NACCHO Smoke Free News : Indigenous smoking rates declining-Tom Calma


“We know that when provided appropriately targeted information and encouraged to lead the solutions, Indigenous people are responding in an overwhelmingly positive manner.  

But, while the decline of smoking is encouraging, we need to be sure we don’t become complacent.  

The challenge to reduce smoking or not take it up is immense and will require a sustained and well-funded effort to really make a difference for our people and close the healthy inequality gap.”

Dr Tom Calma AO National Coordinator Tackling Indigenous Smoking


The recent release of the Victorian Cancer Council report highlighting that one in ten smokers do not believe that smoking causes illness, only a quarter of smokers could link smoking with heart attacks and half with lung cancer means that there is still work to do.

Two in five Aboriginal and Torres Strait Islander people continue to smoke, with one in five dying due to tobacco related illness and costing too many of our peoples’ lives every year.  This burden is too high and emphasises the importance and the urgency needed to continue, and accelerate, efforts to tackle smoking.

However, there are encouraging signs. This research also shows a dramatic increase in awareness of the effects of second-hand smoke on children and unborn babies and generally, strong public awareness of the harms of smoking.

This also follows the promising signs from the 2012-13 Aboriginal and Torres Strait Islander Health Survey which showed that the number of Aboriginal and Torres Strait Islander people smoking is decreasing, declining 10% over the last decade. The survey also showed a decrease in smoking uptake, with more than one third (37.2%) of Aboriginal and Torres Strait Islander adults never smoking (up from 30% in 2002).

Tackling Indigenous smoking programmes are making traction through a population health and capacity development and empowerment approach.

We know that when provided appropriately targeted information and encouraged to lead the solutions, Indigenous people are responding in an overwhelmingly positive manner.  But, while the decline of smoking is encouraging, we need to be sure we don’t become complacent.  The challenge to reduce smoking or not take it up is immense and will require a sustained and well-funded effort to really make a difference for our people and close the healthy inequality gap.

ABS 2012-13 Aboriginal and Torres Strait Islander Health Survey: CLICK HERE

The Perceptions about health effects of smoking and passive smoking among Victorian adults 2003-2011 report found

  • about a quarter of the smokers surveyed could not spontaneously say that heart attacks were caused by smoking.
  • the data also shows less than 10 per cent of current smokers can connect smoking with asthma, gangrene, eye problems or pregnancy problems.
  • And only half of all smokers surveyed could spontaneously link smoking with lung cancer.



Contact the NACCHO SMOKE free team

Contact the NACCHO TATS Talking About The Smokes team

Cancer Council Victoria releases fresh research on the attitudes of smokers, to mark the anniversary of the 1964 report by the US Surgeon General.

On the 50th anniversary of a landmark report linking smoking to cancer, a new report shows one in 10 smokers do not believe smoking causes illness.

Cancer Council Victoria is releasing fresh research on the attitudes of smokers, to mark the anniversary of the 1964 report by the US Surgeon General.

The survey of 4,500 Victorians was conducted by the charity and included a cross-section of smokers and non-smokers.

Todd Harper from Cancer Council Victoria says about a quarter of the smokers surveyed could not spontaneously say that heart attacks were caused by smoking.

He says the data also shows less than 10 per cent of current smokers can connect smoking with asthma, gangrene, eye problems or pregnancy problems.

And only half of all smokers surveyed could spontaneously link smoking with lung cancer.

“I think what we’ve also seen is some improvement over that period of time, we have a majority of people who recognise the harms of passive smoking, but we still have much more to do,” he said.

“Given that smoking still kills 15,000 people every year, given that smoking will kill one in two long-term users, I think it shows the importance and the urgency of keeping up the fight on tobacco.

“We can’t assume for a second that this job is done when we have 15,000 a year in Australia dying because of smoking.”

Health groups call for tougher tobacco laws

Mr Harper says there needs to be tighter licensing rules governing where cigarettes can be sold in some states, and higher licensing fees in the states that have an existing regulatory environment.

Shops do not need a licence to sell cigarettes in Queensland or Victoria.

Licensing arrangements exist in the other states and territories, but Mr Harper says the licences are far too cheap.

“It’s a remarkable contradiction that cigarettes are more freely available than milk and bread, I think we do need to look at ways of restricting the availability of tobacco products,” he said.

“We also need to be doing more to invest in public education campaigns to encourage smokers to quit and to continue to build on the success that we’ve had with smoke-free environments.

“What we’d like to see is that tobacco products weren’t freely available, particularly in places were children are likely to be frequenting.

“So that might be achieved by for example, increasing licence fees for sellers of tobacco products and I think we can also do more to extend smoke-free environments.

“We don’t do enough to recognise that selling tobacco products is not a right, it’s a privilege, these are products that kill one in two long-term users.

“So we do need to see a fee that is appropriate for the level of harm that’s caused and certainly in many cases, we’re seeing fees in the order of hundreds of dollars rather than thousands of dollars which might be a more appropriate starting point.”

A report published in the American Medical Journal this week says despite progress in reducing the prevalence of daily smoking since the 1980s, the number of smokers has “steadily increased” worldwide due to population growth.

The report says: “Although many countries have implemented control policies, intensified tobacco control efforts are particularly needed in countries where the number of smokers is increasing.”

It says between 1980 and 2012, the estimated prevalence of daily smoking for men declined from 41.2 per cent to 31.1 per cent, and women fell from 10.6 per cent to 6.2 per cent.

But it says more than 50 per cent of men are smoking in countries including Indonesia, Laos, Papua New Guinea and East Timor.

50th anniversary of landmark US report linking cigarettes to cancer

Saturday marks 50 years since the US Surgeon General Luther Terry released his report linking cigarettes to cancer.

Simon Chapman is the Professor of Public Health at the University of Sydney.

“This was the second big review after the English reviewed the evidence, which pulled everything together, all the research that existed and said ‘this is a major health problem’, it set the scene for years to come and has caused literally hundreds of millions of people to give up smoking,” Professor Chapman said.

“The Surgeon General is the leading office that pulls together reports about health in the United States and they’ve produced many reports over the years on smoking.

“I think people had understood for many years, people had understood expressions like smoking ‘stunted your growth’, but people had never really understood that smoking was a leading cause of death, in fact it kills more people in the world today than any other single cause.

“This really consolidated that evidence and said that the science was in on it, that smoking killed, as we know today, about half of people who are long term users.”

In 1964, smoking rates sat around 70 per cent for men and 30 per cent of women.

Since then, smoking rates among adults have more than halved, with current figures putting the smoking rate at 17.5 per cent.

Professor Chapman says there was little response in Australia at the time to the report.

