NACCHO Aboriginal Health News : Save $745 million a year by eliminating Indigenous health gap in the NT

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” The total costs resulting from Indigenous health inequality in the NT during 2009–2013 were estimated to be about $16.7 billion, equivalent to nearly one-fifth of the NT gross state product (GSP) for this period (Box 4).14

This result suggests that eliminating the Indigenous health gap could potentially save $745 million each year in direct health costs alone.

In the medium and long term, closing the gap would save $13 billion in indirect and intangible costs over 5 years; savings in direct health costs would be less than one-quarter of the total long term financial benefit of closing the gap.”

The economic benefits of eliminating Indigenous health inequality in the Northern Territory MJA Photo AMA

Download the report nt-health-equity

The Northern Territory covers one-sixth of the Australian landmass, but includes only 1% of its population. Aboriginal and Torres Strait Islander (Indigenous) people constitute about 27% of the NT population (compared with 2.5% nationally) (Box 1).1

Compared with the rest of the population, Indigenous Australians have disproportionate levels of social isolation, poverty, unemployment, lack of education, and inadequate access to health care.2 They also suffer poorer health; for Indigenous people in the NT born between 2010 and 2012, life expectancy at birth was 63 (men) and 69 years (women),3 17 and 14 years less than for non-Indigenous Territorians.

There is consensus that closing the health gap between Indigenous and non-Indigenous Australians requires concerted efforts by all sections of society. In 2009, Australian governments announced a vision for eliminating this gap within a generation: that is, by 2031 (“Closing the Gap”).4 The main focus was on broad consultations with Indigenous people about a range of measures, including health, childcare, schooling and economic participation.4

In this regard, two important questions were asked but remained largely unexplored:

  • How much does the Indigenous health gap cost society?

  • What are the potential economic benefits if the gap were to be eliminated?

The purpose of our study was to provide basic information on the potential economic benefits of reducing the Indigenous health gap, by quantifying the magnitude of the economic burden associated with Indigenous health inequality in the NT on the basis of standard cost-of-illness methodology and using the most recent data.57

Methods

Life expectancy was calculated using population and death data for 2009–2013. Indigenous and non-Indigenous resident population and death registration data were gathered from the Australian Bureau of Statistics and the Australian Coordinating Registry.8 The cost-of-illness approach was adopted for estimating the costs associated with the Indigenous health gap from a societal perspective; that is, all costs were included, regardless of who paid or received the payment: individuals, health care providers, Indigenous and non-Indigenous populations, or a government.7 This approach casts light on the overall magnitude and distribution of the economic costs of illness. All values were expressed in 2011 Australian dollars to account for inflation.

The total monetary value of the Indigenous health gap was estimated by calculating cost differences between the Indigenous and non-Indigenous populations in three categories: direct health costs (hospital, primary care, and other health services, including public health);9 indirect costs associated with lost productivity (missed income, welfare payments, and missed tax revenue, assuming equal opportunity for employment for Indigenous and non-Indigenous people);7 and intangible costs associated with premature deaths (based on years of life lost, YLL).7

Direct health costs were derived from data on overall health expenditure for Australia and expenditure for Indigenous people specifically;9,10 expenditure for non-Indigenous people was calculated by subtracting Indigenous expenditure from total expenditure. The cost differential (excess cost) for Indigenous health care was estimated by calculating the difference between actual expenditure on Indigenous health care and the estimated expenditure if the per capita costs were the same as for non-Indigenous NT residents.

A workforce supply and demand framework was used to assess the indirect costs caused by lost productivity, based on census data and other sources for employment, taxation and welfare payment data (Box 2).1,7,11 Indirect costs (productivity loss) encompassed excess welfare payments by governments, missed tax revenue, and lost efficiencies for the economy related to inadequate human capital development and human resources utilisation. The estimation of indirect costs is described in the Appendix.

The intangible costs attributable to the higher burden of disease were estimated by multiplying the excess YLLs by the value of a statistical life-year (VSLY).12 The YLLs were calculated using NT death data linked with the age-specific life expectancies from the Australian Burden of Disease (BOD) study.13 Following the BOD methodology, YLLs were not discounted for future years, and were costed at $120 000 per life-year, based on the review by Access Economics.12 Sensitivity analysis was undertaken with VSLY assumed to be $50 000, $100 000 or $140 000 per YLL. General inflation rates were applied to pricing the VSLY between 2009 and 2013.

Ethics approval

This study was endorsed by the Human Research Ethics Committee of the NT Department of Health and the Menzies School of Health Research (reference, HREC-2015-2400).

Results

Between 1 January 2009 and 31 December 2013, 9867 deaths of NT residents were registered; 62% were males, and 47% were Indigenous Australians (mean age at death, 51 years v 67 years for non-Indigenous deaths).

Life expectancy at birth for Indigenous men and women was 64 and 69 years respectively, each 15 years lower than for non-Indigenous residents (79 and 84 years respectively).

Over the 5-year study period, direct health costs totalled $9.3 billion (2011 dollars), of which 58% were incurred by Indigenous patients (Box 3), more than double their proportion of the NT population. Per capita expenditure for Indigenous patients was 3.2 times that for non-Indigenous patients (based on total 5-year estimated resident population numbers: Indigenous, 345 968; non-Indigenous, 819 551). This ratio was slightly higher for hospital (3.5) than for primary care and other services (each 3.1). The total excess direct health costs were estimated at $3.7 billion during the 5 years, equivalent to about 40% of total expenditure (Box 3).

The indirect costs arising from lost productivity were estimated by matching the Indigenous supply–demand balance (equilibrium) with that of the non-Indigenous workforce (Box 2).

The excess costs associated with lost productivity attributable to the Indigenous health gap were estimated to be $1.17 billion in 2011, of which $359 million (31%) were excess welfare payments, $293 million (25%) foregone tax revenue, and $515 million (44%) lost efficiencies (Appendix). The total costs of lost productivity attributed to Indigenous health inequality totalled $5.8 billion during 2009–2013 (Box 4).

Wage responsiveness (elasticity) of demand was 1.8, and responsiveness of supply of the Indigenous workforce was 1.5, indicating that the demand and supply for the Indigenous workforce were respectively 80% and 50% higher than those for the non-Indigenous workforce (each 1.0 for demand and supply; Box 2). Based on Box 2, about 20 000 extra jobs at the average wage level would be required to close the gap, equivalent to a 14% expansion of the NT economy.

The intangible cost (burden of disease) estimates were based on excess YLLs. Over the 5-year period, there were 153 458 YLLs in the NT, 87 439 of which (57%) were attributable to Indigenous people, a rate that was 3.1 times that for the non-Indigenous population. The excess 59 571 Indigenous YLLs was equivalent to a total cost of $7.2 billion between 2009 and 2013 (Box 4). Intangible costs comprised the largest category of excess costs in the NT (43%), substantially higher than either direct health costs (22%) or indirect costs caused by lost productivity (35%) (Box 4).

The total costs resulting from Indigenous health inequality in the NT during 2009–2013 were estimated to be about $16.7 billion, equivalent to nearly one-fifth of the NT gross state product (GSP) for this period (Box 4).14 This result suggests that eliminating the Indigenous health gap could potentially save $745 million each year in direct health costs alone.

In the medium and long term, closing the gap would save $13 billion in indirect and intangible costs over 5 years; savings in direct health costs would be less than one-quarter of the total long term financial benefit of closing the gap.

The results of our sensitivity analysis are included in the Appendix.

Discussion

We present evidence that Indigenous health inequality in the NT is both substantial and costly. The total costs attributable to Indigenous health inequality between 2009 and 2013 amounted to $16.7 billion, equivalent to 19% of GSP, a measure of the size of the NT economy. As a comparison, the costs of health inequalities for African, Asian and Hispanic Americans in the United States were estimated to be US$1.24 trillion during 2003–2006, corresponding to 2.4% of the American gross domestic product (GDP).5 The life expectancy gap between black and white Americans was only 4 years in 2010,15 as opposed to the 15 years between the Indigenous and non-Indigenous populations in the NT. A European Union study showed that the cost associated with socio-economic health inequalities was equivalent to 9.4% of GDP.6

Using the general equilibrium what-if analysis, an earlier Deloitte Access Economics study reported that the Indigenous employment gap imposed a cost of close to 10% of GSP in the NT.2 Our study found that 40% of direct health costs in the NT were associated with Indigenous health inequality, higher than the corresponding figures in the US (30%) and EU studies (20%).5,6

Our findings suggest that there would be enormous financial benefits for the NT in the longer term should closing the gap become a reality. The evidence we have presented implies that the total potential long term benefits would be $3.3 billion annually in real terms, and a boost of nearly 20% of GSP in relative terms (Box 4), double the projection by the Deloitte study (9% over 20 years).2 A possible explanation for this difference may be the different focuses of the studies: the Deloitte analysis concentrated on employment, whereas we assessed much broader benefits from a societal perspective. Closing the gap is feasible: between 1994 and 2008, Indigenous employment in Australia increased by 55–70%.16

There are many contributors to health inequality in the NT. Poverty is a cause and consequence of ill health, and the Indigenous population is particularly vulnerable to poverty, especially in remote areas. For example, the NT market basket survey of food and drink prices found that in 2014 they were 54% higher in remote than in urban areas.17 After adjusting for these higher prices, the real income of the average Indigenous person living in a remote community was only 29% of the overall NT average.

