

Part 1 NACCHO Policy

” The committee heard that Aboriginal Community Controlled Health Organisations (ACCHOs) run effective programs aimed at preventing and addressing the high prevalence of obesity in Aboriginal and Torres Strait Islander communities.

Ms Pat Turner, Chief Executive Officer of National Aboriginal Community Controlled Health Organisation (NACCHO), gave the example of the Deadly Choices program, which is about organised sports and activities for young people.

She explained that to participate in the program, prospective participants need to have a health check covered by Medicare, which is an opportunity to assess their current state of health and map out a treatment plan if necessary.

However, NACCHO is of the view that ACCHOs need to be better resourced to promote healthy nutrition and physical activity.

Access to healthy and fresh foods in remote Australia

Ms Turner also pointed out that ‘the supply of fresh foods to remote communities and regional communities is a constant problem’.

From NACCHO Submission Read here 

” Many community members in the NT who suffer from chronic illnesses would benefit immensely from using Health Care Homes.

Unfortunately, with limited English, this meant an increased risk of them being inadvertently excluded from the initiative.

First, Italk Alice Springs produced the English version of the story. Then using qualified interpreters, they produced Aboriginal language versions in eight languages: Anmatyerre, Alyawarr, Arrernte, East Side Kriol, West Side Kriol, Pitjatjantjara, Warlpiri and Yolngu Matha

Read Article HERE

Figure 2.22-1 Proportion of persons 15 years and over (age-standardised) by BMI category and Indigenous status, 2012–13
Proportion of persons 15 years and over (age-standardised)

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Read over 60 Aboriginal Health and Obesity articles published by NACCHO over past 7 Years

What is chronic disease?

Chronic disease is a broad term, which includes type 2 diabetes, heart disease, cancers, certain lung conditions, mental illness and genetic disorders. They are often defined by having complex and multiple causes, and are long-term or persistent (‘chronic’ actually means long-term).

How is obesity linked to chronic disease?

Obesity increases the risk of developing certain chronic diseases, including cardiovascular diseases (heart disease and stroke), sleep disorders, type 2 diabetes and at least 13 types of cancer.

Type 2 diabetes and obesity:

Obesity is the leading risk factor for type 2 diabetes, and even being slightly overweight increases this risk. Type 2 diabetes is characterised physiologically by decreased insulin secretion as well as increased insulin resistance due to a combination of genetic and environmental factors. Left uncontrolled, this can lead to a host of nasty outcomes like blindness, kidney problems, heart disease and even loss of feeling in our hands and feet.

Obstructive sleep apnoea and obesity:

This is another chronic disease often linked to obesity. Sleep apnoea is caused when our large air passage is partially or fully blocked by a combination of factors, including the weight of fat tissue sitting on our neck. It can cause us to jolt awake, gasping for oxygen. It leads to poor sleep, which adds physiological pressure to critical organs.

A woman preparing vegetables for a meal

Cancer and obesity:

This is a disease of altered gene expression. It originates from changes to the cell’s DNA caused by a range of factors, including inherited mutations, inflammation, hormones, and external factors including tobacco use, radiation from the sun, and carcinogenic agents in food. Strong evidence also links obesity to a number of cancers including throat cancer, bowel cancer, cancer of the liver, gallbladder and bile ducts, pancreatic cancer, breast cancer, endometrial cancer and kidney cancer.

Obesity is also associated with high blood pressure and increased risk of heart attack and stroke.

This might sound overwhelming, but it’s not all bad news. Here are a few things we can all start to do today to reduce our risk of obesity and associated chronic disease:

1. Eat more fruit and veg

Most dietary advice revolves around eating less. But if we can replace an unhealthy diet with an abundance of fresh, whole fruits and vegetables – at least two servings of fruit per day and five servings of vegetables – we can reduce our risk of obesity whilst still embracing our love for good food.

2. Limit our alcohol consumption

Forgo that glass of wine or beer after a long hard day at work and opt instead for something else that helps us relax. Pure alcohol is inherently full of energy – containing twice the energy per gram as sugar. This energy is surplus and non-essential to our nutritional needs, so contributes to our widening waistlines. And whether we’re out for drinks with mates or at a function, we can reduce our consumption by spacing out our drinks and holding off before reaching for another glass.

3. Get moving

While not everyone loves a morning sprint, there are many enjoyable ways to maintain a sufficient level of physical activity. Doing some form of exercise for at least 30 minutes each day is an effective way of keeping our waistlines in check. So, take a break to stretch out the muscles a few times during the workday, spend an afternoon at the local pool, get out into the garden or take some extra time to ride or walk to work. If none of these appeal, do some research to find the right exercise that will be fun and achievable.

Two women exercising in a park together

4. Buddy up

There’s nothing like a bit of peer pressure to get us healthy and active. Pick a friend who has the same goals and encourage each other to keep going. Sign up for exercise classes together, meet for a walk, have them over for a healthy meal, share tips and seek out support when feeling uninspired.

5. Prioritise sleep

Some argue that sleep is the healthy icing on the longevity cake. The benefits of a good night’s sleep are endless, with recent research suggesting it can even benefit our decision-making and self-discipline, making it easier to resist that ‘between-meal’ treat. Furthermore, lack of sleep can increase our appetite and see us lose the enthusiasm to stay active.

Above all, we need to foster patience and perseverance when it comes to achieving a healthy weight. It might not happen overnight, but it is within reach.

Let’s start today!

Co-host of the ABC TV series ‘Ask the Doctor’, author of 30 scientific papers and ‘The Doctor’s Diet’ (a cookbook based on science), Dr Sandro Demaio is an Aussie medical doctor and global expert on non-communicable diseases.

NACCHO Aboriginal Women’s and Bubs Health :#ClosetheGap #refreshtheCTGRefresh All-Aboriginal team at ACCHO helps mums raise healthier babies

If they have a healthy pregnancy then the bubba’s going to be healthy once bubba comes along, and they’re going to be healthy adults.

“That [will] be passed on intergenerationally as well, that’s where we’re really going to close the gap.”

Nurse Katarina Keeler said she wants her clients to leave the program feeling empowered to make good choices for themselves and their young families.

By Jacqueline Breen

Towards the end of our interview, in between giggles, Kirri McKenzie hinted at something that has been worrying her.

She is 26 weeks pregnant and woke up that morning feeling teary and short-tempered.

“All I was thinking is, ‘am I going to’?” she said, her big grin flickering off and on.

She has been watching, warily, for any possible signs of pre-natal depression — she presses her hand to her heart at the thought.

“But I guess it was just this morning, and now this morning’s over,” she said.

She laughed: “It’s past lunch now, so we’re getting there!”

Nurse Katarina Keeler sat next to Kirri on the couch watching on, and gently chipped in.

“Don’t forget about all those hormones changing as well,” she said.

Kirri nodded, put her smile back on, and launched in to an anecdote about her recent mood swings and cravings, and a meltdown triggered by the theft of a much-needed hash brown by a younger sibling.

She has Kat’s help on hand for the next two years, at least, although Kirri has already declared the young nurse a de facto aunty for her soon-to-be first-born.

The two are paired together as part of a nurse home visiting program for women having Aboriginal or Torres Strait Islander babies, a program that will hit a milestone in 2019 of 10 years’ operation in Australia.

Four women stand holding dolls

‘We’ve already been there’

The program was imported from the United States where it was first created to help younger, poorer families raise healthier babies.

It was adapted for an Indigenous Australian context and extra funding from the Australian government in 2018 saw it expand to new sites, so it now operates in all states except Tasmania and Western Australia.

In Darwin, where the program has been running for 18 months, the team is all Aboriginal women, working from Danila Dilba Health Service’s northern suburbs clinic.

The shared cultural background helps nervous clients feel more comfortable, said nurse supervisor Colleen Voss.

“They know they’re not going to be judged by anybody,” she said.

“We know what they’re going through because we come from communities also, and we’ve already been there and done all that.”

Navigating the systems

Kat and the other nurse home visitors talk their clients through pregnancy to toddlerhood, covering everything from healthy eating and breastfeeding to the risks of smoking and foetal alcohol spectrum disorder.

But they also go above and beyond the strictly medical stuff, and trouble-shoot problems that could otherwise spiral.

Kirri needed help dealing with Centrelink (“the worst place on earth!”) when she was fired after ongoing morning sickness early in her pregnancy.

And Kat said many clients are living in over-crowded housing, where they have less control over the environment surrounding them and their baby.

“There’s a big wait-list, about five to six years, for [public] housing here in Darwin,” she said.

“That’s one of the biggest stressors that we always have a yarn about with our clients — we help put in the housing application forms, we help with the ID and stuff.