“I think that many people found it difficult to take on board that smoking was as harmful as the report concluded, but in the years since that message has been amplified over and over again,” he said.

“There is really nothing in the history of medical science which is so conclusively demonstrated as the relationship of smoking to disease.

“Publicity which the report attracted immediately started causing many people to give up smoking, if you looked at what was happening particularly post-war, smoking was going up and up and up, and when those reports came out it started immediately going down and it’s been going down ever since.

“The tobacco industry were, predicably, very aggressive in their criticisms of the report. They started hiring tamed scientists who travelled around the world including to Australia, saying ‘Oh, it’s air pollution that’s doing this, it’s not cigarette smoking’, it was genetic and issues like that were raised continually by them.

“Unfortunately in Australia we had to wait 10 years for the government to take its first action which was to put very tiny health warnings on the bottom of cigarette packs.

“There was a lot of political pressure, there were a lot of connections of the tobacco industry into government, some of our leading politicians, documents show, had friendly relations with the tobacco industry at the time and so I think that they were reluctant to act against an industry which was in their own words, just another business.”

NACCHO health news:How to improve the health and wellbeing of Aboriginal youth: a new report


Australia can break the impasse in combating Aboriginal and Torres Strait Islander disadvantage by identifying and emulating elements of success, instead of constantly focusing on failures to deliver meaningful change.

This is the key finding of a landmark report into the social and emotional wellbeing of Indigenous youth, released  at a UNSW research symposium on October 10 2013.

DOWNLOAD 132 page REPORT here

UNSW’s Muru Marri, which looks at Indigenous health and wellbeing, set out to learn from successful public health programs, systematically isolating and analysing the key factors in achieving real progress, to create a blueprint for policy makers, service providers and Indigenous communities.

The report – The Social and Emotional Wellbeing of Indigenous Youth: Reviewing and Extending the Evidence and Examining its Implications for Policy and Practice – identifies the importance of tapping into knowledge from Aboriginal and Torres Strait Islander communities to deliver effective and sustainable youth programs.

The work, commissioned by the former Commonwealth Department of Families, Housing, Communities and Indigenous Affairs, includes in-depth case studies, with six outstanding programs across Australia informing the report.

Researchers found the programs shared common processes such as addressing the cause of poverty and other determinants of health as well as current issues; building on the strengths of culture, community and family; using a ‘bottom-up’ approach; and recognising the importance of leadership from Elders.

The report’s lead author, UNSW Associate Professor Melissa Haswell, says the study affirms that programs that authentically embed Aboriginal ways of being and doing could assist youth to achieve profound changes in their life trajectory.

“Based on the evidence in this report, guided by Aboriginal communities themselves, we have to ask ourselves as a society ‘What do we really want for our disadvantaged youth … how committed are we to making appropriate resources available to close the gap in youth opportunity and potential?’” she said.

The Fifth Annual Research Symposium, hosted by the School of Public Health and Community Medicine brings together UNSW, local and international experts on Indigenous public health, including Patricia Anderson, Chairperson of the Lowitja Institute, Professor Michelle Chino, University of Nevada, UNSW’s Professor Lisa Jackson Pulver and other leading researchers from Muru Marri and the School, the Centre for Primary Health Care and Equity, the National Drug and Alcohol Research Centre and the Kirby Institute at UNSW.
Other research topics to be discussed include:

  • Racism: a public health issue
  • The social determinants of Indigenous health
  • A campaign to cut cannabis use among Indigenous young people, the gunja brain story
  • Sexual health
  • Aboriginal health and ageing
  • The social and cultural resilience and emotional wellbeing of Aboriginal mothers in prison
  • Identification of Aboriginality in general practice
  • The best way to devise and assess health programs for Indigenous populations



Out thanks to Melissa Sweet for her continued support of NACCHO media

When it comes to improving Indigenous health, what works?

By Lisa Jackson Pulver on behalf of Muru Marri

Given their numbers and the billions of dollars spent on them, it is surprising how little is known in the wider community about the support programs which work in Aboriginal and Torres Strait Islander communities. More important, why they work has rarely been studied.

That gap in health research has now been addressed substantially with the release of a report, The social and emotional wellbeing of Indigenous youth.

The report is the result of years of work by Muru Marri at the UNSW at the behest of the former Commonwealth Department of Families, Housing, Communities and Indigenous Affairs.

Too much bureaucratic effort and media attention in Indigenous affairs has focused on the negative: how government programs and policies can fail and why, how resources can be wasted and lives broken. The constant negativity only reinforces the harm being done to Indigenous people.

This report takes the opposite approach. It seeks – at long last, most will say – to identify what exactly makes good programs succeed in supporting and enabling Aboriginal and Torres Strait Islander peoples to thrive and succeed.

Six programs, from Sydney, regional NSW, the Northern Territory, Queensland and South Australia, which have been working successfully for extended periods are analysed in detail, and the factors essential to their success identified.

The report was released on Friday at the University of NSW’s fifth annual symposium on Indigenous health research, Dreaming up the future of Aboriginal and Torres Strait Islander public health.

Associate Professor Melissa Haswell, the report’s lead author, explained the report’s approach: “We already know a lot about negative trajectories that Aboriginal and Torres Strait islander youth are taking.”

But with the programs that work, “what is happening that has helped young people move from the negative to the positive?”

From analysing the six projects, the researchers identified a series of factors critical to success. The projects all did these things – though how they did them sometimes differed in ways appropriate to each one.

The report groups the factors in four concentric layers: from the centre, the way an individual program relates to individual clients, outwards to a program’s sustainability, then to its ability to grow, and last to the outermost layer, the attitude of society as a whole to helping its marginalised members reach their full potential.

Indigenous ways of acting and being are crucial to success.

At the core, for example – the interface between program and client – ten factors are critical to effectiveness. They include:

  • working from strengths, not seeking to correct deficits
  • patience in developing a relationship, before using it to move towards positive change
  • reliability and consistency to build trust
  • facilitating connections to Aboriginal culture and community, and witnessing examples of Aboriginal leadership
  • a non-judgmental approach, using mistakes to learn better choices
  • setting rules and boundaries
  • allowing scope for choice and exploration
  • celebrating small achievements and positive changes
  • fun, creative, enjoyable, inspiring interactions.

Of the four sets of critical factors for success, Melissa Haswell says: ‘You read these and think, “Well, of course.”’

But she says, though they may seem obvious, they can get lost – as the fate of less successful programs shows.

“If we put this list of critical factors first, it will be protected and will guide future programs.”

A keynote address to the symposium from Pat Anderson, chair of the Lowitja Institute, made the case that racism has played a central role in undermining the health system’s performance for Indigenous Australians.