Thirty per cent of NT Indigenous people are located 50 kilometres or more from a primary school and 100 kilometres or more from a health clinic. Remote areas lack economies of scale; 87% of NT Indigenous communities have populations of less than 100 people. Strategies for redressing health disparities should consider how the impact of remoteness might be ameliorated. Solutions may include ensuring access to essential government services for people residing in remote areas, and facilitating resettlement for those who wish to move to larger population centres.18 Overcoming the effects of remoteness, improving public housing, and raising living standards are necessary prerequisites for closing the gap,19 and will also allow economies of scale and a larger population base, which mean that education and health services can be provided more efficiently. This, in turn, will facilitate better access to labour markets for Indigenous people.

NACCHO Aboriginal News Alert : New NT Labor Government hands back decision-making control to Indigenous communities

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“In devolving decision making, Labor will be guided by the principles outlined in the Aboriginal Peak Organisation’s Partnership Principle, which recognises the critically important role that control over life circumstances plays in improving Indigenous peoples lives.

Control is also central to a further fundamental determinant of our health and wellbeing—that of culture.

Culture is a universal aspect of human societies that gives meaning and value to individual and collective existence.”

Aboriginal Peak Organisation’s Partnership Principle

 ” The new NT Labor government will allow remote Northern Territory schools to choose to implement the Direct Instruction teaching method as part of a broader overhaul aimed at giving local people more control over their affairs.

Chief Minister Michael Gunner will also reinstate so-called community cabinets, whereby all ministers and departmental heads periodically conduct government business in the bush to ensure direct exposure to remote communities’ views.

Visiting Numbulwar, on the Gulf of Carpentaria shore about 550km southeast of Darwin, Mr Gunner yesterday said winning back four of five bush seats Labor lost in 2012 was “crucial to us having credibility” as a government for all Territorians.”

Report in The Australian 2 September see full story part 3 below

PHOTO New Arnhem MP Selena Uibo, left, with Chief Minister Michael Gunner and Numbulwar preschooler Relisha Hall, 4. Picture: Ivan Rachman

 “Labor’s win at the Northern Territory election will mean a new dawn for Indigenous affairs and policy making in Australia that will see decision making and control given back to Indigenous Territorians.

NT Labor Policy

The Northern Territory has by far the largest proportion of Indigenous residents with around a third of its population Indigenous.

As such, the Territory is home to some of the biggest challenges in Indigenous affairs, but is also home to a wealth of local policy making nous.  

With occasional involvement by the federal government to varying degrees and success, the policy making wherewithal needed to tackle the range of big and complex issues that touch Indigenous Territorians lives largely sits with NT politicians, bureaucrats, academics, land councils, health and education professionals – and of course with Indigenous Territorians.

Progressing reform to better the way government supports and respects the will of Indigenous NT residents.

It is for this reason the newly elected NT Labor government will deliver the most extensive return of local decision making to Indigenous communities since the Territory achieved self-government in 1978.

Labor will introduce a 10 year road map and local decisions oversight board made up of indigenous leaders from the NT that will see Indigenous communities take control over:

  • Housing;
  • Local government;
  • Education and training;
  • Health;
  • Looking after children; and
  • Law and justice.

The shift is huge. But it’s also an obvious step in progressing reform to improve the way government supports and respects the will of Indigenous Territorians.

Put the intervention and its top down policy making approach well and truly where it belongs: into history.

An NT Labor government will provide the backing where it has a central role to play – namely, in direct financial investment in supporting jobs for Indigenous Territorians including:

  • $4.1m for one off capital grants of up to $100,000 for Indigenous ranger groups to support jobs for Indigenous Territorians on their land;
  • Establish a land management and conservation fund of $2m per year to improve conservation practices on Aboriginal lands and sea country;
  • Amend the Territory Parks and Wildlife Conservation Act to specifically recognise the role of Indigenous ranger groups in managing for conservation across large areas of the Territory; and
  • Provide $500,000 per annum to establish an Indigenous carbon unit within government to deliver carbon abatement and economic development on Indigenous land – this has the potential to unlock tens of millions of dollars of investment and jobs.

Not only does NT Labor’s policy lay important groundwork in the national discussion on constitutional recognition and/or treaty, this policy shift would finally, and thankfully, put the Intervention and its top down policy making approach well and truly where it belongs: into history.

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Guiding principles for our research and policy work

Aboriginal Peak Organisations of the Northern Territory (APO NT) is an alliance comprising the Northern and Central land councils, the North Australian Aboriginal Justice Agency, the Central Australian Aboriginal Legal Aid Service and the Aboriginal Medical Services Alliance Northern Territory.

The alliance was formed in recognition of the fact that our interests and responsibilities as organisations representing and governed by Aboriginal communities and organisations are inextricably linked.

Our shared interests are underpinned by an unwavering commitment to the principles of Aboriginal community control and self-determination.

We share an understanding that tackling the plight of our communities can only be achieved through coordinated action across a broad range of policy areas: in housing, employment, education and health; but equally importantly in ensuring that the right conditions are in place for creating strong, resilient communities.

This requires empowering and giving responsibility to govern our communities and control our organisations in determining our futures—to control and manage the delivery of services, to build and maintain community infrastructure and to develop sustainable enterprises and livelihoods on our traditional lands, as well as on those lands that have been alienated from us.

It requires empowering individuals through developing self-esteem and strong cultural identity that can underpin educational achievement, enhanced capacity to obtain and remain in employment, and to avoid destructive behaviours such as interpersonal violence that all too often lead to contact with the criminal justice system.

And it requires strong action in tackling the scourge of alcohol and other drugs, its underlying causes and accompanying burden of unresolved and ongoing intergenerational trauma in our families and communities.

A belief in evidence

Importantly, our belief in these principles is not merely aspirational, but is supported by a strong evidence base: that of the social determinants of health.

The overwhelming body of evidence of the social determinants of health shows that our health and wellbeing is profoundly affected by a range of interacting economic, social and cultural factors. Key amongst these are:

• Poverty, economic inequality and social status;
• Housing;
• Employment and job security;
• Social exclusion, including isolation, discrimination and racism;
• Education and care in early life;
• Food security and access to a balanced and adequate diet;
• Addictions, particularly to alcohol, inhalants and tobacco;
• Access to adequate health services
• Control over life circumstances.

Psychosocial factors, particularly stress and control, are critically important.

Put simply, the less control we have over our lives the more stress we experience. Stress is associated with anxiety, insecurity, low self-esteem, social isolation and disrupted work and home lives. It can increase the risk of chronic illnesses such as depression, diabetes, high cholesterol, high blood pressure, stroke and heart attack.

This evidence demonstrates that there is a social gradient of health that reflects and affects our opportunities to lead safe, healthy and productive lives for ourselves and our children.

Culture matters!

Control is also central to a further fundamental determinant of our health and wellbeing—that of culture.

Culture is a universal aspect of human societies that gives meaning and value to individual and collective existence.

In the context of societies with dominant and minority cultures, such as Australia, the widespread and persistent suppression of minority cultural practices causes severe disruption, making our communities susceptible to trauma, collective helplessness and endemic maladaptive coping practices.

These can be passed on through the generations, as we have witnessed in relation to the processes of colonisation and past government policies such as those of the Stolen Generations.

We believe that we are also witnessing the generation of such impacts in relation to ongoing government policies, for example, the misguided, coercive approaches of the NT Intervention and Stronger Futures.

The final report of the World Health Organization Commission on the Social Determinants of Health highlighted the issues of cultural suppression and loss, social exclusion and lack of consent and control as key factors affecting Indigenous populations.

The above underscores that the control that we seek over our lives, communities and land is far more than a political aspiration that government may interpret as something it can arbitrarily restrict or deny us. It is as fundamental to our health and wellbeing—and hence to the task of Closing the Gap in life outcomes—as it is to our rights and interests as Aboriginal peoples.