“We just help them navigate those systems a bit easier.”

A long-term vision

In 2017 the Northern Territory youth detention and child protection royal commission said in its final report, like others already had, that early, effective support for vulnerable families can make collisions with those systems less likely later on.

The report also recommended a Productivity Commission review of spending on child and family services in the Northern Territory to ensure that they are coordinated — the NT and Federal Governments are still yet to agree on an inquiry’s terms of reference.

Katarina Keeler said she wants her clients to leave the program feeling empowered to make good choices for themselves and their young families.

“If they have a healthy pregnancy then the bubba’s going to be healthy once bubba comes along, and they’re going to be healthy adults,” she said.

“That [will] be passed on intergenerationally as well, that’s where we’re really going to close the gap.”

NACCHO Aboriginal Health :  The Indigenous Marathon Project @IndigMaraProjct annual search for 12 young Indigenous Australians who are passionate about making a difference : February and March the national Try-Out Tour, visiting remote communities and big cities

“2019 is IMP’s 10th year and its impact has been massive. Running a marathon is hard, doing it in just six months with no running experience demonstrates the incredible strength and resilience of our Indigenous people. It’s an amazing experience – don’t miss it.”

Founded in 2010 by world marathon champion Rob de Castella, IMP is a core program of the Indigenous Marathon Foundation – a health promotion charity that addresses chronic disease in remote communities. IMP now has 86 graduates across Australia, each who have gone on to make their mark on the world

Download the the IMP poster to promote imp a3poster 12-18 (1)

Applications can be made at: www.imf.org.au

Do you have what it takes to cross the finish line of the world’s biggest marathon?

The Indigenous Marathon Project (IMP) has begun its annual search for 12 young Indigenous Australians who are passionate about making a difference.

Each year, IMP selects, educates and trains a squad of inspirational Indigenous men and women to compete in the world’s biggest marathon – the New York City Marathon.

Open to all Indigenous Australians aged 18 to 30, IMP is not looking for the fastest runner. Instead, those who are passionate about becoming positive role models in their communities, who want to drive change and promote healthy lifestyles, are encouraged to apply.

IMP isn’t a sports program; it’s a social change program that uses running as a vehicle to promote the benefits of active and healthy lifestyles, while celebrating Indigenous resilience and achievement.

IMP Head Coach and 2014 graduate of the program, Adrian Dodson-Shaw, said that IMP’s reach was growing every year.

“It’s great to see the number of applications increase year after year, as IMP grows bigger and bigger and more people understand what the project is about,” Mr Dodson-Shaw said. “This isn’t about completing a marathon – it’s about changing your life.”

Mr Dodson-Shaw will set off around Australia in February and March on the national Try-Out Tour, visiting remote communities and big cities, testing the endurance of applicants with a trial run and an interview.

The successful 2019 squad will have to complete four national camps in the lead-up to the NYC Marathon, as well as taking part in the project’s education component, which will see them graduate with a Certificate IV in Sport and Recreation.

Applications can be made at: www.imf.org.au

 

.

.@NACCHOChair Season’s Greetings and a very Happy #ChooseHealth New Year from all the NACCHO mob : Make @DeadlyChoices a #sugarfree 2019 New Year #SugaryDrinksProperNoGood

Season’s Greetings and a Happy New Year from the National Aboriginal Community Controlled Health Organisation

On behalf of NACCHO, the Board and our staff we wish you a safe, happy and healthy festive season.

Please note : Our Canberra Office Closes 20 December and Re Opens 4 January 2019

2018 has been a year of change, with many new members joining the NACCHO Board.

With change comes opportunity, 2019 will see many new and exciting developments as NACCHO continues to enhance better service for the sector.

We look forward to building strong relationships with you, maintain Aboriginal community control and work together in the new year to improve health and well-being outcomes for Aboriginal and Torres Strait Islander peoples.

I hope you all have good health, happiness and a safe holiday season

Ms Donnella Mills Chair NACCHO

Click on our 2018 year in review

If the NACCHO Christmas card isn’t playing, click here to view in a web browser.

”  This campaign is straightforward – sugary drinks are no good for our health.It’s calling on people to drink water instead of sugary drinks.’

Aboriginal and Torres Strait Islander people in Cape York and throughout all our communities experience a disproportionate burden of chronic disease compared to other Australians.’

‘Regular consumption of sugary drinks is associated with increased energy intake and in turn, weight gain and obesity. It is well established that obesity is a leading risk factor for diabetes, kidney disease, heart disease and some cancers. Consumption of sugary drinks is also associated with poor dental health.

Water is the best drink for everyone – it doesn’t have any sugar and keeps our bodies healthy.’

Apunipima Public Health Advisor Dr Mark Wenitong

WATCH Apunipima Video HERE

“We tell ‘em kids drink more water; stop the sugar. It’s good for all us mob”

Read all 60 + NACCHO articles Health and Nutrition HERE

https://nacchocommunique.com/category/nutrition-healthy-foods/

 ” Let’s be honest, most countries and communities (and especially Aboriginal and Torres Strait Islanders ) now face serious health challenges from obesity.

Even more concerning, so do our kids.

While no single mission will be the panacea to a complex problem, using 2017 to set a new healthy goal of giving sugar the kick would be a great start.

Understand sugar, be aware of it, minimise it and see it for what it is – a special treat for a rare occasion.

This New Year’s, make breaking up with sugar your planned resolution.

“Hey sugar – it’s not me, it’s you…”

Alessandro R Demaio  Global Health Doctor; Co-Founded NCDFREE & festival21; Assoc. Researcher, University of Copenhagen and NACCHO supporter ( First Published 2016 see in full below )

We recommend the Government establish obesity prevention as a national priority, with a national taskforce, sustained funding and evaluation of key measures including:

  • Laws to stop exposure of children to unhealthy food and drink marketing on free to air television until 9.30 pm
  • Mandatory healthy food star rating from July 2019 along with stronger food reformulation targets
  • A national activity strategy to promote walking, cycling and public transport use
  • A 20 per cent health levy on sugary drinks

Australia enjoys enviable health outcomes but that is unlikely to last if we continue to experience among the world’s highest levels of obesity.

 CEO of the Consumers Health Forum, Leanne Wells

NACCHO Aboriginal #HealthStarRating and #Nutrition @KenWyattMP Free healthy choices food app will dial up good tucker

” Weight gain spikes sharply during the Christmas and New Year holiday period with more than half of the weight we gain during our lifetime explained just by the period between mid-November and mid-January.

Public Health Advocacy Institute of WA

 ” Labels that warn people about the risks of drinking soft drinks and other sugar-sweetened beverages can lower obesity and overweight prevalence, suggests a new Johns Hopkins Bloomberg School of Public Health study.

The study used computer modelling to simulate daily activities like food and beverage shopping of the populations of three U.S. cities – Baltimore, San Francisco and Philadelphia.

It found that warning labels in locations that sell sugary drinks, including grocery and corner stores, reduced both obesity and overweight prevalence in the three cities, declines that the authors say were attributable to the reduced caloric intake.

The virtual warning labels contained messaging noting how added sugar contributes to tooth decay, obesity and diabetes.

The findings, which were published online December 14 in the American Journal of Preventive Medicine, demonstrates how warning labels can result in modest but statistically significant reductions in sugary drink consumption and obesity and overweight prevalence.”

Diabetes Queensland : Warning labels can help reduce sugary drinks consumption and obesity, new study suggests

 

Global recognition is building for the very real health concerns posed by large and increasing quantities of hidden sugar in our diets. This near-ubiquitous additive found in products from pasta sauces to mayonnaise has been in the headlines and in our discussions.

The seemingly innocuous sweet treat raises eyebrows from community groups to policy makers – and change is in the air.

Let’s review some of the sugar-coated headers from 2016 :

  • The global obesity epidemic continued to build while more than two-in-three Australian adults faced overweight or obesity – and almost one in four of our children.
  • Science around sugary drinks further solidified, with consumption now linked to obesitychildhood obesityheart diseasediabetes (type-2), dental caries and even lower fertility.
  • Australians were estimated to consume a staggering 76 litres of sugary drinks each since January alone, and new reports highlighted that as much as 15% of the crippling health costs associated with obesity could result from sugary drinks consumption.
  • Meanwhile around the planet, more countries took sound policy measures to reduce sugar consumption in their citizens. France, Belgium, Hungary, Finland, Chile, the UK, Ireland, South Africa and many parts of the United States implemented, continued or planned the implementation of pricing policies for sugary drinks.

In short, the over-consumption of sugar is now well recognised as a public health challenge everywhere.

With all this in mind and a New Year ahead, it’s time to put big words into local action. With resolutions brewing, here are seven helpful tips to breaking up with sugar in 2017.