Another keynote speaker, Professor Michelle Chino, from the University of Nevada, Las Vegas, described the health and other challenges facing Native Americans as the result of their history of dispossession and neglect or oppression – challenges which the audience will have recognised only too well from the Australian experience.

My own keynote address covered the many pathways to understanding and progress in Aboriginal and Torres Strait Islander health.

The symposium heard of progress on the Gudaga study – a longitudinal study of Aboriginal children in the Tharawal community in south-western Sydney, which after eight years has now evolved into three separate studies, of crucial importance in understanding the link between early life experience and the transition to school for Indigenous children.

Associate Professor Elizabeth Comino told a seminar session of the lengthy and careful process behind the study – the time taken to win the confidence of the community, involving its members and particularly the mothers participating in the study in decisions about the research.

Other papers covered:

  • successful programs to increase Indigenous participation in sexual health programs
  • how well GPs identify the Indigenous status of their patients
  • Aboriginal child health in cities
  • the marijuana campaign The gunja brain story
  • Indigenous and non-Indigenous participation in school studies
  • the social and cultural resilience and emotional wellbeing of Aboriginal mothers in prison (SCREAM) project
  • alcohol and drug use among Aboriginal and Torres Strait Islander men in prison
  • factors influencing access to primary health care for Aboriginal people in contact with the justice system (SPRINT)
  • Indigenous intervention research, and how it might best be designed
  • the Koori Growing Old Well Study
  • the work of the Outback Eye Service
  • cardiovascular risk among Aboriginal and non-Aboriginal smoking male prisoners.

A panel discussion, chaired by Pat Anderson with five other participants (including this writer) discussed issues facing the Aboriginal and Torres Strait Islander public health workforce.

The list illustrates the strength and the breadth of the research effort now under way into Aboriginal and Torres Strait Islander health at the UNSW.  But their impressive variety and wide scope should not divert attention from the truth at their core.

In the papers, in the panel discussion, and in the Social and Emotional Wellbeing report, one theme stood out: the central importance, when researching Aboriginal and Torres Strait Islander phenomena, or devising programs with Aboriginal and Torres Strait Islander people, of valuing, and basing all work on Indigenous ways of learning, knowing and being.

Without that solid foundation, effort and resources will continue to be under-utilised appropriately.

• Professor Lisa Jackson Pulver is Director of Muru Marri Indigenous Health Unit at the University of NSW



Are you interested in working in Aboriginal health?

NACCHO as the national authority in comprenhesive Aboriginal primary health care currently has a wide range of job opportunities in the pipeline.

Register your current or future interest with our HR TEAM HERE

NACCHO political health news: Abbott Government creates new Indigenous Health Service Delivery Division to replace OATSIH.

Question Time in the House of Representatives

“Funding responsibility for most Indigenous health services remains in the Health Department, to be coordinated by a new Indigenous Health Service Delivery Division (which replaces OATSIH).”

As previously noted, in both Croakey and NACCHO Aboriginal Health Alerts there has been a deal of uncertainty about the fate of Indigenous health programs and services administered by the Federal Health Department and the Office of Aboriginal and Torres Strait Islander Health (OATSIH) under the new Federal Government.


Our thanks to Melissa Sweet (CROAKEY) for providing this Information

While no doubt there are still issues to resolve, at last there is some news – some programs will transfer to the Department of Prime Minister and Cabinet, as outlined below.

But funding responsibility for most Indigenous health services remains in the Health Department, to be coordinated by a new Indigenous Health Service Delivery Division (which replaces OATSIH).

No doubt many will be interested in the prediction that the new arrangements will mean less red tape for service providers.

The departmental statement below has been distributed to the major stakeholders.

“A number of stakeholders have been asking how OATSIH is affected by the Machinery of Government (MoG) changes announced by the Prime Minister recently.

The Prime Minister has indicated that Indigenous affairs will be a significant priority for this Government and has decided to bring together many of the Indigenous policies and programmes under his own Department.

The Health Department has now received clarity on the changes and I am able to confirm that the following programmes or functions will move from Health to the Department of Prime Minister and Cabinet:

  •  A number of strategic policy functions including responsibility for the health performance framework, health expenditure analysis, and life expectancy modelling
  • Bringing them Home and Expanding Link-up programmes
  • Combating petrol sniffing–expanding the supply and uptake of low aromatic fuel         Indigenous Drug and Alcohol treatment services (including staff working on these programmes in State and Territory Offices)
  • Stronger Futures NT Mobile Outreach Service Plus
  • National Sorry Day Committee
  • Indigenous Sport and Active Recreation Programme currently managed by the Sport Branch (previously in the Department of Regional Australia, Local Government and Sport).

The funding responsibility for the majority of Indigenous health services remains in the Health department, to be coordinated by a new Indigenous Health Service Delivery Division (which replaces OATSIH).

This decision recognises the importance of the critical links between Indigenous health programmes and mainstream health structures.

While there are a number of structural changes required as part of the movement of policies and programmes to PM&C, the key priority for Government is to continue to deliver uninterrupted services to Indigenous people. 

It will be business as usual with service providers and funding arrangements during this transition period from both the Health Department and PM&C.

The consolidation of policies and programmes into PM&C will provide significant opportunities, including reducing the red tape burden on service providers.”

Croakey and NACCHO will be interested to hear your response to these changes.

Please leave comments below.


NACCHO JOB Opportunities:

Are you interested in working in Aboriginal health?

NACCHO as the national authority in comprenhesive Aboriginal primary health care currently has a wide range of job oppportunities in the pipeline.

Register your current or future interest with our HR TEAM HERE

NACCHO NATSIHP News:What a report about Aboriginal health can teach journalism


The document portrays racism as being institutionalised within health care — rather than being an aberrant behaviour by a minority. Journalism that has learned this lesson might end up with much more powerful and instructive stories.

Lessons from a report on Aboriginal health issues can be transferred to journalism.

from Melissa Sweet Croakey

Journalism has a lot to learn from the health sector, I’ve often thought. Many of healthcare’s challenges — reducing errors, becoming more responsive to the community, avoiding capture by powerful interests — are relevant for journalism as well. So when the new National Aboriginal and Torres Strait Islander Health Plan 2013-2023 was released last week, I read it looking for what journalists might learn.

Although a federal government publication, it involved extensive consultation with Aboriginal and Torres Strait Islander communities and the health sector. These are some points I took away …

The report makes it clear that racism is a huge health issue. Lately there has been some self-reflection by the media about our role in entrenching gender inequality (including on the front pages of The New York Times). We could also reflect on our own role in entrenching rather than confronting racism.

The document calls for culturally supportive and culturally safe environments in health care. A large part of the media industry has not grappled with what this might look like in journalism, whether for members of our industry, or for communities and people interacting with us.

