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NACCHO Aboriginal Health and #FASD : Record Indigenous incarceration #justjustice rates could be avoided with early clinical assessment: experts

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 “Australia’s prison population recently reached a record 33,791 with 27 per cent of those identifying as Aboriginal or Torres Strait Islanders

Leading experts in Fetal Alcohol Spectrum Disorder (FASD) believe Australia’s record rates of Indigenous incarceration could be dramatically reduced if children were clinically assessed when their troubled behaviour first emerged in the classroom or at home.

In one form or another, Federal, State and Territory Governments have been inquiring into Indigenous prison rates since the 1987 leaving behind a long list of mostly-ignored recommendations “

As reported by Russell Skelton ABC

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NACCHO partnered with the Menzies School of Health Research and the Telethon Kids Institute (TKI) to develop and implement health promotion resources and interventions to prevent and reduce the impacts of Fetal Alcohol Spectrum Disorders (FASD) on Aboriginal and Torres Strait Islander families and young children.

NACCHO Report 1 of 4 :Prevent and reduce the impacts of Fetal Alcohol Spectrum Disorders (FASD)

Key points:

  • Experts say Indigenous incarceration rates could be reduced with early behavioural assessment
  • Fetal Alcohol Spectrum Disorder (FASD) affects many of those incarcerated
  • People with FASD are often unable to instruct a lawyer, understand court procedures and even the decisions handed down when convicted

The facts about FASD

  • FASD covers a range of conditions that can occur in children whose mothers drink during pregnancy
  • Conditions vary from mild to severe
  • The effects can include learning difficulties, behavourial problems, growth defects and facial abnormalities
  • The Australian Drug Foundation believes the condition is “significantly under-reported” in Australia
  • National Health and Medical Research Council guidelines say not drinking at all all during pregnancy is the safest option

A major issue in recent months:

  • Last month the Northern Territory’s adult prison population hit an alarming 15-year high. According to Corrections Commissioner Mark Payne 958 people are being held — almost half aboriginal and Torres Strait Islanders. He expects half will reoffend within two years of being released.
  • A report by Amnesty International Australia found, and ABC Fact Check confirmed, that incarceration rates for Indigenous children were 24 times higher than they were for non-Indigenous children.In WA the rate is 76 per 10,000, in the US, where rates of black incarceration are regarded as the highest in the western world, it is 52.
  • Attorney-General George Brandis and the Indigenous Affairs Minister Nigel Scullion announced the Federal Government have commissioned the Australian Law Reform Commission to investigate factors behind the over representation of Indigenous Australians in prison and to recommend reforms to “ameliorate the national tragedy”.
  • The appointment of a Royal Commission to investigate brutal treatment and years of detainee abuse at Darwin’s Don Dale Youth detention facility.The move followed detailed allegations of mistreatment by the ABC’s Four Corner program.

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The #JustJustice book is was launched  at Gleebooks in Sydney yesterday by Professor Tom Calma AO, and NACCHO readers are invited to download the 242-page e-version

The Federal Government must make good on its promise to listen to, and work with, Aboriginal and Torres Strait Islander people, including engaging with the solutions put forward in the forthcoming #JustJustice essay collection.

The book includes more than 90 articles on solutions to protect the rights of Australia’s First Peoples.

The experts said parents, teachers and health workers were often well aware of unacceptable behaviour in young people — both Indigenous and non-Indigenous — long before they appeared before the courts.

Around 70 per cent of young people in the juvenile justice system are Aboriginal, and research shows rates of the disorder amongst Aboriginal communities are significantly higher than non-Aboriginal communities.

Elizabeth Elliot, professor of Paediatrics and Child Health a Sydney University, said: “What we need is screening tool so teachers and health workers can assess a child’s executive functions and red flag cognitive impairments early on before they encounter the justice system.”

Four Corners: Hidden Harm


Mothers share their anguish over children left brain-damaged by drinking during pregnancy

Paediatrician and clinical research fellow at Perth’s Telethon Kids Institute Dr Raewyn Mutch agreed, saying there was a growing need to identify serious behavioural issues associated with FASD and other developmental disorders such as autism so affected children can be better managed.

Fetal Alcohol Spectrum Disorder, known as FASD, occurs in the children whose mothers consumed alcohol during pregnancy.

Symptoms include lifelong physical, mental, behavioural and learning difficulties. It can cause severe intellectual impairment, learning and memory disorders, high-risk and violent behaviour.

Professor Elliott said reform in Australia had been “glacial” compared with Canada and the United States, as authorities have been slow to acknowledge the extent of the problem.

“In Canada it is estimated that 60 per cent of kids in the juvenile justice system are FASD, it is a huge number,” she said.

“We don’t need another inquiry into the justice system, we need governments to act on the evidence before them from past inquiries,

Professor Elliott was the paediatric specialist involved the ground-breaking Lililwan study initiated by Aboriginal women. The study that found that one in five Indigenous children living in WA Fitzroy River Valley had FASD. Although still teenagers, many were before the juvenile justice.

“For children suffering from FASD, it’s like having the umpire removed from an AFL match, they have difficulties deciding best choices or understanding cause and effect,” Dr Mutch said.

“A person with FASD may have cognitive impairment, language difficulties as severe as being illiterate.”

Professor Elliott, a widely acknowledged authority on FASD, said offenders — non-Indigenous and Indigenous — with fetal alcohol brain damage were often incapable of changing their behaviour and learning from mistakes.

“These are young people who can be easily led, are incapable of understanding the consequences of their actions, have difficulty understanding the boundaries for acceptable behaviour. They can confess to crimes they did not commit.”

Dr Mutch said not only FASD affected individuals ended up in the justice system, but children with developmental difficulties and also children traumatised by conflict and abuse.

She is involved in landmark study of young offenders in WA’s Banksia Hill Detention Centre to establish the prevalence of FASD and other neurological disorders. The study is likely to revolutionise strategies for handling juveniles with “neurodevelopmental” issues.

The study will establish the first authoritative estimate in Australia of FASD among young people in detention. It involves a two day multi-disciplined clinical assessment of children with the hope of developing a screening tool for application among all young people entering the juvenile justice system.

“Children in the juvenile justice system have ended up there for a variety of reasons, many of these kids have learning and memory problems,” Dr Mutch said.

“They may also have speech and language problems. Not all are FASD affected, but all I would predict have experienced severe trauma.”

A ‘national tragedy’

A Productivity Commission report into Indigenous disadvantage released last week confirmed rates of incarceration had failed to drop despite a string of reports, inquiries and recommendations dating back to 1987 Deaths in Custody Royal Commission.

Dr Mutch said children were being excluded from society because their behaviour.

“The central question is what are the factors that caused them to be like that and how best to rehabilitate them,” she said.

Both Professor Elliott and Dr Mutch believe screening and clinical assessments in childhood would identify cognitive problems, enable early treatment and result in profound improvements in troublesome behaviours.

This would have an impact on child protection placements including foster care and the management of group homes where evidence has emerged of inappropriate placements and poor supervision.

Offenders with FASD are easily led, coerced by their peers. They can be incapable of providing a record of events, names of associates and often confabulate even to the extent of making false confessions.

They are often unable to instruct a lawyer, understand court procedures and even the decisions handed down when convicted.

In one form or another, Federal, State and Territory Governments have been inquiring into Indigenous prison rates since the 1987 leaving behind a long list of mostly-ignored recommendations.

The Senate is also inquiring into the indefinite detention of people with cognitive impairments — a central issue when it comes to explaining the “national tragedy”.

The Telethon Kids Institute noted in a submission to Senate inquiry into the indefinite detention of people with cognitive and psychiatric impairment that diagnosis of FASD has been limited by a lack of knowledge and until recently an absence of accepted national diagnostic framework.

Australia’s prison population recently reached a record 33,791 with 27 per cent of those identifying as Aboriginal or Torres Strait Islanders.

 

NACCHO Aboriginal #SexyHealth #ATSIHAW : Aboriginal and Torres Strait Islander #HIV Awareness Week

 

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 This year’s ATSIHAW is themed ‘You and me can stop HIV’ and the focus is on taking personal responsibility, and helping others, to end the spread of once-deadly disease.

ATSIHAW is designed to get people talking about HIV, to raise awareness of prevention methods, and testing and treatment options and to slow the rate of new infections to zero.

ATSIHAW leads into World AIDS Day on 1 st December 

These 4 article from Page 12 and 13  NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

naccho-newspaper-nov-2016 PDF file size 9 MB

” Since we started collecting HIV data among Aboriginal and Torres Strait Islander people in the early 1990s rates of diagnosis have been similar or lower than for non-Indigenous people. It’s been one of the good news stories of Aboriginal health for over two decades. But is this all at risk?

Aboriginal people are at higher risk of HIV because of high rates of other STIs, because of increasing injecting drug use within communities including sharing of injection equipment between people, lower health literacy regarding HIV, less access to primary health care and HIV specialist services “

A/Prof James Ward South Australian Health and Medical Research Institute Adelaide : Dr David Johnson, Public Health Medical Officer, Aboriginal Health Council of South Australia :Dr Salenna Elliott, Public Health Registrar, Aboriginal Health Council of South Australia

 “Hepatitis C is a virus that affects the liver. It is thought that 95% of the Hep C in Australia is acquired through sharing of injecting equipment or other equipment that transfers blood from one person to another, such as for tattooing.

Aboriginal and Torres Strait Islander people are overrepresented in hep C diagnoses in Australia, with an estimated 20,000-30,000 diagnoses in our population.  Without treatment hep C damages the liver, and can result in cancer and death. ”

A/Prof James Ward Head Infectious Diseases Research Aboriginal Health South Australian Health and Medical Research Institute :

See Article 4 below

Each year data are reported for all HIV diagnoses made in the previous year. This data are based on people reporting how they think they acquired HIV, e.g. via heterosexual sex, male-to-male sex, mother to child transmission, sharing injecting drug equipment. Data are also collected on Aboriginal and Torres Strait Islander status.

Over the last five years a worrying trend has emerged: HIV rates are stabilising in the non-Indigenous Australian-born population, while rates are increasing for our population. The rate of HIV diagnosis among Aboriginal and Torres Strait Islander people is now for the first time ever more than double the non-Indigenous rate.

There are also important differences in how HIV is transmitted, with more cases among Aboriginal people attributed to heterosexual sex and injecting drug use.