1. Understand sugar

When it comes to sugar, things can get pretty confusing. Below, I shed some light on the common misunderstandings, but let’s recheck sugar itself – in simplest terms.

Sugar is a type of refined carbohydrate and a source of calories in our diet. Our body uses sugar and other sources of calories as energy, and any sugar that is not used is eventually stored as fat in our liver or on our bellies.

“Free sugars” are those added to products or concentrated in the products – either by us or by the manufacturer. They don’t include sugars in whole fruits and vegetables, but more on that later. For a range of health reasons, the World Health Organization recommends we get just 5% of our daily calories from free sugars. For a fully grown man or woman, this equates to a recommended limit to sugar consumption of roughly 25 grams – or 6 teaspoons. For women, it’s a little less again.

Consume more than this, and our risk of health problems rises.

2. Quit soft drinks

With 16 teaspoons of sugar in a single bottle serving – that’s more than 64 grams– there’s nothing “soft” about soft drinks. Including all carbonated drinks, flavoured milks and energy drinks with any added sugars, as well as fruit drinks and juices, sugary drinks are a great place to focus your efforts for a healthier 2018. Sugary drinks provide no nutritional value to our diets and yet are a major source of calories.

sugartax

What’s more concerning, evidence suggests that when we drink calories in the form of sugary drinks, our brains don’t recognise these calories in the same way as with foods. They don’t make us feel “full” and could even make us hungrier – so we end up eating (and drinking) more. In this way, liquid calories can be seen as even more troubling than other forms of junk foods. Combine this with studies that suggest the pleasure (and sugar spike) provided by sugary drinks may make them hard to give up – and it’s not difficult to see why many of us are drinking higher amounts, more often and in larger servings. This also makes cutting down harder.

The outcome is that anything up to one-seventh of the entire public cost of obesity in Australia could now result from sugary drinks. In other words, cut out the sugary drinks and you’ll be doing your own health a favour – and the health of our federal and state budgets.

3. Eat fruit, not juice

When it’s wrapped in a peel or a skin, fruit sugars are not a challenge to our health. In fact, the sugars in fruit are nature’s way of encouraging us to eat the fruit to begin with. Fruits like oranges, apples and pears contain important fibres. The “roughage” in our foods, this fibre is healthy in many ways but there are three in particular I will focus on. First, it slows our eating down; it is easy to drink a glass of juice squeezed from 7 apples, but much harder to eat those seven pieces whole. Second, it makes us feel full or satiated. And third, it slows the release of the sugars contained in fruit into our blood streams, thus allowing our bodies to react and use the energy appropriately, reducing our chances of weight gain and possibly even diabetes.

Juice, on the other hand, involves the removal of most of those fibres and even the loss of some of the important vitamins. What we don’t lose though, is the 21 grams or more than five teaspoons of sugar in each glass.

In short, eat fruit as a snack with confidence. But enjoy whole fruit, not juice.

4. Sugar by any other name

High-fructose corn syrup, invert sugar, malt sugar and molasses – they all mean one thing: sugar.

As the public awakens to the health challenges posed by sugar, the industry turns to new ways to confuse consumers and make ‘breaking up’ more difficult. One such way is to use the many alternative names for sugar – instead of the ‘s’ word itself. Be on the lookout for:

Evaporated cane juice, golden syrup, malt syrup, sucrose, fruit juice concentrate, dextrose and more…

5. Eat whole foods where possible

Tomato sauce, mayonnaise, salad dressings, gravies, taco sauces, savoury biscuits and breakfast cereals – these are just some of the many foods now often packed with hidden, added sugars.

study found that 74% of packaged foods in an average American supermarket contain added sugars – and there is little evidence to suggest Australia would be dramatically different. Added to food to make it more enjoyable, and moreish, the next tip when avoiding such a ubiquitous additive is to eat whole foods.

It’s hard to hide sugar in plain flour, or a tomato, or frozen peas. Buying and cooking with mostly whole foods – not products – is a great way to ensure you and your family are not consuming added sugars unaware.

6. See beyond (un)healthy claims

Words like “wholesome”, “natural” and “healthy” are clad on many of our favourite ingredients. Sadly, they don’t mean much.

Even products that are full of sugar, like breakfast cereals and energy bars, often carry claims that aim to confuse and seduce us into purchase. Be wary – and be sure to turn the package over and read the ingredients and nutrition labelling where possible (and if time permits).

7. Be okay with sometimes

The final but crucial message in all of this is that eating or drinking sugar is not a sin. Sugar is still a part of our lives and something to enjoy in moderation. The occasional piece of cake, or late night chocolate – despite the popular narrative painted by industry to undermine efforts for true pricing on sugar – these occasional sweet treats are not the driving challenge for obesity. The problem is that sugary drinks, and sugar in our foods, have become every day occurrences.

With this in mind, let’s not demonise sugar but instead let’s see it for what it is. Enjoy some juice or bubbles from time to time but make water the default on an everyday basis. With the average can of cola containing 39 grams or 9 teaspoons of sugar, be OK with sometimes.

Bitter truth

Let’s be honest, We now face serious health challenges from obesity.

Even more concerning, so do our kids.

Learn more about our ACCHO making Deadly Choices

NACCHO Aboriginal Health and #refreshtheCTGRefresh : Download the @AIHW National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: results for 2017 showing improvements in 16 out of a possible 23 measures

Between June and December 2017, improvements were seen in 16 out of a possible 23 measures for which comparable data for both periods were available (see Table S1 for details). Results for a further indicator remained stable between reporting periods.

The improvements were seen in 12 of the 15 process-of-care measures with comparable data. Improvements were also seen in 4 of the 8 outcome measures, while 1 outcome measure remained stable. The largest improvements (4 or 5 percentage points) were seen in the recording practices for the measuring of:

  • influenza immunisations for clients with type 2 diabetes, which rose from 31% to 36%
  • influenza immunisations for clients with chronic obstructive pulmonary disease (COPD), which rose from 32% to 37%
  • influenza immunisations for clients aged 50 and over, which rose from 32% to 36%. ” 

 Extract from good news from AIHW Report

 Download full 158 page report HERE

aihw-ihw-200 (1)

Summary

This is the fifth national report on the Indigenous primary health care national Key Performance Indicators (nKPIs) data collection. It presents data on all 24 nKPI indicators for the first time.

Data for this collection are provided to the Australian Institute of Health and Welfare (AIHW) by primary health care organisations that receive funding from the Australian Government Department of Health to provide services to Aboriginal and Torres Strait Islander people. Some primary health care organisations included in the collection receive additional funding from other sources, including state and territory health departments.

As of the June 2017 data collection, changes have been made to the data extraction method, with the Department of Health introducing a new direct load reporting process. This allowed Communicare, Medical Director, and Primary Care Information System (PCIS) clinical information systems (CISs) to generate nKPI data within their clinical system, and transmit directly to the OCHREStreams portal. Best Practice services were provided with an interim tool while MMEx has always had direct load capability.

61.9 % our ACCHO’s

The new process was introduced to provide a greater level of consistency between CISs, but the change in the extraction method means that data from June 2017 onwards are not comparable with earlier collections.

As the June 2017 collection represents a new baseline for the collection, this report only presents data for June and December 2017.

For 2 indicators (Kidney function tests recorded and Kidney function test results) only December 2017 results are presented due to unresolved data quality issues in June 2017.

See Chapter 2 for more information on the change in extraction method, data quality, and the impact  on the collection, and Appendix E for data improvement projects and the nKPI/Online Service Reporting (OSR) review under way.

Improvements were seen for most indicators between June and December 2017. Although data from these 2 reporting periods are not comparable with earlier reporting periods, an overall pattern of improvement is in keeping with the pattern of improvement previously reported for the period June 2012 to May 2015 (see AIHW 2017). This indicates that health organisations continue to show progress in service provision.

Things to work on

For the 3 process-of-care indicators that did not show improvements—glycated haemoglobin (HbA1c) result recorded (6 months), cervical screening, and Medicare Benefits Schedule (MBS) health assessment for those aged 0–4—the changes were very small (0.5, 0.4, and 0.1 percentage points, respectively).

In the case of cervical screening, this might be due to changes to the cervical screening program, which took effect from 1 December 2017 (see Chapter 4 for details).

Three outcome measures that did not show improvements—HbA1c result of 7% or less, low birthweight, and smoking status of women who gave birth in the previous 12 months—saw changes of between 0.8 and 1.8 percentage points.

