NACCHO Aboriginal #MentalHealth and #SuicidePrevention @cbpatsisp : Health Minister @GregHuntMP welcomes the #YouCanTalk campaign, encouraging our mob struggling with their mental health to reach out and find support

“ The Federal Government welcomes the #YouCanTalk campaign, which encourages Australians struggling with their mental health to reach out and find support.

The awareness campaign is a collaboration between several organisations, including Beyond Blue, Everymind, headspace, Lifeline, ReachOut, RU OK?, SANE Australia, the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, Roses in the Ocean and the Black Dog Institute.

The campaign will take place over the December-January holiday period, in recognition of how difficult this time of year can be for many Australians.

Our Government commends the collaboration of these organisations to raise awareness about the importance of starting a conversation, particularly over the Christmas-New Year period.” 

Health Minister Greg Hunt Press Release continued Part 1 below 

Read over 160 Aboriginal Health and Suicide Prevention articles published by NACCHO over past 7 years 

” Suicide has emerged in the past half century as a major cause of premature mortality and is a contributor to the overall health and life expectancy gap for Aboriginal and Torres Strait Islander peoples.

In 2018 it was the fifth leading cause of death among Aboriginal and Torres Strait Islander peoples, and the age-standardised suicide rate was more than twice as high as the non-Aboriginal and Torres Strait Islander people’s rate.”

What we know about suicide for Aboriginal and Torres Strait Islander people : or see Part 3 Below

Sadly, more than 3,000 Australians choose to end their lives each year – about eight people a day.

Every life lost to suicide is a tragedy, creating a ripple effect that flows through families, friendship groups, schools, workplaces and communities.

That’s why the Federal Government has committed to Towards Zero – working towards reducing the suicide rate to zero.

Towards Zero is a total commitment to the value of each and every life, and recognises the importance of all lives, in all ages, and all groups.

This commitment is backed by our investment of $5.2 billion in mental health and suicide prevention services this financial year, including $63.3 million on suicide prevention activities.

It’s so important for Australians who are struggling to reach out and seek support.

The #YouCanTalk campaign also aims to connect people with tools that can support them through their website

www.lifeinmindaustralia.com.au/youcantalk.

#YouCanTalk exists to encourage all Australians to have a conversation with a friend, family member or work colleague they’re concerned about.

While it can be difficult to talk about suicide, research shows you can have a positive influence on someone who may be considering suicide by initiating a conversation with them and supporting them to seek help.

The main message is you don’t need to be a clinician, a GP, or a nurse to check-in with someone you are worried about.

It is OK to let someone know you have noticed they are struggling and ask them if they are experiencing thoughts of suicide.

It is normal to feel worried or nervous about having a conversation with a friend, family member or work colleague who might be experiencing suicidal thoughts, but there are resources available to help you.

Life in Mind is a national digital gateway providing organisations and communities access to suicide prevention information, programs, services, resources and research.

Part 3

Suicide has emerged in the past half century as a major cause of premature mortality and is a contributor to the overall health and life expectancy gap for Aboriginal and Torres Strait Islanders

In 2018 it was the fifth leading cause of death among Aboriginal and Torres Strait Islander peoples, and the age-standardised suicide rate was more than twice as high as the non-Aboriginal and Torres Strait Islander people’s rate.

The standardised death rate for Aboriginal and Torres Strait Islander peoples (24.1 per 100, 000) was higher than the non-Indigenous rate (12.4 per 100, 000)2.

On average, over 100 Aboriginal and Torres Strait Islander persons end their lives through suicide each year, accounting for 1 in 20 Aboriginal and Torres Strait Islander deaths.

STATISTIC

Further suicide data can be found at the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, and from the ATSISPEP report.

Three main issues can be identified:

  1. There is variable quality of Aboriginal and Torres Strait Islander identification at the state and national levels, resulting in an expected under-reporting of Aboriginal and Torres Strait Islander suicides.
  2. Lack of reporting on suicide due to questions regarding intent, especially in the case of childhood suicides. Similarly, it can be demonstrated that there may be a reluctance to classify adult deaths as suicides for a variety of reasons also.
  3. Delays in reporting data, whereby incidences of Aboriginal and Torres Strait Islander suicide might not be known for months and often years after the fact.

NACCHO Aboriginal #SexualHealth @atsihaw Resources and Events : Plus Dawn Casey ” NACCHO recognises the importance of the Aboriginal and Torres Strait Islander #HIVAwarenessWeek #WorldAIDSDay2019 “


“Exposure to STIs differs for Aboriginal and Torres Strait Islander people.

Our women are diagnosed with HIV, STIs and BBVs at a greater rate than other Australian women and are facing infertility, ectopic pregnancy, spontaneous preterm birth or still-birth.

NACCHO believes this requires greater recognition and commitment from all levels of government to work collaboratively across portfolios and mainstream organisations.

A good example is the current partnership between the Commonwealth Department of Health and NACCHO to address the syphilis outbreak, which has been extraordinary!

It highlights innovation in science and the great work done on the ground by Aboriginal health workers.

There is no better way to provide healthcare than through the 145 Aboriginal Community Controlled Health Organisations (ACCHOs), who deliver holistic, culturally safe, comprehensive primary healthcare across Australia, including those living in very remote areas

Studies have shown that ACCHOs are 23% better at attracting and retaining Aboriginal and Torres Strait Islander clients than mainstream providers. 

If funded adequately ACCHOs are the solution to addressing the increasing rates of STIs, BBVs and HIV/AIDS.”

Dr Dawn Casey, Deputy CEO of NACCHO who spoke at the 2019 parliamentary World AIDS Day breakfast this week. See continued NACCHO Press Release Part 1 and speech notes part 2 Below 

“ATSIHAW has grown bigger, with 132 ATSIHAW events to be held by 73 organisations across Australia this year – mostly in ACCHOs. ACCHOs have embraced ATSIHAW wholeheartedly and this has been key to ATSIHAW’s success.

Community engagement has been pivotal to the improvements in Australia’s HIV response and it’s time to focus on getting HIV rates down in our communities.”

South Australian Health and Medical Research Institute (SAHMRI) Head, Aboriginal Health Equity—Sexual Health and Wellbeing, A/Prof James Ward

Download the 30 Page PDF Report 

2019-SAHMRI-ATSIHAW-booklet

ATSIHAW 2019 dates are November 28 to December 5

View the ATSIHAW 2019 registered events on Facebook or below by state.

NSW | QLD | SA | VIC | WA | ACT | NT | TAS

See Web Page

Part 1 NACCHO Press Release continued 

The National Aboriginal Community Controlled Health Organisation (NACCHO) recognises the importance of the Aboriginal and Torres Strait Islander HIV Awareness Week (ATSIHAW) and the 2019 World AIDs Day to draw attention to the increasing impact of sexually transmitted infections (STIs) on Aboriginal and Torres Strait Islander communities.

In Australia, it has been recorded that the cases of new HIV diagnoses amongst Australians represent a decline of 23% in the last five years.

However, the HIV notification rates within the Aboriginal and Torres Strait Islander population in 2018 was more than twice the rate for the Australian-born non-Aboriginal and Torres Strait Islander people. Source: Kirby Institute

Australia is perceived on the global stage as a world leader in HIV prevention and treatment.

But considering the high prevalence of this issue in Aboriginal and Torres Strait Islander communities, NACCHO understands there is still some way to go.

Part 2 Dawn Casey Speaking Notes

World AIDS Day Parliamentary Breakfast – 27 November 2019

Traditional Owners of this land, the Ngunnawal and Ngambri People. I like to acknowledge other Aboriginal and Torres Strait Islander people in the room.

I would like to thank AFAO for inviting me here to speak this morning.

I would like to acknowledge the Hon Greg Hunt, Minister for Health, the Hon Chris Bowen, Shadow Minister for Health and all the Members of Parliament present here. It is just fabulous to see a bipartisan approach taken to this issue.

Exposure to STIs, HIV and BBVs differs for Aboriginal and Torres Strait Islander peoples. Research tells us that it is more likely attributed to heterosexual sex and injection drug use coming into our communities. And we know that Aboriginal and Torres Strait Islander women are diagnosed with HIV, STIs and BBVs at a greater rate than other Australian women.

This is extremely concerning as the next generation of Aboriginal and Torres Strait Islander women living in remote communities are facing infertility, ectopic pregnancy, spontaneous preterm birth or still-birth.

Let me remind you that there is no better way to provide healthcare than through Aboriginal Community Controlled Health Organisations (ACCHOs). They have been around here for many years and are established and operated by local communities, through locally elected Boards of Management, to deliver holistic and culturally safe and comprehensive primary healthcare.

They punch above their weight, with 145 services nationally providing about three million episodes of care each year for Aboriginal and Torres Strait Islander people across Australia, including those living in very remote areas.

