NACCHO Aboriginal health and racism : What are the impacts of racism on Aboriginal health ?

“On an individual level, exposure to racism is associated with psychological distress, depression, poor quality of life, and substance misuse, all of which contribute significantly to the overall ill-health experienced by Aboriginal and Torres Strait Islander people.

Prolonged experience of stress can also have physical health effects, such as on the immune, endocrine and cardiovascular systems.”

Pat Anderson is chairwoman of the Lowitja Institute, Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research (and a former chair of NACCHO) see her opinion article below

“If you (Indigenous patient) go to a health service and you’re made to feel unwelcome, or uncomfortable or not deserving or prejudged and there are lots of scenarios of Aboriginal people being considered to be perhaps being seriously intoxicated when in fact they’ve been seriously ill.”

Romlie Mokak CEO Australian Indigenous Doctors Association

Read over 100 Aboriginal Health and Racism articles pubished over past 6 years by NACCHO

JUST ADDED 3 March VACCHO POSITION PAPER Health and Racism

It’s well known that Indigenous Australians have much lower life expectancy than other Australians, and have disproportionately high rates of diseases and other health problems.

Could that in part be due to racism?

Would cultural awareness training for health professionals would reduce the incidence of racism ?

Should governments acknowledge and address the impact of factors such as racism on health outcomes?

These are some of the question being asked in the health and community sectors, amid reports of a rise in racist incidents.

How racism affects health

The impact of racism on the health of Aboriginal and Torres Strait Islander people can be seen in:

inequitable and reduced access to the resources required for health (employment, education, housing, medical care, etc)
inequitable exposure to risk factors associated with ill-health (junk food, toxic substances, dangerous goods)
stress and negative emotional/cognitive reactions which have negative impacts on mental health as well as affecting the immune, endocrine, cardiovascular and other physiological systems
engagement in unhealthy activities (smoking, alcohol and drug use)
disengagement from healthy activities (sleep, exercise, taking medications)
physical injury via racially motivated assault

HOW DO WE BUILD A HEALTH SYSTEM THAT IS NOT

World news radio Santilla Chingaipe recently interviewed a number of health organisations

It’s well known that Indigenous Australians have much lower life expectancy than other Australians, and have disproportionately high rates of diseases and other health problems.

Could that in part be due to racism?

The Social Determinants of Health Alliance is a group of Australian health, social services and public policy organisations.

It lobbies for action to reduce inequalities in the outcomes from health service delivery.

Chair of the Alliance, Martin Laverty, has no doubt racism sometimes comes into play when Indigenous Australians seek medical attention.

“When an Indigenous person is admitted to hospital, they face twice the risk of death through a coronary event than a non-Indigenous person and concerningly, Indigenous people when having a coronary event in hospital are 40 percent less likely to receive a stent* or a coronary angiplasty. The reason for this is that good intentions, institutional racism is resulting in Indigenous people not always receiving the care that they need from Australia’s hospital system.”

Romlie Mokak is the chief executive of the Australian Indigenous Doctors’ Association.

Mr Mokak says the burden of ill health is already greater amongst Indigenous people – but this isn’t recognised when they go to access health services.

“Whereas Aboriginal people may present to hospitals often later and sicker, the sort of treatment they might get once in hospital, is not necessarily reflect that higher level of ill health. We’ve got to ask some questions there and why is it that the sickest people are not necessary getting the equitable access to healthcare.”

Mr Mokak says many Indigenous people are victims of prejudice when seeking medical services.

But Romlie Mokak from the Australian Indigenous Doctors Association says the onus shouldn’t be on the federal government alone to improve the situation.

He suggests cultural awareness training for health professionals would reduce the incidence of racism.

“Not only is it at the point of the practitioner, but it’s the point of the institution that Aboriginal people must feel that they are in a safe environment. In order to do this, it’s not simply that Aboriginal people should feel resilient and be able to survive these wider systems, but those services really need to have staff that have a strong understanding of Aboriginal people’s culture, history, lived experience and the sorts of health concerns they might have and ways of working competently with Aboriginal people.”

Martin Laverty says at a recent conference, data was presented suggesting an increase in the number of Australians experiencing racism.

And he says one of the results is an increase in psychological illnesses.

“We saw evidence that said about 10 percent of the Australian population in 2004 was reporting regular occurences of individual acts of racism and that that has now double to being close to 20 percent of the Australian population reporting regular occurences of racism. We then saw evidence that the consequences of this are increased psychological illnesses. Psychological illnesses tied directly to a person’s exposure to racism and discrimination and that this is having direct cost impacts of the Australian mental health and broader acute health system.”

Mr Laverty says it’s time governments acknowledged and addressed the impact of factors such as racism on health outcomes.

He says a good start would be to implement the findings of a Senate inquiry into the social determinants of health, released last year.

“In the country of the fair go, we should be seeing Australian governments, Australian communities acting and indentifying these triggers of racism that are causing ill health and recognising that this is not just something the health system that needs to respond to, but the Australian government can respond by implementing the Senate inquiry of March 2013 that outlines the set of steps that can be taken to overcome these detriments of poor social determinants of health.”

Racism a driver of Aboriginal ill health

On an individual level, exposure to racism is associated with psychological distress, depression, poor quality of life, and substance misuse, all of which contribute significantly to the overall ill-health experienced by Aboriginal and Torres Strait Islander people. Prolonged experience of stress can also have physical health effects, such as on the immune, endocrine and cardiovascular systems.

Pat Anderson is chairwoman of the Lowitja Institute, Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research (and a former chair of NACCHO)

As published in The Australian OPINION originally published in NACCHO July 2013

In July 2013, the former federal government launched its new National Aboriginal and Torres Strait Islander Health Plan.

