NACCHO Aboriginal Health : A call to acknowledge the harmful history of nursing for Aboriginal people

nurses

 ” While we ourselves did not work there, the societal beliefs interwoven with the professional theories practised at that time are a legacy we have inherited. Those attitudes and practices remain present within our professional space.

Have we done sufficient work to decolonise ourselves?

Decolonising is a conscious practice for Aboriginal and Torres Strait Islander nurses. It involves recognising the impact of the beliefs and practices of the coloniser on ourselves at a personal and professional level, then disavowing ourselves from them.

We talk about this in CATSINaM with our Members. We invite our non-Indigenous colleagues to engage in this self-reflective conversation through many aspects of our work.

janine-mohamed-indigenous-x-profile-picture

Janine Mohamed (right), CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), argues we should.

Is it time for the nursing and midwifery professions to reflect on our historical involvement in the subjugation of Aboriginal and Torres Strait Islanders and consider whether we owe a statement of regret for our failures as part of the wider healthcare system to respond to the needs of Aboriginal Australians?

Do formal apologies mean anything?

We welcome your input on this fundamental issue for Australians – and especially input from Aboriginal and Torres Strait Islander nurses and midwives.

Editorial Nurse Uncut Conversations

In September 2016, the Australian Psychological Society issued a formal apology to Indigenous Australians for their past failure as a profession to respond to the needs of Aboriginal patients.

In the past, the NSW Nurses and Midwives’ Association and the ANMF more broadly have issued statements of apology for our professions’ involvement in the practices associated with the forced adoption of babies from the 1950s to 1980s.

In doing so we recognised that while those nurses and midwives were working under direction, it was often they who took the babies away from mothers who had been forced, pressured and coerced into relinquishing their children and we apologised for and acknowledged the pain these mothers, fathers and children had experienced in their lives as a result.

Following the recent commendable move by the Australian Psychological Society, is it now time for the nursing and midwifery professions to reflect on our historical involvement as healthcare providers in the subjugation of Aboriginal and Torres Strait Islanders and consider whether we owe a similar statement of regret for our failures as part of the wider healthcare system to respond to the needs of Aboriginal Australians?

But firstly, do such apologies mean anything?

Professor Alan Rosen AO (a non-indigenous psychiatrist) makes a cogent argument for an apology by the Australian mental health professions to Aboriginal and Torres Strait Islander peoples:

The recent apology by the Australian Psychological Society to Aboriginal and Torres Strait Islander people is of profound national and international significance.

The APS is believed to be the first mental health professional representative body in the world to endorse and adopt such a specific apology to indigenous peoples for what was done to them by the profession as part of, or in the name of, mental health/psychological assessment, treatment and care.

The APS Board also substantially adopted the recommendation of its Indigenous Psychologists’ Advisory Group (IPAG), whose Indigenous and non-Indigenous members crafted this apology together. This sets a fine precedent.

As some other Australian mental health professional bodies are still considering whether to make such an apology, it is to be hoped that the APS has set a new trend. The APS has provided a robust example of how to do it well and in a way that it is more likely to be considered to be sincere and acceptable by Aboriginal and Torres Strait Islander peoples.

Historically, Aboriginal and Torres Strait Islander peoples have suffered much more incarceration, inappropriate diagnoses and treatments and more control than care in the hands of mental health professionals, facilities and institutions.

This is also true for all First Nations peoples, globally.

Professor Rosen argues that such apologies demonstrate concern for possible historical wrongs, either deliberate or unwitting, by professionals and institutions and the enduring mental health effects of colonialism. The Croakey.org article goes on to describe the purposes and goals of an apology, why they are worth doing and proposes a template.

So, just as we have recognised and apologised for the role our professions played in forced adoptions, is it now time to examine and take responsibility for our professions’ historical contribution to undermining Indigenous Australians’ social and emotional health and wellbeing?

Janine Mohamed (right), CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), argues we should.

Between 1908 and 1919, hundreds of Aboriginal patients were incarcerated in the Lock Hospitals off the coast of Carnarvon, with more than 150 people dying there. The West Australian government established the hospitals for the treatment of Aboriginal people with sexually transmitted infections, but there remains considerable doubt as to the accuracy of such diagnoses – many of which were made by police officers.

The Fantome Island Lock Hospital operated in Queensland from 1928-45 under similar arrangements, detaining Aboriginal people with suspected sexually transmitted infections. There was also a lazaret on Fantome Island (1939-73) for segregated treatment of Aboriginal people with Hansen’s disease.

Aboriginal people taken to the hospitals were often forcibly removed from their families and communities and transported in traumatic conditions, in chains and under police guard. There is also evidence of medical experimentation and abuse.
The NSW Nurses and Midwives’ Association has embarked on the process of developing a Reconciliation Action Plan. As a first step, over coming months we will be working on developing a more thorough understanding of how historical practices have affected Aboriginal and Torres Strait Islander people in our care.

We welcome feedback, especially from our Aboriginal and Torres Strait Islander colleagues.

NACCHO Aboriginal Health and Chronic Disease #prevention

 

prevention

 ” The Australian Chronic Disease Prevention Alliance recommends that the Australian Government introduce a health levy on sugar-sweetened beverages, as part of a comprehensive approach to decreasing overweight and obesity, and with revenue supporting public education campaigns and initiatives to prevent chronic disease and address childhood obesity.

A health levy on sugar-sweetened beverages should not be viewed as the single solution to the obesity epidemic in Australia.

Rather, it should be one component of a comprehensive approach, including restrictions on children’s exposure to marketing of these products, restrictions on their sale in schools, other children’s settings and public institutions, and effective public education campaigns[42].

Health levy on sugar-sweetened beverages

ACDPA Position Statement

Key messages

  •  The Australian Chronic Disease Prevention Alliance (ACDPA) recommends that the Australian Government introduce a health levy on sugar-sweetened beverages (sugary drinks)i, as part of a comprehensive approach to decreasing overweight and obesity.
  •  Sugar-sweetened beverage consumption is associated with increased energy intake and in turn, weight gain and obesity. Obesity is an established risk factor for type 2 diabetes, heart disease, stroke, kidney disease and certain cancers.
  •  Beverages are the largest source of free sugars in the Australian diet. One in two Australians usually exceed the World Health Organization recommendation to limit free sugars to 10% of daily intake (equivalent to 12 teaspoons of sugar).
  •  Young Australians are the highest consumers of sugar-sweetened beverages, along with Aboriginal and Torres Strait Islander people and socially disadvantaged groups.
  •  Young people, low-income consumers and those most at risk of obesity are most responsive to food and beverage price changes, and are likely to gain the largest health benefit from a levy on sugary drinks due to reduced consumption.
  •  A health levy on sugar-sweetened beverages in Australia is estimated to reduce consumption and potentially prevent thousands of cases of type 2 diabetes, heart disease and stroke over 25 years. The levy could generate revenue of $400-$500 million each year, which could support public education campaigns and initiatives to prevent chronic disease and address childhood obesity.
  •  A health levy on sugar-sweetened beverages should not be viewed as the single solution to the obesity epidemic in Australia. Rather, it should be one component of a comprehensive approach, including restrictions on children’s exposure to marketing of these products, restrictions on their sale in schools, other children’s settings and public institutions, and effective public education campaigns.

i ‘Sugar-sweetened beverages’ and sugary drinks are used interchangeably in this paper. This refers to all non-alcoholic water based beverages with added sugar, including sugar-sweetened soft drinks and flavoured mineral waters, fortified waters, energy and electrolyte drinks, fruit and vegetable drinks, and cordials. This term does not include milk-based products, 100% fruit juice or non-sugar sweetened beverages (i.e. artificial, non-nutritive or intensely sweetened). 2

About ACDPA

The Australian Chronic Disease Prevention Alliance (ACDPA) brings together five leading non-government health organisations with a commitment to reducing the growing incidence of chronic disease in Australia attributable to overweight and obesity, poor nutrition and physical inactivity. ACDPA members are: Cancer Council Australia; Diabetes Australia; Kidney Health Australia; National Heart Foundation of Australia; and the Stroke Foundation.

This position statement is one of a suite of ACDPA statements, which provide evidence-based information and recommendations to address modifiable risk factors for chronic disease. ACDPA position statements are designed to inform policy and are intended for government, non-government organisations, health professionals and the community.

www.acdpa.org.au

Chronic disease

Chronic diseases are the leading cause of illness, disability, and death in Australia, accounting for around 90% of all deaths in 2011[1]. One in two Australians (i.e. more than 11 million) had a chronic disease in 2014-15 and almost one quarter of the population had at least two conditions[2].

However, much chronic disease is actually preventable. Around one third of total disease burden could be prevented by reducing modifiable risk factors, including overweight and obesity, physical inactivity and poor diet[2].

Overweight and obesity

Overweight and obesity is the second greatest contributor to disease burden and increases risk of type 2 diabetes, heart disease, stroke, kidney disease and some cancers[2].

The rates of overweight and obesity are continuing to increase. Almost two-thirds of Australians are overweight or obese and one in four Australian children are already overweight or obese[2]. Children who are overweight are also more likely to grow up to become overweight or obese adults, with an increased risk of chronic disease and premature mortality[3].

The cost of obesity in Australia was estimated to be $8.6 billion in 2011-12, comprising $3.8 billion in direct costs and $4.8 billion in indirect costs[4]. If no further action is taken to slow obesity rates in Australia, the cost of obesity over the next 10 years to 2025 is estimated to total $87.7 billion[4].