In the past five years:

  • 21% of cases in the Aboriginal population were attributed to heterosexual sex, compared to 14% amongst non-Indigenous people
  • 16% of cases among Aboriginal people were attributed to injecting drug use compared to 3% of cases in the non-Indigenous population .
  • 58% of new cases in the Aboriginal population were attributed to anal sex between men, compared to 80% among non-Indigenous people

These rising rates and different transmission patterns are of concern. At the global level we have seen that HIV can escalate quickly once it takes hold in marginalised populations such as Indigenous peoples, people who inject drugs, sex workers and prisoners.

This has happened among Canada’s First Nations peoples and in Saskatchewan, clinicians and communities are calling for a state of emergency to be declared because of rapidly escalating HIV rates.  Factors that place our communities at risk of an HIV epidemic include the high prevalence  of other sexually transmissible infections (STIs) that increase risk of HIV transmission, limited access to sexual health services, education  and prevention programs (particularly in regional and remote communities) and

HIV-related stigma and shame. For us to turn about the clear divergence in HIV rates between our population and the non-Indigenous we must act now.

While community education and awareness, condoms and safe sex are still the mainstay of HIV prevention – as are clean needles and syringes, detox services and drug rehabilitation for people who inject drugs – the use of HIV treatment medications is also now a major component of prevention strategies. We need to understand these new prevention tools and work out how to ensure their benefits reach our communities.

Treatment as prevention – the game-changer

Advances in HIV treatment medications mean that it’s now possible for someone with HIV to live as long as the person next to them who doesn’t. Modern treatments also mean that the amount of HIV in the blood of a person with HIV can be reduced to an undetectable level.

This is not a cure, but a person with an undetectable viral load is virtually non-infectious. At a community wide level, the more people with HIV who reach an undetectable viral load the less chance there is for people to acquire HIV.  This is called ‘treatment as prevention’.

A drug to prevent HIV

There’s also now a pill that can protect against HIV. Called Pre-Exposure Prophylaxis or PrEP for short,  PrEP involves HIV-negative people taking an HIV treatment antiretroviral drug before risk exposure, for example before having sex, to protect against contracting HIV. PrEP is only recommended for people most at risk of HIV – including men who have anal sex with men, and HIV-negative men or women with an HIV-positive partner.

Don’t forget PEP

Post exposure prophylaxis is a tablet you take after a high risk exposure to HIV. PEP works by preventing HIV entering the lymph system- but only if it is given within 72 hours after the exposure. PEP is available at most hospital Emergency departments and at sexual health services nationally.

For us to turn around rising HIV rates among Aboriginal people we need:

  1. Enhanced community education and awareness about HIV and sexual health at both national and local level, such as Aboriginal and Torres Strait Islander HIV Awareness Week which has just completed its third year of activities
  2. Continued promotion of safe sex and safe injecting, with improved community access to condoms, testing and treatment for STIs, Needle and syringe programs
  3. Capacity for referrals to appropriate drug treatment services
  4. Appropriate testing for HIV in Aboriginal primary care services for people at risk of HIV, including people who have a recent other STI diagnosis
  5. Enhanced early diagnosis and treatment rates, and education regarding the personal and community benefits of treatment as prevention.
  6. Community education on HIV, including on ‘treatment as prevention’, PrEP and to address HIV-related stigma and shame.

The cure for HIV is still a long way off, so we all need to do our bit to ensure HIV doesn’t take hold in our communities.

We acknowledge Ms Linda Forbes, of SAHMRI (proof read articles on Pages 12/13 ).

STI rates remain unacceptably high in our communitites

A/Prof James Ward Head Infectious Diseases and Sarah Betts STI Coordinator Aboriginal Health Council of South Australia

Rates of common sexually transmissible infections (STIs) among our communities remain grossly disproportionate to rates among non-Indigenous Australians.

In the policy and programming context, it could be said that in the scheme of things, persisting high rates of STIs are alarming but not requiring more urgent attention than other areas of Aboriginal health, such as diabetes, cardiovascular and child and maternal health-but should it be that way?

The failure to address high rates of STIs in has immediate and long-term implications for our communities. Poor outcomes in pregnancy, shame and stigma, interpersonal violence as an outcome of STI transmission, infertility and a much higher chance that HIV will be transmitted are just some of these. Those most affected are young people, and the more remote a young Aboriginal person’s community, the more likely they are to have not just one STI but multiple STIs. Young people in our remote communities face many challenges – let’s at least act to reduce the pervasive risk of STIs.

The main STIs

Let’s take a look at some of the most common infections:

  • Chlamydia is the most common STI in Australia, affecting both Aboriginal and non-Indigenous Australians, predominantly in the age group 15-25 years. Rates among Aboriginal people are between 3 and 5 times that of the non-Indigenous population, whether in cities, regional and remote areas. Chlamydia rarely has symptoms. It is easily tested for and treated with a one-off dose of antibiotics. If not detected and treated chlamydia can cause pelvic inflammatory disease and other serious complications in women, including poor outcomes in pregnancy.
  • Gonorrhoeae and syphilis disproportionately affect young Aboriginal people, particularly in remote and isolated communities. Rates of gonorrhoeae are 30 times higher for the Aboriginal population compared to the non-Indigenous population; and syphilis rates are five times higher. An outbreak of syphilis that started in 2011 and has spread across northern and central Australian remote communities has us way out of reach of once was thought to be possible; eliminating syphilis from our communities. Both STIs can cause major issues in pregnancy, including loss of the baby, and babies can be born with both infections. Both conditions are relatively easy tested for and treated with antibiotics.
  • Trichomonas is another STI very prevalent among Aboriginal and Torres Strait Islander people. In remote communities we have found that around 25% of women found to have trichomonas. Untreated Trichomonas can cause premature birth and low birth weight and of course facilitate HIV transmission

Upping STI testing and treatment rates

So testing and treating STIs is straightforward if they’re diagnosed early, but the consequences of failing to detect and treat infections are huge. We need to understand what’s stopping people getting tested. Shame and stigma obviously play a part, including for young people – how can we get to the point that young people in our communities see sexual health checks as a normal part of living a healthy life?  How can we ensure that babies aren’t born with STIs?

The work happening at the individual health service and NACCHO affiliate level as well as in mainstream, is great. But we need to intensify our focus on:

  1. Developing innovative community education and awareness to make sure young people are aware of these STIs and the need to test
  2. Equipping young people with skills and tools to prevent STIs
  3. Ensuring we are all aware that STIs often don’t have symptoms but are easily tested for and cured
  4. Ensuring our health services are offering regular testing as per clinical guidelines
  5. Normalising STI testing, including by making sure that that STI testing is offered as part of Adult Health Assessments, particularly for young people between 16 and 29 years.
  6. At a broader systemic level I believe an additional two national KPIs would be beneficial for raising the profile of this issue, in addition to a special PIP for full STI and BBV testing and elevation of STI testing in the Adult health check.

We have been working hard in research, trying to make sense of why STIs are still so common and to develop strategies bring down these unacceptably high rates. But much more work is required. The recent defunding of 20 or so Aboriginal sexual health worker positions in NSW should not even have been.

Hyper-vigilance is needed. Let’s all get onto this together – our young people have the right to enjoy full and healthy sexual relationships with their loved ones now and into the future.

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Hepatitis B – improving access to vaccination, diagnosis and treatment

A/Prof Benjamin Cowie, Director of the WHO Collaborating Centre for Viral Hepatitis, Doherty Institute

Aboriginal people were among the first groups in who hepatitis B was discovered in the 1960s – which is why for a while the virus was known as ‘The Australia Antigen’.

The proportion of Aboriginal and Torres Strait Islander people living with chronic (long-term) hep B is around 10 times that of non-Indigenous people born in Australia. Of the 230,000 Australians estimated to be living with hep B, around 20,000 are thought to be Aboriginal or Torres Strait Islander people, and new infections with hep B are still occurring at 4 times the rate in Indigenous Australians.

Most people living with chronic hep B were infected as babies or young children, with infection being passed from mother to child or between young children. Someone infected as a baby has a 90% chance of going on to chronic hep B; while someone infected as an adult only has a 5% chance of going on to long term infection, but can still get very sick in the short term. In Australia, most infections in adults are caused through sexual contact with someone with hep B, or through unsafe injecting drug use.

Chronic hep B infection usually causes no symptoms and for most people will cause no long-term health problems – but for around 1 in 4 people living with hep B, the virus can cause severe liver scarring (cirrhosis) or liver cancer. We know that liver diseases are one of the important causes of the life expectancy gap experienced by Indigenous Australians – hep B is one of the conditions responsible for this. Recent evidence from research in the Northern Territory suggests that Aboriginal people have a unique strain of the hep B virus passed on over many years that could explain why hep B in some Indigenous people might have a more severe course.

Unlike the other STIs and BBVs, hep B can be prevented by a safe, effective vaccine which has been provided for all infants in Australia since 2000 (and in the Northern Territory since 1990). As a result, new hep B infections in children born since 2000 (and in those who received adolescent catch-up vaccination from 1998 onwards) have fallen substantially. However funded hepatitis B vaccine for Indigenous adults is available only in some states and territories, which limits access for Aboriginal and Torres Strait Islander people who remain at much higher risk of hep B infection. This inequality in access cannot continue.

For people who already have hep B infection, vaccination has no effect. We know many people living with hep B, including Indigenous people, have never been diagnosed. However being tested for hep B is easy – it’s a simple blood test which can tell whether someone has hep B, is immune through past infection or vaccination, or if a person needs vaccination. National guidelines suggest all Aboriginal and Torres Strait Islander adults whose hep B status isn’t known should be offered testing.

If someone is found to have hep B, they should receive counselling and household and sexual partners should be tested and vaccinated if not immune. Highly effective treatments for hep B are available in Australia that greatly reduce the chance of developing liver scarring or cancer, and involve taking a tablet once a day. However unlike for hep C, these are not cures – treatment needs to continue, often for many years. We know that in many areas of Australia where most people living with hep B are Indigenous people, treatment uptake is very low – this needs to be changed urgently. With better access to prevention, diagnosis and treatment, the burden of hep B on Indigenous health can be eliminated in coming years.

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Hepatitis C – the bad news and the good

A/Prof James Ward Head Infectious Diseases Research Aboriginal Health South Australian Health and Medical Research Institute

Hepatitis C is a virus that affects the liver. It is thought that 95% of the Hep C in Australia is acquired through sharing of injecting equipment or other equipment that transfers blood from one person to another, such as for tattooing. Aboriginal and Torres Strait Islander people are overrepresented in hep C diagnoses in Australia, with an estimated 20,000-30,000 diagnoses in our population.  Without treatment hep C damages the liver, and can result in cancer and death.