As with all such plans, much depends on how it is implemented. With the details of how it is to be turned into meaningful action yet to be worked out, many Aboriginal and Torres Strait Islander people, communities and organisations and others will be reserving their judgment.

Nevertheless, there is one area in which this plan breaks new ground, and that is its identification of racism as a key driver of ill-health.

This may be surprising to many Australians. The common perception seems to be that racism directed towards Aboriginal and Torres Strait Islander people is regrettable, but that such incidents are isolated, trivial and essentially harmless.

Such views were commonly expressed, for example, following the racial abuse of Sydney Swans footballer Adam Goodes earlier this year.

However, the new health plan has got it right on this point, and it is worth looking in more detail at how and why.

So how common are racist behaviours, including speech, directed at Aboriginal and Torres Strait Islander people?

A key study in Victoria in 2010-11, funded by the Lowitja Institute, documented very high levels of racism experienced by Aboriginal Victorians.

It found that of the 755 Aboriginal Victorians surveyed, almost all (97 per cent) reported experiencing racism in the previous year. This included a range of behaviours from being called racist names, teased or hearing jokes or comments that stereotyped Aboriginal people (92 per cent); being sworn at, verbally abused or subjected to offensive gestures because of their race (84 per cent); being spat at, hit or threatened because of their race (67 per cent); to having their property vandalised because of race (54 per cent).

Significantly, more than 70 per cent of those surveyed experienced eight or more such incidents in the previous 12 months.

Other studies have found high levels of exposure to racist behaviours and language.

Such statistics describe the reality of the lived experience of Aboriginal and Torres Strait Islander people. Most Australians would no doubt agree this level of racist abuse and violence is unwarranted and objectionable. It infringes upon our rights – not just our rights as indigenous people but also our legal rights as Australian citizens.

But is it actually harmful? Is it a health issue? Studies in Australia echo findings from around the world that show the experience of racism is significantly related to poor physical and mental health.

There are several ways in which racism has a negative effect on Aboriginal and Torres Strait Islander people’s health.

First, on an individual level, exposure to racism is associated with psychological distress, depression, poor quality of life, and substance misuse, all of which contribute significantly to the overall ill-health experienced by Aboriginal and Torres Strait Islander people. Prolonged experience of stress can also have physical health effects, such as on the immune, endocrine and cardiovascular systems.

Second, Aboriginal and Torres Strait Islander people may be reluctant to seek much-needed health, housing, welfare or other services from providers they perceive to be unwelcoming or who they feel may hold negative stereotypes about them.

Last, there is a growing body of evidence that the health system itself does not provide the same level of care to indigenous people as to other Australians. This systemic racism is not necessarily the result of individual ill-will by health practitioners, but a reflection of inappropriate assumptions made about the health or behaviour of people belonging to a particular group.

What the research tells us, then, is that racism is not rare and it is not harmless: it is a deeply embedded pattern of events and behaviours that significantly contribute to the ill-health suffered by all Aboriginal and Torres Strait Islander Australians.

Tackling these issues is not easy. The first step is for governments to understand racism does have an impact on our health and to take action accordingly. Tackling racism provides governments with an opportunity to make better progress on their commitments to Close the Gap, as the campaign is known, in Aboriginal and Torres Strait Islander health. The new plan has begun this process, but it needs to be backed up with evidence-based action.

Second, as a nation we need to open up the debate about racism and its effects.

The recognition of Aboriginal and Torres Strait Islander peoples in the Constitution is important for many reasons, not least because it could lead to improved stewardship and governance for Aboriginal and Torres Strait Islander health (as explored in a recent Lowitja Institute paper, “Legally Invisible”).

However, the process around constitutional recognition provides us with an opportunity to have this difficult but necessary conversation about racism and the relationship between Australia’s First Peoples and those who have arrived in this country more recently. Needless to say, this conversation needs to be conducted respectfully, in a way that is based on the evidence and on respect for the diverse experiences of all Australians.

Last, we need to educate all Australians, especially young people, that discriminatory remarks, however casual or apparently light-hearted or off-the-cuff, have implications for other people’s health.

Whatever approaches we adopt, they must be based on the recognition that people cannot thrive if they are not connected.

Aboriginal and Torres Strait Islander people need to be connected with their own families, communities and cultures. We must also feel connected to the rest of society. Racism cuts that connection.

At the same time, racism cuts off all Australians from the unique insights and experiences that we, the nation’s First Peoples, have to offer.

Seen this way, recognising and tackling racism is about creating a healthier, happier and better nation in which all can thrive.

Pat Anderson is chairwoman of the Lowitja Institute, Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research.

NACCHO Congress Alice Springs NEWS : Effective partnerships” in Aboriginal community controlled health sector could be copied in housing and employment

“There are two separate but interdependent health systems, the hospital for the really sick, and Congress for primary health care, minimising the need for hospital admissions. In that way the primary health care of Congress, identifying patients’ health issues early, works hand in glove with the NT’s hospital system.

This “effective partnership” in health between the NT and Federal governments and the Aboriginal community controlled health sector could readily be copied in the housing and employment fields, leading to equally positive results.

Donna Ah Chee, (pictured above left with Pat Anderson ) CEO of the $38m a year Central Australian Aboriginal Congress,

“Investing in Aboriginal community controlled health makes economic $ense”

Justin Mohamed chair of NACCHO launching the NACCHO Healthy Futures Summit Melbourne Convention Centre June 24-26

A meeting of some 60 non-government organisations (NGOs) yesterday heard about successful ways for services to cooperate, but also laid bare absurd failures of the current system.

FROM THE ALICE NEWS : FOLLOW HERE

The meeting was not open to the public but Donna Ah Chee, CEO of the $38m a year Central Australian Aboriginal Congress, says her organisation’s role in the health system showed how an NGO can complement – not duplicate – state providers.