The document portrays racism as being institutionalised within health care — rather than being an aberrant behaviour by a minority. Journalism that has learned this lesson might end up with much more powerful and instructive stories. As the ABC presenter Waleed Aly wrote earlier this year, in the wake of yet another publicised incident of abuse, “our real problem is the subterranean racism that goes largely unremarked upon and that we seem unable even to detect”.

Nareen Young, CEO of the Diversity Council of Australia (and a tweeter on these issues), says the media could help by spending less time arguing about what constitutes racism, as this unending debate is exacerbating the hurt. “We need to say that if something hurts someone deeply, it is racist,” she said. The council would like to work with the media to identify areas for improvement.

The plan’s holistic approach to health is something we all could learn from. Indeed, GP Dr Tim Senior has argued for a wider adoption of the Aboriginal definition of health. Much media reporting reinforces a narrow biomedical focus, and neglects the wider determinants of health — like the importance of an equitable education system, an inclusive society and a healthy environment. If journalists incorporated the plan’s broad understanding of health into our work, we might see more useful reporting — whether on health or wider policy issues.

The document stresses the importance of culture, language and cultural identity to the social and emotional wellbeing of Aboriginal and Torres Strait Islander people. Yet so often, media reports portrays culture as a negative. If reporting such concerns, then at the least this broader context needs to be included. Beyond that, how might journalism contribute to wider acknowledgement of culture? Through use of language, for example?

The plan also stresses the importance of acknowledging and understanding the diversity of Aboriginal and Torres Strait Islander peoples. The fact that different people hold different views does not automatically mean conflict and division. Is journalism capable of respect for diversity?

The plan emphasises the importance of strengths-based approaches to Aboriginal health, rather than a focus on the deficit model that is so common amongst both the media and health sectors. Journalism can be overly focused on the deficit model — telling us about problems we often already know about — rather than investigating potential solutions. This is not an argument for “soft” journalism — it is actually easier to describe problems, whether in Aboriginal health, climate change or obesity, than to do the hard yards of solutions-focused journalism.

The plan also underlines the impact of the past upon contemporary health and wellbeing, referring to the legacy of intergenerational trauma. Most of the recent media coverage celebrating the 200th anniversary of European explorers crossing the Blue Mountains did not even canvass the implications for the area’s Aboriginal peoples. Surely this type of coverage — that privileges one historical experience and account over another — exacerbates the intergenerational trauma identified by the new plan.

No doubt some hackles will rise about the idea that we in the media have a responsibility for our work’s impact. But the industry’s engagement with mental health initiatives suggests there is a wider awareness and willingness to evolve our practices.

This piece is written from my perspective as a non-indigenous journalist. I wish I’d had the chance to reflect on these issues earlier in my career. There are many journalists and organisations, particularly in the community sector, whose work reflects the principles underlying the new national health plan.

And the digital era is enabling initiatives like the Cherbourg MoJo project in Queensland which is equipping young people with the skills to tell their community’s stories. You can see this as a digital media project or as a health intervention, given that it aims to improve self-esteem, confidence, literacy, and to “present a less marginalised view of the community”.

So while journalism can learn plenty from the health sector, it works both ways. The Cherbourg project suggests the skills of journalism can be harnessed for improving a community’s wellbeing. Mind you, the ancient art of telling stories was around long before the modern concept of journalism was invented.

*Melissa Sweet is a PhD candidate at Canberra University, and is researching journalism and Aboriginal and Torres Strait Islander health

NACCHO news: Aboriginal Families Study: a population-based study keeping community and policy goals in mind

“This paper describes the development of a statewide study in South Australia that aims to invite approximately 300 women giving birth to an Aboriginal baby to talk about their experiences of using services during pregnancy, labour and birth, and the first 4–12 months after having a baby

We are delighted to confirm that the final versions of your manuscript have been published on the International Journal for Equity in Health website,

Mary Buckskin, CEO , Aboriginal Health Council of SA (pictured above)

Title: Aboriginal Families Study: a population-based study keeping community and policy goals in mind right from the start


Authors: Buckskin  Mary, Ah Kit  Jackie, Glover  Karen, Mitchell  Amanda, Miller  Roxanne, Weetra  Donna, Wiebe  Jan, Yelland S Jane, Newbury  Jonathan, Robinson  Jeffrey, Brown J Stephanie,

Journal: International Journal for Equity in Health

The study has been developed by researchers based at the Murdoch Children’s Research Institute and the University of Adelaide, in partnership with the Aboriginal Health Council of South Australia Inc.


Background: Australian Aboriginal and Torres Strait Islander women are between two to five times more likely to die in childbirth than non-Aboriginal women, and two to three times more likely to have a low birthweight infant.

Babies with a low birthweight are more likely to have chronic health problems in adult life.

Currently, there is limited research evidence regarding effective interventions to inform new initiatives to strengthen antenatal care for Aboriginal families.


The Aboriginal Families Study is a cross sectional population-based study investigating the views and experiences of Aboriginal and non-Aboriginal women having an Aboriginal baby in the state of South Australia over a 2-year period.

The primary aims are to compare the experiences and views of women attending standard models of antenatal care with those accessing care via Aboriginal Family Birthing Program services which include Aboriginal Maternal Infant Care (AMIC) Workers as members of the clinical team; to assess factors associated with early and continuing engagement with antenatal care; and to use the information to inform strengthening of services for Aboriginal families.

Women living in urban, regional and remote areas of South Australia have been invited to take part in the study by completing a structured interview or, if preferred, a self-administered questionnaire, when their baby is between 4–12 months old.

Discussion: Having a baby is an important life event in all families and in all cultures. How supported women feel during pregnancy, how women and families are welcomed by services, how safe they feel coming in to hospitals to give birth, and what happens to families during a hospital stay and in the early months after the birth of a new baby are important social determinants of maternal, newborn and child health outcomes.

The Aboriginal Families Study builds on consultation with Aboriginal communities across South Australia. The project has been implemented with guidance from an Aboriginal Advisory Group keeping community and policy goals in mind right from the start. The results of the study will provide a unique resource to inform quality improvement and strengthening of services for Aboriginal families.

Keywords: Antenatal care, Health inequalities, Indigenous health, Maternal health, Participatory research, Perinatal health outcomes.


Australian Aboriginal and Torres Strait Islander women are between two to five times more likely to die in childbirth than non-Indigenous women, and two to three times more likely to have a low birthweight infant [1].

Babies with a low birth weight are more likely to die in infancy [2], more likely to be admitted to neonatal intensive care [3], and may be more likely to have serious health problems (e.g. cardiovascular disease, diabetes) in adult life [4]. Recent data suggest that in some Australian states, including South Australia, the proportion of low birth weight babies born to Aboriginal mothers may be increasing [5,6].