ACCHOs provide culturally safe, comprehensive primary health care consistent with our people’s needs, this includes: home and site visits; provision of medical, public health and health promotion services; allied health, nursing services; assistance with making appointments and transport coordination; help to access child care or to deal with the justice system and drug and alcohol services.

Our people trust us with their health. Studies have shown that ACCHOs are 23% better at attracting and retaining Aboriginal and Torres Strait Islander clients than mainstream providers.

If funded adequately ACCHOs are the solutions to addressing the increasing rates of STIs, BBVs and HIV/AIDS. The current partnership between the Department of Health to address the syphilis outbreak has been extraordinary! It highlights innovation in science and the great work done on the ground by Aboriginal health workers.

I would like to leave with one message:

It is only with everyone working together that we will be able to help minimise the impact of STIs, BBVs and HIV/AIDS in the community. Mainstream organisations need to do their part and collaborate and work collectively with us.

Nationally, there is a high-quality network of Aboriginal controlled service providers that get results – understand them, connect with them and identify mutually beneficial areas to work together

Picture above Tim Wilson MP and his quote : At Parliament today, we gathered to remember & honour those lost to HIV/AIDS, redouble our efforts to stop new transmissions and stigma + mark tomorrow’s start of Aboriginal and Torres Strait Islander HIV Awareness Week.

Find out more here: atsihiv.org.au

Part 3 Health Minister Greg Hunt Press Release 

World AIDS Day is held on 1 December each year. It raises awareness across the world and in the community about HIV and AIDS.

It is a day for people to show their support for people living with HIV and to remember and honour those who we have lost.

In the 2019–20 Budget, the Morrison Government invested $45.4 million to implement Australia’s five National Blood-Borne Viruses (BBV) and Sexually Transmissible Infections (STI) Strategies.

These strategies will make a deep and profound difference in reducing the health impacts and stigma of BBV and STI, including HIV.

Today, I am pleased to announce that our Government will provide additional, ongoing support for people with HIV and other BBV and STI’s by extending funding to six national peak organisations, providing almost $3 million for 2020-21.

In addition, from 1 December 2019, Australians living with HIV will save more than $8,500 a year with the listing of a new combination medicine on the Pharmaceutical Benefits Scheme (PBS).

It is estimated that 850 Australians with HIV will benefit from the listing of Dovato® (dolutegravir with lamivudine) on the PBS, which will provide more choice for them in how they can manage their HIV.

Effective once daily treatments such as Dovato and other new medicines can control the virus so that people living with HIV can enjoy long, healthy and productive lives.

With the PBS subsidy, people living with HIV will pay just $40.30 per script, or $6.50 with a concession card for Dovato®.

Australia continues to be a world leader in the response to HIV. The number of new HIV diagnoses today is at its lowest in nearly 20 years.

Our success is built on a model of partnership between government, people living with HIV, community based organisations, health professionals and researchers.

We are seeing more people tested for HIV and initiating treatment for HIV. There are also more people living with a suppressed viral load. In addition, improved access to HIV prevention methods, including the PBS-listed pre exposure prophylaxis (PrEP), helps reduce the number of new HIV diagnoses.

We are also looking to address stigma and discrimination.

The Eighth National HIV Strategy 2018-22, guides our partnership approach over the next four years to virtual elimination of HIV transmission by 2022.

We aim to be one of the first countries in the world to eliminate new HIV transmissions.

NACCHO Aboriginal Health News / Download : The AMA 2019 Report Card on Indigenous Health launched at @DanilaDilba ACCHO #Darwin by @amapresident that focusses on the oral health status of Aboriginal and Torres Strait Islander people in Australia

” Good oral health is fundamental to our overall health and wellbeing. It allows us to eat and speak without pain, discomfort or embarrassment.

Aboriginal and Torres Strait Islander children and adults have much higher rates of dental disease that their non-Indigenous counterparts across Australia, which can largely be attributed to the social determinants of health.

Indigenous Australians are also less likely to receive the dental care that they need.” 

The 2019 Report Card on Indigenous Health focusses on the oral health status of Aboriginal and Torres Strait Islander people in Australia was launched in Darwin last week 

Download the 36 Page Report HERE

2019 AMA Report Card on Indigenous Health

Pictured above : Warren Snowdon MHR Member for Lingiari ,Tony Bartone, President of the Australian Medical Association. Shannon Daly. Deputy Chairperson of Danila Dilba, NT Minister for Health Natasha Fyles: Member for Nightcliff .

Good oral health is fundamental to our overall health and wellbeing. It allows us to eat and speak without pain, discomfort or embarrassment.

Aboriginal and Torres Strait Islander children and adults have much higher rates of dental disease that their non-Indigenous counterparts across Australia, which can largely be attributed to the social determinants of health. Indigenous Australians are also less likely to receive the dental care that they need.

Opportunities exist for political leaders at all levels of government to implement solutions to improve the oral health of Aboriginal and Torres Strait Islander people in Australia. This includes increasing fluoridation of Australia’s water supplies, enhancing oral health promotion, growing the Indigenous dental workforce and strengthening data collection to monitor and evaluate the oral health status and the performance of oral health care services.

Fundamentally, governments must ensure that Aboriginal and Torres Strait Islander people have access to affordable, culturally appropriate oral health care programs.

Many Aboriginal and Torres Strait Islander people rely on public oral health services, where they exist.

However, the availability of these services depends on government funding, which is often short-term. Consequently, a significant proportion of the Indigenous population live without regular dental care, which has adverse health outcomes.

Oral health care is an important part of primary health care.

We urge governments to note the recommendations contained in this Report Card and put them into action to improve the oral health of Aboriginal and Torres Strait Islander people in Australia.

Related document (Public): 

2019 AMA Report Card on Indigenous Health.pdf

Related AMA content (Internal page): 

Aboriginal and Torres Strait Islander Health Report Cards

Oral health is fundamental to overall health and wellbeing. Good oral health allows people to eat, speak and socialise without pain, discomfort or embarrassment.

Five action areas present opportunities for governments to improve the oral health of Aboriginal and Torres Strait Islander people in Australia. They are:

  • Fluoridated water supplies, especially in
  • Oral health promotion that works with fluoride varnish programs and a tax on sugar-sweetened
  • An effective dental workforce with greater participation of Aboriginal and Torres Strait Islander
  • Better coordination and reduced institutional racism in oral health care for Aboriginal and Torres Strait Islander
  • Data to know that the work being done is making a

Government action is needed because Aboriginal and Torres Strait Islander children and adults have dental disease at two to three times the rates of their non-Indigenous counterparts in urban, rural, and remote communities across Australia. They are also much less likely to get needed dental care.

The social determinants of health, such as poverty, racism, and colonialism contribute to a large proportion of the oral health gap between Aboriginal and Torres Strait Islander people and their non-Indigenous peers.

As a result, Aboriginal and Torres Strait Islander pre-school and primary-school-aged children are much more likely to be hospitalised for dental problems.

Community water fluoridation is a safe, effective, and equitable way to reduce dental decay. In Australia, access to fluoridated water varies due to the lack of a national approach.

This disadvantages Aboriginal and Torres Strait Islander people compared with non-Indigenous Australians because a greater proportion livein rural and regional areas, where water fluoridation is less common.

The situation is particularly concerning in Queensland where nearly half of the Aboriginal and Torres Strait Islander population does not have water fluoridation. Australian Government funding for State and Territory dental services is a lever to push for more water fluoridation.

Fluoride varnish programs also help in preventing dental decay, with proven effect in Aboriginal and Torres Strait Islander communities. The application is simple and requires minimal training. Australian Government leadership is needed to identify and remove the regulatory, administrative and program barriers to effective fluoride varnish programs for Aboriginal and Torres Strait Islander children and adults.

Sugary drinks are a major source of sugar that fuels tooth decay. A tax on sugar-sweetened beverages will reduce consumption and tooth decay, as well as the incidence of obesity, diabetes, heart disease, and stroke. Nearly 70 per cent of Australians are in favour of taxes on soft drinks.

Aboriginal and Torres Strait Islander people are nearly twice as likely to suffer from dental pain as non- Indigenous Australians, and five times as likely to have missing teeth. Pain from dental disease, and damage to teeth, can be effectively managed by dental practitioners.

Governments need to provide Aboriginal and Torres Strait Islander people with culturally safe dental care programs that are planned and implemented through collaborative and equal partnerships between communities and providers.

It is also well understood that health outcomes for Aboriginal and Torres Strait Islander patients are improved when they are treated by Aboriginal and Torres Strait Islander health professionals.

However, Aboriginal and Torres Strait Islander people are grossly under-represented in the oral health workforce. The goal of 780 Aboriginal and Torres Strait Islander dental practitioners by 2040 should be set as a target to promote employment parity in the dental workforce.

Finally, more comprehensive, consistent and coordinated oral health data are needed to better monitor and evaluate oral health status, as well as the performance of oral health care services across Australia. This in turn will lead to improvements in the oral health of Aboriginal and Torres Strait Islander people.

