Aboriginal Health #NRW2017 : @AHCSA_ and @PAFC @AFL to support new @DeadlyChoices Aboriginal health checks in South Australia

 

” The Deadly Choices program’s intent is to provide a measurable difference in addressing Aboriginal health issues. 

“Aboriginal people have far higher mortality rates than the average population and die at much younger ages. Despite government intentions to ‘close the gap’, the problem isn’t getting any better,

Chronic disease and preventable health conditions are taking a toll on our communities and we need to find innovative ways to move the dial toward better health outcomes.

We hope, with support from the Port Adelaide Football Club, our Deadly Choices initiative will encourage our young people to take responsibility and stop smoking, stay active and look after their own wellbeing, and that of their families.”

Aboriginal Health Council of SA chairperson John Singer

Port Adelaide has signed a memorandum of understanding (MOU) with the Aboriginal Health Council of South Australia Ltd (AHCSA) to deliver Deadly Choices – a program that will build awareness of healthy lifestyle choices and encourage regular health checks.

‘Deadly’ is a common term used to express positivity or excellence within Aboriginal communities, and Deadly Choices is designed to help improve the excellent health choices made by Aboriginal people in South Australia.

Gavin Wanganeen ( right ) won the 1993 Brownlow Medal. Wanganeen is a descendant of the Kokatha Mula people.

The program is based on a successful model used in Queensland since 2009 with the Brisbane Broncos, developed by Adrian Carson and his team and staff at the Institute for Urban Indigenous Health.

That program led to a 1300 per cent increase in Aboriginal and Torres Strait Islander people undergoing health checks.

Deadly Choices provides participants with limited edition merchandise in exchange for taking part in educational programs and undergoing regular health checks.

The merchandise is provided as a ‘money can’t buy’ incentive, with revenue from undergoing health checks used to fund subsequent stages of the program.

Port Adelaide players will support the promotion of the program and encourage participants to take part in the eight-week education program to receive their Deadly Choices footy guernsey.

As part of the program:

  • Education programs will be launched in the Anangu Pitjantjatjara Yankunytjatjara Lands (APY Lands) in collaboration with the Nganampa Health Council in June, in support of Port Adelaide’s WillPOWER program.
  • Curriculum will cover leadership, chronic disease, tobacco cessation, nutrition, physical activity, harmful substances, healthy relationships, access and health checks.
  • Health checks will be provided in the first stage of Deadly Choices by AHCSA-aligned members, which already provided comprehensive primary health care in SA.
  • Long-term partnerships with the South Australian Health and Medical Research Institute (SAHMRI) are being explored to established metropolitan clinics to provide health check services.

Port Adelaide chief executive officer Keith Thomas said the decision to partner with AHCSA is a continuation of Port Adelaide’s commitment to helping forge tangible outcomes for Aboriginal communities in South Australia.

In his CEO Update, Thomas reflected on the fact 70% of Aboriginal deaths are related to chronic disease, while the life expectancy for an Aboriginal person is on average, 10 years less than the wider population.

“We are proud to partner with AHCSA to deliver Deadly Choices across South Australia,” said Mr Thomas.

“The Deadly Choices program perfectly links to the healthy lifestyle messages we promote through WillPOWER and the Aboriginal Power Cup programs.

“We’re very excited to be making a contribution to the health agenda in Aboriginal communities around South Australia.”

 

NACCHO Aboriginal Health and #Alcohol : Draft terms of reference for a another comprehensive review of alcohol policy in the #NT

 ” The Northern Territory has the second highest alcohol consumption in the world. Misuse of alcohol has devastating health and social consequences for NT Aboriginal communities.

APO NT believes that addressing alcohol and drug misuse, along with the many health and social consequences of this misuse, can only be achieved through a multi-tiered approach.

APO NT supports evidence based alcohol policy reform, including:

  • Supply reduction measures
  • Harm reduction measures, and
  • Demand reduction measures.

To address alcohol and drug misuse within Aboriginal and Torres Strait Islander communities, the social and structural determinants of mental health must be addressed,

Parliamentary Inquiry into the Harmful use of Alcohol in Aboriginal Communities

On 17 April 2014, APO NT submitted their written evidence to the House of Representatives Standing Committee on Indigenous Affairs on the Inquiry into the harmful use of alcohol in Aboriginal and Torres Strait communities.

The APO NT submission made 16 recommendations to the committee: SEE INFO Here

Read  NACCHO Alcohol and other drugs 164 Articles over 5 years HERE

RESPONSIBLE ALCOHOL POLICY =

A SAFER COMMUNITY :  NT Government Press Release 10 March 2017

The Health Minister Natasha Fyles today released draft terms of reference for a comprehensive review of alcohol policy in the Northern Territory.

Minister Fyles said the Government was determined to tackle the cost of alcohol abuse on our community and the review will give all Territorians an opportunity to have their voices heard.

“We recognise that, while everyone has the right to enjoy a drink responsibly, alcohol abuse is a significant cause of violence and crime in our community,” Ms Fyles said.

“All Territorians have the right to feel safe, to have their property, homes and businesses secure from damage and theft.

“They also have the right to access health, police and justice services, without having critical resources diverted by the crippling effects of alcohol abuse.

“That’s why Territory Labor has consistently advocated, and implemented, a range of policies to reduce the harm caused by alcohol abuse.

“When last in Government we implemented the Banned Drinker Register (BDR), described by Police as the best tool they had to fight violent crime.

“In Opposition we were clear we would reinstate the BDR and impose a moratorium on new takeaway licences.

“Since coming to Government we have:

  • worked efficiently across agencies to bring back the BDR by September 1
  • imposed a moratorium on new takeaway liquor licences (except in exceptional circumstances) – October 2016
  • strengthened legislation to ensure Sunday trade remains limited – November 2016
  • limited the floor space for take away alcohol stores – December 2016
  • introduced new Guidelines for liquor licensing to allow for public hearings – 2 February 2017

“While some of these policies aren’t popular, their effectiveness is backed by evidence.

“This review is an important chance for the community to have their say and to ensure that all facets of alcohol policy complement our determination to make the Territory safer.

“An expert panel will be commissioned to look at alcohol policies and alcohol legislation, reporting to government on:

  • evidence based policy initiatives required to reduce alcohol fuelled crime
  • ensuring safe and vibrant entertainment precincts
  • the provision of alcohol service and management in remote communities
  • decision-making under the Liquor Act
  • the density of liquor licences (concentration, type, number and location of liquor licences ) and the size of liquor outlets

“Broad public consultation will be undertaken as part of the review, with multiple avenues for interested people, groups and communities to put forward their views.

“I look forward to hearing from not only the loudest and most powerful voices in our community, but also the many women, children, families and communities who all too often bear the cost of alcohol abuse in the Northern Territory.”

The review will start in April with a report and recommendations delivered to government in late September 2017.

The government will then develop a response to the recommendations for the development of the Alcohol Harm Reduction Strategy and legislative reform agenda.

These will be released publicly along with the Expert Advisory Panel’s final report.

To view the draft terms of references go to: https://health.nt.gov.au/professionals/alcohol-and-other-drugs-health-professionals/alcohol-policies-and-legislation-review

Submissions are now being accepted at:  AODD.DOH@nt.gov.au

NACCHO Aboriginal Male Health : How Redfern’s Sol Bellear prevented a massive life-threatening heart attack

sol-4-copy

 ” I’ve been part of campaigns urging Aboriginal men to lead healthy lifestyles and get regular medical checks, but I didn’t follow my own advice.

If there’s one legacy I leave, I want it to be that Aboriginal men more regularly present for check-ups.”

“We need to take responsibility. We owe this to our families and our communities. We don’t need to keep dying too early from preventable heart disease.”

As the long-term Chair of the Aboriginal Medical Service and a Board member since 1975, Sol didn’t practice what he preached when it came to his own health.