Contents

  • 1 Introduction
    • The nKPI collection
    • Structure of this report
  • 2 Data quality
    • Data quality issues
    • Additional considerations for interpreting nKPI data
  • 3 Maternal and child health indicators
    • Why are these indicators important?
    • 3.1 First antenatal visit
    • 3.2 Birthweight recorded
    • 3.3 MBS health assessment (item 715) for children aged 0-4
    • 3.4 Child immunisation
    • 3.5 Birthweight result
    • 3.6 Smoking status of females who gave birth within the previous 12 months
  • 4 Preventative health indicators
    • Why are these important?
    • 4.1 Smoking status recorded
    • 4.2 Alcohol consumption recorded
    • 4.3 MBS health assessment (item 715) for adults aged 25 and over
    • 4.4 Risk factors assessed to enable cardiovascular disease (CVD) risk assessment
    • 4.5 Cervical screening
    • 4.6 Immunised against influenza-Indigenous regular clients aged 50 and over
    • 4.7 Smoking status result
    • 4.8 Body mass index classified as overweight or obese
    • 4.9 AUDIT-C result
    • 4.10 Cardiovascular disease risk assessment result
  • 5 Chronic disease management indicators
    • Why are these important?
    • 5.1 General Practitioner Management Plan-clients with type 2 diabetes
    • 5.2 Team Care Arrangement-clients with type 2 diabetes
    • 5.3 Blood pressure result recorded-clients with type 2 diabetes
    • 5.4 HbA1c result recorded-clients with type 2 diabetes
    • 5.5 Kidney function test recorded-clients with type 2 diabetes
    • 5.6 Kidney function test recorded-clients with cardiovascular disease
    • 5.7 Immunised against influenza-clients with type 2 diabetes
    • 5.8 Immunised against influenza-clients with chronic obstructive pulmonary disease
    • 5.9 Blood pressure result-clients with type 2 diabetes
    • 5.10 HbA1c result-clients with type 2 diabetes
    • 5.11 Kidney function test result-clients with type 2 diabetes-eGFR
    • 5.12 Kidney function test result-clients with type 2 diabetes-ACR
    • 5.13 Kidney function test result-clients with cardiovascular disease-eGFR
  • 6 Discussion
    • Data improvements
  • Appendix A: Background to the nKPI collection and indicator technical specifications
  • Appendix B: Data completeness
  • Appendix C: Comparison of nKPI results
  • Appendix D: State and territory and remoteness variation figures
  • Appendix E: Data improvement projects
  • Appendix F: Guide to the figures
  • Glossary
  • References

NACCHO Aboriginal Women’s Health #SistersInside #imaginingabolition : Our CEO Pat Turner address to @SistersInside 9th International Conference Decolonisation is not a metaphor’: Abolition for First Nations women

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

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

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

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

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

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

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

See Pats full speaking notes below

Theme of the day: ‘Decolonisation is not a metaphor’: Abolition for First Nations women

About Sisters Inside

  • Sisters Inside responds to criminalised women and girls’ needs holistically and justly. We work alongside women and girls to build them up and to give them power over their own lives. We support women and girls to address their priorities and needs. We also advocate on behalf of women with governments and within the legal system to try to achieve fairer outcomes for criminalised women, girls and their children.
  • At Sisters Inside, we call this ‘walking the journey together’. We are a community and we invite you to be part of a brighter future for Queensland’s most disadvantaged and marginalised women and children.

Sisters Inside Website Website 

In Picture above Dr Jackie Huggins, Pat Turner, Jacqui Katona, Dr Chelsea Bond and June Oscar, Aunty Debbie Sandy and chaired by Melissa Lucashenko.

Panel: Why abolition for First Nations Women?

Panel members:

  • Dr Jackie Huggins AM FAHA (Co-Chair, National Congress of Australia’s First Peoples)
  • Pat Turner AM (CEO, National Aboriginal Community Controlled Health Organisation)
  • Dr Chelsea Bond (Senior Lecturer, University of Queensland)
  • Jacqui Katona (Activist & Sessional Lecturer (Moondani Balluk), Victoria University)
  1. Imprisonment, colonialism, and statistics
  • The Australian justice system was founded on a white colonial model that consistently fails and seeks to control and supress Aboriginal and Torres Strait Islander peoples.
  • Indigenous peoples are overrepresented in the prison system:
    • Aboriginal and Torres Strait Islander adults are 12.5 times more likely to be imprisoned than non-Indigenous Australians.[i]
    • Our women represent the fastest growing group within prison populations and are 21 times more likely to be imprisoned than non-Indigenous women.[ii]
  • Imprisonment is another dimension to the historical and contemporary Aboriginal experience of colonial removal, institutionalisation and punishment.[iii]
  • Our experiences of incarceration are not only dehumanising. They contribute to our ongoing disempowerment, intergenerational trauma, social disadvantage, and burden of disease at an individual as well as community level.
  1. Aboriginal and Torres Strait Islander women’s experiences of imprisonment
  • The Change the Record report found that most Aboriginal and Torres Strait Islander women who enter prison systems:
    • are survivors of physical and sexual violence, and that these experiences are most likely to have contributed to their imprisonment; and
    • struggle with housing insecurity, poverty, mental illness, disability and the effects of trauma.
  • Family violence must be understood as both a cause and an effect of social disadvantage and intergenerational trauma.
  • Risk factors for family violence include poor housing and overcrowding, substance misuse, financial difficulties and unemployment, poor physical and mental health, and disability.[iv]
  • Imprisoning women affects the whole community. Children are left without their mothers. The whole community suffers.
  1. Kimberley Suicide Prevention Trial
  • The Kimberley Suicide Prevention Trial, of which NACCHO is a member, provides a grim example of the link between trauma, suicide, incarceration and the social determinants of health.
  • The rate of suicide in the Kimberley is seven times that of other Australian regions.
  • Nine out of ten suicides involve Aboriginal people.
  • Risk factors include imprisonment, poverty, homelessness and family violence.
  • Western Australia has the highest rate of Aboriginal and Torres Strait Islander imprisonment.
  1. Imprisonment and institutional racism
  • The overrepresentation of Aboriginal peoples in prison systems is not simply a law-and-order issue.[v] The trends of over-policing and imprisoning of Indigenous peoples are examples of institutional racism inherent in the justice system. [vi]
  • Institutional racism affects our everyday encounters with housing, health, employment and justice systems.
  • Institutional racism is not only discriminatory; it entrenches intergenerational trauma and socioeconomic disadvantage.[vii]
  • Exposure to racism is associated with psychological distress, depression, poor quality of life, and substance misuse, all of which contribute significantly to the overall ill-health experienced by Indigenous people. We are twice as likely to die by suicide or be hospitalised for mental health or behavioural reasons.
  1. Ways forward see opening quote Pat Turner 
  2. The role of ACCHSs in supporting Indigenous women

Increasing access to the health care that people need

  • Racism is a key driver of ill-health for Indigenous people, impacting not only on our access to health services but our treatment and outcomes when in the health system.
  • Institutional racism in mainstream services means that Indigenous people do not always receive the care that we need from Australia’s hospital and health system.
  • It has been our experience that many Indigenous people are uncomfortable seeking help from mainstream services for cultural, geographical, and language disparities as well as financial costs associated with accessing services.
  • The combination of these issues with racism means that we are less likely to access services for physical and mental health conditions, and many of our people have undetected health issues like poor hearing, eyesight and chronic conditions.

Early detection of health issues that are risk factors for incarceration

  • The Aboriginal Community Controlled Health model provides answers for addressing the social determinants of health, that is, the causal factors contributing to the overrepresentation of Indigenous women’s experiences of family violence and imprisonment.
  • Aboriginal Community Controlled Health organisations should be funded to undertake comprehensive, regular health check of Aboriginal women so that risk factors are identified and addressed early.

Taking a holistic approach to health needs and social determinants of health and incarceration

  • Overall, the Aboriginal Community Controlled Health model recognises that Aboriginal and Torres Strait Islander people require a greater level of holistic healthcare due to the trauma and dispossession of colonisation which is linked with our poor health outcomes.
  • Aboriginal Community Controlled Health is more sensitive to the needs of the whole individual, spiritually, socially, emotionally and physically.
  • The Aboriginal Community Controlled Model is responsive to the changing health needs of a community because it of its small, localised and agile nature. This is unlike large-scale hospitals or private practices which can become dehumanised, institutionalised and rigid in their systems.
  • Aboriginal Community Controlled Health is scalable to the needs of the community, as it is inextricably linked with the wellbeing and growth of the community.
  • The evidence shows that Aboriginal Community Controlled organisations are best placed to deliver holistic, culturally safe prevention and early intervention services to Indigenous women.
  1. About NACCHO
  • NACCHO is the national peak body representing 145 ACCHOs across the country on Aboriginal health and wellbeing issues. In 1997, the Federal Government funded NACCHO to establish a Secretariat in Canberra, greatly increasing the capacity of Aboriginal peoples involved in ACCHOs to participate in national health policy development.
  • Aboriginal Community Controlled Health first arose in the early 1970s in response to the failure of the mainstream health system to meet the needs of Aboriginal and Torres Strait Islander people and the aspirations of Aboriginal peoples for self-determination.
  • An ACCHO is a primary health care service initiated and operated by the local Aboriginal community to deliver holistic, comprehensive, and culturally appropriate health care to the community which controls it, through a locally elected Board of Management. ACCHOs form a critical part of the Indigenous health infrastructure, providing culturally safe care with an emphasis on the importance of a family, community, culture and long-term relationships.
  • Our members provide about three million episodes of care per year for about 350,000 people. In very remote areas, our services provided about one million episodes of care in a twelve-month period. Collectively, we employ about 6,000 staff (most of whom are Indigenous), which makes us the single largest employer of Indigenous people in the country.