Free sugars and weight gain

There is increasing evidence that high intake of free sugarsii is associated with weight gain due to excess energy intake and dental caries[5]. The World Health Organization (WHO) strongly recommends reducing free sugar intake to less than 10% of total energy intake (equivalent to around 12 teaspoons of sugar), or to 5% for the greatest health benefits[5].

ii ‘Free sugars’ refer to sugars added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

In 2011-12, more than half of Australians usually exceeded the recommendation to limit free sugar intake to 10%[6]. There was wide variation in the amounts of free sugars consumed, with older children and teenagers most likely to exceed the recommendation and adults aged 51-70 least likely to exceed the recommendation[6]. On average, Australians consumed around 60 grams of free sugars each day (around 14 teaspoons)[6]. Children and young people were the highest consumers, with adolescent males and females consuming the equivalent of 22 and 17 teaspoons of sugar each day respectively [6].

Beverages contribute more than half of free sugar intake in the Australian diet[6]. In 2011-12, soft drinks, sports and energy drinks accounted for 19% of free sugar intake, fruit juices and fruit drinks contributed 13%, and cordial accounted for 4.9%[6]. 3

Sugar-sweetened beverage consumption

In particular, sugar-sweetened beverages are mostly energy-dense but nutrient-poor. Sugary drinks appear to increase total energy intake due to reduced satiety, as people do not compensate for the additional energy consumed by reducing their intake of other foods or drinks[3, 7]. Sugar-sweetened beverages may also negatively affect taste preferences, especially amongst children, as less sweet foods may become less palatable[8].

Sugar-sweetened beverages are consumed by large numbers of Australian adults and children[9], and Australia ranks 15th in the world for sales of caloric beverages per person per day[10].

One third of Australians consumed sugar-sweetened beverages on the day before the Australian Health Survey interview in 2011-12[9]. Of those consuming sweetened beverages, the equivalent of a can of soft drink was consumed (375 mL)[9]. Children and adolescents were more likely to have consumed sugary drinks than adults (47% compared with 31%), and consumption peaked at 55% amongst adolescents[9]. Males were more likely than females to have consumed sugary drinks (39% compared with 29%)[9].

Australians living in areas with the highest levels of socioeconomic disadvantage were more likely to have consumed sugary drinks than those in areas of least disadvantage (38% compared with 31%)[9]. Half of Aboriginal and Torres Strait Islander people consumed sugary drinks compared to 34% of non-Indigenous people[9]. Amongst those consuming sweetened beverages, a greater amount was consumed by Aboriginal and Torres Strait Islanders than for non-Indigenous people (455 mL compared with 375 mL)[9]. 4

The health impacts of sugar-sweetened beverage consumption

WHO and the World Cancer Research Fund (WCRF) recommend restricting or avoiding intake of sugar-sweetened beverages, based on evidence that high intake of sugar-sweetened beverages may increase risk of weight gain and obesity[7, 11]. As outlined earlier, obesity is an established risk factor for a range of chronic diseases[2].

The Australian Dietary Guidelines recommend limiting intake of foods and drinks containing added sugars, particularly sugar-sweetened beverages, based on evidence of a probable association between sugary drink consumption and increased risk of weight gain in adults and children, and a suggestive association between soft drink consumption and an increased risk of reduced bone strength, and dental caries in children[3].

Type 2 diabetes

Sugar-sweetened drinks may increase the risk of developing type 2 diabetes[3]. Evidence indicates a significant relationship between the amount and frequency of sugar-sweetened beverages consumed and increased risk of type 2 diabetes[12, 13]. The risk of type 2 diabetes is estimated to be 26% greater amongst the highest consumers (1 to 2 servings/day) compared to lowest consumers (<1 serving/month)[13].

Cardiovascular disease and stroke

The consumption of added sugar by adolescents, especially sugar-sweetened soft drinks, has been associated with multiple factors that can increase risk of cardiovascular disease regardless of body size, and increased insulin resistance among overweight or obese adolescents[14].

A high sugar diet has been linked to increased risk of heart disease mortality[15, 16]. Consuming high levels of added sugar is associated with risk factors for heart disease such as weight gain and raised blood pressure[17]. Excessive dietary glucose and fructose have been shown to increase the production and accumulation of fatty cells in the liver and bloodstream, which is linked to cardiovascular disease, and kidney and liver disease[18]. Non-alcoholic fatty liver disease is one of the major causes of chronic liver disease and is associated with the development of type 2 diabetes and coronary heart disease[18].

There is also emerging evidence that sugar-sweetened beverage consumption may be independently associated with increased risk of stoke[19].

Chronic kidney disease

There is evidence of an independent association between sugar-sweetened soft drink consumption and the development of chronic kidney disease and kidney stone formation[20]. The risk of developing chronic kidney disease is 58% greater amongst people who regularly consume at least one sugar-sweetened soft drink per day, compared with non-consumers[21].

Cancer

While sugar-sweetened beverages may contribute to cancer risk through their effect on overweight and obesity, there is no evidence to suggest that these drinks are an independent risk factor for cancer[7]. 5

A health levy on sugar-sweetened beverages

WHO recommends that governments consider taxes and subsidies to discourage consumption of less healthy foods and promote healthier options[22]. WHO concludes that there is “reasonable and increasing evidence that appropriately designed taxes on sugar-sweetened beverages would result in proportional reductions in consumption, especially if aimed at raising the retail price by 20% or more”[23].

Price influences consumption of sugar-sweetened beverages[24, 25]. Young people, low-income consumers and those most at risk of obesity are most responsive to food and beverage price changes, and are likely to gain the largest health benefit from a levy on sugary drinks due to reduced consumption[23]. While a health levy would result in lower income households paying a greater proportion of their income in additional tax, the financial burden across all households is small, with minimal differences between higher- and lower-income households (less than $5 USD per year)[26].

A 2016 study modelled the impact of a 20% ad valorem excise tax on sugar-sweetened beverages in Australia over 25 years[27]. The levy could reduce sugary drink consumption by 12.6% and reduce obesity by 2.7% in men and 1.2% in women[27]. Over 25 years, there could be 16,000 fewer cases of type 2 diabetes, 4,400 fewer cases of ischaemic heart disease and 1,100 fewer strokes[27]. In total, 1,600 deaths could potentially be prevented[27].

The 20% levy was modelled to generate more than $400 million in revenue each year, even with a decline in consumption, and save $609 million in overall health care expenditure over 25 years[27]. The implementation cost was estimated to be $27.6 million[27].

A separate Australian report is supportive of an excise tax on the sugar content of sugar-sweetened beverages, to reduce consumption and encourage manufacturers to reformulate to reduce the sugar content in beverages[28]. An excise tax at a rate of 40 cents per 100 grams was modelled to reduce consumption by 15% and generate around $500 million annually in revenue[28]. While a sugary drinks levy is not the single solution to obesity, the introduction of a levy could promote healthier eating, reduce obesity and raise revenue to combat costs that obesity imposes on the broader community.

There is public support for a levy on sugar-sweetened beverages. Sixty nine percent of Australian grocery buyers supported a levy if the revenue was used to reduce the cost of healthy foods[29]. A separate survey of 1,200 people found that 85% supported levy revenue being used to fund programs reducing childhood obesity, and 84% supported funding for initiatives encouraging children’s sport[30].

An Australian levy on sugar-sweetened beverages is supported by many public health groups and professional organisations.

 

NACCHO Aboriginal Health and @TheRACP #Budget2017 submission : Healthy people, Healthy Lives

 nt

” Aboriginal and Torres Strait Islander health leadership and authentic community engagement is crucial to achieving improved health outcomes.

The Aboriginal Community Controlled Health sector is of vital importance in delivering effective, culturally appropriate care to Australia’s First Peoples; and service development and provision should be led by Aboriginal and Torres Strait Islander health organisations where possible.

The sector must have long-term and secure funding to both retain and grow their capacity.”

Extract from  The Royal Australasian College of Physicians (RACP)  pre-budget submission for 2017-2018, Healthy people, Healthy Lives, which outlines key health funding recommendations for the Australian Government.

First Aboriginal eye doctor Kris Rallah-Baker working at Sunrise health clinic at Mataranka in the Northern Territory. Photo: Michael Amendolia

Download the full submission here :

healthy-people-healthy-lives-racp-pre-budget-submission-2017-18

The submission addresses various topics including child and adolescent health, Aboriginal and Torres Strait Islander health, preventive health, climate change and health, as well as health system reform.

The submission makes a range of recommendations including:

  •  increased investment in early childhood development to give all Australians the best, healthiest start in life
  •  concerted efforts to close the gap in health outcomes between Aboriginal and Torres Strait Islander people and non-Indigenous Australians
  •  strong preventive health measures which will reduce preventable illness and disease, focusing in particular on reducing the harms of alcohol and increasing the availability of alcohol treatment services to those who need them
  •  funding for a national campaign to encourage conversations about end-of-life care preferences, and the development of flexible models of care that enable people to receive palliative care at home.

Aboriginal and Torres Strait Islander Health :

Healthy People, Healthy Lives:

RACP Pre-Budget Submission 2017-18

Aboriginal and Torres Strait Islander people continue to experience poorer health outcomes than non-Indigenous Australians. The latest ‘Closing the Gap’ report found that Australia is not currently on track to close the life expectancy gap by 2031 – with the gap remaining close to ten years for both men and women.

To address the inequity that exists between Aboriginal and Torres Strait Islander people and non-Indigenous Australians and improve access to care, continuing focus and appropriate funding is required.

