Professor Ngiare Brown, (pictured above being interviewed for SBSTV last week at the NACCHO summit) Executive Manager of Research for NACCHO and a co-Chief Investigator of the new centre, says:
“This is an exciting opportunity to work in collaboration with leaders in their field. Translation health is often overlooked but it will be critical in helping to address the biggest priorities in the Indigenous health gap.
“This centre will build leadership and capacity in Aboriginal health and the community controlled sector, and will support the development of culturally relevant services that will lead to positive change,” she says.
PRESS RELEASE
The University of Adelaide has won $2.48 million to establish a new national Centre of Research Excellence, in partnership with the South Australian Health and Medical Research Institute (SAHMRI), the National Aboriginal Community Controlled Health Organisation (NACCHO) and the University of Wollongong.
The centre will use the best available evidence to prevent, manage and treat chronic disease among Indigenous people.
The funding from the National Health and Medical Research Council (NHMRC) has been awarded to the University of Adelaide’s Professor Alan Pearson AM, who is Chief Investigator of the new NHMRC Centre of Research Excellence (CRE) for Translational Research in the Management of Chronic Disease in Indigenous Populations.
“The aim of our centre is clear: to improve health outcomes among Aboriginal and Torres Strait Islander people with a chronic disease,” says Professor Pearson.
“As a population, Indigenous people have significantly poorer health than other Australians and typically die at much younger ages. We hope to save lives and improve people’s quality of life by translating science to better health practice.”
Professor Pearson has an international reputation in the field of translating evidence into policy and practice in health care. He is Head of the University of Adelaide’s School of Translational Health Science and Executive Director of the Joanna Briggs Institute.
“Our research will review existing knowledge about the prevention, management and treatment of chronic disease in Indigenous populations. Based on that information, we will conduct much-needed programs to translate and implement evidence into Indigenous health care,” Professor Pearson says.
“Importantly, to maximise outcomes, this work will be conducted in close collaboration with NACCHO and their member services.”
Professor Alex Brown, Leader of the Aboriginal Research Unit at SAHMRI and a co-Chief Investigator of the new centre, says chronic diseases such as heart disease, diabetes and kidney disease account for 80% of the life expectancy gap between Aboriginal and non-Aboriginal Australians.
“The reasons why Indigenous people suffer from high rates of chronic disease are extremely complex. Our work is aimed at making inroads into this massive problem on a clinical, policy and population level,” Professor Brown says.
Professor Ngiare Brown, Executive Manager of Research for NACCHO and a co-Chief Investigator of the new centre, says: “This is an exciting opportunity to work in collaboration with leaders in their field. Translation health is often overlooked but it will be critical in helping to address the biggest priorities in the Indigenous health gap.
“This centre will build leadership and capacity in Aboriginal health and the community controlled sector, and will support the development of culturally relevant services that will lead to positive change,” she says.
The University’s Deputy Vice-Chancellor (Research), Professor Mike Brooks, says today’s announcement is further proof of the strong research collaborations that exist in Adelaide.
“The awarding of this new Centre of Research Excellence is a major vote of confidence in the quality of research being conducted in this State, and our researchers’ ability to translate their work into real health outcomes,” Professor Brooks says.
“Congratulations to all of the partners involved in this new centre, which has the opportunity to make a significant impact on a national scale.”
“Who knows and cares most about Aboriginal health? We do. So give us the funding and the knowledge and partner with us to enable us to be responsible for our own health and wellbeing.”
Ted Wilkes
When Noel Pearson launched The Quiet Revolution, the book of Marcia Langton’s 2012 ABC Boyer Lectures, he had the audience in the palm of his hand for almost an hour.
Pearson spoke quietly and clearly about pathways to being “bourgeois”, as he called himself. “Why can’t Australians be proud of us being middle class? Why can’t non-Aboriginal folk in Australia support us in our quest to be part of an elite, to own our own homes and participate in the Australian economic and social fabric?” he asked.
This is an edited extract from essay “On the ground: Key to successful policy outcomes” in GriffithREVIEW 41, available now.
It was a great talk that explored the creation of an Aboriginal and Torres Strait Islander middle class. Even if you heard the lectures, read the essays — the power of the words on the page put paid to the simplistic criticism that they were just a defence of the mining industry. This is a part of a much bigger project, a transformation, that for the first time means First Nations people are being trained and employed in all areas of the Australian workforce. And doing so in ways that retain and share their culture with others.
