NACCHO Aboriginal Health and Communities #CoronaVirus News Alert No 10 of 10 March 17 : Contributions updates from our CEO Pat Turner and Dr Mark Wenitong plus messages from Debbie Kilroy and Thema Plum who have tested positive


In this special Corona Virus edition 10

1.The Guardian: Pat Turner Calls on the army for community help

2.The Australian Community visits to communities banned

3. SkyNews :NT Bans travel to remote Indigenous communities

4.Debbie Kilroy tests positive

5.DR Mark Wenitong update Cape York Communities : Today’s update

6.Thelma Plum Tests positive

7. Preventing the spread of Coronavirus (COVID-19) 

Read all 10 NACCHO Aboriginal Health and Coronas Virus Alerts HERE

1.The Guardian : Pat Turner Calls on the army for community help

Australia’s peak Aboriginal health group, representing hundreds of health care services, wants state and territory governments to make urgent arrangements to protect Aboriginal people in remote areas who are highly vulnerable to Covid-19.

From the Guardian 

The National Aboriginal Community Controlled Health Organisation (Naccho) said governments should consider deploying the army in remote areas, where health workers face major challenges in containing any outbreak, including a lack of access to equipment, testing and urgent emergency care.

“Everybody has to step up, that’s how serious this is,” the Naccho CEO, Pat Turner, said.

“State and territory governments need to do everything they can to stop this getting into our communities. If this gets into any remote community, there will be a high rate of deaths. Our communities will be devastated, because of the already low levels of health.

“The army is our friend in this situation. They have the necessary resources, and we should be briefing army health co-ordinators and have them on standby to be deployed [to places that] we have difficulty reaching, helping us manage this pandemic,” Turner said.

Remote-area health workers urgently need more personal protective equipment, she said, after receiving reports that clinics in the Kimberley region of Western Australia had received only two sets each of masks, gloves and gowns for healthcare staff to use.

Turner said the equipment is essential for remote workers because timely testing is not available and they are relying on clinical diagnosis of Covid-19.

“It can take up to two weeks for tests to be returned, and in that time, if someone has it, the whole community will get it,” Turner said.

Local and state governments must prepare isolation and quarantine centres, she said, because “self-isolation is just unrealistic where there’s overcrowding in housing because of decades and decades of government neglect.

The state governments need to be working with local communities to identify structures that can be adapted for isolation, and they need two kinds: one for suspected cases, and the other for people who are known to have it.”

Naccho is providing a briefing for the Aboriginal taskforce on Covid-19, which will report to the national cabinet today .

“The national cabinet meeting tomorrow should realise the seriousness of this for Aboriginal Australia and make sure the necessary resources are provided immediately,” Turner said.

“We need information urgently on what to do in every situation. Our health services need to know.”

Naccho represents 143 Aboriginal community-controlled health services across the country.

On the weekend, the Northern Land Council (NLC) suspended all existing non-essential permits to visit Aboriginal lands, and said it won’t grant any new ones until further notice.

“The NLC has received many calls from community members asking that we do all we can to ensure the safety and protection of Aboriginal people,” the CEO, Marion Scrymgour, said.

“This decision will not affect the permits issued to doctors, nurses, teachers, police officers, council workers and others that provide essential services for Aboriginal people out bush,” she said.

The NLC and Naccho have both called on the federal government to consider the concerns of the traditional Aboriginal owners of Kakadu national park, who say it should close immediately. Parks Australia has been contacted for comment.

On the Tiwi Islands, the weekend’s AFL grand final and art fair, which usually draw thousands of visitors, were closed to outsiders.

The Northern Territory government said it is implementing current national advice for self-isolation of 14 days for all international arrivals and a ban on cruise ships for 30 days. Government schools across the Northern Territory will remain open.

It has produced health announcements in nine Aboriginal languages, including Warlpiri and Yolngumatha, and set up a hotline for territory residents: 1800 008 002.

There is one confirmed case of Covid-19 in the Northern Territory: a tourist who is currently in Royal Darwin hospital.

2.The Australian : Community visits to communities banned

From The Australian March 17

Aboriginal communities across northern and inland Australia are moving to protect themselves from the coronavirus by restricting contact with the outside world.

The Northern Territory on Monday announced a ban on all non-essential visits to about 70 ­remote settlements, endorsed by the major Aboriginal land councils. It comes as leaders in parts of Western Australia’s Kimberley ­region prepare to isolate their communities for several weeks and move frail relatives to distant outstations.

Several Queensland state ­departments have already suspended bush travel, with Aboriginal community heads calling for a lockout of all but essential service

South Australia’s Anangu Pitjantjatjara Yankunytjatjara Lands announced strict entry rules ­earlier this month with the support of Indigenous Australians Minister Ken Wyatt.

However, doubts are emerging about whether indigenous people will respect movement restrictions, and if they could be attracted to towns by stimulus handouts.

Experts think indigenous people are particularly vulnerable to COVID-19 because they suffer higher rates of chronic conditions such as diabetes and rheumatic heart disease. Research after the 2009 H1N1 “swine flu” pandemic showed indigenous people were more than eight times more likely to be hospitalised.

NT Chief Minister Michael Gunner assured remote Territorians that banning non-essential travel did not mean leaving them to fend for themselves. “Everything you need to be healthy and safe, you will have,” he said.

“The people that you need to be there will be there. But the health advice to us is also clear: you are safest in your home communities.

“To protect you, we are keeping non-essential people away from you. If you don’t need to travel out of your community, then don’t. Just like the rest of us, you are safer in your home community.”

The dirt road to the West Australian town of Balgo will be closed on Sunday for at least five weeks after Wirrimanu Council members decided it was the only way to keep people safe. Should COVID-19 still threaten their community, they plan to move elders even further into the bush.

WA Chief Health Officer ­Andrew Robertson said discussions were under way with the Royal Flying Doctor Service and St John Ambulance about transport from remote areas.

“It’s obviously going to place a strain on some budgets, but these are unusual circumstances,” he said. “We expect that mild cases could be managed at home.”

Lockhart River Mayor Wayne Butcher said it was now “too dangerous” to allow unrestricted movement into the Cape York ­indigenous community.

Additional reporting: Michael McKenna

3.SkyNews: NT Bans travel to remote Indigenous communities


4.Debbie Kilroy tests positive: her message 

SATURDAY: We were on the same plane as Peter Dutton earlier so we had to be tested for coronavirus on Saturday when we arrived back from the USA. We have now been quarantined and awaiting test results. I am confused as to why the PM & other Cabinet members were not quarantined after being in contact with Dutton & we were.

UPDATE: Tests came back for #COVIDー19 & Neta-Rie Mabo & I have coronavirus.

We are not being hospitalised as there’s limited beds available. We are the first ones being quarantined in community.

Yes it’s frightening but I’m healthy & so is Neta. We should be fine after 14 days ♥️ Take care of yourselves plz cause this virus is serious for our most disadvantaged people in our communities.

The way to slow the spread of this virus is to self quarantine. Plz take responsibility and self quarantine.

Take the advice from medical professionals not politicians who are playing politics with our lives.

Take care of yourselves 😍


5.DR Mark Wenitong update Cape York Communities


6.Thelma Plun Tests positive

Australian singer-songwriter Thelma Plum has expressed concern around the impact of coronavirus on vulnerable communities after testing positive for the disease.

Plum says she is “doing really good” while in Brisbane Metro North Hospital after being diagnosed on Sunday.

One of Queensland’s 68 cases, she has not indicated where and when she may have caught the disease but said doctors indicted she will remain in hospital until at least Friday.

The proud Indigenous woman urged prioritisation of Australia’s most vulnerable people in response to the crisis.

“I cannot stress enough how much this virus has the potential to severely harm our communities (particularly our Indigenous communities),” she wrote on Instagram.

“We need to know that the public health system is going to care for our communities.”

Plum said she was worried about disadvantaged people spreading the disease while being unable to stay home from work when infectious.

“Schools need to be shut down but there needs to be structures in place that can ensure low income families and vulnerable people aren’t being left in the dark.

“People need to work from home and if they aren’t able to, the government needs to step in (and) fin

7. Preventing the spread of Coronavirus (COVID-19) 

Example of our ACCHO Info sharing with communities

There is greater risk of COVID-19 causing serious illness in individuals living in communities with chronic disease, such as remote Indigenous communities.