The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (NATSIHP) Implementation Plan in 2015 has not been supported with sufficient, secure funding and resources, which is risking its success.

Funding uncertainty and changes creates significant issues for the continuity of services to patients and for organisations in retaining and building their capacity.

The RACP strongly supports existing programs to improve equitable access to specialist care, including the Rural Health Outreach Fund (RHOF) and Medical Outreach Indigenous Chronic Disease Program (MOICDP). The RACP recommends that the Australian Government continue its investment in these programs, undertaking evaluation to ensure the funding models are achieving positive health outcomes for Aboriginal and Torres Strait Islander peoples.

Given the recent focus by the Australian government on improving mental health and reducing suicide rates in Aboriginal and Torres Strait Islander communities, the RACP supports the analysis, reporting and implementation of evidence-based solutions, with input from and led by these communities, to improve the quality and delivery of mental health promotion and suicide prevention services. The RACP supports the establishment of clearinghouses which enable effective access to relevant, high quality information and resources to support these efforts.

The RACP recommends that the Australian government:

  • Allocate secure long-term funding to progress the strategies and actions identified in the NATSIHP Implementation Plan.
  • Provide secure, long-term funding for the Rural Health Outreach Fund (RHOF) and Medical Outreach Indigenous Chronic Disease Program (MOICDP).
  • Allocate sufficient and secure long-term funding to the Aboriginal Community Controlled Health Sector to support the sector’s continued provision of Indigenous-led, culturally sensitive healthcare.
  • Build and support the capacity of Indigenous health leaders by committing secure long-term funding to the Indigenous National Health Leadership Forum.
  • Reinstate funding for a clearinghouse modelled on the previous Closing the Gap clearinghouse, as recommended in the latest draft of the Fifth National Mental Health Plan.

Healthy People, Healthy Lives:

RACP Pre-Budget Submission 2017-18

Preventive Health

A clear, appropriately funded, nationally-coordinated strategy for preventive health must be prioritised in the Federal Budget.

Preventive health measures can have a powerful impact on the overall health of a population, particularly as the number of Australians living with chronic conditions continues to grow. Chronic illnesses such as heart disease, stroke, kidney disease, cancer, and type II diabetes account for 85 per cent of the burden of disease in Australia.

Investing in reducing the harms of alcohol

As a causal factor in more than 200 disease and injury conditions, it is clear that alcohol is a major risk factor for chronic disease, and efforts to reduce alcohol consumption must be central to preventive health measures. Alcohol-related harms create enormous social and economic costs to Australian society, with estimates putting the annual costs of alcohol misuse at between $15 billion and $36 billion.

 The RACP calls on the Australian government to increase funding for alcohol treatment and prevention services, with specific funding allocated towards making these services available outside major metropolitan centres and to groups at greatest risk, including young people, risky drinkers and Aboriginal and Torres Strait Islander people.

The RACP has long considered the WET and rebate to be particularly dangerous as they encourage the production and consumption of cheap wine, whose low price makes its attractive to underage and problem drinkers. The RACP is very disappointed that the Australian Government has watered down its proposed tightening of the WET rebate announced in the 2016-17 Federal Budget. The RACP considers this a backward step in efforts to reduce the harms of alcohol.

The RACP recommends that the Australian government:

Develop a national preventive health strategy to address and lower risk factors for preventable illnesses and diseases.

• Increase funding for alcohol treatment including workforce development to address unmet demand for treatment.

• Increase funding for prevention services in order to reduce the incidence of alcohol use disorders.

• Reform alcohol taxation to introduce a volumetric taxation system for all alcohol products and abolish the Wine Equalisation Tax (WET) and rebate.

• Allocate a proportion of the increased revenue raised from volumetric taxation to funding alcohol treatment and prevention services.

Press Release

RACP President Dr Catherine Yelland said that the Australian Government must commit sustained funding to ensure the Australian healthcare system is able to support the health needs of all Australians.

“We need a health system that gives all Australians the best chance of living long and healthy lives; offering high quality, patient-centred care underpinned by clinical best practice.

“We need a system that is innovative, with a focus on integrated care and preventive health so that unnecessary health costs and avoidable illnesses are minimised.

“RACP members provide specialist medical care to Australians at every stage of their lives and their recommendations to the Government on healthcare policy are summarised in this submission. We hope the Australian Government is listening closely,” said Dr Yelland.

About The Royal Australasian College of Physicians (RACP):

The RACP trains, educates and advocates on behalf of more than 15,000 physicians and 7,500 trainee physicians across Australia and New Zealand.

The College represents a broad range of medical specialties including general medicine, paediatrics and child health, cardiology, respiratory medicine, neurology, oncology, public health medicine, occupational and environmental medicine, palliative medicine, sexual health medicine, rehabilitation medicine, geriatric medicine and addiction medicine. Beyond the drive for medical excellence, the

RACP is committed to developing health and social policies which bring vital improvements to the wellbeing of patients.

The College offers 60 training pathways. These lead to the award of one of seven qualifications that align with 45 specialist titles recognised by the Medical Board of Australia or allow for registration in nine vocational scopes with the Medical Council of New Zealand.

 

NACCHO Aboriginal Elder’s Health : Apunipima #ACCHO signs palliative care MOU for 5 remote Cape York communities

cape-york

It is great to see that St Vincent’s Health Australia is not only willing to fund this project, but is willing to walk alongside Apunipima and NPAFACS on how we can best help these communities,”

Mrs Patricia Yusia, a Board Member of Apunipima Cape York Health Council, voiced a sigh of relief about the project.

“It’s going to be a learning exercise and an exercise in trust-building. We need to listen to the people in community, and understand what they want from their palliative care service, so that it will cater to the requirements of those who will access it,”

“From there, an appropriate service model can be developed, and then local stories will spread about how members of the communities will die respectfully, at home, on country and with family.”

Associate Prof Mark Boughey, Deputy Director of St Vincent’s Hospital Melbourne’s Centre for Palliative Care, said – first and foremost – he and his colleagues would listen to the communities about their palliative care needs

St Vincent’s Health Australia (SVHA) has committed $450,000 to bring culturally appropriate palliative care services to five Aboriginal and Torres Strait Islander communities in the Northern Peninsula Area (NPA) of Cape York as part of an MOU with Northern Peninsula Area Family and Community Services (NPAFACS) and Apunipima Cape York Health Council (Apunipima).

People living in remote Cape York communities – in particular the five Aboriginal and Torres Strait Islander communities of Bamaga, Seisia, Injinoo, Umagico and New Mapoon – experience some of the highest levels of chronic disease and poorest health outcomes in Australia yet don’t have access to local palliative care. The nearest palliative care is more than 1000 kms away in Cairns.

St Vincent’s Health Australia – the nation’s largest not-for-profit health and aged care provider and a provider of palliative care services for more than 125 years – said it responded to a need, raised by NPAFACS through Apunipima, for expert guidance to develop a high-quality, culturally appropriate palliative care service tailored and accessible to the communities of the Cape.

The MOU outlines SVHA’s commitment over five years to achieve in partnership with NPAFACS, Apunipima and the communities of the NPA, including:

  • Participation in the Commonwealth Government’s palliative care education program (Program of Experience in the Palliative Approach or PEPA) which includes capacity for palliative care specialists to visit Aboriginal health services to facilitate palliative care learning.
  • provision of advanced palliative care training for local staff;
  • community capacity building through ongoing clinical support;
  • development of a culturally appropriate model of care and a business plan to establish a permanent palliative care service, and;
  • provision of specialist care and support of palliative care clients via telehealth.

The NPA palliative care project is an extension of an ongoing partnership between St Vincent’s and Apunipima that already provides primary healthcare services to 11 Cape York communities and advocates for 17 others, including those of the Northern Peninsula Area.

“With the highest levels of chronic disease in the country and an average life expectancy of 58 years, there’s considerable need for high-quality and culturally appropriate end of life care in our region,” said Ms Ugari Nona, President, NPAFACS.

“There are currently no palliative care services north of Cairns, some 1000kms away, and certainly no end of life care services appropriate to the cultural requirements of Aboriginal and Torres Strait Islander peoples in Cape York.”

For the people of NPA’s five communities who have a life-limiting illness, accessing end of life care means leaving the community, leaving family and country to travel to Cairns.

“It’s hard enough for those who are dying to move away to Cairns, but it’s also very hard for the family who can’t be with them,” said Councillor Edward Newman, Mayor of the Northern Peninsula Area Regional Council.

“In most cases, our elders go down to Cairns for palliative care, close to death, and often don’t return – and it’s their family, the community that suffers the burden of them dying away.”

Cllr Newman said St Vincent’s commitment to help address NPA’s end of life service needs has been a welcome step, however sustained commitment, for not just the current Elders but the young people who will one day be Elders and Leaders of the communities, it’s an essential requirement for long-term success.

“This five year plan is a good start, and I’m thankful to have the support of St Vincent’s and Apunipima. However to build community capacity to provide culturally appropriate palliative care across NPA in the long-term, we’ll need at least a 20-year plan – a real long-term vision for the future.”

Project oversight will be undertaken by a steering group comprising representatives from Northern Peninsula Area Family and Community Services, Apunipima Cape York Health Council, St Vincent’s Health Australia and St Vincent’s Hospital Melbourne’s Centre for Palliative Care.