The two major dental diseases are tooth decay (caries) and gum disease (periodontal disease). Both diseases can cause pain, loss of function, and disfigurement.

Tooth decay is a chronic disease caused by dietary sugar. Oral bacteria ferment sugar to produce acids that demineralise, and ultimately destroy, the teeth. Tooth decay progresses with age, creating a lifelong burden.1 Gum disease damages the bone and gum supporting the teeth, and its progress is insidious, with symptoms of pain and loose teeth in the advanced stages

Gum disease susceptibilit varies between individuals, with a genetic component, and is exacerbated by smoking and diabetes.2,

 

NACCHO Aboriginal Children’s Health News : Read @June_Oscar #strongcommunitiesnsw @AbSecNSW Speech plus Download the 56 page @AusHumanRights National Scorecard assessing outcomes for children rights across Australia.

“While most Australian children live in safe, healthy environments and do well, there are some groups whose rights are not well protected, which impacts negatively on their wellbeing and ability to thrive.

This includes Aboriginal and Torres Strait Islander children, children with disability, children in care, children in rural and remote locations, those from culturally and linguistically diverse backgrounds, and LGBTI children,”.

AHRC National Children’s Commissioner, Megan Mitchell this week released a scorecard assessing outcomes for children rights across Australia. See AHRC Press Release Part 1 Below

Download the Scorecard HERE

ahrc_childrensrights_scorecard2019

“ Aboriginal and Torres Strait Islander children continue to face significant disadvantage across a range of domains relevant to their rights and wellbeing, including in health and education, discrimination, exposure to family violence, and overrepresentation in child protection and youth justice systems.

This overall disadvantage has roots in past government policies and practices, and the continued legacy of intergenerational trauma and disadvantage that these policies created. “

Current issues in the area of Aboriginal Children’s Health health see Part 2 Below or Page 23 of report

Read over 370 Aboriginal children’s health  articles published by NACCHO over past 7 years

The removal of Aboriginal and Torres Strait Islander children from their families is one of Australia’s most serious human rights concerns,

“Of the 99 deaths in custody investigated in 1991 in the Royal Commission into Deaths in Custody, it was found that almost half had previously been removed from their parents. We have to call out these systemic failings, where the overrepresentation of children in care, driven and compounded by poverty, makes unimaginable crisis all the more likely in our communities.”

Aboriginal and Torres Strait Islander children removed from their families and placed in out-of-home care are 16 times more likely to be in youth justice supervision than those who are not. “

In a powerful speech on November 20, Aboriginal and Torres Strait Islander Social Justice Commissioner June Oscar called for government at all levels in Australia to “flip the system from crisis to prevention investment”.

The keynote speech, delivered at the AbSec Biennial Conference, draws attention to the direct and cyclical link between high rates of removal of Indigenous children into out-of-home care and poor outcomes for Indigenous communities across Australia. See Part 3 below 

Part 1 AHRC Press Release

One of the scorecard’s most significant recommendations is to raise the age of criminal responsibility. It makes clear there is no good rationale for detaining children under the age of 14, in any form of detention.

“All Australian governments need to recommit to the principle of child detention as a measure of last resort, because placing children behind bars amounts to taking away their childhood and disrupting their healthy development. It makes them more likely to go on and reoffend,” said Commissioner Mitchell.

The age of criminal responsibility in Australia is ten, which is low compared to many other countries, and the United Nations Committee on the Rights of the Child has recommended all countries increase the minimum age of criminal responsibility to at least 14 years.

“While most Australian children live in safe, healthy environments and do well, there are some groups whose rights are not well protected, which impacts negatively on their wellbeing and ability to thrive. This includes Aboriginal and Torres Strait Islander children, children with disability, children in care, children in rural and remote locations, those from culturally and linguistically diverse backgrounds, and LGBTI children,” said Commissioner Mitchell.

Mental health outcomes for Australian children are concerning, with suicide the leading cause of death for children aged 5–17 in 2017 and 35,997 hospitalisations for intentional self- harm in the ten years to 2017.

“There is a national shortage of mental health services and more needs to be done to care for the mental health and emotional wellbeing of young people and much earlier in their lives,” Commissioner Mitchell said.

The scorecard calls on the Federal Government to develop a National Plan for Child Wellbeing and to appoint a Cabinet level Minister with responsibility for driving children’s issues at the national level.

The scorecard also addresses children’s rights in relation to immigration detention and  the impact of climate change on children’s rights, health and an adequate standard of living.

Mikiko Otani, a member of the United Nations Committee on the Rights of the Child presented the scorecard at a conference at Melbourne University on November 20 .

It coincides with the 30th anniversary of the United Nations Convention on the Rights of the Child.

Part 2

Aboriginal and Torres Strait Islander children continue to face significant disadvantage across a range of domains relevant to their rights and wellbeing, including in health and education, discrimination, exposure to family violence, and overrepresentation in child protection and youth justice systems. This overall disadvantage has roots in past government policies and practices, and the continued legacy of intergenerational trauma and disadvantage that these policies created.[i]

Current issues in the area of health include:

  • There are major gaps in data on important health issues affecting Aboriginal and Torres Strait Islander children.[ii]
  • Since the Closing the Gap target baseline was set in 2008, Aboriginal and Torres Strait Islander child mortality rates have declined by 10%.[iii] However, the gap between Aboriginal and Torres Strait Islander children and non-Indigenous children has not narrowed, because the non-Indigenous rate has declined at a faster rate.[iv]
  • Ear disease is a significant health issue facing Aboriginal and Torres Strait Islander children.
  • In 2012–13, 30% of Aboriginal and Torres Strait Islander children aged 2–14 were overweight or obese, compared with 25% of their non-Indigenous counterparts.[v]
  • The likelihood of probable serious mental illness has been found to be consistently higher among Aboriginal and Torres Strait Islander children compared to their non-Indigenous peers.[vi]
  • Aboriginal and Torres Strait Islander children aged 4–17 accounted for 19.2% of all child deaths due to suicide between 2007–15. [vii]
  • The levels of sexually transmitted infections (STIs) in children, especially those from Aboriginal and Torres Strait Islander communities, are concerning.

Numerous studies confirm the negative impact of Aboriginal and Torres Strait Islander peoples’ experiences of racial discrimination, including institutional racism.[viii] Settings that were identified as places of concern include employment, education, shops, public spaces and sport, health and justice.[ix]

Data on hospitalised injury among Aboriginal and Torres Strait Islander people between 2011–12 and 2015–16 show the most commonly reported perpetrator of assaults on Aboriginal and Torres Strait Islander peoples was a family member.[x]

Aboriginal and Torres Strait Islander children continue to be significantly overrepresented in Australia’s child protection systems.[xi] Aboriginal and Torres Strait Islander children are subject to care and protection orders at ten times the rate of non-Indigenous children.[xii] The number of Aboriginal and Torres Strait Islander children who were subject to care and protection orders has steadily risen from 15,500 in 2014 to 20,500 in 2018.[xiii]

School attendance, literacy and numeracy outcomes did not meet the Closing the Gap targets for Aboriginal and Torres Strait Islander children set by the Australian Government for 2018.[xiv] However, targets to halve the gap in Year 12 attainment or equivalent by 2020 and to have 95% of Indigenous four-year-olds enrolled in early childhood education by 2025 are on track.[xv]

One in ten Aboriginal and Torres Strait Islander people reported speaking an Australian Indigenous language at home in the 2016 Census.[xvi]

While the National Curriculum for schools includes a framework for Aboriginal and Torres Strait Islander languages, there is no national approach and the programs implemented in schools vary greatly across jurisdictions.

Current issues in the area of youth justice include:

  • While around 5% of children aged 10–17 in Australia are from an Aboriginal or Torres Strait Islander background, half (49%) of the children under youth justice supervision on an average day in 2017–18 were Aboriginal and Torres Strait Islanders.[xvii]
  • Aboriginal and Torres Strait Islander children are overrepresented in both detention and community-based supervision at all ages but are particularly overrepresented in the younger age groups.
  • Children placed in out-of-home care are 16 times more likely than children in the general population to be under youth justice supervision in the same year.[xviii] This risk increases when the child is Aboriginal or Torres Strait Islander.[xix]

Part 3 : In a powerful speech on November 20, Aboriginal and Torres Strait Islander Social Justice Commissioner June Oscar called for government at all levels in Australia to “flip the system from crisis to prevention investment”.

The keynote speech, delivered at the AbSec Biennial Conference, draws attention to the direct and cyclical link between high rates of removal of Indigenous children into out-of-home care and poor outcomes for Indigenous communities across Australia.

“The removal of Aboriginal and Torres Strait Islander children from their families is one of Australia’s most serious human rights concerns,” said Commissioner June Oscar.

“Of the 99 deaths in custody investigated in 1991 in the Royal Commission into Deaths in Custody, it was found that almost half had previously been removed from their parents. We have to call out these systemic failings, where the overrepresentation of children in care, driven and compounded by poverty, makes unimaginable crisis all the more likely in our communities.”

