“ Regarding the environmental improvements, we know that the NT Aboriginal population has the worst housing in Australia.  

Around 60% of Aboriginal people live in over-crowded housing and one third live in poorly maintained houses. 

This directly impacts on the ability of our people to maintain healthy living practices such as ensuing their kids have clean faces and clean clothes. 

We cannot keep on relying on antibiotics to get rid of trachoma – to be sustainable, there must be major improvements in environmental health and housing.

Improving housing will also lead to improvements in other infectious diseases that are way too common in our people in the NT

John Paterson CEO of the Aboriginal Medical Services Alliance of the NT or AMSANT. See full Speech Part 1 Below

Alice Springs Declaration

At the 2019 Close the Gap in vision 2020 conference, held in Alice springs, delegates heard that improvements in environmental health and housing are essential to eliminate trachoma and to reduce rates of other childhood infections that can lead to serious conditions such as rheumatic heart disease, blindness and deafness.

The conference heard about good progress in reducing trachoma rates but also that there had been some stalling in remote Central Australian communities where trachoma remains endemic and will not be eliminated unless housing is addressed.

Over half of Aboriginal people in the NT live in overcrowded housing and nearly one third live in poorly maintained housing. This is by far the worst result of any jurisdiction in Australia.

The Conference noted that there is currently a political impasse between the Commonwealth and Northern Territory governments which is preventing the completion of an agreement to enable desperately needed Commonwealth investment in Aboriginal housing to be made available.

The Conference was also concerned at the very slow pace of implementation of the Northern Territory government funded housing program, where only 62 million of 220 million has been spent in the first two years.

The delegates demand that both levels of government urgently work to fix this impasse to ensure that Aboriginal housing investment can be made available to address the critical housing needs in the NT and contribute to improving the health and wellbeing of Aboriginal Territorians.

This declaration was unanimously endorsed

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CTG19 ALICE SPRINGS DECLARATION

” Supporting and improving the local primary health care service capacity to confidently perform eye assessments should reduce the dependency on visiting eye specialists.

Going forward I see the promotion of these items as a highly effective way of investing in people and communities to have the capacity to manage and improve their own health outcomes.

Building local workforces must be key and I know that’s easier said than done.

The Roadmap to Close the Gap for Vision is a standout example of a program that has been successful in its impact towards closing the First Nations health gap.

Remarkable results have been achieved in just under a decade and the Roadmap recommendations are well on the way to being fully implemented.

Progress in Indigenous eye health has long been a challenge, making the success of this collaborative work even more remarkable.

The Hon Warren Snowdon Opposition Spokesperson Indigenous Health Keynote Address #CTG19 see full speech part 2 Below

Good morning everyone. My name is John Paterson and I am the CEO of the Aboriginal Medical Services Alliance of the NT or AMSANT. As many of you will know, AMSANT is the peak body for Aboriginal community controlled health services in the Northern Territory.

I’d like to begin by acknowledging the traditional owners, the Arrernte past, present and future, of the land on which we’re meeting: Mbantua – also known as Alice Springs.

To everyone here today, welcome to this important conference that is for the first time being held outside of Melbourne.

It will provide us with a great opportunity to share challenges, learnings and new ideas in a key regional centre for Aboriginal Australians who live in remote and very remote settings.  Aboriginal culture is strong and proud here, as it is across the NT.

Welcome to the many attendees from the NT and right across Australia. Thank you for the work you do in eye health and your interest in improving Aboriginal health outcomes.

I would like to begin by talking a little about the history of our sector in the NT.

It is a story of self-determination.

And it is a story about the passion and dedication in developing essential primary health care services to our people from the ground up.

It is a story about always being a strong advocate for our people.

Our sector provides comprehensive primary health care from Darwin to the most remote areas of the NT.

Central Australian Aboriginal Congress is 45 years old and is the second oldest ACCHS after Redfern. It is also the largest ACCHS in the NT and one of the largest in Australia.

Miwatj is the largest remote ACCHS in Australia and Utopia is the oldest ACCHS based in a very remote region, having also recently turned 40.

We have in total 26 members – 13 of which provide comprehensive primary health care across the NT.

We work in partnership with the Northern Territory Government, who also provide Aboriginal PHC services to the NT. However, ACCHSs are the larger of the two providers and our sector is expanding in line with the Commonwealth and NT Government commitment to transition PHC services to community control.