What individuals can do

To limit the spread of Coronavirus to and within Aboriginal and Torres Strait Islander communities, individuals are asked to take the following precautions:

  • Do not travel to a remote community unless necessary
  • To prevent germs spreading, wash your hands often with soap and water or with disinfectant rub for about 20 seconds
    • Clean hands are essential before eating or preparing food, and after going to the bathroom
  • Avoid touching your own eyes, mouth and nose
  • Shower regularly and practice good hygiene
  • Avoid touching other people (hugs, handshaking) unless absolutely necessary
  • Maintain your distance from people who are coughing or sneezing as much as possible
  • Cover your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.
  • Stay home if you feel unwell. If you are concerned and have a fever, cough, sore throat and/or difficulty breathing, seek medical attention but call in advance. Follow the directions of your local health authority.

What community leaders can do

Community leaders can:

  • Consider options for restricting non-essential travel in and out of communities.
  • Identify the most effective way to communicate messages to your community (eg. Shop noticeboards, men’s groups, mother’s groups, schools, Facebook, community radio)
  • Promote good hygiene practices and make available handwashing/hygiene facilities throughout the community.

NACCHO Aboriginal Health and Communities #CoronaVirus News Alerts March 13- 16 : Contributions from our CEO Pat Turner, Prime Minister Scott Morrison, Dr Mark Wenitong, Dr Norman Swan and Marion Scrymgour

In this special Corona Virus edition

1.Pat Turner NACCHO Appearance on The Drum

2.Prime Minister Scott Morrison’s press conference

3.Department of Health download videos

4.Dr Norman Swan

5.DR Mark Wenitong

6.Marion Scrymgour CEO NLC

Read all previous Aboriginal Health and Corona Virus articles published by NACCHO since January

1.Pat Turner NACCHO Appearance on The Drum

Pat Turner, CEO of the National Aboriginal Community Controlled Health Organisation (NACCHO), warned tonight that if the novel coronavirus gets into Aboriginal communities, “it will be absolute devastation without a doubt”.

In particular, she urged state and local governments to lift their games, but acknowledged that some local governments, like those in Alice Springs and Halls Creek, were acting.

Turner also called for action to address “the national disgrace” of inadequate Aboriginal housing given the implications for infection control, and for screening of communities in vulnerable areas, stating that the docking of a cruise ship in Broome today had caught health authorities unawares.

The ACCHO sector had been working very hard to get out information to communities and clinics, but needed the Government to fund their services at a realistic level, she told ABC TV’s The Drum program.” 

Urgent calls for more resources to protect Aboriginal and Torres Strait Islander communities from COVID-19 From Croakey Read HERE in full 

Watch the full episode of The Drum on IView (Available till 20 March )

2.Prime Minister Scott Morrison’s press conference

 “Today, I now want to move to the decisions that we have taken that were consistent with the plan that I’ve outlined to you.

First of all, the National Security Committee met before the National Cabinet today and we resolved to do the following things; to help stay ahead of this curve we will impose a universal precautionary self-isolation requirement on all international arrivals to Australia, and that is effective from midnight tonight.

Further, the Australian government will also ban cruise ships from foreign ports from arriving at Australian ports after an initial 30 days and that will go forward on a voluntary basis. The National Cabinet also endorsed the advice of the AHPPC today to further introduce social distancing measures.

Before I moved to those, I just wanted to be clear about those travel restrictions that I’ve just announced. All people coming to Australia will be required, will be required I stress, to self isolate for 14 days.

This is very important. What we’ve seen in recent, in the recent weeks is more countries having issues with the virus.

And that means that the source of some of those transmissions are coming from more and more countries.

Bans have been very effective to date. And what this measure will do is ensure that particularly Australians who are the majority of people coming to Australia now on these flights, when they come back to Australia, they’re self-isolation for 14 days will do an effective job in flattening this curve as we go forward.

And there are major decisions that were taken today that reflect changing where we are heading.

The facts and the science, the medical advice will continue to drive and support the decisions that we are making as a National Cabinet, as indeed as a federal Cabinet at the Commonwealth level.

But the truth is that while many people will contract this virus that it’s clear, just as people get the flu each year, it is a more severe condition than the flu, but for the vast majority, as I said last week, for the majority, around 8 in 10 is our advice, it will be a mild illness and it will pass. “

 Prime Minister Scott Morrison press conference 15 march : Download full Transcript here 

PM Scott Morrison press conference full transcript

Download PM Press Release

Prime Ministers Press Release

3.Department of Health campaign download videos 

Download Videos

Coronavirus video – Help Stop The Spread

Coronavirus video – Recent Traveller

Coronavirus video – Stay Informed

Coronavirus video – Good Hygiene Starts Here

Dr Norman Swan provides some simple advice regarding Coronavirus.

– Wash your hands regularly with soap and water; or with hand sanitiser.

– Try to keep your distance from other people; and avoid physical contact

– If you need to sneeze or cough, do it into a fresh tissue which you then discard; or into your elbow.

– If you have a cough or a cold, it’s most likely that you have just a cough or a cold; but talk to your Doctor about it before turning up to a surgery.

For more information visit or

5. Dr Mark Wenitong

Dr Mark speaks with Black Star Radio about Coronavirus and the simple steps you can take to protect yourself.

“If you’re not sure, give the clinic a call and we’ll tell you what to do.” Dr Mark


6.Marion Scrymgour CEO NLC

“The NLC has received many calls from community members asking that we do all we can to ensure the safety and protection of Aboriginal people in their communities who are very concerned about the spread of COVID-19.

Should this virus break out in our communities, we don’t have the manpower to deal with this.

The NLC will be launching an information campaign in Indigenous languages to inform people about hygiene, testing for coronavirus and for them to avoid travel outside communities.

NLC staff have also cancelled their non-essential travel to communities including its regional council meetings.

“Somebody could come out and they could get infected and then go back into the community.

“The position we’re taking is if we can push back that virus taking hold in our communities, that’s a good thing. It means we can work at getting better prepared.”

The decision comes after the Northern Territory Government decided it will stop its employees from making non-essential travel to remote communities.

The NLC has received many calls from community members asking that we do all we can to ensure the safety and protection of Aboriginal people in their communities who are very concerned about the spread of COVID-19 “

Chief executive officer Marion Scrymgour said the move was to protect Aboriginal people in the communities who already faced issues like chronic health conditions, lack of resources and overcrowded housing.

Read in full HERE

NACCHO Aboriginal and Torres Strait Islander Health and #COVID19 News : A decade on, swine flu legacy shapes our Indigenous response to #coronavirus : With commentary from James Ward , Olga Havnen and FAQ’s AMSANT

We definitely didn’t get it right in 2009, and there have been plenty of papers written about that.

But Aboriginal people are much more engaged in this (COVID19 ) planning process, so we’re in a much better position than we were then.”

University of Queensland Indigenous health expert James Ward, a member of the working committee that drafted the new guidelines, released on Wednesday .

Full article Part 2 below and for Indigenous guidelines see Part 3 below or Download HERE.


Read all NACCHO Corona Virus articles HERE

” Major issues include housing people, and the deployment of additional health workforce capacity.

We would need deployment based on where the need is greatest, and will people want to do it? This will need a dynamic response.

But the commonwealth has a clear sense of the need to provide good structures for the vulnerable in our communities.

“The key thing is getting good information, clear and consistent, to our communities.

And the big message is hand-washing.”

There are major issues to consider, “depending on how serious it gets, and events as they unfold”, according to Olga Havnen, a member of the taskforce and CEO of the Darwin-based Aboriginal health organisation Danila Dilba

See Guardian article Part 1 below

AMSANT is engaging with our members, NACCHO and the Northern Territory Government and  Commonwealth Governments  about supporting our members and Aboriginal communities through a potential COVID 19 outbreak : Download


The federal government has set up a national Indigenous advisory group to fast-track an emergency response plan for Aboriginal communities that are among the most vulnerable to any potential spread of Covid-19.

The taskforce met last Thursday as remote Aboriginal communities in South Australia began to strictly limit visitors for the next three months, worried that if Covid-19 arrives it will be “devastating” for their elders and people with existing health problems.

The Anangu Pitjantjatjara Yankunytjatjara (APY) have introduced strict rules for entry to their lands, which they can to do under the APY Land Rights Act.

“We are protecting our people, especially those who hold our ancient cultural knowledge, and we know they are already vulnerable as they are quite old,” APY general manager Richard King said.

“A lot of our people present with comorbidities like diabetes and renal failure. We have high smoking rates, overcrowding in housing, overall poor hygiene.

“It’s almost a perfect storm to support the transmission of these types of diseases.

“The problem with this one is it has a 3.4% fatality rate, which is high, but with our cohort, if it gets here, it’s going to be devastating.”

The Aboriginal and Torres Strait Islander advisory group on Covid-19 is made up of leaders from the Aboriginal community controlled health sector, state and territory health and medical officials, Aboriginal communicable disease experts, the Australian Indigenous Doctors’ Association and the National Indigenous Australians Agency.