Aboriginal and Torres Strait Islander children removed from their families and placed in out-of-home care are 16 times more likely to be in youth justice supervision than those who are not.

“If we fail to change the course, the number of Aboriginal and Torres Strait Islander children in out-of-home care will more than triple over the next 20 years,” said Commissioner June Oscar.

“The numbers must be reversed. For this to happen we have to know the lives, the stories and histories that sit behind the statistics. This data cannot remain faceless it has to be told through our words and our experiences, our strengths and resilience, and our hope commitment and determination for a different future.

“A system that is siloed, operating free of our lived realities and contexts, segments our families across service sectors and institutions. When it comes to the protection, care and support of our children this approach is disastrous as there is limited focus on the systemic interconnected issues that need to be resolved for children to remain at home, and the vital supports that our parents and families need to keep children with them.

“For this to happen, Governments at all levels must change ways of working so that processes, policies, programs and services are community-led, strengths-based and trauma-informed.

“To effectively respond to the systemic issues we have to break the cycle of inequality and interventions.

“Changing this system is the responsibility of all Australians. Insisting that governments invest in prevention is about developing a national narrative of equality where everyone is given the best start in life and has the chance to succeed. To be all of who they are without fear of being dispossessed, taken away, condemned and discriminated against.

“The Australia we want is one that embraces, includes and celebrates our diversity. That is the society our children have belonged to since time began and it is the Australia they deserve and have a right to.”

You can read the full text of Commissioner June Oscar’s speech to the AbSec Biennale Conference here

NACCHO Aboriginal Health Media Alerts : 1.Today 18 Nov watch @HealthJusticeAu Webinar features our @NACCHOChair Donnella Mills 2. Listen to our CEO Pat Turner 2019 review interview @abcspeakingout 3.Watch Rachel Perkins deliver the first 2019 Boyer Lecture

 

1.Health Justice Partnerships webinar today 18 November features our NACCHO Chair Donnella Mills 

Monday 18 November – 2:30pm – 4:00pm AEDT 

A quiet revolution is taking place across Australia and it’s transforming the way some of the most vulnerable in our community access legal services. In a practitioner-led movement, community lawyers have been moving out of their offices and into the most unlikely of places – hospitals and community health settings – to collaborate with health services and their patients to address unmet, health-harming legal need.

Known as health justice partnerships (HJPs), these collaborations work by embedding legal help into healthcare services and teams.

Health Justice Partnerships will explore the growing body of evidence that shows there are groups of people who are vulnerable to intersecting legal and health problems, but who are unlikely to turn to legal services for solutions.

Facilitated by Jason Rostant, a panel examines what takes a HJP partnership beyond ‘status quo’ services in terms of purpose, structure, activity and resourcing.

Panellists include:

  • Donnella Mills, Lawyer, Lawright and Chair, National Aboriginal Community Controlled Organisation (NACCHO
  • Tessa Boyd Caine, CEO, Health Justice Australia
  • Jane Cipants, Director Client Service, Legal Aid
  • Sandra Gates, Director Allied Health and Clinical Support, The Royal Women’s Hospital

*Panelists subject to change

Get to know

  • Legal problems that affect health
  • The definition of a health justice partnership
  • Evidence supporting the HJP model
  • Create partnerships with existing local social resource providers and expand capacity to address social needs
  • The development and sustainability of the community service sector

Register here to watch the Webinar 

2.Our CEO Pat Turner interviewed by  Larissa Behrendt on Speaking Out 16 Nov

 

Pat Turners 2019 Year in Review Features include

1.Closing the gap / Have Your Say consultations

2. Minister for Indigenous Australians Ken Wyatt has urged the senior advisory group co-designing an Indigenous Voice to Government to take hold of the “moment in time” before them to change the lives of Indigenous Australians.

3. Yuendumu police shooting: Indigenous groups demand action

4.New $90 Million funding for our ACCHO’s

Listen here to Interview

3. Leading filmmaker Rachel Perkins echoes the Uluru Statement from the Heart in the first of her ABC Boyer Lectures:

Watch on IView

I am reminded of the distinguished poet and stateswoman, Oodgeroo Noonuccal, when she wrote:

“Let no-one say the past is dead.

“The past is all about us and within.”

Warning: Aboriginal and Torres Strait Islander readers are advised that this article contains images of people who have died.

Watch the full speech see link below

Watch Rachel Perkins deliver the first 2019 Boyer Lecture on ABC iview

For Indigenous people have not lost from our minds the history of our nation, not only its deep past of thousands of years, but also the events on April 29, 250 years ago, when James Cook ordered his men to fire upon the two men on the shore.

It is likely they were Gweagal warriors, who stood before him in defence of their family behind them on the beach. Cook’s action signalled the Crown’s intentions; the transfer of a continent, from one people to another, by force if necessary, a phenomenon we politely call colonisation.

Our generation wasn’t standing on the deck of the Endeavour or on the shores of Kamay Botany Bay in 1770, just as we weren’t present during the massacres as the colonial frontier progressed from south to north.

However, as my father Charles Perkins, the Indigenous leader who came to prominence in the 1960s for leading the Freedom Ride, said:

“We cannot live in the past, but the past lives in us.”

The past has made us. We are its inheritors, for better or worse, and this is now our time.

How we move forward from this moment will set the course of relationships between Indigenous people and their fellow Australians into the future.

https://www.abc.net.au/news/2019-11-16/boyer-lecture-rachel-perkins-echoes-uluru-statement/11696504

NACCHO Aboriginal Health and #Remote Communities : #WA Minister @benwyatt It is time we have a genuine dialogue about securing the ­future of remote communities and work towards establishing a long-term partnership between Aboriginal communities and state and commonwealth governments

“ The commonwealth has shown it has no interest in sustaining remote communities in Western Australia. In recent years the commonwealth has transferred its long-held responsibilities for housing and essential and municipal services to the state. And its legal responsibility to administer social security payments for people living in remote communities is operated punitively through the CDP and cashless debit card scheme.

Promoters of this approach say it is the most effective way to address passive welfare and to protect children and women in communities — and, to a certain extent, I am attracted to this rationale. Removing the never-ending humbugging between generations is a worthy aim, but removing cash from a vast landmass with no supporting technology is not working.

It is time we have a genuine dialogue about securing the ­future of remote communities and work towards establishing a long-term partnership between Aboriginal communities and state and commonwealth governments.

That partnership should incorporate strategies that break the institutionalised ghetto status of these communities and also understand how communities interact with each other. It should also involve best-practice governance models and vastly improved service delivery.

 To me Ngaanyatjarra would be an ideal trial site for such an approach.”

Opinion article in The Australian from Ben Wyatt the West Australian Minister for Aboriginal Affairs

Last week I drove from Perth to Warburton and Warakurna, two of the most remote communities on Earth.

Arriving at Warburton, population about 500 people, I visited the community’s administration office and became instantly immersed in the madness people there were dealing with.

A single mother was desperately contacting a distant call centre hoping to have her bank account reactivated after keying the wrong pass code given to her.

Unable to produce the required evidence to identify herself she was told to travel a thousand kilometres to Alice Springs to front in person.

She was desperate and broken.

Another woman with children to feed sought emergency relief after her income was suspended by Centrelink for breaching her work-for-the-dole conditions un­der the Community Development Program. At the counter a range of community people queued, demanding that overwhelmed staff help them navigate a social security ­income and banking system that to anyone appears impossibly complex.

This happens regularly, I was told repeatedly, where people have their income cancelled if they fail to report to Centrelink fortnightly on any changes to their living circumstances, miss a monthly report to Jobactive, which runs the CDP scheme, or do not comply with the requirement to work 20 hours a week for the dole all year round.

Given that English is generally not Ngaanyatjarra people’s first language, lack of phone access and the real­ity that people move between communities for all sorts of cultural and social reasons, the numbers of people denied social security payments is, of course, growing.

Other people complained they could not access funds from their bank because they had been conscripted on to the commonwealth’s income management debit card scheme — usually while spending time in Kalgoorlie — without fully understanding the consequences.

The scheme, which quarantines 80 per cent of social security payments to a special bank card that can be used only at certain vendors and cannot be used to buy alcohol and gamble, is being rolled out in Kalgoorlie and the Goldfields as part of a national trial.

The grog-free Ngaanyatjarra lands are not part of the trial and Ngaanyatjarra people who have been ensnared in the scheme through their visits to Kalgoorlie and other Goldfields towns are joining the increasing number of destitute people who rely on their already impoverished families to survive.

A line of these cards is kept behind the office reception in an attempt by the community’s administration to, somehow, turn these cards, inoperable in the lands, into cash.

Clearly there has been significant problems in implementing the scheme, with its Canberra-based designers having no idea how the Goldfields and Ngaanyatjarra Lands operate as an integrated region.