Originally published by Our Mob 22 Dec 2017

Watch recent NACCHO TV Interview with Sol Bellear

All images in this story: Courtesy of the Bellear family

Land Rights legend Sol Bellear considers himself one of the lucky ones.

A decision Sol made some nine months ago to lead a healthier lifestyle not only saved his life but made him more determined to lead the campaign for men’s health.

A few months before he was to die from a massive heart attack, Sol decided to change his life.

While driving back together from a New South Wales Aboriginal Land Council (NSWALC) meeting in West Wyalong, Sol’s colleague, Acting CEO, Cal Davis told him about a diet he had started to control his diabetes.

“Sol was pretty interested in the diet and said he wanted to try it out,” Cal says.

“So I got him some books and he started to get his calories down and eat more low-carbohydrate, Mediterranean-style meals.”

The diet immediately brought results. Within eight weeks, Sol had lost seven kilos. But then his weight plateaued. When he started to do some light exercise he found he was short of breath after only a few steps.

Sol’s doctor referred him to cardiologist, Dr Raj Puranik who for seven years has conducted monthly clinics at the Redfern Aboriginal Medical Service.

“We took an ultrasound and I was concerned that an area of Sol‘s heart muscle wasn’t working,“ Dr Puranik said.

“After we did an angiogram (or x-ray of the heart), we found that two of his coronary arteries were 100 percent blocked and the other was 90 percent blocked.  So he was surviving on just ten percent blood flow.”

Sol could have suffered a life-threatening heart attack at any time.

How Sol Bellear prevented a massive life-threatening heart attack

A member of the surgical team that operated on Sol later told him that he was just three to four weeks away from a massive heart attack that would most likely have killed him.

Sol was rushed to the Royal Prince Alfred Hospital where surgeons performed an emergency coronary bypass operation.

Surgeons split his chest open and grafts were used to bypass the blockages in his arteries.

After four hours the operation was a success and Sol woke to see his concerned family huddled around his bed.

“You wake up in the Intensive Care Unit and all your family are there.  And you look at their faces and see all their grief.  You think, so this is what I’ve put them through,” he said.

As the long-term Chair of the Aboriginal Medical Service and a Board member since 1975, Sol didn’t practice what he preached when it came to his own health.

“I’ve been part of campaigns urging Aboriginal men to lead healthy lifestyles and get regular medical checks, but I didn’t follow my own advice.”

Sol was a keen sportsman who played rugby league for the South Sydney Rabbitohs and Redfern All Blacks, but after he retired from football he didn’t maintain regular exercise or watch his diet.

“I was working long hours, drinking too much and eating too many rubbish foods.”

Although he spent a large part of his life at the Aboriginal Medical Service, Sol, like many men, didn’t prioritise a visit to the doctor.

“It’s an ego thing. We think we’re bullet proof … it will never happen to me. But it did happen.”

Since his brush with death, Sol has been struck by how many of his friends and colleagues have had heart bi-passes.

“They say to me: ‘Brother, you’re now a member of the zipper club.’  But this isn’t a club where we want any new members.”

However, Sol knows that he is one of the lucky ones. After the operation he was at home recovering and feeling bored so he got out some old photos from his playing days.

There was one that was of the Redfern All Blacks team from 1978.

There are 20 young men in the photo including the ball boys.

Now all but six of them are dead, many from heart disease.

sol-1978-team

“The greatest tragedy is that many of the deaths of these young men were preventable,” Sol says.

“The only thing separating me from them is luck.”

Dr Puranik says that Australia will never close the mortality gap between Aboriginal and non-Aboriginal people without action on heart disease.

“Heart disease is the number one driving factor behind the gap. It’s the number one killer but 90 percent of cardiac disease is preventable,” he says.

His years at the Redfern AMS have convinced Dr Puranik that getting the model of health care delivery right is crucial to overcoming the problem.

“We need to take our clinics to Aboriginal people in their community-controlled medical services and show through images rather than just tell them how their heart muscle is working.”

The secret, he says, is patience and building trust.

“When we first started out at Redfern in June 2009 we had a no show rate of around 90 percent.  Now we have seen more than 6,000 patients and the number of people who don’t turn up for appointments is down to 10 percent.”

Sol says that Aboriginal men can’t just leave it to the doctors to solve the problem.

“We now have some of the best doctors in the world at our Medical Services, but only we can change the way that we live by having regular check-ups and a healthier lifestyle,” he says.

Sol says that when you hit 40, you need to start getting regular check-ups – even if you play regular sport and feel fit and healthy.

“By the time you move through your 50s and 60s you should have a clear idea of your blood pressure, blood sugar and cholesterol levels.

You don’t want to leave it as long as I did – where you’re playing Russian roulette with your heart.”

Sol urges Aboriginal men to adopt a healthier lifestyle by not smoking, cutting down on alcohol and keeping weight down through healthy foods and regular exercise.

Dr Puranik says that there are some clear warning signs that indicate you should seek urgent medical attention.

These include pain to the left side of the central chest, neck or arm pain – particularly related to exercise, dizzy spells or blackouts, chest pain that wakes you up from sleep as well as breathlessness or palpitations.

Incredibly, given how close he came to death, just one month after surgery Sol’s normal heart function had been fully restored.

A veteran of the Aboriginal Land Rights movement and a pioneer of Aboriginal media, sports legal and health services, Sol says that nothing now matters as much to him as overcoming heart disease amongst Aboriginal men.

“If there’s one legacy I leave, I want it to be that Aboriginal men more regularly present for check-ups.”

“We need to take responsibility. We owe this to our families and our communities. We don’t need to keep dying too early from preventable heart disease.”

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For NACCHO Media Contact

Colin Cowell Editor 0401 331 251

Email mailto:nacchonews@naccho.org.au

NACCHO #HIV #AIDS2016 : Fears for Indigenous HIV epidemic as diagnosis rates rise in Australia

HIV

” The potential exists for HIV to escalate rapidly in the Aboriginal and Torres Strait Islander population – as has been the experience in other Indigenous populations globally. This potential is due to three main issues:

  • very high rates of other sexually transmissible infections (STIs) exist in many communities, and the presence of these increases the chances that HIV can be transmitted
  • increasing rates of injecting drug use – including increasing rates of methamphetamine (ice) use in Aboriginal communities, and
  • the close proximity of Papua New Guinea (PNG) to the Torres Strait Islands, and the mobility and interaction of PNG nationals and Torres Strait Islanders. PNG has the highest recorded rates of HIV in the Asia-Pacific”

Associate Professor James Ward is Head, Infectious Diseases Research Aboriginal and Torres Strait Islander Health at South Australian Health and Medical Research Institute (SAHMRI) and a guest editor of HIV Australia.U And Me Can Stop HIV (article second)

“Public health authorities are warning that Australia could be on its way to an HIV epidemic in Indigenous communities.

We know that Indigenous Australians have poorer health overall and often have poorer access to health services, so just getting diagnosed can be a real problem, Support structures for HIV infection are not always in place in Indigenous communities.

The Aboriginal and Torres Strait Islander community traditionally hasn’t had high levels of HIV, so there’s still a lot of stigma and fear,

‘The young people we’ve diagnosed have known very little about HIV, so we have a lot of education to do for them, their sexual partners and sometimes their families if they’re willing to involve their families, which often they’re not.

Cathy Van Extel reports on the latest figures from far north Queensland.

“Research into a cure for HIV has been gathering momentum. Global investment in cure research has more than doubled in the last four years, in contrast with investment in other HIV programs.

Given the effectiveness of antiretroviral drugs in both treating and preventing HIV infection, however, cure research raises a range of important questions about priority setting in global health.

Curing HIV – or at least achieving long-term remission – is possible, under the right circumstances.”