APO NT’s work is informed by these principles and the evidence on which they are based and we will continue to communicate with government to ensure that our voice is heard.

Labor will let remote schools choose Direct Instruction: Gunner

The new Labor government will allow remote Northern Territory schools to choose to implement the Direct Instruction teaching method as part of a broader overhaul aimed at giving local people more control over their affairs.

Chief Minister Michael Gunner will also reinstate so-called community cabinets, whereby all ministers and departmental heads periodically conduct government business in the bush to ensure direct exposure to remote communities’ views.

Visiting Numbulwar, on the Gulf of Carpentaria shore about 550km southeast of Darwin, Mr Gunner yesterday said winning back four of five bush seats Labor lost in 2012 was “crucial to us having credibility” as a government for all Territorians.

“It’s really important that we do as much as possible to make sure that locals have meaningful control of their lives. Because when we make decisions in Darwin or when we make decisions in Canberra, we get it a little bit right, but if we get it wrong we get it a lot wrong,” he said.

“If you make decisions locally, occasionally you’re going to make mistakes. But when you get it right you get a lot right, and when you get it wrong you get it a little wrong.

“We will avoid what is often a common mistake and that is, if someone makes a mistake locally, we strip that decision-making power back to Canberra or back to Darwin.”

He visited Numbulwar with incoming local Labor member Selena Uibo, who was until recently a Direct Instruction teacher at the community school. The method was introduced to the Territory by former education minister Peter Chandler under the previous CLP government.

Ms Uibo praised DI and said she would push for broader ­adoption. “I found that it was doing its job in terms of teaching young people who were not Eng­lish speakers the system and the context of learning English and breaking down and contextualising English as part of reading as well,” she said.

Numbulwar School Council chairwoman Hida Ngalmi said DI was “working”.

“We need our children to speak English and to learn how to put their sentences together properly … we don’t want them speaking Kriol all the time,” she said. The school also runs a program aimed at revitalising the Wubuy language.

Teachers Lauren Zaharani and Chris O’Neil also said they found the DI method useful.

“It’s my first experience (of DI) and I think it’s working,” said Mr O’Neil. “It’s certainly building their reading capacity.”

Year 8 students Shrell Manggurra and Alphias Numamurrdidi said they looked forward to going to high school and getting jobs.

Mr Gunner said he was pleased with the positive feedback about DI from Numbulwar.

“I’ve had reports from other communities where it hasn’t quite been the right thing,” he said. “We want to make sure that the schools, locally, can develop how they teach in their classrooms as suits their community — we want to give that flexibility.”

Mr Gunner said the priority should be educational outcomes.

“I don’t think anyone in the Territory should be satisfied with our current results. We have to, and must, do better,” he said.

Labor has committed $300,000 for each school to be spent on improvements to the education environment that would not otherwise be possible under the triaged system of ­maintenance.

Numbulwar School plans to use the money to move sand to create a larger play area and ­better carpark, and to purchase hydroponic equipment for older kids to use.

NACCHO News Alert : AMSANT welcomes the ongoing commitment and constructive Government partnerships

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AMSANT welcomes the ongoing commitment and constructive partnership between the Commonwealth and the Northern Territory Government to work with the Aboriginal community controlled  sector to address the health and wellbeing issues of Aboriginal Territorians.”

“And we are especially pleased by the launching of a new Framework Agreement for the NT that is coinciding with this Summit.”

Marion Scrymgour, Chairperson, AMSANT (See previous post for renewed agreement details )

Presentation to the Third Aboriginal Health /Health Ministers Summit Darwin, 30th July 2015 Marion Scrymgour, Chairperson, AMSANT

Picture Above : Marion Scrymgour with John Elferink and Senator Fiona Nash celebrating the signing of the agreement  

I would like to begin by acknowledging the traditional owners of the land on which we meet, the Larrakia people, and their elders past and present.

I would also like to acknowledge the Assistant Minister for Health, Senator the Hon Fiona Nash; Minister for Health, the Hon John Elferink; the Hon Jack Snelling; the Hon Helen Morton, and other distinguished attendees.

AMSANT is very pleased to co-host this summit with the Northern Territory Minister for Health, the Honourable John Elferink MLA.

It’s particularly significant for AMSANT, having last year marked 40 years of Aboriginal community controlled health services in the NT and 20 years since AMSANT was established.

This is an important opportunity for all of us working to improve the health and wellbeing of Aboriginal and Torres Strait Islander people, to share and collaborate on that journey for the important years ahead.

AMSANT’s Aboriginal community controlled member services provide high quality comprehensive primary health care to our communities across the Northern Territory. We are working with government to progressively transition further services to community control and to continue to build on our shared record of improved health outcomes.

We have achieved a steady and in many ways remarkable health improvement in the NT that Christine will be presenting on shortly.

What I would like to do in my presentation is to briefly reflect the context and history of these health improvements that have laid strong foundations for the road ahead. And also some important lessons from what didn’t work.

An important precursor was the National Aboriginal Health Strategy, or the NAHS, developed in 1989. The NAHS outlined a way forward for Aboriginal health built on the foundation of Aboriginal community controlled comprehensive primary health care. Our sector took a leading role in its development.

It was a good plan with some significant outcomes, but ultimately let down in its implementation.

It resulted in the establishment of the Council for Aboriginal Health; State and Territory Tripartite Forums; a specialised health branch, the Office of Aboriginal Health; and a national Aboriginal community-controlled health organisation, which became NACCHO.

The Tripartite Forums proved to be an unwieldy and unsuccessful model for collaborative health planning, but other initiatives such as a specialised health branch and the establishment of NACCHO have been important developments.

Crucially, the NAHS was never properly funded. $232 million was allocated over five years: $171 million for housing and infrastructure, and $47 million nationally for Aboriginal health services. This was far less than the $3 billion estimated as necessary for full implementation of the NAHS, and states and territories failed to match the Commonwealth funding, resulting in a grossly under-funded health system.

At this time, in 1990, the Aboriginal and Torres Strait Islander Commission, or ATSIC, was established and assumed national responsibility for Indigenous health.

This proved to be a further mistake.

The resulting underfunding of Aboriginal health services meant Aboriginal health continued to languish.

In this era, our health services had to apply every year for their core funding from ATSIC. There were no three-year funding agreements and much uncertainty from year to year, making it very difficult to attract and retain staff. Very few new Aboriginal health services were set up as such services were not considered to be necessary to improve Aboriginal health.

The 1994 evaluation of the NAHS showed that, effectively, it was never implemented.

It was in this climate that AMSANT was formed in 1994 after a 3-day meeting of community controlled health services in Alice Springs. Its key objectives were: expanding community control; increasing resources; and improving training, salaries, and conditions for Aboriginal Health Workers.

AMSANT’s first major campaign, alongside other stakeholders, was to have administrative responsibility for Aboriginal primary health care transferred from ATSIC to the Commonwealth Health Department.

This was a very controversial move but was based on the carefully reasoned assessment that Aboriginal health funding would be forever constrained unless funds could be accessed from mainstream health funding, especially MBS and PBS. There was also a need for a specialist department within the health department that understood and had special expertise in Aboriginal primary health care. The Office for Aboriginal and Torres Strait Islander Health Services, or OATSIH, was formed in 1995.

The impact of the transfer on access to increased funds has been very dramatic. In the year of the transfer, in 1995, there was only $70 million available to fund Aboriginal primary health care, however there has been a continuing increase in this funding since then to more than $1 billion per year for Aboriginal health.

Securing increased funding was complemented with a campaign to improve administrative arrangements for Aboriginal primary health care. Setting up a transparent and accountable planning structure was a key objective.

The signing of the Framework Agreement between AMSANT and the NT and Commonwealth governments in April 1998 saw the planning structure come into being—the Northern Territory Aboriginal Health Forum.

It is through the Forum that collaborative needs based planning has occurred enabling crucial improvements to the health system throughout the NT.

And for the first time the Aboriginal community controlled health sector was at the table as an equal with government. AMSANT is the permanent chair of the Forum.

However, inadequate and inequitable funding remained a key problem.

There was a need for a completely new funding model that combined pooled grant funding with access to Medicare and the PBS. AMSANT successfully campaigned for the Commonwealth Government to adopt a new Integrated Funding model as part of the new Primary Health Care Access Program or PHCAP. This required the pooling of all Commonwealth and Territory grant funds as well as access to MBS and PBS, and this mixed mode funding model remains the current way Aboriginal health services in the NT are funded.

AMSANT and Forum secured increased and more equitable program funding for Aboriginal primary health care through PHCAP, which divided the NT up into 21 health zones based on geographic, cultural and social affiliations.