The collaboration between the Territory’s health services, the Commonwealth Health Department and Aboriginal community controlled health services including Congress makes the NT the only jurisdiction on target to “close the gap” in life expectancy by 2031.

As a result of this successful partnership Ms Ah Chee says there had been about a 30% reduction in “all causes” of early death with the death rate declining from 2000 to 1400 people per 100,000,” says Ms Ah Chee.

The partnership on the ground means that services like Congress works on preventative health – keeping as many people as possible out of hospital – and if they have to go there, take care of them when they come out.

“There are two separate but interdependent health systems,” says Ms Ah Chee, “he hospital for the really sick, and Congress for primary health care, minimising the need for hospital admissions.”

In that way the primary health care of Congress, identifying patients’ health issues early, works hand in glove with the NT’s hospital system.

Ms Ah Chee says the competitive tendering for government money is at the root of much of much dysfunction, causing “fragmentation of services, a multitude of services on the ground”.

She says in one small bush community there are about 17 providers just in the mental health field: “It’s bureaucracy gone mad. Everyone goes for the dollar. Better needs based planning is what’s urgently required.”

Ms Ah Chee says the meeting, called by the Department of the Chief Minister, has shown up the potentials and the problems of the system. It now remains to be seen what is done about them

The importance of our NACCHO member Aboriginal community controlled health services (ACCHS) is not fully recognised by governments.

The economic benefits of ACCHS has not been recognised at all.

We provide employment, income and a range of broader community benefits that mainstream health services and mainstream labour markets do not. ACCHS need more financial support from government, to provide not only quality health and wellbeing services to communities, but jobs, income and broader community economic benefits.

A good way of demonstrating how economically valuable ACCHS are is to showcase our success at a national summit.

SUMMIT WEBSITE FOR MORE INFO

NACCHO Healthy Futures Summit Melbourne 24-26 June 2014 : Invitation to submit abstracts

On behalf of the NACCHO Board and Secretariat it is my pleasure to invite you to submit an abstract to the NACCHO Healthy Futures Summit at the Melbourne Convention and Exhibition Centre 24-26 June 2014.

ALL ABSTRACTS MUST BE SUBMITTED VIA THE ABSTRACT PORTAL

The importance of our NACCHO member Aboriginal community controlled health services (ACCHS) is not fully recognised by governments.

The economic benefits of ACCHS has not been recognised at all.

A good way of demonstrating how economically valuable ACCHS are is to showcase our success at a national summit.

SUMMIT WEBSITE FOR MORE INFO REGISTER

NACCHO would like to demonstrate to the government at this summit how investing more in ACCHS is the best way of promoting better health more employment, more jobs and greater community economic benefits.

ABSTRACT SUBMISSIONS ONLINE

NACCHO Healthy futures Summit-Melbourne 24-26 June 2014

NACCHO invites abstracts submission from its members the Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholder organisations to showcase policy frameworks, best practice and investment in Aboriginal Health.

The delegates will be a representation from all over Australia in clinical practice, policy and research.

IMPORTANT DATES

Call for Abstracts open	25 February
All Abstracts Due	21 Mar 2014
Abstract Notifications	4 April 2014
Presenter Registration Due	18 April 2014
Early bird registrations open	25 February 2014
Early-Bird registrations Closes	18 April 2014
Program released	4 April 2014
Exhibition and sponsorship	16 May 2014
NACCHO 2014 Summit	24 -26 June 2014

Program Streams

1.Economic Development

Economic models of investment into Aboriginal Community Controlled Health Organisation
Economic models of investment through partnership
Income generation through Aboriginal Community Controlled Health Organisations
Brokerage Modelling with Aboriginal Community Controlled Health Organisation

2.Health Reform

2.1 Workforce

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

National, State, Regional and Local Workforce Needs Analysis
Models of success
Recruitment and Retention Strategies
Mentoring Programs
Workforce Innovation Partnership
Career pathways that incorporate Scope of Practice within ACCHO’s

2.2 Continuous Quality Improvement

Affiliate Registered Training Organisations Capacity Building of ACCHO’s through scope of practice
Accreditation
Clinical Standards

3.Healthy Futures

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

Clinic Practice/frontline servicing
Mental Health
Social Emotional Wellbeing
Drug & Alcohol
Mums & Babies
Women’s Health
Men’s Health
Oral Health
Aged Care
Disabilities
Adolescent
Sexual Health

4.Youth

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

Investment in Youth by Aboriginal Community Controlled Health Organisations
Career pathways within an ACCHO, Affiliates and key stakeholders
Youth Leadership
Mentoring
Healthy Lifestyles and Youth
Health Promotion Strategies

5.Research & Data

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

Population Health
Best practice models
Gap and Needs analysis
Research within Aboriginal Community Controlled Health Organisations
Research Partnerships
Health Information
Importance of Data
Cultural protocols into practice
What’s the Aboriginal Community Controlled Health Data telling us?

General guidelines for submissions

Abstracts will only be accepted by submitting through the online process below .
Abstracts must be a maximum of 300 words .
All abstracts must be original work.
The abstract will contain text only; no diagrams, illustrations, tables or graphics.
All presenting authors must register and pay for their registration for the conference by 18 April 2014 otherwise the presentation will be removed from the program.
The NACCHO advisory group reserves the right to accept and reject abstracts for inclusion in the program and allocate to a format that may not have been initially specified by the author/presenter.
The conference organisers will not be held responsible for submission errors caused by internet service outages, hardware or software delays, power outages or unforeseen events.
It is the responsibility of the presenting author to ensure that the abstract is submitted correctly. After an author has submitted their abstract, they should check their abstract was uploaded successfully.
All authors will receive notification of the outcome of their submission on 4 April 2014.
Responsibility for the accuracy of abstracts rests with the author.
Where there are co-authors, only one abstract is to be submitted. The presenting author is responsible for ensuring the co-authors agree with and are aware of the content before submitting the abstract.
An abstract which does not adhere to these requirements will not be accepted

ALL ABSTRACTS MUST BE SUBMITTED VIA THE ABSTRACT PORTAL

For further information contact the NACCHO SUMMIT TEAM 02 6246 9300 or EMAIL

NACCHO political alert:Federal inquiry into the harmful use of alcohol in Aboriginal and Torres Strait Islander communities

The House of Representatives Standing Committee on Indigenous Affairs has announced an inquiry into the harmful use of alcohol in Aboriginal and Torres Strait Islander communities.