The new taskforce will consider the health, social and cultural needs of Aboriginal and Torres Strait Islander peoples, using principles of shared decision-making and co-design. The management plan will focus on current containment activities as well as preparations for mitigation and treatment phases.

The APY board decided on Thursday to refuse entry for the next three months to anyone who has been in mainland China since early February, or been in contact with someone confirmed to have coronavirus, or who has travelled to Iran, South Korea, Japan, Italy or Mongolia.

Anyone in those categories who wants to visit needs to have tested negative for the virus, and will have to submit a copy of the test results along with a statutory declaration to be considered for entry.

State and federal agencies don’t need to apply for a permit to enter but King said he hoped they would comply with the ban.

Indigenous Australians minister Ken Wyatt has agreed to postpone a scheduled visit next month.

There have been no known Covid-19 cases on APY lands to date, but the prime minister, Scott Morrison, has expressed concern about the vulnerability of those in remote Indigenous communities.

During the 2009 swine flu outbreak, Aboriginal and Torres Strait Islander people made up 11% of all identified cases, 20% of hospitalisations and 13% of deaths.

The Northern Territory is also developing a remote health pandemic plan, due to be released this week .

NT Chief medical officer Dianne Stephens acknowledged the “significant” logistical problems with using self-isolation as a response in remote communities, where overcrowding in housing is a major issue.

“So we are working out ways in every community where we can institute social distancing, where we can have a safe place for people to be quarantined if they’re unwell,” she said.

The NT health minister, Natasha Fyles, announced yesterday that a pandemic clinic had been set up at Royal Darwin hospital

Part 2

Australian health authorities preparing for the threat of a widening COVID-19 outbreak have taken the unprecedented step of producing specific guidelines to protect highly vulnerable Aboriginal and Torres Strait Islander communities.

The initiative is underwritten by memories of the devastating toll on Indigenous communities from the 2009 swine flu pandemic.

An Aboriginal person from a Central Desert community was the first national casualty of that outbreak, with the Indigenous population ultimately suffering death rates six times higher from that crisis than the general population.

“Aboriginal people are much more engaged in this planning process, so we’re in a much better position than we were then”: University of Queensland Indigenous health expert James Ward.

“We definitely didn’t get it right in 2009, and there have been plenty of papers written about that,” said University of Queensland Indigenous health expert James Ward, a member of the working committee that drafted the new guidelines, released on Wednesday.

“But Aboriginal people are much more engaged in this planning process, so we’re in a much better position than we were then.”

Aboriginal health researcher Kristy Crooks said the exclusion of Indigenous people from decision-making was a crucial failure in the government response to the 2009 pandemic.

“The flu pandemic showed that the one-size-fits-all approach to public health emergencies are unlikely to work for our communities, so tailoring approaches to meet the needs of families is important,” said Crooks, a PhD candidate with the Menzies School of Health Research at Charles Darwin University.

It is the first time federal authorities have tailored an epidemic response plan to a specific community.

So far, there have been no confirmed cases of the coronavirus in any Indigenous communities, however health authorities confirmed the first case of the virus in Darwin on Wednesday, raising the prospect that it may spread to remote communities in the Northern Territory.

Ward said that Indigenous Australians faced a number of risk factors for respiratory illnesses like COVID-19.

One quarter of the Indigenous population lives in remote areas, which makes access to health services difficult. While many communities had some health services, he said, they are already at capacity and therefore ill-equipped to handle the surge in demand an outbreak of COVID-19 would bring.

The Indigenous population is also highly mobile, with people frequently travelling between communities, often over long distances. Many also live at close quarters in overcrowded housing, meaning disease can spread rapidly and widely.

Then there is the reality, underlined in the latest Closing the Gap Report to Federal Parliament, that Indigenous Australians are already sicker than the rest of the population, and have far more comorbidities, which can make respiratory illnesses much more severe. This was often compounded by a reticence within the Indigenous community to seek medical care, Ward said.

“I think it’s quite clear that Aboriginal people have had very negative experiences with health care services,” he said. “So our population might ignore or not recognise symptoms, or think ‘why would it be coronavirus?’.

“So they might present late to a hospital or clinic, and that may be too late to prevent major outbreaks in communities.”

The newly published guidelines include six “key response strategies” for assisting Aboriginal and Torres Strait Islander communities in the event of an outbreak.

Several focus on appropriate communication and engagement with community leaders, to ensure Indigenous people are at the heart of the decision-making process.

Kristy Crooks said the direction for people to isolate themselves from the rest of their community during the flu pandemic was unrealistic due to cultural and family obligations outweighing national health policies.

“Celebrations are seen as important as sorry business, so people might have still attended large events and gatherings while sick with respiratory problems.”

Crookes will be considering how pandemic planning for COVID-19 can be tailored to communities through First Nations panels.

The research, supported by the Australian Partnership for Preparedness Research on Infectious Disease Emergencies, will empower Indigenous people to determine what the best strategies are to reduce the risk of Covid-19 spreading in their communities, Crooks said.

The working committee responsible for the Indigenous response will remain in constant communication with both the chief medical officer Brendan Murphy, as well as hundreds of health organisations and Indigenous community leaders around the country.

“We will be monitoring very closely to ensure that appropriate messaging and communication goes out to Aboriginal communities,” said Ward. In the Northern Territory, this will include delivering messages to remote communities in the local language.

But Ward said it was equally important to involve non-Indigenous organisations in the preparations.

“We need to make sure there is an adequate response from other organisations too, because this will ensure flexibility in delivering the necessary health care services.”

The new guidelines also include provisions for quarantine and isolation in Indigenous communities, emphasising that families need to be involved in the decision-making around quarantine.

“This can be achieved through exploring with families what quarantine looks like, working through how it might impact on the family and their way of living, and identifying ways around it.”

Ward said at this stage Indigenous health services, including those in remote communities, were not being sent any extra medical supplies or personnel.

“There’s a whole lot of activity going on, obviously, but at the moment there is no coronavirus in a remote community and we don’t expect it’s an immediate threat.”

Part 3 : Aboriginal and Torres Strait Islander communities

Key drivers of increased risk of transmission and severity

  • Mobility: Aboriginal and Torres Strait Islander peoples are highly mobile, with frequent travel often linked to family and cultural connections and community events involving long distances between cities, towns, and communities. In addition, remote communities have a high flow of visitors (e.g. tourists, fly-in fly-out clinicians and other workers). This increases the risk of transmission even in generally isolated
  • Remoteness: A fifth of the Aboriginal and Torres Strait Islander population lives in remote and very remote areas. There is often reduced access health services, these are usually at capacity in normal circumstances and are often reliant on temporary staff. Limited transport options may further inhibit presentations and delay laboratory
  • Barriers to access: Unwell people may present late in disease progression for many reasons including lack of availability of services, institutional racism, and mistrust of mainstream health
  • Overcrowding: Many Aboriginal and Torres Strait Islander communities have insufficient housing infrastructure, which results in people living in overcrowded conditions. This facilitates disease transmission and makes it difficult for cases and contacts to maintain social distance measures and self-quarantine.
  • Burden of disease: Aboriginal and Torres Strait Islander people experience a burden of disease 2.3 times the rate of other Australians. This may increase the risk of severe disease from SARS-CoV-2.

Key response strategies

  • Shared decision-making and governance: Throughout all phases, COVID-19 response work should be collaborative to ensure local community leaders are central to the response. Further risk reduction strategies and public health responses should be co-developed, and co-designed, enabling Aboriginal and Torres Strait Islander people to contribute and fully participate in shared decision-making.
  • Social and cultural determinants of health: Public health strategies should be considered within the context of a holistic approach that prioritises the safety and well- being of individuals, families and communities while acknowledging the centrality of culture, and the addressing racism, intergenerational trauma and other social determinants of health.
  • Community control: The Aboriginal Community Controlled Health Services (ACCHS) sector provides a comprehensive model of culturally safe care with structured support and governance systems. The network of ACCHS and peak bodies should be included in the response as a fundamental mechanism of engagement and
  • Appropriate communication: Messages should be strengths-based and encompass Aboriginal ways of living, including family-centred approaches during both prevention and control phases. They should address factors that may contribute to risk such as social determinants of health, including living arrangements and accessibility to
  • Flexible and responsive models of care: Consider flexible health service delivery and healthcare models (e.g. pandemic assessment centres, flexible ACCHSs clinic hours/location with additional staffing, and home visits). Consider employing the use of point of care influenza tests, where available, to help determine whether influenza is implicated in presentations in the
  • Isolation and quarantine: Families should feel empowered and be part of decision- making around quarantine. This can be achieved through exploring with families what quarantine looks like, working through how it might impact on the family and their way of living, and identifying ways around it. Family members will want to visit unwell people in hospital. It should be made clear that there are other ways to be with sick family members in hospital, maintain communication with families and communities in lieu of gatherings (e.g. staying socially connected through the internet and video calling).