Two successful regional health services were subsequently established through the Aboriginal Coordinated Care Trials: Katherine West Health Board in 1999 and the Sunrise Health Service in 2005. Due to the severe limitations of the Medicare “cash out” approach, these services transited to PHCAP funding agreements in order to help secure their sustainability.

These services demonstrated that regionalised community control can produce better services and improved health outcomes. Rolling out this model across the Territory remains a major objective of the joint planning process under Forum.

Effectively rolling out this agenda required a further critical development that needs mention. Because in order to allocate increased funds effectively and equitably there needed to be a clearer idea of what core services and programs should be funded in each health zone.

Forum set about developing the first version of the Core Functions of Primary Health Care in 2001, and this was used to direct the initial investment under the PHCAP. $30 million new investment over 5 years from 2001 to 2006 took the average investment from $600 per capita on average to about $1800. There was also a marked improvement in equity through the needs based planning process of the Forum compared with the prior heavily politicised funding allocations.

An updated version in 2007 was used in negotiating new investment provided under the Expanded Health Services Delivery Initiative, or EHSDI, that accompanied the NT Emergency Response in July 2007. $50 million in new investment was provided in return for identified core services and corresponding core indicators. This took the system up to the current average of about $2500 per capita.

A third version, developed in 2011, is still to be implemented. In this version there are five domain areas of comprehensive primary health care under which there are more detailed descriptors of key services and programs.

The key gap areas that have been addressed in the third version are in early childhood, family support, alcohol, tobacco and other drugs, and aged and disability services. New funding coming into the NT in these areas is not currently being allocated under a core services approach or within the planning mechanism of the Forum.

The significance of having the NT Aboriginal Health Forum as an effective, high-level health planning body with the Aboriginal sector at the table cannot be understated.

It has delivered demonstrably better outcomes in the NT.

In 2009 an agreement was signed by the Forum partners, committing Government to transition all Aboriginal primary health care services in the NT to Aboriginal community control.

This was a landmark achievement.

And this year the Forum has established the Pathways to Community Control Working Group to progress the regionalisation process.

And in what is a kind of return to the future for AMSANT, we are revisiting one of our founding objectives in developing the Aboriginal Health Worker workforce, now, of course, referred to as Aboriginal Health Practitioners. However, this time it is in partnership with the NT Government through the Back on Track program and with the support of Forum.

AMSANT is greatly heartened by the continuing contributions and commitment of the NT and Commonwealth governments to Aboriginal primary health care and to the Forum.

And we are especially pleased by the launching of a new Framework Agreement for the NT that is coinciding with this Summit.

The final message I want to leave you with concerns the new National Aboriginal and Torres Strait Islander Health Plan. It is a good plan, as was the National Aboriginal Health Strategy all those years ago. History has shown that such plans fail at the implementation stage for three main reasons. Firstly, a lack of long-term commitment of funding. Secondly, a lack of commitment from states and territories to the concept of a national plan. And lastly, a lack of accountability.

We must learn from history and get this right. We need a ten-year funding commitment. We need the draft implementation plan to be endorsed by AHMAC. And we need key performance indicators that make everyone accountable. Annual reports on progress against these indicators should be tabled in Parliament as part of the Closing the Gap commitment.

Anything less would in our opinion be inviting failure.

And we simply can’t afford that.

Thank you.

NACCHO Aboriginal health news: Action plan to increase the number of Aboriginal Health Practitioners

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Pictured above AMSANT CEO John Paterson along with Aboriginal Medical Services Alliance NT chair Marion Scrymgour  and Central Australian Aboriginal Congress CEO Donna Ah Chee who will sit on the Back on Track taskforce

Minister for Health Robyn Lambley has today announced the Back On Track taskforce that will lead an action plan to increase the number of Aboriginal Health Practitioners in the Northern Territory.

“It was wonderful to see that the Country Liberals Government’s Aboriginal Health Practitioners Back on Track plan received support from all sides of politics in Parliament today,” Mrs Lambley said.

“In July I announced that we would boost the number of Aboriginal Health Practitioners across the Territory by 10 per cent a year.

“We are also committed to working with five key communities including Wadeye and Papunya to reach specific targets of Aboriginal Health Practitioners working in health clinics

“Today I am pleased to announce that I have so far asked Aboriginal Medical Services Alliance NT chair Marion Scrymgour, AMSANT CEO John Paterson and Central Australian Aboriginal Congress CEO Donna Ah Chee to sit on the Back on Track taskforce.

“I will chair the Taskforce and together we will concentrate on reaching these targets.

“We will work closely with community leaders, health managers and current Aboriginal Health Practitioners.

“I am committed to ensuring that representatives from the Department of Health visit communities that have been left without an Aboriginal Health Practitioner for years, to work with the community to encourage people to train as Aboriginal Health Practitioners.

“We need to know the barriers to successful outcomes. We need to find ways through those barriers, because as far as I am concerned, the result is too important to too many Territorians and their communities.

“We cannot afford to let this fall by the wayside and fail our remote areas as the previous Labor Government did, if we are to see real progress in Indigenous health outcomes and economic opportunity in our remote communities.

“Encouraging more Aboriginal Health Practitioners into health clinics across all areas of remote Australia is an important national health issue for Indigenous people.

“I’m looking forward to standing up in Parliament next year and reporting to the Assembly that we are well and truly back on track in the Territory.”

 

 

NACCHO Aboriginal health : Radical rethink of housing is key to a healthy future in remote communities: Scullion

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Opinion article by NIGEL SCULLION Minister for Indigenous Affairs

As published in The Australian March 2014

PICTURE ABOVE from THE STRINGER TONY ABBOTT MUST DO  :Inspection of Strategic Indigenous Housing and Infrastructure Programme work in Santa Teresa, Northern Territory, April 2011. Tony Abbott with Adam Giles, Alison Anderson and Nigel Scullion.

The National Partnership Agreement on Remote Indigenous Housing initiated by the former government in 2008, has not delivered on the promise of being a ‘long-term fix to the emergency’ in remote Indigenous housing.

 The byzantine national agreement arrangement is unwieldy and does not reflect the very different environments that need to be dealt with across the country.  Bilateral agreements with states and the Northern Territory may be a better way to go.

In very remote Australia, housing is central to meeting our priorities of getting kids to school, encouraging adults into work and providing for safe communities where the rule of law applies.

More than $2.5 billion was spent by the Rudd/Gillard government from 2008 through the national agreement.  Indigenous Australians tell me that they have not got value for money.

Delivery of housing in remote communities has been marked by delays, cost blowouts and bureaucracy.

New houses can cost more than $600,000 and have an average lifespan of only 10 to 12 years.  There have been poor standards of construction, unsatisfactory rental payment arrangements and sub-standard tenancy management.

Despite this massive expenditure there can be no argument that overcrowding remains chronic in remote Australia where there is no regular, functional housing market. There are no private rental options and no home ownership opportunities in most of these places. Most of these communities are dependent on Commonwealth funded public housing and this has been badly managed.

Residents of remote communities need to have the option, as others in Australia enjoy, of private rental and home ownership. Any strategies that we adopt must work towards that goal.

A radical rethink is overdue.

The states and Northern Territory governments must manage remote Indigenous housing just as they do other public housing.  Rental agreements should be in place and enforced; rents should be collected; any damage caused by occupants should be paid for by occupants; and, municipal services should be delivered to acceptable standards by the jurisdictions.

This is how social housing operates in non-remote areas.  Why should it be any different in remote Indigenous communities?

Why have we come to expect lower standards from housing authorities and residents in remote areas? Is it another layer of passive racism to accept less for Indigenous people in remote Australia?

Why are we building houses in places where land tenure arrangements prevent people from ever buying the house?

One aspect that I will be focusing on is how we can offer housing in a way that encourages mobility for those who want to move to areas with better employment opportunities.

I will be working with the states and Northern Territory governments to reform the current arrangements that are clearly failing residents of Indigenous communities.

In negotiations, I will want to set some conditions that might include:

  • moving relatively quickly towards building social housing only in those places that have appropriate land tenure arrangements in place for home ownership;
  • attractive mobility packages for remote residents, including portability of special housing and home ownership eligibility for those who want to move to areas with stronger labour markets;
  • ensuring rents are set at mainstream social housing rates and requirements of tenants are specified, understood and complied with;
  • a requirement for states and territories to apply their usual sale of social housing policy, as occurs in urban and regional areas, based on realistic market values; and
  • priority for the allocation of social housing to families in employment or where children are regularly attending school.

We also need to ensure that people in social housing are not adversely affected when taking up employment opportunities. This however is mainly an issue for mainstream social housing rather than remote Indigenous housing.

