NACCHO #justJustice Prison Health News Alert : Health cure needed for Indigenous incarceration

Prison

“Shamefully, poor health is a big part of this picture. The ‘imprisonment gap’ is a symptom of the health gap. As doctors, we believe that prevention is better than cure. By focusing on health, wellbeing, and diversion from the justice system, particularly for the young, lives can be transformed, to the benefit of the whole community. Sick people do not belong in prison; but too often, that is where they can end up, and that is no way to get better – in any sense.

We believe that these programs should be driven by Indigenous leaders and those working in the field, providing health services, representation, and advocacy, and would be pleased to work the government to develop these programs. The national underfunding of Aboriginal and Torres Strait Islander health services must also be corrected, with increased investment in Aboriginal and Torres Strait Islander community-controlled health organisations.”

The Law Society of South Australia and Australian Medical Association (SA) are jointly and overwhelmingly concerned by the rate of Indigenous imprisonment in Australia.

We call on Federal and State Governments to prioritise justice reinvestment programs and “close the gap” targets which give better solutions to preventing Indigenous offending than the four walls of a jail cell.

The AMA’s recent Report Card on Indigenous health and imprisonment reveals a clear link between health outcomes and imprisonment rates. The report shows that community-based initiatives help prevent re-offending.

President of the Law Society, David Caruso, said: “These initiatives focus on prevention and early intervention. They target the reasons for criminality and are effective in reducing re-offending and giving people options for a law abiding life”.

Justice reinvestment is supported by lawyers and doctors. The Chief Justice of South Australia, the Honourable Chris Kourakis, has voiced his support for justice reinvestment in the latest “Aboriginal Justice” edition of The Law Society Bulletin.

The Law Society and AMA (SA) agree that diversion programs should focus on issues endemic to disadvantaged Indigenous communities including poor health, particularly mental illness, and substance abuse. These issues are among the most significant drivers of the imprisonment of Aboriginal and Torres Strait Islander peoples.

“Our Aboriginal communities need and deserve better and smarter approaches to getting people out of the criminal justice system and prisons. We need evidence-based solutions that have rehabilitation as their aim,” Mr Caruso said.

“It is not a quick fix but we need to firmly invest in change now. The sooner we do so, the sooner we show a commitment to breaking the cycle of disproportionate and unacceptable numbers of Aboriginal people in the criminal justice system.”

“Crime, poverty and ill-health should not be daily concerns for Aboriginal people, or any members of our community. But for too many, it is a reality. We need multi-sector commitment to create better opportunities and health for our First Peoples,” Mr Caruso said.

“Both the health and justice systems are failing Indigenous Australians,” said AMA(SA) President Dr Janice Fletcher. “While passionate, hard-working people are dedicating their lives to making a difference in these areas, it is still not enough. Our whole health and justice systems need to do much better.”

“Aboriginal and Torres Strait Islander people are dying sooner than other Australians, and are significantly over-represented in custodial settings. They are 13 times more likely to be imprisoned than their non-Indigenous peers.

“Shamefully, poor health is a big part of this picture. The ‘imprisonment gap’ is a symptom of the health gap. As doctors, we believe that prevention is better than cure. By focusing on health, wellbeing, and diversion from the justice system, particularly for the young, lives can be transformed, to the benefit of the whole community. Sick people do not belong in prison; but too often, that is where they can end up, and that is no way to get better – in any sense,” said Dr Fletcher.

The South Australian Government has been investigating the implementation of a justice reinvestment pilot program, but sufficient funding has not been made available to establish a program as yet. The Law Society and AMA (SA) call on the Government to honour its election promise and commit funding to establish a justice reinvestment pilot program. Further, the Law Society and AMA (SA) call on the Federal Government to coordinate a national justice reinvestment program in conjunction with States and Territories, focusing on areas with high rates of crime and disadvantage.

We believe that these programs should be driven by Indigenous leaders and those working in the field, providing health services, representation, and advocacy, and would be pleased to work the government to develop these programs. The national underfunding of Aboriginal and Torres Strait Islander health services must also be corrected, with increased investment in Aboriginal and Torres Strait Islander community-controlled health organisations.

Support needed for our next NACCHO Aboriginal Health Newspaper

Celebrating the 10th Anniversary of the Close the Gap Campaign for the governments of Australia to commit to achieving equality  for Indigenous people in the areas of health and  life expectancy within 25 years.”