  • Large red dot: 500 people or more
  • Medium red dot: 200 to 499
  • Small red dot: 50 to 199
  • Smaller back dot: less than 50 people

Visiting these communities I was struck by an overwhelming sense that people are disempowered and punished by a digital world of faceless and distant ­bureaucratic controllers.

Centrelink no longer posts cheques, and financial transfers to personalised bank accounts assume people have access to computers and banks. There are no banks in ­remote communities.

This, combined with declining finances coming into the lands through increased payment cancellations as punishment and the increasing conscriptions on to the cashless card scheme has meant the Warburton community council has had to establish its own quasi banking system through recirculating money from the community store.

This situation is unsustainable. There is already a crisis of ­financial security in Warburton and other Ngaanyatjarra communities.

I sense the next phase of this crisis is community implosion resulting in a major population relocation to towns such as Kalgoorlie and Laverton if policies aimed at supporting remote communities don’t change; a ­dynamic that would be replicated throughout remote Australia.

 

NACCHO Aboriginal Youth Health #ClosingtheGap #HaveYourSayCTG : The #NACCHOYouth19 Conference kicks off today in Darwin with a great line up of inspirational speakers

“Young people make up 54 per cent of the Aboriginal and Torres Strait Islander population and look up to the example set by generations past and present to navigate ever-changing and complex social and health issues.

We are thrilled to announce an illustrious line-up of speakers at the NACCHO Youth Conference and are expecting to host around 100 Aboriginal and Torres Strait Islander youth delegates from across the country.

The conference will provide opportunities to explore and discuss issues of importance to young people, their families and communities, and help shape our youth towards becoming tomorrow’s leader.”

NACCHO Acting Chair, Donnella Mills.

The National Aboriginal Community Controlled Health Organisation (NACCHO) will today host its annual National Youth Conference, Members’ Conference and AGM from 4–7 November 2019 at the Darwin Convention Centre, commencing with the Youth Conference on 4 November.

The 2019 theme for the Members’ Conference is Because of Them, We Must! Improving health outcomes for people aged 0-to-29-year-olds. In line with the theme follows the central focus on building resilience for the NACCHO Youth Conference Healthy youth, healthy future.

NACCHO is thrilled to announce some of the featured speakers for the 2019 Youth Conference which include:

Preston Campbell, Former NRL star, community leader and founder of the Preston Campbell Foundation;

Brooke Blurton, Noongar-Yamatji woman, social media influencer and youth advocate;

Jarlyn Spinks and Katy Crawford of the Kimberley Aboriginal Medical Service (KAMS) team for the campaign ‘Her Rules Her Game’ which celebrates the strength of Aboriginal women playing football in the Kimberley region;

Marlee Silva, Gamilaroi-Dunghutti woman and Co-Founder of #tiddas4tiddas, an Aboriginal and Torres Strait Islander women’s empowerment social media initiative;

Brendan Dunn of the Coalition of Peaks Secretariat in Canberra;

Dr.Mangatjay Mcgregor, Yolgnu man from Milingimbi and intern doctor at the Royal Darwin Hospital;

Oliver Tye, Noongar man based on Ngunnawal Country in the ACT and Policy Officer at NACCHO.

Part 2 Closing the Gap / Have your say about youth issues 

Deadline extended to Friday, 8 November 2019.

 

The engagements are now in full swing across Australia and this is generating more interest than we had anticipated in our survey on Closing the Gap.

The Coalition of Peaks has had requests from a number of organisations across Australia seeking, some Coalition of Peak members and some governments for more time to promote and complete the survey.

We want to make sure everyone has the opportunity to have their say on what should be included in a new agreement on Closing the Gap so it is agreed to extend the deadline for the survey to Friday, 8 November 2019.

This will help build further understanding and support for the new agreement and will not impact our timeframes for negotiating with government as we were advised at the most recent Partnership Working Group meeting that COAG will not meet until early 2020.

There is a discussion booklet that has background information on Closing the Gap and sets out what will be talked about in the survey.

The survey will take a little bit of time to complete. It would be great if you can answer all the questions, but you can also just focus on the issues that you care about most.

To help you prepare your answers, you can look at a full copy here

The survey is open to everyone and can be accessed here:

https://www.naccho.org.au/programmes/coalition-of-peaks/have-your-say/

NACCHO Aboriginal cultural safety in health care: New @AIHW monitoring framework assesses progress in achieving cultural safety in the health system for Indigenous Australians

” For the purpose of developing a monitoring framework cultural safety is defined with reference to the experience of the Indigenous health care consumer, of the care they are given, their ability to access services and to raise concerns.

Some of the essential features of cultural safety include an understanding of one’s culture; an acknowledgment of difference, and a requirement that caregivers are actively mindful and respectful of this difference.

The presence or absence of cultural safety is determined by the experience of the recipient of care and is not defined by the caregiver (AHMAC 2016).” 

AIHW Online Report HERE

Or Download Summary

Cultural safety in health care_ monitoring framework

1.Culturally respectful health care services

Cultural respect is achieved when the health system is a safe environment for Indigenous Australians, and where cultural differences are respected. This module reports on how health care is provided, and whether cultural respect is reflected in structures, policies and programs.

The 2017–18 Online Services Report data showed that among Indigenous primary health care providers:

  • 95% had a formal commitment to providing culturally safe health care
  • 84% had mechanisms to gain advice on cultural matters
  • over 70% of organisations  with a formal board had over half of Board members who were Indigenous
  • nearly 4 in 10 provided interpreter services; while around one third offered culturally appropriate services such as bush tucker, bush medicine and traditional healing.
  • 41% of health staff employed in these organisations were Indigenous
  • almost all (99%) provided cultural orientation for non-Indigenous staff.

National health workforce data showed that from 2013 to 2017:

  • the number of Aboriginal and Torres Strait Islander medical practitioners employed in Australia increased from 234 to 363
  • the number of Indigenous nurses and midwives employed in Australia increased from 2,434 to 3,540.

See more info PART 2 Below for modules 2 and 3

Part 1 Cultural Safety Background

The concept of cultural safety has been around for some time, with the notion originally defined and applied in the cultural context of New Zealand. It originated there in response to the harmful effects of colonisation and the ongoing legacy of colonisation on the health and healthcare of Maori people—in particular in mainstream health care services.

A commonly accepted definition of cultural safety from the Nursing Council of New Zealand (2002:7) is the ‘effective nursing or midwifery practice of a person or family from another culture, and is determined by that person or family… Unsafe cultural practice comprises any action which diminishes, demeans or disempowers the cultural identity and wellbeing of an individual.’

A distinctive feature of this definition of cultural safety is its emphasis on the provision of culturally safe health care services as defined by the end users of those services, notably, the Maori people of Aotearoa New Zealand, not by the (non-Maori) providers of care.

The National Collaboration Centre for Indigenous Health in Canada (2013) notes that culturally safe health care systems and environments are established by a continuum of building blocks:

Cultural awareness ⟹ Cultural sensitivity ⟹ Cultural competency ⟹ Cultural safety

The centre states that cultural safety ‘…requires practitioners to be aware of their own cultural values, beliefs, attitudes and outlooks that consciously or unconsciously affect their behaviours. Certain behaviours can intentionally or unintentionally cause clients to feel accepted and safe, or rejected and unsafe. Additionally cultural safety is a systemic outcome that requires organizations to review and reflect on their own policies, procedures, and practices in order to remove barriers to appropriate care.’

In Australia, there has been increasing recognition that improving cultural safety for Aboriginal and Torres Strait Islander health care users can improve access to, and the quality of health care. This means a health system where Indigenous cultural values, strengths and differences are respected; and racism and inequality is addressed.

There are difficulties in both defining and measuring generalised concepts such as cultural respect and cultural safety. They include lack of conceptual clarity and agreement on terms, the qualitative nature of the concepts, and the diversity of Indigenous Australians and their perceptions.

The Australian literature uses various definitions of cultural safety, and related concepts such as cultural respect and cultural competency, and what these mean in relation to the provision of health care.

For the purpose of developing a monitoring framework cultural safety is defined with reference to the experience of the Indigenous health care consumer, of the care they are given, their ability to access services and to raise concerns. Some of the essential features of cultural safety include an understanding of one’s culture; an acknowledgment of difference, and a requirement that caregivers are actively mindful and respectful of this difference. The presence or absence of cultural safety is determined by the experience of the recipient of care and is not defined by the caregiver (AHMAC 2016).

Two important aspects of culturally safe health care across the literature are, how it is provided and how it is experienced, and these form the basis for the monitoring framework (see AHMAC 2016; CATSINAM 2014; AIDA 2014; DHHS 2016; NACCHO 2011; Department of Health 2015).

How health care is provided

  • behaviour, attitude and culture of providers: respects and understands Indigenous culture and people
  • defined with reference to the provision of care, including governance structures, policies and practices

How health care is experienced  by Indigenous people

  • feeling safe, connected to culture and cultural identity is respected
  • can only be defined by those who receive health care

The importance of cultural respect and cultural safety is outlined in Australian government documents such as the Cultural Respect Framework 2016–26 for Aboriginal and Torres Strait Islander Health, and the National Aboriginal and Torres Strait Islander Health Plan 2013–23.