Both Noel Pearson and Marcia Langton are unapologetically part of the Aboriginal elite. Like W.E.B. Du Bois in the US a century ago, their cool analysis and forthright advocacy discomforts those with a rusted frame for thinking about First Nations people, one that consigns them to intergenerational underachievement.
Du Bois believed that the top 10% of any culture or population group is the vanguard that brings others along and around them. Born in 1868, three years after the end of the American Civil War, Du Bois was the first African-American to receive a doctorate from Harvard (and also later from Berlin) and one of America’s first sociologists to use large social surveys to examine the circumstances of people living in disadvantaged urban areas. His idea of the “talented tenth” was based on the notion that groups like the African-American population needed leaders with the very best education (his doctorate was in classics, philosophy and science) and this leadership would propel the success.
He established the National Association for the Advancement of Colored People in America, but left his homeland as a result of the Joseph McCarthy witch-hunts and died, at 95, in Ghana, a few days before Martin Luther King Jr gave his “I have a dream” speech. He was enormously influential in fighting for full civil rights in America but earned the enmity of radicals who favoured more direct action.
Langton’s essays are as bold, and potentially transformative, as Du Bois’ writings were a century ago. She writes:
“Indigenous participation in education systems and the economy are the main pathways out of the miserable conditions that produce ongoing disadvantage and reduce Aboriginal capacity to enjoy their rights as first Australians and citizens of one of the richest nations on earth.”
Well, they could be transformative if non-Aboriginal Australians really heard the messages on these issues. As she writes:
“The majority of Australians have remained ignorant of the reasons for the high levels of disadvantage that Indigenous people face, both because the reasons are complex, and because there is a wealth of misinformation as well as irrational belief about Aboriginal people in circulation.”
Langton is not party political, and she believes that these issues should not be politically divisive and “the truth is always much more complicated than the policy positions of governments, parties and campaign offices would have us believe”.
At the Telethon Institute for Child Health Research we made a commitment to employing and training as many First Nations researchers as we could, with the aim of giving the Aboriginal research agenda to them. Well-respected, nationally recognised elder Ted Wilkes put it simply:
“Who knows and cares most about Aboriginal health? We do. So give us the funding and the knowledge and partner with us to enable us to be responsible for our own health and wellbeing.”
It was clear he understood the social determinants of health better than anyone, so we concentrated on changing the culture within the institute to enable Aboriginal leadership to grow.
“Engaging Aboriginal people in the development of programs and methods results in them getting exactly the services they need, in their environments and for their unique circumstances.”
Sandra Eades joined the Institute as a PhD student in the mid-1990s, where she became one of the first First Nations people to secure a National Health and Medical Research Council (NHMRC) grant as leading chief investigator. She employed an outstanding group of Aboriginal health workers as research assistants to conduct a longitudinal study of first-time Aboriginal mums and their babies in urban Perth. This group of researchers proved Wilkes’ approach.
The study successfully enrolled the mothers, and the institute was able to follow their babies in ways that would not otherwise have been possible. It was a true partnership between those with different types of knowledge. Its success convinced the institute that employing and training First Nations researchers and using their methods was essential for the success of the research agenda.
All these health workers-turned-researchers had been trained by another pioneering First Nations Westen Australian health professional, Dr Joan Winch, who set up Marr Mooditj, the first Aboriginal health worker training program in Australia.
Eades had a huge influence on the NHMRC with her roadmap for supporting Aboriginal health research. One brilliant idea from that and other public health strategic planning was Capacity Building Grants to redress this neglected area. In 2005, the Institute won the first such grant in Aboriginal health, with a team of 10 Aboriginal investigators: Michael Wright, Ted Wilkes, Helen Milroy, Sandra Eades, Ngiare Brown, Juli Coffin, Dawn Bessarab, Jan Hammill, Cheryl Kickett-Tucker and Glenn Pearson.
Over the five years of the grant most completed their PhDs and all have become leaders. A group of them, plus Pat Dudgeon and Rhonda Marriott, formed the group of eight chief investigators who subsequently secured NHMRC support for a Centre of Research Excellence in Aboriginal Health and Wellbeing: From Marginalised to Empowered.
I recall helping to write this grant only to have it totally rewritten by the Aboriginal chief investigators. They were committed to a different paradigm of research methodology than mine. They wanted to conduct their own research projects with full engagement with Aboriginal community groups, shifting the power for participation at every stage — from the planning through to data collection, interpretation and implementation. I had instead written a good NHMRC quantitative application hoping that once we got the grant we could incorporate these more qualitative approaches.
I warned that NHMRC was not ready for such a radical proposal. I was wrong. The whoops of joy when they succeeded raised the roof.