NACCHO Aboriginal Ear Health : Tackling Aboriginal ear disease will help close the gap

close-the-gap

” We should be embarrassed that Aboriginal Australians have the world’s worst incidence of middle ear infection and the worst deafness rates because of those infections. More than 90 per cent of young Aboriginal children have hearing-aid-level deafness for much of the year and 35 per cent of central Australian Aboriginal children have perforated eardrums at any one time.

The situation is a disgrace.”

Chris Perry is president of the Australian Society of Otolaryngology Head and Neck Surgery as published

Aboriginal children develop ear infections at a younger age and are affected more severely ­than any other racial group in the world by a factor of up to three. They have harmful bacteria colonising their nose and throat very early in life. The ear infections cause a build-up of infective fluid behind the eardrums that frequently burst and result in holes in these eardrums and a purulent discharge from the ears. These eardrum perforations often do not heal and the infection can dissolve the tiny middle ear bones called the ossicles, which conduct sound to the hearing nerves.

The partial deafness from infections is devastating to a child’s language development, ­especially where English is the second language. Children who are partially deaf never fully understand the spoken word. They find it difficult to follow conversations and to listen to what a teacher is saying. They become easily bored and disillusioned at school – that’s why we see the high rates of truancy and illiteracy among them.

Poor educational results lead to poverty and high unemployment levels. If you are illiterate it is hard to move away from an isolated community with high unemployment, violence and substance abuse issues.

Damien Howard, the distinguished academic psychologist from the Northern Territory, has documented the association of deafness in Aboriginal communities with violence, substance abuse, mental illness, suicide and the high rates of Aboriginal incarceration, especially in juvenile ­detention facilities.

Many ear, nose and throat surgeons, whom I represent, pediatricians, audiologists, education­alists and Aboriginal health workers have been involved in the research of this problem as well as the important provision of interventions that help mitigate the far-reaching, devastating consequences of this true pandemic.

Multiple health department jurisdictions, health regions, universities and medical centres across rural and outer suburban Australia are aware of the issue but still today these well-intentioned ­interventions are largely untested, not always evidence-based and are rarely benchmarked.

The terrible images from the Don Dale Youth Detention Centre and the high rates of Aboriginal incarceration have been brought to the attention of ordinary Australians who, through the years, have grown accustomed to tales of truancy, substance abuse, overcrowding and youth suicide.

The association of deafness as an important but remediable root cause has been unaccountably ­ignored, especially in Closing the Gap strategies, and unfortunately this reflects badly on us, the health practitioners and researchers who should be advocating for adequate treatment of this condition.

There is no shortage of surgeons, pediatricians, audiologists, speech therapists, educationalists and health workers wanting to help. States and territories need to come together to finance interventions that work.

Sound amplification systems in classrooms, hearing aids where appropriate, the training of teachers going to communities on how to teach a class of deaf kids, timely and appropriate GP and primary healthcare interventions, and timely surgery and vaccinations within the communities do work. Preventive action and early treatments are extremely cost ­effective when considered against the effects of hearing impairment.

It costs up to $60,000 to lock up a child for a year, and that is often followed by a life of welfare dependency. Australia would save a great deal of money and raise health and wellbeing among ­Aboriginal Australians by making ear health a priority.

A recognition of the consequences of inaction on Aboriginal deafness and the risk this poses to making any progress to closing the gap is essential. It should never be normal for people to have to suffer with ear disease and deafness. I am encouraged that this past year we have had a strong show of support from parliamentarians in Canberra and across several states and territories who have pledged their support to making Aboriginal ear disease a thing of the past.

To close the gap in health, we need a definitive ­national approach to address the Aboriginal ear disease crisis. The Ear Health for Life campaign that will be launched this year will draw together stakeholders from the health, social services, education and government sectors. It will raise awareness of this terrible problem, encourage preventive and early intervention action, and advocate for a co-ordinated national approach.

A nationally co-ordinated, evidence-based, benchmarked and multi-level response to the devastating rates of Aboriginal ear disease will boost Australia’s ability to close the gap. Join us in making this the year of ear health for all.

Chris Perry is president of the Australian Society of Otolaryngology Head and Neck Surgery.

Aboriginal Health and #Racism : NACCHO submission to #SavetheRDA #18C Inquiry into #Freedomofspeech

 savetherda

” NACCHO does not believe the operation of Part IIA of the Racial Discrimination Act 1975 (Cth) (the “RDA”) imposes unreasonable restrictions upon freedom of speech [taking into account the meaning given to that phrase in the Terms of Reference], or that sections 18C and 18D should be reformed. NACCHO’s submission instead argues that:

  • Racism and racial vilification causes harm to individuals, to groups and society as a whole. The submission will summarise evidence of the important links between racism and health and wellbeing and the specific impacts of racism on the health and wellbeing of Aboriginal and Torres Strait Islander people.
  • Racism and racial vilification experienced by Indigenous Australians is a widespread, serious and ongoing problem. The submission summarises recent evidence of the prevalence and nature of racist behaviours, including speech, directed at Aboriginal and Torres Strait Islander people.
  • Any weakening of current restrictions on freedom of speech will directly undermine and work in opposition to existing Government strategies and programs for improving Aboriginal and Torres Strait Islander people’s health.
  • Combating racial discrimination is a key strategy for closing the gap in health outcomes between Indigenous and non-Indigenous Australians and achieving the Australian Government’s vision for an Australian health system that is free of racism and inequality and where all Aboriginal and Torres Strait Islander people have access to health services that are effective, high quality, appropriate and affordable. The submission discusses some evidence-based approaches to addressing racial discrimination and helping to achieve this vision. “

Matthew Cooke Chair of NACCHO

Download our full submission here

submission-to-inquiry-into-freedom-of-speech-and-rda-draft

 

na

 

FROM : NACCHO PO Box 5120  Braddon ACT 2612 8 December 2016

TO : Committee Secretary Parliamentary Joint Committee on Human Rights

PO Box 6100 Parliament House Canberra ACT 2600

Dear Committee Secretary

INQUIRY INTO FREEDOM OF SPEECH IN AUSTRALIA

Introduction

The National Aboriginal Community Controlled Health Organisation (NACCHO) is a living embodiment of the aspirations of Aboriginal communities and their struggle for self-determination. NACCHO is the national peak body representing over 140 Aboriginal Community Controlled Health Services across the country on Aboriginal health and wellbeing issues. It has a history stretching back to a meeting in Albury in 1974.

NACCHO represents local Aboriginal community control at a national level to ensure that Aboriginal people have greater access to effective health care across Australia, and advocates for culturally respectful and needs-based approaches to improving health and wellbeing outcomes through Aboriginal Community Controlled Health Services. Our members continue to demonstrate that they are the leading provider of culturally appropriate, comprehensive, primary health care to Aboriginal people across the nation, exceeding Government or private providers.

The definition of “health” adopted by NACCHO and its members is in accordance with that described in the 1989 National Aboriginal Health Strategy:

“Aboriginal health means not just the physical wellbeing of an individual, but refers to the social, emotional and cultural wellbeing of the whole community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total wellbeing of their community. It is a whole of life view and includes the cyclical concept of life-death-life.”

Aboriginal people enjoy quality of life through whole-of-community self-determination and individual spiritual, cultural, physical, social and emotional wellbeing.

  1. Summary

NACCHO does not believe the operation of Part IIA of the Racial Discrimination Act 1975 (Cth) (the “RDA”) imposes unreasonable restrictions upon freedom of speech [taking into account the meaning given to that phrase in the Terms of Reference], or that sections 18C and 18D should be reformed. NACCHO’s submission instead argues that:

  • Racism and racial vilification causes harm to individuals, to groups and society as a whole. The submission will summarise evidence of the important links between racism and health and wellbeing and the specific impacts of racism on the health and wellbeing of Aboriginal and Torres Strait Islander people.
  • Racism and racial vilification experienced by Indigenous Australians is a widespread, serious and ongoing problem. The submission summarises recent evidence of the prevalence and nature of racist behaviours, including speech, directed at Aboriginal and Torres Strait Islander people.
  • Any weakening of current restrictions on freedom of speech will directly undermine and work in opposition to existing Government strategies and programs for improving Aboriginal and Torres Strait Islander people’s health. Combating racial discrimination is a key strategy for closing the gap in health outcomes between Indigenous and non-Indigenous Australians and achieving the Australian Government’s vision for an Australian health system that is free of racism and inequality and where all Aboriginal and Torres Strait Islander people have access to health services that are effective, high quality, appropriate and affordable. The submission discusses some evidence-based approaches to addressing racial discrimination and helping to achieve this vision.

It is NACCHO’s strongly held view that there is no current or historical evidence, nor any policy or legal imperatives to support the notion that the handling of complaints made to the Australian Human Rights Commission under the Australian Human Rights Commission Act 1986 (Cth) should be reformed. NACCHO believes the process provides important access to remedies for victims of racial vilification with most complaints resolved through an accessible mediation process.

NACCHO can find no objective analysis of Part IIA of the RDA shows that the laws are not being interpreted sensibly by the courts. The laws appear to generally strike an appropriate balance between the right to freedom of expression and the right to freedom from racial discrimination and vilification.

NACCHO is not alone in its view that the current inquiry as unnecessary, misconceived and mischievous, noting that:

  • Australians made their support for legislation against racial vilification very clear two years ago in response to the proposed Freedom of Speech (Repeal of s. 18C) Bill 2014 which proposed major changes to section 18C of the RDA.
  • The terms of reference appear to be inconsistent with the proper enforcement of the RDA and thereby appear to seek to undermine the rule of law and the statutory role of the Australian Human Rights Commission.
  1. Position Statement

The link between racism and health and wellbeing

The link between self-reported perceptions or experiences of racism and poorer physical and mental health is established and the pathways from racism to ill-health are now well understood by health researchers.