Author Lecturer in ethics, HIV prevention, UNSW Australia: The Conversation Remind me again, how close are we to a cure for HIV?

Image above : To acknowledge #AIDS2016 Conference in South Africa NACCHO  presents an update on Indigenous Australia : Today, there are 36.9 million people living with HIV/AIDS in the world and more than 95% of those living with HIV are in developing countries where access to effective health care is often challenging. SEE WEBSITE http://www.aids2016.org/

In the same week that Australia declared AIDS was no longer a public health issue, doctors have raised the alarm about a spike in new HIV cases involving Indigenous Australians in far north Queensland.

If we don’t act soon, there could be a whole lot of misery ahead for a lot of people.

Darren Russell, Cairns Base Hospital

Cairns normally records one or two new cases of HIV infection annually. This year, however, there have been nine diagnoses to date—and all have been Indigenous patients.

Dr Darren Russell, the director of sexual health at Cairns Base Hospital, says the spike comes on the back of a small increase in new cases in north Queensland last year.

‘We’re up to nine cases so far this year and we are only halfway through the year,’ he says.

‘We are concerned about it, and although we don’t think things are out of control, we are a bit worried.’

North Queensland a HIV hotspot

Nationally, homosexual men account for around 85 per cent of HIV cases, compared to 65 per cent among Indigenous people.

The new HIV infections in Cairns primarily involve younger gay or bisexual men, aged in their 20s and 30s.

While Cairns has emerged as a hotspot for new HIV infections, there is concern the virus could spread.

‘A lot of these people are very young and very mobile so there is the potential for spread to occur outside of Cairns,’ Russell says.

Health authorities are worried that Australia could follow Canada in experiencing an HIV epidemic in its indigenous population.

‘The Canadian epidemic came out of nowhere and has been a huge problem,’ Russell says.

‘If we don’t adequately address issues around Indigenous sexual health the same thing could happen here.

‘We don’t want to be too alarmist but at the same time if we don’t act soon there could be a whole lot of misery ahead for a lot of people.’

Indigenous access to services a factor

Russell says there are a range of challenges in managing HIV in Indigenous populations.

‘We know that Indigenous Australians have poorer health overall and often have poorer access to health services, so just getting diagnosed can be a real problem,’ he says.

He says support structures for HIV infection are not always in place in Indigenous communities.

‘The Aboriginal and Torres Strait Islander community traditionally hasn’t had high levels of HIV, so there’s still a lot of stigma and fear,’ he says.

‘The young people we’ve diagnosed have known very little about HIV, so we have a lot of education to do for them, their sexual partners and sometimes their families if they’re willing to involve their families, which often they’re not.

‘In order to address those issues we need to reduce the stigma, get more people tested and diagnosed, and we need to enable them to stay on their medications.

‘They are all big challenges for anyone, let alone the Indigenous population.’

What’s behind the increase?

Doctors believe the increase in HIV infections in Cairns is linked to a syphilis epidemic, which has affected Indigenous communities across northern Australia for several years.

‘There are probably a few factors that are leading to this increase,’ Dr Russell says.

‘We have a syphilis epidemic across far north Queensland along with the Northern Territory and north-west Australia at the moment and we’re seeing a lot of syphilis where previously we had it almost under control.

‘Syphilis makes it much easier to acquire HIV so that could be one of the factors driving it.’

HIV infections by the numbers

The actual number of Indigenous HIV diagnoses each year remains small compared to the overall national figure.

In 2014, of the 1081 new cases of HIV around Australia, 33 involved Indigenous Australians.

Worryingly, the rate of HIV diagnosis among Aboriginal and Torres Strait Islander people is now higher than the rate for non-Indigenous Australians. In 2014 it was 5.9 per cent compared to 3.7 per cent.

The Kirby Institute reported in its 2015 Annual Surveillance Report that the HIV diagnosis rate in Aboriginal and Torres Strait Islander people has increased in the past five years and ‘requires a strengthened focus on prevention in this vulnerable population’.

The Kirby Institute also found that the rate of syphilis infection in the Aboriginal and Torres Strait Islander population in 2014 was four times higher than the rate in the non-Indigenous population.

According to Russell, the number of syphilis infections appears to have plateaued or decreased in some areas such as Cape York and Torres Strait but continues to rise in other northern regions, particularly among younger Indigenous Australians.

Syphilis rates remain a concern in the Top End of the Northern Territory, and are increasing in the Kimberley region of Western Australia. There is also a danger of the syphilis epidemic spreading to Indigenous communities in Central Australia.

The role of government

The federal government is under pressure to act to prevent a sexual health crisis. Russell has described the federal response to date as disappointing.

‘We have a Closing the Gap scheme that is really silent on the issue of sexual health and sexually transmitted infections, and yet one of the health factors that could really cause a huge amount of damage to Indigenous Australians is poor sexual health including syphilis and HIV,’ he says.

‘They’re not getting the priority that they should.

‘I’m not suggesting we de-prioritise other chronic health conditions, but we do need to have more focus federally, and more funding and support when it comes to sexual health and HIV.’

U And Me Can Stop HIV December 2015

Aboriginal and Torres Strait Islander HIV Awareness Week (ATSIHAW) is an annual program of events that seeks to raise awareness about the impact of HIV among Aboriginal and Torres Strait Islander people.

Although the inaugural event was only held twelve months ago, it is already well recognised as key event for raising awareness and mobilising action to address HIV among Aboriginal and Torres Strait Islander communities.

HIV diagnoses among the Aboriginal and Torres Strait Islander population is increasing, yet for many years now there has been little or no investment by governments targeted at enhancing our communities’ knowledge and awareness of HIV.

While the number of annual HIV diagnoses for Aboriginal and Torres Strait Islander people is fairly low at present (around 30 new diagnoses per year), in 2014 the notification rate of newly diagnosed HIV infection was 1.6 times higher for the Aboriginal and Torres Strait Islander population compared to the non Indigenous population (5.9 vs 3.7 per 100,000 in 2014).

The potential exists for HIV to escalate rapidly in the Aboriginal and Torres Strait Islander population – as has been the experience in other Indigenous populations globally. This potential is due to three main issues:

  • very high rates of other sexually transmissible infections (STIs) exist in many communities, and the presence of these increases the chances that HIV can be transmitted
  • increasing rates of injecting drug use – including increasing rates of methamphetamine (ice) use in Aboriginal communities, and
  • the close proximity of Papua New Guinea (PNG) to the Torres Strait Islands, and the mobility and interaction of PNG nationals and Torres Strait Islanders. PNG has the highest recorded rates of HIV in the Asia-Pacific region.

In the five year period 2010–2014, when comparing rates of new HIV infection among the Aboriginal and Torres Strait Islander population with the non- Indigenous Australian born population, a higher proportion of notifications were attributed to injecting drug use (16% vs 3%); heterosexual sex (20% vs 13%); and 22% vs 5% of new HIV diagnoses were among females.

Based on CD4+ cell counts at diagnosis, in 2014 a third (30%) of the new HIV diagnoses among the Aboriginal and Torres Strait Islander population were determined to be late.

ATSIHAW events

The 2015 ATSIHAW  launched at the Wuchopperen Aboriginal Health Service in Cairns on the 30 November.

Speakers included Assoc Professor James Ward, SAHMRI (South Australian Health and Medical Research Institute), Dr Mark Wenitong, Apunipima Cape York Aboriginal Health Council, HIV-positive speakers, and youth and elders from the Cairns region and community.

The launch was followed by a training day on Tuesday the 1 December for health service staff working in the Cairns region, to learn about updates on HIV diagnosis, risk factors, prevention strategies, treatment updates, care and management of people living with HIV and outbreak management – including privacy confidentiality stigma and discrimination.

On 2–3 December, ATSIHAW, in partnership with the HIV Foundation Queensland, ASHM (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine) and the National Aboriginal Community Controlled Health Organisation, hosted a high level summit in Brisbane to discuss strategies and actions for moving forward an agenda that is urgently required.