Next publication date 6 April 2016

Advertising and editorial closes 18 March 2016

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Response to this NACCHO media initiative has been nothing short of sensational over the past 3 years , with feedback from around the country suggesting we really kicked a few positive goals for national Aboriginal health.

Thanks to all our supporters, most especially our advertisers, NACCHO’S Aboriginal Health News is here to stay.

NACCHO Aboriginal #AHWW Healthy Weight Week : We can close the Indigenous nutrition gap – here’s how

FOOD

After years of neglect and a notable absence in last week’s Closing the Gap report, nutrition is finally being recognised as integral to closing the gap on Indigenous disadvantage.

This article is part of the NACCHO series for #AHWW Healthy Weight Week

This belated realisation is puzzling, given poor diet is a major cause of type 2 diabetes, heart disease, kidney disease and some cancers. Nutrition is particularly poor in Aboriginal and Torres Strait Islander communities, where it is estimated that at least 19% of the burden of disease is due to poor diet; much more than due to smoking.

From Amanda Lee The Conversation

Unhealthy discretionary (“junk”) foods that are high in salt, fat or sugar make up more than 41% of the energy intake of Aboriginal and Torres Strait Islanders in Australia.

On top of this, more than 20% of Aboriginal and Torres Strait Islanders report running out of food during the last 12 months and not being able to afford to buy more.

One of the rejected Close the Gap equity targets was that, by 2018, 90% of Indigenous families could access a healthy food basket for less than 25% of their income. But healthy foods can still cost double this.

What works

Improving nutrition can be complex, but the people of Minjilang in Arnhem Land showed in the early 1990s that rapid, marked and sustained health improvements are possible. In just 12 months, the community achieved a reduction in LDL (bad) cholesterol levels (12%), lowered blood pressure (8%), improved vitamin levels, weight and diabetes.

The main reason for success was that the multi-strategy Survival Tucker program was directed by the community.

However, these positive results have not been widely replicated.

Improving nutrition is complicated but it’s possible. Sophie Nelson and son Juriahus in Pipalyatjara, South Australia. Photo by Suzanne Bryce, NPY Women’s Council

What doesn’t work

The National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000-2010 provided a framework to address both food supply and demand. But while evaluation showed some promising results, particularly in workforce development, implementation was poorly resourced and patchy.

In 2009, the Council of Australian Governments developed the National Strategy for Food Security in Remote Indigenous Communities. Again, a subsequent audit found that resourcing had been poor, so few outcomes were achieved.

Since 2010, there has been a nutrition policy vacuum in Australia. Aboriginal and Torres Strait Islander communities and health services persevere, but efforts tend to be opportunistic, fractured and ad hoc due to lack of resources, support and coordination.

Current projects mainly focus on nutrition education of children and school-based activities including gardening. Healthy lifestyle workers were involved in some of these activities but are being phased out.

Remote community store groups such as Arnhem Land Progress Association and Retail Stores in Queensland, have confirmed the benefits of store nutrition policies.

Outback Stores was established by the Commonwealth government in 2006 to improve diet in remote communities. This publicly funded venture provides little transparency around nutrition data, but last week admitted to selling 1.1 million litres of sugar-sweetened soft drink per year in its 36 stores.

Most recent nutrition research efforts focus on cutting high sugar intakes or increasing the intake of fruit and vegetables. But while these seem like obvious targets, it’s not that simple.

Our recent study describes efforts to improve nutrition over the past 30 years in Central Australian communities now serviced by Mai Wiru Regional Stores Council. It shows that some improvements have been made: decreasing sugar (from 30% to 22% of energy intake), increasing availability and affordability of fruit and vegetables leading to a doubling of consumption, and consequent improvement in some nutrient intakes.

However, the overall effect has been a decrease in total diet quality. “Junk” food’s contribution to the average energy intake increased by 3%, with locals consuming more sugar-sweetened soft drinks, convenience meals such as microwavable pizzas and unhealthy take-away foods.

During this time, Mai Wiru also lost funding for its nutritionist.

Reforms need to improve availability, affordability, accessibility and promotion of healthy food. Christine Watson, Mutitjulu, NT. Photo by Suzanne Bryce, NPY Women’s Council

These results confirm that Aboriginal communities can exert control over some aspects of their food supply. But overall, concerted action and more resources are required to help communities tackle the broader impacts of the current Australian food system on our health.

A major barrier is that community stores are seen as small businesses rather than as essential services and are subject to commercial pressures to sell cheap, unhealthy food at high profit margins.

One worrying recent example is the advent of private-enterprise bakeries in Northern Territory communities. These are promoted as providing local employment opportunities and solutions to food insecurity but mainly sell unhealthy options.