[i] https://www.alrc.gov.au/publications/over-representation

[ii] Human Rights Law Centre and Change the Record Coalition, 2017, Over-represented and overlooked: the crisis of Aboriginal and Torres Strait Islander women’s growing over-imprisonment: NB: The foreword is written by Vicki Roach, a presenter in the next session of the Abolition conference

[iii] file://nfs001/Home$/doris.kordes/Downloads/748-Article%20Text-1596-5-10-20180912.pdf – John Rynne and Peter Cassematis, 2015, Crime Justice Journal, Assessing the Prison Experience for Australian First Peoples: A prospective Research Approach, Vol 4, No 1:96-112.

[iv] Australian Institute of Health and Welfare. 2018. Family, domestic and sexual violence in Australia. Canberra.

[v] https://www.theguardian.com/australia-news/2017/feb/20/indigenous-incarceration-turning-the-tide-on-colonisations-cruel-third-act

[vi] ‘A culture of disrespect: Indigenous peoples and Australian public institutions’.

[vii] https://www.theguardian.com/australia-news/2018/jul/12/indigenous-women-caught-in-a-broken-system-commissioner-says

NACCHO Aboriginal Health and #rethinksugarydrink : A new campaign asking people to reduce their sugar intake highlights the link between obesity and 13 different types of cancer

 ” Obesity is now a leading preventable cause of cancer , but less than half of all Australians are aware of the link . A new campaign launched today by Cancer Council Victoria is aiming to change this.

In a ground-breaking new public awareness campaign, Cancer Council Victoria will expose the link between obesity and 13 types of cancer by depicting the toxic fat around internal organs.

As many as 98% of Australians are aware that obesity is a risk factor for type 2 diabetes and heart disease, but as little as 40% of Australians know about its link with cancer . ”

Being above a healthy weight is now a leading preventable cause of cancer. Our new campaign urges people to avoid to reduce their risk

You wouldn’t put this much sugar in a tea or coffee? But if you’re drinking one soft drink a day, over 20 years – that’s 73,000 teaspoons.”

Dr Gihan Jayaweera

A third of Victorians admit to drinking more than a litre of sugary drink each week 7, that’s more than 5.5kgs of sugar a year. We want people to realise that they could be drinking their way towards weight gain, obesity and toxic fat, increasing their risk of 13 types of cancer,”

Dr Ahmad Aly

 ” 69% of Aboriginal and Torres Strait Islander people are considered overweight (29%) or obese (40%); among children this is 30% (20% overweight, 10% obese) “

Read over 60 NACCHO Aboriginal Health and Obesity articles

Or see Statistics part 2 Below 

SEE NEWS COVERAGE

https://www.9news.com.au/7f9400a3-9f9d-4e39-9eb2-eef88a7291ce

Cancer Council Victoria CEO, Todd Harper, acknowledged that the campaign’s portrayal of toxic fat could be confronting but said so was the fact that nearly two-thirds of Australians were overweight or obese 4.

“While talking about weight is a sensitive issue, we can’t shy away from the risk being above a healthy weight poses to our health.” Mr Harper said.

“With around 3,900 cancers in Australia each year linked to being above a healthy weight, it’s vital that we work hard to help people understand the link and encourage them to take steps to reduce their risk 5.”

Sugary drinks contribute the most added sugar to Australians’ diets 6, so Cancer Council Victoria is focusing on how these beverages can lead to unhealthy weight gain, which can increase the risk of certain cancers. The campaign will communicate that one way of reducing the risk is to cut sugary drinks from your diet.

The ad features Melbourne surgeon Dr Ahmad Aly exposing in graphic detail what sugary drinks could be doing to your health, as his laparoscopic camera delves inside a patient’s body to expose the dangerous toxic fat around internal organs.

Watch Video 

Dr Aly has seen first-hand the impact toxic fat has on people’s health and hopes the campaign will make people think again before reaching for sugary drinks.

Jane Martin, Executive Manager of the Obesity Policy Coalition, said that while the campaign aims to get people thinking about their own habits, Cancer Council Victoria and partner organisations are also working to encourage governments, the food industry, and communities to make changes.

“It’s virtually impossible to escape the enormous amount of marketing for sugary drinks surrounding us on TV, social media and public transport. It’s also easier to get a sugary drink than it is to find a water fountain in many public places, and that’s got to change. We need to take sugary drinks out of schools, recreation and healthcare settings to make it easier for Victorians to make healthy choices.”

“The need for a healthy weight strategy in Victoria, as well as nationally, is overdue. In the same way tobacco reforms have saved lives, we now need to apply the same approach to improving diets”, Ms Martin said.

Case study: Fiona Humphreys

Since giving up the sweet stuff, Fiona Humphreys has more energy and has managed to shed the kilos and keep them off.

“I used to drink at least two sugary drinks every day as a pick me up, one in the morning and one in the afternoon. I was addicted to the sugar rush and thought I needed them to get through my busy day.”

“After giving up sugary drinks I saw an immediate change in both my mood and my waistline. I lost 7 kilos just by making that one simple change and I haven’t looked back.”

“I decided to go cold turkey and switched to soda or mineral water with a slice of lime or lemon. I tricked my mind to enjoy the bubbles and put it into a beautiful glass. I feel healthier and my mind is clearer as a result.”

The campaign will run for five weeks and be shown on TV and radio and will feature across social media channels as well as outdoors across the state.

A dedicated campaign website cancervic.org.au/healthyweight will provide factsheets for health professionals and consumers and digital elements about how to make small lifestyle changes to improve people’s health.

Top tips to avoid sugary drinks 

  • Avoid going down the soft drink aisle at the supermarket and beware of the specials at the checkout and service stations.
  • If you’re eating out, don’t go with the default soft drink – see what other options there are, or just ask for water.
  • Carry a water bottle, so you don’t have to buy a drink if you’re thirsty.
  • Herbal teas, sparkling water, home-made smoothies or fruit infused water are simple alternatives that still taste great.
  • For inspiration and recipe ideas visit cancervic.org.au/healthyweight

How is sugar linked to weight gain

Sugar is a type of carbohydrate which provides energy to the body. However, eating too much sugar over time can lead to weight gain. Strong evidence shows that being above a healthy weight increases the risk of developing 13 different types of cancer and chronic diseases including cardiovascular disease and type 2 diabetes.

Let’s unpack what happens when our body receives more energy than it needs, how this can lead to weight gain and what you can do to decrease your risk of cancer.

Where do we find sugar?

In terms of health risks, we need to be concerned about ‘added sugar’. That is, sugar that has been added to food or drink.

Natural sugars in foods

  • Fruit and milk products
  • High in nutrients – vitamins, minerals, fibre or calcium.
  • We should eat these foods every day.

Sugar added to food

  • Processed foods
  • These foods are unhealthy and high in energy (kJ).
  • They don’t have other nutrients we need such as fibre, vitamins and minerals.
  • We should limit these foods.

Aboriginal and Torres Strait Islander Communities

Aboriginal and Torres Strait Islander communities tend to have higher rates of obesity and sugary drink consumption and experience poorer health outcomes as a result.

We know that more than half of the Aboriginal and Torres Strait Islander community drink sugary drinks almost every day.

