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 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 approachingso 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 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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NACCHO Aboriginal Health and Justice : Clintons walking journey for hope and justice

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The road to justice is a long one fraught with difficulties and obstacles that only the most determined and committed can overcome to achieve the justice, human rights and respect deserved.

But he needs the support and help of Australians, in particular, Indigenous Australians, to reinforce this message to the federal government and invite positive action to help, not hurt, our nation’s First Peoples.

Deep within Clinton Pryor’s heart lies an overwhelming commitment to justice, hope and peace in his country for the First Nation Peoples.”

Wajuk man Clinton Pryor has embarked on a Walk For Justice across Australia to discuss the impacts government decisions are having on local indigenous communities in Western Australia.

NACCHO calls on all its members to assist Clinton on his journey to Canberra

Anyone interested in supporting Clinton Pryor’s Walk for Justice can visit his Facebook page , Twitter profile or website

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Article page 20 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

Written by Emma Meconi

But he needs the support and help of Australians, in particular, Indigenous Australians, to reinforce this message to the federal government and invite positive action to help, not hurt, our nation’s First Peoples.

“The government is going to close communities and I need your help to make a stand against the government,” he said on his website.

“As a young indigenous man and my people, it is our duty to look after the planet.

“Our elders fought so hard to get this community built. That community is very important to us.”

Mr Pryor does not want to see his community shut down because of funding cuts to vital services.

He is embarking on this walk so he can raise awareness nationwide and let the Prime Minister know closing communities is not right.

He wants to save his people from losing their home and country.

He began his journey in Perth in September this year and will complete it in Canberra in May next year.

He will travel thousands of kilometres on foot to deliver his very important message directly to the Prime Minister.

His message is one of hope and justice for Aboriginal Australia and it all began with a life changing moment in Mr Pryor’s life when he was a teenager.

“The hardest part of my life [was] when my father passed away when I was 16 years old. It was the day my life changed forever.

“I put my hand on his head and promised him three things and that was to help my people, look after my family and keep our people’s culture alive,” he explained.

Pryor is from the Mulan community in the east Kimberley region in far North-Eastern Western Australia.

His family moved to Perth when he was seven and this is where he grew up and he now still lives in Perth, in the suburb of Rivervale.

Up until his father’s passing, Mr Pryor had enjoyed a fairly fulfilling high school journey.

He said that the best part of his life was when he was in high school and played footy, had a girlfriend and a job and spent his weekends surfing at the beach.

Like most young men, he dreams of a life where he will be a Dad and have his own family and fulfil his childhood dream of making a change in the world.

But the rhythm of life with its constant changes brings moments of light and darkness, happiness and sadness, hope and despair, harmony and challenges.

Pryor experienced a period of homelessness not long after his father passed away.

“I lost my job, my girlfriend left me and I left home to live on the street for two years before I got myself together and back on track again because I knew if I didn’t move on with my life and not believe in myself I was not going nowhere with life,” he said on his website.

Pryor said the disconnection from others and not having a home was the hardest part of being homeless.

“The hardest thing when I was homeless was not having no money, no home and no-one caring for me or asking me how I being. It was like no-one cared about me and it feels like I was alone.”

Connection to country and growing up in a remote community reinforces why this walk is so vital.

“Community life is very important because it keeps my people out of town or out of the city because in town and in the city there is drugs, alcohol and violence.”

He said that community life is controlled by the elders who lead in a traditional way in accordance with their own law and this law which they have followed for 60,000 years keeps them calm and harmonised.

He strongly believes in his people’s spirituality and feels very connected to living life around him and the Great Spirit in the air, everywhere.

“I can tell what is right and what is not right. It is a sense in my heart that I can tell something is good or something is bad and tell by the animal around me if it is going to be a great day or not.”

He gains his strength from this force in the land around him and in return he loves and cares for the land, looks after her and protects her.

He stated that one threat to this harmony with country and land was mining companies because of the damage caused to the land wounds the culture and heart of indigenous people and damages their spiritual home.

“My people, we believe that when we die we come back and be a part of the tree, animal, rock, river, the air and the land itself. That is why I am very connected to the land because I know that those who pass on before me are always with me and around me. The great energy of life.”

He does not want to see what he cares most about in this world, his family, friends and culture, destroyed by corporate greed.

Similarly, he does not want to see the forced closure of remote communities and the resulting homelessness because of government spending cuts.

He said he had been involved in protests and rallies and was not prepared to give up on the belief that together he will win the fight for First Nation people of the land we all stand on.

“The most things I worry about is seeing a lot of my people living homeless, watching the land being destroyed and my culture dying out.”

This was a critical aspect of this walk because closing a community is not just taking people away from their home and leading to homelessness and feeling lost, it is also disconnecting them from their spiritual home and their identity.

“If community are closing down the sacred site, cave art and the song lines are under threat and can be lost forever without the young generation knowing their culture and about their people and how we live on the land,” Pryor said.

He wants to give his people hope and make sure they do not give up and that they keep fighting no matter what happens.

His message to the Prime Minister will be to ask the government to give the elders full control of their communities without interference by government.

More broadly, Pryor wants to emphasise the importance of a treaty in moving forward in an independent, harmonious and accepting way so Indigenous Australians can live the way they always have.

By undertaking this walk, Pryor will also be honouring the past, which is an important element in the Indigenous ritual where young men go walkabout to learn survival skills and spiritual awakening.

Pryor will have a lot of time for reflection and contemplation about the significance this walk will hold for indigenous Australians and also our nation as a whole and how things should change for the better.

“This walk is about bringing people from different cultures back together and showing that if there is any hope for this country we must work together.”

Songlines form the essence of spirituality and connection to land in indigenous culture and as Mr Pryor travels across Australia he will take some roads that follow songlines and some that don’t.

But all the while he wants to learn about his people and culture and what is happening to them now.

His aim is to “know the truth about how my people are living and understand the different law and dreamtime story.”

He said that something needs to be done and he hopes to meet and speak with many people along the way and create a force for good across the nation that he hopes the Prime Minster will be interested in hearing about.