What more needs to be done?

Evidence-based nutrition programs are required urgently in urban, rural and remote locations.

Reforms must include structural and regulatory changes to improve availability, affordability, accessibility and promotion of healthy food. Increased community capacity to prepare, cook and store healthy foods is also essential, for example, by improving housing.

Evidence-based economic interventions such as freight-subsidies, cross-subsidisation of healthy food and “fat taxes” need to be trialled.

Effective primary care strategies such as targeted family support, “well person’s health checks”, breastfeeding promotion and infant growth assessment and action programs are ready and waiting for funding to be implemented and expanded.

Above all, to improve Aboriginal and Torres Strait Islander nutrition and health we need real community consultation, improved public governance and political will.

NACCHO NEWSPAPER PROMOTION

Celebrating the 10th Anniversary of the Close the Gap Campaign for the governments of Australia to commit to achieving equality  for Indigenous people in the areas of health and  life expectancy within 25 years.

Response to this NACCHO media initiative has been nothing short of sensational, with feedback from around the country suggesting we really kicked a few positive goals for national Aboriginal health.

Thanks to all our supporters, most especially our advertisers, NACCHO’S Aboriginal Health News is here to stay.

We are now looking to all our members, programs and sector stakeholders for advertising, compelling articles, eye-catching images and commentary for inclusion in our next edition April 6

This 24-page newspaper is produced and distributed as an insert in the Koori Mail, circulating 14,000 full-colour print copies nationally via newsagents and subscriptions.

Our audited readership (Audit Bureau of Circulations) is 100,000 readers!

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NACCHO Submission to the Senate Select Committee on Health to inquire and report on health policy, administration and expenditure

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The most effective and sustainable way to engage Aboriginal people is the community controlled model, underpinned by principles of self-determination and community development. Real savings and progress in healthy outcomes for Aboriginal and Torres Strait Islander people can only be made by shifting expenditure on hospitals to Comprehensive Primary Health Care providers, who deliver preventative treatments.

NACCHO reject proposed additional healthcare costs, in the form of a GP co-payment and a rise in the cost of accessing PBS medicines, which would discourage Aboriginal and Torres Strait Islander patients seeking preventative health care and proactively managing chronic disease. Reducing the Medicare Benefit Schedule (MBS) rebates and incentives would impact the capacity of Aboriginal Community Controlled Health Services (ACCHS) to develop and maintain a sustainable service delivery model.

Recommit to the funding of health promotion and early intervention programs, which deliver long-term benefits through improved health and wellbeing and reduce the burden on the healthcare system at the tertiary and acute end of care. To ensure continued inroads to Close the Gap in overall life expectancy and the infant mortality gap for Aboriginal and Torres Strait Islander children, funding for Aboriginal and Torres Strait Islander-specific population health initiatives and child and maternal health programs must be maintained.

Focus needs to be placed on redirecting the expenditure gap in the mainstream services with relatively lower uptake by Aboriginal and Torres Strait Islander people to the ACCHS sector to better meet demand.

ACCHS provide a long-term employment pathway for Aboriginal and Torres Strait Islander people, but uncertainty discourages greater uptake of positions in the sector. Greater funding commitments are required to facilitate pathways for Aboriginal and Torres Strait Islander people to become health professionals across a diverse range of professions, such as clinical workers, administrative officers and in management.

Funding for ACCHS should be at a minimum indexed for population growth, demand for services and inflation.

The shift away from National Partnership Agreements and the defunding of the COAG Reform Council challenges the transparency and independence of measuring progress in Closing the Gap targets. Renewed commitments are needed to ensure monitoring of outcomes and allocation of resources remains equitable and relevant.

The full submission can be downloaded here.

MJA Article: Markers of hepatitis B infection and immunity in patients attending Aboriginal community controlled health services

Print

Hepatitis B virus (HBV) infection remains an important cause of morbidity and mortality in Aboriginal and Torres Strait Islander people, who have high rates of infection compared with non-Indigenous Australians. An article published in the Medical Journal of Australia this month looks at a study aimed at increasing the evidence base around HBV in Aboriginal and Torres Strait Islander people through an analysis of routine clinical encounter data.

Concluding that a substantial proportion of patients tested were susceptible to HBV, with a high percentage potentially infectious compared with the general population. High levels of active infection and susceptibility to infection suggest many opportunities for transmission and indicate the potential benefit of routine HBV testing and vaccination in this population.

Download article here …