The Overview also examined factors contributing to health, including nutrition and body weight. Some statistics of note include:

  • dietary risks contribute 9.7% to the total burden of disease for Aboriginal people
  • 69% of Aboriginal and Torres Strait Islander people are considered overweight (29%) or obese (40%); among children this is 30% (20% overweight, 10% obese)
  • 54% of Indigenous Australians meet the daily recommended serves of fruit; only 8% meet the daily recommended serves of vegetables
  • both measures are lower in remote communities compared with urban areas and intake is far more likely to be inadequate among the unemployed and those who did not finish school
  • on average, Aboriginal and Torres Strait Islander people consume 41% of their daily energy in the form of discretionary foods — 8.8% as cereal-based products (cakes, biscuits & pastries) and 6.9% as non-alcoholic beverages (soft drinks)
  • average daily sugar consumption is 111g — two-thirds (or the equivalent of 18tsp of white sugar) of which are free sugars from discretionary foods and beverages
  • 22% of Aboriginal people reported running out of food and being unable to afford more in the past 12 months; 7% said they had run out and gone hungry — both were more prevalent in remote areas

In the latest issue of JournalWatch, Dr Melissa Stoneham takes a look at obesity in Australia’s remote Indigenous communities and the struggle to eat well against the odds

Read in full at Croakey

Yorta Yorta woman Michelle Crilly gave up her sugary drink habit and hasn’t looked back. Watch her story.

Video: Rethink Sugary Drink - Michelle Crilly

Read more about the ‘Our Stories’ campaign and hear from more inspiring Victorian Aboriginal community members who have cut back on sugary drinks on our partner site Rethink Sugary Drink.

NACCHO Aboriginal Health and #BreastCancerAwarenessMonth : Download @AIHW BreastScreen Australia monitoring report :Download #Indigenous Resources from @CancerAustralia 

 

” Around 55% of women in the targeted age group of 50–74 participated in the BreastScreen Australia in 2015–2016 with more than 1.7 million screening. Breast cancer mortality has decreased since BreastScreen Australia began from 74 deaths per 100,000 women aged 50–74 in 1991 to 44 deaths per 100,000 women in 2015.

While Indigenous women experience a lower age-standardised incidence rate of breast cancer than non-Indigenous women (rate ratio of 0.9; AIHW 2017c), breast cancer is still the most common cancer diagnosed in Indigenous women. “

Download the full AIHW Report aihw-can-116

NACCHO Aboriginal Women’s Health #BreastCancerAwareness #getChecked : 1.Download #Indigenous Resources from @CancerAustralia 

Participation in BreastScreen Australia and breast cancer outcomes in Indigenous women

Aboriginal and Torres Strait Islander women of Australia, hereafter respectfully referred to as Indigenous women, experience a high burden from breast cancer.

While Indigenous women experience a lower age-standardised incidence rate of breast cancer than non-Indigenous women (rate ratio of 0.9; AIHW 2017c), breast cancer is still the most common cancer diagnosed in Indigenous women.

Aspects of breast cancer and breast screening in Indigenous women are reported by the AIHW and others in various reports and publications, but considering these data individually is not as valuable as considering all available data collectively.

This chapter therefore brings together the BreastScreen Australia participation, incidence and mortality data that previously appeared in several places in this report, and supplements these with additional analyses on incidence, survival and mortality, as well as incorporating data and findings from other published sources.

5.1 Participation in BreastScreen Australia in Indigenous women

Indigenous status of women who participate in BreastScreen Australia is self-reported by women at the time of their screen.

In 2015–2016, participation of Indigenous women aged 50–74 in BreastScreen Australia was 39.1%, compared with the non-Indigenous rate of 54.3% (age-standardised).

Participation trends for Indigenous and non-Indigenous women are shown in Figure 5.1. Historical Indigenous participation rates have been recalculated using new Indigenous population estimates so that meaningful comparisons between reporting periods can be made (see Box 5.1).

Trend data show that the participation rates in Indigenous women aged 50–69 have increased, from around 32%–33% for all reporting periods between 2001–2002 and 2011–2012 to 38% in 2014–2015 and 39% in 2015–2016—although Indigenous women have always had a lower participation rate than non-Indigenous women (Figure 5.2).

Lower participation of Indigenous women may reflect a decreased opportunity to screen, compared with non-Indigenous women, and/or different screening behaviour of Indigenous women (that is, being less likely to screen even with the same opportunity to do so). There may also be a level of under-reporting of Indigenous status in BreastScreen data (as Indigenous status is self-reported by women at the time of their screen), which would also have the effect of lowering the apparent participation rate. This is because under-identification of Indigenous women in BreastScreen data would reduce the size of the numerator without affecting the denominator.

 

Figure 5.1: Participation of women aged 50–74 in BreastScreen Australia, by Indigenous status, 2015–2016 

Source: AIHW analysis of BreastScreen Australia data. Data for this figure are available in Table A1.8.

Figure 5.2: Participation of women aged 50–69 in BreastScreen Australia, by Indigenous status, 1996–1997 to 2015–2016

42 BreastScreen Australia monitoring report 2018

Box 5.1: Indigenous populations

This report uses Indigenous population estimates based on the 2011 Census, which were the most recent estimates available at the time of preparation of this report.

New Indigenous population estimates were released by the ABS in 2014 based on the 2011 Census. These estimates included backcasts of the Indigenous population, as well as population projections to 2026. The backcast estimates of the Indigenous population were considerably larger than those previously published based on the 2006 Census.

This is in part due to improvements in Census coverage and enumeration of Indigenous Australians in the 2011 Census, and an increased likelihood that individuals identified themselves and their children as Indigenous. Historical Indigenous participation rates have been recalculated using these new Indigenous population estimates so that meaningful comparisons between reporting periods can be made over time. Rates presented in this report should not be compared with previously published rates that used population estimates based on the 2006 Census.

Results of a recent Queensland project, ‘Closing the Gap in Breast Cancer Screening’, suggest that different screening behaviour of Indigenous women may play a significant role in their lower participation rates. This project aimed to address barriers to screening for Indigenous women through culturally appropriate messages, art shows and partnerships with local Indigenous groups, in order to build trust, educate and support Indigenous women to attend BreastScreen Australia. The project reported an increase in Indigenous participation from 49% to 56% in 2 years.

Initiatives such as these are common to state and territory BreastScreen programs. These strategies and initiatives are designed to be culturally sensitive and appropriate to the knowledge, attitudes and beliefs of Aboriginal and Torres Strait Islander women. They include dedicated and appropriate communication resources, group bookings for Indigenous women who would prefer to attend as a group, and the use of Indigenous artwork. BreastScreen workers liaise closely with Aboriginal Health Workers and Aboriginal and Torres Strait Islander community groups to increase acceptance of screening.

In the last quarter of 2014–15, the Australian Government ran the National BreastScreen Australia Campaign to support the expansion of the program to women aged 50–74. The campaign included additional communication activities for Aboriginal and Torres Strait Islander consumers, with materials developed in consultation with Aboriginal and Torres Strait Islander women.

Access to BreastScreen services for Indigenous women is a national policy feature of BreastScreen Australia, which has developed National Accreditation Standards (NAS) Measures to ensure that this policy feature is met by services accredited through BreastScreen Australia (see Box 3.3 for more information on NAS Measures and accreditation). These NAS Measures, along with other NAS Measures related to access and participation in BreastScreen Australia, underpin BreastScreen Australia’s aim to maximise the proportion of women in the target population who are screened every 2 years. Table 3.1 shows the NAS Measures related to participation.

5.2 Breast cancer outcomes in Indigenous women

The source of national cancer incidence data in Australia is the Australian Cancer Database (ACD), which is compiled from data supplied by state and territory cancer registries. The cancer registers rely on pathology forms as their primary source of information—which do not include Indigenous status in all states and territories. However, the cancer registers collect

BreastScreen Australia monitoring report 2018 43

information from additional sources, such as hospital records and death records, which allows for information on Indigenous status to be collected where possible.

The level of identification of Indigenous status in the ACD for the period 2009–2013 is considered sufficient to enable analysis in 5 jurisdictions, with data from New South Wales, Victoria, Queensland, Western Australia and the Northern Territory. While the majority (89.9%) of Australian Indigenous people live in these 5 jurisdictions, the degree to which data for these jurisdictions are representative of data for all Indigenous people is unknown (ABS 2012).

Analysis of data from these jurisdictions showed that, in 2009–2013, Indigenous women aged 50–74 had a lower incidence rate of breast cancer, at 251 new cases per 100,000 women, compared with 285 new cases for non-Indigenous women (Figure 5.3)—with a similar trend for all ages (99 compared with 111 per 100,00 women).

Note: Rates age-standardised to the Australian population as at 30 June 2001; ‘Total’ rate includes women with a ‘not stated’ Indigenous status and is therefore greater than the ‘Non-Indigenous’ rate.

Source: AIHW Australian Cancer Database 2014. Data for this figure are available in Table A7.8.