He has a large social network of family, friends, his people and elders who are all supporting him and have encouraged him to do what he believes in.

He is not sure what he will say to the Prime Minister specifically but local elders have told him he will know what to say after he has done his walk.

The experience of walking over this vast land should serve to empower, embolden and strengthen Mr Pryor as he gets closer to achieving his goal.

Deep within Clinton Pryor’s heart lies an overwhelming commitment to justice, hope and peace in his country for the First Nation Peoples.

This commitment is ignited by a spiritual connection to country and culture that commands the nation’s respect, acceptance, appreciation, understanding and encouragement.

Time will tell if the Prime Minister shares an interest and affinity with the peaceful continuation of one of our nation and planet’s oldest and enriching cultures and civilisation.

The Prime Minister, increasingly seen as representing the big end of town and disconnected from the realities confronted by Indigenous Australians, did not respond to requests for comment on Mr Pryor’s Walk for Justice.

Anyone interested in supporting Clinton Pryor’s Walk for Justice can visit his Facebook page and Twitter profile.

NACCHO Aboriginal Health And Racism : News Ltd declares war on #18C and the ABC

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” Various newspapers, but particularly the Australian, have been publishing articles for years blaming violence in Aboriginal communities on traditional culture, or questioning Indigenous funding, or aspects of Indigenous identity, and even though I find many of these articles to be painfully ignorant, racist, offensive and insulting.

I am aware that they are within their legal rights to talk about these issues and share these opinions, even if I think they often border on advocating for cultural genocide.

This is an important distinction. Much of the anti-18C rhetoric has been built around the idea that ‘just because someone is thin-skinned and easily offended, it shouldn’t be against the law’.”

Luke Pearson founder of @IndigenousX writing for  NITV  : There has been an amazing amount of misinformation about 18C from various journalists and commentators in the 5 years since Andrew Bolt was rightly found to have been in breach of 18C of the Racial Discrimination Act.

*Differences of opinion are important in media, like the how the Australian’s editors don’t think the word Indigenous deserves a capital I, and I don’t think the people I mentioned in my article, or the australian itself, deserve capital letters either. See Below no 2

See NACCHO 57 published articles about Aboriginal Health and racism  

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 ” The Australian has produced more than 134,000 words on section 18C of the Racial Discrimination Act in the three months since the publication of that Bill Leak cartoon. To put that in perspective, that is more words than are in Harper Lee’s To Kill a Mockingbird, George Orwell’s 1984, or Lao Tzu’s The Art of War.

Prime Minister Malcolm Turnbull says “elite” media organisations like the ABC keep bringing up 18C as an issue for public discussion, but The Australian has produced enough words on the controversial section of the Racial Discrimination Act to fill a novel.

A Crikey analysis of stories written by journalists, editors and columnists at The Australian about 18C between August 4, when the original Leak cartoon was published, and today reveal the publication has produced 178 pieces on the matter, including 94 news stories, 84 opinion pieces, and 30 articles that made the front page.

In total, there have been 134,569 words on 18C since August — and the publication was obsessed with the RDA even before the cartoon was published.”

The Oz has literally written more about the ‘thought police’ than George Orwell did
Josh Taylor and Tamsin Rose
Crikey Journalist and Crikey Intern

 ” What the research tells us, then, is that racism is not rare and it is not harmless: it is a deeply embedded pattern of events and behaviours that significantly contribute to the ill-health suffered by all Aboriginal and Torres Strait Islander Australians.

Tackling these issues is not easy. The first step is for governments to understand racism does have an impact on our health and to take action accordingly. Tackling racism provides governments with an opportunity to make better progress on their commitments to Close the Gap, as the campaign is known, in Aboriginal and Torres Strait Islander health. The new plan has begun this process, but it needs to be backed up with evidence-based action.

Second, as a nation we need to open up the debate about racism and its effects “

Pat Anderson former Chair of NACCHO

NACCHO Aboriginal health and racism : What are the impacts of racism on Aboriginal health ?

 NOEL PEARSON PINPOINTS ABC’s ‘SOFT RACISM’

 “Noel Pearson could hold an audience just by reading a supermarket receipt, and for good reason. The prominent indigenous leader is a thoroughly compelling speaker, able to express complex notions of history and destiny in ways that are clear and inspiring.

He also carries significant moral authority, which is why Pearson’s criticism yesterday of the ABC is worth prolonged consideration.

Speaking at the Sydney launch of author Troy Bramston’s Paul Keating biography, Pearson began with a quote from Cicero and worked his way to a concluding line from Machiavelli. In between Pearson dwelt for a time on themes of political ambition and public trust.

All of it was fascinating but his comments on the ABC were the most pointed and powerful of Pearson’s entire address.

Pearson slammed the ABC as a “miserable, racist national broadcaster” that through its coverage of indigenous affairs was engaging if the “soft bigotry of low expectations”. The billion-dollar broadcaster featured he said a “spittoon’s worth of miserable people” who are “wishing the wretched to fail”.

They need blacks to remain alien from mother’s bosoms, carceral in legions, living shorts lives of grief and tribulation,”Pearson continued, drawing a straight line from the ABC’s annual tax-funded wealth to the deprivations of Aboriginal communities in Australia’s north.

“Because, if it was not so, against whom could they direct their soft bigotry of low expectations, about whom could they report misery and bleeding tragedy ?. Between Quadrant’s hard bigotry of prejudice from the right and the ABC’s soft bigotry of low expectations on the left, lies this common ground of mutual racism”.

The ABC yesterday offered a statement defending itself but Pearson’s accusations will ring true to ABC indigenous coverage.- which is anathema to Pearson – is the ABC’s view of Aboriginal Australians as being essentially shaped by welfare and dependence.

Former Prime Minister Paul Keating, who also spoke at yesterday’s book launch echoed the thoughts of many when he suggested Pearson go into politics.

“I always thought Noel would be Australia’s Obama”, Keating said, “but Noel has to learn one thing you have to make commitments.