The theme of this conference – “Strengthen and sustain” – resonates with the foundational principles of our sector including the need to build capacity and self-determination.

The ACCHS sector aims to provide comprehensive primary health care with our larger services providing a broad and expanding range of services that go beyond providing physical health care. Comprehensive primary health care includes Social and Emotional Wellbeing, social support, youth work, health promotion and prevention, with some now extending into aged care and even disability care.

The broad range of services considered to be part of primary health care is in line with the Alma Ata Declaration of 1978, where primary health care leaders from around the world – including leaders from the Aboriginal community controlled sector – set out a vision of primary health care that is now reflected in how our sector operates.

The declaration emphasised the need for communities to have a say and be involved in the running of primary health care, hence the fundamental importance we attach to our sector being community controlled.

Another principle of the Declaration is that comprehensive primary health care should work with government policy makers and other sectors such as employment and housing, to address the conditions that lead to poor health. Our sector strives to do this at every level, from the community to national levels, and even on the international stage.

In the NT, one of the main ways we are achieving this is by working with other Aboriginal peak bodies in an Alliance called the Aboriginal Peak Organisation NT, or APONT. APONT includes AMSANT, along with the Central and Northern Land Councils, who assist traditional owners and native title holders in the management and development of their land, including through Aboriginal ranger groups and increasingly, community development projects.

The Alma Ata declaration also emphasised the need to aim for equity of outcomes in health care provision – noting that across the world including in rich countries such as Australia, there is an unacceptable health gap between the well off and those living in poverty. As you all know, on our own country, this health gap is even larger between Aboriginal Australians and the rest of Australia. Equity is a foundational principle of our sector.

The first national Aboriginal Health Strategy, in 1989, reflected these principles and others including the need to take a holistic view of health care, including the physical, social, spiritual and emotional health of people.

This strategy recognised the inter-relationship between good health and the social determinants of health and the need to partner with sectors outside health. The strategy also emphasised capacity-building of community-controlled organisations and the community itself to support local and regional solutions to improving health.

This was a fine strategy, however, an implementation plan was not properly developed and the strategy was not properly funded. This has been a recurring story in Aboriginal health over the years.

The most recent national Aboriginal health plan is also based on self-determination, including the need for community control and the critical importance of the social and cultural determinants of health.

As I hope most of you know, there are a national set of Close the Gap targets that are soon due to expire, that guide our efforts to improve Aboriginal health.  Sadly only 3 of the 8 target are currently on track – and the health gap is one of those that is not on track.

In fact, despite marked improvement in life expectancy in the NT over the last thirty years, life expectancy in the NT now seems to be stalling which is due to the failure to address social determinants, and the ever-growing chronic disease epidemic in our people.

I believe we would have seen much more progress towards closing the gap if the vision first set out in 1989 in the National Aboriginal Health Strategy had been implemented by both the Federal and State governments, including the critical need to commit to self-determination.

While that precious opportunity has foundered for the last three decades, I believe we are once again at a critical juncture and seeing a shift towards governments working in equal partnership with our people. This trend must continue if we are to see sustainable improvement.

At a national level, I am very heartened to see that the process to refresh the Closing the Gap targets is now developing into an equal partnership between Aboriginal leaders across Australia and Commonwealth, State and Territory governments through the Council of Australian Governments or COAG process.

We now, for the very first time, have a large group of Aboriginal peak bodies working closely with government to set the forward agenda for tackling the health gap. Our national peak organisation, NACCHO, led by an inspiring Aboriginal Alice Springs leader – Pat Turner – is at the vanguard of this work.

Read all 50 plus NACCHO Aboriginal Eye Health Articles Here

I represent APONT on this national coalition, ensuring that our leadership in the Northern Territory continues to influence the national agenda. We will be working hard to ensure that the targets reflect the critical issues affecting the health of our people – across the social determinants, and including issues such as housing,  the skyrocketing imprisonment rates and tragically high rates of children in the child protection system.

How does all of this high-level government policy relate to eye care?

We know that our Aboriginal community controlled health services in the NT are under resourced.

Six years ago, a study was done in a small ACCHS in the NT – one of our better funded services. The study looked at how much it cost to carry out all the chronic disease care recommended by the CARPA manual – which is the guideline that all our services use.