The Australian Commission on Safety and Quality in Healthcare (ACSQHC) also included six Aboriginal and Torres Strait Islander specific actions in the National Safety and Quality Health Service Standards to improve care for Aboriginal and Torres Strait Islander people in mainstream health services.

 Part 2 Summary

The cultural safety monitoring framework covers three domains: the first focusing on how health care services are provided, the second on Indigenous patients’ experience of health care, and the third on measures regarding access to health care.

Data are reported from a wide range of available national and state and territory level sources to provide a picture of cultural safety, though there are significant data gaps. Sources include both national administrative data collections and surveys of Indigenous health care users.

2.Patient experience of health care

The experiences of Indigenous health care users, including having their cultural identity respected, is critical for assessing cultural safety. Aspects of cultural safety include good communication, respectful treatment, empowerment in decision making and the inclusion of family members.

National survey data show that:

  • in 2014–15, an estimated 80% of Indigenous Australians who consulted a doctor/specialist in the last 12 months said that their doctor always/often listened carefully, while an estimated 85% said that their doctor always/often showed respect for what was said.
  • in 2012–13, an estimated 20% of Indigenous Australians reported being treated unfairly by health care staff in the last 12 months.

The differences in rates of Indigenous and non-Indigenous hospital patients who choose to leave prior to commencing or completing treatment are frequently used as indirect measures of cultural safety. Among:

  • emergency department presentations in 2015–16, around 8% of Indigenous patients and 5% of non-Indigenous patients took own leave or did not wait
  • hospitalisations in 2013–15, around 3% of Indigenous and 0.5% of non-Indigenous patients left against medical advice or were discharged at their own risk.

3.Access to health care services

Indigenous Australians experience poorer health than non-Indigenous Australians’, but they do not always have the same level of access to health services. This is due to a range of different reasons, including remoteness and affordability. Selected measures of access to health care services for Indigenous and non-Indigenous Australians are used to monitor disparities in access.

  • BreastScreen participation rates for the two year period 2016–2017 for Indigenous women were 27% compared with 34% for non-Indigenous women.
  • Indigenous Australians waited longer to be admitted for elective surgery in 2017–18 than non-Indigenous Australians (median waiting time of 48 days and 40 days, respectively).
  • In 2015, the potentially avoidable mortality rate for Indigenous Australians was over 3 times the rate for non-Indigenous Australians (345 and 105 per 100,000 respectively).

Data gaps

Monitoring cultural safety and cultural respect in the health system, and the impact it has on access to appropriate health care, are limited by a lack of national and state level data. This is particularly the case in relation to reporting on the policies and practices of mainstream health services, such as hospitals and primary health care services.

There is also limited data on the experiences of Indigenous health care users. Most jurisdictions undertake surveys about patients’ experiences in public hospitals, but there was  not a lot of available data on Indigenous patient experience. A high proportion of Indigenous Australians use mainstream health services, so further data developments in this area are required to allow for more comprehensive reporting across the health sector.

NEXT PAGE 

 

Aboriginal #Rural and #Remote Health #ClosingTheGap #HaveYourSayCTG : New @AIHW Report says the mob living in remote and regional areas are dying preventable deaths from treatable conditions because of a lack of access to health services

 “Australians living in remote and regional areas are dying preventable deaths from treatable conditions because of a lack of access to health services.

The damning assessment is contained in a new Australian Institut­e of Health and Welfare report on rural and remote health, which finds that those in the bush rely heavily on general practitioners to provide primary healthcare services in the absence of specialist doctors.

But patients most in need of GPs often can’t access them, with those in remote areas six times as likely as those in metropolitan centres to report they had no access­ to one.”

From Natasha Robinson The Australian October 24 Continued Part 1 below

Aboriginal and Torres Strait Islander people are more likely to have higher rates of chronic conditions, hospitalisations and poorer health outcomes than non-Indigenous Australians

The differences in health outcomes in Remote and Very remote areas may be due to the characteristics of these populations.

The proportion of the population that is Indigenous, is much higher in more remote areas

However, more Indigenous Australians live in Major cities and Inner regional areas (61% of Indigenous Australians) compared with Remote and Very remote areas (19%) “

From the AIHW Report see Part 2 Below

Download full report HERE

Rural & remote health

Part 1 The Australian media report 

The report comes as The Australian revealed yesterday that the numbers of domestically trained doctors entering GP training had fallen for the third year in a row, with rural areas relying heavily on overseas-trained doctors to fill the workforce shortfall.

The AIHW report finds people in remote areas die five years before­ their city counterparts, with a life expectancy of 76 years.

More than 70 per cent of those living in regional areas are overweight or obese, less than one in 10 eat the recommended number of serves of vegetables per day, and one-quarter have high blood pressure or mental health problems.

Rural Australians are dying of diabetes at much higher rates than city dwellers, and many cancers­ go undetected because of a lack of acces­s to screening programs.

“The rate of potentially avoidable deaths increased as remote­ness increased,” the report says. “These are deaths among people aged 75 and under from conditions considered potentially preventable through individualised care, and/or treatment through existing primary or hospital care.”

The Australian College of Rural and Remote Medicine said the situation was a “tragedy”.

“We have a rural health crisis that extends right across from our Aboriginal and Torres Strait Island­er people to our rural communities,” said college president Ewen McPhee.

“I think it’s a tragedy that rural communities continue to be neglec­ted.”

In many tiny towns across the country, residents rely on the Royal Flying Doctor Service to provide access to a GP.

Yesterday in Stonehenge in remote­ central Queensland, doctor­ Arthur Beggs and nurse Jo Mahony­ flew in to provide the fortnightly mobile GP service for the town and surrounding areas of about 50 people.

“A lot of people don’t want to bother us unless they are really unwell and that’s really typical of the stoic, outback approach,” Dr Beggs said.

The RFDS has introduced a chronic disease management plan to the town, tracking baseline health measurements and flying specialist allied health practitioners in every few weeks to provide extra services.

Dr Beggs knows the challenges of being a rural GP, but says the difficulties are outweighed by the satisfaction of the work.

“I find rural and remote medicine fascinating and much more fulfilling than I do city-based medicine,” he said.

A recent report published by the Medical Deans of Australia found only 15 per cent of medical students in their final year of study said they were interested in becomin­g GPs, the lowest figure in five years.

Dr Beggs said attracting GPs to rural and remote areas was key to improving health outcomes in the bush.

“Modern medicine is all about specialties,” he said.

“The specialties can seem a more lucrative and controlled environm­ent than the realms of general practice, which is unfortun­ate because general practice­ gives you a much better overview of people and their health.”

Part 2

Profile of rural and remote Australians

See AIHW Online version HERE

For more information on Aboriginal and Torres Strait Islander health by remoteness see: The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples: 2015 and the Aboriginal and Torres Strait Islander Health Performance Framework (HPF) report

Overall, more Australians live in Major cities compared with rural and remote areas

. In 2017, the proportion of Australians by area of remoteness was:

72% in Major cities

18% in Inner regional areas 8.2% in Outer regional areas 1.2% in Remote areas

0.8% in Very remote areas (ABS 2019b).

On average, people living in Remote and very remote areas were younger than those living in Major cities ( gures 1a and 1c).

Australians aged 25–44 were more likely to live in Remote and very remote areas and Major cities compared with Inner regional and outer regional areas. However, a higher proportion of people aged 65 and over lived in Inner regional and outer regional areas and Major cities, compared with Remote and very remote areas ( gures 1a, 1b and 1c).

Rural and remote Australia encompasses many diverse locations and communities and people living in these areas face unique challenges due to their geographic isolation.

Those living outside metropolitan areas often have poorer health outcomes compared with those living in metropolitan areas. For example, data show that people living in rural and remote areas have higher rates of hospitalisations, mortality, injury and poorer access to, and use of, primary health care services, compared with those living in metropolitan areas.

Health inequalities in rural and remote areas may be due to factors, including:

  • challenges in accessing health care or health professionals, such as specialists social determinants such as income, education and employment opportunities higher rates of risky behaviours such as tobacco smoking and alcohol use
  • higher rates of occupational and physical risk, for example from farming or mining work and transport-related accidents.

Despite poorer health outcomes for some, the Household, Income and Labour Dynamics in Australia (HILDA) survey found that Australians living in small towns (fewer than 1,000 people) and non-urban areas generally experienced higher levels of life satisfaction compared with those in urban areas (Wilkins 2015).

Rural and remote Australians also report increased community interconnectedness and social cohesion, as well as higher levels of community participation, volunteering and informal support from their communities (Ziersch et al. 2009).

Part 3 National : Closing the Gap / Have your say CTG deadline extended to Friday, 8 November 2019.