NACCHO Chair Justin Mohamed said the NACCHO secretariat will be working closely with its 150 members to make sure the role of Aboriginal Community Controlled health is recognised in any future long-term plans and recommendations as identified in NATSIHP the National Aboriginal and Torres Strait Islander Health plan 2013-2023

NACCHO ALCOHOL AND OTHER DRUGS NEWS ALERTS

The Chair of the Committee, Dr Sharman Stone, said that ‘The Committee is not singling out Aboriginal and Torres Strait Islander people as the only group that have problems with alcohol.

We know that Aboriginal and Torres Strait Islander people are more likely to abstain from alcohol than non- Aboriginal and Torres Strait Islander people. However we are concerned that Aboriginal and Torres Strait Islander people, who do consume alcohol, drink at riskier levels which has a greater impact on their health.’

Dr Stone said ‘while there is no doubt that alcohol abuse has a significant impact on families and communities right across Australia, Aboriginal and Torres Strait Islander people are between four and five times more likely to be hospitalised, and between five and eight times more likely to die as a result of harmful alcohol use

‘Statistics such as these are of great concern. The Minister has supported the Committee’s determination to identify the social and other determinants of high risk alcohol consumption. We will also identify the strategies and programs which may have had some beneficial outcomes, comparing international experience. The prevalence and impacts of FASD and FAS will also be given a particular focus. We wish to hear from specialists and communities about what is working and why and submissions are now being called for.’

The Committee will inquiry into and report on:

Terms of Reference

The Committee will inquire into and report on the harmful use of alcohol in Aboriginal and Torres Strait Islander communities, with a particular focus on:

• Patterns of supply of, and demand for alcohol in different Aboriginal and Torres Strait Islander communities, age groups and genders

• The social and economic determinants of harmful alcohol use across Aboriginal and Torres Strait Islander communities

• Trends and prevalence of alcohol related harm, including alcohol-fuelled violence and impacts on newborns e.g. Foetal Alcohol Syndrome and Foetal Alcohol Spectrum Disorders

• The implications of Foetal Alcohol Syndrome and Foetal Alcohol Spectrum Disorders being declared disabilities

• Best practice treatments and support for minimising alcohol misuse and alcohol-related harm

• Best practice strategies to minimise alcohol misuse and alcohol-related harm

• Best practice identification to include international and domestic comparisons

Interested persons and organisations are invited to make submissions addressing the terms of reference by Thursday 17 April 2014 .

SUBMISSIONS AND MORE INFO

NACCHO needs to improve how we connect, inform and engage into the Ifuture.

SURVEY LINK

NACCHO political alert : Health Minister Dutton signals major overhaul of health :Full transcript 7:30 report

“Well I’m saying when you look at the fact that over the course of the next four years the funding is projected to go up in public hospitals by 50 per cent.

If you look at over the course of the last 10 years where payments have gone up under Medicare Benefits Schedule where we pay the doctors and pay for pathology and diagnostic tests and whatnot, it was $8 billion a year 10 years ago; it’s $18 billion a year today.”

Minister for Health Peter Dutton Speaking on ABC 7:30 report , read full transcript below

OR VIEW FULL INTERVIEW HERE

According to reports in the Guardian the federal health minister, Peter Dutton, has signalled dramatic changes to Medicare to address “staggering” increases in health spending, confirming the Abbott government would consider a new fee for visits to the doctor.

Laying the groundwork for politically sensitive reforms, Dutton said he wanted to “start a national conversation about modernising and strengthening Medicare”. He said the health system was “riddled with inefficiency and waste” and warned that doing nothing to address the long-term budget burden was not an option.

In a speech in Brisbane on Wednesday, the minister flagged a greater role for the private sector and private insurers in primary care as the government wanted to “grow the opportunity for those Australians who can afford to do so to contribute to their own healthcare costs”.

But Labor seized on his comments of evidence that the government planned “to destroy universal healthcare in Australia” by making people pay more to access services.

The shadow health minister, Catherine King, said Dutton’s claims about rising health costs were “hysterical” as Australia spent 9.1% of its gross domestic product on health compared with 17% by the United States.

Dutton followed up his speech with an interview on the ABC’s 7.30 program in which he said the country should debate how governments and consumers paid for health services. He said the discussion should include payment models for people who had “a means to contribute to their own healthcare”.

A discussion about who pays for our health system and how is what Federal Health Minister Peter Dutton has flagged, suggesting those with a mean to contribute may have to pay more.

Transcript

SARAH FERGUSON, PRESENTER: Federal Health Minister Peter Dutton today called for a fearless, far-reaching debate about Australia’s health system, saying that current spending is unsustainable. He’s now flagging major changes to health services, with Australians who can afford it paying more for healthcare and medicines.

The minister has revealed he’s looking at a potential Medicare co-payment, which some argue could mean the end of universal healthcare. It comes after a controversial week in the Health portfolio, with junior Health Minister Fiona Nash accused of doing the bidding of the junk food industry, pulling down a healthy consumers’ website years in preparation. Peter Dutton joined me earlier from Brisbane.