Figure 5.3: Incidence of breast cancer in women aged 50–74 (New South West, Victoria, Queensland, Western Australia and the Northern Territory), by Indigenous status, 2009–2013

Survival

Crude survival was also calculated, and found to be lower for Indigenous women, compared with non-Indigenous women—crude survival was 73.7% for Indigenous women of all ages, compared with 84.3% for non-Indigenous women of all ages during the period 2009–2013. Similarly, crude survival was lower in Indigenous women when restricted to women aged 50–74 (75.4% compared with 89.0% for non-Indigenous women).

Mortality

The source of mortality data is the AIHW National Mortality Database, in which information on Indigenous status is considered to be adequate for reporting for 5 jurisdictions: New South Wales, Queensland, Western Australia, South Australia and the Northern Territory.

In 2011–2015, the mortality rate from breast cancer was higher in Indigenous women aged 50–74, at 55 deaths per 100,000 women, compared with 46 deaths for non-Indigenous women (Figure 5.4). While participation in BreastScreen Australia has a direct effect on the incidence of breast cancer, additional factors come into play for mortality from breast cancer, such as the stage of cancer at diagnosis, and access to treatment.

NACCHO Aboriginal Health and #Cancer Policies , Strategies and Future directions : Latest @HealthInfoNet review shows many cancers are preventable among Aboriginal and Torres Strait Islander people

‘The review shows that cultural safety in service provision, increased participation in breast, bowel and cervical screening and reduction in risk factors will improve outcomes for cancer among Aboriginal and Torres Strait Islander people.

The good news is that many cancers are considered to be preventable. Lung cancer is the most commonly diagnosed cancer among Aboriginal and Torres Strait Islander people, followed by breast cancer, bowel cancer and prostate cancer.

Tobacco smoking is still seen as the greatest risk factor for cancer’.

HealthInfoNet Director, Professor Neil Drew

Read over 75 Aboriginal Health and Cancer articles published by NACCHO last 6 years

“Aboriginal and Torres Strait Islander Community Controlled Health Services

Aboriginal and Torres Strait Islander Community Controlled Health Services are located in all jurisdictions and are funded by the federal,state and territory governments and other sources [91].

They are planned and governed by local Aboriginal and Torres Strait and Torres
Strait Islander communities and aim to deliver holistic and culturally appropriate health and health-related services.

Services vary in the primary health care activities they offer. Possible activities include: diagnosis and treatment of illness or disease; management of chronic illness; transportation to medical appointments; outreach clinic services; immunisations; dental services; and dialysis services.

Aboriginal and Torres Strait Islander cancer support groups have been identified as important for improving cancer awareness and increasing participation in cancer screening services [92].

Aboriginal women attending these support groups have reported an increased
understanding of screening and reported less fear and concern over cultural appropriateness, with increases in screening rates [19].

Support groups have also been found to help in follow up and ongoing care for cancer survivors [19, 93], particularly where they are shaped to meet the needs of Aboriginal and Torres Strait Islander people [73, 94].”

See Page 12 of Review

Download Review+of+cancer+among+Aboriginal+and+Torres+Strait+Islander+people

The Australian Indigenous HealthInfoNet (HealthInfoNet) at Edith Cowan University has published a new Review of cancer among Aboriginal and Torres Strait Islander people.

The review, written by University of Western Australia staff (Margaret Haigh, Sandra Thompson and Emma Taylor), in conjunction with HealthInfoNet staff (Jane Burns, Christine Potter, Michelle Elwell, Mikayla Hollows, Juliette Mundy), provides general information on factors that contribute to cancer among Aboriginal and Torres Strait Islander people.

It provides detailed information on the extent of cancer including incidence, prevalence and survival, mortality, burden of disease and health service utilisation.

This review discusses the issues of prevention and management of cancer, and provides information on relevant programs, services, policies and strategies that address cancer among Aboriginal and Torres Strait Islander people.

The review provides:

  • general information on factors (historical/protective/risk) that contribute to cancer among Aboriginal and Torres Strait Islander people
  • detailed information on the extent of cancer among Aboriginal and Torres Strait Islander people, including: incidence, prevalence and survival data; mortality and burden of disease and health service utilisation
  • a discussion of the issues of prevention and management of cancer
  • information on relevant programs, services, policies and strategies that address cancer among Aboriginal and Torres Strait Islander people
  • a conclusion on the possible future directions for combating cancer in Australia

Selected Extracts

Policies and strategies

There are very few national policies and strategies that focus specifically on cancer in the Aboriginal and Torres Strait Islander population. The National Aboriginal and Torres Strait Islander Cancer Framework is therefore significant as the first national approach to addressing the gap in cancer outcomes that currently exists between Aboriginal and Torres Strait Islander people and the non-Indigenous population [132]. However, over the past 30 years, there have been a number of relevant strategies and frameworks developed addressing cancer in the general population, and broader aspects of Aboriginal and Torres Strait Islander health. A selection of national policy developments relevant to addressing cancer among Aboriginal and Torres Strait Islander people are described briefly below.

Selected national policy developments relevant to addressing cancer among Aboriginal and Torres Strait Islander people

2018 Lung Cancer Framework: Principles for Best Practice Lung Cancer Care in Australia is released
2016 National Framework for Gynaecological Cancer Control is released
2015 First National Aboriginal and Torres Strait Islander Cancer Framework is released
2015 Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan is released
2014 Second Cancer Australia Strategic Plan 2014–2019 is published
2013 First National Aboriginal and Torres Strait Islander Health Plan 2013–2023 is published
2011 First Cancer Australia Strategic Plan 2011–2014 is published
2008 National Cancer Data Strategy for Australia is released
2003 Report Optimising Cancer Care in Australia is published
1998 First National health priority areas cancer control report is published
1996 Cancer becomes one of four National health priority areas (NHPA)
1988 Health for all Australians report is released
1987 First National Cancer Prevention Policy for Australia is published

 

It was not until the late 1980s that national cancer control strategies and policies began to be developed [133]. In 1987, the first National Cancer Prevention Policy for Australia, was published by the Australian Cancer Society (ACS) (now the Cancer Council Australia) based on a series of expert workshops [134].

It outlined what prevention activities were currently being undertaken, what should be undertaken and suggested a number of goals, targets and strategies in the areas of cancer prevention and early detection and screening. This policy has been updated many times over the years [133] and is still in publication as the National cancer control policy [135].

The following year, in 1988, the Health for all Australians report, commissioned by the Australian Health Ministers’ Advisory council (AHMAC), recognised that cancers could be influenced by primary or secondary prevention strategies [136]. The report recommended nine goals and 15 targets related to cancers, based on those put forward by the National Cancer Prevention Policy for Australia. Cancer prevention and strategies relating to breast, cervical and skin cancer and tobacco smoking were recommended as initial priorities under the National Program for Better Health. These were then endorsed at the Australian Health Ministers Conference and funding was provided.

In 1996, cancer control was identified as one of four National health priority areas (NHPA). This led, the following year, to the publication of the First report on national health priority areas 1996, which outlined 26 indicators spanning the continuum of cancer care, and included outcome indicators, indicators relating to patient satisfaction and the creation of hospital based cancer registries [137].

In 1998, the first NHPA cancer control report was produced [138]. It identified a number of opportunities for improvements in cancer control, including within ‘special populations such as Indigenous people’ [138].

In 2003, the report Optimising cancer care in Australia was jointly developed by The Cancer Council Australia, the Clinical Oncological Society of Australia (COSA) and the National Cancer Control Initiative (NCCI), with strong consumer input [139]. This report made 12 key recommendations, including that the needs of Aboriginal and Torres Strait Islander people be the focus of efforts to bridge gaps in access to and utilisation of culturally sensitive cancer services.

In 2008, the National Cancer Data Strategy for Australia aimed to provide direction for collaborative efforts to increase data availability, consistency and quality [140]. It reported that although Indigenous status is recorded by cancer registries, data quality is poor, and recommended that the quality of Indigenous markers in hospital and death statistics collections needs to improve if cancer registries are to have better data.

In 2011, Cancer Australia published the first Cancer Australia strategic plan 2011–2014, which aimed to identify future trends in national cancer control and to outline strategies for the organisation to improve outcomes for all Australians diagnosed with cancer [141]. It was followed in 2014, by the Cancer Australia Strategic Plan 2014–2019, which had an increased focus on improving quality of cancer care and outcomes for Aboriginal and Torres Strait Islander people [142].

In 2013, the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 (the Health plan) was developed to provide a long-term, evidence-based policy framework approach to closing the gap in disadvantage experienced by Aboriginal and Torres Strait Islander people [143].

The Health plan emphasises the importance of culture in the health of Aboriginal and Torres Strait Islander people and the rights of individuals to a safe, healthy and empowered life. Its vision is for the Australian health system to be free of racism and inequity and all Aboriginal and Torres Strait Islander people to have access to health services that are effective, high quality, appropriate and affordable. This led to the publication of the Implementation plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 in 2015 [90], which outlines the strategies, actions and deliverables required for the Australian Government and other key stakeholders to implement the Health plan.