I hope Noel plays a greater role in leadership than he has to date. “

Daily Telegraph Editorial 22 November : Image above Front Page

18C doesn’t stop anyone from talking about any aspect of Aboriginal culture or identity : Luke Pearson

Among the more egregious of these has been the idea that 18C prevents people from talking about issues of Aboriginal culture and identity – whether it be about ‘fair-skinned’ Aboriginal people, Indigenous funding, or domestic violence.

There is nothing about 18C which prevents anyone sharing any opinion about any of these topics, and the exemptions offered by 18D further ensures that these topics are open for discussion.

The most recent article making these false assertions was from chris mitchell* in, no surprises here, the australian.

In this article mitchell laments how white people like andrew bolt aren’t allowed to have opinions about the topics mentioned above, for legal reasons, and then goes on to share his opinion about those topics.

He writes: “bolt is understandably sensitive to the legal position he faces after the bromberg judgment. But he is dead right when he implies privately that the issue of light-skinned, self-identifying Aborigines needs to be discussed.”

“The losers when people who are largely of European heritage and live a mainstream middle-class life win prizes and preferment because of claimed indigeneity are the really disadvantaged, whom most Australians would rightly think deserve the hand-up being awarded so often today to those who hardly need it.”

There you go, chris mitchell, you just talked about the thing that you said needs to be discussed but can’t be. Maybe you are quietly hoping that you too will have an 18C claim made against you, because you know that 18D allows you to talk about it, or maybe you are sincerely ignorant to the fact that you are talking about the thing you think you can’t talk about.

18C doesn’t prevent you from talking about any of what you are saying, and the Bolt case highlighted this point: “Nothing in the order for relief should be taken to suggest that it is unlawful for a publication to deal with racial identification.

Mr bolt and HWT [Herald and Weekly Times] were not found to have contravened section 18C of the RDA simply because of subject matter of the articles, but rather because of the manner in which that subject matter was dealt with.”

Simply put, he said things about people that simply weren’t true, and that any decent journalist would have very easily found weren’t true, so much so that the only conclusion was that he racially vilified people for the key purpose of racially vilifying them.

So even if the changes to 18C from ‘insult’ and ‘offend’ to ‘vilify’ were made it probably wouldn’t have helped bolt in his case because he racially vilified people, unreasonably and in bad faith.

Various newspapers, but particularly the australian, have been publishing articles for years blaming violence in Aboriginal communities on traditional culture, or questioning Indigenous funding, or aspects of Indigenous identity, and even though I find many of these articles to be painfully ignorant, racist, offensive and insulting, I am aware that they are within their legal rights to talk about these issues and share these opinions, even if I think they often border on advocating for cultural genocide.

This is an important distinction. Much of the anti-18C rhetoric has been built around the idea that ‘just because someone is thin-skinned and easily offended, it shouldn’t be against the law’.

The Human Rights Law Centre, a not-for-profit organisation, released a myth-busting document about the case after the misinformation about the legislation started doing the rounds.

In it they write: “There is no general right not to be offended in Australia. The price of free speech is that we accept that people should generally be able to say offensive things. But there are limits to the kinds of offensive things we can say. Our laws make it a criminal offence to use profane or indecent language or behave in an offensive or insulting way in public. Our sexual harassment laws make it unlawful to engage in unwanted or unwarranted sexual behaviour that is offensive.

The racial vilification laws make it unlawful to do things that are reasonably likely to “insult, offend, humiliate or intimidate” on the grounds of race. The Courts have interpreted the laws sensibly and have said the laws only apply to behaviour that has “profound and serious effects, not to be likened to mere slights”.”

They also state “Mr bolt’s articles didn’t fall within the exemption because the court found that his articles contained multiple errors of material fact, distortions of the truth and inflammatory and provocative language. This meant that he could not rely on any of the free speech exemptions.”

18C doesn’t stop anyone from talking about any issue whatsoever; it does however prevent people from using ‘multiple errors of material fact, distortions of the truth and inflammatory and provocative language’ in clear efforts to racially vilify people.

If people think 18C should be changed from ‘offend’ and insult’ to ‘vilify’ because that would be a stronger threshold then okay, that’s fine. The main problem I have with this seemingly never ending ‘debate’ is when people pretend that 18C prevents from talking about any issue to do with any aspect of Indigenous identity or policy, because it simply doesn’t.

That’s not to say that I don’t get annoyed when people write racist opinions and try to present them as fact, of course I do. I don’t look forward to every other hearing what the latest racist article that has been published is.

I don’t just think is a sad indictment of just how popular racism in our country still is, I think it is why racism is still so popular.

As for actual conversations around matters of public interest, I am all for them. The application of the three point criteria for Aboriginal identity isn’t perfect, and people can and should talk about ways it could be improved. Indigenous funding is a dog’s breakfast, even more so after the introduction of the so-called Indigenous Advancement Strategy, and this too should be looked at critically and again, it already can be.

It would also be great if there were more sincere attempts to understand the complexities of contemporary Aboriginal identities and how they have been impacted on by the countless government policies that have attempted to define and quantify Aboriginality in Australia’s history.

For example, there is a document on the Australian Parliament House website called ‘Defining Aboriginality in Australia’, which mentions that “’Blood-quotum’ classifications entered the legislation of New South Wales in 1839, South Australia in 1844, Victoria in 1864, Queensland in 1865, Western Australia in 1874 and Tasmania in 1912.

Thereafter till the late 1950s States regularly legislated all forms of inclusion and exclusion (to and from benefits, rights, places etc.) by reference to degrees of Aboriginal blood. Such legislation produced capricious and inconsistent results based, in practice, on nothing more than an observation of skin colour.”

That is interesting information, and can help provide context to the current conversation that people like to pretend isn’t the continuation of a 200 year old conversation about how Aboriginal people should be defined and controlled.