The bad news is that over the last five years rates of hep C diagnoses have increased by 43% in our community, yet the in the non-Indigenous community have been stable. Particularly concerning are rates of diagnosis among people in the age group 15-24 years of age with rates 8 times higher than non-Indigenous people in the same age group.  This age group is concerning because it is most likely that these infections are new infections given the nature of Hepatitis C being transmitted primarily through injection drug use.  Also of concern because of the high and rising Indigenous incarceration rates is the proportion of people in Australian prisons who are diagnosed with hep C, with an estimated 50-65% of all prisoners diagnosed with Hep C.

The good news however is there is now a cure for Hep C

But there is great news about hep C treatment:

  • There is now a cure for hep C. Daily tablets for 10-12 weeks are more than 90% effective of curing hep C
  • The cost of these tablets is subsidised by the Government – a full script costs around $40
  • Hep C treatment can be organised by Aboriginal Community Controlled Health Services or any GP practice.
  • There are very few side effects from these new tablets that cure hep C.

In the first 6 months since the Australian Government approved this new medication for treating hep C almost 20,000 Australians have been cured. Of these we do not know how many Aboriginal and or Torres Strait Islander people have been cured but our suspicion is relatively low numbers.

Aboriginal and or Torres Strait Islander people who have been diagnosed with Hep C have the right to get the advantage of this major breakthrough in Hep C treatment. Now is the time to encourage someone you know who is living with hep C to take treatment for this condition.   The more people we can get cured of hep C the better the chances are of reducing new infections in the community.

 

NACCHO Aboriginal Health #RHD : AMA Report Card on Indigenous Health highlights need for Aboriginal community controlled services

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“With Aboriginal and Torres Strait Islander Australians still 20 times more likely to die from RHD, the AMA’s call for firm targets and a comprehensive and consultative strategy is welcome. We encourage governments to adopt these recommendations immediately.

“As noted by the AMA, it is absolutely critical that governments work in close partnership with Aboriginal health bodies. Without strong community controlled health services, achieving these targets for reducing RHD will be impossible.

While this is a long term challenge, the human impacts on Aboriginal and Torres Strait Islander communities are being felt deeply right now. Action is required urgently.

NACCHO is standing ready to work with the AMA and governments to develop and implement these measures. We have to work together and we have to do it now.”

National Aboriginal Community Controlled Health Organisation (NACCHO) Chairperson Matthew Cooke pictured above at Danila Dilba Health Service NT with AMA President Dr Michael Gannon (right ) and the Hon Warren Snowdon MP Shadow Assistant Minister for Indigenous Health (left )

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” RHD, which starts out with seemingly innocuous symptoms such as a sore throat or a skin infection, but leads to heart damage, stroke, disability, and premature death, could be eradicated in Australia within 15 years if all governments adopted the recommendations of the latest AMA Indigenous Health Report Card.

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AMA President, Dr Michael Gannon see full AMA Press Release below

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 ” We have many of the answers, we just need commitment from Govt to help implement necessary changes ”

Ms Olga Havnen is the CEO of Danila Dilba Biluru Binnilutlum Health Service in Darwin

NACCHO Press Release

The peak Aboriginal health organisation today welcomed the release of the Australian Medical Association’s Report Card on Indigenous Health as a timely reminder of the importance of community controlled services.

The 2016 Report Card on Indigenous Health focuses on the enormous impact that Rheumatic Heart Disease (RHD) is having on Aboriginal and Torres Strait Islander people in Australia with a ‘Call to Action to Prevent New Cases of RHD in in Indigenous Australia by 2031’.

DOWNLOAD the Report Card here :

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AMA RELEASES PLAN TO ERADICATE RHEUMATIC HEART DISEASE (RHD) BY 2031

AMA Indigenous Health Report Card 2016: A call to action to prevent new cases of Rheumatic Heart Disease in Indigenous Australia by 2031

The AMA today called on all Australian governments and other stakeholders to work together to eradicate Rheumatic Heart Disease (RHD) – an entirely preventable but devastating disease that kills and disables hundreds of Indigenous Australians every year – by 2031.

AMA President, Dr Michael Gannon, said today that RHD, which starts out with seemingly innocuous symptoms such as a sore throat or a skin infection, but leads to heart damage, stroke, disability, and premature death, could be eradicated in Australia within 15 years if all governments adopted the recommendations of the latest AMA Indigenous Health Report Card.

The 2016 Report Card – A call to action to prevent new cases of Rheumatic Heart Disease in Indigenous Australia by 2031 – was launched at Danila Dilba Darwin  Friday 25 November

Dr Gannon said the lack of effective action on RHD to date was a national failure, and an urgent coordinated approach was needed.

“RHD once thrived in inner-city slums, but had been consigned to history for most Australians,” Dr Gannon said.

“RHD is a disease of poverty, and it is preventable, yet it is still devastating lives and killing many people here in Australia – one of the world’s wealthiest countries.

“In fact, Australia has one of the highest rates of RHD in the world, almost exclusively localised to Indigenous communities.

“Indigenous Australians are 20 times more likely to die from RHD than their non-Indigenous peers – and, in some areas, such as in the Northern Territory, this rate rises to 55 times higher.

“These high rates speak volumes about the fundamental underlying causes of RHD, particularly in remote areas – poverty, housing, education, and inadequate primary health care.

“The necessary knowledge to address RHD has been around for many decades, but action to date has been totally inadequate.

“The lack of action on an appropriate scale is symptomatic of a national failure. With this Report Card, the AMA calls on all Australian governments to stop new cases of RHD from occurring.”

RHD begins with infection by Group A Streptococcal (Strep A) bacteria, which is often associated with overcrowded and unhygienic housing.

It often shows up as a sore throat or impetigo (school sores). But as the immune system responds to the Strep A infection, people develop Acute Rheumatic Fever (ARF), which can result in damage to the heart valves – RHD – particularly when a person is reinfected multiple times.

RHD causes strokes in teenagers, and leads to children needing open heart surgery, and lifelong medication.

In 2015, almost 6,000 Australians – the vast majority Indigenous – were known to have experienced ARF or have RHD.

From 2010-2013, there were 743 new or recurrent cases of RHD nationwide, of which 94 per cent were in Indigenous Australians. More than half (52 per cent) were in Indigenous children aged 5-14 years, and 27 per cent were among those aged 15-24 years.

“We know the conditions that give rise to RHD, and we know how to address it,” Dr Gannon said.

“What we need now is the political will to prevent it – to improve the overcrowded and unhygienic conditions in which Strep A thrives and spreads; to educate Indigenous communities about these bacterial infections; to train doctors to rapidly and accurately detect Strep A, ARF, and RHD; and to provide culturally safe primary health care to communities.”

The AMA Report Card on Indigenous Health 2016 calls on Australian governments to:

Commit to a target to prevent new cases of RHD among Indigenous Australians by 2031, with a sub-target that, by 2025, no child in Australia dies of ARF or its complications; and

Work in partnership with Indigenous health bodies, experts, and key stakeholders to develop, fully fund, and implement a strategy to end RHD as a public health problem in Australia by 2031.

“The End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRC) is due to report in 2020 with the basis for a comprehensive strategy to end RHD as a public health problem in Australia,” Dr Gannon said.

“We need an interim strategy in place from now until 2021, followed by a comprehensive 10-year strategy to implement the END RHD CRC’s plan from 2021 to 2031.

“We urge our political leaders at all levels of government to take note of this Report Card, and to be motivated to act to solve this problem.”

The AMA Indigenous Health Report Card 2016 is available at https://ama.com.au/article/2016-ama-report-card-indigenous-health-call-action-prevent-new-cases-rheumatic-heart-disease

TIME TO TAKE HEART

Labor calls on the Turnbull government to take heart and address Rheumatic Heart Disease, an entirely preventable public health problem which is almost exclusively affecting First Nation Peoples.

Labor welcomes the release of the Australian Medical Association’s 2016 Aboriginal and Torres Strait Islander Health Report Card, A Call To Action To Prevent New Cases Of Rheumatic Heart Disease In Indigenous Australian By 2031.

Poor environmental health conditions, like overcrowded housing remain rampant in Aboriginal and Torres Strait Islander communities, devastating families and the lives of young people.

“As the AMA’s report card suggests, we must build on the success of the 2009 Commonwealth Government Rheumatic Fever strategy, established to improve the detection and monitoring of Acute Rheumatic Fever and Rheumatic Heart Disease.

Funding under the Rheumatic Fever strategy is uncertain after this financial year,” Ms King said.

The Productivity Commission’s report Overcoming Indigenous Disadvantage [OID] released last week found 49.4% of Aboriginal and Torres Strait Islander peoples in remote communities live in overcrowded housing. Additionally, the report details no significant improvement in Aboriginal and Torres Strait Islander Peoples access to clean water, functional sewerage and electricity.

“We know Rheumatic Heart Disease is a disease of poverty and social disadvantage, which is absolutely preventable. Aboriginal and Torres Strait Islander communities, especially in the Top End of the Northern Territory, suffer the highest rates of definite Rheumatic Heart Disease,” Mr Snowdon said.

Labor applauds the work of the Take Heart Australia awareness campaign, and their work to educate and advocate putting Rheumatic Heart Diseases on the public health agenda.

“Like always, Aboriginal and Torres Strait Islander communities need to be front and centre in taking action. The most positive outcomes will come through communities working with Aboriginal and Community Control Health Organisations to design and deliver programs tailored to their needs,” Senator Dodson said.

The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 noted more than three years ago the association of RHD with ‘extremes of poverty and marginalisation’, these conditions remain and are almost exclusively diseases of Indigenous Australia.

If we are serious about closing the gap, we must take heart, and address this burden of Rheumatic Heart Disease facing First Nation Peoples.

ACTION TO END RHEUMATIC HEART DISEASE (RHD) IN 15YRS

The Heart Foundation has today supported the Australian Medical Association (AMA) call for governments to work together to eliminate Rheumatic Heart Disease (RHD) in 15 years, by 2031.

Heart Foundation National CEO, Adjunct Professor John Kelly (AM) said RHD was an avoidable but widespread disease that kills and harms hundreds of Indigenous Australians every year.

“Considering how preventable RHD is, it is a national shame that our Indigenous population are left languishing.

“The Heart Foundation has strongly advocated from the RHD strategy. We continue to call on the government to fund the National Partnership Agreement on Rheumatic fever strategy and Rheumatic Heart Disease Australia (RHD Australia) with a $10 million over 3 years’ commitment, “Adj Prof Kelly said.

With the AMA predicting that RHD could be eradicated in Australia within 15 years if all governments adopted its recommendations, the time to act is now.

“We need to boost funding for the national rheumatic fever strategy. New Zealand is allocating $65 million over 10 years. A robust approach can put an end to RHD as a public health issue within 15 years,” Adj Prof Kelly said.