The Summit, opened by the Queensland Health Minister, the Hon Cameron Dick MP, was held in recognition of the need to urgently address the fact that STIs and blood borne viruses are part of our communities’ overwhelming burden of disease, particularly:

  • for remote communities – STIs (chlamydia, gonorrhoea, syphilis and trichomonas), as well as hepatitis B
  • for urban and regional areas – hepatitis C and chlamydia
  • emerging HIV transmission risks from drugs such as methamphetamines (‘ice’) – both due to unsafe injecting and condomless sex.

During ATSIHAW, community events were held across Australia at over 30 Aboriginal Community Controlled Health Services in most jurisdictions and at other HIV organisations such as AIDS Councils, aimed at raising awareness of HIV in our communities.

ATSIHAW also recruited high profile Ambassadors to help spread the word about HIV in our communities and the roles all individuals can play in stopping HIV.

Our ATSIHAW Ambassadors include Prof Pat Anderson AM, Prof Kerry Arabena, Dr Marlene Kong, and Mr Dion Tatow, to name a few.

View profiles of some of our ATSIHAW Ambassadors


Associate Professor James Ward is Head, Infectious Diseases Research Aboriginal and Torres Strait Islander Health at South Australian Health and Medical Research Institute (SAHMRI) and a guest editor of HIV Australia.

 

NACCHO #HealthElection16 : AMA launches Key Health Issues / Aboriginal Health policy for 2016 Federal Elections

Brian

” The gap in health and life expectancy between Aboriginal and Torres Strait Islander people and other Australians is still considerable, despite the commitment to closing the gap.

The AMA sees progress being made, particularly in reducing early childhood mortality rates, and in addressing major risk factors for chronic disease, such as smoking. However, to close the gap in Indigenous health, Government must commit to improving resourcing for culturally appropriate primary health care for Aboriginal and Torres Strait Islander people, and the health workforce.

Including increased investment in Aboriginal and Torres Strait Islander community controlled health organisations. Such investment must support services to build their capacity and be sustainable over the long term;

Brian Owler AMA President pictured above Matthew Cooke Chair of NACCHO at recent NACCHO Event Parliament House Canberra : The Aboriginal Policy is part of a 16 Page AMA Health Issues Document  

“The Medicare freeze is not just a co-payment by stealth – it is a sneaky new tax that punishes every Australian family,”

Professor Owler said, with the elderly and chronically ill among those most affected see press release here AMA LAUNCHES NATIONAL CAMPAIGN AGAINST THE MEDICARE REBATE FREEZE (FED)

Putting Health First

Download the 16 Pages here AMA Key Health Issues Federal Election 2016

Health policy will be at the core of the 2016 Federal Election.

The AMA is non-partisan. It is our role during election campaigns, as it is throughout the terms of governments, to highlight the issues we think will be of greatest benefit to the health system, the medical profession, the community, and patients.

As is customary, the AMA will focus on the respective health policy platforms presented by the major parties in the coming weeks.

The next Government must invest significantly in the health of the Australian people.

Investment in health is the best investment that governments can make.

We must protect and support the fundamentals of the health system.

The two major pillars of the system that mean most to the Australian people are quality primary health care services, led by general practice, and well-resourced public hospitals.

The AMA has advocated strongly and tirelessly on these issues for the term of the current Government.

General practice and public hospitals are the priority health issues for this election.

The AMA is calling on the major parties to lift the freeze on the Medicare Benefits Schedule (MBS) patient rebate. The freeze was extended until 2020 in the recent Budget. The freeze means that patients will pay more for their health care. It also affects the viability of medical practices.

We also need substantial new funding for public hospitals. The Government provided $2.9 billion in new funding in the Budget, but this is well short of what is needed for the long term.

We must build capacity in our public hospitals. Funding must be better targeted, patient-focused, and clinician led.

The AMA is also calling for leadership and effective policy from the major parties on Indigenous health, medical workforce and training, chronic disease management, and a range of important public health measures.

The AMA will release a separate Rural Health Plan, responding to the unique health needs of people in rural and regional Australia, later in the election campaign.

Elections are about choices. The type of health system we want is one of those crucial decisions.

In this document, Key Health Issues for the 2016 Federal Election, the AMA offers wide-ranging policies that build on what works. We offer policies that come from the experience of doctors who are at the coalface of the system – the doctors who know how to make the system work best for patients.

The AMA urges all political parties to engage in a competitive and constructive health policy debate ahead of the election on 2 July.

Indigenous Health Policy Continued

Despite the recent health gains, progress remains frustratingly slow and much more needs to be done. A life expectancy gap of around 10 years remains between Aboriginal and Torres Strait Islander people and other Australians, with recent data suggesting that Indigenous people experience stubbornly high levels of treatable and preventable conditions, high levels of chronic conditions at comparatively young ages, high levels of undetected and untreated chronic conditions, and higher rates of co-morbidity in chronic disease. This is completely unacceptable.

It is not credible that Australia, one of the world’s wealthiest nations, cannot address health and social justice issues affecting just three per cent of its citizens. The Government must deliver effective, high quality, appropriate and affordable health care for Aboriginal and Torres Strait Islander people, and develop and implement tangible strategies to address social inequalities and determinants of health.

Without this, the health gap between Indigenous and non-Indigenous Australians will remain wide and intractable.

The AMA calls on the major parties to commit to:

  • correct the under-funding of Aboriginal and Torres Strait Islander health services;
  • establish new and strengthen existing programs to address preventable health conditions that are known to have a significant impact on the health of Aboriginal and Torres Strait Islander people such as cardiovascular diseases (including rheumatic fever and rheumatic heart disease), diabetes, kidney disease, and blindness;
  • increase investment in Aboriginal and Torres Strait Islander community controlled health organisations. Such investment must support services to build their capacity and be sustainable over the long term;
  • develop systemic linkages between Aboriginal and Torres Strait Islander community controlled health organisations and mainstream health services to ensure high quality and culturally safe continuity of care;
  • identify areas of poor health and inadequate services for Aboriginal and Torres Strait Islander people and direct funding according to need;
  • institute funded national training programs to support more Aboriginal and Torres Strait Islander people to become health professionals to address the shortfall of Indigenous people in the health workforce;
  • implement measures to increase Aboriginal and Torres Strait Islander people’s access to primary health care and medical specialist services;
  • adopt a justice reinvestment approach to health by funding services to divert Aboriginal and Torres Strait Islander people from prison, given the strong link between health and incarceration;
  • appropriately resource the National Aboriginal and Torres Strait Islander Health Plan to ensure that actions are met within specified timeframes; and
  • support for a Central Australia Academic Health Science Centre. Central Australia faces many unique and complex health issues that require specific research, training and clinical practice to properly manage and treat, and this type of collaborative medical and academic research, along with project delivery and working in remote communities, is desperately needed.

Australian Medical Association joins campaign against Medicare rebate freeze

AMA POSTER

Download the AMA Press Release

AMA LAUNCHES NATIONAL CAMPAIGN AGAINST THE MEDICARE REBATE FREEZE (FED)

Article below originally published here

Tens of thousands of specialist doctors are joining GPs’ war against the Turnbull government’s extended freeze on Medicare rebates, increasing pressure on the Coalition’s health record ahead of the federal election.

The Australian Medical Association has distributed posters to its members, warning patients that they will be out of pocket because the cost of running the medical practice will continue to rise as Medicare rebates stay frozen until 2020.

“You will pay a new or higher co-payment every time you visit your GP, every time you visit other medical specialists, every time you need a blood test, and every time you need an X-ray or other imaging,” it says, alongside a photo of a woman comforting a crying child.