Even the comments made by andrew bolt were not remotely new. bruce ruxton expressed similar sentiments years ago when he asked the Federal Government to amend the definition of Aboriginality “to eliminate the part-whites who are making a racket out of being so-called Aborigines at enormous cost to the taxpayers.” It is also interesting to note that the footnote for that quote on the aph.gov.au website article is, you guessed it, the Australian, in 1988.

ruxton’s quote always reminds of another famous quote made in the 1980s, lang hancock’s ‘solution to the Aboriginal problem’:

“Those that have been assimilated, earning good living wages among the civilised areas, that have been accepted into society and have accepted society and can handle society I’d leave them well alone. The ones that are no good to themselves and can’t accept things, the half-castes, and this is where most of the trouble comes, I would dope the water up so that they were sterile and would breed themselves out in future, and that would solve the problem.”

I wonder if that quote would get flagged under 18C as it currently stands, or if people think this is an example of the sort of Free Speech debate that we should be having and that 18C is stopping?

It certainly didn’t stop gary johns from writing an article in the australian arguing that women on the dole should be forced onto contraception, or calling Aboriginal women ‘cash cows’ on the bolt report,

“Look, a lot of poor women in this country, a large proportion of whom are Aboriginal, are used as cash cows, right? … They are kept pregnant and producing children for the cash.

Now, that has to stop.” – Not quite a call for sterilisation, but not quite as far away from lang hancock’s comments as I would like either, given that the latter were made over 30 years later.

So, again, what exactly does 18C stop anyone from talking about? It certainly doesn’t seem to have slowed the australian down all that much?

*Differences of opinion are important in media, like the how the australian’s editors don’t think the word Indigenous deserves a capital I, and I don’t think the people I mentioned in my article, or the australian itself, deserve capital letters either.

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NACCHO Aboriginal Eye Health : Annual update -The Roadmap to Indigenous eye health is closing the gap

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 ” Eye health and good vision is an important issue for everyone, but particularly for Aboriginal and Torres Strait Islander people.

It accounts for a significant proportion of the health gap between Indigenous and non-Indigenous people. I’m pleased to report that progress is being made.

The National Eye Health Survey, released on World Sight Day this year, also tells an important story. Rates of blindness amongst Aboriginal and Torres Strait Islander people have improved from 6 times to 3 times as much compared with non-Indigenous people.

And the prevalence of active trachoma among children in at-risk communities fell from 21% in 2008 to 4.6% in 2015.

The Roadmap to Close the Gap for Vision has played a part in prompting actions that contribute to this improvement. The Roadmap outlines a whole of system approach to improving Indigenous eye health, and achieving equity between Aboriginal and non-Aboriginal eye health outcomes.

There is however still work to be done on Closing the Gap for Vision. For example, half of Indigenous participants with diabetes had not had the recommended retinal examination.

NACCHO has been involved with the Roadmap from its inception, and had a long relationship with Indigenous Eye Health at the University of Melbourne, and with RANZCO. We’re pleased with the great work and good progress being made.”

 Ms Patricia Turner, Chief Executive Officer, of the National Aboriginal Community Controlled Health Organisation (NACCHO) launching  The 2016 Annual Update on the Implementation of the Roadmap to Close the Gap for Vision

Pat Turner pictured above with Mark Daniell President, RANZCO,  and Prof Hugh Taylor at the launch.

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The gap in blindness in Indigenous communities has been halved since 2008 through collective implementation of the sector-supported Roadmap to Close the Gap for Vision, according to a report launched yesterday

Speaking at the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Annual Scientific Congress in Melbourne, Laureate Professor Hugh R Taylor AC, Harold Mitchell Chair of Indigenous Eye Health at the University of Melbourne said that progress is being made on every single recommendation in the Roadmap to Close the Gap for Vision, which was developed by Indigenous Eye Health at the University of Melbourne.

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Download copy of the Report 2016-annualupdate

Eleven of the 42 recommendations have now been fully implemented, with almost two thirds of all activities completed.

“In terms of regional implementation of the Roadmap, there has been positive engagement. We are working with 18 regions across the country covering almost half of the nation’s Indigenous population,” Professor Taylor said.

“We can report that at the beginning of this project, we found rates of blindness and impaired vision were up to six times higher than for non-Indigenous populations. This has now been halved,” he said.

“While the rate stands at three times more than the national average, this is still a very encouraging improvement. With on-going national support, we are determined to reach eye health parity with the rest of the Australian population.”

In his role as Chair of Indigenous Eye Health, Professor Taylor is also working with Indigenous leaders, partners and members of the community in a mission to eliminate trachoma in Australia.

“We are the only developed nation with endemic disease and only in Indigenous communities. Many Indigenous communities are now trachoma free and we can turn our attention to other main causes of blindness and poor vision in Indigenous communities: cataract, refractive error and diabetes,” Professor Taylor said.

Since 2008 rates of trachoma in children in outback communities has fallen from 21% to 4.6%. “We are really seeing some striking progress but we still need to focus on the hot spots.”

“The 2016 Roadmap update shows we are making great progress and are on track to close the gap for Indigenous vision completely in the next four years.”

 

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NACCHO Aboriginal Health Funding alert : $13.1m infrastructure grants for existing regional, rural and remote general practices.

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 ” Grants may be used for a range of infrastructure projects, including construction, fit-out and/or renovation of an existing general practice building, supply and installation of information and communication technology equipment or medical equipment.

Grants of up to $300,000 will be provided to successful applicants in 2017. All successful applicants will be required to match the Commonwealth funding contribution.”

Assistant Minister for Rural Health Dr David Gillespie

“Improved training facilities, such as communication technology, will also ensure that rural doctors can increase their own training opportunities, so they can continue to keep their skills current and maintain their practice at the high level that they strive for and that rural communities deserve.”

Dr Ewen McPhee, President of the Rural Doctors Association of Australia (RDAA) see full press release below

The Australian Government has committed $13.1 million in funding under the Rural General Practice Grants Program (the Program) for grants up to $300,000 each to deliver improved health services through additional infrastructure, increased levels of teaching and training for health practitioners, and more opportunities to deliver ‘healthy living’ education to local communities.

The Program will provide an opportunity for general practices within Modified Monash Classification 2-7 to deliver increased health services in rural and regional communities.