Peter Dutton, thank you very much for joining us.

PETER DUTTON, HEALTH MINISTER: Pleasure. Thank you, Sarah.

SARAH FERGUSON: You said in your speech today that in the past 10 years the cost of Medicare has increased by 120 per cent, the Pharmaceutical Benefits Scheme by 90 per cent, hospital care by 80 per cent. You say that’s not sustainable and something must be done. What exactly is it that you are planning to do?

PETER DUTTON: Well the first thing that we have to do is have a conversation with the Australian people to say that we want to strengthen and modernise Medicare. It’s a system that, obviously, all Australians, including myself, hold near and dear. But it’s a system that was set up in the 1980s and we have to accept the changing and ageing demographic of our society, we have one of the highest obesity rates in the world, we have cancers that if early detection takes place, we can help those people if we have better connections between people and their GPs – all of those things are great, but they have to be paid for. So we have to look at where it is we’re spending money at the moment, whether or not that’s the most efficient way to spend the money so that we can strengthen and sustain our system into the future.

SARAH FERGUSON: Now, does that include increasing the costs of healthcare for those who can afford to pay more?

PETER DUTTON: Well I think it does and at the moment government pays about 70 per cent of that which we spend on health each year, and I know these figures sort of gloss – are glossed over or go over people’s heads, but $140 billion at the moment we’re spending each year on health that we raise about $10 billion a year out of the Medicare levy. There is enormous amounts of money to be spent. There are lots of technologies coming through, and as a First World country, we want to adopt those early and we have to have a conversation about how we pay for those and those that have a capacity to pay in many cases are already paying within the system, but we have to have a discussion about how it is that payment model works going forward.

SARAH FERGUSON: Individuals are already contributing about 18 per cent of the cost of their own health care. Are you saying those payments are going to have to go up?

PETER DUTTON: Well I’m saying when you look at the fact that over the course of the next four years the funding is projected to go up in public hospitals by 50 per cent. If you look at over the course of the last 10 years where payments have gone up under Medicare Benefits Schedule where we pay the doctors and pay for pathology and diagnostic tests and whatnot, it was $8 billion a year 10 years ago; it’s $18 billion a year today. We have to look at the next 10 years where we we’re going to have millions of people who will go onto the age group of over 65. I want to make sure that we can provide for those and we do have to have a national discussion about who pays for what and how the Government pays going forward and how consumers pay for those health services.

SARAH FERGUSON: Specifically, for example, are you in favour of introducing a Medicare copayment. A figure of $6 a visit has been touted already?

PETER DUTTON: Well there are suggestions that have been made both in favour and against this particular proposal, but it’s one aspect that the Government will need to consider. The Commission of Audit obviously …

SARAH FERGUSON: And what’s your own view – what’s your own view on that? Excuse me.

PETER DUTTON: Well my own view is that people at the moment pay a co-contribution through when they buy their medicines, regardless of their income. People pay as little as $6 for a $17,000 prescription, a single prescription. People pay a copayment at the moment for their private health insurance. 11 million Australians have private health insurance. Many Australians already pay a copayment when they go to see the doctor. Now, the issue is how you guarantee access, particularly for those who are without means, and how you don’t deter people from going to see a doctor if there is some sort of a payment mechanism in place.

SARAH FERGUSON: You also raise the issue today of the ageing population. Is your government going to be forced to make older people who have more resources pay more for their healthcare?

PETER DUTTON: Well, I don’t want to single anybody out, but what I would say is that as a general principle, in a society where we have an ageing of our population, regardless of people’s age, if they have a means to contribute to their own health care, we should be embarking on a discussion about how that payment model will work.

SARAH FERGUSON: And is that going to require a new form of means testing to make that possible?

PETER DUTTON: Well, not necessarily, and again, this is the recommendations that we’ll wait to see from the Commission of Audit. I want to make sure that, for argument’s sake, we have a discussion about you or me on reasonable incomes whether we should expect to pay nothing when we go to see the doctor, when we go to have a blood test, should we expect to pay nothing as a co-contribution and other taxpayers to pick up that bill. I think these are all reasonable discussions for our population to have.

SARAH FERGUSON: Now, you set out as the key rationale for your speech today the dramatically rising rates of obesity and diabetes in society, yet your own junior minister, Fiona Nash, shut down a website which was designed to help prevent those scourges. Was that a mistake?

PETER DUTTON: It wasn’t a mistake. The Government obviously has a number of people who were advising us in these particular areas. The issue that you speak of is a reasonable discussion to take place. But to put this issue into perspective, there was a system that was proposed in relation to a star rating that people could assess whether or not they purchased particular foods based on that system or that star rating system. The system hasn’t started, and as I understand the minister’s position, she said that the website shouldn’t proceed until there had been a rolling out of this system or a better understanding …

SARAH FERGUSON: But that wasn’t the view of those people who had been involved in putting that website together; they said it was ready to go.

PETER DUTTON: Well again, I mean, you’ve got Labor premiers sitting around the table in South Australia and Tasmania, two of the worst-performing health systems in the country. I don’t place much credibility in what might have been leaked by Labor ministers out of that meeting. I find Fiona Nash not only to be an effective minister, but a very decent person. I think she’s served her constituency well.

SARAH FERGUSON: That’s not actually the question here. Excuse me, minister, …

PETER DUTTON: Well it goes to credibility and the credibility that I place in this debate is with Senator Nash and I think she has done the right thing here. We’ll have a proper discussion about what we should do in terms of food labelling and the rest of it, but we aren’t going to be cajoled or bullied by people like SA or Tasmania or indeed the ACT, who have very poor performing health systems.

SARAH FERGUSON: Forgive me for interrupting. It doesn’t just go to the credibility of the minister. I’m asking you for your opinion. These are exactly the tools that public health experts say the public needs to fight diabetes and obesity. Do you still maintain that website should be taken down?