 

The engagements are now in full swing across Australia and this is generating more interest than we had anticipated in our survey on Closing the Gap.

The Coalition of Peaks has had requests from a number of organisations across Australia seeking, some Coalition of Peak members and some governments for more time to promote and complete the survey.

We want to make sure everyone has the opportunity to have their say on what should be included in a new agreement on Closing the Gap so it is agreed to extend the deadline for the survey to Friday, 8 November 2019.

This will help build further understanding and support for the new agreement and will not impact our timeframes for negotiating with government as we were advised at the most recent Partnership Working Group meeting that COAG will not meet until early 2020.

There is a discussion booklet that has background information on Closing the Gap and sets out what will be talked about in the survey.

The survey will take a little bit of time to complete. It would be great if you can answer all the questions, but you can also just focus on the issues that you care about most.

To help you prepare your answers, you can look at a full copy here

The survey is open to everyone and can be accessed here:

https://www.naccho.org.au/programmes/coalition-of-peaks/have-your-say/

NACCHO Aboriginal Kidney Health #NIKTT #NIDTC2019 #ClosingTheGap #HaveYourSayCTG : Our CEO Pat Turner pays tribute to her Uncle Charlie Perkins in speech to the National Indigenous Dialysis and Transplantation Conference

 ” Every which way you look at renal disease in Aboriginal people, the only solutions that will work in the long term are those that are Aboriginal–led, culturally responsive, located in Aboriginal organisations and evaluated through an Aboriginal lens.

As I have described below, Danila Dilba and KAMS show you the proven capacity of community control to deliver results and accelerate outcomes for people with chronic renal disease.  

Both services have people sharing their experiences at this conference.  Keep an eye out for their presentations.

To our non-Indigenous supporters in the audience today, I believe these examples about HOW we want to work together will be inspiring. Please expand your discussions during the conference with a positive acknowledgement of community control, and the rights we have as Aboriginal and Torres Strait Islander peoples to shape our own destiny, to partner with you as equals in service delivery, and to be accountable. ” 

Pat Turner NACCHO CEO

Read all Aboriginal Kidney Health articles published by NACCHO

Read all 160 Aboriginal Health and Diabetes articles published by NACCHO 

Before I begin, I acknowledge the Arrernte people and their country on which we meet today.  As many of you may know, I am back home where I was born and feeling very much re-energised by the country that knows me so well, my family and friends.

This conference brings together both community and health care sectors.  A hugely diverse audience!   Your efforts at this conference will help shape a five-year National Indigenous Kidney Transplantation Strategy to be provided to the Commonwealth in 2020.

With this conference mandate, I hope you will permit me to reflect on the WHY, the HOW and the WHEN of what we are all trying to achieve together.

The WHY is both personal and professional for me.

At the time of his death in 2000 from renal complications, one of my uncles had been the longest living Australian kidney transplant recipient.

And my uncle had been many other ‘firsts’ in his life.  For example:

  • The first Aboriginal person to graduate with a university degree
  • The first Aboriginal person to play soccer at elite level

and

  • The first Aboriginal person to be the permanent head of an Australian government department.

My uncle’s name?  Charlie Perkins.

His transplant in 1972 – the year he arrived in Canberra for the Tent Embassy  – gave my uncle another 28 years of life.

Instead of dying at 36 years of age, he died nearly three decades later at 64.

Imagine if his life had been cut short at 36, which is what would have happened without his renal transplant.

In the words of then Senator Aiden Ridgeway in the Senate chamber in October 2000  about my uncle: “we would not have had his contribution to the life of the nation”.

Dying in his mid-thirties would have been a tragic loss for the country.  BUT, it would ALSO have been a tragic personal loss for uncle’s family, including me, and his communities.   It would have robbed us of someone we loved far too soon.

Every Aboriginal and Torres Strait Islander person whose life you save is just as important  to their family and community as my uncle was to me and mine.

While each one may not have the same national profile as Charlie Perkins, each person has a life with meaning and importance.

The old man you treated last week could be a respected cultural boss, a law man, an esteemed knowledge holder in his own community.

The young woman you treat next week could be on her own journey to become a healer, an artist or elder in her own right, as her community ordains.

The next 20 year-old your efforts engage in renal health could be Australia’s first Aboriginal Prime Minister, or the Chancellor of Australia’s first Indigenous university or our 1000th Aboriginal doctor.

You never know.  You must take the long view.

Every premature death from preventable renal disease inflicts a shortfall in community capacity and resilience: now and in the future.

Every funeral adds to our intergenerational trauma, our collective loss and our … exhaustion!  We have plenty of reserves  — history shows my people always manage to bounce back.  BUT the preventable toll of chronic renal disease must stop.

So there it is.  The WHY is huge!

Because of this WHY, let me now share a few ideas about HOW.

My first example comes from Danila Dilba Health Service in Darwin. 

Data points taken over a ten-year period provided Danila Dilba with unique insights about the management and disease trajectory of people with chronic renal disease before and after the appointment of a Renal Case Manager to their team.   Creating this Renal Case Manager position specifically aimed to delay progression of their clients to end-stage kidney disease.

Danila Dilba recruited this new position in early 2008.   With this new role, all members of the primary healthcare team were to be supported through the provision of systematic patient monitoring, and access to the latest advice about evidence-based practice for very complex clinical challenges.  As a learning organization, Danila Dilba also committed to an independent evaluation of these service changes.

Before this new role, there were clear gaps in care that needed improving.  For example:

  • Documentation in the electronic clinical record system.  Only 60% of patients were identified with their diagnosis.
  • Screening of ‘at risk’ patients was very low. Although there were over 500 patients with diabetes for example, few of these had been screened for chronic renal disease.
  • There was underuse of the GP management plan.  Only 63% of patients had a current plan. Only 14% of these contained self-management goals.  Only 26% contained clinical goals.

Using the ten-year data, this independent evaluation documented convincing improvements. The evaluation showed that Danila Dilba increased screening and monitoring of people under their care with Stage 3 to 5 chronic renal disease.

Prompt access to expert knowledge at the tertiary level also increased the organisation’s competence to recognise and effectively manage patients with chronic renal disease and associated complex comorbidities.

BUT the risk of tertiary renal services taking over the management of people to the exclusion of their other health priorities was avoided.

There was a significant increase in the timely identification of people in Stage 3 rather than the later, more difficult stages of chronic renal disease.  In fact, the patient numbers with Stage 3 grew from fifteen to 101 patients. The growth in the number of people in Stages 4 and 5 was less dramatic in absolute numbers, but a positive improvement was shown.  There was an increase in clinic visits for people with more advanced disease and, overall, improved management of risk factors.

As a result of this initiative, those patients with both renal disease and diabetes were better managed in terms of meeting agreed evidence-based targets for diabetes control.

At Danila Dilba, the proportion of patients meeting specific clinical targets for their care has sat above 90% consistently since 2012. Indeed, management of patients with diabetes has been above average since these data audits commenced.  There was a very welcome stabilization of diabetes control for those with Stage 5 renal disease.  This is fantastic for the patient’s wellbeing.

Of course, you’ll also be asking whether this increased service output delayed progression of chronic renal disease!

Before the program, 50% of patients ended up with Stage 5 within two and half years of identification.  After the program, progression had slowed down dramatically.  Rather than two and half years, the time it took to progress had extended out to four years.  This represents a significant delay in disease progression.  I find these results very positive.  In my mind, the rate of progression seems to have been nearly halved.  My congratulations to the team.

Overall, this experience has helped shift Danila Dilba to a ‘systems approach’. Their new service design, which also takes services close to home, has increased client access and increased client numbers.  This is what community-controlled primary health care is all about.  Screening for chronic renal disease is embedded in annual health checks.   Anyone with acute kidney injury is managed with clinical precision, until their kidney function returns to usual.  Since 2014, there has also been a doubling of people with diabetes, so Danila Dilba staff are managing much more complexity.

As a result of these initiatives, those patients with both renal disease and diabetes are better managed in terms of meeting agreed evidence-based targets for diabetes control.  The evidence is convincing.  Danila Dilba’s national KPIs are either AT or VERY CLOSE to their 2023 targets.

At Danila Dilba, there is a careful balance between ‘siloed’ technical expertise held by those with super-speciality knowledge about chronic kidney disease, and the need for care that looks at the whole person.  As Dr Sarah Giles has said “We’re not managing numbers, we are caring for people”.  Danila Dilba is preventing disease onset through effective risk factor management AND preparing people with serious renal disease and their families for choices, for a planned transition to dialysis.

I learned from the Transplant Society’s Performance Report that Aboriginal Australians are less likely than other Australians to receive a kidney transplant primarily because they are less likely to be put on the waiting list.  The need for culturally competent pre-transplant education is indisputable.  What Danila Dilba shows is that this education cannot happen out-of-the-blue without an existing relationship between the person, their family AND a health service they trust.  Expanding that waiting list is a clear role for community-controlled primary health care in concert with their tertiary service colleagues.