It found that the service was under funded to the tune of $1700 per person per year. This funding gap may have increased since then.  The AMA has recently reiterated that there is a large funding gap in Aboriginal primary health care.

We cannot build specialist services, including specialist eye services, on a foundation of an under-resourced primary health care sector.  Our sector must be properly funded.

Trachoma is often described as a disease of poverty, which is one of the reasons why its continued existence in Australia, and almost exclusively in Aboriginal communities, is a national disgrace.

The World Health Organisation has developed the SAFE strategy for eliminating trachoma.

I am sure most of you know that the S stands for surgery, A for antibiotics, F for facial cleanliness and E for Environmental Improvements.

Regarding the environmental improvements, we know that the NT Aboriginal population has the worst housing in Australia.

Around 60% of Aboriginal people live in over-crowded housing and one third live in poorly maintained houses.

This directly impacts on the ability of our people to maintain healthy living practices such as ensuing their kids have clean faces and clean clothes.

We cannot keep on relying on antibiotics to get rid of trachoma – to be sustainable, there must be major improvements in environmental health and housing.

Improving housing will also lead to improvements in other infectious diseases that are way too common in our people in the NT, including skin sores and sore throats – which can both precipitate RHD; and with skin sores also being linked to high rates of renal disease.

A recent data linkage study found that over-crowded housing was by far the biggest reason for children missing school – accounting for over 30 days of missed school a year on average.

We know that poor school attendance is very closely linked to poor school results.  Our children need decent living conditions if they are to thrive both physically but also socially and at school.

What is AMSANT doing about the shocking state of housing in the NT?

AMSANT has worked as part of the APONT alliance in supporting the formation of an Aboriginal Housing committee, AHNT, and is supporting AHNT to become the recognised Aboriginal housing peak body for the NT. Along with AHNT, we are working closely with NT Department of Housing to develop a community led housing strategy, to return Aboriginal housing to community control.

More info Register 

This is a long journey – but it is already bearing some fruit.

However, currently, as many of you will be aware from recent media reports – the NT and Commonwealth are at a stand-off about desperately needed Commonwealth funding for remote Aboriginal housing.

We must have cooperation between the two levels of government to address our housing crisis. We are tired of the excuses and political stand offs, while our communities suffer.

If they would for one moment stop and listen to us, come and talk with us, they would hear our message loud and clear – we want a seat at the decision-making table.

It the Prime Minister and the State and Territory Premiers and Chief Ministers can agree on an equal partnership with Aboriginal peak bodies on Closing the Gap, then the Commonwealth and NT governments can do the same for Aboriginal housing. We say – make it happen!

And now to eyes.

Eye health matters. In Australia, people with even mild vision loss have a risk of dying that is 2.6 times higher than those with good vision.

Vision loss causes 11% of the Indigenous health gap, meaning it accounts for 11% of years of life lost to disability for Indigenous people. It is the third leading cause of the gap behind cardiovascular disease and diabetes.

The 2008 National Indigenous Eye Health Strategy demonstrated the huge gap between the eye health of Indigenous and other Australians:

• Indigenous adults were 6 times more likely to become blind as non-Indigenous, despite 94% of this vision loss being preventable or treatable;
• Australia was the only developed country in the world to have endemic trachoma in some regions;
• And yet studies showed that Indigenous children have better eyesight than others.

However, as you know, a lot is happening in the eye space and primary health care is a critical part of that work.

The work done to close the gap for vision has been very successful. The progress made on the Roadmap to Close the Gap for Vision, which comprises action against over 40 recommendations, is substantial and impressive, particularly given the number of stakeholders in many sectors who have contributed to its achievements.

One of the achievements in the NT has been the formation and ongoing success of regional eye health coordination groups, which are collaborations and partnerships involving all the key eye health stakeholders including primary health care, and are an important component of the Roadmap to Close the Gap for Vision.

The Central Australian and Barkly collaboration has been working effectively for 10 years now, and has been joined in recent years by a Top End collaboration.

AMSANT is involved in both groups and has been funded by the Fred Hollows Foundation to become more involved, including through a position supporting the Central Australian committee.

However, I hope that you have got the message that everyone in health care – including those in eye health care – need to think more broadly about health and not just focus on their part of the gap.

The Aboriginal vision of health is holistic and specialist services need to be built on a strong primary health care foundation.