Racism contributes to reduced access to societal resources and services such as education, employment, housing and medical care which impact on health and wellbeing. Evidence suggests that racism experienced in the delivery of health services contributes to low levels of access to health services by Aboriginal and Torres Strait Islander people. Aboriginal and Torres Strait Islander people may be reluctant to seek much-needed health, housing, welfare or other services from providers they perceive to be unwelcoming or who they feel may hold negative stereotypes about them. Racism has flow on effects for individuals’ social cohesion and for workforce participation, productivity and educational achievement.

Experiences of racism lead to inequitable exposure to risk factors including stress and cortisol dysregulation affecting mental health (anxiety and depression) as well as injury from racially motivated assault. Prolonged experience of stress can also have physical health effects, such as on the immune, endocrine and cardiovascular systems.

Longitudinal and cross-sectional studies both nationally and internationally have found a strong association between experiences of racism and ill-health and psychological distress, mental health conditions such as depression and anxiety, and risk behaviours such as substance use, all of which contribute significantly to the overall ill-health experienced by Aboriginal and Torres Strait Islander people.

More subtle experiences of racism strongly linked to poor mental health outcomes include feelings of being left out and avoided; a form of social exclusion that results from both direct and indirect racism. Ongoing harmful effects of racism including anxiety and depression continue long after exposure to racist incidents and that individuals also experience anxiety on behalf of relatives and loved ones.

Chronic exposure to racism leads to excessive stress, which is an established determinant of obesity, inflammation and chronic disease. Analysis of the 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey found that Indigenous Australians with high/very high levels of psychological distress were 1.3 times as likely to report having circulatory disease and 1.8 times as likely to report having kidney disease. The Productivity Commission’s Overcoming Indigenous Disadvantage: Key Indicators 2016 report showed that the situation is worsening, with the proportion of adults reporting high levels of psychological distress increasing from 27 per cent in 2004-05 to 33 per cent in 2014-15, and hospitalisations for self-harm increased by 56 per cent over this period.

Children and young people’s health and wellbeing

Children and young people’s perspectives and experiences of racism, and the ways in which such experiences impact their health and wellbeing should be a key consideration for the Committee.

Neuroscience and molecular biology tell us that early life experiences and exposures ‘get under the skin’ and become biologically embedded. A survey of research on the health effects of racism on children by UNICEF concluded that toxic stress in childhood is especially harmful, with ever increasing evidence that exposure to high levels of stress and adversity in childhood influences later physical and mental health and cardiovascular, metabolic and immune function right through to mid-life and older adulthood. Young people who experience high levels of racial discrimination were also found to have increased sleep difficulties, cellular aging, inflammation, and physiological wear and tear. UNICEF has stated that children and young people who are targets of racial discrimination are at higher risk of increased anxiety and depression, behavior difficulties, suicide and self-harm. Racial discrimination quite literally can get under the skin and make our children and young people sick.

UNICEF’s survey noted that racism experienced by a carer, family member or peer, that may or may not be witnessed by the child, has also been shown to place children and young people at risk. Studies show increased risk of common childhood illnesses, social emotional difficulties, and risk of overweight and obesity among children with carers and families who experience racism. Witnessing or hearing about racism in the media and online, including stereotyped, negative portrayals, is one harmful form of vicarious racism that also places children at risk.

The impact of racism on the health of Aboriginal and Torres Strait Islander people

Racism is a key social determinant of health for Aboriginal and Torres Strait Islander people, and can deter people from achieving their full capabilities. The impact of racism on the health of Aboriginal and Torres Strait Islander people can be seen in:

  • inequitable and reduced access to the resources required for health (employment, education, housing, medical care, etc);
  • inequitable exposure to risk factors associated with ill-health (junk food, toxic substances, dangerous goods);
  • stress and negative emotional/cognitive reactions which have negative impacts on mental health as well as affecting the immune, endocrine, cardiovascular and other physiological systems;
  • engagement in unhealthy activities (smoking, alcohol and drug use);
  • disengagement from healthy activities (sleep, exercise, taking medications); and
  • physical injury via racially motivated assault.

Research and survey results indicate a common response to experiencing racism is to subsequently avoid similar situations: 35% of those who reported in the 2012–13 Australian Aboriginal and Torres Strait Islander Health Survey that they had been treated badly, said they usually responded to discrimination by avoiding the person or situation. This holds implications across health, education and employment sectors.

Henry et al argue that healthcare in Australia is institutionally racist, but, more importantly, that such racism represents one of the greatest barriers to improving the health of Aboriginal and Torres Strait Islander people. There is a growing body of evidence that the health system itself does not provide the same level of care to indigenous people as to other Australians. This systemic racism is not necessarily the result of individual ill-will by health practitioners, but a reflection of inappropriate assumptions made about the health or behaviour of people belonging to a particular group.

Institutionalised racism occurs in many contexts in the Australian health system:

  • Barriers to hospitals and health care institutions: Institutional racism manifests itself in (1) the adoption, administration, and implementation of policies that restrict admission; (2) the closure, relocation, or privatisation of hospitals that primarily serve Aboriginal and Torres Strait Islander communities; and (3) the continued transfer of unwanted patients (known as patient dumping) by hospitals and institutions. Such practices have a disproportionate impact on Aboriginal and Torres Strait Islander people.
  • Discriminatory policies and practices can take the form of medical redlining, excessive wait times, unequal access to emergency care, and lack of continuity of care, which all have a negative effect on the type of care received.
  • Lack of Language and Culturally Competent Care – cultural competency involves ensuring that all health care providers can function effectively in a culturally diverse setting; it involves understanding and respecting cultural differences including diverse groups with diverse histories, languages, cultures, religions, beliefs, and traditions. Without understanding and incorporating these differences, health care cannot be provided in a culturally competent manner.

How commonly is racism directed at Indigenous Australians?

The common perception seems to be that racism directed towards Aboriginal and Torres Strait Islander people is regrettable, but that such incidents are isolated, trivial and essentially harmless. Such views were commonly expressed, for example, following the racial abuse of Sydney Swans footballer and former Australian of the Year, Adam Goodes, earlier in 2015. Recent evidence suggests that racism and racial vilification experienced by Indigenous Australians is a widespread, serious and ongoing problem.

A key study in Victoria in 2010-11, funded by the Lowitja Institute, documented very high levels of racism experienced by Aboriginal Victorians. It found that of the 755 Aboriginal Victorians surveyed, almost all (97 per cent) reported experiencing racism in the previous year. This included a range of behaviours from being called racist names, teased or hearing jokes or comments that stereotyped Aboriginal people (92 per cent); being sworn at, verbally abused or subjected to offensive gestures because of their race (84 per cent); being spat at, hit or threatened because of their race (67 per cent); to having their property vandalised because of race (54 per cent). Significantly, more than 70 per cent of those surveyed experienced eight or more such incidents in the previous 12 months. Racism occurred across a broad range of settings and was commonly experienced in shops (67%), public spaces (59%), employment (42%), housing (35%), while nearly a third (29%) of respondents experienced racism in health settings. There were no differences in experiences of racism due to gender, age or geographical location. Other studies have found high levels of exposure to racist behaviours and language. For example, in the 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey, 16% of respondents reported that they were treated badly in the previous 12 months because they identify as Indigenous Australians.

A recent survey to gain insight into discriminatory attitudes and beliefs of non-Indigenous Australians (aged 25–44 years) towards Indigenous Australians conducted by Beyond Blue in 2014 found a general lack of awareness of what behaviour is considered discriminatory, along with widespread belief that behaviours such as employment discrimination are considered an ‘unconscious act’ by the perpetrator. Key findings include:

  • Discrimination is commonly witnessed, with 40% seeing others avoid Indigenous Australians on public transport and 38% witnessing verbal abuse.
  • Almost a third (31%) witnessed employment discrimination against Indigenous Australians and 9% admit they themselves discriminate in this context.
  • One in four (25%) do not agree that discrimination has a negative personal impact for Indigenous Australians.
  • More than half (56%) believe that being Indigenous makes it harder to succeed.
  • Many believe it is acceptable to discriminate, with 21% admitting they would move away from an Indigenous Australian if they sat nearby, and 21% would watch an Indigenous Australian’s actions when shopping.

Evidence-based approaches to reducing racism

The law has an important role to play in addressing the harm caused by racial discrimination and racial vilification. By setting standards of conduct, the laws constrain the spread of racism and racial hatred, and encourage people to speak out against racism, complementing broader education strategies. Protecting people from that harm is an appropriate object of government legislation, as recognised by the International Covenant on Civil and Political Rights and the International Convention on the Elimination of All Forms of Racial Discrimination. Freedom of expression is not an absolute right and preventing the harm caused by racist speech is of sufficient importance to warrant appropriate restrictions on freedom of speech as in sections 18C and 18D.