The Program commences with a call for Expressions of Interest (EOI), in which suitable organisations will be identified and subsequently invited to submit a full application.

Project Officer Details Name: Health State Network
Ph: 02 6289 5600 E-mail: Grant.ATM@health.gov.au
Closing date 2:00 pm AEDST on 13 December 2016

Submit your detail here

Teaching, training and retaining the next generation of health workers in rural, regional and remote Australia is a priority for the Coalition Government.

Assistant Minister for Rural Health Dr David Gillespie said the Coalition Government has moved to streamline the former Rural and Regional Teaching Infrastructure Grants program to better respond to the needs of rural communities and support the work of rural general practices.

“A more streamlined and simplified two-step application process is now open through the new Rural General Practice Grants (RGPG) program,” Dr Gillespie said.

“General practice in rural Australia faces unique challenges in healthcare including the ability to attract and retain a health workforce.

“The RGPG program will enable existing health facilities to provide teaching and training opportunities for a range of health professionals within the practice and for practitioners to develop experience in training and supervising healthcare workers.

“I believe that strong, accessible primary care in regional Australia helps alleviate pressure on the public hospital system and at the same time it also provides opportunities for earlier intervention and better patient outcomes.”

“Our Government wants Australians, no matter where they live, to have access to quality health services,” Dr Gillespie said.

“I also want our health professionals who live and work in rural, regional and remote Australia to have access to teaching and training opportunities so they remain in general practice and in the communities that need them the most.”

Grant documentation will be available from the Department of Health’s Tenders and Grants page at www.health.gov.au/tenders.

Rural doctors congratulate government on new grants program

Australian rural doctors are today welcoming the announcement of a streamlined Rural General Practice Grants (RGPG) program, just announced by Dr David Gillespie, Assistant Minister for Rural Health.

Dr Ewen McPhee, President of the Rural Doctors Association of Australia (RDAA), said that the announcement was a reflection of the importance the Coalition Government places on rural and remote health care.

“We are extremely pleased that Minister Gillespie has been so proactive in his Rural Health portfolio, and he has shown a great understanding of the need for increased training facilities to enable the education of the next generation of rural doctors,” Dr McPhee said.

“The RGPG will allow more of our highly skilled doctors in rural areas to improve their training capacity, allowing them to take on more young doctors in training and ensure they have access to quality educational opportunities in rural areas.

“Research shows us that young doctors who undertake training in rural areas, and have a good experience in their placement, are more likely to choose rural medicine as a career.

“Grants enabling doctors to improve and expand their training facilities will play a key role in the recruitment and retention of the rural doctor workforce of the future,” Dr McPhee said.

While infrastructure grants have been available for rural practices for some time, the application process was onerous, complicated and time consuming, putting it out of the reach of many small practices who did not have the time or expertise to successfully apply.

Grants can be used for a range of projects, including construction, fit-out and/or renovation of an existing general practice building, supply and installation of information and communication technology equipment or medical equipment.

“Simplifying and streamlining the process will ensure that these smaller clinics will no longer be disadvantaged by the system,” Dr McPhee said.

Many doctors enjoy the opportunity to engage with young doctors and be a part of their training journey. We look forward to more of our colleagues being able to participate in this way thanks to the Coalition’s commitment to rural health.

“Improved training facilities, such as communication technology, will also ensure that rural doctors can increase their own training opportunities, so they can continue to keep their skills current and maintain their practice at the high level that they strive for and that rural communities deserve.

“We thank Minister Gillespie for his recognition of the importance of this area.”

The third Rural Health Stakeholder Roundtable was held at Parliament House in Canberra on the 16 November 2016.

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Twenty years ago one of Australia’s greatest health challenges was a lack of doctors coming through the system.

Today, that challenge has been overcome with latest research predicting a surplus of 7000 doctors by 2030,” the Federal Minister for Rural Health, Dr David Gillespie, said today.

“The new challenge is no longer the number of doctors in our nation’s health workforce, but where they are distributed.

“This issue, along with the need for greater numbers of allied health professionals in the bush, are among the major topics to be discussed at the third Rural Health Stakeholder Roundtable at Parliament House in Canberra today,” Dr Gillespie said.

“The Roundtable was attended by an impressive representation of rural health stakeholders, from rural doctors associations, medical educators, rural health consumer and advocacy groups, Aboriginal medical services, rural and remote allied health organisations and health workforce professionals.

“We have an outstanding health workforce in the regional, rural and remote areas of this country and today’s roundtable is designed to get all the key players together with government to work out the very best strategies to support them and the work they do for our more isolated communities.”

Minister Gillespie said the Coalition Government is investing record funding in health as part of its commitment to strengthen the regional, rural and remote health system so that Australians living in these areas have access to the best care available.

“Our Government is working in partnership with these people to deliver health care to rural and remote communities through a broad range of initiatives as part of our record funding investment in the health portfolio.”

The Roundtable will discuss today the establishment of the National Rural Health Commissioner (the Commissioner), a new role to champion the cause of rural practice.

The Commissioner will work with rural, regional and remote communities, the health sector, universities, specialist training colleges and across all levels of Government to improve rural health policies.

Another priority item on the agenda is the development of the National Rural Generalist Pathway. This will improve access to training for doctors in rural, regional and remote Australia, and recognise the unique combination of skills required for the role of a rural generalist.

“General practitioners with advanced skills in areas such as general surgery, obstetrics, anaesthetics and mental health are commonly required in the bush also,” Dr Gillespie said.

“We want to make sure these skills are encouraged, developed and properly remunerated.”

Minister Gillespie said the Coalition Government had increased its investment in education and training initiatives both in medical and allied health professions to create a longer term ‘pipelines’ of boosting the rural health workforce.

“The new multidisciplinary training pipeline incorporating the Rural Clinical Schools and University Departments of Rural Health across regional Australia will be a critical component as we boost the capacity of training through our investment in Regional Training Hubs to bring more doctors and allied health professionals to the bush,” he said.

In response to recommendations put forward to the Rural Classification Technical Working Group, an independent group that has assisted the Government to implement the new geographical classification system, I announce today that more support will be provided to medical practitioners working in Cloncurry, Queensland and Roebourne, Western Australia.