I know that a number of jurisdictions are focused on reform and I look forward to working with them.

However, if a state or territory is not up to the task, the Commonwealth might have to step in and take over delivery of social housing or contract providers with significant Indigenous and community involvement to do the job.

 

You can hear more about Aboriginal health and social determinants at the NACCHO SUMMIT June Melbourne Convention Centre

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The importance of our NACCHO member Aboriginal community controlled health services (ACCHS) is not fully recognised by governments.

The economic benefits of ACCHS has not been recognised at all.

We provide employment, income and a range of broader community benefits that mainstream health services and mainstream labour markets do not. ACCHS need more financial support from government, to provide not only quality health and wellbeing services to communities, but jobs, income and broader community economic benefits.

A good way of demonstrating how economically valuable ACCHS are is to showcase our success at a national summit.

SUMMIT WEBSITE FOR MORE INFO

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NACCHO 2014 Summit news: Partnership opportunities to sponsor NACCHO SUMMIT open today

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Why you should be considering

The 2014 NACCHO Healthy Futures Summit

for sponsorship and exhibition opportunities

The NACCHO 2014 Summit in June at the Melbourne Convention Centre offers an unparalleled opportunity for you to build relationships with NACCHO, our affiliates, stakeholders, government and our 150 Aboriginal community controlled health organisations that are committed to improving Aboriginal health and Closing the Gap by 2030.

The theme this year is:
“Investing in Aboriginal community controlled health makes economic sense.” After reading this newsletter and obtaining our Summit Partnership and Exhibition Opportunities prospectus, we think you will agree that a sponsorship investment in the NACCHO 2014 Health Summit “makes economic sense”.

Delegates at the Summit will be looking for partnerships, products and services that will help them improve delivery of comprehensive primary health care for their patients and communities and the overall cost efficiency of their service finance and administrative delivery.
Become a sponsor and take advantage of the many excellent sponsorship and exhibition opportunities that are available to promote your organisation at Australia’s most prestigious and well-attended Aboriginal health conference.

What you will achieve by sponsoring and exhibiting?

Achieve profile and brand enhancement through your association with, and support for Australia’s national authority in comprehensive Aboriginal primary health care.

Your involvement in, and contribution to the NACCHO 2014 Summit will help you meet your business objectives:

  • Network and exchange knowledge to better identify community wants and needs
  • Identify prospective health sector supply and partnership opportunities
  • Promote how your product or service will enhance the delivery of a sustainable Australian Aboriginal health sector
  • Support Australia’s Aboriginal health capabilities by providing insightful, relevant and practical information to your clientele about your brand values and attributes
  • Build community relationships and increase your company networks within the Australian Aboriginal health sector
  • Increase sales through direct promotion of your business
  • Promote your staff, products and services among the Aboriginal  health businesses and service industries

NACCHO 2014 SUMMIT Objectives

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NETWORK with the movers and shakers of the Aboriginal health sector

LEARN about the latest research and developments in Aboriginal health

SHARE experiences and ideas with forward thinkers

MEET with clinicians, researchers, industry innovators and others who share the desire to deliver better health to all
BENEFITS OF PARTNERSHIP NACCHO Member Services and state territory Affiliates will be attending the Summit so this is a perfect opportunity to interact with delegates first hand.
It is a unique opportunity for government, non-government organisations, and private industry to promote their products and services to NACCHO member services from all over Australia.

OPPORTUNITIES INCLUDE

To obtain a copy of the NACCHO SUMMIT 2014 SPONSORS PROSPECTUS call NACCHO now or complete enquiry form here – See more at: http://www.naccho.org.au/events/summit-sponsors-exhibition

PLATINUM EAGLE

Only ONE available (Price on application)

This is the premier opportunity for your organisation to become the major sponsor of the National Aboriginal Community Controlled Health Organisation’s (NACCHO) 2014 Healthy Futures Summit. Your organisation will have an exclusive profile for the period leading up to the Summit and at the event, with your organisation’s logo displayed in conjunction with the Summit logo.
THE BENEFITS

  • One complimentary exhibition stand (3m x 3m) in your preferred position from the spaces available.
  • The chance to prominently display your corporate banner (to be provided by your organisation) in the main plenary room during the Summit.
  • Your organization’s name/logo will be displayed in conjunction with the Summit logo in a prominent position at the Summit to ensure maximum exposure.
  • As well as the following acknowledgement; “The NACCHO2014 Healthy Futures Summit  is proudly supported by our Platinum Sponsor (your Company Name/logo Displayed Here)”.
  • Acknowledgement as Platinum Sponsor in publicity associated with the Summit marketing.
  • Your organisations logo will be prominently featured on a range of print materials (excluding pads, pens, name badges, lanyards and satchels).
  • Acknowledgement as the Platinum Sponsor of the Summit on the website with a short organisational profile and a link to your organization’s website.
  • Your logo will be displayed on the cover of the Summit program as the principle sponsor of the summit.
  • Your logo will be displayed on the Summit name badges as the principle sponsor of the summit.
  • An opportunity to address the Summit in plenary sessions.
  • The opportunity to include a suitable promotional item or a piece of literature (one flyer or brochure) in the Summit satchel.
  • Your organisation will receive two complimentary satchels with all the Summit information and materials.
  • Three complimentary full  Summit delegate registrations,
  • You will also receive an additional two complimentary to the Welcome Event and Dinner with a reserved table.
  • Your organisation will have access to SUMMIT delegate information

GOLD KANGAROO

Only ONE available (price on application) This is an opportunity for your organisation to become the Gold Sponsor of the NACCHO’s 2013 Summit. Your organisation will have a high exposure for the period leading up to the event, with your organisation’s name and logo displayed in conjunction with the Summit logo.

TRADE EXHIBITION BOOTH

$ 3,520 Inc. GST

You will have the opportunity to offer your products and services to the entire delegation as well as all of the summit break hospitality will be held in the exhibition area. Delegates will also be encouraged to visit all stands if the Expo passport sponsorship is taken up.

SPACES ARE LIMITED AND SELL FAST (as at 9 March only 24 left)

  SILVER PLATYPUS and BANDICOOT on PASSPORTS Only TWO Available

This is an opportunity not to be missed, become one of two Silver Platypus and Bandicoot Passport Sponsors of the NACCHO2014 Healthy Futures Summit. Each delegate will be given your passport at the beginning of the Summit and, if they visit of the booths and have their passport stamped they are eligible to win one of several major prizes drawn at the end of the Summit.
MORNING & AFTERNOON BREAK

Only Three Available Become the Morning & Afternoon Break Sponsor for a day at the NACCHO 2014 Summit
LUNCH

Only THREE Available Become the Lunch Sponsor of the NACCHO 2014 Summit for a day.
SATCHEL

Only ONE Available

Get your business logo mobile, as this sponsorship option allows your organisation to become the Satchel Sponsor. These quality satchels will be handed to all delegates and exhibitors at the Summit.
PADS & PENS

Only One Available

Take a firm grasp of this marketing opportunity. Become the pads & pens Sponsor at the NACCHO 2014 Summit.
ADVERTISING in Summit handbook

For an additional cost you can have an advertisement printed in the Summit Handbook

. FULL PAGE ADVERTISEMENT                   $ 700 + GST

HALF PAGE ADVERTISEMENT                   $ 500 + GST (must be landscape)

QUARTER PAGE ADVERTISEMENT           $ 400 + GST (must be portrait)

All advertisements will be printed in colour and must be according to your specifications.
For further information and pricing contact:

Josh Quarmby NACCHO SUMMIT TEAM Partnership:

Contact: 02 6246 9345

or email

Or for more information complete the enquiry form HERE

NACCHO Aboriginal Health : Senator Nova Peris pushes campaign on alcohol-related domestic violence

2014-03-04 10.52.05

Senator Peris said in the Northern Territory an indigenous woman is 80 times more likely to be hospitalised for assault than other Territorians.

“I shudder inside whenever I quote that fact because it makes me picture the battered and bloodied women we see far too often in our hospitals.

“Every single night our emergency departments in the Northern Territory overflow with women who have been bashed.”

Picture above :Senator Nova Peris along with Opposition colleagues  addressing the NACCHO board at Parliament House Canberra this week

LABOR’S first indigenous MP Nova Peris has challenged the Australian Medical Association to advocate for more action in tackling alcohol-related domestic violence.

In a powerful speech, Senator Peris said alcohol-related domestic violence was on the rise and ruining the lives of Aboriginal women.

She told the launch of the AMA’s national women’s health policy that the AMA must use its high standing in the community to “advocate for more action in tackling alcohol-related domestic violence”.