The Victorian Coalition for Aboriginal Health Equality argues for addressing discrimination against Aboriginal and Torres Strait Islander people through a human rights approach. The principles of human rights emphasise empowerment for all Indigenous peoples and provide a clear, positively oriented set of principles to guide individuals and organisations in addressing discriminatory behaviours, practices and policies. The Coalition has identified the following evidence-based approaches to addressing racial discrimination:

  • Taking Preventive Action – Preventive action is a more effective and efficient public health intervention than responding to individual incidents of prejudice; a range of preventive actions can be undertaken at the interpersonal and organisation level.
  • Communication, Training and Behavioural Change – International evidence shows that it is more effective to seek to change behaviours than to address underlying beliefs; strategies that curb racist behaviours will have a positive impact on reducing Aboriginal people’s experiences of racism. Underpinning this behavioural change, it is vital to provide accurate information and offer sound alternative explanations to racist views, to build a consensus that supports culturally safe behaviours.
  • Strategic Approaches – Individuals, organisations, advocates and governments should incorporate longitudinal strategies and develop long-term plans for addressing discrimination rather than proposing rather one-shot interventions; effecting behavioural change and addressing institutionalised forms of inequality take time and cannot be effectively implemented without a commitment to continual improvement.

Any weakening of current restrictions on freedom of speech will directly undermine and work in opposition to existing Government strategies and programs for improving Aboriginal and Torres Strait Islander people’s health. Combating racial discrimination is a key strategy for closing the gap in health outcomes between Indigenous and non-Indigenous Australians and achieving the Australian Government’s vision outlined the National Aboriginal and Torres Strait islander Health Plan 2013-2023. The Health Plan vision is:

“The Australian health system is free of racism and inequality and all Aboriginal and Torres Strait Islander people have access to health services that are effective, high quality, appropriate and affordable. Together with strategies to address social inequalities and determinants of health, this provides the necessary platform to realise health equality by 2031.”

The Health Plan’s accompanying Implementation Plan, released by the then Minister for Rural Health, Senator the Hon. Fiona Nash, in 2015, takes forward the overarching vision by progressing strategies and actions that prevent and address systemic racism and discrimination in the health system. The Implementation Plan focuses on the Australian Government’s role in ensuring that the health system is free of racism. It includes strategies to reduce racism and discrimination and improving the cultural safety of the mainstream health system, including primary health care. Strategies and actions such as empowering youth and adolescents to be proud of their identity and culture and recognising the centrality of culture in the health and wellbeing of Aboriginal and Torres Strait Islander peoples are also supported. Any moves to water down the existing restrictions upon freedom of speech through reform of sections 18C and 18D of the RDA will jeopardise this strategic investment and presents major risks for the effective implementation of the Health Plan.

  1. Conclusion

The link between self-reported perceptions or experiences of racism and poorer physical and mental health is established and the pathways from racism to ill-health are now well understood by health researchers. Racism and racial vilification experienced by Indigenous Australians is a widespread, serious and ongoing problem.

Any weakening of current restrictions on freedom of speech will directly undermine and work in opposition to existing Government strategies for improving Aboriginal and Torres Strait Islander people’s health. Combating racial discrimination is a key strategy for closing the gap in health outcomes between Indigenous and non-Indigenous Australians and achieving the Australian Government’s vision for an Australian health system that is free of racism and inequality.

In conclusion we wish to express our very profound concerns that the terms of reference for this inquiry appear to suggest that the right to freedom of speech is superior to the right to freedom from discrimination, in particular in the form of racist vilification. Freedom of expression is not an absolute right and preventing the serious harm caused by racist speech is of sufficient importance to warrant appropriate restrictions on freedom of speech as currently contained in sections 18C and 18D of the RDA.

Please contact Dawn Casey on (02) 62** **** or by email at dawn.casey@naccho.org.au if there is any area of this submission for which we can provide further assistance or information.

Yours faithfully,

Matthew Cooke

Chairperson

NACCHO

References:

  1. Anderson, P (2013) “Racism a driver of ill health”, The Australian; July 27, 2013 http://www.theaustralian.com.au/national-affairs/opinion/racism-a-driver-of-ill-health/news-story/caed7cfeca6b5a9051ee1fd18042923d
  2. Australian Health Ministers’ Advisory Council, 2015, Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report, AHMAC, Canberra.
  3. Department of Health, Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023, Australian Government, Canberra, 2015
  4. Australian Government, National Aboriginal and Torres Strait Islander Health Plan 2013–2023, Australian Government, Canberra, 2013 http://www.health.gov.au/NATSIHP
  5. Ferdinand, A., Paradies, Y. & Kelaher, M. 2012, Mental Health Impacts of Racial Discrimination in Victorian Aboriginal Communities: The Localities Embracing and Accepting Diversity (LEAD) Experiences of Racism Survey, The Lowitja Institute, Melbourne.
  6. Paradies, Yin (2006) “A systematic review of empirical research on self-reported racism and health”, International Journal of Epidemiology, (35) pp. 888-901.
  7. Coalition for Aboriginal Health Equality Victoria, 2014, Racial Discrimination and Health Outcomes for Aboriginal and Torres Strait Islander People http://www.vaccho.org.au/assets/01-RESOURCES/TOPIC-AREA/POLICY/Position-Statement-on-Racial-Discrimination-and-Health-Outcomes-for-Aboriginal-and-Torres-Strait-Islander-People.pdf
  8. SCRGSP (Steering Committee for the Review of Government Service Provision) 2016, Overcoming Indigenous Disadvantage: Key Indicators 2016, Productivity Commission, Canberra.
  9. Priest N, 2016, Research reveals what racism can do to a child’s body http://www.unicef.org.au/blog/november-2016/research-reveals-what-racism-can-do-to-a-childs-body?utm_source=facebook&utm_campaign=racism&utm_medium=page-post&utm_content=research-reveals-blog-post-1
  10. Henry BR, Houston S, Mooney GH. (2004) “Institutional racism in Australian healthcare: a plea for decency”, The Medical Journal of Australia 2004 May 17; 180(10): 517-20.
  11. Beyond Blue 2014, Discrimination against Indigenous Australians: A snapshot of the views of non-Indigenous people aged 25-44. https://www.beyondblue.org.au/docs/default-source/research-project-files/bl1337-report—tns-discrimination-against-indigenous-australians.pdf?sfvrsn=2
  12. Australian Bureau of Statistics, Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia, 2012-13 (Cat no. 4727.0.55.001)
  13. Mooney G. “Inequity in Australian health care: how do we progress from here?” Aust N Z J Public Health 2003; 27: 267-270. See also Y Paradies, ‘A systematic review of empirical research on self-reported racism and health’ (2006) 35(4) International Journal of Epidemiology 888; D Williams & R Williams-Morris, ‘Racism and mental health: The African American experience’ (2000) 5(3–4) Ethnicity and Health 243; J Soto, N Dawson-Andoh & R BeLue, ‘The relationship between perceived discrimination and generalized anxiety disorder among African Americans, Afro Caribbeans, and non-Hispanic whites’ (2011) 25(2) Journal of Anxiety Disorders 258; E Pascoe & L Richman L, ‘Perceived discrimination and health: A meta-analytic review’, (2009) 135(4) Psychological Bulletin 531.
  14. National Best Practice Framework for Indigenous Cultural Competency in Australian Universities (Universities Australia, 2011).

 

NACCHO Aboriginal #HealthyFutures : 2017 #Prevention Resolutions and Reconciliation for Federal Govt :

santa

“We know that where you live greatly impacts on your health.

However, it is also important to acknowledge that such differences are more likely attributable to the socio-economic circumstances and the spread of wealth within these regions rather on the locations themselves.

Four PHAA New Year’s resolutions for governments in 2017:

1. Develop and implement a National Food and Nutrition Plan to provide national guidance and consistency

2. Stop the marketing of ‘junk food’ to children

3. Implement a sugar tax and invest the money generated in to public health initiatives

4. Greater investment in targeted anti-tobacco campaigns

Resolutions  2017  : Michael Moore CEO of the Public Health Association of Australia (PHAA).

 ” Sections of the media writing off the outcome of consultations around constitutional recognition, after the first of 12 discussions among Aboriginal and Torres Strait Islander Australians in Hobart just over a week ago, are selling the nation short.

This is the first time Indigenous Australians have been authorised to design and undertake their own nationwide consultation process and it concerns the future of a relationship that has been fraught from the start.”

Reconciliation 2017 : Is it too early to write off Aboriginal reconciliation see article 2 below

Photo above File footage It is not every day that Santa Claus himself visits Ramingining, a remote community 560 kilometres east of Darwin in Arnhem Land. Thanks  Ronnie Garrawurra for your portrayal of the  ” big black man man in red.”

Latest AIHW Healthy Communities data provides for New Year’s resolutions for governments

The latest health data released from the Australian Institute of Health and Welfare (AIHW) has provided for some important New Year’s resolution for the government to improve the health of all Australians.

NACCHO Aboriginal Health @AIHW download 3 reports Alert :

Obesity and smoking rates higher in regional Australia

And NACCHO Healthy Futures report Card

reportcard-1

The data, which has been separated in to local areas including Primary Health Networks (PHN), shows ongoing disproportionate health differences between metropolitan and regional/rural areas.

For example, those living in the Western NSW PHN are 30% more likely to be overweight or obese and more than three times more likely to smoke than those living in Northern Sydney PHN. This puts them at high risk of cancer, diabetes and cardiovascular disease.

Variations in health risk and outcome is evident in differences between metropolitan areas even when there is not much distance between areas. In these cases geographical differences can still be substantial. One example is the overweight and obesity rates between Eastern Melbourne PHN (65.9%) and South Eastern Melbourne PHN (59.3%).

The government must take action to address these health issues which are two of the biggest yet preventable risk factors for chronic disease and premature death.

New Year’s Resolutions for governments

Each year on 1 January millions of Australians make New Year’s resolutions to improve their own health.