“I am pleased to also announce an additional workforce support in the form of a rural loading will be applied to all doctors working in these two towns from 1 January 2017,”  Minister Gillespie said.

“The additional loading will be up to $25,000 per annum through the General Practice Rural Incentives Program and will recognise exceptional circumstances faced in attracting and retaining a workforce in these locations.

“The Coalition Government’s broader health reforms will have direct benefits for regional, rural and remote health, with the patient at the centre of care. Localised, integrated, community-driven health care is the order of the day,” Dr Gillespie said.

“The Rural Health Stakeholder Roundtable is a central part of informing policy reform in rural Australia and I am looking forward to fruitful discussions with participants today.”

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NACCHO Aboriginal Health ” What Works Part 9 ” ; Hon Linda Burney’s Menzies Research Oration ” Community led programs “

 

Shadow Minister for Human Services Linda Burney makes her maiden speech in the House of Representatives at Parliament House in Canberra, Wednesday, Aug. 31, 2016. (AAP Image/Mick Tsikas) NO ARCHIVING

” Paternalism is symptomatic of a view of Aboriginal Australia which sees Indigenous people purely as the problem.

It speaks to that old lie – that Aboriginal people have inflicted this deprivation on themselves, and that governments must save them from themselves.

Despite my pessimism about the current direction of government approaches to the Aboriginal community I do see some cause for optimism.

The communities which are doing best are those which have found ways to support their own initiatives despite failing Government approaches.

I take heart from organisations like Tharawal in Sydney’s South-Western Suburbs – an Indigenous health services ( and NACCHO Member  ) which does not just focus on treating illness when it occurs.

They target what Sir Michael Marmot calls “the social determinants of health” and what the Menzies School of Health Research has worked so hard to identify. Stable housing, early education and social support.

And they are seeing excellent results. You know it is about providing this information to the organisations that already work in communities – it is not a lack of ideas, we know the programs that work and they are community led. ”

Hon Linda Burney MP : ” Truth telling and generosity – Healing the Heart of the nation  : Oration Menzies School of Health Research Darwin 18 Nov 2016

Photo above : the first elected Aboriginal woman in the House of Representatives Shadow Minister for Human Services Linda Burney makes her maiden speech at Parliament House in Canberra, Wednesday, Aug. 31, 2016. (AAP Image/Mick Tsikas)

I open by acknowledging the Larrakia people on whose land we meet today.

I pay my respects to their elders past and present. I also take this opportunity to acknowledge their long struggle for equality, for land rights and for self determination.

I pay tribute to the Larrakia peoples’ determination in the face of denial and I mourn with them the loss of so many elders before their 23 year struggle for land rights could be resolved.

In acknowledging country I do not just pay tribute and respect –

I am acknowledging the fundamental truth that this land has played host to thousands of years of lived human experience.

Cultures evolving and changing since the first sunrise.

I want to thank the school for hosting me today. The world class socio-medical research published by the Menzies School of Health Research will lead to very real improvement in the standard of living for many Aboriginal people.

I also acknowledge today the special guests in the audience;

 Commissioner Mick Gooda, of the Royal Commission in into Juvenile Detention

 Tony McAvoy SC, the first Aboriginal Senior Council

And of course my colleagues;

 Senator Malarndirri McCarthy

 Luke Gosling MP

 Various Northern Territory administrator and MPs.

It is an honour to be invited to deliver the Menzies’ School of Health Research Oration for 2016.

If I can I’d like to offer my thoughts on 4 things –

  1. Truth telling and forgiveness, as I did for the Lingiari Oration in 2007 I want to remind you all of the importance of narrative and the need for truth as the bedrock of our reconciliation process;
  2. Recognition of First Peoples in our constitution – our next great project in truth telling and the one to which we must turn our attention to now;
  3. The perilous state of our Governments’ Indigenous Affairs policy today. and;
  4. The way, as I see it, forward from here.

But I want to start by appealing to your optimism – the facts of our condition can be dispiriting but I am reminded of the lessons taught to me by the late Faith Bandler.

I had the extraordinary honour of being invited by Faith’s daughter, Lilon, to speak at her memorial service in the Great Hall at Sydney University.

Faith more than anyone understood that we are playing the long game – it require understanding and devotion but most of all it requires patience.

The memory of Faith is an appropriate one – it was the work of Faith, along with so many others like Jessie Street and Alan Duncan that convinced the Menzies and Holt Government to hold the 1967 Referendum.

That 10 year campaign saw the revitalisation of the fight for Aboriginal and Torres Strait Islander rights and began the journey of truth telling.

In my first speech to the Australian Parliament I told the story of an older non- Aboriginal woman making her way to the voting booth late on Election Day.

It was cold and dark and her daughter urged her just to give up and go home as she slowly made her way across the park to the local public school– but she insisted.

She said that her opportunity to vote for an Aboriginal woman “was history”. She saw that she had a stake in that election that transcended “bread and butter political issues”, she didn’t need to be an Aboriginal person to understand that.

She knew that the election of an Aboriginal woman was not just a victory for Aboriginal people; it was a part of our shared national history.

Not so long ago that would not have been the case – we had two distinct historical narratives.

A white one and a black one.

“White” Australia (as it was then) had no interest in Indigenous history, and “Black” Australia had no stake in engaging with a “White” future.

That old woman proved to me that we are changing this.

For the 1988 bicentenary campaign our signature poster was “white Australia has a black history.” –

That campaign, led by Kevin Cooke and Reverend Harris (with a young Linda Burney too) sums up the feeling.

I can think of few venues in which it is be more appropriate to discuss the reconciliation movement –

A school of health research; which, along with education, is one of the greatest areas of need for Aboriginal people and,

One named for our 12th Prime Minister; who governed in an era which saw the revitalisation and renewed push for equality and self-determination for our people.

His reign marked a turning point – the beginning of the end for the Australia which was nestled firmly in the bosom of the British Empire.

It was a time of national coming of age.

