2017 Report Card on Indigenous Health

  ” Report Cards can be daunting, they can be challenging, and they can be inspiring – but above all, they are valuable.

They help provide foundations for informed decision making – something I thoroughly endorse.

And in the case of Indigenous health, they highlight issues that many of the more than 27,000 registered doctors, students and advocates who the AMA represents, deal with every day.

So I commend the AMA on its 2017 Report Card on Indigenous Health – the latest in a series of highly authoritative and respected reports on the crucial issue of Aboriginal Aboriginal and Torres Strait Islander health.’

The Hon Ken Wyatt launch speech see in full Part 5

Part 3 INDIGENOUS EAR HEALTH – AMA CALLS FOR ACTION TO END A ‘LIFE SENTENCE’ OF HARM

AMA Indigenous Health Report Card 2017: A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities

The AMA today issued a challenge to all Australian governments to work with health experts and Indigenous communities to put an end to the scourge of poor ear health – led by chronic otitis media – affecting Aboriginal and Torres Strait Islander Australians.

At the launch of the 2017 AMA Indigenous Health Report Card in Canberra today, AMA President, Dr Michael Gannon, said the focus on ear health was part of the AMA’s step by step strategy to create awareness in the community and among political leaders of the unique and tragic health problems that have been eradicated in many parts of the world, but which still afflict Indigenous Australians.

The Report Card – A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities – was launched by the Minister for Indigenous Health, The Hon Ken Wyatt AM.

“It is a tragedy that, in 21st century Australia, poor ear health, especially chronic otitis media, is still condemning Indigenous people to a life sentence of hearing problems – even deafness,” Dr Gannon said.

“Chronic otitis media is a disease of poverty, linked to poorer social determinants of health including unhygienic, overcrowded conditions, and an absence of health services.

“It should not be occurring here in Australia, one of the world’s richest nations. It is preventable.

“Otitis media is caused when fluid builds up in the middle ear cavity and becomes infected.

“While the condition lasts, mild or moderate hearing loss is experienced. If left untreated, it can lead to permanent hearing loss.”

Dr Gannon said that, for most non-Indigenous Australian children, otitis media is readily treated.

“The condition in the non-Indigenous population passes within weeks, and without long-term effects.

“But for many Aboriginal and Torres Strait Islander children, otitis media is not adequately treated. It persists in chronic forms over months and years. At worst, it is there for life.”

Estimates show that an average Indigenous child will endure middle ear infections and associated hearing loss for at least 32 months, from age two to 20 years, compared with just three months for a non-Indigenous child.

Dr Gannon said the AMA wants a national, systematic approach to closing the gap in the rates of chronic otitis media between Indigenous and non-Indigenous infants and children in Australia.

“We urgently need a coordinated national response to the lasting, disabling effects and social impacts of chronic otitis media in the Indigenous adult population,” Dr Gannon said.

“We urge our political leaders at all levels of government to take note of this Report Card and be motivated to act to implement solutions.”

The AMA calls on Australian governments to act on three core recommendations:

Recommendation 1:

That a coordinated national strategic response to chronic otitis media be developed by a National Indigenous Hearing Health Taskforce under Indigenous leadership for the Council of Australian Governments (COAG). This should build on and incorporate existing national and State and Territory level responses and include:

•  a critical analysis of current approaches, and to identify the range of reasons that current chronic otitis media crisis persists;
•  the development of a COAG Closing the Gap target about new cases of chronic otitis media and hearing loss in Indigenous infants and children under 12 years of age;
•  a national otitis media surveillance program to monitor prevalence and support a targeted and cost-effective national response;
•  a significantly increased focus on prevention – both primordial prevention with a focus on the social determinants of the disease, and primary prevention including family and community health literacy about otitis media;
•  a central, adequately funded and supported role for primary health care and Aboriginal Community Controlled Health Services (ACCHS) in a systematic approach to the prevention, detection, treatment, and management of otitis media; and
•  access to ear, nose and throat (ENT) specialists, particularly within ACCHS and other Indigenous-specific primary health care services, based on need

Recommendation 2:

That the national approach proposed in Recommendation 1 include addressing the wider impacts of otitis media-related developmental impacts and hearing loss, including on a range of areas of Indigenous disadvantage such as through the funding of research as required. This includes:

•  a national approach to supporting Indigenous students with hearing loss that aims to remove disadvantage that they may face in educational settings;
•  a national approach to developing hearing loss-responsive communication strategies in all government and non-government agencies providing services to Indigenous people including – but not limited to – health, mental health, justice, and employment services; and
•  exploring the support role of the National Disability Insurance Scheme (NDIS) to Indigenous people with hearing loss

Recommendation 3:

That attention of governments be re-directed to the recommendations of the AMA’s 2015 Indigenous Health Report Card, which called for an integrated approach to reducing Indigenous imprisonment rates by addressing underlying causal health issues (including otitis media and related hearing loss and developmental impacts), with the expectation of appropriate action. The health issues to be addressed include mental health problems, cognitive disabilities, alcohol and drug problems, hearing loss, and developmental impacts associated with otitis media. 3

Part 4 : Background

•  Indigenous children experience some of the highest rates of chronic suppuratives otitis media (CSOM) in the world.
•  Chronic otitis media in infancy and childhood can affect Indigenous peoples’ adult health and wellbeing as much as cardiovascular disease or diabetes, and its effects are significant ‘life sentences’ of disability.
•  Chronic otitis media has life-long impacts that bring greater risk of a range of adult social problems, not the least of which is incarceration. The association of chronic otitis media-related hearing loss and the high rates of Indigenous imprisonment has been noted for over 25 years now – but with little action evident

The AMA Indigenous Health Report Card 2017 – A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities – is at https://ama.com.au/article/2017-ama-report-card-indigenous-health-national-strategic-approach-ending-chronic-otitis

Part 5 Ken Wyatt Speech

I’d like to acknowledge the traditional custodians of the land on which we meet – the Ngunnawal and Ngambri people – and pay my respects to their Elders, past and present.

I thank AMA President Dr Michael Gannon and Associate Professor Kelvin Kong of the Royal Australasian College of Surgeons for their words, and acknowledge:

• AMA Secretary-General Anne Trimmer
• Representatives from the College,
• the AMA’s Indigenous Health Taskforce,
•  the National Aboriginal Community Controlled Health Organisation (NACCHO), and Aboriginal medical centre

My Parliamentary colleagues, and distinguished guests.

Report Cards can be daunting, they can be challenging, and they can be inspiring – but above all, they are valuable.

They help provide foundations for informed decision making – something I thoroughly endorse.

And in the case of Indigenous health, they highlight issues that many of the more than 27,000 registered doctors, students and advocates who the AMA represents, deal with every day.

So I commend the AMA on its 2017 Report Card on Indigenous Health – the latest in a series of highly authoritative and respected reports on the crucial issue of Aboriginal Aboriginal and Torres Strait Islander health.

Over the past 15 years, this annual Report Card has highlighted priority issues such as low birth weight babies, institutionalised inequities and racism, government funding, medical workforce, rheumatic heart disease, and best practice in primary care.

I welcome this year’s Report Card, with its focus on ear health and hearing loss, which can have devastating impacts.

Compounding this is the fact that the most common ear afflictions are almost entirely preventable.

For all the wrong reasons, ear disease is highly prevalent in Indigenous children and repeated episodes can lead to hearing loss and deafness, if not treated early.

The impact of this can have lifelong effects on education, employment and wellbeing.

Nowhere have these consequences been more evident than in my home State of Western Australia, where significant numbers of hearing-impaired Aboriginal people have been unable to secure mining boom jobs, despite their best efforts and support from major companies.

While I agree with Dr Gannon that this Report Card can be ‘a catalyst for government action to improve ear health among Aboriginal and Torres Strait Islander people’, I would like to point out that the Turnbull Government has much work under way aimed at improving Indigenous ear health.

We are resolutely committed to turning this problem around.

The AMA’s Report Card calls for a national, systematic and strategic approach to address chronic otitis media and its impacts in Indigenous communities, and for this approach to be reflected in the Council of Australian Governments Closing the Gap targets.