NACCHO Aboriginal Health and #HearingAwarenessWeek A/Prof @KelvinKongENT is working to #closethegap in ear health for Aboriginal and Torres Strait Islander kids by finding better treatments and preventative approaches so kids are not limited by their hearing.

I aim to make a national profile of the problem of ear disease and hearing loss. It is an important issue for all Australian levels of government, policy makers and health service providers.

The severe impact imposed by hearing loss needs greater acknowledgement, especially in communities where a majority of people are affected, such as the Aboriginal and Torres Strait Islander communities.

We are also seeing too many children in our urban, regional and rural communities being affected and waiting too long for access to specialist care.

This is a health problem that costs our nation a great deal of money, not just in medical treatments but in the social cost of people not receiving enough education to get a good job and provide security for themselves and their families in the future.

Associate Professor Kelvin Kong : Read interview full BIO Part 2

Read over 40 Aboriginal Health and Ear Hearing articles published by NACCHO

 “ Up to nine in every ten Aboriginal and Torres Strait Islander children under the age of three in the Northern Territory, suffer from otitis media, or “glue ear”, in one or both ears. If left untreated this can have a devasting impact on a child’s entire life trajectory.

The Hearing for Learning Initiative will increase early detection of otitis media, by training local community members to become ear experts that support on the ground health and education services. This will decrease the need for fly-in fly-out specialists, reduce the treatment waiting period and create employment opportunities for up to 40 community-based workers in the Northern Territory. ” 

Download Menzies Press Release 

Media release Hearing for learning a focus on Bathurst Island

World Hearing Day was on 3 March 2020. The theme this year is “Don’t let hearing loss limit you”.

World Hearing Day coincides with Hearing Awareness Week in Australia (1 to 7 March).

This year’s theme is “Don’t let hearing loss limit you”. This theme highlights how timely and effective interventions can help people with hearing loss reach their full potential.

World Hearing Day coincides with Hearing Awareness Week in Australia (1 to 7 March).

Hearing loss in Australia

In Australia, almost 4 million people have some form of hearing loss. This continues to grow as our population ages.

The most common causes of hearing loss are:

  • age-related
  • excessive exposure to loud noise

Hearing loss caused by exposure to loud noise is preventable. The best interventions for hearing loss are early interventions, no matter how old you are.

If you or someone you know is worried about hearing loss, we encourage you to have your hearing checked.

The Healthdirect website provides more information on the signs of hearing loss and ways to help prevent hearing loss.

Hearing Services Program

The Australian Government is working to reduce hearing loss and the consequences of hearing loss in Australia.

The Government’s $581 million Hearing Services Program provides high quality hearing services and devices to some of our most vulnerable people.

In 2018-19, the program delivered services to over 785,000 clients, including:

  • older Australians
  • veterans
  • young children
  • Aboriginal and Torres Strait Islander people
  • people living in rural and remote areas

The Australian Government has also committed $4 million in funding for up to 600,000 free online hearing tests for children. Parents of children aged between four and 17 can visit the Sound Scouts website for more information.

Find out more about hearing and hearing loss on the Hearing Services Program website.

Part 2 Interview with Associate Professor Kelvin Kong


Ear disease in Australian Indigenous populations is deplorable. I am working to closing the gap in ear health to bring all Indigenous Australian children to the same level of well-being and health care access as their non-Indigenous counterparts.

The rates of ear disease are higher for Aboriginal and Torres Strait Islander children across Australia, with some communities having 90% of young children affected. This causes hearing loss leading to massive disadvantage in early learning and development of language and social skills, which can have devastating repercussions throughout life.

Our Newcastle ear research team works to understand the pathophysiology of chronic ear disease in Australian Indigenous and non-Indigenous sufferers to understand the nature of ear infections and find better treatments and preventative approaches in early childhood.

Unfortunately, some babies will acquire infections within the first months of life and go on to have recurrent infections that impact upon their ability to hear and learn. Importantly missing on hearing the voices (and stories) of their family members at this vitally important period of early development.

I aim to make a national profile of the problem of ear disease and hearing loss. It is an important issue for all Australian levels of government, policy makers and health service providers.

The severe impact imposed by hearing loss needs greater acknowledgement, especially in communities where a majority of people are affected, such as the Aboriginal and Torres Strait Islander communities. We are also seeing too many children in our urban, regional and rural communities being affected and waiting too long for access to specialist care.

This is a health problem that costs our nation a great deal of money, not just in medical treatments but in the social cost of people not receiving enough education to get a good job and provide security for themselves and their families in the future.

The journey of solving the ear health issues must be community led and translated into models of care that have a holistic approach. Our research must also have capacity and ensure any solutions are sustainable.


Why did you get into research?

It was heartbreaking growing up in the Worimi community enduring the health disparities first hand. I have always had a passion to help address the inequality and have been lucky enough to be afforded the opportunities to allow me to complete the full circle and be a care giver.

As an ENT surgeon I have treated people all across Australia, including people in Newcastle (Awabakal country), with terrible states of ear disease.

The lack of access to health care and the escalation of a problem that should have been addressed long ago, is a driver to increase the momentum of a solution.

The impact of research into the causes and interventions, cannot be overestimated, so that young babies will not progress to the stage where surgery is desperately needed to restore some hearing so they can participate in a normal childhood and have aspirations and dreams not limited by their hearing.

What would be the ultimate goal for your research?

The ultimate goal is for all Australian children, both Indigenous and non-Indigenous, to have the same chance of having healthy ears, no matter where they reside in Australia.

We need everyone to have enough awareness of the problems, to put the time and resources into finding treatments and interventions, so that no child should expect to go through life suffering the loneliness, loss of self-esteem and lack of education that many children experience with ear disease and as adults in later life.


Kelvin graduated from the University of NSW in 1999. He embarked on his internship at St. Vincent’s Hospital in Darlinghurst and pursued a surgical career, completing resident medical officer and registrar positions at various attachments. Along the way, he has been privileged in serving the urban, rural and remote communities.

He was awarded his fellowship with the Royal Australasian College of Surgeons in 2007. Once completed he pursued further training in Paediatric ENT surgery, being grateful and honored by his fellowship at The Royal Children’s Hospital, Melbourne in 2007-8. He is now practising in Newcastle (Awabakal Country) as a Surgeon specializing in Paediatric & Adult Otolaryngology, Head & Neck Surgery (Ear, Nose & Throat Surgery).

He has joined an outstanding group of surgeons at Hunter ENT and together they provide a varied comprehensive practice. He has a very broad adult and paediatric Otology, Rhinology and Laryngology practice, whilst having special interests in Paediatric Airway, Adult and Paediatric Cochlear Implantation, Voice and Swallow disorders and Head & Neck Cancer management.

He is an active member of RACS and ASOHNS, serving on the Indigenous Health and Fellowship Services Committees. He has published articles and presented on a variety of ear, nose and throat conditions as well as Indigenous health issues both nationally and internationally.  He is active in reviewing articles for publication, lecturing and teaching allied health professional, medical students at several universities and both unaccredited and advanced medical and surgical trainees. His commitment and professionalism was recognised in July 2017 when he was appointed the Secretary of the Australian New Zealand Society of Paediatric Otolaryngology. He was also honored to have won the Australian Indigenous Doctor of the year in 2017.

As Australia’s first Indigenous surgeon, Assoc. Prof. Kong is committed to improving the ear health of Indigenous children and has often participated in news articles and television interviews to bring the attention of the Australian public to the disparity in Indigenous and non-Indigenous child health. He makes regular trips to Australia’s remote regions to provide ear health services that would otherwise not be available.

Kelvin hails from the Worimi people of Port Stephens, north of Newcastle, NSW, Australia. Being surrounded by health, he has always championed for the improvement of health and education. Complementing his practice as a surgeon, he is kept grounded by his family, who are the strength and inspiration to him, remaining involved in numerous projects and committees to help give back to the community.

Future Focus

Being able to hear is such a privilege often taken for granted. The quality of life through the enjoyment if sound and education is a human right. I want everyone to understand the importance of ear disease in childhood and particularly how vital it is that we stop this problem from affecting so many Australian Indigenous children. We need to work together to raise the standards of living and access to medical care so that our First people are not living from one generation to the next in sub-standard circumstances.  We need to see our children finishing their education, able to gain employment and live alongside non-Indigenous Australians with the same opportunities and the same quality of life. We need see them to strive toward their dreams.