I am no political fan of Menzies but I think it is true to say that without him there could have been no Whitlam or Keating or Hawke.

Their fiercely independent and inclusive model of Australian identity was born of a rebellion against the era of Menzies.

So in this sense we owe him a debt of sorts.

When I was only 4 years old in 1961, Sir Robert Menzies hosted a delegation of Aboriginal people from mainland states.

They had already been fighting for years to see a referendum held which would grant Aboriginal people equal rights.

There was considerable excitement amongst the attendees, a meeting with Prime Minister was in itself a victory for a community almost completely excluded from the political process at that point.

Menzies served his guests alcoholic drinks.

Our Prime Minister was shocked when informed by one of the attendees that that act was illegal under state law.

Such was the denial of truth and the refusal to see discrimination in our country at that time – the sitting prime minister was, himself, unaware of this discrimination.

It was paternalism in its worst form.

Menzies resigned when I was 9 years old – he had been a constant on the radio and on TV for those who had them, for much longer than that.

This explains to some extent the reverence with which so many look back on this time. To them it was stable and prosperous.

But even looking back through the rose tinted glasses of nostalgia – we cannot help but catch glimpses of the rampant discrimination of that era in the corners of our eyes.

Forced removal; captured so hauntingly in Archie Roaches’ “Took the Children Away, Government or church run reserves dictating the terms on which Aboriginal people could live, and; Government decrees which saw indigenous languages banned or even outlawed.

This was an era in which the Indigenous people of this continent were still considered biologically inferior, in which the White Australia policy still enjoyed bipartisan support.

It was a time in which the voices of women, non-white Australians and marginalised groups were systematically silenced.

So, while I pay my respects to Robert Menzies I cannot deny this truth. Nostalgia and reverence aside, this was an age of acute racism and a total denial of history.

We still considered ourselves an outpost of the British Empire, the millennia of Aboriginal history on this continent not only ignored, it was actively being hidden and destroyed.

I don’t know what Sir Robert Menzies would think of me delivering an oration named for him;

A woman;

An Aboriginal person, and;

A Labor member of Parliament.

Things have certainly changed.

If he didn’t accuse me of being a communist first, he might ask whether we had any political views in common and he might be surprised to hear where things stand today.

The fact is, regardless of political stripe, Menzies and I share some core political beliefs.

Sir Robert Menzies believed that government intervention could be a tool for good; he believed that the role of government was to empower the “forgotten” Australians and; He did saw economic growth as a means to an end not an end unto itself.

In his 1961 election address he noted that “a growing nation must be a healthy one”, and while it would be up to Whitlam to introduce a nationwide health scheme,

Menzies invested significantly in the area.

He was amongst the first leaders in Australia to recognise that the health of the community was a valuable measure of its prosperity.

And while his view of the 1967 Referendum was in some ways conflicted (Menzies himself having campaigned against some proposals) he also oversaw the passage of the 1963 Commonwealth Electoral Act which granted universal suffrage to Aboriginal people regardless of the state in which they were born.

Like the story of all governments when it comes to First Peoples’, Menzies legacy is mixed.

Menzies to some extent defined his generation but he was still a captive of the more exclusionary views of his day.

Truth Telling and Reconciliation

When it comes to the reconciliation process to date, truth telling is important.

Truth telling has been a theme of my public life to date.

In my view the path to reconciliation must be grounded in a fundamental commitment to truthfulness – it is one of the cornerstones of reconciliation.

As Dr Alex Boraine, deputy chair of South Africa’s Truth and Reconciliation Commission, noted at the Melbourne Reconciliation convention in 1997;

“Reconciliation… must be grounded in reality. There are 3 anchors which can keep us on the ground…. The first of these anchors is the experience of truth… of telling, of coming to terms with the truth of our past and the truth understood in this way transcends lies… it rejects denial to come clean in order to build, to heal.”

I told you earlier how surprised Menzies was to hear that the law prohibited serving his Aboriginal guests alcohol.

If not deliberately, then subconsciously, he had chosen not to see this discrimination.

As has much of the Australian community for the majority of our post-colonial history.

We cannot afford to do that.

In the last 30 years we have started to lay the anchor of truth –

We have a curriculum which teaches the truth of our history, we have a political system which now includes a record number of First Peoples and we have almost reached a national consensus about the imperative for action on closing the gap.

This kind of truth telling is not purely symbolic.

Children in our schools now understand that the history of Australia, or at least the

Australian continent, extends far beyond 228 years of colonisation.

And that is important. We won’t really be able to treat the malaise which afflicts

Aboriginal communities until the broader community understands the impact of generational disadvantage and cyclical poverty.

When Kevin Rudd delivered the apology to the stolen generation in the federal parliament he undertook a momentous act of truth-telling.

When that speech concluded two older Aboriginal women handed the Prime Minister and the Opposition leader a coolomon – it was an astounding act of generosity.

For that generosity we owe considerable gratitude, but it also demonstrates in part why the apology was so important.

That act of truth telling opened the door to forgiveness – and without it we cannot see old enmities consigned to the past.

After The Apology, as I walked into the marble foyer of the parliament I ran into Aunty May Robinson, an elder from South Western Sydney.

She held in her hands a black and white photo – and her only words to me when we saw each other were;

“Linda! I bought mum.”

We fell into each other’s arms crying.

Recognition

It is my hope that the Recognition of First Peoples in our constitution will be another of these great moments of truth telling, and that it will pave the way for a greater depth of understanding.

As it stands we have a Constitution which tells the story of western democracy; the Westminster system of government and a thousand years of its development.

But it says nothing of the more than 40,000 years of lived experience on this continent that preceded European arrival.

Our Constitution, the document on which the Parliament I sit in is founded, does not tell the truth. It is a fundamental failing and one that we cannot continue to ignore.

This is a part of the reconciliation process that Dr Boraine talked about almost 20 years ago and it is a fundamental part of our nation building project.

The symbolism of recognition belies powerful consequences.

I saw the feeling of relief on the faces of those old women in the Parliament after the apology and felt the relief of the broader Australian community at finally having acknowledged the truth.