The Australian Government has set agreed targets for closing the gap in Indigenous disadvantage outlined by the Council of Australian Governments (COAG) in the National Indigenous Reform Agenda [7].

Under the terms of this agreement, federal, state and territory governments have committed to closing the gap in life expectancy between Aboriginal and non-Aboriginal Australians within a generation, and halving the gap in mortality rates for Aboriginal children under five within a decade.

Key performance indicators for the National Indigenous Reform Agenda include: an increase in the proportion of Aboriginal and Torres Strait Islander mothers receiving antenatal care in the first trimester of pregnancy (≤13 weeks’ gestation) and in the proportion of Aboriginal and Torres Strait Islander mothers attending five or more antenatal visits; and a reduction in the proportion of Aboriginal and Torres Strait Islander infants with a low birthweight (<2,500 grams).

New funding made available under the COAG National Partnership Agreement on Indigenous Early Childhood Development has facilitated a range of new programs and initiatives to strengthen antenatal care and child and maternal health services for Aboriginal families in all Australian states and territories [8].

Currently there is a dearth of research evidence regarding effective intervention strategies to inform these initiatives [9-12].

Most of the available evidence comes from small-scale local evaluation studies, predominantly undertaken in regional and remote locations [13-20]. The roll out of COAG funding under the National Partnership Agreement has in effect created an Australia wide ‘natural experiment’ in seeking to improve maternal and perinatal outcomes for Aboriginal and Torres Strait Islander women and children. It is vital that lessons learned fromthe range of programs being developed and implemented with COAG funding are captured by concurrent evaluation at a state and territory level.

However, there is still no complete national perinatal data for Aboriginal mothers and babies. State and territory based perinatal data collections vary in their capacity to ascertain Aboriginal and Torres Strait Islander status of mothers and infants, and steps have only recently been taken to include information regarding status of the infant in the minimum data set for most state jurisdictions [21].

This paper describes the development of a statewide study in South Australia that aims to invite approximately 300 women giving birth to an Aboriginal baby to talk about their experiences of using services during pregnancy, labour and birth, and the first 4–12 months after having a baby.

The study has been developed by researchers based at the Murdoch Childrens Research Institute and the University of Adelaide, in partnership with the Aboriginal Health Council of South Australia Inc. (AHCSA). The project arose in the context of planning for a population-based postal survey of recent mothers in South Australia and Victoria.

In 2006, the researchers planning this survey approached the AHCSA about working in partnership on a project to provide avenues for Aboriginal women’s voices to be included in the research. At our initial meeting we discussed the idea of seeking funding to facilitate consultations with Aboriginal community organisations and communities in South Australia as a way to seek input into development of the research. The Aboriginal Families Study is the name given to the project that grew out of these discussions. South Australia where the project is based is one of six Australian states, and covers a geographic area four times the size of the UK.

Often when researchers approach Aboriginal community organisations and/or communities, they already havea fairly well developed research question and study protocol in mind. We did not. This paper charts the social history of the project, and outlines the steps we took to get from our initial discussions in 2006 to the stage of developing the study protocol, governance arrangements, and procedures for carrying out the study.

These include: obtaining ‘in principle’ support from the Board of Management of the AHCSA for the conduct of consultations with Aboriginal communities about the project; development of a project agreement between MCRI and the AHCSA; establishment of an Aboriginal Advisory Group to guide the consultations, and subsequently, the development of the study protocol, and conduct of the research; statewide consultations with  Aboriginal communities, policy makers and service providers preceding development of the study design and methods; a lengthy pilot study phase that tested different versions of the study questionnaire and recruitment procedures; obtaining ethics approval from a variety of institutional ethics committees; development of a Research Agreement covering governance arrangements for the research phase of the study signed by all partner organisations and study investigators; appointment and training of the fieldwork team; through to recruitment and interviewing of women in urban, regional and remote areas of South Australia.

NACCHO Aboriginal health news:Kidney disease in Aboriginal Australians perpetuates poverty


The recent death of the lead singer of Yothu Yindi, is a high-profile example of an event all too common in Aboriginal Australia.

Reproduced from the Conversation

Roger Smith Director of The Mothers and Babies Research Centre at the Hunter Medicial Research Institute at University of Newcastle and Kirsty Pringle Research Fellow in Reproductive Health at University of Newcastle

Older Aboriginal Australians (40 to 60 years old) are more than 15 times more likely to die of kidney disease than non-Aboriginal Australians. This is an age that’s normally the prime life. But not only is it a tragedy for the individuals involved but has a much wider effect on the community.

Elders in all communities are a repository of knowledge and of accumulated wealth. Early death of key older family members deprives younger community members of the benefit of accrued knowledge of culture and both financial and social support.

The structure of the broader Australian population is like a pillar with similar numbers of people in all age groups. This means that a young non-Aboriginal child will often receive support and guidance from two mature adults with back up from four, still-living grandparents.

The population structure in Aboriginal Australia is quite different and is more like a triangle, with many more children than adults and even fewer living grandparents. This means that an Aboriginal child receives support and guidance from far fewer adults.

This pyramid like structure is generated partly by early death of Aboriginal adults from heart disease, diabetes and kidney disease.

Not a great start

Heart disease, diabetes and kidney disease are non-communicable diseases that are strongly influenced by the environment. Increasing evidence suggests that all three begin as the baby is developing in the uterus. This concept is known as fetal programming or the developmental origins of adult health.

Let us explain by using kidney disease as an example to illustrate the concept. Skin sores can become infected with the bacteria known as streptococcus, this type of infection can lead to kidney damage known as glomerulonephritis. This can happen in childhood, and, if it happens to a girl, her kidneys may already be damaged by the time she becomes pregnant.

The insidious cycle of kidney disease in the Aboriginal population. Jonathan Paul

Studies in pregnant sheep have demonstrated that if the mother’s kidney function is damaged, then the kidneys of the developing fetus also become damaged. This allows kidney damage to be passed across generations.

Studies by others suggest that this is happening to many Aboriginal mothers and their babies. Aboriginal mothers often have evidence of kidney disease already present during pregnancy and Aboriginal babies are frequently born with a much smaller number of nephrons (the functional units of the kidney). Typically around 400,000 while non-Aboriginal babies have over one million.

This reduction in nephron numbers is linked to impaired growth within the uterus of many Aboriginal babies who are born too small (known as growth restriction), twice as often as non-Aboriginal babies.

A better way forward

If we are to close the gap in Aboriginal life expectancy and well-being, we need to focus on the beginning of life inside the uterus. We need to ensure high quality care and support for Aboriginal mothers and their babies.