It comes a week after the Royal Australian College of General Practitioners announced its 32,000 members would urge their patients to lobby local MPs against the move. The groups share about 8000 members, adding about 22,000 more specialist doctors to the campaign.

The AMA’s campaign similarly encourages patients to contact their local MPs and election candidates, but goes further to directly blame the Turnbull government for the extra cost: “The government has cut Medicare and wants you to pay for it.”

While pathologists on Friday agreed to retain bulk-billing rates in exchange for reduced regulatory pressure on rents under a deal with Health Minister Sussan Ley, the AMA maintains that they and diagnostic imaging services will remain under pressure to charge patients, with the government’s cuts to bulk-billing incentive payments deferred till later in the year.

The AMA’s president, Professor Brian Owler, said many doctors had absorbed costs but the extension “has pushed them over the edge”. They may charge patients a $30 co-payment to cover costs associated with moving to a private billing system, more than triple the Abbott government’s failed and deeply unpopular $7 GP co-payment, he said.

“The Medicare freeze is not just a co-payment by stealth – it is a sneaky new tax that punishes every Australian family,” Professor Owler said, with the elderly and chronically ill among those most affected.

While most specialists (about 70 per cent) already charged patients a co-payment, having had their rebates frozen for decades, the extended freeze could reduce the bulk-billing rate further, an AMA spokesman said.

Labor froze indexation for eight months in 2013, lifting it briefly for GPs in 2014-15. The Coalition extended it for four years in 2014, and this year extended it a further two years to 2020, to save $925.3 million.

Opposition Leader Bill Shorten said Labor opposed the extended freeze at the leaders’ debate on Friday, but would not say whether it would commit to lifting it if elected.

Thirty per cent of 400 GPs surveyed by the College said they would stop all bulk-billing, including for concession card holders, due to the extended freeze. Another 18 per cent said the practice would start charging a co-payment, but cap annual out-of-pocket fees for concession card holders.

Thirty per cent said they would maintain a mixed billing policy, and 10 per cent would continue to bulk bill all patients. Twelve per cent said they were already privately billing all their patients.

The Turnbull government plans to cut bulk-billing incentives for pathology and diagnostic imaging services to save $650 million over four years. Pathology Australia, which had warned this would lead more doctors to charge patients for pap smears, blood and urine tests, has agreed to drop its public campaign against the cuts.

Ms Ley said: “The Coalition will increase Medicare investment to $26 billion per year by 2020-21, while introducing revolutionary reforms such as Health Care Homes that cement a GP’s role at the centre of patient care.”

While she appreciated many GPs’ efforts to keep costs down during the indexation freeze, she was disappointed that “there’s no reciprocal offer to assist taxpayers with the immediate financial challenges our budget faces while [Health Care Homes are] implemented”.

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NACCHO #HealthElection16 , it’s time to encourage all political parties to focus on Aboriginal health

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With an early Federal Election looking likely, it’s time to encourage all political parties to focus on Aboriginal health and the critical role of the community controlled sector in improving services and health outcomes for Aboriginal and Torres Strait Islander people.

The Turnbull Government has flagged it will call a Double Dissolution Election on July 2 if the Senate refuses to pass the Australian Building and Construction Commission (ABCC) Bill, targeting unions. The Prime Minister has until May 11 to call the poll.

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A decade after governments agreed to bipartisan support for the Close the Gap agreement, the National Aboriginal Community Controlled Health Organisation (NACCHO) Chairperson, Matthew Cooke, said long term commitment from politicians to strengthen and grow the community controlled sector, through partnership with it, must be a priority for all political parties.

“One of the principles that is espoused by all levels of government on Aboriginal issues is that engagement with Aboriginal communities and organisations is the only way to successfully close the gap,” Mr. Cooke said.

“Time and again we see evidence that supports that principle.

“Our own sector, managed by Aboriginal people for Aboriginal people, is making the biggest in-roads against the Closing the Gap health targets.

“Our services provide over two million episodes of care nationally each year and have made the biggest gains against the targets to halve child mortality and improve maternal health. “

“Indeed, our services have successfully contributed to the Close the Gap targets that have reduced child mortality rates by 66% and overall mortality rates of Aboriginal and Torres Strait Islander people by 33% over the last two decades.

The Australian Institute of Health and Welfare’s Healthy Futures Report Card (2015) also highlights ACCHOs’ continued improvement in other areas that measure good practice in primary health care.

Those improvements include increasing the proportion of regular patients who are recorded as having an MBS health assessment; patients with existing conditions who are immunised against influenza; and, patients with Type 2 Diabetes receiving MBS General Practice Management Plans and MBS Team Care Arrangements.

“The fact is, Aboriginal people prefer health care that is holistic and provided in a culturally sensitive environment and that’s why our service delivery model works,” Mr Cooke said.

“Too many Aboriginal people have experienced racism and judgement in the mainstream health system, along with a very clinical approach to health care that doesn’t recognise connections to community and country.

“The holistic approach to health that operates in the Aboriginal Community Controlled sector takes a broader look, considers the range of complex issues affecting health and includes educating patients and preventative measures.

“And it works.”

Mr Cooke said he’d like all parties to commit to a roadmap to extend the reach of Aboriginal health services to ensure more Aboriginal people in more areas can access Aboriginal Community Controlled health care.

“Our services are struggling to meet the demand,’ Mr Cooke said.

“We know many Aboriginal people are driving many kilometers, often past several mainstream service providers, to access the culturally safe care offered by our services.

“Many miss out altogether as they don’t have access to a service where they live.

“Expanding the Aboriginal community controlled network would help improve the health outcomes for Aboriginal people.

“It would mean refocusing the heath system a bit – and a better allocation  of the funding pie, ensuring long-term funding certainty, fairer tendering processes and faster decision making by government departments.”

“I believe there’d be real rewards in terms of better health outcomes for Aboriginal people for that effort. ”

Mr Cooke said that approach is confirmed by the Productivity Commission Report released at the end of last year on the National Indigenous Reform Agreement Performance Assessment 2013-14.

“That Report showed mainstream services have not proved they can deliver better outcomes than our sector,” he said.

Mr Cooke said Aboriginal people would also be looking closely at commitments around the Government’s controversial Indigenous Advancement Strategy, which saw the transfer of important Aboriginal health programs to the Department of Prime Minister and Cabinet.

See story Page 4 :Indigenous Advancement Strategy report: Abbott-era indigenous cuts went too far, Senate inquiry

That Strategy’s tendering process drew heavy criticism from respondents to a recent Senate Inquiry.

“The Aboriginal controlled health sector is not afraid of contestability, in fact it welcomes it,” Mr Cooke said. “Yet that was a patently unfair process that didn’t consider results on the ground.”

Mr Cooke said overall he was optimistic about the possible outcomes an election could bring.

“There is a real opportunity in an election campaign to hear the commitments of future governments to Aboriginal people.

“We are hopeful all parties will make Aboriginal health a priority and work with us toward reducing the persistent health gaps between Aboriginal and non-Aboriginal people.”

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NACCHO chair encourages our award winning health services

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Youngsters at the Indigenous Governance Awards winning Institute for Urban Indigenous Health: Photo Wayne Quilliam

National Aboriginal Community Controlled Health Organisation Chair Matthew Cooke is encouraging all of its 150 member services to enter this year’s Indigenous Governance Awards (IGA).

This year the awards will celebrate organisations that are developing local solutions to local problems with culture as a source of strength and innovation and no one does it better than our Aboriginal community controlled health services said Mr Cooke.

One of the NACCHO/QAIHC members, the Institute for Urban Indigenous Health in Brisbane, became a finalist last year for its ‘Work it Out’ and ‘Deadly Choices’ programs, which was a major achievement giving they were only in their fifth year of operation. This recognised how the programs impacted on the health and wellbeing of Aboriginal and Torres Strait Islanders in South-East Queensland,” he said.