More than anything else Recognition will add another thread to the tapestry of our national identity – a history and a story that we can all share.

I do not concede to any argument that suggests this act will be divisive. The true act of division would be a continued denial of the truth of settlement and invasion.

Recognition and Paternalism

I am also hopeful that Recognition will pave the way to a more consistent and effective approach to Government policy in the area.

For all the talk of “Prime Ministers for Indigenous Affairs” and a bipartisan commitment to closing the gap, we are yet to see the progress we need.

Life expectancy for First Australians is almost 10 years shorter than the rest of the community – the number blows out considerably further for those in rural or remote communities.

Our young people are locked up at ever increasing rates – almost 48% of those in the juvenile justice system are Aboriginal.

Our birthweights are consistently lower, as are our educational outcomes and our average earnings.

We are making slow progress – but it is not enough.

For every year that passes without dramatic improvement in our condition we draw closer to a point at which we will have failed yet another generation.

In the last week of Parliament I attended the launch of a report on the National Aboriginal Suicide Prevention Strategy.

How can it be that for Aboriginal people attending the funerals of young people is so commonplace?

One of the women who attended, Norma Ashwin, a mother who has lost her child, summed up the feeling of her community –

“We have nothing. Our kids have no hope, nothing, just a sense of no belonging… [we have] Lost everything…”

It is easy to see how in the face of this despair, Governments can turn to lazy policy options and to the comfort of the past.

Perhaps in frustration at slow progress Conservatives have done what they usually insist they will not – let the government pick and choose winning initiatives while ignoring community voices.

Conservative forces have continued to drive us back towards the paternalism of the past – from the “10 point plan” on native title and the destruction of ATSIC in the late 1990s — through to the very recent cuts to legal services, defunding of advocacy organisations and of course the denial of support for the National Congress of Australia’s First Peoples.

Half a billion dollars has been pulled out of the Indigenous affairs budget.

The trend is clear.

A concerted effort to silence the voices of Aboriginal leaders and a refusal to accept what we already know to be true —- solutions to our problems need to be found with communities, not imposed upon them.

Don Dale provides a perfect example – the Koori media had reported this story months before any mainstream news agency did and members of the local community will tell you – they had raised these issues before.

Indeed we know now that the both the Federal and State Governments’ were well aware of the issue.

But the story received scant political attention. Key advocacy organisation which could have raised the issues more loudly, either didn’t have the resources or didn’t exist anymore.

Paternalism isn’t just a failed policy approach because it pacifies communities and because it deprives individuals of their rights to self-determination –

It necessarily makes communication one way, from top to bottom.

Inflicting policy decisions on Aboriginal communities and then arriving later for a photo op and twitter post is not a substitute for consultation.

In the 1886 Corranderk petition to the Victorian government William Barak wrote on behalf of his people;

“Could we get our freedom back…to come home when we wish and also to go for our good health when we need it…”

It troubles me that today that I am increasingly asked by our community those same questions today – “can WE offer a solution?”… “can WE provide the services?” … “can WE our own choices?”

Command and control policy from Canberra will not help – at best it might make politicians and public servants in Canberra feel better at not having to hear cries for help

Paternalism is symptomatic of a view of Aboriginal Australia which sees Indigenous people purely as the problem.

It speaks to that old lie – that Aboriginal people have inflicted this deprivation on themselves, and that governments must save them from themselves.

Optimism and a Way Forward

Despite my pessimism about the current direction of government approaches to the Aboriginal community I do see some cause for optimism.

The communities which are doing best are those which have found ways to support their own initiatives despite failing Government approaches.

I take heart from organisations like Tharawal in Sydney’s South-Western Suburbs – an Indigenous health services which does not just focus on treating illness when it occurs.

They target what Sir Michael Marmot calls “the social determinants of health” and what the Menzies School of Health Research has worked so hard to identify. Stable housing, early education and social support.

And they are seeing excellent results.

I also see innovative new approaches, like the University of Melbourne’s first thousand days campaign – recognising that supporting Aboriginal and Torres Strait Islander families in that vital period bears real long term fruit.

Increasing birthweight, providing drug and alcohol support for expectant and new mothers – along with a whole range of other early interventions.

I am optimistic because we know that many of the solutions we need already exist – they are not prohibitively expensive or impossible to institute.

Here at the Menzies School of Health Research for example, you’ve done the research.

You know it is about providing this information to the organisations that already work in communities – it is not a lack of ideas, we know the programs that work and they are community led.

They just require political bravery – and with a record number of First Australians inside our parliament and an increasingly active and determined community outside it, I am confident we can find that will.

I am confident that you can find it on my side of the chamber – I have never had more faith in my party’s commitment to Indigenous Affairs.

I am optimistic because for the first time since colonisation we have a parliament that is beginning to represent the community and we will soon have a constitution that tells the truth.

I talked earlier about Faith Bandler and her long game.

She saw better than most that the campaign for the 1967 referendum was much longer than 10 years – it was a starting point for the project we are still running today.

Martin Luther King Jr said that “The arc of the moral universe [was] long but [that it] bends towards justice”

I think Faith agreed, I know I do.

But Faith more than most saw that it was up to us to shape that arc – and I am confident that we can.

We will have set backs, and we’ve taken some steps backwards but those aberrations do not define the trend.

This is a process of national healing, it is a long journey and it does take time.

To do it we need to tell the truth; and we are starting to do that.

We need generosity; and believe that the First Peoples have that in spades.

And most of all we need to accept that Aboriginal and Torres Strait Islander people are a part of the solution not just the problem.

Most of all I take my optimism from the determination of Aboriginal and non- Aboriginal communities across Australia.

In her first speech to the Federal Parliament not so long ago your Senator for the Northern Territory Malarndirri McCarthy said in reference to her people’s struggle for land rights;

“[We are] battle fatigued, perhaps we are better to acquiesce? But we are here still, and we are not going away.”

I think the sentiment applies far more broadly – now more than ever I believe in our communities’ commitment to addressing these issues.

We are not going anywhere.