We need to develop ways of identifying babies at risk of kidney disease early to prevent deterioration of kidney function that could be transmitted across generations into the future.

Progress is being made. In Tamworth, a research team from the University of Newcastle’s department of rural health is recruiting young Aboriginal mums and their children and seeking to identify markers of kidney impairment in urine samples.

In Townsville, a neonatologist is using retinal photographs of newborn babies’ eyes to identify those at risk of kidney disease (the blood vessels at the back of the eye reflect the way the blood vessels in the kidney are also developing).

If we can reduce the burden of kidney disease, we can improve not only the health of Aboriginal Australians but also their cultural and material wealth by allowing more older Aboriginal people to transmit their knowledge and resources to the next generation. Intervening early in life to optimise health is a much more effective strategy than trying to correct accumulated damage in later life.

Acknowledgement: Della Yarnold also contributed to this article.

NEW:NACCHO presents CROAKEY’s new fortnightly HEALTH WRAP feature


Introducing a new fortnightly feature at NACCHO Aboriginal Health News Alerts

In partnership Melissa Sweet’s Croakey – The Health Wrap, we will aims to highlight interesting and important news and developments.


It will link you into some of the interesting and important health news from the previous fortnight, including items covered at Croakey and elsewhere.

It is compiled by experienced health and medical journalist/editor Kellie Bisset, who is communications director at the Sax Institute.

Kellie Bisset, an experienced health and medical journalist/editor who is communications director at the Sax Institute (follow her at @medicalmedia), has kindly offered to provide this column as a probono service to Croakey readers.


By Kellie Bisset

A big fortnight in mental health

An active two weeks of discussion around mental health – both locally and internationally – was jump-started with the release of DSM 5, the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, which has, among other things, included a new diagnosis for prolonged grief.

Has labelling of mental illness got out of hand? Writing for The Conversation, Professor Emeritus of Psychiatry at Duke University Allen Frances strongly believes the new manual will lead to “diagnostic inflation”, but others, such as Professor Nick Glozier say its influence is overstated.

This middle-of-the-road Conversation piece by psychiatry lecturer Darryl P. Watson is a good overview of the debate. Meanwhile, health news watchdog Gary Schwitzer highlights a PLOS Medicine editorial on the paradox of over-treatment it says is fuelled by pharma marketing and “profound under-recognition” of mental health issues affecting millions across the globe.

Meanwhile, the Mental Health Council of Australia and National Mental Health Commission hosted a meeting to outline the NGO sector’s long-term blueprint for improving the lives of those with mental illness and their carers. And a National Summit jointly hosted in Sydney by NSW and Federal Ministers for Mental Health explored the issue of premature death among people with mental illness. At Croakey, Mark Ragg pre-empted the summit with a piece arguing that without dollars, all the talk would be for naught.

A funding announcement was made the day before the summit; the Federal Government said headspace would be given $247 million to deliver nine early psychosis youth services under the EPPIC program. This prompted a Croakey post from Sebastian Rosenberg arguing that current state/federal governance of mental health in Australia is unworkable and cannot deliver a “new deal” for mental health. Associate Professor Jane Burns, CEO of the Young and Well Cooperative Research Centre, also blogged about the importance of allowing young people to shape research, practice and policy in youth mental health.

Also in the news was the launch of a new National Aboriginal and Torres Strait Islander suicide prevention strategy, promising a holistic, early intervention approach focused on working with Aboriginal and Torres Strait Islander peoples to build strong communities. The aims are to reduce the causes, prevalence, and impacts of suicide on individuals, families, and communities.

As the American Psychiatric Association and the Royal Australian and New Zealand College of Psychiatrists both held their annual meetings (check #APAAM13 and #ranzcp for tweetstreems), the Hunter Institute of Mental Health launched two reports on the needs and experiences of those caring for someone with a mental illness. Institute Associate Director Jaelea Skehan outlines them both in this Croakey post, and along with the SMH’s Amy Corderoy, reminds us of the daily difficulties faced by carers, who often face their own mental health issues.


Pointed views on display in vaccination debate

Moves to amend the NSW Public Health Act to make childcare entry conditional on parents vaccinating their children or registering for an exemption have been widely praised. But some, including Julie Leask and Hal Willaby who wrote this piece on Croakey and The Conversation, argue the move is flawed and could have unintended negative consequences for children and marginalise some parents even further. The Queensland Opposition has proposed similar legislation.

Meanwhile, the RACGP has been forced to defend its continuing education program after an SMH report revealed it had accredited a training course that perpetuated vaccination myths. The broader issue of vaccination was also brought to light in a new SBS documentary – Jabbed – and The Conversation’s Sunanda Creagh reported on a new Australian Prescriber paper showing pneumococcal disease has plunged by 97% since vaccination.


Over-diagnosis, misdiagnosis and unnecessary tests

The ABC’s Sophie Scott raised concerns over pop-up clinics that screen for heart attacks and strokes in a story that highlights once again the ethics of preventive screening for asymptomatic people. And Amy Corderoy at the SMH took aim at the millions of potentially unnecessary Vitamin D tests being ordered for healthy people.

The Hospital Alliance for Research Collaboration also heard from international expert Dr Mark Graber on how to address the untapped problem of diagnostic medical error. Dr Graber says patients play an important role in highlighting errors, but Reuters points out that research from JAMA Internal Medicine shows patients are still struggling with basic patient information materials, many of which are full of jargon and difficult to navigate.


Perspectives on risk

It’s been more than two weeks since Angelina Jolie chose to reveal the dramatic news of her preventive double mastectomy in the New York Times and in the wake of this there has been much written and said about her decision and the broader issue of breast cancer risk. Hilda Bastian has explored the concepts of risk and overdiagnosis in this Croakey piece, which also links to other useful articles on the topic.


Food glorious food – or not

The ongoing dialogue about the role of Big Food in the obesity epidemic took a new turn with Cancer Council Victoria research showing children are more likely to choose unhealthy foods over healthier products if they carry nutritional claims or endorsements from sporting stars.

An interesting piece from highlights a recent discussion led by Yale researcher Dr Kelly Brownell about how the growing literature around how food affects the brain could be a “game-changing concept”. He says this potentially opens the doors to tobacco-style litigation exploring whether food manufacturers knowingly modified products.

In Australia, the Federal Government announced a further $800,000 in funding for the Food and Health Dialogue, a coalition of public health and industry groups that is working to reduce salt, sugar and saturated fat in processed foods.