This is only one of many potential award winning health services that should be encouraged to enter these prestigious awards “ Mr Cooke said : Applications for the Awards close on May 20 : visit www.reconciliation.org.au/iga/ for more information

 

NACCHO #CTG10 Reports : NT intervention ‘fails on human rights’ and closing the gap

NT

“There have been some improvements to Indigenous child mortality with this target on track to be met by 2018. However, despite narrowing the gap in life expectancy, the rate of improvement is far too slow to close the gap. The situation is particularly bad for Indigenous people living in the Northern Territory, whose life expectancy is nearly 15 years shorter than non-Indigenous Australians

SEE HEALTH AND LIFE EXPECTANCY REPORT CARD

The Northern Territory intervention has failed to deliver substantial reform in any of the areas covered by the Close the Gap goals and has also failed to meet Australia’s international human rights obligations, an independent report has found.

 in The Guardian reports

Nearly a decade after the Northern Territory intervention, residents of Indigenous town camps in Alice Springs are fighting to regain control of their lives as they wrestle with longstanding social problems

Photo above: Aboriginal children playing at one of the town camps in Alice Springs when the intervention started in 2007. An independent report shows the strategy has failed to deliver substantial reform in any target area. Photograph: Anoek de Groot/AFP/Getty Images

The report, by the Castan Centre for Human Rights at Monash University, rated the intervention, which was rebadged in 2012 and now operates as the “stronger futures” policy, four out of 10 for its general human rights performance and failed it against seven other human rights measures, including the right to self-determination.

It also gave fail marks to every Close the Gap measure except education – which it scored at five out of 10 for improvements in primary school attendance – and urged the government to include incarceration rates as a new Close the Gap target, pointing to an “increasing and inordinate amount of Indigenous Australians being incarcerated”.

Malcolm Turnbull is set to deliver his first update on the Closing the Gap targets on Wednesday.

The national targets were set by the Council of Australian Governments in 2008, a year after the NT intervention began, and, according to the most recent update delivered by the then prime minister Tony Abbott in February 2015, most are not on track to be met.

The target of getting all Indigenous four-year-olds in remote communities into early childhood education was missed in 2013, with just 85% instead of the target of 95% enrolled.

The 2015 update, which Abbott described as “profoundly disappointing”, said the targets of closing the life expectancy gap between Indigenous and non-Indigenous Australians within a generation, halving the gap in literacy and numeracy by 2018, and halving the gap in employment outcomes by 2018 were not on track. Literacy and numeracy rates had not improved since 2008 and Indigenous employment had fallen.

Two more targets, to halve the gap in child mortality rates by 2018 and to halve the gap in year 12 completion rates by 2020, were listed as on track.

However, the author of the Castan Centre report said it appeared unlikely that any of the targets would be met in the Territory.

Close the Gap and Closing the Gap – what’s the difference?

Two similarly named programs are working towards the same goal of reducing inequality between Indigenous and non-Indigenous Australians

“The intervention was meant to improve the lives of Indigenous people in the Northern Territory, but at this rate the gap between Indigenous and non-Indigenous people may never close in many areas,” Dr Stephen Gray said.

He urged the government to adopt a new target of reducing Indigenous incarceration rates, as was recommended by the Close the Gap steering committee in 2014.

According to the latest Australian Bureau of Statistics data, Indigenous people made up 3% of the population but 27% of the prison population, and 52% of all young people in detention. In the NT, Aboriginal and Torres Strait Islander peoples make up 86% of the adult prisoner population and 96.9% of young people in detention. Incarceration rates are up 41% since the start of the intervention.

In November, the Australian Medical Association called rates of Indigenous imprisonment a “health and justice crisis”.

“I think there’s a perception that because family violence is such a crisis, because assault rates and child abuse are at such a crisis, we should not be always going on about Aboriginal imprisonment rates,” Gray said. “That sense that you can’t improve one without worsening the other is false.”

Amnesty International agreed, telling Guardian Australia that “any efforts at Closing the Gap cannot ignore these areas of massive inequality and the role that law and justice policy play in disadvantage.”

Reports of child abuse in the NT have decreased since 2010, but there has been a 500% increase in reports of self harm or suicide by Indigenous children and a sharp rise in the number of Indigenous children in care.

Gray said it was difficult to unpick the complicated mass of policy that governed the lives of Indigenous people in the NT, and that made it difficult to evaluate.

The intervention began with bipartisan support under the Howard government in 2007 as a response to a report about horrific levels of child sexual abuse in some Aboriginal communities, and was delivered as a complex suite of laws that altered everything from welfare payments to land tenure.

There was this presumption of rampant child sexual abuse in Aboriginal communities,” Gray told Guardian Australia. “It has been the excuse for a large number of other reforms that don’t really relate to child sexual abuse or family violence at all, like land reforms. It’s got very little to do with the original goals of the intervention.”

In 2008, the Rudd government reshaped it to focus on the new Closing the Gap targets but punitive measures remained, including more police, the removal of customary law and cultural practices from consideration in sentencing, quarantining welfare payments of those judged to have “neglected” their children, and tough penalties for possessing alcohol or pornography, as did the suspension of the Racial Discrimination Act.

The Northern Territory National Emergency Response Act expired in 2012 and was extended by the Gillard government until 2022, under the new name of the Stronger Futures in the Northern Territory Act. The Racial Discrimination Act was reintroduced but the percentage of an individual’s welfare payments that could be quarantined under the BasicsCard increased to 70%, and penalties for possessing porn or alcohol in dry communities, including a single can of beer, increased to six months’ jail.

By then the government had produced 98 reports and seven parliamentary inquiries into the intervention, a weight of information Gray said obscured its negative effects, particularly the impact on human rights.

“There’s a danger that things get out of check because of the swift pace of apparent change,” he said. “Because wheels keep turning, another policy gets rebadged, funding gets moved, but the real pace of life in Aboriginal communities remains the same.”

The result, the report said, was that many of Australia’s international human rights obligations, including the right of Indigenous peoples to self-determination, continued to be “directly and knowingly violated or ignored”.

Prof Jon Altman, from the Alfred Deakin Centre for Citizenship and Globalisation, said the Castan Centre’s evaluation of the intervention was too generous. The government deserved a zero out of 10, he said, for its attempts to improve education, and a negative score on employment rates which had gone backwards since the decision to abolish the community development employment projects (CDEP) program, which employed about 33,000 Indigenous people, particularly in remote communities.

Altman, who has spent 40 years working in Aboriginal communities in the NT in particular, said the services previously delivered by community-led CDEP organisations were now being done by non-Indigenous organisations, while many who had worked under CDEP remained on “passive welfare”.

Aboriginal people are exceptional. When we can all acknowledge that, the gap will close

Chris Sarra

 

Despite the dire outcomes of the Closing the Gap report, there is great potential in Indigenous communities. Our greatest challenge might be in believing that

“The state needs to admit that it’s actually doing worse than Aboriginal community-based organisations,” he said

Altman argued the Close the Gap program should be abolished, saying it was assimilationist, had alienated Aboriginal and Torres Strait Islander people and had produced no significant benefits.

“It’s all based on a policy, an ideology, that progress in closing the gap will require people to adopt western norms,” he told Guardian Australia. “And that’s a pretty hard line. It really doesn’t leave people much wiggle room if they don’t want to be changed.

“My advice to the prime minister is to stop talking about closing the gap and start talking about improving people’s wellbeing and livelihoods, because those things are taking a hammering.”

 

 

NACCHO Healthy Welfare Card debate : Government’s Healthy Welfare Card no solution to alcohol abuse

Grog

“Our people do not need a compulsory blanket approach to tackling these issues. We want to work with government to develop long-term, effective solutions to the challenges we face.