This call to action was part of the release of the AMA’s 2016 Indigenous Report Card – A call to action to prevent new cases of Rheumatic Heart Disease in Indigenous Australia by 2031.

“We want a strong and robust strategy to tackle this challenge. We will be working with the AMA to support and advocate for these recommendations which include:

  • A commitment to a target to prevent new cases of RHD among Indigenous Australians by 2031, with a sub-target that, by 2025, no child in Australia dies of ARF or its complications; and
  • Working in partnership with Indigenous health bodies, experts, and key stakeholders
  • to develop, fully fund, and implement a strategy to end RHD as a public health problem in Australia by 2031.

 

NACCHO Aboriginal Health , Racism and #18C : Sen. Patrick Dodson speech ” It’s interesting that bigotry is back in favour “

 

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 ” We talk of all sorts people who make up the Australian nation; Chinese and Indians and Lebanese, all sorts of people, Africans who are part of Australian population who bring with their cultures a richness to this nation, and instead of us moving to accept and appropriate the better things of their cultures, we seek to continuously divide and create ways to sustain divisions and sustain the denigration of our fellow Australians.

Nothing wrong with freedom, particularly if you’re from the ruling class. There’s a hell of a lot wrong with freedom if you’ve got to battle to experience if, if you’ve got to fight for it.

I was born before the 1967 referendum and we weren’t even counted in the census of this country as Aboriginal People.

When this government didn’t have any power to make laws for Aboriginal people because it was excluded by crafters of our constitution in 1901.

 The whole battle for recognition for freedom to enjoy the basics of being a citizen in this nation had to be fought for by black and white Australians … Jessie Street and Faith Bandler and many others and what I see today is the ideological creep back to bigotry and to racism.

Senator Patrick Dodson Shadow Assistant Minister for Indigenous Affairs

Watch the full speech here

RACIAL DISCRIMINATION LAW AMENDMENT

(FREE SPEECH) BILL

It’s interesting that bigotry is back in favour. Back in 2014 when Abbott Government sought to repeal 18c of the Racial Discrimination Act to allow for all sorts of things to travel under the guise of free speech, it was defeated and Labor would be opposed to this particular amendment that’s being proposed by Senator Leyonhjelm and others.

At least Senator Leyonhjelm as a libertarian appears to be committing himself to a push because of principle, but I’m not sure whether that’s the case in relation to the Turnbull Government. To me it represents some weakness. The bill put forward by the members goes even further than the Abbott Government ever did in trying to repeal part IIA of the RDA in its entirety.

As I say this is something Labor Party could never support. We created this part of the Act and we’re proud of it and we will continue to defend it.

Labor opposed the changes to the Racial Discrimination Act in 2014 and again we will oppose them in 2016. We’ll stand shoulder to shoulder with the communities across this country which is something people on the other side seem to forget.

This is about human beings – people of different cultures who are Australians, who have all sorts of different ways of interpreting English. English has its own form of tyranny – and that tyranny is what causes wars, assaults, arguments and violence and the speakers who grow up with English have to understand that’s not the only frame of reference through which world is interpreted because there’s no clear definition; it seems to me, of what constitutes whiteness and the culture of whiteness.

It’s fine if you sit in some leafy suburb and never rub shoulders with people who battling to interpret and navigate their way through modernity in this land of Australia with its highly sophisticated culture and its complexity of protocols and procedures and social ethos.

We have to understand that today is not the day to be changing this section of the Racial Discrimination Act. It’s not the day. We see every night on the news the bigotry and the racism, the hatred the killings that take place in Middle East borne out by different interpretations that people extract from words.

You only have to look to Indonesia just recently the President was coming here to Australia he had to curtail his trip because of the alleged words used by one of the Governors that offended sections of the community and that matter is still afoot.

So words do matters and how we use words is critical in the way we go about our business and the way we go about communication and have no doubts that racism is something that isn’t growing wild out there in the fields, it’s actually tendered in a flower box sitting on the window sills of flats and houses and that matter is something we as all Australians should be working to get rid of so that freedom that was spoken about by Senator Leyonhjelm can in fact be enjoyed by all citizens.

If you watched news last night our colleague the Honourable Anne Aly, in the other place, receiving death threats because of stupidity of language used by one of our Ministers to excite some lunatic in our society to threaten violence and death to her and her family.

This is what words do. It’s all very well in a debating class in a university there’s no freedom out there in the mainstream when you don’t understand and comprehend the difference between debate and prejudice, when you don’t understand difference between being subjugated to racist taunts and to denigration.

As I said we don’t debate the definition of whiteness or the culture of whiteness and nor should we. But there is something we need to pull ourselves up on and that is the age old reality of what’s it like to talk in the shoes of someone else who is different, diverse and has a richness of their own culture, when we talk about them, when we write about them and when we print things in relation to them.

Freedom is a very treasured thing and it starts with defending as has been said in an ideological sense, the rights of people, but with rights comes responsibilities and in a complex multi-cultural society lets stress also the responsibilities to note that other Australians do not see things entirely the way we might from a Eurocentric position or from an Anglo Celtic background or sense of tradition and culture and polity so it’s important when we’re debating these matters to understand that many Australians are not sitting in the chamber, they’re listening to this chamber and they’re taking the leadership of this chamber as the litmus test of what this nation stands for and if this nation cannot stand up for the weakest and the poorest and those who are most vulnerable because of their race, their ethnicity, or their beliefs then we have become a very sad replication of what democracy is all about.

There’s no need for this particular amendment. There’s been over a 20 year period where this has operated substantially to the benefit of our nation.

The defences available under18D are clear and are there not only to facilitate the freedom of speech that people which to exercise and the freedom of expression but also to give an indication of what is not permissible and how it might be mitigated or adjudicated by a court if it has to go to a court and can’t be dealt with in an arbitration.

Madam acting deputy speaker Labor is not going to be supporting this amendment and certainly any future amendment to this particular section of Racial Discrimination Act. Thank you.

NACCHO Aboriginal #Kidney Health #IGA2016 : Western Desert Dialysis mob take out major Indigenous Governance Award

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On Thursday night Western Desert Dialysis took out the top award at the 2016 Indigenous Governance Awards, announced at a ceremony in Sydney.

Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation, also known as Western Desert Dialysis.

Our mission is to improve the lives of people with renal failure, reunite families and reduce the incidence of kidney disease in our communities.

 Run by Aboriginal people for Aboriginal people and work to provide culturally appropriate dialysis services in remote communities, helping people to get home to country and family.

NACCHO chair Matthew Cooke on behalf of all 150 members congratulates Western Desert Dialysis  and all the finalists ( see list below )

Watch these videos here

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Western Desert Dialysis helping Indigenous people in ‘kidney disease capital of the world’ By Tom Maddocks    Photo above Kirstie Parker

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Photo: Western Desert Dialysis has treated some patients like Josephine Woods (R) for years. (ABC News: Tom Maddocks)

Morgan Hitchcock from Western Desert Dialysis does not mince words on why his organisation is so badly needed in Central Australia.

“This is the kidney disease capital of the world and Aboriginal people bear the burden the most,” he said.

Mr Hitchcock is the business manager at the charity, which sends out a mobile dialysis treatment centre, known as the Purple Truck, to those who need it in remote communities.

He knows better than most why it makes such a difference.

“We respect traditional treatment for sickness but we also adopt the best of Western medicine,” he said.

About the awards

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The Finalists

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Fears people could die without treatment

The Purple Truck Photo: The Purple Truck is the mobile dialysis unit that Western Desert Dialysis sends to remote communities. (Supplied: Western Desert Dialysis)

There is no cure for kidney disease, and the only reliable treatment is dialysis or a transplant. Patients with renal disease need treatment three times a week.

People develop kidney disease because of chronic diseases such as type-2 diabetes, which is rife among Aboriginal people.

Before the Western Desert Dialysis service was available, patients had to travel from remote communities to Alice Springs to get the vital treatment they needed.

For some it was a difficult trip and many feared they would die.

Now people know they can get help in their own communities from the mobile treatment centre.

The service began with the simple desire to get a dialysis machine to the remote Western Desert community of Kintore, on the border with Western Australia, but the idea grew into something much bigger.

Mr Hitchcock said the Federal Government did not initially believe the service would work and it would be a waste of money, but it defied the odds.

“It’s talking about something sad, talking about kidney disease, but then it’s also an inspiring story about the way Aboriginal people, people from the desert, got together, raised some money and started their own organisation,” Mr Hitchcock said.

“Government is on board now but the organisation started from nothing when government said they weren’t going to help.”

Group uses traditional and Western treatments

Morgan Hitchcock from Western Desert Dialysis
Photo: Morgan Hitchcock says Western Desert Dialysis respects traditional treatments. (ABC News: Tom Maddocks)

At the group’s main office in Alice Springs, known as Purple House, patients can access a doctor and social support services.

They can also see traditional healers, known as Ngangkaris, and use bush medicine.

Josephine Woods, who has been receiving dialysis treatment at Purple House for many years, said it was “good for people from different kinds of tribes”.

“Patients will be sent home if they get homesick to visit family, get treatment and come back to Alice Springs,” she said.

Ms Woods is also part of a consumer group of patients who regularly meet with service providers.

“It’s good to know about renal patients and how they treat them,” she said

Press Release

Reconciliation Australia in partnership with BHP Billiton Sustainable Communities, tonight revealed the winners of the Indigenous Governance Awards 2016 and celebrated the strength of Aboriginal and Torres Strait Islander-led organisations and projects across Australia.

Following a rigorous judging process, Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation (Western Desert Dialysis) was selected as the winner of the Category A Award for incorporated organisations, while Murdi Paaki Regional Assembly (Murdi Paaki) was honoured as winner of the Category B Award for non-incorporated projects.

Commenting on Category A winner, Western Desert Dialysis, Chair of the Indigenous Governance Awards, Professor Mick Dodson, said: “It’s their humanity that stands out in their governance. They strike me as a family that really cares for every member of that family in the way they deliver services. Aboriginal culture has been wrapped around access to modern medicine and allows it to be administered in a holistic and culturally appropriate way.”

Category B winner Murdi Paaki’s success “Comes from the fact they’re made up of community members, which gives them power to advocate”, said Professor Dodson. “They show leadership, vision, and fearlessness, and they are practicing self-determination.”

A highly commended honour was awarded to Kanyirninpa Jukurrpa in Category A, for its work strengthening Martu people’s connection with Country and leadership capacity; and Ara Irititja in Category B, for its dedication to digitally archiving culturally significant materials from the APY Lands.