“In the lead up to 2017 the PHAA calls on governments to make four New Year’s resolutions to help Australians improve their health wherever they live” continued Mr Moore.

Four New Year’s resolutions for governments in 2017:

1. Develop and implement a National Food and Nutrition Plan to provide national guidance and consistency

2. Stop the marketing of ‘junk food’ to children

3. Implement a sugar tax and invest the money generated in to public health initiatives

4. Greater investment in targeted anti-tobacco campaigns

health-4

NACCHO Aboriginal Health Alert #GetonTrack Report :

The ten things we need to do to improve our health

“The Healthy Communities report comes one week after the launch of the Getting Australia’s Health on Track by the Australian Health Policy Collaboration and the joint policy on food security for Aboriginal and Torres Strait Islander Peoples.

These documents reinforce the need for significant action by government to address preventable illnesses,” added President of the PHAA David Templeman.

“Getting Australia’s Health on Track and the Healthy Communities reports provides us with a guide forward. This is of particular importance in relation to the concerted effort required to improve the health and wellbeing not only of people in rural and remote areas, but particularly for Aboriginal and Torres Strait Islander People,”

“We know what is needed. The time for the government to act is now,” concluded Mr Templeman.

healthy-xmas

 

It’s way too early to write off Aboriginal reconciliation

Sections of the media writing off the outcome of consultations around constitutional recognition, after the first of 12 discussions among Aboriginal and Torres Strait Islander Australians in Hobart just over a week ago, are selling the nation short.

This is the first time Indigenous Australians have been authorised to design and undertake their own nationwide consultation process and it concerns the future of a relationship that has been fraught from the start.

The very least we should expect of ourselves as a nation is to respectfully allow that process – 12 dialogues undertaken in cities and regional centres across Australia, culminating in a convention at Uluru next April – to play out.

As The Age‘s Michael Gordon wrote on Saturday, we need to “allow the Indigenous consultation process on recognition to run its course, confident that all options for constitutional change will be seriously canvassed before and at a convention at Uluru in April”.

The task of the Referendum Council is to advise the Prime Minister and Opposition Leader on a way forward that is both acceptable to Aboriginal and Torres Strait Islander people, and likely to be supported by the Australian electorate more broadly via a referendum.

That task necessarily involves respectful consultation with Indigenous Australians, and will inevitably uncover a broad spectrum of views on what meaningful recognition would look like to them.

This approach is entirely consistent with Article 19 of the Declaration on the Rights of Indigenous People, which Australia formally endorsed in 2009. It obliges states to “consult and co-operate in good faith with the Indigenous peoples concerned through their own representative institutions in order to obtain their free, prior and informed consent before adopting and implementing legislative or administrative measures that may affect them”.

Free prior and informed consent represents the best practice standard for the involvement of Indigenous peoples in decisions that affect them, and it goes well beyond a mere box-checking exercise. It is the collective right of Indigenous peoples under international law, which serves to safeguard other rights.

To break the concept down into its constituent parts:

• “Free” means free from manipulation, intimidation or coercion

• “Prior” means occurring well in advance of any decision-making, with adequate time for traditional Indigenous decision-making and consensus processes

• “Informed” means that consent is based on fulsome, objective, accurate and easily understandable information. It also means allowing Aboriginal and Torres Strait Islander peoples and communities to access independent legal advice to reach an informed decision, and

• “Consent’ means communities as a whole, including women, men, young people and different community organisations, have the power to reasonably understand the options and approve or reject a decision. This involves considerations of who has the right to speak for a community, consultation and participation processes, good faith negotiations and properly resourcing communities to have an equal opportunity to have their say.

That the Hobart consultation raised the issue of treaty is neither surprising, nor the recognition death knell commentators are disingenuously suggesting.

And for anyone to suggest that talk of treaty should be somehow muzzled is to deny the nation a process that is of enormous value in and of itself.

As more than one state premier and scores of lawyers and academics have pointed out, constitutional recognition and treaty are ultimately separate issues that will require two separate processes, which are not mutually exclusive.

That said, many people support both objectives, and many people and institutions are working towards them contemporaneously. It is inevitable that both issues will arise in any free, informed discussion about either.

Surely it is not beyond us to let this process play out in good faith, to see if we can indeed find a path forward that is acceptable to our First Peoples and to the rest of us. This also involves consultation with members of the wider community, who are making submissions via the council’s website, and communicating their views through a multiplicity of other channels, including the media.

If such a path is not available to the nation at this time, let us call that at the appropriate time, when people have exercised this rare opportunity.

In the meantime, we must all of us – Indigenous and non-Indigenous – respect each other enough to continue to seek that elusive intersection of perspectives for the benefit of the nation and all Australians.

Mark Leibler AC is senior partner at Arnold Bloch Leibler and co-chairman of the Referendum Council on Constitutional Recognition of Aboriginal and Torres Strait Islander Australians

10

@IAHA_National Indigenous Allied Health Workforce Development Framework Survey

iaha-survey

 ” This Workforce Survey is being conducted by Indigenous Allied Health Australia (IAHA), a national not-for-profit member-based Aboriginal and Torres Strait Islander allied health association. IAHA supports students and graduates across all tertiary educated Allied Health professions.

IAHA want your help in identifying the development needs for the workforce – this survey is for present and past Aboriginal and Torres Strait Islander Allied Health graduates and students.”

We would also like your ideas and suggestions to attract, recruit, support and retain Aboriginal and Torres Strait Islander people in the Allied Health professions.

The Landscape Survey provided us with valuable information regarding the sector as a whole and enabled us to build this Workforce Survey for individuals.

Please be assured that the information reported in this survey will be strictly confidential and only deidentified aggregate data will be used in any report.

How long will it take? – We anticipate that the survey will take approximately 20 minutes to complete.

Other instructions for completing the survey:

1. The survey will be open from 1st December 2016 until 3rd February 2017.
2. The survey data will not be submitted to us until you select “done” on the last page.
3. Please call Craig Gear on 0410695659 if you have any queries about the survey, or contact Indigenous Allied Health Australia on (02) 6285 1010.

Thank you for your participation!

_wqp4048

Gari Watson is a Goreng Goreng, Gangulu and Biri Gubba man who grew up in Brisbane, Queensland with his family, including three older siblings. Gari was the third Indigenous dentist to graduate from James Cook University (JCU) in 2014. “I knew from the age of 12 when I got braces that I wanted to be a dentist

ah-ah

NACCHO Aboriginal #healthyfutures and skin #cancer : Sun protection and dark skin: what you need to know

 aboriginal-children-2-720x547

” Australia has the highest incidence of melanoma and other skin cancers in the world, and while skin cancer is more common in people with light skin, it’s a dangerous misconception that darker skinned people aren’t at risk.

In a 2014 study, one third of Aboriginal and Torres Strait Islander participants from Northern and Central Australia had vitamin D deficiency, which carries some very negative health implications: low vitamin D levels are linked to an increased risk of diseases like diabetes and heart disease.

Given the burden of these chronic diseases in Aboriginal and Torres Strait Islander people, and their contribution to a much reduced life expectancy, more research is needed on the role of sun exposure and vitamin D.

Across all aspects of the healthcare system, overcoming the disadvantage within Indigenous heath is, and needs to be, a priority – dermatology is no exception.”

By Ellen Sima from SBS TV

Cancer Help , Resources and further information for Aboriginal people

Fair or freckled skin, red or blond hair and blue or green eyes: these are the common calling cards of skin cancer susceptibility. But while the risks in darker skinned people is generally reduced, it’s certainly not absent.

In Aboriginal and Torres Strait Islander people – a group with diverse, but commonly darker skin tones – melanoma and other skin cancers are less prevalent than in the non-Indigenous population, but still cause deaths every year.

Public health campaigns – think ‘slip, slop, slap’ – are often targeted to light skinned people, however the inequalities in the availability and appropriateness of health care can impact how different groups access diagnosis and treatment.

Some studies out of the US and UK suggest that, when people of colour (POC) do get skin cancers, they’re often diagnosed at a later stage and carry a higher mortality risk.

Combine this with the dearth of research on skin cancer in darkly pigmented people (studies on skin cancer in Aboriginal and Torres Strait Islanders are particularly sparse), and the picture for darker skinned people is pretty unclear.

In light of this, this article can’t offer any health advice on sun protection beyond that put forward by the Cancer Council.

What it can do is look at what skin cancers are, how different types of pigmentation can change a person’s risk of skin cancer, and go over some other health considerations for sun protection in dark skin that you can bring up with your doctor.

The skin you’re in, and where it could become cancerous:

Some quick human biology: your skin is your largest organ, and is made up of the epidermis (upper layer) and the dermis (lower layer). When skin is exposed to the sun, ultraviolet (UV) rays can damage its DNA, causing the uncontrolled growth of abnormal cells.

The most common types of skin cancer all begin in the epidermis (the upper skin layer), and are handily named after the types of cells they start in:

Basal cell carcinoma (BCC): the basal cells are column-shaped and form the bottom layer of the epidermis. BCC can look like a lump or scaly patch, pale, pink or dark in colour. It’s usually slow growing, rarely spreading to other parts of the body. The earlier it’s found, the easier it is to treat.

Squamous cell carcinoma (SCC): the squamous cells are in the upper layer of the epidermis. SCC can look like a thickened scaly spot or rapidly growing lump, and tends to grow quickly. If left untreated, it can spread to other parts of the body, but this isn’t very common.