There are two major changes in this approach — the first is to truly engage with the people who are the intended recipients of the services that are needed. This demands familiarity with a well-developed, internationally accepted set of methods known as ‘community participation action research’. There are well-established ways to do this, which have been used with the “Untouchables” (Dalits) in India and the First Nations in Nunavut (Canada). As a result, service delivery has been revolutionised.
It is not rocket science, but grounded in a self-evident truth: most of us only use the services we trust, that we feel we have some control over and that benefit our families and ourselves.
Aboriginal people in this country have little experience of exercising such a fundamental power over the services deemed appropriate for them. For many decades these services have been shaped by distant experts who thought they knew best.
Engaging Aboriginal people in the development of programs and methods results in them getting exactly the services they need, in their environments and for their unique circumstances. It also provides jobs, an additional advantage to them, which adds to the efficacy of the services. Aboriginal people will travel across the metropolitan area to attend an Aboriginal-controlled service.
This means that while the overarching principles of services can be developed centrally by government agencies — for example, early childhood learning is good for children to be ready for school, or complete vaccination prevents childhood infections, or sugary foods and drinks should be avoided to prevent type 2 diabetes — the way that these services are implemented should be done in collaboration with those who will be affected, the people themselves. Otherwise they simply do not work.
Some suggestions for how researchers and health services might do a better job of engaging with Aboriginal patients and communities have come from a research project spanning rural, regional and remote NSW.
The suggestions include taking time to develop trust and relationships (including with community members outside of the health sector), recruiting Aboriginal staff, and engaging patients and communities through art and social media.
The NHMRC-funded Gomeroi gaaynggal program recruits Aboriginal women in early pregnancy and monitors their health and that of their infants throughout pregnancy. It aims to promote the early detection, diagnosis and prevention of diabetes and kidney disease.
Work began on setting up the program in 2006, recognising that many Aboriginal women are deeply mistrustful of mainstream pregnancy-related healthcare services, and this contributes to low uptake of antenatal care.
Sharing some strategies that work for Aboriginal health
Lynsey Brown writes:
Based on their experiences in Walgett (NSW) and other regional, rural and remote Aboriginal communities, Dr Kym Rae and colleagues describe strategies to improve recruitment and retention of Aboriginal people in research and antenatal programs.
The lessons learnt stem from the NHMRC-funded Gomeroi gaaynggal program, which investigates health issues across pregnancy and the post-natal period.
The Gomeroi gaaynggal team also works in partnership with the Aboriginal community and a range of health service providers to deliver an ArtsHealth program that addresses health literacy and service use.
The authors describe key strategies for recruitment and retention that can be applied across diverse regions.
Promoting both ownership and engagement, they note how community consultation must occur across multiple levels. For example, when establishing a health service, it is important to include conversations with not only health professionals but also organisations and individuals working in different areas across a range of social determinants of health (eg, housing, education, justice system), and particularly engaging with local community Elders.
It is this open and trusting dialogue that enables partnerships between researchers, clinicians and communities.
Community consultation is a step towards building trust, which is necessary between researchers and the community, and between research teams and partner organisations. However, trust takes time.
The authors describe prioritising recruitment of Aboriginal staff to enable open discussions, friendships and a supportive mentored environment, which helps this trust and sense of collaboration to develop.
The use of new technologies (in areas with adequate internet connectivity) is also discussed in detail. Social media such as Facebook can be beneficial in establishing connections, maintaining contact, keeping up-to-date with developments, providing opportunity for private emails, and encouraging communication at less cost than a phone call.
The importance of addressing local needs is emphasised, with the authors identifying successful recruitment and retention strategies in different areas.
For regional areas, provision of food and transport vouchers reduces costs for families travelling to health services. Further, Aboriginal staff spend time liaising closely with community members and health services staff.
In rural areas arranging transport and improving local access to services are key strategies. Facebook is also particularly valuable in promoting connection between the program and participants in this space.
Additionally, the authors highlight the benefits of requesting details of three contact people for each participant, to enable connection with families who often change residences.
In the remote region, the key factor is collaboration between the research team and the local Aboriginal Medical Service – with co-located offices and matching uniforms promoting an ongoing partnership.
Despite centres in different locations determining their own approach, it seems the generated strategies are applicable to other health professionals working to close the gap.
• Lynsey Brown is Research Associate, PHC RIS
• Rae K, Weatherall L, Hollebone K, Apen K, McLean M, Blackwell C, et al. (2013). Developing research in partnership with Aboriginal communities – strategies for improving recruitment and retention. Rural and Remote Health 13: 2255. (Online)
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