BHP Billiton Chief External Affairs Officer Geoff Healy said good governance is critical to BHP Billiton and it’s engagement with Indigenous peoples around the world.

“Good governance delivers better, more transparent and accountable decision making and builds confidence in organisations and their leadership.” Page | 2

“BHP Billiton has been proud to support the Indigenous Governance Awards since they began in 2005. These finalists are great examples of the benefits that flow when good governance standards are in place.” Mr Healy said.

The calibre of the finalist organisations from which the winners were selected was the most outstanding in the twelve-year history of the Awards.

“This was certainly the highest standard of finalists we’ve ever had. They’ve all got the administrative nuts and bolts of good governance in order and are taking innovative approaches to community leadership. Across the board, we have seen the governance of Aboriginal and Torres Strait Islander-led organisations improve exponentially and these finalists could teach non-Indigenous organisations many things about innovation and success”, reflected Professor Dodson.

Remarking on significance of the Awards, Professor Dodson said “It’s time that mainstream Australia takes notice of these outstanding organisations and projects, and adopts a new discourse focused on Aboriginal and Torres Strait Islander success.”

In total, $60,000 prize money will be distributed through the Awards. The winner in each category will receive $20,000, and the highly commended organisations will each be awarded $10,000. Additionally, all nine finalists will be partnered with a high profile corporate organisation for 12 months, which will provide mentoring and assistance in an area identified by the finalist.

– ENDS –

Winner biographies

Category A

Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation

Based in Alice Springs, Western Desert Dialysis is an Aboriginal community-controlled, not-for-profit organisation providing dialysis treatment and support services to Indigenous renal patients from remote communities in Northern and Western Australia. Their name means “making all families well”, and it recognises that people must be able to stay on Country, to look after and be looked after by their families. Their mission is to improve the lives of people with renal failure, reunite families, and reduce the incidence of kidney disease in their communities. Run by Aboriginal people for Aboriginal people, Western Desert dialysis works to provide culturally appropriate health care for people in remote communities, helping people to get home to Country and family.

Category B

Murdi Paaki Regional Assembly

The MPRA is the peak governance body for Indigenous people in the west, north-west and far west of NSW, made up of representatives of the 16 Indigenous communities, Murdi Paaki Aboriginal Young and Emerging Leaders and NSW Aboriginal Land Council Councillors from across the region. The Aboriginal population of the MP region at the time of the 2011 Census was 8,331 (considered to be an under-estimate), or 18% of a total population of 48,797. It is the peak body for engaging with Government at all levels, and for the myriad agencies of Government to engage with Aboriginal people of the region. The MPRA’s major role is enabling and requiring a more strategic emphasis on engagement, responsiveness, co-ordination and accountability of Government and non-government agencies and the programs they deliver to and with Indigenous people.

Highly commended biographies

Category A

Kanyirninpa Jukurrpa

Based in Newman, Western Australia, Kanyirninpa Jukurrpa (KJ) was established to help Martu look after their culture and heritage and to ensure that Martu’s ongoing connection with country would remain strong. KJ’s programs include an extensive ranger program in five communities, a leadership program, a return-to-country program and a program of diverse cultural knowledge management. Together, they have generated transformative change across the Martu communities. The outcomes span a wide range of social, cultural and economic benefits to both Martu and other stakeholders, such as the state and federal governments. Since its formation, KJ has grown to the point where it is the single biggest employer of Martu. One of the less tangible but equally important successes has been the reinstatement of cultural authority of the Martu Elders. They have an increased confidence in their ability to shape their future and have responded positively to the interest and commitment of younger Martu to learn and fulfil their cultural obligations.

Category B

Ara Irititja

Based in Adelaide, Ara Irititja’s goal is to create a sustainable, growing collection of historic and cultural multimedia material related to Aboriginal people from or on the APY Lands in SA, NT and WA and to repatriate it to communities across these lands. Ara Irititja also record cultural material for the archive and play an active role in ensuring that the archive can be accessed effectively in remote communities. Ara Irititja project is about the conservation of memory in a culture based on oral tradition. This is memory that goes beyond most cultural imaginations, back before the invention of writing, and many centuries before the Christian era. Every Anangu Elder carries a story — one that has been handed down through many generations and our project provides a platform for these stories to be told. Keeping Culture KMS not only conserves this knowledge — by photo, by video, by sound, by documentation — but also, by its nature it allows these stories to live. Most importantly, it allows them to live with the people to whom they belong.

Indigenous Governance Awards 2016 finalists Category A – Incorporated organisations Category B – Non-incorporated projects
 Kalyuku Ninti – Puntuku Ngurra Limited

 Mallee District Aboriginal Services (MDAS)

 Marninwarntikura Women’s Resource Centre

 Muru Mittigar Limited

 Tangentyere Council Aboriginal Corporation

 Warlpiri Youth Development Aboriginal Corporation (WYDAC)

 Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation

  

 Ara Irititja

 Murdi Paaki Regional Assembly

 

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This year’s theme:

Strengthening Our Future through Self Determination

 NACCHO Interim 3 day Program has been released

                       The dates are fast approaching – so register today
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NACCHO Aboriginal Health News Alert : Cape York healthcare ‘too risky’ for doctors

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 ” There is money going into the Cape, but I’m not sure where it is all going,the service overall is incoherent and non-strategic. Also there was a “fragmentation’’ in the delivery of services between the three ­providers.

We issued­ a statement in September calling for action to “stem the tide of the increase in rates of chronic conditions and preventable illness in children and more generally remote communities’’ on Cape York.

Dr Mark Wenitong, the public health chief of Apunipima Cape York Health Council ( NACCHO Member ) , a Cairns-based service that prov­ides preventive health programs

Watch NACCHO TV Interview with Dr Mark Wenitong

‘Apunipima is working hard to address not only the health issues in remote communities but the social and economic ones as well.

We believe that community knows what’s needed and our role is honour and facilitate that.

These statistics show how much work there is to be done but also some real successes. As community controlled health model is rolled out across Cape York we can expect to see some real changes in terms of health outcomes for our people.’

Apunipima Primary Health Care Manager Paula Arnol said the Chief Health Officer’s findings showed the huge amount of work to be done to bring Cape York’s Aboriginal and Torres Strait Island population to achieve health parity with the rest of the state and the country :

Download report summary here  hhhs-profiles-torres-cape

Chief Health Officer’s 2016 Torres and Cape Hospital and Health Service Population Health Status  Profile  : See Apunipima’s Response in full below

Photo above : Baby Sharntai Possum with grandfather John Clark and mum Sharmilah Clark. Picture: Brian Cassey

Reported by :  The Australian

Doctors across Cape York, including Royal Flying Doctor Service staff, have been warned against working in Aboriginal commun­ities because of the risk to patient safety through understaffing and poor support services.

Medical indemnity insurers have been advising contracted doctors that they should consider quitting because of the “medico-legal risk’’, as evidence emerges of a spike in preventable illness and deaths in the communities.

Veteran health practitioners are resigning in droves because of dangerous workloads, inadequate record-keeping of patient medical files and poor support services.

A recent survey found 80 per cent of doctors and nurses working for one of the three health providers on Cape York saw adverse events in relation to patient safety at an unacceptable level.

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Health workers complain of a chaotic recall system — which is supposed to prompt and monitor follow-up treatments for patients — and poor sharing of medical files between health services.

Cape York mayors have report­ed a massive jump in deaths in recent years and scoffed at official­ records used to influence government health policy.

Dr  Wenitong, the public health chief of Apunipima, a Cairns-based service that prov­ides preventive health programs, said government death records were “completely unreliable’’.

The Australian Salaried Medic­al Officers Federation of Queensland, which represents public-sector doctors, has claimed the number of deaths across Cape York jumped fourfold between 2014 and last year.

The RFDS, contracted by the Queensland government to suppl­y GPs in Cape York, has been at war with doctors’ groups over their changes to the staffing of community clinics.

Legal advice show that medic­al-indemnity insurers have told doctors they should consider resigni­ng or changing roles because­ of the risks of continuing working under the conditions.

The legal advice is at the centre of the dispute between doctor groups and health service management, with ASMOFQ president James Finn recently warning that the RFDS had to act.

“It would be indefensible in the first instance, if an adverse patient outcome occurred as it was found that RFDSQ failed to address known medico-legal risks present at the time,’’ Dr Finn said in a letter in September.

In Kowanyama, on the western Cape, the RFDS wound back a five-day-a-week service to the 1200-strong community and now sends two doctors to the clinic from Monday afternoon to Wednesday lunch.

Records show the two doctors have been seeing more than 100 patients each day, leading to the departure of the community’s two long-serving GPs this year.

Doctor Cheryl Choong said patient safety was suffering and she quit the RFDS this year after her repeated concerns were ignored­ and she was branded an “outlier’’.

Dr Choong, who worked in Kowanyama for nearly four years, said an equivalent-sized population in regional Queensland would have twice as many doctors and nurses.

“We were drowning in work, it was overwhelming, and I was told just to suck it up,’’ she said.

In Kowanyama, official births, deaths and marriages records show that four people died last year. But official records from the local health clinic show there were 27 burials in Kowanyama that year, compared with an average of seven to 10 a year about a decade ago, with no marked population change.

It is believed the statistics are distorted because many people are treated in the community before­ being flown to Cairns, where they die and where their deaths are recorded.

The Australian has spoken to health workers across Cape York who told similar stories of having to turn away patients or of being unable to investigate possible seriou­s health issues because of the workload and poor systems.

All three services — Queensland Health, Apunipima and the Flying Doctors — have different patient medical file systems, which are not compatible.

Local Kowanyama ranger John Clark told The Australian he took his six-month-old granddaughter Sharntai to the clinic recently after she had vomited at least five times in a morning.

“We waited there for hours, but at the end of the day they said they couldn’t see her, there were so many people,’’ he said.

“It was frightening, there had been a bad flu going around and these things can go really bad, but thankfully she got better.

“A big problem now is that becaus­e most of the permanent staff have been forced out, we are being treated by a different doctor or different nurse every time, and have to go through the same questioning over and over.’’

Kowanyama Mayor Michael Yam told The Australian yesterday the health service in his community was “sick and neglected’’.

“There are too many funerals, too much sadness,’’ he said.

“We need doctors that are here every day: it is a big community and we needed the services to be delivered in a better way.

“Where is the health funding going?’’

A spokesman for Queensland Health Minister Cameron Dick issued a statement saying that it was unaware of data supporting claims of increased deaths on Cape York communities.

The statement also conceded there were problems in retaining staff and said that the government was trying to develop a system so that the health services could share information.