Melanoma: melanocytes are located in the basal cell layer and produce melanin pigment. Melanoma are aggressive tumors, and while this cancer is less common than BCC and SCC, it’s much more likely to spread to other parts of the body (like your brain, bones and lungs) through your lymphatic system and bloodstream.

Pigmentation – what’s it got to do with skin cancer risk?

The colour of a person’s skin is strongly influenced by their skin pigments, which are determined by their genetics and lifestyles factors, like sun exposure.

Remember those melanocytes (where melanomas form)? These cells produce melanin and package it in organelles called melanosomes. The melanin in skin comes in two main types: eumelanin is black or brown protective pigment, while pheomelanin is a yellow-red colour.

The type and amount of melanin each person produces will affect their pigmentation (skin colour). Eumelanin is abundant in darker skinned people, who produce more melanin than people with light skin.

For those among us who tan in the sun, exposure to UV rays increases the production of melanin by the melanocytes; when the melanin accumulates in the epidermal layers, a tan builds up and the skin darkens.

Melanin helps protect skin against the sun’s rays by absorbing UV radiation in the surface layers, reducing the risk of cellular DNA damage that can lead to skin cancer.

This protective melanin helps reduce skin cancer risk in dark skinned people.

The flip side – dark skin and vitamin D deficiency

While this melanin barrier can protect against UV damage, it can also make it more difficult for darker skinned people to get the Vitamin D they need.

Vitamin D, known as the ‘sunshine vitamin’, is produced when our skin is exposed to ultraviolet B (UVB) light. Melanin filters this light, reducing the penetration of UVB and putting darker skinned people at a higher risk of vitamin D deficiency.

sun

A local perspective: sun exposure and health risks for Aboriginal and Torres Strait Islander people

While the research on skin cancer in Aboriginal and Torres Strait Islanders is pretty thin on the ground, some stats published in the Australian Institute of Health and Welfare give a general picture of melanoma incidence:

Between 2005-2009, the rate for melanoma in Indigenous Australians was 9.3 cases in 100,000 people, compared to 33 cases per 100,000 in non-Indigenous Australians.

For BCC and SCC cancers, the data is extremely limited, as, unlike melanoma, these cancers aren’t mandatory to report in state and territory registries.

To gain a better understanding of what skin cancer risks are at play for the diverse Aboriginal and Torres Strait Islander population, more research is needed.

For more information on how to stay safe in the sun this Summer, contact Cancer Council Australia

 

NACCHO Aboriginal Health #Obesity and the #sugartax : Barnaby Joyce on the merits of a sugary drinks tax

 sugartax

Amata was an alcohol-free community, but some years earlier its population of just under 400 people had been consuming 40,000 litres of soft drink annually.

The thing that I say in community meetings all the time is that, the reason we’re doing this is so that the young children now do not end up going down the same track of diabetes, kidney failure, dialysis machines and early death, which is the track that many, many people out here are on now,”

Mai Wiru, meaning good health, and managed by long-time community consultant John Tregenza.

The Sugar Trip on Australian Story  View HERE

” With most complex issues, you start somewhere.  You come up with evidence-informed policies and you try them out.  You rigorously evaluate their performance, and learn by doing.

But not with obesity.  “Complexity” is the new enemy of action.  Since the causes of obesity are complex, every “single” policy advanced in response can be dismissed as a dangerously simplistic solution to a complex problem.

Welcome to obesity, the problem we’re not allowed to start to fix.

Except with personal responsibility, of course.!!!

A tax on sugary drinks will get National Party politicians in trouble with sugar producers, and Liberal Party politicians in trouble with big food.

The real problem is that it might work.  Based on the experience of Mexico, a sugary drinks tax will very likely cause consumers to purchase fewer sugary drinks.

Despite batting it away, a tax on sugary drinks is on the public agenda, and it’s here to stay.  I don’t see the sugary drinks industry winning on this issue indefinitely.

Partly because Australian health researchers will keep it on the agenda.”

 Edited highlights from :   Sydney Health Law

sugar

 

“We need a national healthy weight strategy which includes a comprehensive approach to tackle overweight and obesity in all parts of Australia.

“While there’s no silver bullet for reducing overweight and obesity rates, there are key policies which we know can make a significant difference to the health of all Australians.”

The Obesity Policy Coalition recommends four key actions by government to address the obesity problem:

  1. Develop and implement a long-term, comprehensive, integrated strategy to address obesity.
  2. Take action to substantially reduce children’s exposure to unhealthy food marketing.
  3. Introduce a 20 per cent tax on sugar-sweetened beverages and use the money raised to offer healthy food subsidies for people on low incomes and to support obesity prevention initiatives.
  4. Make the Health Star Rating System mandatory, to ensure it is displayed on all packaged food products.

The Healthy Communities: Overweight and obesity rates across Australia, 2014-15 report finds that in 2014-15:

  • The percentage of overweight or obese adults ranged from 53% in Northern Sydney to 73% in Country SA
  • Overweight and obesity rates were generally higher in regional PHN areas than in metropolitan PHN areas
  • After excluding adults who were overweight, the percentage of obese adults ranged from 16% in Central and Eastern Sydney to 38% in Country SA
  • The obesity rate was 25% or higher in 18 of the 28 PHN areas for which results were available.

Once more with feeling…Barnaby Joyce on the merits of a sugary drinks tax

When I looked up from marking exams and saw the look on Barnaby Joyce’s face, I just knew he was seeing red about the Grattan Institute’s proposal for a sugary drinks tax, levied at a rate of 40 cents per 100 grams of sugar.

The Grattan Institute report estimates that such a tax would reduce the consumption of sugary drinks by about 15% and generate up to half a billion dollars that could help to pay for a broad array of obesity-related programs.

Imagine!  A public health policy that fights obesity, diabetes and tooth decay AND generates revenue.

The National Party hate the idea. Deputy Prime Minister and Leader of the Nationals, Barnaby Joyce told reporters: Pictured here with the Asst Minister for Rural Health Dr David Gillespie

barnaby

“If you want to deal with being overweight, here’s a rough suggestion: stop eating so much, and do a bit of exercise.  There’s two bits of handy advice and you get that for free.  The National Party will not be supporting a sugar tax”.

Well that’s what he said.

But here’s what I heard: “We know that obesity and diabetes are out of control.  But we have ideological objections to being part of the solution”.

The same day that Minister Joyce shared these thoughts with reporters, the Australian Food and Grocery Council issued a press release saying that it was seeking a “constructive response to obesity”.

“Obesity is a serious and complex public health issue with no single cause or quick-fix solution”, explained the AFGC, but “it is not beneficial to blame or tax a single component of the diet”.

Personal responsibility…the answer to obesity, traffic accidents, terrorism, Zika virus, perhaps everything?

In a limited sense, Barnaby Joyce is right.

The only cure for personal obesity is personal responsibility.

But personal responsibility has turned out to be a spectacularly poor solution to “societal obesity”.

By societal obesity, I am referring to the trend towards overweight and obesity that has arisen over the past few decades and now affects the majority of adult men and women (and more than one in four children).

Since each of us is an individual, and because we live in a culture that prizes individual autonomy, it’s easy to fall into the trap of believing that individual effort, personal motivation, is the solution to the world’s ills.

But just as the global epidemics of obesity and diabetes were not caused by a catastrophic, global melt-down in personal responsibility, personal responsibility is equally unlikely to provide the magic solution.

That’s where public policies come in.

Governments know all this, but with the exception of tobacco control, they seem reluctant to apply their knowledge in the area of preventive health.

The fact is, from road traffic accidents to terrorism, smart governments:

  • acknowledge the complexity of the factors that contribute to societal problems;
  • They acknowledge that multiple interventions are needed, in many settings;
  • They acknowledge that possible solutions need to be trialled now, under conditions of uncertainty, instead of handing the problem to future generations.
  • They monitor the actions they take, because healthy public policy is a dynamic, ongoing process; and finally
  • They give a damn.  Meaning that they recognise they are accountable to the community for helping to solve difficult, societal problems, and for the performance of the public policies they administer.

Imagine if Australia’s government took that approach with obesity.

The debate about a sugary drinks tax is here to stay: it will never go away

A tax on sugary drinks will get National Party politicians in trouble with sugar producers, and Liberal Party politicians in trouble with big food.

The real problem is that it might work.  Based on the experience of Mexico, a sugary drinks tax will very likely cause consumers to purchase fewer sugary drinks.

Despite batting it away, a tax on sugary drinks is on the public agenda, and it’s here to stay.  I don’t see the sugary drinks industry winning on this issue indefinitely.

Partly because Australian health researchers will keep it on the agenda.

It will come back, and back.  Especially as evidence of its success accumulates overseas.

One conversation worth having is how revenues from a sugary drinks tax might support agricultural producers in rural Australia, helping to cushion them from the adverse effects (if any) of the tax and creating incentives for the production of a sustainable and healthy food supply.

That is simply one question worth considering during the process of developing a national nutrition policy (which we don’t currently have).

In the meantime, Australian health advocates need to broaden their base.

Advocacy for public policy action on obesity needs to become more closely integrated with advocacy on food security.   And advocacy in both areas needs to be linked more closely to action on reducing health inequalities.

But enough about all that.  You really came here for Barnaby, didn’t you?

OK, here he is:

The ATO is not a better solution than jumping in the pool and going for a swim. The ATO is not a better solution than reducing your portion size. So get yourself a robust chair and a heavy table and, halfway through the meal, put both hands on the table and just push back. That will help you lose weight.”

healthy-xmas