Report from PATRICIA KARVELAS   The Australian

SEE AMA Position Statement on Women’s Health below

“Today I call on the AMA to formally adopt a policy position that supports the principle that people who have committed alcohol-related domestic violence be banned from purchasing alcohol at the point of sale.

“The technology to implement point-of-sale bans exists; it is cost effective and has been proven to work.”

Senator Peris said in the Northern Territory an indigenous woman is 80 times more likely to be hospitalised for assault than other Territorians.

“I shudder inside whenever I quote that fact because it makes me picture the battered and bloodied women we see far too often in our hospitals.

“Every single night our emergency departments in the Northern Territory overflow with women who have been bashed.”

In 2013, domestic violence assaults increased in the Northern Territory by 22 per cent, she said.

She criticised the incoming NT government’s August 2012 decision to scrapped the banned drinker register.

“For those of you who may not be familiar with the banned drinker register, or BDR as it is also known, it was an electronic identification system which was rolled out across the Northern Territory.

“This system prevented anyone with court-ordered bans from purchasing takeaway alcohol — including people with a history of domestic violence.

“Around twenty-five hundred people were on the banned drinker register when it was scrapped. “Domestic violence perpetrators were again free to buy as much alcohol as they liked. As predicted by police, lawyers and doctors, domestic violence rates soared.”

Senator Peris said she had met with doctors, nurses and staff from the emergency department in Alice Springs and they confirmed these statistics represent the true predicament they faced every day.

“Every night the place is awash with the victims of alcohol fuelled violence, with the vast majority of victims being women.”

She said the Northern Territory faces enormous issues with foetal alcohol spectrum disorder.

“We have such high rates of sexually transmitted infections, especially and tragically, with children.

“Rates of smoking are far too high, and diets are poor and heart disease is widespread.”

Senator Peris’s speech was well received by the AMA, which committed to taking on her challenge.

AMA SHINES LIGHT ON VIOLENCE AGAINST WOMEN AND THE HEALTH NEEDS OF DISADVANTAGED AND MINORITY GROUPS OF WOMEN

AMA Position Statement on Women’s Health 2014

The AMA today released the updated AMA Position Statement on Women’s Health.

The Position Statement was launched at Parliament House in Canberra by the Minister Assisting the Prime Minister for Women, Senator Michaelia Cash, Senator for the Northern Territory, Nova Peris, and AMA President, Dr Steve Hambleton.

Dr Hambleton said that all women have the right to the highest attainable standard of physical and mental health.

“The AMA has always placed a high priority on women’s health, and this is reflected in the breadth and diversity of our Position Statement,” Dr Hambleton said.

“We examine biological, social and cultural factors, along with socioeconomic circumstances and other determinants of health, exposure to health risks, access to health information and health services, and health outcomes.

“And we shine a light on contemporary and controversial issues in women’s health.

“There is a focus on violence against women, including through domestic and family violence and sexual assault.

“These are significant public health issues that have serious and long-lasting detrimental consequences for women’s health.

“It is estimated that more than half of Australian women have experienced some form of physical or sexual violence in their lifetimes.

“The AMA wants all Australian governments to work together on a coordinated, effective, and appropriately resourced national approach to prevent violence against women.

“We need a system that provides accessible health service pathways and support for women and their families who become victims of violence.

“It is vital that the National Plan to Reduce Violence against Women and their Children is implemented and adequately funded.”

Dr Hambleton said the updated AMA Position Statement also highlights areas of women’s health that are seriously under-addressed.

“This includes improving the health outcomes for disadvantaged groups of women, including Aboriginal and Torres Strait Islander women, rural women, single mothers, and women from refugee and culturally and linguistically diverse backgrounds,” Dr Hambleton said.

“We also highlight the unique health issues experienced by lesbian and bisexual women in the community.”

Dr Hambleton said that the AMA recognises the important work of Australian governments over many years to raise the national importance of women’s health, including the National Women’s Health Policy.

“There has been ground-breaking policy in recent decades, but much more needs to be done if we are to achieve high quality equitable health care that serves the diverse needs of Australian women,” Dr Hambleton said.

“Although women as a group have a higher life expectancy than men, they experience a higher burden of chronic disease and tend to live more years with a disability.

“Because they tend to live longer than men, women represent a growing proportion of older people, and the corresponding growth in chronic disease and disability has implications for health policy planning and service demand.”

The Position Statement contains AMA recommendations about the need to factor in gender considerations and the needs of women across a range of areas in health, including:

  •  health promotion, disease prevention and early intervention;
  •  sexual and reproductive health;
  •  chronic disease management and the ageing process;
  •  mental health and suicide;
  •  inequities between different sub-populations of Australian women, and their different needs;
  •  health services and workforce; and
  •  health research, data collection and program evaluation.

Background:

  • cardiovascular disease – including heart attack, stroke, and other heart and blood vessel diseases – is the leading cause of death in women;
  •  for women under 34 years of age, suicide is the leading cause of death; and
  • in general, women report more episodes of ill health, consult medical practitioners and other health professionals more frequently, and take medication more often than men.

The AMA Position Statement on Women’s Health 2014 is at

https://ama.com.au/position-statement/womens-health

NT alcohol crackdown makes gains, but questions over mandatory rehabilitation remain

By Michael Coggan NT ABC

It appears that stationing police officers outside bottle shops in regional towns in the Northern Territory has had a significant impact on alcohol consumption.

The latest figures show consumption has dropped to the lowest level on record, but the statistics do not include the impact of the mandatory rehabilitation policy or punitive protection orders.

The ABC has investigated the situation as a new federal parliamentary inquiry is promising to test the evidence.

On a weeknight in Darwin’s city centre, locals and tourists mingle at Monsoons, one of the pub precinct’s busy watering holes.

Less than a block away, six women have found their own drinking place under the entrance of an office building, sheltered from monsoonal rain.

Most of them are visiting from Indigenous communities on Groote Eylandt in the Gulf of Carpentaria. They’re “long-grassing” – living rough on the city streets.

Northern Territory Labor Senator Nova Peris is here to talk to them.

One of the women, from the Torres Strait Islands, tells the Senator how she is trying to get through a catering course while struggling with homelessness and alcoholism.

“I am doing it. I’m trying to get up and I’m finding it hard,” she said.

In an interview after talking to the “long-grassers”, Senator Peris emphasised how homelessness makes alcohol abuse among Aboriginal people more obvious than alcohol use in the non-Indigenous community in Darwin.

“Those ladies, they weren’t from Darwin, they were from communities that came in, so they’re homeless and they drink when they come into town and it’s easy to get alcohol [in town].”

Senator Peris also blames alcohol abuse for much of the poor health in Aboriginal communities.

“When you look at alcohol-related violence, when you look at foetal alcohol syndrome, when you look at all the chronic diseases, it goes back to the one thing and it’s commonly known as the ‘white man’s poison’,” she said.

Alcohol-related hospital admissions increase, senator says

The Northern Territory has long grappled with the highest levels of alcohol abuse in the country, but figures released recently by the Northern Territory Government show the estimated per capita consumption of pure alcohol dropped below 13 litres last financial year for the first time since records started in the 1990s.

Territory Country Liberals Chief Minister Adam Giles believes a more targeted response by police has made a difference.

But Senator Peris says data released last week tells a different story.

Senator Peris has quoted figures showing an 80 per cent increase in alcohol-related hospital admissions over the past 14 months as evidence that the previous Labor government’s banned drinker register was working.

The Territory Government scrapped the BDR when it won power in September 2012.

Alice Springs-based associate professor John Boffa from the Peoples Alcohol Action Coalition wants to see the consumption figures verified.

“If it’s true, it’s very welcome news and it would reflect the success of the police presence on all of the takeaway outlets across the territory,” he said.

Parties, police association at odds

In regional towns where alcohol-fuelled violence is high, police have been stationed outside bottle shops to check identification.

Anyone living in one of the many Aboriginal communities or town camps where drinking is banned faces the prospect of having their takeaway alcohol seized and tipped out.

Northern Territory Police Association president Vince Kelly believes police resources are being concentrated on doing the alcohol industry’s work.

Mr Kelly has also questioned the will of the two major political parties to introduce long-term alcohol supply reduction measures since it was revealed that the Australian Hotels Association made $150,000 donations in the lead-up to the last Territory election.

“No-one I know gives away $150,000 to someone and doesn’t expect something back in return,” he said.

But Mr Giles dismisses Mr Kelly’s view.

“I don’t respond to any comment by Vince Kelly from the Police Association, I think that he plays politics rather than trying to provide a positive outcome to change people’s lives in the territory,” he said.

Giles stands by alcohol rehab program

The Federal Indigenous Affairs Minister has asked a parliamentary committee to investigate the harmful use of alcohol in Indigenous communities across the country.