Specialised/Technical Skills

  • Consultant ear, nose and throat surgeon
  • Causes of ear infections
  • Paediatric Airway
  • Adult and Paediatric Cochlear Implantation
  • Voice and Swallow disorders
  • Head & Neck Cancer management
  • Randomised controlled trials
  • Aboriginal and Torres Strait Islander health
  • Educator
  • Policy development
  • Mentor
  • Father, Husband, Brother, Worimi man



NACCHO Aboriginal Health and #CoronaVirus #COVID19 : PM @ScottMorrisonMP says work is being done to prepare Indigenous communities for possible coronavirus outbreak

Given the level of chronic disease Aboriginal people suffer that makes them vulnerable.

People are concerned about the spread of this – but putting in place a whole series of measures that’s what we have to do.

Communication was essential towards educating communities about the risks posed by the virus – but cautioned against undue panic.

Everyone is better equipped in terms of information this time around and are better informed.

What’s important is we don’t take our feet off the pedal that we continue to make sure people are engaged.”

NACCHO Deputy Chief Executive Officer Dawn Casey told SBS News it is well known Indigenous people suffer 2.3 times the burden of disease compared with other populations

The National Aboriginal Community Controlled Health Organisation (NACCHO) has begun reaching out to community health services to implement possible emergency response plans. See full article Part 2 below

Read all previous Aboriginal Health and Corona Virus NACCHO Articles Here

And we also suffer a lot of chronic disease, which makes elderly patients more susceptible to any infection.

Testing is another worry — it takes at least a week if you live in a place like Balgo because the sample has to go to the nearest town, Broome, and then down to Perth.

She said she understood that one Pilbara community was restricting access by outsiders as an infection control measure, but Kimberley communities were open.

A number of workers in the Kimberley medical service’s five remote clinics servicing 10 communities had “self-selected” and isolated themselves for a time after returning from countries flagged as of concern.

We may end up with staffing problems in remote clinics if that escalates.”

Lorraine Anderson, medical director of the Kimberley Aboriginal Medical Service, said remote clinics were already on the lookout for symptoms consistent with the virus.

Indigenous health organisations will gather in Canberra next Tuesday to discuss the threat the virus poses to communities with little ability to isolate patients.

Dr Anderson said it was difficult to isolate people in communities where housing was scarce. See Part 3 Below 

Part 1 :NSW Health and the AH&MRC will be hosting a webinar this Wednesday 4th March 2020 from 12-1pm.

This webinar will focus on coronavirus and influenza and what you and your service can do to protect your communities.

The following people will be speaking and there will be an opportunity to raise and discuss concerns and needs that you have:

  • Reuben Robinson, CEO, Galambila Aboriginal Health Service
  • Dr Kerry Chant, Chief Health Officer, NSW Health
  • Kylie Taylor and Kristy Crooks, Hunter New England Public Health team

The link to participate in the webinar is here:

For further information please contact Megan Campbell, Centre for Aboriginal Health on

Part 2 The Federal Government is concerned about the potential for coronavirus to spread in remote Indigenous communities.

There have been no known COVID-19 cases among Indigenous Australians to date – but work is already being done to prepare the “vulnerability” of these populations against possible infection.

Prime Minister Scott Morrison said authorities have reached out to these communities to increase their preparedness against an outbreak in

“We have been engaging with Indigenous leaders because in remote Indigenous communities if the virus were to get to those places, obviously there is a real vulnerability there,” he said.

“So we have been reaching out to those communities to work through how preparedness can be put in place.”

Some 10,000 coronavirus tests have been carried out here, with 34 people returning positive results including the first person-to-person transmissions in the country.

The University of Queensland’s Professor James Ward is one of those who has been working “hard” behind the scenes to prepare Indigenous communities.

The Federal Government will be distributing national guidelines over how to respond to COVID-19 if it appears in these populations.

Mr Ward told SBS News the remoteness, limited access to health services, vulnerability to disease and mobility of Indigenous communities could all make them more at risk.

“The longer this goes on … the greater the chances are of it reaching some of our most remote communities,” he said.

He said the potential for individuals to live in crowded living situations could also be a factor.

“We are working very hard behind the scenes to get our communities prepared,” he said.

“We’ve already seen in previous pandemics in 2009 – it affected the most remote of our communities.”

Research published following the 2009 A(H1N1) swine flu outbreak showed that Aboriginal and Torres Strait Islander people made up 11 per cent of all identified cases, 20 per cent of hospitalisations and 13 per cent of deaths.

This is despite them making up just three per cent of the population – meaning Indigenous people were 8.5 times more likely to be hospitalised.

Mr Ward said steps are being taken to make sure Indigenous communities are better prepared this time and ensure they are not deterred from accessing health services.

He said communication needed to involve families and communities in decision-making over quarantine measures and in providing local health services additional support as required.

“The response has to proportionate to the risks in individual communities around the country,” he said.

“How do we communicate this in a way that doesn’t create fear and panic and moves populations away unnecessarily from other communities to their own?”

Globally there have been more than 88,500 infections and at least 3000 deaths spanning some 70 countries and regions.

The National Aboriginal Community Controlled Health Organisation (NACCHO) has begun reaching out to community health services to implement possible emergency response plans.

Part 3 The Australian Continued

A Pilbara miner is at the centre of a coronavirus scare, with resources workers and remote communities fearing they could be dangerously exposed.

The worker at the Fortescue Metals’ Christmas Creek mine has been placed in isolation after returning from Indonesia with flu-like symptoms.

“One of our team members has presented with symptoms that meet the Department of Health’s minimum criteria for testing for COVID-19,” FMG chief executive Elizabeth Gaines said. “We are implementing all necessary precautions in accordance with health guidelines.

“The employee has been isolated pending the outcome of the test, which we anticipate receiving within 48 hours.”

Clinics in Aboriginal communities are also concerned, particularly given relatively high rates of diabetes and heart and lung conditions.

Scott Morrison said on Wednesday that the federal government was talking to Aboriginal leaders “because in remote indigenous communities if the virus were to get to those places, obviously there was a real vulnerability there”.

“And so we’ve been reaching out to those communities to work through how preparedness can be put in place,” the Prime Minister said.


NACCHO Aboriginal Health and #Racism #Aliens : Professor Marcia Langton ” Hysteria over High Court’s ruling is hateful and wrong ” Plus extra comment Stan Grant

” Sixty-five thousand years. This is the earliest established date of human occupation on the Australian continent. It was reported two years ago by archaeologists, based on “the results of new excavations conducted at Madjedbebe”, a rock shelter in Arnhem Land. 

Last week the High Court judges implicitly acknowledged in their findings in the Love and Thoms cases that Aboriginal Australians — even those born overseas and not citizens of Australia — are not within the reach of the “aliens” power in section 51(xix) of the Constitution.

The commonwealth should not resort to entrenchment of race hate and discrimination in dealing with the intersection of criminality, mixed-descent Aboriginal people who are not Australian citizens, and the Migration Act.

This case demonstrates that rule of law is alive and well. What is not clear is whether the ideological use of race in our politics will cease.

We can be sure, though, that hysteria about these issues will continue because weaponising race in the tabloid media is commercially lucrative and builds brand value in the absence of sound citizen values and respect for the rule of law.” 

Marcia Langton is Professor of Australian Indigenous studies at the University of Melbourne. Read full article Part 2 below .

Originally published The Australian 15 February

Read over 120 Aboriginal Health and Racism articles published by NACCHO over past 8 years 

Part 1 Stan Grant 

” This was about our nation’s history: the legacy of dispossession.

Where do First Nations people fit within the Commonwealth? What is it to be Australian? Indigenous? Can we be equally one and the same?

Can two centuries of imported British law and tradition here, extinguish a connection, law, and lore that has existed for time immemorial?

These questions go to the very heart of the legitimacy of the nation. This is what Indigenous people call Australia’s unfinished business.

The judges’ opinions make fascinating and inspiring reading. They are profound, wise, and sensitive.”

The High Court has widened the horizon on what it is to be Indigenous and belong to Australia

Additional comments from Stan Grant (added by NACCHO FYI ) Read in full HERE

Part 2

Daniel Love and Brendan Thoms, ( pictured above ) the former born in Papua New Guinea and the latter in New Zealand, are not citizens but both have an Aboriginal parent. Both ran foul of the law and were charged and sentenced for assault occasioning bodily harm.

The ­Migration Act enabled Home Affairs personnel to cancel their visas, place them in immigration detention and arrange for deportation to their countries of birth. The commonwealth argued in the appeal against their deportation that “since the plaintiffs were not citizens, they were necessarily aliens, and therefore the commonwealth had the jurisdiction to ­deport the plaintiffs pursuant to s 51(xix) of the Constitution”.

The High Court found to the contrary “that the common law must be taken to have recognised that Aboriginal persons ‘belong’ to the land. This recognition is inconsistent with the treatment of Aboriginal persons as strangers or foreigners to Australia. The status of alien provided for in s 51(xix) therefore cannot be applied to them.”