The international health research has shown that health systems built on a strong primary health care foundation are more equitable affordable and sustainable.

I believe that the eye care gap will not sustainably close – along with the rest of the health gap – if we do not have political commitment to self-determination, and an equitable approach to funding Aboriginal primary health care, based on need.

And we also  need a commitment to fixing the social determinants of health, equitably, based on need and Aboriginal-led.

We must avoid the situation where specialist areas advocate separately to government for their bit of Aboriginal health funding without seeing the bigger picture and the lack of resources on the ground in primary health care.

We need to work together in true partnership if we are to close the gap and that means we MUST be at the decision-making table, not an afterthought.

So thank you for all the work that you do in eye health care- we do appreciate it.

And I hope that you enjoy the two days and go back to your work refreshed, invigorated and inspired.

Thank you.

Part 2 : ADDRESS TO THE CLOSE THE GAP FOR VISION BY 2020

From the outset I want to stress that Federal Labor is acutely aware that Australia remains the only developed country with endemic trachoma, which is only found in our Aboriginal and Torres Strait Islander communities.

Further, while we acknowledge the scourge of Trachoma, cataract is the leading cause of blindness for Aboriginal and Torres Strait Islander adults and is 12 times more common than for non-Indigenous Australians. We have seen inroads in the rates of trachoma, many thanks to people in this room.

Trachoma has dropped from 21 per cent in outback children in 2008 to 3.8 per cent in 2018 and is on track to be eliminated by the end of 2020. This is a marvellous achievement and I again want to thank the tireless effort, tenacity and dedication of those in this room over the last decade in ensuring this has remained a front and centre issue for consecutive governments across partisan lines.

Today I want to discuss three things:

• Where to now and looking beyond 2020
• How we can build on the success of the Roadmap in other spaces and;
• What to expect from a Shorten Labor Government

As the incidence of Trachoma lessens and is likely to be completely eliminated come 2020/21, we will face different vision-loss challenges. Blindness and impaired vision among Aboriginal people was six times the national rate in 2008, and it is now down to three times the national rate. However, Aboriginal and Torres Strait Islander Australians are still most likely to experience permanent vision impairment, with most cases of avoidable blindness resulting from uncorrected refractive error, diabetic retinopathy and cataracts.

One in 10 Aboriginal and Torres Strait Islander adults is at risk of Diabetic Retinopathy, which we all know can lead to irreversible vision loss. Aboriginal and Torres Strait Islander people wait on average 63% longer for cataract surgery than non-Indigenous Australians. Almost two-thirds of vision impairment among Aboriginal and Torres Strait Islander people is due to uncorrected refractive error- often treatable with a pair of glasses.

And I want to note here, that I welcomed Minister Wyatt’s announcement in August last year to commit $2 million to provide Aboriginal and Torres Strait Islander people with easier access to affordable prescription glasses. This was a positive first step.

The case for well-informed advocacy around uncorrected refractive error, diabetic retinopathy and cataracts in the First Nation population must be a priority for this sector come 2020 and beyond. As we edge towards the complete elimination of Trachoma the traction from governments’ and the funding which comes attached I anticipate will lessen. This will be no surprise to people in this room.

Security of funding will decline without ongoing strategic advocacy from the sector. There will need to a be a sustained and coordinated approach as there has been with the Roadmap to ensure this doesn’t curtail the inroads that are being made in other areas of vision loss. For example; Aboriginal and Torres Strait Islander Australians with diabetes have significantly fewer recommended eye checks than the non-indigenous Australian population and this incidence is particularly escalated in remote and regional areas [35% comparted with 64% respectively].

The total indirect cost of blindness as a result of diabetic retinopathy and diabetic macular oedema, the most frequent manifestations of diabetic retinopathy, is estimated to be more than $28,000 per person. Early investment into coordinated primary healthcare presents a powerful fiscal argument for governments at all levels.

These are the sorts of messages I encourage the sector to advocate for, we are in fiscally uncertain times so governments are constantly looking for costefficient measures.  The fact the up to 98 per cent of diabetes-related blindness can be prevented through annual eye exams and timely treatment in the early stages of disease, is compelling.

Investing in professional development and training to enhance existing clinicians’ skills to perform eye-health assessments can produce significant savings for both the patient and the tax payer. I am a proponent of the MBS 715 item [Aboriginal Health Check] and the annual MBS 12325 item [Diabetic Retinopathy Screening] to be employed in all instances, as both schedule items promote early screening and diagnosis, preventing future complications and the costs associated with vison impairment.