Addressing obesity by designing healthier environments remains a hot topic internationally. Californian public health officials are using their latest research to influence planned cuts to transit services. And Newsday’s great story on a New Jersey real estate agent who agitates for walkable neighbourhoods shows public health advocates can be found anywhere. In the same vein, US public television station KCET has produced a series on walking, travelling to cities across the US that are transforming themselves into more walkable communities.


Politics and Policy

Croakey offered a perspective from Stephen Duckett on Opposition health spokesman Peter Dutton’s address to last week’s Australian Institute of Company Directors meeting. His comments on Medicare Locals indicate at the very least they would be renamed under a Coalition Government.

Federal Health Minister Tanya Plibersek took on the pharmaceutical industry with a pointed media release highlighting its inconsistent position on the main drivers of increased PBS spending. And the Government released the Mason review of health workforce programs and indicated changes to the way towns are geographically classified for Government funding.

In her Lowitja O’Donoghue Oration at the University of Adelaide, CEO of Danila Dilba Health Service Olga Havnen called on the “fault lines” between politicians, bureaucrats, NGOs and the Aboriginal Community Controlled Health sector to unite to make a real difference. She said a “doctrine of risk intolerance” had taken hold and caused government funds to be moved away from community-led organisations.


The gaps are getting bigger

Widening health gaps across Australia make it imperative to consider the social determinants of health across all policy areas, argue the Social Determinants of Health Alliance (SDOHA) and the Consumers Health Forum. Responding on Croakey to last week’s release of two reports from the COAG Reform Council, SDOHA renewed its call for Parliament to adopt the World Health Organisation’s Closing the Gap in a Generation report.

In Geneva, Medicus Mundi International and the People’s Health Movement made a very clear statement to the 66th session of the World Health Assembly calling on the WHO to “undertake more robust research and initiate actions” on social determinants of health. This, and a wrap of the assembly, can be found in this Croakey post.

In Canada, doctors are talking about the medicinal effect of increasing people’s incomes. The Canadian Medical Association is conducting a national dialogue tour to ask people how poverty affects their health. And in Britain, The Independent reports that just under a third of people are excluded from mainstream society because they cannot afford to join in cultural activities.

Iceland though, may have some answers. This BBC News Magazine article explores the lack of violent crime in the country and makes some associations with the lack of a class system and views about equality. Denmark is also looking at a systematic approach to health and wealth through technical innovation, as this Croakey piece from Dr Johnny Marshall explains.


The smoke wars

Plain cigarette packaging is in the news again, with reports that Ireland will follow Australia’s public health lead. But as Croakey highlighted last week, there are still those determined to bend the rules; NACCHO has had to call out a company designing ‘skins for smokes’ that has appropriated the Aboriginal flag. Meanwhile, WHO Director General Dr Margaret Chan took the opportunity at the 66th World Health Assembly to make it absolutely clear that the WHO will never be on speaking terms with the tobacco industry.

Perhaps sound advice for the US Food and Drug Administration? This paper in PLOS Medicine analyses documents released through litigation to explore the industry’s attempts to influence the FDA.


Other Croakey reading you may have missed this fortnight:

And some shout outs to @sophiescott2, @reemarattan, @ivanoransky, @LRussellWolpe, @preventioninst, @healthageingAU, @EvidenceNetwork, @SimonChapman6, @AmyCorderoy for being valuable sources of news on Twitter this week.

• Kellie Bisset is The Sax Institute’s Communications Director. She has worked in mainstream and medical journalism and communications for more than 20 years. During that time she edited both of Australia’s weekly medical publications for doctors, Australian Doctor and Medical Observer and developed a strong interest in health policy and evidence. The Sax Institute is a not-for-profit organisation that drives the use of research evidence in health policy and planning.

NACCHO health news:Healing the Fault Lines: uniting politicians, bureaucrats and NGOs for improved outcomes in Aboriginal Health.


Prominent Aboriginal Territorian and the current CEO of Danila Dilba Health Service Olga Havnen argues that the “fault lines” between politicians, bureaucrats and NGOs and the Aboriginal Community Controlled Health sector must unite to make a real difference.

A little known positive aspect of the Northern Territory Intervention was a significant increase in resources to Aboriginal Comprehensive Primary Health Care.

This, along with parallel initiatives under Closing the Gap, gave some hope that the decades long demands from our sector for substantial extra resources in primary health care was at last being heard.

However, while we have been making some advances in the Northern Territory, we face the potential for a “race to the bottom” in Aboriginal health where the interests of politicians, bureaucrats and NGOs potentially outweigh the evidence of Aboriginal community control.

 Prominent Aboriginal Territorian and the current CEO of Danila Dilba Health Service Olga Havnen argues that the “fault lines” between these groups and the Aboriginal Community Controlled Health sector must unite to make a real difference.

Extract from the 16 pages speech which can now be download from NACCHO

I am currently the CEO of Danila Dilba Health Service in Darwin, which has not long ago celebrated its 20th anniversary. We are an Aboriginal Community Controlled Health Service—and part of a broader, national movement of community controlled comprehensive primary health care that has its origins in Redfern some 42 years ago.

At the core of what we have achieved over those many years has been an aggressive approach to basing our work on evidence. Our accumulated achievements have always been based on what works—in clinical as well as social practice.

At the heart of what we have strived to achieve is the development of a practice—both clinical and social—that displays our strong and central commitment to comprehensive primary health care.

This model was codified at an international level at Alma Ata in 1978, and subsequently endorsed by the World Health Organisation (WHO) and the United Nations:

Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

Primary health care is socially and culturally appropriate, universally accessible, scientifically sound, first level care.

You can download  Olga Havnen full speech 16 pages here

PRESS Coverage below and picture from the Australian May 29

REMOTE indigenous communities are suffering from a government culture of “risk intolerance” which has diverted funding from community-led organisations, a leading Aboriginal figure has said.

Olga Havnen, the Northern Territory’s former co-ordinator general for remote services, last night attacked successive governments for choosing large non-government organisations for service delivery ahead of smaller indigenous-led organisations.

Ms Havnen said many community-led service delivery organisations had “disappeared” since the Northern Territory Emergency Response in 2007.

“Aboriginal control of service delivery in many areas has withered on the vine,” she said in the Lowitja O’Donoghue Oration at the University of Adelaide.

“Despite jurisdictional, national and international evidence that community control over service delivery achieves better results, with control being a key element in the social determinants of health, for example, we have gone backwards.”

 Ms Havnen, whose position in the Territory was abolished by the new Country Liberal Party government in October, said there had been a “massive expansion” of NGO involvement in service delivery with “many millions of dollars” flowing to non-indigenous NGOs and multinational NGOs, regardless of their effectiveness.

She said in the past decade, only one new community controlled health service had been established in the Territory and only two remote health clinics handed across to community control.