I agree with Mr Tudge when he says, “collectively we have to get control of the alcohol abuse that destroys communities and threatens the next generation”, but I disagree that the card is “the solution”. Serious addiction requires thoughtful treatment options rather than punitive measures and silver bullets.”

Mick Gooda the Aboriginal and Torres Strait Islander Social Justice Commissioner responding to Alan Tudge is the Assistant Minister to the Prime Minister and Assistant Minister for Social Services

Read here or below Alan Tudge article

Photo: Empty beer cans in Binjari make up the shapes of bodies for 10 people who died from alcohol-related causes. (Clare Rawlinson: ABC)

In Aboriginal and Torres Strait Islander communities across the country, old wounds are being reopened. Many of our people are being forced to revisit the past trauma of income management and stolen wages.

The federal government’s Healthy Welfare Card has created great concern and contention, as the measure will disproport­ionately affect Aboriginal and Torres Strait Islander people, and claw back our hard-won rights and freedoms.

The government, with the support of the opposition, has passed legislation, without any amendments and with very little consultation, to control the finances of Aboriginal and Torres Strait Islander peoples in three trial sites, beginning with the South Aust­ralian town of Ceduna next month. The third proposed site, of Halls Creek in the Kimberley, rejected the idea out of hand, with the shire president Malcolm Edwards saying it had adopted the position of its Aboriginal advisory committee to reject the plan.

“At the last meeting, they voted against having the card. They thought it was a bit unfair because it targeted everyone,” Mr Edwards said.

All welfare recipients in the trial areas will have 80 per cent of their welfare quarantined to a bank card. Only 20 per cent of their welfare payment would be available in cash, which the Assistant Minister for Social Services, Alan Tudge, has himself admitted could leave some welfare recipients with as little as $60 in their pocket each week.

It is deeply troubling that the government is “contemplating how to proceed should the trials prove successful” before any trials have even begun.

It begs the question — have the trials been structured in such a way the results have already been predetermined?

What is most perplexing is the government’s apparent fascination with controlling the finances of Aboriginal and Torres Strait Islander peoples.

Our mob are once again the guinea pigs in a trial program lacking any evidence base.

As I outlined in my 2015 Social Justice and Native Title Report, where people have experienced benefits as a result of income management, the results have been modest when compared to their stated objectives. For many, income management results in few or no benefits, and a “sense of loss of control, shame and unfairness”.

Any possible benefit of the card must be weighed against the sense of disempowerment our people ­already face. It must be weighed against the stigma our people continue to face, and the restrictions placed on our basic rights and freedoms we fought so hard for.

We are told by the government that the measure will tackle the ­serious issue of alcohol and drug abuse within our communities.

There is no doubt that alcohol and drug abuse are contributing factors to creating dangerous and disruptive communities; and all children have the right to grow up in safe, nurturing environments — Aboriginal and Torres Strait ­Islander children are no exception.

We have no evidence to support the prediction that a restriction on cash payments will curb an individual’s addiction or their ability to provide a safe environment for their children.

According to Mr Tudge, restricting supply is an effective measure to address these problems. But in the same way that people with serious addiction can circumvent restrictions on supply, they will undoubtedly find innovative ways to circumvent limits on their capacity to purchase.

The role of government is to provide effective policy, based on the best available evidence. In the case of the Healthy Welfare Card, there is no conclusive evidence that it will effectively address issues of alcohol and drug abuse, and encourage good parenting.

Our people do not need a compulsory blanket approach to tackling these issues. We want to work with government to develop long-term, effective solutions to the challenges we face.

I agree with Mr Tudge when he says, “collectively we have to get control of the alcohol abuse that destroys communities and threatens the next generation”, but I disagree that the card is “the solution”. Serious addiction requires thoughtful treatment options rather than punitive measures and silver bullets.

The hardest part of this proposal to accept is that yet again the treatment of our people will be ­different to mainstream Australia, and it is this differentiation of treatment that we have fought so hard to bring into the open.

Mick Gooda is the Aboriginal and Torres Strait Islander Social Justice Commissioner.

Alan Tudge Article

Having agreed with East Kimberley leaders to implement the cashless welfare debit card, the government is now receiving ­requests across Western Australia for its introduction. In most cases the requests are from council or community leaders who are desperate about the situation of their community and hope the card will provide a breakthrough. In Leonora in the Goldfields, for example, a further tragic suicide, this time of a 15-year-old girl, ­was the catalyst for the call out.”

Alan Tudge is the Assistant Minister to the Prime Minister and Assistant Minister for Social Services.

Alcohol is always the target. It is the poison that destroys lives and makes many of our remote communities unsafe. In the Northern Territory, for example, two-thirds of the catastrophic rates of violence are related to ­alcohol, according to the territory’s children’s commissioner. Parties at night keep children awake and make homes unsafe. Extraordinary rates of child ­neglect occur.

When a community is drowning in grog, other initiatives ­become so much harder to ­implement. Restricting the supply of ­alcohol has been the most effective measure to date. In ­places like Groote Eylandt and Bickerton ­Island, alcohol manage­ment plans have led to a 67 per cent ­reduction in aggravated assaults. But restricting supply is difficult in larger mainstream towns. Further, residents can travel outside the restricted area and grog-runners have been innovative in ­finding ways to bring in the prohibited products.

The welfare debit card has the same objective as a supply restriction but tackles the problem from the demand side: the welfare cash that pays for the grog and funds the destruction. Without the cash, systemic abuse becomes more difficult.

The card itself has been ­designed to look and operate like an ordinary debit card, but it has been programmed to restrict cash withdrawals and be inoperable at every bottle shop and gambling house in the country.

Ceduna in South Australia and the East Kimberley will be the first two trial locations for the card. Every working age income support recipient will have 80 per cent of their payments placed onto it while the remaining 20 per cent will continue to go into their savings account.

Whenever the card is used for purchases above $10, a text mes­sage will be sent to the recipient’s phone informing them of their new account balance. If a person leaves the community, the card will travel with them.

Of course, you cannot simply stop a person’s addiction overnight. In each location, extra drug and alcohol services are being added to help people reduce their dependencies. Other com­plementary reform initiatives have also been negotiated. In the East Kimberley, for example, there is a strong employment focus to leverage the existing economic base. This includes training into guaranteed jobs, fulltime work for the dole and employment brokers. These initiatives are nothing short of a full-scale ­assault on alcohol abuse.

While the design of the card and the content of the reform plan is critical, equally important is the manner in which they have been developed in partnership with local community leaders at the trial locations.

The initiatives have not been foisted upon the communities but have been co-designed with the most important indigenous and non-indigenous leaders in the ­region, along with the respective state governments.

They have set the priorities, determined the settings of the card and consulted with the broader community. The imple­mentation of the card and its complementary reforms will continue in a similar manner.

This approach to reform will not guarantee the success of the trials but will significantly boost its chances. It is also aligned with the core philosophy advocated by Noel Pearson, Sean Gordon and other senior indigenous ­leaders in their Empowered Communities ­report.

However, working in this way is not straightforward. Many elements have to come together: ­devolved authority within the public service; a single senior public servant on the ground who can earn the trust of local residents and be a problem solver; a reform-minded local leadership group; and political backing, knowing the approach carries risk. These require cultural as much as structural change.

So where to from here? The trials in Ceduna and East Kimberley will begin in the next few months. We have legislative authority for a third trial site and consultations have commenced in a couple of locations.

Naturally we are starting to contemplate how to proceed should the trials prove successful. Offering the card to other regions would be a logical next step, ­beginning with those West ­Australian locations that have ­already shown initial support. Others have suggested that the card could have wider application.

It is early days, but one thing is clear: collectively we have to get control of the alcohol abuse that destroys communities and threatens the next generation with up to a quarter of babies being born brain damaged from foetal alcohol spectrum disorder in some places.

The cashless welfare debit card may be the solution.