“The Cape and Torres HHS (Hospital and Health Service) is also working with the AMAQ, RFDSQ, Rural Doctors Association and the commonwealth-funded PHN (Primary Health Networks) to improve the sharing of clinical information across orga­nisations,’’ it said. “This work will support the development of the new electronic platform.

“Attracting and retaining qualified staff in rural and remote areas is challenging and the Cape and Torres HHS works collab­orat­ively with hospital and health services to maintain ­appropriate levels of staffing in the Cape and Torres communities.’’

Chief Health Officer’s 2016 Torres and Cape Hospital and Health Service Population Health Status Profile

Apunipima’s Response

Apunipima Cape York Health Council is an Aboriginal community controlled health organisation which provides comprehensive primary health care to 11 Cape York communities, advocates on behalf of another six and services around 7000 Aboriginal and Torres Strait Islander patients.

Primary Health Care Manager Paula Arnol said the Chief Health Officer’s findings showed the huge amount of work to be done to bring Cape York’s Aboriginal and Torres Strait Island population to achieve health parity with the rest of the state and the country.

‘Apunipima is working hard to address not only the health issues in remote communities but the social and economic ones as well.

We believe that community knows what’s needed and our role is honour and facilitate that. These statistics show how much work there is to be done but also some real successes. As community controlled health model is rolled out across Cape York we can expect to see some real changes in terms of health outcomes for our people.’

96 percent of pregnant women attended five or more antenatal visits

What Apunipima is doing

  • Apunipima’s award winning health worker led home visiting Baby One Program™, which runs from pregnancy until bub is 1000 days old, engages and educates women about the value of antenatal checks
  • Fruit and vegetable vouchers given away at key points during pregnancy to ensure high engagement
  • Regular visits to community by maternal and child health nurses who provide antenatal care
  • Local, trusted maternal and child health workers provide the link between community and maternal and child health nurses / midwives

95 percent on 5 year olds are fully immunised

What Apunipima is doing

  • Apunipima’s award winning health worker led home visiting Baby One Program™, which runs from pregnancy until bub is 1000 days old, encourages and educates families to immunise their children
  • The Baby One Program™ is led by trusted, community based maternal and child health workers who provide the link between families and Apunipima’s doctors, nurses and allied health staff
  • Regular visits to community by Maternal and Child Health Nurses who provide the full immunisation schedule

21 percent of adults are daily smokers

What Apunipima is doing

Apunipima received a Tackling Indigenous Smoking Regional Grant as part of the National Tackling Indigenous Smoking program. Nationally, the program aims to improve the health of Aboriginal and Torres Strait Islander people through local efforts to reduce harm from tobacco.

The Apunipima Tackling Indigenous Smoking (TIS) Team is working closely with Cape York communities to deliver locally appropriate programs and activities that aim to:

  • Engage community members in tobacco cessation activities
  • Improve access to culturally appropriate quit support
  • Encourage and support smokers to quit
  • Encourage and support non-smokers to avoid uptake
  • Raise awareness in communities about the health impacts of smoking and passive smoking
  • Support communities to establish smoke-free homes, workplaces and public spaces

31 percent of adults are obese

What Apunipima is doing

  • Piloting the Better Health Program in Napranum, a family focused healthy lifestyle program to manage and reduce overweight and obesity in children through encouraging families to eat well and become more active one along who would like to make healthy lifestyle changes.
  • Leading a two year project focused on building the capacity of remote communities and councils in Cape York to implement local solutions to reduce high consumption of sugary drinks and promote water as the healthy drink of choice.
  • Delivering Need for Feed cooking program with high school students at Western Cape College in Term 1 2017

Aboriginal and Torres Strait Islander Queenslanders made up 70 percent of potentially preventable hospital admissions – among the top contributors were dental and diabetes complications

Diabetes

What Apunipima is doing

  • Building capacity for self-management through access to the latest technology to improve understanding of blood glucose control and its relationship to food, exercise and medications.
  • Targeting prevention of diabetes through engagement with women of child bearing years to prevent gestational diabetes or achieve exceptional control if pre-existing type 2 diabetes mellitus.
  • Working with Health Promotion teams as able to promote healthy lifestyles and diabetes prevention.
  • Provision of diabetes risk assessments and clinical health assessments to enable early detection and management of risk factors for diabetes.
  • In-depth education and case management of clients with pre-existing diabetes around complications risk and management of same to improve outcomes.
  • Due to the increasing number of children and youth with type 2 diabetes mellitus in our region, engagement with partners to prevent, detect early and manage effectively this concerning new trend.
  • Development of appropriate educational tools, materials and literature to improve health literacy around the understanding of diabetes self-management and inter-generational prevention to achieve best outcomes.

Dental conditions

What Apunipima is doing

Leading a two year project focused on reducing children’s exposure to sugary drinks in remote communities and promote water as the healthy drink of choice. The initiative will be a collaborative effort involving multiple agencies and service providers in Cape York working together and will see rollout of social marketing campaigns, development and implementation of community driven plans to improve the food and drink environment

 

80 percent of the deaths were considered premature;

68 percent of the people who died were of Aboriginal and Torres Strait Islander descent, and half of those deaths occurred in people under the age of 53.5 years compared to 64.5 years

What Apunipima is doing

  • Expanding our network of community driven, community run health care centres which provide culturally appropriate primary health care, increase access and take up and positively affect local socioeconomic indicators.
  • Launching the Chronic Conditions Strategy 2016-2026 which details the 10 vision and organisational approach Apunipima will take to work with Cape York communities in the prevention, treatment and management of chronic conditions. This strategy reflects current best practice, is based on research and in line with national and other state approaches.
  • Launching a Position Statement on Food Security for Cape York, calling for action to improve food supply and affordability in remote communities. Food insecurity directly impacts on people’s ability to maintain adequate nutrition status to support good health. People experiencing financial difficulty are typically constrained to a poor diet which fuels an ongoing cycle of inadequate nutrition, obesity and chronic disease.

Please note that the Chief Health Officer’s report refers to entire population (25,498) of the Torres and Cape Hospital and Health Service. Apunipima looks after around 7000 Cape York patients, around 27 percent of the total population.

#NACCHOagm2016 Aboriginal Health : How community-based innovation can help Australia close the Indigenous gap

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“Aboriginal self-determination must be front and centre in any decision making processes if we are to truly see major gains to Close the Gap in Indigenous health and social and economic wellbeing.

The importance of the ACCHO sector is widely and formally acknowledged across the Australian health and social sectors – from GPs to hospital emergency facilities. ACCHOs are Australia’s largest, single national and preferred primary health care system for Aboriginal people.

In 2015 all major political parties supported the 10 year Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan (2013 – 2023). 

NACCHO will persevere in its efforts to turn positive talk into positive action “

Matthew Cook Chair NACCHO Editorial July 2016

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This year’s theme:

Strengthening Our Future through Self Determination

 NACCHO Interim 3 day Program has been released

                       The dates are fast approaching – so register today

 

 ” The third factor is the effectiveness of Indigenous organisations, including local government. These are the local institutions that endure between successive policy rounds.

These organisations are the only structures of Indigenous self-governance in Australia to which powers, functions and resources can be devolved.

By providing political counterpoints to government, they contribute to a better-balanced system. New interventions should build, not corrode, their capability.”

Mark Moran is the author of Serious Whitefella Stuff: When solutions became the problem in Indigenous affairs, which is out now. Mark Moran, Chair of Development Effectiveness, The University of Queensland writing in the Conversation

 

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There is a strong bipartisan consensus that Australia needs to close the gap in Indigenous disadvantage. It is a credit to the federal government that it has remained consistent in monitoring progress. But while maintaining these targets is important, Australia clearly has an implementation problem.

Consistent with his widespread call for innovation, Prime Minister Malcolm Turnbull remarked in this year’s Closing the Gap address to parliament that:

The Closing the Gap challenge is often described as a problem to be solved – but more than anything it is an opportunity. If our greatest assets are our people, if our richest capital is our human capital, then the opportunity to empower the imagination, the enterprise, the wisdom and the full potential of our First Australians is an exciting one.

Across remote Australia, such innovation is occurring locally in practice, under the radar of government policies and support. Central to this innovation are relationships between community leaders and trusted outsiders, and the shared understanding and new knowledge they derive.

If these relationships stay stable for long enough, innovation does emerge. Given enough time, trusted outsiders can learn about the context of a community and the richness of culture, history, family and place. And community leaders can learn about the system of Indigenous affairs and its many layers of conditionality and gatekeepers.

There is an untold story of reconciliation here, born from hard days of working through problems. We can look to this innovation and stop fixating on finding the elusive policy solution.

Too many programs, not enough impact

Remote Indigenous communities of fewer than 1000 people are supported by more than 80 programs and services. Each has public finance rules to ensure none of the money is misappropriated and that it performs against KPIs. Most are success stories with a support base in community and government.

Yet, with so many programs operating, how does the relative disadvantage of Indigenous people remain so acute?

We need only look to the sheer ratio of programs and services to so few people to see part of the problem. As these programs typically don’t take into account the effects of each other, their measurements are highly questionable.

Operating in unison, these programs combine into complex policy hybrids, the effects of which are unknown. If there is a parallel here it is pharmacology, when chronically ill patients take a cocktail of drugs for multiple health problems – a situation that also sadly besets many Indigenous people. While each drug may have been rigorously tested using randomised control trials, the effect when five or ten of these combine is largely unknown.

We need to look at other things than policy solution.

I have spent the past 12 months looking for a standard of evidence that might sort through this complexity, to find the best performers and team players. I have looked closely at randomised control trials, reverse cross-over (quasi-experimental) design, comparative case study analysis, process tracing, Bayesian analysis and fiscal ethnography. I have spoken to some of the leading experts in these methods.

The problem is that there are just too many programs for too few people. It is too causally dense, with too many conjunctions and too few who are not “treated” who might form a control.

If we can’t measure the effects of individual programs, we must remain sceptical about which programs are working. We need to look at other things than policy solutions.

Let local innovation lead

We know some things about the conditions under which this innovation occurs, through case studies such as those in my book, Serious Whitefella Stuff. There are few universal policy solutions, but there are processes, capabilities and support factors involved that do indeed travel. Here are four such factors to emerge from our research.

The first is just simply stability. When government stabilises the policy environment, those on the ground have the opportunity to adapt.

New policies tend to dismiss everything before them, sweeping away organisations, jobs, people and long-term relationships. In the Northern Territory, the aftermath of The Intervention and the creation of the super shires led to the departure of long-term employees and community organisations.

New policies should build on – not undermine – the achievements of their predecessors. For as long as progress remains elusive we can’t afford to ignore earlier gains.