“It is a process which has allowed government agencies to quarantine themselves from what they too often ascribe as risk in funding Aboriginal organisations,” she said.

“By this I mean that nothing is done, or can be done, that might in any way shape or form come back to haunt politicians or bureaucrats at a Senate estimates hearing or their state and territory equivalents.”

Ms Havnen, who is now chief executive of the Danila Dilba Health Service in Darwin, an Aboriginal community controlled health service, said that there needed to be a fundamental change in the relationship between Aboriginal service delivery in the Territory and elsewhere, and politicians, bureaucrats and NGOs who were involved in the process.

“The politicians and public servants can be agents of innovation and change if they abandon risk intolerance,” she said.

“Similarly, the response of NGOs to the last decade or so of reaping the benefits of government funding into Aboriginal service delivery must also change.

“Risk intolerance cannot be part of Closing the Gap.”

Ms Havnen said she remained concerned about many elements of the 2007 intervention into Northern Territory communities, which would continue to have a psychological impact “for many years”.

NACCHO Medicare Locals news:Coalition to conduct formal review of Medicare Locals if elected

Question Time in the House of Representatives

Speaking at the Australian Medical Association (AMA) conference in Sydney on Friday, opposition health spokesman Peter Dutton said questions remained over the role of Medicare locals, the 61 organisations set up by Labor to co-ordinate primary care.

“Some Medicare locals appear to be doing a good job,” Mr Dutton said.

“But in some cases, health professionals have expressed their frustration, or indeed indifference, to their existence.”

Read NACCHO previous coverage of Medicare Locals

Medicare Locals and the Aboriginal Community Controlled Health Sector: Where are we? Where are we going?

Response from AML Alliance CEO Claire Austin is in the comments below

Mr Dutton has previously criticised Medicare Local, labelling it a bureaucracy that has not improved health services.

On Friday, he said he was concerned Medicare Local could act as a commonwealth-subsidised competitor that disrupted other health services, rather than raising the level of care.

“Contracts have been signed secretly, and the government refuses to provide any further detail about 3000 people now employed across the Medicare Local network,” Mr Dutton said.

He said the coalition would consult experts including general practitioners and clinicians in its review.

The Australian Healthcare and Hospitals Association (AHHA) called on the coalition to reveal its plans for Medicare Local ahead of September’s election.

“Deferring decisions until after the election leaves patients, families, communities and health service providers in limbo,” AHHA chief Prue Power said.

“The health sector is a complicated system and changes in one area can have significant implications for the rest of the system.

“The coalition need to be upfront about their plans for Medicare locals and for primary health care more broadly.

“Health and access to health care services are important issues for all Australians and they have a right to know what is planned before the election so they can make an informed decision on election day.”

AML Alliance, the peak body for Medicare Local, said it would welcome the opportunity to outline to the coalition how Australia’s primary health care system was improving.

“We have a wealth of data available to inform the opposition about the Medicare Local sector and I look forward to the opposition actively seeking this information from us,” AML Alliance chief executive Claire Austin said in a statement.

“Medicare Locals are … ensuring better management of chronic diseases such as diabetes, heart disease, smoking cessation programs and asthma, for example.”

Ms Austin said AML Alliance would treat a review as an opportunity “to fill in the information gaps the coalition seems to have about Medicare locals”.

Read more:

NACCHO condemns Aboriginal flag “skins for smokes” that covers up health warnings

Skins 2

NACCHO condems the use of “skins for smokes”  that uses cultural content and copyright imagery on cigarette packets to  negate health promotion efforts, such as Australia’s recent introduction of plain packaging laws and calls on the Federal Government to ban the sale under that legistlation

Authors: Karen McPhail-Bell, Chelsea Bond & Michelle Redman-MacLaren (see details Blow)

For just $5.29 Australians can now purchase “Skins” from local, independent grocers to cover their cigarette packet with the Aboriginal or Torres Strait Islander flag.

We argue that this use of cultural content and copyright[1] imagery on cigarette packets negates health promotion efforts, such as Australia’s recent introduction of plain packaging laws and the subsequent dismissal of a legal challenge from the tobacco industry.

Aboriginal and Torres Strait Islander people smoke over twice the rate of non-Indigenous Australians (ABS 2010). Health promotion practitioners working to reduce these smoking rates face the challenge of the broader historical and cultural context of smoking behaviour.

In response, health promotion efforts have endeavoured to shift, displace and resist the notion that unhealthy behaviours, such as smoking, are inherently part of Aboriginal and Torres Strait Islander culture.

Some examples of this approach include Queensland Health’s Smoke-free Support Program (Smoking: It could cost us our culture), the Institute for Urban Indigenous Health’s Deadly Choices campaign and other initiatives beyond Queensland (for example, Adams et al 2010; Basinkski and Parkinson 2001).

Brady (2002) has noted how throughout colonial contact, Europeans have exploited Aboriginal addiction to nicotine and therefore as health practitioners, we are concerned about what may be the continued exploitation of Aboriginal and Torres Strait Islander people for economic gain.

We also note that Skins are available with the Australian flag and are concerned that more broadly, cultural and national pride is being manipulated by these companies. In other words, the sale of products that appropriate cultural content and copyright imagery for the purpose of enhancing the appeal of cigarettes is cause for alarm for us.

As a practice, health promotion endeavours to secure equal opportunity and resources to enable people to achieve their full potential in life. Thus, we raise this issue for your awareness and welcome your analysis, comments and suggestions for action. We are also working on possible responses with advocacy organisations.

Acknowledgement: The authors would like to acknowledge the contributions of Arika Errington (NACCHO) to this article.


Adams K, Liebzeit A, Jakobi M. (2010). “How’s your sugar?: A deadly website for you, your family and your community.” Aboriginal and Islander Health Worker Journal, Aug;34(5):2.

Australian Bureau of Statistics (2010). “The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, October 2010.” Journal ABS Cat No 4704.0(Issue)

Basinski D, Parkinson D. (2001). “’We saw we could do it ourselves’: Koorie Cultural Regeneration Project.” Australian Journal of Primary Health;7(1):111-5.

Brady, M. (2002) “Health inequalities: Historical and cultural roots of tobacco use among Aboriginal and Torres Strait Islander people” Australian and New Zealand Journal of Public Health 26(2): 120-124

[1] We note that both the Aboriginal and Torres Strait Islander flags are copyrighted materials and therefore must be reproduced in accordance the provisions of the Copyright Act 1968 or with the permission of the artists, respectively Harold Thomas and the Island Coordinating Council.

[i] School of Social Work and Public Health, Queensland University of Technology; ?

[ii] Aboriginal and Torres Strait Islander Unit, University of Queensland;

[iii] School of Medicine and Dentistry, James Cook University;