PETER DUTTON: If the system hasn’t started, I don’t see an argument for the website being up in place and that’s the decision rightly that the minister took.

SARAH FERGUSON: Did you know that her chief-of-staff was a lobbyist for the food and soft drink industry?

PETER DUTTON: Well, again, Sarah, these are matters that have been trawled over.

SARAH FERGUSON: What’s the answer to the question, if you would?

PETER DUTTON: Well I knew of course, as everybody else did, Mr Furnival’s history, but today is our opportunity to talk about ways in which we can strengthen Medicare going forward and that’s the speech I gave today and I think that’s the discussion the public wants to hear about, about how can we provide …

SARAH FERGUSON: Except that you’re – minister, if I may say, you’re the person that raised the issue of obesity and diabetes, that wasn’t me.

PETER DUTTON: Sure.

SARAH FERGUSON: You made that the centrepiece of your speech, the opening lines in fact.

PETER DUTTON: Sure.

SARAH FERGUSON: You’re saying you knew that Mr Furnival was a lobbyist for the food and drink industry. Doesn’t that mean there was a clear conflict of interest between his past and the actions of your minister?

PETER DUTTON: No, the appropriate, the appropriate – as I’m advised, the appropriate declarations were made and signed, and as I say, Mr Furnival now has moved on. Our discussion today was about the fact that we have one of the highest obesity rates in the world. About two in three Australians have – are either overweight or obese. We now have about 2,200 young children and youngsters who are identified as having Type 2 diabetes. That’s what I was speaking about today and frankly I think that’s a much more substantive discussion to have with the public and if we do that then we can talk about the ways that we can make our system sustainable going forwards.

SARAH FERGUSON: Thank you very much indeed for joining us, Mr Dutton.

PETER DUTTON: My pleasure. Thank you.

NACCHO needs to improve how we connect, inform and engage into the Ifuture.

SURVEY LINK

NACCHO Aboriginal Health :Social media the new health danger in Aboriginal Communities

The use of social media in the region is also problematic because of the small population size of remote communities, and the complex family relationships that often break down into community division.

The exposure of the mental health epidemic afflicting children in the lands comes as community leaders call for more action to protect children. Some community members say the government must consider a strong response, such as community boarding houses, to keep children safe at night.

ABORIGINAL teenagers in remote communities of central Australia are using Facebook to regularly threaten suicide, prostitute themselves and talk about substance abuse.

Child welfare advocates have sent The Australian Facebook posts from children as young as 13 that lay bare the dysfunction of the region.

Bullying is also commonplace, with teenagers regularly threatening violent abuse on the site.

Picture Above: Nyuminya Ken, from Ernabella in the APY Lands of South Australia, has sent her daughter away to school in Victoria to escape cyber bullying. Picture: Stuart McEvoy Source: News Corp Australia

Story Sarah Martin Published THE AUSTRALIAN 20 FEB

PREVIOUS ARTICLES FROM NACCHO about Social media

The disturbing posts include a teenage girl expressing “real shame” at young girls in her community who “strip their self when they hanging out for dope”.

The Australian has seen at least a dozen posts of children from the Anangu Pitjantjatjara Yankunytjatjara lands threatening suicide, and posts of teenagers listing mobile phone numbers to procure sex.

Nyuminya Ken, a respected elder in the community of Ernabella, said there was widespread concern about the inappropriate use of Facebook.

One post has a young girl saying “all the man stop ringing to my phone, I’m little kids, not big woman … I don’t like big man”. In another post, a pregnant 18-year-old says she is addicted to sniffing laundry products, saying: “Damaging this kids brain. Cnt get rid of it. Gona sniff it all night till I get sick.” Another girl, understood to be just 14, threatens to hang herself when her family goes to sleep. “Feel lost right now hang myself,” the girl writes.

Child Protection Minister Jennifer Rankine said she had ordered Families SA to do an immediate check on each of the children, whose posts were brought to the department’s attention by The Australian.

“I have been advised that only one of the seven young people is known to Families SA,” Ms Rankine said. “An FSA officer has been instructed to check on this child’s welfare immediately.

“I have also instructed FSA to work with SA Police in an effort to … check on their welfare.”

A spokeswoman for the minister said police had checked on the children and they were “safe and happy”.

Mrs Ken said that she had spoken to the region’s women’s council and police about its use, and wanted more action to prevent it adding to the community’s ills.

“All the girls are doing Facebook, and we don’t want it on their phones,” she said.

She said she had asked for the police to come to the school to talk to students about the Facebook “problem.”

A Facebook spokeswoman said the safety of users was a priority. “Facebook takes threats of self-harm very seriously. We also work with suicide prevention agencies around the world to provide assistance for people in distress.”

As for the site being used for minors to procure sex, the spokeswoman said Facebook had a strict policy, involving law enforcement collaboration, against the sharing of pornographic content and any explicitly sexual content where a minor was involved.

If you are depressed or contemplating suicide, help is available at Lifeline on 131 114.

NACCHO needs to improve how we connect, inform and engage into the Ifuture.

SURVEY LINK

NACCHO Aboriginal healthy debate: Mandatory cultural training in Aboriginal Health. Do GPs need it?

“GPs are in a key position to make a difference. We are the first point of contact in the health care system, gate keepers to other health services, and advocates for our patients. However, the Australian Bureau of Statistics reports that 15% of Aboriginal and Torres Strait Islander people had wanted to go to a doctor in the previous 12 months but had not gone.”

From The Australian Doctor Professor Jennifer Reath

The RACGP is again leading the way in addressing health needs of Aboriginal and Torres Strait Islander Australians.