Alan Tudge is the Assistant Minister to the Prime Minister and Assistant Minister for Social Services.

NACCHO Male Health : Dr Mick on a mission to get men talking about prostate cancer and sexual health

Dr Mick

Men might not want to talk about their sexual health but Dr Adams, who is a descendent of the Yadhiagana/Wuthuti people of Cape York Peninsula in Queensland, believes many doctors are not asking either.

“Men have to ask doctors the questions as well as doctors asking the question

Doctors need to throw in a phrase like how you going, how’s the old boy, is he getting up, is he getting the job done?

Dr Mick Adams 

The World Today Lucy Martin reports

Health researchers have launched a new education kit in the hope that it will start a conversation amongst Indigenous men about prostate cancer and erectile dysfunction.

Prostate cancer is the most commonly diagnosed cancer in Australia, with nine men dying from the disease every day, but experts say many men do not want to talk about it and some doctors are loathe to ask.

Putting men on the spot is what Perth doctor Mick Adams does best.

The Edith Cowan University health researcher has travelled around Australia asking Indigenous men why they are so reluctant to talk about their health, especially when it comes to erectile dysfunction and prostate issues.

“The interesting thing about it was a lot of men knew what was going on in their bodies, but a lot of them were suffering in silence,” he said.

“I think the medical jargon puts them off because they don’t really understand what’s going on and what’s happening medically.”

‘It’s about starting a conversation’

Dr Adams found just 30 per cent of men surveyed had spoken to their doctor about a prostate test.

“I asked men to fill in a questionnaire and some of them were big macho men, they said ‘I don’t need that, I’m a big stud and I can do it all night’,” he said.

“I said ‘Well, I’ll go talk to your wife about it’.

[Doctors need to] throw in a phrase like how you going, how’s the old boy, is he getting up, is he getting the job done?

Dr Mick Adams

“The [wife then] turns around and said, ‘Yes give me that questionnaire, I’ll fill it in for him’.

“It’s about starting that conversation and putting blokes on the spot as well.”

Men might not want to talk about their sexual health but Dr Adams, who is a descendent of the Yadhiagana/Wuthuti people of Cape York Peninsula in Queensland, believes many doctors are not asking either.

“Men have to ask doctors the questions as well as doctors asking the questions,” he said.

“[Doctors need to] throw in a phrase like how you going, how’s the old boy, is he getting up, is he getting the job done?

“It’s tongue-in-cheek, but it eases the men into a comfortable position.

“You really got to be mindful about how you approach these issues.

“I find men want to talk about it, but someone has to start the conversation with them.”

Stigma associated with cancer in Indigenous communities

Events like Movember, where men grow moustaches to raise money and awareness, have sparked a national conversation about prostate cancer, but Anthony Lowe from the Prostate Cancer Foundation of Australia said many men were still reluctant to talk about it or get tested.

“It’s very important to diagnose prostate cancer early because if its diagnosed before it escapes from the prostate gland it can be treated,” he said.

“If it’s spread, there are treatments that can be done but it can’t be cured, so it’s important to catch it at that stage when it can be cured.”

Mr Lowe said Indigenous men were less likely to be diagnosed with prostate cancer, and when they were diagnosed, mortality rates were significantly higher than non-Indigenous Australians.

There’s a sense in Indigenous communities that if you get cancer you are going to die.

Anthony Lowe

The foundation is today releasing a series of flipcharts with information about prostate health, cancer treatment and advice for family.

“We did extensive research and consultation with Indigenous communities and what we learned is that there’s a low level of knowledge of prostate cancer and there are certain stigmas associated with it as well,” Mr Lowe said.

“There’s a sense in Indigenous communities that if you get cancer you are going to die.

“We also learnt the digital rectal examination carries significant stigma in Aboriginal communities particularly, so we really wanted to counter that and get the correct health message out.”

The tool will be used by health groups and doctors to help start the discussion.

Dr Mick Adams, who opened a national men’s health conference in New South Wales last week, said it was long overdue.

“I did a public lecture series two nights ago — there was over 140 people there and the majority were men,” he said.

“I asked who had had a prostate check-up in the last three months and three put up their hand.

“I then asked who had talked to their partners about sexual health and prostate cancer and I think the same three put up their hand.

“What information are they getting? What encouragement are they getting?

“We really need to start looking at ways of getting men to start opening up about it.”

NACCHO Health News: Download Inquiry report into the harmful use of Alcohol in ATSI communities June 2015

New Microsoft Word Document

The consumption of alcohol at high risk levels is a national issue, however, the focus of this inquiry is the harmful use of alcohol in Aboriginal and Torres Strait Islander communities.

DOWNLOAD 200+ Page REPORT HERE

Many reports and studies have recommended stemming the flow of alcohol to address the problems, but usually these works do not analyse why a person drinks at levels which cause them and their loved ones harm. The social and economic determinants of harmful alcohol use such as unemployment, poor housing, racism, trauma, poor education and peer pressure mean that Aboriginal and Torres Strait Islander communities are overly impacted by the harm caused by alcohol consumed at high levels.

A recent Amnesty reports note that it costs $440,000 per year to keep one young person in detention in Australia. This report recommends that justice reinvestment strategies should redirect these resources to overcoming the deprivation and despair in so many Aboriginal and Torres Strait Islander communities.

This report addresses strategies and treatments found to help in addressing the harmful use of alcohol. Community led solutions are always the key to uptake and success. Unfortunately slow government processes, for example approving community produced alcohol management plans and the short length of project funding often frustrates community initiatives.

The magnitude of the problem caused by high risk consumption of alcohol is often hidden by the lack of collection of useful data for example at the time of hospital admissions, when children are put into out of home care because of their neglect, when people are incarcerated because of alcohol related crime and when children are born with Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Spectrum Disorder (FASD) at some of the highest rates in the world.

The committee found examples of the world’s best practice at places like Groote Eylandt and Fitzroy Crossing. These communities, led by women’s initiatives, have demonstrated courage and determination to tackle alcohol harm to provide a safe environment for their families and community. The committee commends them and hopes that their strategies can be used as examples of a way forward for other communities.

FASD or FAS is creating generations of children whose brain damage will reduce their potential to live lives full of promise and well-being. The rates of FAS and FASD in some Aboriginal and Torres Strait Islander communities in Australia are amongst the highest in the world and yet FAS and FASD are not recognised as a disability for many social security allowances and payments. The lack of knowledge about, and recognition of FASD and FAS extends beyond the failure to have it officially recognised for social security and NDIS purposes, it also needs to be understood in schools, the criminal justice system and in the health sector.

The committee found that impacts of alcohol on children in communities represents a national tragedy as it is manifested in children growing up with fathers, and increasingly mothers, who are incarcerated, as the children’s abuse and neglect leads to the need for out of home care at record levels, missed schooling and too often ultimately become young alcohol addicts or abusers of other illicit substances.

This committee urges adoption of these recommendations as a matter of urgency given the extent of harm and intergenerational afflictions when alcohol is consumed at such high risk levels.

The Hon Dr Sharman Stone MP

Chair

 

The Committee will inquire into and report on the harmful use of alcohol in Aboriginal and Torres Strait Islander communities, with a particular focus on:

  • patterns of supply of, and demand for alcohol in different Aboriginal and Torres Strait Islander communities, age groups and genders
  •  the social and economic determinants of harmful alcohol use across Aboriginal and Torres Strait Islander communities
  •  trends and prevalence of alcohol related harm, including alcohol-fuelled violence and impacts on newborns e.g. Foetal Alcohol Syndrome and Foetal Alcohol Spectrum Disorders
  •  the implications of Foetal Alcohol Syndrome and Foetal Alcohol Spectrum Disorders being declared disabilities
  •  best practice treatments and support for minimising alcohol misuse and alcohol-related harm
  • best practice strategies to minimise alcohol misuse and alcohol-related harm.