The establishment of diabetic eye screening rates as a key performance indicator for Primary Health Networks is a sensible way to drive MBS revenue and improve eye health outcomes. Further, employing MBS item service delivery models, is a sustainable model of care which does not rely on ongoing or recurrent government funding. Increased information-sharing around the schedule benefits can produce significant preventative health gains to the target communities as well as provide large fiscal returns to service practices.  It’s a no brainer.

Further, supporting and improving the local primary health care service capacity to confidently perform eye assessments should reduce the dependency on visiting eye specialists. Going forward I see the promotion of these items as a highly effective way of investing in people and communities to have the capacity to manage and improve their own health outcomes.

Building local workforces must be key and I know that’s easier said than done.

The Roadmap to Close the Gap for Vision is a standout example of a program that has been successful in its impact towards closing the First Nations health gap. Remarkable results have been achieved in just under a decade and the Roadmap recommendations are well on the way to being fully implemented. Progress in Indigenous eye health has long been a challenge, making the success of this collaborative work even more remarkable. This work has undergone rigorous scientific process and has a strong evidence base.

Importantly it has been strongly supported by local communities and organisations, including leading peak bodies and philanthropic organisations.

This disciplined coordination is what I think other sectors can really look towards and aspire to. And I must say this discipline is attributed in major part to the work of Professor Taylor. Stopping trachoma and other infections through the promotion of good hygiene practices and the emphasis on health hardware are pathways to negate further chronic health conditions.

Including: Ear infections and otitis media

• Respiratory infection
• Tooth and gum disease
• Skin infections
• Kidney disease

And I think most markedly

• Rheumatic Heart Disease

The Roadmap has been able to achieve comprehensive culturally safe coordination in navigating all levels of care which is critical when managing health conditions, such as avoidable blindness.  Skilled workforce shortage complications in regional areas can ultimately be ameliorated by investing in people and communities to have the capacity to manage and improve their own health outcomes.

I know Diabetic retinopathy cameras and trained operators are being placed in more than 150 Aboriginal health clinics across Australia and this ideally must be the model we aspire for in other complex health areas. This model has been promoted and driven throughout the Roadmap.

To reiterate my major point, Labor is committed to Closing the Gap in eye health. The Roadmap was established under Labor and has since made significant improvements to the eye health of First Australians, as I’ve acknowledged. A Shorten Labor Government is committed to fully implementing the Roadmap to Close the Gap for vision.

A Shorten Labor government appreciates there is still work to be done to close the gap to meet the 2020 deadline. As an outcome of the Roadmap there are many regions of Australia where successful eye care programs have been developed providing high quality eye care for First Australians.

We acknowledge these successes and aim to build on and enhance these existing services. Now is the time to consolidate this good work and finally end avoidable blindness to ensure we meet our World Health Organisation obligations and successfully eliminate Trachoma. As Professor Taylor says, “we can’t afford to take our foot off the accelerator.” Equitable access to specialist and general eye health care services is critical to reducing high rates of preventable blindness among Aboriginal and Torres Strait Islander people.

We’ve seen too many cases of good work in Aboriginal affairs left unevaluated and subsequently dismantled, especially under the Abbott/Turnbull/ Morrison government. The Tackling Indigenous Smoking program is a case in point which we’ve witnessed under this Government.

Guiding all the decisions under a Shorten Labor Government will be evidence- based policy.  The Federal Labor team will certainly have more to say on this and you can expect further announcements in the coming months in the lead up to the election. But I can say that any further investments will be to meet the 2020 Roadmap.

Under a Shorten Labor government we will be prioritising:

• The national implementation of regional coordinators
• Population based funding of outreach services
• Case management and local coordination
• Prompt housing repair and maintenance to ensure First Australians have access to safe and functioning bathrooms

We’re at the pointy end of finalising our election commitments but I do want to use this opportunity to encourage the experts before me to bring forward any policy proposals you have. If anyone wishes to share any policy ideas, as some have already, by all means I am open to hearing them and sharing them with my Federal Labor team. And for anyone in this room who isn’t aware I have an open-door policy, so please don’t hesitate to get in touch in near future.

I think that’s enough from me.

Thank you for your time this morning.