I note the AMA recommends that any such national response be developed for COAG by a National Indigenous Hearing Health Taskforce, importantly under Indigenous leadership, and that it should build on and incorporate existing national, State and Territory-level responses.

In March, the COAG Health Council agreed to explore the feasibility of such a national approach to reducing the burden of middle ear disease.

The Queensland Department of Health has leadership of this proposal, and plans to take it to the Australian Health Ministers’ Advisory Council next week, when it is scheduled to consider the matter on 8 December.

Alongside this, the House of Representatives Standing Committee on Health, Aged Care and Sport Inquiry into Hearing Health and Wellbeing of Australia is calling for a national strategy to be developed and additional funding provided.

The recommendations of the committee’s report – titled ‘Still waiting to be heard’ – are currently being given detailed consideration by the Turnbull Government, as are the findings of the Department of Health’s independent examination of Commonwealth ear health initiatives.

The AHMAC work and the ‘Still waiting to be heard’ report will inform the way forward on Indigenous ear health.

It’s also pertinent to note a number of other initiatives that will contribute directly to improved ear health.

The Turnbull Government has committed to incorporating a social determinants and cultural determinants of health approach in the next iteration of the five-year Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan, due to be released in 2018.

As Dr Gannon has pointed out, ‘social determinants of health contribute to the development of ear disease …. and act as barriers to treatment and prevention.’

The release of the Cultural Respect Framework 2016–2026, which was endorsed by AHMAC early this year, will underpin the delivery of culturally competent health service delivery.

A culturally competent approach by health professionals is critical to the health and wellbeing of Aboriginal and Torres Strait Islander people who, like all Australians, have the right to safe, culturally comfortable care of the highest clinical standard.

Further, COAG is currently working to refresh the Closing the Gap targets, including the health targets.

Initiatives like these demonstrate the commitment of good minds and good people to tackling our nation’s most confronting health issue – Indigenous health.

That commitment is also reflected in Commonwealth funding. To improve ear health, a total of $76.4 million, from 2012–13 to 2021–22, is being provided through the Indigenous Australians’ Health Programme, and the National Partnership on Northern Territory Remote Aboriginal Investment.

This funding is increasing access to clinical services, including surgery. It is providing equipment, training health professionals and raising awareness of otitis media symptoms and the need for early treatment.

In the past year, this has resulted in around 47,000 patient contacts in more than 300 locations across Australia.

More than 200 surgeries were provided, and over 1000 health professionals received training in 80 locations.

More than 1000 pieces of diagnostic equipment were available across 170 sites; and clinical guidelines were made available nationally.

As well, under the Australian Hearing Specialist Program for Indigenous Australians, the Australian Government provides hearing services in more than 200 Aboriginal and Torres Strait Islander communities across Australia each year to help overcome distance, culture and language barriers.

Successful initiatives, such as Children’s Health Queensland’s Deadly Ears program, are making a difference. Deadly Ears has helped almost halve the rate of Chronic Otitis Media, working at 11 outreach services in rural and remote areas.

So, clearly, there is a large body of work underway at local, State and national levels – but just as clearly, we must continue our focus, build our partnerships and broaden our approach.

While primary care is fundamental to ear health solutions, we must work together with Aboriginal communities to advance other areas of life which impact on health and wellbeing.

The Turnbull Government understands this, and this is the basis for our whole-of-government policies, including housing, education, employment and health service delivery.

We are focussed on what works, so efficient and successful models of care can be shared and replicated.

We are concentrating on grassroots empowerment, to support local responsibility, and in turn, to grow personal commitment.

Finding ear health solutions is a shared responsibility – for all governments, the medical profession, health workers, and parents and their children.

Reducing ear problems is one of my top Indigenous health priorities, and I’m confident we can start to make real gains in this critical area.

While there is undoubtedly a way to go, evidence-based Report Cards like this will help ensure we are on the right track.

The Turnbull Government is listening.

I commend the AMA for its work, and look forward to continuing our shared dedication to better hearing for Indigenous people.

Thank you.