Following the Mabo (No 2) decision in 1992, the response from the Coalition, business, mining, farming and grazing leaders, along with the usual pack of shock jocks, was hysterical and, above all, wrong. So, too, the response during this past week from the hard right and the far right to the High Court decisions in Love v Commonwealth and Thoms v Commonwealth: hysterical, wrong and misleading.

The facts are more important than ever. The idea of “race” — in defining Aboriginal people, in tackling our standing in the Constitution, in legislation and in our everyday enjoyment of civil rights — must be replaced by a more accurate conception of peoples with unique and ancient cultural and genealogical links to this continent.

The eastern part of Australia became a colony of England in 1770, when Lieutenant James Cook declared it a British possession at Possession Island in the Torres Strait. It was Eddie Koiki Mabo from a nearby island, Mer or Murray Island, in 1982, who challenged the arrogance of this imperialist declaration and the legal fiction on which it was based — terra nullius, the Latin term for “empty land belonging to no one” and more particularly governed by no one. In 1992, the High Court recognised within severe limits the pre-existing native title laws of the indigenous peoples and overturned terra nullius.

On January 26, 1788, the colony of NSW was established and thereafter other parts of Australia were declared colonies, eventually numbering six in all. Aboriginal societies and their territories were overrun by settlers and, in many parts, if they survived at all, they did so in much-reduced and horrible circumstances.

The impact of this history on the surviving indigenous populations are many, and the continued attacks on our self-identification as Aboriginal is one of them and, it must be said, is a new and intensified focus of racist attacks.

The contributions of Andrew Bolt to misinformed public perceptions of who is and who is not Aboriginal weaponised this style of attack among the far right. Mark Latham proposed DNA testing for all Aboriginal people, even though this is not possible given the state of the science.

Moreover, the great fear among Aboriginal people who directly bear the burden of our terrible history is the recent proposal to Home Affairs Minister Peter Dutton for a register.

This would be the worst instance of racial profiling and establish the grounds for a race-based purge of Aboriginal people. How else should they interpret the relentless drive of Dutton, whose response following the announcement of the decision in Love and Thoms was that he would amend the Migration Act?

How can he do this without suspending the Racial Discrimination Act?

Without entrenching ­racism in our laws?

The High Court affirmed the three-part definition of an Aboriginal person: he or she must be ­descended from an Aboriginal person, must identify as Aboriginal and be recognised by his or her community as such. Facts matter in assessing these issues and, despite the hysteria, that this arrangement has worked well as an administrative guideline for almost a half-century should give Australians confidence.

Australians should feel pride in our common law because it is logical and just: “It follows that a person whom an Aboriginal society has determined to be one of its members cannot answer the description of an alien according to the ordinary understanding of that word.”

Justice Virginia Bell, one of the four judges in the majority, noted: “Whether a person is an Aboriginal Australian is a question of fact.” She went on to point to the origins of the three-part definition of Aboriginality in the Tasmanian dam case in which Justice William Deane proposed the meaning of the term “Australian Aboriginal” as “a person of Aboriginal descent, albeit mixed, who identifies himself as such and who is recognised by the Aboriginal community as an Aboriginal”. Deane inclined to the view that the reference was to the “Australian Aboriginal people generally rather than to any particular racial sub-group”.

The Love and Thoms submissions relied on Justice Gerard Brennan’s formulation in Mabo (No 2) for the meaning of “Aboriginal” Australian: “(m)embership of the indigenous people depends on biological descent from the indigenous people and on mutual recognition of a particular person’s membership by that person and by the elders or other persons enjoying traditional authority among those people.”

The shift from a cultural interpretation of an indigenous polity in the Tasmanian case to a biological one in the Mabo case is a reflection of the increasing misunderstanding of the notion of race, the colonial racialisation of hundreds of Aboriginal peoples as a single race and the worsening commitment to a eugenicist view of humanity, even among our most educated.

A cultural and historical view of indigenous peoples, their antiquity and their belonging is key to getting constitutional issues right. Race is a dangerous concept and my view is that we must dispense with it.

The High Court declined, however, to determine the facts on Aboriginality in the case of Love and Thoms, and instead found: “If the commonwealth did not accept Mr Love’s pleaded case, that he is a member of the Aboriginal race of Australia, the appropriate course was for the proceeding to have been remitted to the Federal Court of Australia for the facts to be found.”

There is so much to understand about the High Court’s findings, and further issues will be raised by the Federal Court if the commonwealth does, indeed, seek clarification of the Aboriginality of Love. The commonwealth should not resort to entrenchment of race hate and discrimination in dealing with the intersection of criminality, mixed-descent Aboriginal people who are not Australian citizens, and the Migration Act.

This case demonstrates that rule of law is alive and well. What is not clear is whether the ideological use of race in our politics will cease. We can be sure, though, that hysteria about these issues will continue because weaponising race in the tabloid media is commercially lucrative and builds brand value in the absence of sound citizen values and respect for the rule of law.


NACCHO Aboriginal Health and the #ClosingtheGap debate : Professor Ian Ring  “  For actual progress to occur  I suggest 7 steps fundamental shifts in policy and practice  to turn around the efforts to #closethegap “

The good news is that the lack of progress in Closing the Gaps can be turned around, but this requires capitalising on the opportunities presented by the COAG partnership and a fundamental shift in the way programs are run.

I am encouraged that First Peoples and government are finally in the one forum where funding and policy can be aligned and jurisdictional and Indigenous responsibilities assigned and monitored – through the Partnership Agreement with the Coalition of Peak Aboriginal and Torres Strait Island Organisations and the Council of Australian Governments(COAG).

This is a historic development, but one which enables but does not necessarily, of itself, guarantee progress.

For actual progress to occur, there needs to be some fundamental shifts in policy and practice.

I suggest the following 7 steps to turn around the efforts to close of the gap “

Professor Ian Ring AO, Hon DSc see full CV part 2 below : Original published ANTAR 

Read over 600 Aboriginal and Close the Gap articles published by NACCHO over past 8 years

Read all the Coalition of Peaks Closing the Gap articles published by NACCHO 

Noting the Prime Minister Scott Morrison will deliver his governments Closing the Gap report Wednesday 12 February

Close the Gap, Coalition of Peaks and Closing the Gap what is the difference ?

Close the Gap is a public awareness campaign focused on closing the health gap. It’s run by numerous NGOs, Indigenous health bodies and human rights organisations.

The campaign was formally launched in 2007, after the release of the social justice report by the Aboriginal and Torres Strait Islander social justice commissioner, Dr Tom Calma.

Close the Gap gained support from state and federal governments when the Council of Australian Governments (Coag) set two health aims among their six targets in 2008: achieving health equality within a generation and halving the gap in mortality rates for children under five within a decade.

In 2008 then prime minister Kevin Rudd and then opposition leader Brendan Nelson also signed the Close the Gap statement of intent.

The Coalition of Peaks is a representative body comprised of around fifty Aboriginal and Torres Strait Islander community controlled peak organisations that have come together to be partners with Australian governments on closing the gap, a policy aimed at improving the lives of Aboriginal and Torres Strait Islander people.

In 2016, Australian governments wanted to refresh the closing the gap policy which had been in place for ten years.  During this refresh process, many Aboriginal and Torres Strait Islander organisations told governments that we needed to have a formal say on the design, implementation and evaluation of programs, services and policies that affect us.

In March 2019, the Coalition of Peaks entered an historic formal Partnership Agreement on Closing the Gap with the Council of Australian Governments (COAG) which sets out shared decision making on Closing the Gap.

View the Coalition of Peaks Website HERE 

Closing the Gap

Closing the Gap is the name given to Coag’s 2008 national strategy to tackle Indigenous inequality, which includes the Indigenous Reform Agreement, a commitment to closing the gap between Indigenous and non-Indigenous Australians within a specific timeframe, with six key targets

View the latest Closing the Gap Website HERE

” Everyone deserves the right to a healthy future and the opportunities this affords.

However, many of Australia’s First Peoples are denied the same access to healthcare that non-Indigenous Australians take for granted.

Despite a decade of Government promises the gap in health and life expectancy between Aboriginal and Torres Strait Islander peoples and other Australians is widening.

The Close the Gap Coalition — a grouping of Indigenous and non-Indigenous health and community organisations — together with nearly 200,000 Australians are calling on governments to take real, measurable action to achieve Indigenous health equality by 2030.” 

National Close the Gap Day March 17 Campaign website

Ian Ring suggests the following 7 steps to turn around the efforts to close of the gap 

1.Target Setting

Firstly, target setting is not simply a process of setting out what results would be desirable but needs to take into account what actual services and resources would be required to achieve the targets – and how long it would take to both measure and achieve them. Targeting and budgeting must go hand in hand, and targeting without budgeting is simply a recipe for failure and disappointment.