SEE BELOW RACGP

Government must not become complacent if Close the Gap progress to continue

At the RACGP Convocation last year a proposal that the RACGP should look at moving towards compulsory cultural awareness education as part of the QI & CPD requirements was passed.

It will now go to the RACGP Council for consideration.

The statistics about the health disparities between Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians don’t need to be reiterated here.

Close the gap

We all know that Aboriginal people die 10-12 years younger than their non-Indigenous counterparts. In spite of their poorer health status Aboriginal and Torres Strait Islander people receive lower standards of care when they present to health services.

Aboriginal people presenting to hospital with cardiac chest pain are 40% less likely to receive revascularisation procedures in stroke care, Indigenous patients were less likely to receive timely allied health assessment and were three times more likely to die or to be dependent at discharge.

Though there are many reasons for these disparities in care, it is clear that health services have an important role in improving the health of Aboriginal and Torres Strait Islander people.

GPs are in a key position to make a difference. We are the first point of contact in the health care system, gate keepers to other health services, and advocates for our patients. However, the Australian Bureau of Statistics reports that 15% of Aboriginal and Torres Strait Islander people had wanted to go to a doctor in the previous 12 months but had not gone.

The majority of these were in non-remote areas.

Watch: http://www.youtube.com/watch?feature=player_embedded&v=auCk9kn6ENE

It is clear from both the published evidence and from what Aboriginal and Torres Strait Islander people are telling us that one of the reasons they don’t present to doctors is that too often non-Indigenous health practitioners don’t understand what is important to their Aboriginal and Torres Strait Islander patients – their history, cultural world-view and lived experience of being Aboriginal and Torres Strait Islander.

Often we are not recognising that our patients are Aboriginal or Torres Strait Islander, despite the fact that the immunisation requirements, screening and preventive health recommendations and management strategies, including access to medications, are all clinical decisions which depend on this.

The evidence shows that education in cultural awareness, which encompasses an awareness of how history and culture impact on health and on trust in health services, are essential for providing high quality care.

Many Australian trained GPs will have developed an awareness of an Indigenous Australian history during this their schooling and their medical school training. Some however, will have studied medicine in other countries or studied at a time when Indigenous health was not part of the medical school teaching.

Though GP vocational training now includes some teaching about Aboriginal and Torres Strait Islander health, there are many GPs in practice today who will not have undertaken this learning.

In any case, like most areas of learning, cultural competency is not something that can be learned in one workshop. Cultural competence requires life-long learning and reflection. The best way of providing the opportunity for all GPs to gain and maintain these skills, is through QI & CPD.

Cardiopulmonary Resuscitation training has been compulsory in the RACGP program for two triennia now without much controversy.

Statistics from Europe indicate an incidence of cardiac arrest in the community to be 37.72 per 100,000 person years (the figure for the US being 54.99). On this basis, a quick back of the envelope calculation would indicate that a GP with 2000 patients on their books would have two to three patients each triennium who have a cardiac arrest. In most circumstances the GP would not be in attendance at the time.

In contrast, you are far more likely as a GP to treat an Aboriginal or Torres Strait Islander patient and to make a difference to their health outcomes.

We know that Aboriginal and Torres Strait Islander people comprise 2.5% of the population, and BEACH data shows us that if we ask each of our patients we increase the number of patients we identify from 1.0% to 2.1%.

Evidence from the Kanyini vascular collaboration shows that when Aboriginal people engage with culturally appropriate services they trust, there is good opportunity for high quality cardiovascular prevention.

Inala at Queensland Health and the Majellan General Practice in Brisbane are just two examples of how primary health care services and general practices can make changes that improve their accessibility to Aboriginal and Torres Strait Islander people.

GPs have a proud history of doing what is necessary to improve the health of the communities in which they work. Providing access for our Aboriginal and Torres Strait Islander patients to culturally safe, effective medical care is just another example of this.

The RACGP is embarking on a conversation with its members and with Aboriginal and Torres Strait Islander people to determine best ways forward, for we all know that GPs are at the forefront of improving the health of Australia’s first peoples.

RACGP PRESS RELEASE CLOSE THE GAP

Government must not become complacent if Close the Gap progress to continue

12 February 2014

The Royal Australian College of General Practitioners (RACGP) welcomes the release of the Prime Minister’s sixth Closing the Gap report highlighting positive progress made towards meeting the Close the Gap targets but urges the Government to not become complacent.

The report, launched at today’s Close the Gap Parliamentary event aims to provide insight into the key determinants of health, education, employment and community safety in meeting the Close the Gap objectives.

RACGP Chair of the National Faculty of Aboriginal and Torres Strait Islander Health, Associate Professor Brad Murphy, said figures released in the report suggest positive progress has been made in some Close the Gap objectives including child mortality, however there is still considerable progress to be made in other areas such as improving life expectancy.

“The Federal Government’s leadership in the delivery of measures to meet the Close the Gap targets is essential if real progress is to be made.

“The empowerment of Aboriginal and Torres Strait Islander peoples and communities must occur alongside a coordinated strategic, policy driven response,” said A/Prof Murphy.

The RACGP believes general practice and primary healthcare is in the optimum position to improve life expectancy, identified within the report as a key objective in need of urgent progression.

“No outcome acts in isolation.

“We know the benefit general practice holds in the provision of preventive healthcare for Aboriginal and Torres Strait Islander peoples; however life expectancy is affected by a range of factors beyond addressing health risks including education and employment status.

“The health and social care sector employs 15% of the total Aboriginal and Torres Strait Islander workforce¹, the highest rate of any sector.

“An investment in Aboriginal and Torres Strait Islander health, including to the Community Controlled sector, not only works towards curbing health disparities, but is also an investment in Aboriginal and Torres Strait Islander employment,” said A/Prof Murphy.