The committee is expected to examine the application of new policies in the Territory, including mandatory alcohol treatment that was introduced in July 2013.

People taken into police protective custody more than three times in two months can be ordered to go through a mandatory three-month alcohol rehabilitation program.

The figures showing a drop in consumption pre-date the introduction of mandatory rehabilitation but Mr Giles believes the policy is making a difference.

So far there is not enough evidence to convince Professor Boffa that mandatory treatment is making any difference.

“We just don’t have publically available data on the numbers of people who have completed treatment, [or] how long people who have completed treatment have remained off alcohol,” he said.

One of the women from Groote Eylandt explained how she had been locked up to go through the mandatory treatment program but was now back on the grog.

“I was there for three months and we didn’t like it,” he said.

The Chief Minister’s political stablemate, Indigenous Affairs Minister Nigel Scullion, has commended the Territory Government for using a mix of police intervention and mandatory rehabilitation, but says jail is not the solution.

“We can’t keep treating people who are sick as criminals. However annoying they might be, people who are alcoholics are ill,” he said.

Alcohol Protection Orders seen to criminalise alcoholism

Police were given the power to issue Alcohol Protection Orders to anyone arrested for an alcohol-related offence, attracting a jail sentence of six months or more.

Aboriginal legal aid services have criticised the orders for criminalising alcoholism.

Priscilla Collins from the North Australian Aboriginal Justice Agency says the orders are predominantly being handed out to Aboriginal people, threatening jail time if they are breached.

“Alcohol protection orders are really being issued out like lolly paper out on the streets. You can be issued one just for drinking on the street, for drink driving. We’ve already had 500 handed out this year,” she said.

Mr Kelly has welcomed the introduction of APOs as a useful tool but has questioned what they will achieve.

“The community and the Government and everybody else needs to ask itself what the end game is,” he said.

“Are we going to end up with even fuller jails? No matter what legislation we introduce we’re not going to arrest our way out of alcohol abuse and Aboriginal disadvantage in the Northern Territory.”

Do you know more? Email investigations@abc.net.au

 

 

 

You can hear more about Aboriginal women’s health  at the NACCHO SUMMIT

summit-2014-banner

The importance of our NACCHO member Aboriginal community controlled health services (ACCHS) is not fully recognised by governments.

The economic benefits of ACCHS has not been recognised at all.

We provide employment, income and a range of broader community benefits that mainstream health services and mainstream labour markets do not. ACCHS need more financial support from government, to provide not only quality health and wellbeing services to communities, but jobs, income and broader community economic benefits.

A good way of demonstrating how economically valuable ACCHS are is to showcase our success at a national summit.

SUMMIT WEBSITE FOR MORE INFO

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NACCHO CTG member response :NT only jurisdiction on track to close the gap by 2031: Congress Alice Springs

Donna Ah chee

Closing the Gap is working but requires long term commitment and investment

“The NT is the only jurisdiction currently on track to close the gap by 2031.

This achievement is in large part, the result of governments working in genuine partnership with Aboriginal community-controlled health services and investing new funds where they are most needed.

This is strong evidence that the significant investment in the NT, especially the investment in Aboriginal primary health care, is working”,

 Ms Donna Ah Chee (pictured above left )the CEO of Congress, NACCHO board member and former CEO of NACCHO

The Central Australian Aboriginal Congress Aboriginal Corporation welcomed the latest Closing the Gap report card, calling for an emphasis on continued commitment and long-term investment by the Council of Australian Governments to meet meaningful targets in Aboriginal disadvantage.

“Overall there has only been a small improvement across the nation in closing the life expectancy gap for Aboriginal people. However, looking at averages across the nation does not tell the story of significant improvement in Aboriginal life expectancy rates in the Northern Territory. The NT is the only jurisdiction currently on track to close the gap by 2031. This achievement is in large part, the result of governments working in genuine partnership with Aboriginal community-controlled health services and investing new funds where they are most needed. This is strong evidence that the significant investment in the NT, especially the investment in Aboriginal primary health care, is working”, said Ms Donna Ah Chee the CEO of Congress.

“The fact that the nation is on track to achieve its goal to halve the gap in year 12 educational attainment by 2020 is important. Achieving better educational outcomes is largely a precursor to stable, meaningful employment at a reasonable income level. However, the improvement in education is not uniform and a lot more needs to be done in remote communities across the NT.

“Although the addition of a new target on closing the gap in school attendance rates may be useful, Congress is disappointed that the new target was not more directly focused on closing the gap in actual Educational outcomes. Attendance at school is important but it it’s only a means to a successful outcome which is completing year 12 studies and being fully literate and numerate. If children have entered school without the developmental capacity to learn and do well then attendance alone will not be sufficient to address the gap in educational and employment outcomes.

“Congress suggested that the new target could have been to close the gap in the Australian Early Development Index scores of children aged five years, as this is the key to closing the gap in both school attendance and successful educational outcomes. We need a “bottom up” strategy to addressing school attendance which ensures our kids enter school capable and ready so that school is where they want to be not where they have to be.

“Congress also welcomed the improvement in Aboriginal child mortality rates.

“It is a concern that there has been no progress on some targets, especially the employment target, but there is a wide ranging review currently underway on this issue which will hopefully lead to some useful new approaches. In the meantime, it is vital that all Australian governments, through COAG, recommit to the long term cooperation and  investment that is clearly working though the Closing the Gap National Partnership Agreements”, said Ms Ah Chee.

For more information, contact Emily MacKenzie, Communications Officer, on 8953 7814 or by email at emily.mackenzie@caac.org.au.

NACCHO Aboriginal health debate : Chronic drinking problem in the NT costs about $642 million annually

Alice

One new policy that does appear effective is stationing police officers outside bottleshops. Regrettably this has also stirred up racial tension. The officers check drinkers’ IDs to see if they live in a proscribed area, and confiscate their purchases if they do. John Boffa (Congress Aboriginal Health ) a spokesman for the People’s Alcohol Action Coalition, estimates reductions in domestic violence of up to 50 per cent in Alice Springs when police cover all 11 liquor outlets at once.

Priscilla Collins, chief executive of the North Australian Aboriginal Justice Agency, thinks both AMT and APOs unfairly target the most disadvantaged, who are often also the most visible. “They will probably end up going back to the long grass,”

IF the Northern Territory were a country, it would rank alongside vodka-soaked ex-Soviet republics in terms of per capita alcohol consumption; not long ago it would have been second in the world.

 Refer NACCHO NT AMSANT grog summit news:

Four major outcomes on alcohol policy and its impact on Aboriginal people and communities

PICTURE :Police on duty outside a Northern Territory bottleshop. ‘The (alcohol) industry is now being propped up by the Alice Springs police force,’ says head of the police union Vince Kelly. Picture: Amos Aikman Source: News Limited

Alcohol abuse costs the NT about $642 million annually in police time, corrections, judicial support, medical treatment and lost productivity – equivalent to roughly $4000 per person or 4 1/2times the national average – according to research quoted by the government last year. The latest figures show per capita alcohol consumption is again on the rise, ending a six-year decline.

Territory drivers are 20 times more likely than the national average to be caught over the limit; booze is a factor in many road deaths. A majority of Territory assaults involve alcohol and the Territory’s assault victimisation rate is more than 50 per cent above the rest of the nation’s.

In 2011-12, indigenous women were 18 times more likely to be bashed than non-indigenous women, and four times more likely than the Territory average.

Last financial year saw almost 40 per cent more alcohol-related assaults and almost 60 per cent more domestic violence related assaults than the equivalent period five years ago.

Since the Country Liberals took office 18 months ago, Aboriginal groups and legal and health policy experts have accused the Territory government of criminalising drunkenness, ignoring evidence and favouring the interests of the alcohol industry.

The government insists its policies are both appropriate and working, though many cracks have emerged. The CLP campaigned on a pledge to cut crime by 10 per cent annually – which by a slip of the tongue quickly became 10 per cent in a four-year term once it took office. CLP backbencher Gary Higgins recently acknowledged MPs are receiving a “barrage of complaints” about alcohol abuse from the community. His comments drew a quick rebuke from Chief Minister Adam Giles, who said: “We know that there are issues with alcohol in our society, but anyone who has a good look at the statistics will see that things are getting better.”

After repeatedly dodging questions about the saga unfolding on his doorstep, federal Indigenous Affairs Minister and NT senator Nigel Scullion proposed a sweeping national inquiry into drinking habits. The following day he appeared to have been overruled by his colleagues in favour of a tighter probe into Aboriginal drinking that will scrutinise the CLP policies more closely. Giles has already suggested any inquiry would be “navel gazing”. Nevertheless, the process offers his government an opportunity to gracefully adjust its course.