2.Needs-Based Funding

Secondly, it is a cardinal principle behind government social policy that service provision should be related to need. For example, no one questions the fact that far more is spent on health care for the elderly than on the young who enjoy much better health.

However, while in broad terms the level of need for health care in Aboriginal and Torres Strait Islander people, based on the Burden of Disease studies is approximately 2.3 times higher than for the rest of the population, though the jurisdictions spend $2 approximately pc (87% of needs based requirements) on health for every $1 spent on the rest of the population, the Commonwealth only spends $1.21pc on Aboriginal and Torres Strait Islander people for every $1 spent on the rest of the population (barely half [53%] of the needs based requirements).

This is particularly important as the Commonwealth is largely responsible for the out-of-hospital services required to bring down preventable admissions and deaths. It is utopian and unrealistic to believe that gaps can be closed by spending relatively less on people with worse health.

This is not a plea for some kind of special deal for First Peoples but rather for a level of expenditure that anyone else of the population with equivalent need would receive.

Funds are required to address market failure, particularly with the underuse of Commonwealth funding schemes (MBS/PBS) and to fill current service gaps with services that work and particularly, services designed by and for Aboriginal people (ACCHS). Similar principles apply to other areas of government policy and service provision eg housing, education, welfare etc.

3.Focus on Services

Thirdly, there seems to be a widespread belief that targets are somehow self-fulfilling, that all that is required is to set targets, measure them and that somehow or other the targets can be achieved.

This is of course nonsense, but indicative of the need for skills training in health planning and related fields (see below). Having set targets, it is absolutely necessary to consider what services are required to achieve the targets, what services are available and what services are missing, and the investment required to fill the service gaps. For services that are available, it is fundamentally important to have evaluation as a mandatory routine to see if the services are accessible, and effective – and if not, why not, and then take the necessary management decisions to improve service delivery (see management below).


There is clear evidence across a range of fields (health, education, housing, justice etc) that significant progress is possible using methods that are tried and tested.

But Aboriginal health and related issues are not so simple that anyone can tackle them effectively. They are complex and require considerable skills and service delivery experience for effectiveness.

Throwing staff in at the deep end is inefficient, and not fair either to the staff or to Indigenous people. Health planning, for example, is a defined skill and requires specific training and a manifest lack of planning skills lies at the heart of suboptimal service delivery A fundamental understanding of culture is an absolute necessity as is a very solid grounding in service delivery experience. The need for training extends right across the board and applies to clinicians, health service administrators  and public servants.

For each individual the question needs to be asked – what training does this person require in order to fulfil their role with maximum effectiveness? It is time for amateur hour to come to an end and for the development and implementation of a National Training Plan to ensure all involved are adequately equipped  for their individual roles – and it will not be possible to adequately realise on the investments involved in Indigenous service provision without appropriate staff training.


For many, the concept of management is little better than sitting around and hoping that somehow, miraculously, next year’s results will be better. That is not how Gaps are Closed.

A formal, integrated, multilayered management system is required – supported by appropriate information and evaluation systems.

At the service delivery level there needs to be formal review processes, at least mid-year and annually, to consider both process and outcome measures in relation to the specified targets – with a timeframe that is based on trajectories which set out what results can and should be expected at different points of time.These measures need to be replicated at regional and jurisdictional levels in the context of a wider consideration of staffing, training and resourcing issues. At the national level the focus needs to be on both resourcing and policy issues. At every level, the question needs to be how well are we doing, and what needs to be done to achieve better results – and then to take the appropriate management decisions required to achieve the targets.

6.Continuous Quality Improvement

There is incontrovertible evidence that sizeable and rapid gains are possible in both chronic disease  and in the health of mothers and babies. But those gains require high quality services and are not achieved without proper systems for measuring, monitoring and improving the quality of services.

Such approaches are standard throughout industry and need to be a formal component of health service delivery and other areas of social policy. CQI processes have been used for some services but need to be mandated and funded as a national requirement so that everyone involved in Indigenous service provision lives and breathes service quality enhancement and participates in the formal processes involved.

7.Learning from national and international experience

There are many fine examples of Indigenous Health service delivery – and some of the best health services in the country are provided by the Aboriginal Community Controlled Health Services.

The Institute of Urban Indigenous Health in South-East QLD (IUIH) is an outstanding example of how to integrate Primary Health Care services, both Indigenous and mainstream, under Aboriginal and Torres Strait Islander leadership. in achieving the desired results in term of Closing the Gap.

It is just one of a number of examples around the country, but such examples need to become systematic, comprehensive and national throughout Australia. There are similar examples of services for mothers and babies which reduce low birth weight rates and lower perinatal mortality. In the important field of chronic disease, it has been demonstrated that systematic application of current knowledge can achieve dramatic reductions in mortality in short time periods.  We know what to do, have shown that impressive results can be achieved but nationally, progress in both child health and chronic disease falls a long way short of what is required. There needs to be formal support programs, to replicate successful models of these services, adapted as needed to meet local needs, right throughout Australia.

Similarly, successful programs like Housing for Health, developed for the Commonwealth (and subsequently dropped [!] but picked up by the NSW government) have improved housing and consequently health, and doing so by training and employing local Aboriginal people. It beggars belief that programs of such obvious worth are not universally delivered across Australia, and that needs to be rectified as a matter of urgency.

In other fields, child development and justice reinvestment programs have been shown to be effective and cost effective, both in Australia and overseas, but implemented on a piecemeal and patchy basis in Australia. That cannot continue.

Government budgets tend to focus on outlays rather than investment – and more importantly, return on investment. This is inefficient and, in the end, wasteful. The recent NZ Wellbeing budget shows a different approach and needs careful consideration.


None of the measures above are radical or untested or impossible to implement. Indeed, they are standard throughout much of the world. Not implementing them has proved costly in terms of poor results and suboptimal returns on investment.

The time for amateurism is over and Australia needs to lift its game. and these standard measures, under First Peoples leadership, and in the context of the COAG partnership, we can make a significant contribution to the achievement of Australia’s national Goals to Close the Gap.

The Gaps can and should be closed – but not by fine words and good intentions.

Much progress is possible in relatively short periods of time and Australia could and should be the world leader in Indigenous affairs.

Part 2 Professor Ian Ring AO, Hon DSc

Professor Ian Ring AO, Hon DSc is a Professorial Visiting Fellow, School of Public Health and Community Medicine, University of New South Wales, Adjunct Professor in the School of Indigenous Australian Studies, James Cook University and Honorary Professorial Fellow in the Research and Innovation Division at Wollongong University.

He was previously Head of the School of Public Health and Tropical Medicine at James Cook University, Principal Medical Epidemiologist and Executive Director, Health Information Branch, at Queensland Health, and Foundation Director of the Australian Primary Health Care Research Institute at the Australian National University.

He has been a Member of the Board of the Australian Institute of Health, Member of the Council of the Public Health Association and the Australian Epidemiological Association.

He is an Expert Advisor to the Close the Gap Steering Committee and a member of the International Indigenous Health Measurement Group, Aboriginal and Torres Strait Islander Demographic Statistics Expert Advisory Group, Scientific Reference Group Indigenous Clearinghouse, Australian Indigenous HealthInfoNet Advisory Board, and AMA Taskforce on Indigenous Health.

NACCHO Aboriginal Health and #FASD #BacktoSchool : Download or View @NOFASDAustralia Teachers play a critical role in facilitating positive learning and life outcomes for students with FASD.

” NACCHO in 2018 partnered with the Menzies School of Health Research and the Telethon Kids Institute (TKI) to develop and implement health promotion resources and interventions to prevent and reduce the impacts of Fetal Alcohol Spectrum Disorders (FASD) on Aboriginal and Torres Strait Islander families and young children.”

 Although high rates of alcohol consumption have been reported across all Australian populations, research shows that Aboriginal and Torres Strait Islander women are more likely to consume alcohol at harmful levels during pregnancy, thereby greatly increasing the risk of stillbirths, infant mortality and infants born with an intellectual disability.”

FASD is an umbrella term used to describe the range of effects that can occur in individuals whose mother consumed alcohol during pregnancy.

These effects may include physical, mental, behavioral, developmental, and or learning disabilities with possible lifelong implications.”

From the FASD Strategy 2018 -2028 NACCHO Post 

Teachers play a critical role in facilitating positive learning and life outcomes for students with FASD.

These children do not respond to traditional instructions or classroom management techniques, and while many children with FASD have average or high intelligence, they also have complex needs which impact many aspects of the school environment. Behaviours and challenges of a child with FASD vary, and can include:

  • learning difficulties
  • impulsiveness
  • difficulty connecting actions to consequences (don’t learn from mistakes)
  • difficulty making and keeping friends
  • attention / hyperactivity
  • memory challenges (short and long term)
  • developmental delays

NOFASD Australia’s website provides a range of resources for teachers and educators.