The second community-controlled example I’d like to share with you today is from the Kimberley region.

There, the Kimberley Aboriginal Medical Services known as KAMS has taken a pioneering step in becoming the first aboriginal community controlled renal healthcare service in Australia.  And quite possibly in the world.  This service is known as Kimberley Renal Services, or KRS, a wholly owned subsidiary of KAMS.  By running KRS itself, KAMS ensures a culturally appropriate renal healthcare service is available for Aboriginal people with chronic renal disease close to home.

There are 124 people currently receiving lifesaving haemodialysis treatment cared for by KRS. KRS provides renal healthcare services within four renal health centres.  These are located in the towns of Broome, Derby, Fitzroy Crossing and Kununurra.  Another 18 patients have chosen Home Therapy.   But there is a very large number of Kimberley people waiting in Perth to be able to come back home for dialysis.  Perth is a long way from country.

After many years frustrated by a model that wasn’t working for communities, KAMS secured significant funding for this service innovation which they have designed with absolute attention to cultural safety and clinical outcomes.

KRS has ensured a multi-disciplinary team approach is available to support people throughout their renal healthcare journey.  Access to the renal health centres is provided 6 days a week Monday to Saturday all year round.  The only days that the service is not available are Sunday’s and Christmas Day.

In designing their own solution, our colleagues in KAMS thought it was important to emphasise health as a priority, not disease.  So the decision was made to change from the previous term ‘dialysis units’ to the new term, ‘renal health centres’.   Anyone can engage with their renal health centre for advice, information and understanding.

There is a focus on local staff in each of these sites, learning and doing and caring for their families and communities in jobs vital for the community.  These local KRS staff include Aboriginal Health Workers, Patient Care Assistants, Aboriginal care co-ordinators and Aboriginal nurses.   KAMS is committed to Aboriginal employment.  Currently, 36% of the staff employed in KRS is Aboriginal.   There is an affirmative Aboriginal employment policy and, because KRS is managed by KAMS, cultural values permeate the entire service.  No patient is seen without an Aboriginal staff member.  All non-Indigenous staff recognise that Aboriginal staff guide their practice.

As a matter of necessity, there are three “renal GPs” in the team.  These are qualified GPs credentialed for independent practice who have also gained specific expertise in the nuanced management of chronic renal disease and other medical conditions affecting kidney function.  In a region the size of Germany, this works in a shared care model.

KRS has also been designed to conduct scheduled outreach to communities.  In doing so, this KRS multidisciplinary team does not cut across primary health care. Indeed, KRS has a shared care model that requires a strong foundation in primary health care to work.  This partnership is best when there are common values, clear team arrangements and community control.  Clinical medical records are shared. The renal team offers in-service training, both formal and informal, any time they are visiting a location for regular community outreach visits.  There can be telephone enquiries about patients at any time.

Another part of this service addresses community engagement and life-saving prevention. There are approximately 2,800 people known to KRS who are in Stages 1 to 3 of chronic renal disease across the region.  It is this commitment to prevention that will stem the tide of future incidence.

KAMS is looking outwards and wants to ensure none of these people in Stages 1, 2 or 3 progress to the more critical Stages 4 or 5.  Currently, there are 138 people progressing to End Stage Kidney Disease.  These patients will require haemodialysis within the next 12 to 18 months.  This will more than double the caseload.  With this projection, people are asking why the region does not yet have at least one full-time residential nephrologist.  Addressing this unresolved aspect of medical workforce planning and distribution nationally is critical to successful chronic disease management, and achieving equity of access to renal replacement therapy that our people deserve.

Having visited the Kimberley last week, I was most impressed by the commitment to evidence-based renal disease management through Australia’s first community-controlled renal healthcare service. Speaking with staff and community, the best outcomes are coming through with community-controlled primary health care.  Indeed, this KAMS model can’t work unless there is a strong foundation of community-controlled primary health care.

I learned last week that some of the greatest frustrations occur when primary health care is understaffed, especially when members of the primary health care team are pulled off chronic disease management for a different priority, OR when locum staff don’t handover properly and neglect to check critical pathology results.  These “stop-start” dynamics in primary health care are seen in all settings across the country.  They compromise shared care models.  They are also unsafe for patient care.

For this reason, NACCHO is leading national projects to ensure that core services are fully funded in primary health care and deliver the outcomes our people deserve.

NACCHO supports statements by various governments to transition Aboriginal primary health care to community control.   Successful transition of one local primary health care service in East Arnhem from government management to community control achieved a 400% (yes, FOUR hundred percent) increase in episodes of care within five years.  This community engaged with an Aboriginal community-controlled primary health care service in a way that increased health checks beyond the national average.  More babies were born with healthy weights.  You, in the audience, know better than me the importance of healthy human development right from the beginning of conception to ensure healthy kidneys for life!

Every which way    you look at renal disease    in Aboriginal people, the only solutions that will work in the long term are those that are Aboriginal–led, culturally responsive, located in Aboriginal organisations and evaluated through an Aboriginal lens.

As I have described, Danila Dilba and KAMS show you the proven capacity of community control to deliver results and accelerate outcomes for people with chronic renal disease.  Both services have people sharing their experiences at this conference.  Keep an eye out for their presentations.

To our non-Indigenous supporters in the audience today, I believe these examples about HOW we want to work together will be inspiring. Please expand your discussions during the conference with a positive acknowledgement of community control, and the rights we have as Aboriginal and Torres Strait Islander peoples to shape our own destiny, to partner with you as equals in service delivery, and to be accountable.

So that covers the WHY and the HOW.

I want to talk about WHEN.

WHEN should we start working differently together? 

The answer is right now.

An historic Partnership Agreement on Closing the Gap has been signed between COAG and the national Coalition of Peak Aboriginal and Torres Strait Islander Organisations.  Now, for the first time, Aboriginal and Torres Strait Islander people through their peak representatives will share decision making with governments on Closing the Gap.

This Partnership Agreement has created a high-level COAG Joint Council for Indigenous Affairs.

This Joint Council is made up of 22 members.  That means a Minister from the Commonwealth Government, a Minister from each State and Territory Governments, and a representative from local government. This makes up ten members.

What about the other twelve?

The Coalition of Aboriginal Peak Bodies has ensured that the majority of members on this Joint Council are Aboriginal or Torres Strait Islander representatives.  Chosen by us, in the majority, working for our mobs.

The Joint Council has three reform priorities.  These are:

  1. Establishing shared formal decision making between Australian governments and Aboriginal and Torres Strait Islander people at the State/Territory, regional and local level to embed ownership, responsibility and expertise on Closing the Gap.
  2. Building and strengthening Aboriginal and Torres Strait Islander community-controlled organisations to deliver services and programs in priority areas.
  3. Ensuring all mainstream government agencies and institutions undertake systemic and structural transformation to contribute to Closing the Gap.

This commitment to equal partnership through COAG has brought us to the table.  There’s no going back.

The Joint Council also agreed to the Coalition of Peaks leading engagements with Aboriginal and Torres Strait Islander people to ensure others can have a say on the National Agreement on Closing the Gap.  Surveys are out now and can be submitted anytime by Friday 25 October.

So to close my presentation to you today, a final reflection.

I am mindful that the Bulletin of the World Health Organization recently carried an article stating that kidney disease is ‘THE most neglected chronic disease’.

….. but neglected by whom?

Certainly NOT by anyone in THIS audience!

I applaud your dedication and your hard work.  By being here in Alice Springs, your commitment to better health for Aboriginal and Torres Strait Islander peoples in Australia is visible and much appreciated.

I know this issue is complex and no doubt frustrating.  Occasionally, you must feel completely demoralized in your work.  The Society’s Performance Report recognizes there is ‘no easy fix’.

But please be strengthened by the WHY, the HOW and the WHEN I have described today.

Working together, we can achieve even more than my uncle ever imagined.

National : Closing the Gap / Have your say CTG deadline extended to Friday, 8 November 2019.

 

The engagements are now in full swing across Australia and this is generating more interest than we had anticipated in our survey on Closing the Gap.

The Coalition of Peaks has had requests from a number of organisations across Australia seeking, some Coalition of Peak members and some governments for more time to promote and complete the survey.

We want to make sure everyone has the opportunity to have their say on what should be included in a new agreement on Closing the Gap so it is agreed to extend the deadline for the survey to Friday, 8 November 2019.

This will help build further understanding and support for the new agreement and will not impact our timeframes for negotiating with government as we were advised at the most recent Partnership Working Group meeting that COAG will not meet until early 2020.

There is a discussion booklet that has background information on Closing the Gap and sets out what will be talked about in the survey.

The survey will take a little bit of time to complete. It would be great if you can answer all the questions, but you can also just focus on the issues that you care about most.

To help you prepare your answers, you can look at a full copy here

The survey is open to everyone and can be accessed here:

https://www.naccho.org.au/programmes/coalition-of-peaks/have-your-say/