The second factor is the capability of frontline workers. Much effort is targeted at building the capability of local Indigenous people and organisations, but what about the capability of visiting outsiders?

Half of the universities in Australia offer tertiary education to prepare students to work in international development, but there is no equivalent for remote Indigenous communities. Why is this so, when the contexts are only more complex and confronting? So you arrive in a community from scratch, work it out through the school of hard knocks. Few go the distance, and few Indigenous leaders have the endurance to cope with the revolving door of recruits.

Outcomes are determined on the rocks of implementation and on the actions of community leaders and outside workers. This is the real engine room of Indigenous affairs, not the boardrooms or broadsheets of capital cities.

The third factor is the effectiveness of Indigenous organisations, including local government. These are the local institutions that endure between successive policy rounds.

These organisations are the only structures of Indigenous self-governance in Australia to which powers, functions and resources can be devolved. By providing political counterpoints to government, they contribute to a better-balanced system. New interventions should build, not corrode, their capability.

Finally, frontline workers need to find new ways to collaborate with each other. In such a crowded institutional space, collective efforts between programs will enhance effectiveness, beyond the ingenuity of any one program.

Regardless of the policy solution and measurement system, outcomes are determined on the rocks of implementation and on the actions of community leaders and outside workers. This is the real engine room of Indigenous affairs, not the boardrooms or broadsheets of capital cities.

An innovation-driven system in Indigenous affairs is a future that already exists, if politicians would only shift their gaze.

 

 

NACCHO Aboriginal Health #WhiteRibbonDay 25 November : $21 million Indigenous Women’s Safety Package to Stop the Violence

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 ” The Australian Government recently ( September 2016) announced a $100 million package of measures to provide a safety net for women and children at high risk of experiencing violence.  The package will improve frontline support and services, leverage innovative technologies to keep women safe, and provide education resources to help change community attitudes to violence and abuse.

One in six Australian women has experienced violence from a current or former partner, and 63 women have been killed so far this year.

For Indigenous women the situation is even worse – they are 34 times more likely to be hospitalised as a result of family violence.

The package includes $21 million for specific measures to help Indigenous women and communities.”

Prime Minister Malcolm Turnbull 24 September Press Release :

Full White Ribbon Day speech below

Or Download prime-minister-white-ribbon-day-speech

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White Ribbon Day Website

Women and children in Australia have the right to feel safe and live without fear of violence.

In recent weeks, we have seen yet again the devastating impact that domestic and family violence has on our community. The tragic and avoidable deaths of women and their children at the hands of current or former partners or family members highlight the need for urgent action.

We must elevate this issue to our national consciousness, and make it clear that domestic, family or sexual violence is unacceptable in any circumstances.

Today the Australian Government is announcing a $100 million package of measures to provide a safety net for women and children at high risk of experiencing violence.  The package will improve frontline support and services, leverage innovative technologies to keep women safe, and provide education resources to help change community attitudes to violence and abuse.

The package includes $21 million for specific measures to help Indigenous women and communities.

COAG has made domestic violence a national priority, and governments are acting. But recent events show we are not moving fast enough.

This package responds to the initial advice of COAG’s Advisory Panel on Reducing Violence against Women and their Children – chaired by Ken Lay and deputy-chaired by Rosie Batty and Heather Nancarrow – which was provided to COAG at its special meeting on 23 July 2015.

This is part of the Government’s longer term response to domestic and family violence and the COAG Advisory Panel’s final report, due in early 2016, will advise on what further measures could be introduced.

Today’s package is in addition to the Australian Government’s $100 million investment in the Second Action Plan of the National Plan, and the $30 million national campaign to reduce violence against women and their children, jointly funded with the states and territories.

We look forward to working with states and territories to trial innovative new technologies to keep women safe, to train more frontline staff to recognise and respond appropriately to women experiencing violence, and to provide better resources and infrastructure to police working in remote Indigenous communities.

We will work with businesses and community groups to keep women safe from being tracked and harassed through mobile phones, and provide integrated services through dedicated domestic violence units in domestic and family violence hotspots.

We look forward to working with all Australians to say that enough is enough; that women and children must be safe in their homes and on our streets; and that domestic and family violence is never acceptable.

Immediate practical actions to keep women safe include:

  • $12 million to trial with states the use of innovative technology to keep women safe (such as GPS trackers for perpetrators), with funding to be matched by states and territories.
  • $5 million for safer technology, including working with telecommunications companies to distribute safe phones to women, and with the eSafety Commissioner to develop a resource package about online safety for women, including for women from CALD communities.
  • $17 million to keep women safe in their homes by expanding successful initiatives like the Safer in the Home programme to install CCTV cameras and other safety equipment, and a grant to the Salvation Army to work with security experts to conduct risk assessments on victim’s homes, help change their locks and scan for bugs.
  • $5 million to expand 1800RESPECT, the national telephone and online counselling and information service, to ensure more women can get support.
  • $2 million increased funding for MensLine for tools and resources to support perpetrators not to reoffend.
  • Up to $15 million to enable police in Qld to better respond to domestic violence in remote communities and for measures that reduce reoffending by Indigenous perpetrators.
  • $3.6 million for the Cross Border Domestic Violence Intelligence Desk to share information on victims and perpetrators who move around the cross border region of WA, SA and the NT.

Immediate measures to improve support and services for women will include increased training for frontline staff and trials of integrated service models:

  • $14 million to expand the DV-alert training programme to police, social workers, emergency department staff and community workers to better support women, and work with the College of General Practitioners to develop and deliver specialised training to GPs across the country.
  • $15 million to establish specialised domestic violence units to provide access to coordinated legal, social work and cultural liaison services for women in a single location, and allow legal services to work with local hospitals, including for women from CALD communities and women living in regional/remote areas.
  • $5 million for local women’s case workers, to coordinate support for women, including housing, safety and budgeting services.
  • $1.4 million to extend the Community Engagement Police Officers in remote Indigenous communities in the Northern territory.
  • Up to $1.1 million to help remote Indigenous communities prevent and better respond to the incidence of domestic violence through targeted support.

$5 million will also be provided as a longer-term measure to change the attitudes of young people to violence, through expanding the Safer Schools website to include resources for teachers, parents and students on respectful relationships.

This will build on the $30 million national campaign (jointly funded by the Commonwealth, states and territories) to change young people’s attitudes to violence, which will commence in early 2016.

PRIME MINISTER Speech :

Download full speech here prime-minister-white-ribbon-day-speech

Well thank you very much Nicholas and thank you Michael very much for your inspiring words.

This is of course – this is a project that unites all the parties. And in a place where there is plenty of disagreement, it is wonderful to see the Labor Party, the Opposition, The Greens, the Coalition, Pauline Hanson, all sitting there together united in this one cause. Many other colleagues here as well. So I want to acknowledge everybody here.

This is an issue that is not above politics, it is not beyond politics, it is something in which all of the participants from the political process are united and that is even more important.

So I want to thank you all for being here. I want to thank the Chief of the Defence Force and all of his defence leaders

here today for the great leadership they’re showing.

I also want to thank the founders of White Ribbon. I want to thank its CEO, Libby Davies, Nicholas Cowdery. I want to thank Telstra too for sponsoring this event.

Most importantly, I want to acknowledge the victims of domestic violence and their families, whose courage and suffering we honour today. Yours are the faces and the stories behind the statistics that we are determined to change.

Today, I recommit to my role as a White Ribbon Ambassador.

And I encourage all men to wear a white ribbon as a sign of respect for women. As a sign that you do not tolerate violence or disrespect of women, and as a vow to stand up and speak out wherever you see it.

On White Ribbon Day, we stand together ‐ men and women ‐ and we condemn the actins of the few who commit domestic violence.

And we call on all men to respect women and show that they abhor violence against women, to stand with us and say so.

We want to enlist men in this campaign because we know how powerful it is when men say to their brothers, their fathers, their sons, their mates

Yes, it is true that some men are victims of domestic violence.

But the overwhelming majority of victims of family violence are women and children. And the overwhelming majority of the perpetrators are men.

We know for Aboriginal and Torres Strait Islander women, they are 34 times more likely to experience domestic violence.

That’ why all of us here today and many more men across the country are leading by example and calling out

That’ why all of us here today and many more men across the country are leading by example and calling out domestic violence for what it is ‐ a crime.

Nicholas nailed it in his opening remarks –this is not a private matter, it is a crime. The term domestic violence which I suspect is too established to be dispensed with, is one that has the risk of minimizing what is a crime of violence.

And it has to be seen and rejected and stopped as a crime.

Now as Prime Minister, I have led a national conversation about the importance of respect for women.

Disrespecting women does not always result in violence against women. But all violence against women begins with disrespecting women.

This is a key insight and one we must never forget.

This is about respect.

Now we can all make a difference. We can be better role models. That is critical, especially for us here as leaders.

Whether we are leaders in business –I see Tony Warren from Telstra. Whether we are leaders of the Defence Forces or the Public Service or parliamentarians.

All of us are leaders and we have to be role models.

But above all as parents, we have to raise our sons from the earliest age to respect women ‐ beginning with their mothers and their sisters ‐ the women closest to them, the first women they meet, they learn to live with.

They must be taught to respect them, and we must encourage and teach our daughters to have greater self‐esteem.

Last month, I hosted the COAG National Summit on Reducing Violence against Women and their Children, with the Queensland Premier –it was the first of its kind.

The Summit brought together First Ministers, Women’ Safety Ministers and more than 150 experts and leaders to reaffirm our commitment as a nation to stopping violence against women and children.

There, along with my State and Territory colleagues, we launched a Third Action Plan, which had extensive community input, engagement and buy‐in.

On this White Ribbon Day, may you be sustained by this solidarity and by the knowledge that we will not rest unti you are safe.

Thank you very much.

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NACCHO Aboriginal Health Debate : # A sugary drinks tax could recoup some of the costs of #obesity while preventing it

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Personal responsibility, not the Australian Tax Office, should determine how much sugar Australians consume, says Barnaby Joyce. Often as not, Barnaby’s recovery program involves half a packet of Marlboros, which he calls bungers.

Barnaby was much agitated on Wednesday about the suggestion by the Grattan Institute that a tax on high-sugar fizzy drinks might go some way towards alleviating Australia’s obesity problem.

“This is one of the suggestions where right at the start we always thought was just bonkers mad,” he declared, adding his party would not be supporting a sugar tax.

This shouldn’t knock you cold with surprise. Barnaby is the leader of the Nationals. Name a sugar-growing area and you’ll find a Nationals or a Liberal National Party member at the local school fete knocking back a mug of raw sugar-cane juice and proclaiming it God’s food.