The first National Aboriginal and Torres Strait Islander Cancer Framework (the Framework­) was released in 2015, to address disparities and improve cancer outcomes for Aboriginal and Torres Strait Islander people [56]. It provides strategic direction by setting out seven priority areas for action and suggests enablers that may help in planning or reviewing strategies to address each of the priority areas. The Framework aims to improve cancer outcomes for Aboriginal and Torres Strait Islander people by ensuring timely access to good quality and appropriate cancer related services across the cancer continuum.

In 2016, Cancer Australia released the National Framework for Gynaecological Cancer Control to guide future directions in national gynaecological cancer control to improve outcomes for women affected, as well as their families and carers [144]. It aims to ensure the provision of best practice and culturally appropriate care to women across Australia by offering strategies across six priority areas, of which one pertains specifically to improving outcomes for Aboriginal and Torres Strait Islander women.

In 2018, Cancer Australia released the Lung Cancer Framework: Principles for Best Practice Lung Cancer Care in Australia [145]. It aims to improve the outcomes and experiences of people affected by lung cancer by supporting the uptake of five principles: patient-centred care; multidisciplinary care; timely access to evidence-based care; coordination, communication and continuity of care and data-driven improvements.

Future directions

The National Aboriginal and Torres Strait Islander Cancer Framework (the Framework­) provides guidance for individuals, communities, organisations and governments [56]. The Framework was developed in partnership with Menzies School of Health Research, and was informed by a systematic review of the evidence and extensive national consultations. The parties involved in these consultations included Aboriginal and Torres Strait Islander people affected by cancer, health professionals working with Aboriginal and Torres Strait Islander people and experts in Indigenous cancer control. The Framework outlined seven evidence-based priority areas for action as follows:

  • improving knowledge and attitudes about cancer
  • focusing prevention activities
  • increasing participation in screening and immunisation
  • ensuring early diagnosis
  • delivering optimal and culturally appropriate treatment and care
  • involving, informing and supporting families and carers
  • strengthening the capacity of cancer-related services to meet the needs of Aboriginal and Torres Strait Islander people.

Each of these priorities was accompanied by a number of enablers to assist in planning or reviewing strategies to address that priority. The enablers provide flexible approaches to meeting the priorities that allow for local context and needs.

The development of the Framework has been responsible for gathering national support and agreement on the priorities and for creating a high level of expectation around the ability to address the growing cancer disparity [146]. Cancer Australia has since commenced a number of projects and initiatives that focus on one or more of the priorities identified by the Framework. One project aims to identify critical success factors and effective approaches to increasing mammographic screening participation for Aboriginal and Torres Strait Islander women [147]. A leadership group on Aboriginal and Torres Strait Islander cancer control tasked with driving a shared agenda to improve cancer outcomes has also been established [148]. In addition, the development of a monitoring and reporting plan for the Framework is underway.

Quality data are critical to understanding the variations in cancer care and outcomes of Aboriginal and Torres Strait Islander people, and to inform policy, service provision and clinical practice initiatives to improve those outcomes. However, it has been repeatedly reported in the literature and by the Framework, that current data are inadequate or incomplete, and there is a significant need for improved local, jurisdictional and national data on Aboriginal and Torres Strait Islander people with cancer [56149-151]. In particular, the need for primary healthcare services to address the under identification of Aboriginal and Torres Strait Islander status in data registries. A project currently underway in SA, which is likely to have relevance to other regions, aims to develop an integrated comprehensive, cancer monitoring and surveillance system for Aboriginal people, while also incorporating their experiences with cancer services [149].

Both the Framework and the literature have identified a need for a more supportive and culturally appropriate approach across the cancer care continuum for Aboriginal and Torres Strait Islander people [5677151152]. The Wellbeing Framework for Aboriginal and Torres Strait Islander Peoples Living with Chronic Disease, (Wellbeing framework), aims to assist healthcare services to improve the quality of life and quality of care, as well as health outcomes, for Aboriginal and Torres Strait Islander people living with chronic disease [153]. This addresses the identified need for more supportive and culturally appropriate care as it attempts to incorporate the social, emotional, cultural and spiritual aspects of health and wellbeing, as well as the physical aspects.

The Wellbeing framework is underpinned by two core values, which are considered fundamental to the care of Aboriginal and Torres Strait Islander people [153154]. These core values highlight that wellbeing is supported by:

  • upholding people’s identities in connection to culture, spirituality, families, communities and country and
  • having culturally safe primary healthcare services in place.

The Wellbeing framework consists of four essential elements for supporting the wellbeing of Aboriginal and Torres Strait Islander people living with chronic disease [153154]. These show the importance of having:

  • locally defined, culturally safe primary health care services
  • appropriately skilled and culturally competent health care teams
  • holistic care throughout the lifespan
  • best practice care that addresses the particular needs of a community.

The Wellbeing framework suggests a number of practical and measurable applications for applying or achieving the underlying principles of each element. It has the capacity to be adapted by primary healthcare services, in consultation with the communities they serve, to more effectively meet the chronic and cancer care needs of their communities [153154].

 

The Leadership Group on Aboriginal and Torres Strait Islander Cancer Control was established in 2016-17 to:

  • provide strategic advice and specialist expertise in Indigenous cancer control
  • encourage cross-sector collaboration in addressing the priorities in the National Aboriginal and Torres Strait Islander Cancer Framework
  • share knowledge across the sector to leverage opportunities.

Concluding comments

Despite considerable improvements in cancer detection and treatment over recent decades, Aboriginal and Torres Strait Islander people diagnosed with cancer generally experience poorer outcomes than non-Indigenous people for an equivalent stage of disease [2797]. This is highlighted by statistics which showed that, despite lower rates of prevalence and hospitalisation for all cancers combined for Aboriginal and Torres Strait Islander people compared with non-Indigenous people, between 1998 and 2015, the age-standardised mortality rate ranged from 195 to 246 per 100,000 while the rate for non-Indigenous people decreased from 194 to 164 per 100,000 [2].

Furthermore for 2007–2014, while 65% of non-Indigenous people had a chance of surviving five years after receiving a cancer diagnosis, only 50% of Aboriginal and Torres Strait Islander people did [2].

The disparities are particularly pronounced for some specific cancers – for lung cancer the age-standardised incidence rate for Aboriginal and Torres Strait Islander people was twice that for non-Indigenous people, while for cervical cancer the rate was 2.5 times the rate for non-Indigenous people for 2009–2013 [2].

The factors contributing to these poorer outcomes among Aboriginal and Torres Strait Islander people are complex. They reflect a broad range of historical, social and cultural determinants and the contribution of lifestyle and other health risk factors [6], combined with lower participation in screening programs, later diagnosis, lower uptake and completion of cancer treatment, and the presence of other chronic diseases [2798155]. Addressing the various factors that contribute to the development of cancer among Aboriginal and Torres Strait Islander people is important, but improvements in some of these areas, particularly in reducing lifestyle and behavioural risk factors, are likely to take some time to be reflected in better outcomes.

Current deficiencies in the prevention and management of cancer suggest there is considerable scope for better services that should lead to improvements in the short to medium term. Effective cancer prevention and management programs that are tailored to community needs and are culturally appropriate are vital for the current and future health of Aboriginal and Torres Strait Islander people [5657]. Providing effective cancer prevention and management also requires improved access to both high quality primary health care services and tertiary specialist services. Effective and innovative programs for the prevention and management of cancer among Aboriginal and Torres Strait Islander people do exist on an individual basis and, in some cases, the efforts made to engage Aboriginal and Torres Strait Islander people in screening programs, in particular, are impressive. However, a more coordinated, cohesive national approach is also required.

Reducing the impact of cancer among Aboriginal and Torres Strait Islander people is a crucial aspect in ‘closing the gap’ in health outcomes. The National Aboriginal and Torres Strait Islander cancer framework [56] may be an important first step in addressing the current disparity in cancer outcomes and raises the probability of real progress being made. Cancer Australia has recently released the Optimal Care pathway for Aboriginal and Torres Strait Islander people which recommends new approaches to cancer care and with the aim of reducing disparities and improving outcomes and experiences for Aboriginal and Torres Strait Islander people with cancer [156]. As encouraging as these developments are, substantial improvements will also depend upon the effective implementation of comprehensive strategies and policies that address the complexity of the factors underlying the disadvantages experienced by Aboriginal and Torres Strait Islander people.

Action beyond the health service sector that addresses the broader historical, social and cultural determinants of health are also required if real progress is to be made [6].