The CLP’s first act in office was to abolish Labor’s Banned Drinker Register, a point-of-sale supply restriction designed to curb heavy drinking. For almost a year, while the new government convulsed with internal ructions, nothing replaced the BDR. Then less than a month after Giles took power in a coup in March, his government unveiled a forced alcohol rehabilitation program called Alcohol Mandatory Treatment. The scheme, which has been running for seven months, involves locking up habitual drinkers in treatment centres with fences and guards.

Associated legislation was passed in the face of vocal opposition. At about $43,000 per drinker treated, AMT is more expensive than many private rehabilitation clinics. Experts think 5 per cent success would be good going. More than 150 people have completed the program; the government has established 120 beds. Alcohol Rehabilitation Minister Robyn Lambley says some patients have had their lives changed, but others are known to have relapsed.

Before Christmas a system of on-the-spot alcohol bans, Alcohol Protection Orders, was also legislated, again despite opposition. These affect people charged with, but not necessarily convicted of, offences in which alcohol was deemed a factor.

The government argues these policies transfer responsibility from society to drinkers, but important figures, such as head of the NT police union Vince Kelly, argue that is a furphy. “If you’re an alcoholic you haven’t got (personal responsibility) in the first place, and if you’re an intergenerational alcoholic you probably don’t know what the concept means.”

Not long ago a doctor who played a key role in establishing AMT, Lee Nixon, walked out in disgust. “A large number of (AMT patients) had little understanding of the process, and at the end of the time when they were there, were still asking, ‘Why am I here?’,” Nixon told ABC’s Lateline. “At the outset it was clear that we were introducing a program with no evidential base for effectiveness.” One drinker had her treatment order overturned by a court on the grounds she received it without proper legal representation. Justice groups say few drinkers appear before the AMT Tribunal with a lawyer.

Priscilla Collins, chief executive of the North Australian Aboriginal Justice Agency, thinks both AMT and APOs unfairly target the most disadvantaged, who are often also the most visible. “They will probably end up going back to the long grass,” she says.

Shortly after taking up his post, Alcohol Policy Minister Dave Tollner openly acknowledged one of AMT’s goals was to push drinkers to “go and hide out in the scrub”. AMT is now being reviewed.

The CLP has trenchantly refused to contemplate imposing any new supply restrictions. Giles told a gathering of hoteliers drinking was a “core social value”, while Tollner said Labor had treated publicans “akin to heroin traffickers”. The latest round of annual political returns to the Australian Electoral Commission reveal the alcohol industry’s main lobby, the Australian Hotels Association, has emerged as the Territory’s largest political donor. The organisation contributed $300,000, split between the major parties in the lead up to the August 2012 Territory election. According to an analysis of declared donations, the lobby donated almost 14 times as much per head of population in the Territory while the BDR was in place than it has in any other jurisdiction in the past decade.

At the time it was abolished there was little evidence clearly supporting the BDR. However it has since become clearer that although policy did not turn around increases in alcohol-related harm and violence as promised, it may have blunted them. Some quite senior CLP figures talk privately about bringing the BDR back.

One new policy that does appear effective is stationing police officers outside bottleshops. Regrettably this has also stirred up racial tension. The officers check drinkers’ IDs to see if they live in a proscribed area, and confiscate their purchases if they do. John Boffa, a spokesman for the People’s Alcohol Action Coalition, estimates reductions in domestic violence of up to 50 per cent in Alice Springs when police cover all 11 liquor outlets at once.

However the approach is a de facto supply restriction, with responsibility for enforcement transferred from the liquor retailer to the public service, as Kelly points out: “The (alcohol) industry is now being propped up by the Alice Springs police force.”

Combined with AMT’s high price tag, the government’s measures do not look at all cost effective. Assuming the number of people taking up drinking is proportional to population growth overall, the government would need at least five times the present number of AMT beds just to keep the number of alcoholics stable. The cost of that would exceed $1 billion by the end of the decade, or roughly 20 per cent of last year’s Territory budget.

Higgins called for a bipartisan inquiry with measures his government officially opposes – an alcohol floor price, shorter opening hours and BDR-like supply controls – put back on the table. “While they do inconvenience a lot of people, all of them should be considered,” he said. Kelly thinks there is a “gaping hole” in public policy around alcohol supply issues. “Neither the Labor government or the CLP government has covered itself in glory when it comes to that type of thing because they’re simply too close to the industry,” he says.

“There has got to be some serious question about whether (an inquiry) is warranted.”

A serious investigation would need to consider not just the efficacy of a range of policies, but the circumstances in which they are applied. Alcohol bans in remote communities push drinkers into towns, where their drinking often worsens. Proscribed urban areas leave residents who can legally buy takeaway alcohol unable to legally drink it. Stationing police outside bottleshops increases familial pressure on those living in non-proscribed areas to become involved in the alcohol supply trade; anecdotal evidence suggests the black market is thriving.

Some federally administered draft alcohol management plans are stuck in limbo, in part because it is unclear what the basic requirements are for Aboriginal communities to responsibly manage alcohol themselves. Community leaders often blame disenfranchisement for their giving up on the task. Many people familiar with these issues say the solutions lie not in textbooks or boardroom chats, but in the lives of Aboriginal people; another desktop study will not help.

It is also worth considering whether alcohol-related harm can be reduced to acceptable levels soon, or just mitigated and hidden. Not even the last of those has been accomplished so far. NT Attorney General John Elferink argues for stricter controls on welfare to break the link between welfare dependency and drinking: “We can build massive institutions to deal with alcoholism, but while the federal government pours free money into our jurisdiction, spending millions of dollars every fortnight, we as a government are going to be spending millions of dollars every fortnight cleaning up the mess.” Without action on several of these fronts, the NT’s alcohol abuse crisis looks likely to get worse.

NACCHO Aboriginal health news; Aboriginal organisations to put communities back in control

131031 - Media Release re NGO principles endorsement (EMBARGOED UNTIL MIDNIGHT 30 October)_Page_1

An alliance of Aboriginal organisations and non-Aboriginal NGOs will today launch a set of principles aimed at empowering Aboriginal organisations and communities in the NT to take control of their futures.

DOWNLOAD THE PRINCIPLES HERE

“Today a number of local, national and international NGOs have publically endorsed a set of principles which will guide partnership centred approaches for NGOs working in Aboriginal communities” said Ms Priscilla Collins, spokesperson for Aboriginal Peak Organisations NT (APO NT). (A copy of the principles is attached.)

“These non-Aboriginal NGOs have agreed to work together with Aboriginal organisations and communities to promote Aboriginal community-control of service delivery. It’s about putting Aboriginal people back in the driver’s seat”, said Mr John Paterson, spokesperson for APO NT.

Organisations endorsing the principles include national and international NGOs engaged in delivery of health and community services in the Northern Territory. A full list of NGOs that have endorsed the principles is below.

Development of the principles was informed by a forum in Alice Springs in February that brought together sixty participants from twenty-seven non-Aboriginal NGOs and six NT Aboriginal representative organisations – the first gathering of its kind in the NT. The forum acknowledged that there are a number of NGOs that already have good working relationships with Aboriginal organisations, but this is not systematic.

The principles present significant opportunities for these organisations to learn from each other, create better partnerships and working relations with Aboriginal organisations operating at the ground level and achieve better outcomes for communities.

Organisations leading the initiative include APO NT, Strong Aboriginal Families, Together (SAF,T), the National Congress of Australia’s First Peoples, the Australian Council of Social Service (ACOSS) and the NT Council of Social Service (NTCOSS).

“It is important that Aboriginal and non-Aboriginal organisations work side by side in partnership to put Aboriginal people back in control of service delivery in their communities,” said Mr Lindon Coombes, CEO of The National Congress of Australia’s First Peoples (Congress).

The general consensus reached at the Alice Springs Forum was that the formal endorsement of the principles by organisations should effectively operate as a voluntary code.

“This work represents significant leadership and partnership from both the Aboriginal and non-Aboriginal NGO sector, in pioneering new ways to work together to get the best possible outcomes for Aboriginal people in remote NT communities,” said Mr Simon Schrapel, President of ACOSS.

The next stage of the collaboration will be to operationalise the principles.

“We look forward to working together to develop operational guidelines for how these important principles will work in practice,” said Ms Wendy Morton, Executive Director of NTCOSS.

“This is something that Aboriginal agencies have been wanting for a long time. These principles will guide the development of true partnerships that will result in better understanding and outcomes for all concerned,” said Terry Chenery, Acting CEO of SAF,T.

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