We have also produced a number of webinars including a 45 minute webinar for teachers which can be viewed here.

Some valuable resources include:

The Marulu FASD Strategy publication Fetal Alcohol Spectrum Disorder (FASD) and complex trauma: A resource for educators is valuable for educators and other professionals.

This book contains detailed information about FASD and how it interacts with trauma, and provides many practical strategies for supporting young people with FASD in the classroom.

South Australia’s Department of Education has a comprehensive webpage on Fetal Alcohol Spectrum Disorder which can be accessed here. This page covers the education implications of FASD, managing FASD in education and care, supporting children and families with FASD and related resources. Downloadable resources include:

  • An interoception support planwhich provides a detailed explanation and opportunity for the development of individualised strategies to assist children to understand their bodies and thus self-regulate.
  • sensory overview support planwhich can provide a detailed understanding of individual sensory difficulties and assist in developing strategies to minimise sensory overload in the education setting.
  • regulation scale which assists children and adolescents to identify what is impacting their mood, what signals their body is giving them, and ways to respond and manage their change in mood.

WRAP Schools has produced short videos based on 8 Magic Keys: Developing Successful Interventions for Students with FAS by Deb Evensen and Jan Lutke. These are valuable resources for teachers and may be beneficial for parents and caregivers too. Read an overview of each Magic Key and watch them here.

NOFASD Australia’s resource, an Introduction to Teachers, can be downloaded and completed by parents/carers to provide specific information on strengths, challenges, and effective strategies for their individual child.

We recommend you access NOFASD’s comprehensive resources for teachers and educators. Recommended links include:

Supporting students with FASD – online learning

Trying Differently Rather Than Harder – highly recommended reading

Teaching a student with FASD

Understanding FASD: A comprehensive guide for pre-k to 8 educators

What teachers can do

Finally, this video describes a shift in approach when working with students with FASD:

To read other NOFASD Australia blogs click here.

You may also like to read Edmonton and Area Fetal Alcohol Network’s blog KNOWFASD: Academic Difficulties.

NACCHO Aboriginal Health and #WorldCancerDay @CancerAustralia and @HealthInfoNet Many cancers are preventable among Aboriginal and Torres Strait Islander people

” In Australia, the poorest among us are 30% more likely to die of cancer than the richest.

There is also a big gap in cancer outcomes for our Indigenous Australian population, where incident rates from cancer are 10% higher than non-Indigenous Australians and mortality rates are 30% higher.

Similarly, cancer incidence (particularly cancers with poorer prognoses) and mortality are significantly higher outside capital cities, with outcomes worsening in step with remoteness.

So why are money, cultural background, geographic location and cancer types leading to some Australians being left behind?

More research is required to definitively pinpoint why these trends are occurring, but several factors stand out. More needs to be done to promote healthy lifestyles and cancer prevention to some parts of our community.

As an example, we know that smoking rates are higher in Indigenous populations and among poorer Australians and also link to cancers with poorer prognosis such as lung cancer.

Continued investment in anti-smoking campaigns tailored to these communities is critical in reducing this disparity. Currently around 40% of Indigenous Australians smoke compared with 12.2% of the general Australian population. In remote communities, this rises to around 60%.

Other unhealthy lifestyles that can increase cancer risk, including excessive alcohol consumption, physical inactivity, an unhealthy diet and obesity, are also more prevalent among socio-economically disadvantaged populations

Professor Sanchia Aranda is the CEO of Cancer Council Australia

Read over 75 Aboriginal Health and Cancer articles published by NACCHO last 8 years

According to the Cancer Council Australia 1 in 3 cancers could be preventable through lifestyle choices.

We know that preventing cancer is one of the most effective ways of creating a cancer free future.

At least one in three cancer cases could be prevented and the number of cancer deaths could be reduced significantly by choosing a cancer smart lifestyle.

Each year, more than 13,000 cancer deaths are due to smoking, sun exposure, poor diet, alcohol, inadequate exercise or being overweight.

Fortunately, there are a number of simple lifestyle changes you can make to help reduce your risk of cancer such as:

  • Maintaining a healthy weight
  • Eat a healthy diet
  • Regular exercise
  • Quitting smoking
  • Reducing alcohol intake
  • Being SunSmart
  • Get checked

Read more about the seven steps to reducing your cancer risk in Cancer Council’s cancer prevention lifestyle fact sheets.

Read full article and link to resources

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

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

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


“Aboriginal and Torres Strait Islander Community Controlled Health Services

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

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

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

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

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

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

See Page 12 of 2018 Review

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

The Australian Indigenous HealthInfoNet (HealthInfoNet) at Edith Cowan University published a in 2018 Review of cancer among Aboriginal and Torres Strait Islander people.

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

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

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

The review provides:

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

Selected Extract

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

Concluding comments

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

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

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

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

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

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

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


NACCHO Aboriginal Health News Alert : New Report @ABSStats Aboriginal and Torres Strait Islander health survey shows mixed outcomes : But fewer of our mob are #Smoking

 “A new report shows mixed health outcomes for Aboriginal and Torres Strait Islander people with a reduction in smoking and improvements in how people feel about their health but an increased proportion of people with chronic conditions causing significant health problems.

The 2018-19 National Aboriginal and Torres Strait Islander Health Survey released today by the Australian Bureau of Statistics (ABS) examines long-term health conditions, risk factors, and social and emotional well-being indicators.

The survey included Aboriginal and Torres Strait Islander people from all states and territories and included people in both non-remote and remote areas.” 

Please note formal NACCHO response press release out Friday 

Indigenous and Social Information Program Manager, Stephen Collett, said positive outcomes included a decrease in people aged 15 years and over who smoked every day, falling from 41 per cent in 2012-13 to 37 per cent in 2018-19.

“In addition, the proportion of young people who had never smoked increased between 2012-13 and 2018-19 from 77 per cent to 85 per cent for 15 to 17 year-olds and from 43 per cent to 50 per cent for those aged 18 to 24,” he said.

“The results also show a decline in the proportion of people aged 18 years and over who consumed more than four standard drinks on one occasion in the last 12 months, down from 57 per cent in 2012-13 to 54 per cent in 2018-19.”

However, 46 per cent of Aboriginal and Torres Strait Islander people had one or more chronic conditions that posed a significant health problem, up from 40 per cent in 2012-13.

“People living in non-remote areas were more likely to report having one or more chronic conditions (48 per cent) than people living in remote areas (33 per cent).

“The proportion of people with diabetes was higher in remote areas (12 per cent) than non-remote areas (7 per cent) and similarly, rates of kidney disease were higher in remote areas (3.4 per cent) than non-remote areas (1.4 per cent).”

Between 2012-13 and 2018-19 the proportion of people who were overweight or obese increased both for children aged 2-14 years (up from 30 per cent to 37 per cent) and those aged 15 years and over (up from 66 per cent to 71 per cent).

More than four in 10 people (45 per cent) rated their health as excellent or very good, up from 39 per cent in 2012-13 and more than half (57 per cent) of children aged 2-17 years had seen a dentist or dental professional in the last 12 months.

Key statistics Health

  • More than four in 10 (46%) people had at least one chronic condition that posed a significant health problem in 2018–19, up from 40% in 2012–13.
  • The proportion of people with asthma in remote areas (9%) was around half the proportion for people living in non-remote areas (17%).
  • More than one in 10 people aged two years and over reported having anxiety (17%) or depression (13%).
  • More than four in 10 (45%) people aged 15 years and over rated their own health as excellent or very good in 2018–19, up from 39% in 2012–13.

Risk factors

  • The proportion of people aged 15 years and over who smoked every day decreased from 41% in 2012–13 to 37% in 2018–19.
  • The proportion of children aged 2–14 years who were overweight or obese increased from 30% in 2012–13 to 37% in 2018–19.
  • The proportion of people aged 15 years and over who had consumed the recommended number of serves of fruit per day declined for those living in remote areas from 49% in 2012–13 to 42% in 2018–19.
  • Sugar sweetened drinks were usually consumed every day by around one-quarter (24%) of people aged 15 years and over.

Use of health services

  • More than half (57%) of children aged 2–17 years had seen a dentist or dental professional in the last 12 months.
  • The proportion of people who did not see a GP when needed in the last 12 months was higher for those living in non-remote areas (14%) than remote areas (8%).

The National Aboriginal and Torres Strait Islander Health Survey collected data on a broad range of health-related topics, language, cultural identification, education, labour force status, income and discrimination — for full details see Survey topics (appendix).

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