But Barnaby wasn’t simply stopping at political solidarity with his northern MPs.

He had some Barnaby-advice on how you might lose weight without taxing sugar.

“People are sitting on their backside too much, and eating too much food and not just soft drinks, eating too many chips and other food,” he lectured.

“Well, so the issue is take the responsibility upon yourself. The Australian Taxation Office is not going to save your health, right. Do not go to the ATO as opposed to go to your doctor or put on a pair of sandshoes and walk around the block and…go for a run.

The ATO is not a better solution than jumping in the pool and going for a swim.

The ATO is not a better solution than reducing your portion size.

“So get yourself a robust chair and a heavy table and halfway through the meal, put both hands on the table and just push back. That will help you lose weight.”

Barnaby Joyce, living miracle, offers a health plan : Pictured above David Gillespie Assistant Minister for Rural Health and Member for Lyne

Note 1: The Federal electorates of Lyne which takes in Taree and Port Macquarie has been identified at the Number One stroke ‘hotspot’ in Australia.Refer

Note 2 : The Minister is not to be confused with David Gillespie Author of How Much Sugar and Sweet Poison : Why Sugar makes us fat .

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In the wake of the progress report on Closing the Gap, the Indigenous Affairs Minister Nigel Scullion has declared sugary soft drinks are “killing the population” in remote Indigenous communities.

Key points:

  • Closing the Gap report found worst health outcomes found in remote communities
  • One remote community store drawing half of total profits from soft drink sales, Senator Scullion says
  • Senator Scullion says he thinks attitudes to soft drink are changing

According to evidence provided to Senate estimates today, at least 1.1 million litres of so-called “full sugar” soft drink was sold in remote community stores last financial year.

NACCHO Health News Alert : Scullion says sugary soft drinks ‘killing the population’ in remote Aboriginal communities

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Grattan Institute report

 ” Obesity is a major public health problem  In Australia more than one in four adults are now classified as obese, up from one in ten in the early 1980s.

And about 7% of children are obese, up from less than 2% in the 1980s.

The sugary drinks tax  revenue could be spent on obesity programs that benefit the disadvantaged, reducing the regressivity of the tax.

While the beverage and sugar industries are strongly opposed to any tax on sugar, their concerns are overblown.

A sugar-sweetened beverages tax will reduce domestic demand for Australian sugar by around 50,000 tonnes, which is only about 1% of all the sugar produced in Australia. And while there may be some transition costs, this sugar could instead be sold overseas (as 80% of Australia’s sugar production already is).

A tax on sugary drinks is a public health reform whose time has come.

The Conversation

A sugary drinks tax could recoup some of the costs of obesity while preventing it

In our new Grattan Institute report, A sugary drinks tax: recovering the community costs of obesity, we estimate community or “third party” costs of obesity were about A$5.3 billion in 2014/15.

Obesity not only affects an individual’s health and wellbeing, it imposes enormous costs on the community, through higher taxes to fund extra government spending on health and welfare and from forgone tax revenue because obese people are more likely to be unemployed.

In our new , A sugary drinks tax: recovering the community costs of obesity, we estimate community or “third party” costs of obesity were about A$5.3 billion in 2014/15.

We propose the government put a tax on sugar-sweetened beverages to recoup some of the third-party costs of obesity and reduce obesity rates. Such a tax would ensure the producers and consumers of those drinks start paying closer to the full costs of this consumption – including costs that to date have been passed on to other taxpayers. There is the added benefit of raising revenue that could be spent on obesity-prevention programs.

The scope of our proposed tax is on non-alcoholic, water-based beverages with added sugar. This includes soft drinks, flavoured mineral waters, fruit drinks, energy drinks, flavoured waters and iced teas.

While a sugary drinks tax is not a “silver bullet” solution to the obesity epidemic (that requires numerous policies and behaviour changes at an individual and population-wide level), it would help.

Why focus on sugary drinks?

Sugar-sweetened beverages are high in sugar and most contain no valuable nutrients, unlike some other processed foods such as chocolate. Most Australians, especially younger people, consume too much sugar already.

People often drink excessive amounts of sugary drinks because the body does not send appropriate “full” signals from calories consumed in liquid form. Sugar-sweetened beverages can induce hunger, and soft drink consumption at a young age can create a life-long preference for sweet foods and drinks.

We estimate, based on US evidence, about 10% of Australia’s obesity problem is due to these sugar-filled drinks.

Many countries have implemented or announced the introduction of a sugar-sweetened beverages tax including the United Kingdom, France, South Africa and parts of the United States. The overseas experience is tax reduces consumption of sugary drinks, with people mainly switching to water or diet/low-sugar alternatives.

There is strong public support in Australia for a sugar-sweetened beverages tax if the funds raised are put towards obesity prevention programs, such as making healthier food cheaper. Public health authorities, including the World Health Organisation and the Australian Medical Association, as well as advocates such as the Obesity Policy Coalition, support the introduction of a sugar-sweetened beverages tax.

What the tax would look like

We advocate taxing the sugar contained within sugar-sweetened beverages, rather than levying a tax based on the price of these drinks, because: a sugar content tax encourages manufacturers to reduce the sugar content of their drinks, it encourages consumers to buy drinks with less sugar, each gram of sugar is taxed consistently, and it deters bulk buying.

The tax should be levied on manufacturers or importers of sugar-sweetened beverages, and overseas evidence suggests it will be passed on in full to consumers.

We estimate a tax of A$0.40 per 100 grams of sugar in sugary drinks, about A$0.80 for a two-litre bottle of soft drink, will raise about A$400-$500 million per year. This will reduce consumption of sugar-sweetened beverages by about 15%, or about 10 litres per person on average. Recent Australian modelling suggests a tax could reduce obesity prevalence by about 2%.

Author provided/The Conversation, CC BY-ND

Low-income earners consume more sugar-sweetened beverages than the rest of the population, so they will on average pay slightly more tax. But the tax burden per person is small – and consumers can also easily avoid the tax by switching to drinks such as water or artificially sweetened beverages.

People on low incomes are generally more responsive to price rises and are therefore more likely to switch to non-taxed (and healthier) beverages, so the tax may be less regressive than predicted. Although a sugar-sweetened beverages tax may be regressive in monetary terms, the greatest health benefits will flow through to low-income people due to their greater reduction in consumption and higher current rates of obesity.

The revenue could also be spent on obesity programs that benefit the disadvantaged, reducing the regressivity of the tax.

While the beverage and sugar industries are strongly opposed to any tax on sugar, their concerns are overblown. Most of the artificially sweetened drinks and waters, which will not be subject to the tax, are owned by the major beverage companies.

A sugar-sweetened beverages tax will reduce domestic demand for Australian sugar by around 50,000 tonnes, which is only about 1% of all the sugar produced in Australia. And while there may be some transition costs, this sugar could instead be sold overseas (as 80% of Australia’s sugar production already is).

A tax on sugary drinks is a public health reform whose time has come.

NACCHO Aboriginal Health News Alert : Health Minister, Sussan Ley, is forecasting many changes to the health workforce

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The Health Minister, Sussan Ley, is forecasting many changes to the health workforce, driven by technology and growing demand for services.

She has revealed her insights in an article for the latest edition of the Consumers Health Forum journal, Health Voices, published today and titled Health consumers and workforce – are we engaged?  focusing on the issues facing Australia’s health workforce in providing patient-centred care.

The Minister’s article is one of 20 articles by workforce leaders and experts signalling big changes in health workforce composition and practices, including the development of more consumer-focused care systems.

See http://healthvoices.org.au/volume/issues/november-2016/

Ms Ley writes that with developing technology, growing community expectations and population ageing, the demand for health services will increase while the labour market will tighten.  “A future health workforce that is flexible and responsive to changing requirements for health service delivery is essential to ensure Australia maintains its high standards of health care, and to ensure that all communities have appropriate access to the care they need.”

Ms Ley says the Australian Health Practitioner Regulation Agency (AHPRA) prescribing working group is reviewing regulatory policies related to the prescribing of scheduled medicines.

She also says that current evidence on doctor numbers indicates a likely oversupply of 7,000 by 2030.  “With data projections continuing to indicate issues of maldistribution of doctors, especially in rural and remote communities, the Department of Health can ensure that policy initiatives are aimed to address these issues,” Ms Ley says.

The CEO of the Consumers Health Forum, Leanne Wells, says the Minister’s conclusion that getting workforce mix right would help ensure a sustainable, consumer-centred health system, showed the right direction given the challenges facing health care.

“The expert articles in this latest Health Voices edition show that even after two major national reviews into the health workforce there is still much scope to ensure we get the most effective care from the most appropriate health care professionals.

“There is a wide range of opinions express in the journal on how we can achieve best practice.  But the best starting point should be what is best for the patient and consumer.

“Several of the authors make the logical point that consumers have an important influence in health workforce decisions,” Ms Wells said.

Excerpts from Health Voices include:

  • “Integrated care must involve all health professions and go across health jurisdictions. And most importantly, it must involve and be focused on patients and their families and carers if we are to unlock its full potential,” Dr Catherine Yelland, President of the Royal Australasian College of Physicians.

 

  • “Well you may ask then, if nurses and midwives have always practiced person-centred care, and they are the largest cohort of the health workforce at 376,880 strong, why is this not evident in the health care system of today?” Lee Thomas, Federal Secretary of the Australian Nursing and Midwifery Federation.

 

  • ”Too many health professionals squander their valuable skills on work that other people could do,” Professor Stephen Duckett, health program director at the Grattan Institute.

 

  • “Demand and ‘need’ for health care seem limitless because of very high patient expectations and because ‘demand’ is partly determined by health professionals who can reduce treatment thresholds and create more demand if necessary – there are no unemployed doctors – and for many services there is a waiting list. Professor Anthony Scott, head, Health Economics Research Program at the Melbourne Institute of Applied Economic and Social Research.

 

  • In reality, a ‘simple’ visit to the GP can make a big difference to a patient’s health. Comprehensive, longitudinal care is about much more than just seeing patients when they are sick,” Dr Michael Gannon, Federal President of the Australian Medical Association.

 

  • “Yet, many patients, advocates and family carers continue to report feeling excluded from decisions about care by health professionals who they perceive as not listening to or understanding their perspective,” Professor Sharon Lawn, director of Flinders University’s Human Behaviour and Health Research Unit.

 

Health Consumers and workforce – are we engaged?  Read the 20 expert articles of this edition of Health Voices  at http://healthvoices.org.au/volume/issues/november-2016/

For NACCHO Newspaper

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 NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

naccho-newspaper-nov-2016 PDF file size 9 MB

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