The RACGP is a member of the Close the Gap Steering Committee which today released its 2014 progress and priorities report providing both the Close the Gap campaign and Australian Governments with a blueprint for closing the health equality gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by 2030.

“Achieving Aboriginal and Torres Strait Islander health equality is an ambitious yet achievable task and these two reports reflect a shared commitment to the improvement of Aboriginal and Torres Strait Islander peoples’ lives,” said A/Prof Murphy.

In its 2014–15 pre-budget submission, the RACGP called on the Government to commit to the funding and implementation of the National Aboriginal and Torres Strait Islander Health Plan 2013–2023, developed by the Department of Health, as a vital step to improving Aboriginal and Torres Strait Islander health and wellbeing.

The RACGP is committed to supporting all Close the Gap efforts and is proud of the daily work of many of its members to improve health outcomes for their Aboriginal and Torres Strait Islander patients.

NACCHO needs to improve how we connect, inform and engage into the Ifuture.

SURVEY LINK

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NACCHO weekly health news wrap :Health Minister Peter Dutton backs less bureaucrats, more frontline GPs

LABOR’S “dud’’ Medicare Locals will be rebadged and redesigned after GPs complained that the $1.8 billion bureaucracy is failing to deliver real services to patients.

See previous NACCHO reports here

NACCHO Aboriginal healthly debate: Medicare Locals (MLs) their future is unclear ?

Also below Croakey Health WRAP

Senior government sources have revealed that a review into the system has confirmed some sites underperforming. Staff working at Medicare Locals also hate the name, complaining patients think they can claim Medicare refund there or actually see a doctor.

But the review has come with a hefty $550,000 price tag according to tender documents obtained by the Sunday Telegraph. Despite the contract running for just three months, it comes with a $550,000 contract for accounting services awarded to Deloitte.

Medicare Locals were established by the Rudd-Gillard government and were designed to better integrate GP and primate health care services. Unlike GP superclinics, they are not a shopfront with doctors.

Doctors have also labelled the program a dud, with the Australian Medical Association releasing a survey stating that 75 per cent of GPs believed the program had “not resulted in any improvement in access to, or deliver of primary healthcare, and should be scrapped.”

Health Minister Peter Dutton confirmed he would announce changes to Medicare locals when he had considered the findings of the review.

“Labor wasted billions in health and we have to get the system back on track so we can pay for cancer drugs, the ageing population and the massive onset of dementia and obesity,’’ he said.

But Labor health spokeswoman Catherine King said any moves to scrap Medicare locals, reduce funding or close some down would represent a broken election promise.

“Any cut to Medicare Locals would be a clear broken promise by the Prime Minister.

Medicare Locals are transforming the way primary care is delivered across Australia and making it easier for all Australians to get to doctors, psychologists, nurses and other allied health professionals,’’ she said.

During the election, the Prime Minister announced he would review Medicare locals if elected, admitting he cannot guarantee they will stay “exactly the same.”

“I don’t guarantee they’re all going to stay exactly the same. Our focus is on trying to move the money from the back office to frontline services,’’ he said.

“Now, can I say that absolutely no Medicare Local will close? I can’t say that.”

But a week later, during a leaders’ debate on August 27, Mr Abbott also pledged: “we are not shutting any Medicare Locals.”

By Melissa Davey

Welcome back to the fortnightly Health Wrap, and the first for 2014. We hope your start to the year has been a healthy one. There have been some hot health topics in the headlines for the past couple of weeks, and they have particularly focussed on alcohol and cancer.

World Cancer Day reveals some sombre projections

A cancer tidal-wave is on the horizon, the BBC reports, leaving World Health Organisation (WHO) scientists warning that that much tougher restriction on alcohol and sugar intake is needed. The BBC also reports the World Cancer Fund as saying that the public still has a huge level of naivety about the importance of diet and alcohol intake in cancer prevention.

Alcohol is an attributable factor in nearly 2000 new cancer diagnoses a year in Scotland, with an increased risk of developing breast, head, neck, oesophagus, bowel and liver cancers, the Herald Scotland reports. The article says that even drinking alcohol within sensible limits may lead to an increase in cancer risk.

The success of the program has prompted some Australian health experts to call for cigarette-style warning labels to be placed on alcohol packaging warning of cancer and other risks, news.com.au reports.

World Cancer Day on February 4 coincided with the release of the WHO’s World Cancer Report, which found cancer had surpassed heart disease as the biggest killer in Australia. In 2011 there were 7.87 million cancer deaths compared to 7.02 million from heart disease (stroke deaths were considered separately), the report found.

Also concerning was the release of Cancer Council NSW data that revealed NSW men over 50 are three times as likely to die from melanoma as women the same age, partly because more than half of men in that age bracket are not aware of the high risk associated with skin cancer.

Meanwhile the New York Times asks if we are giving ourselves cancer, in this piece examining the link between radiation – particularly from CT scans– and the disease.

Finally, The European Cancer Patient’s Bill of Rights was unveiled this week to address the differences in care received by cancer patients across Europe. Some 1000 medical organisations and cancer groups from 17 European countries collaborated to produce the Bill.

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A mixed response to alcohol law reforms

The NSW government has revealed its latest plan to curb alcohol-related violence which will see an eight-year minimum sentence for alcohol or drug-fuelled assaults that result in death, while bottle shops will close at 10pm across the state and licensed premises in the centre of Sydney won’t be allowed to let new patrons in after 1.30am. The laws have civil liberties groups up-in-arms, the ABC’s PM reports.

But NSW Opposition leader John Robertson believes the plans don’t go far enough, telling SBS that the announcement is rife with loopholes. “We have lock-outs with loopholes where small bars will be exempt from lock-outs,” Mr Robertson said to SBS. “Backpacker bars will be exempt from lock-outs and hotels with bars will also be exempt from lock-outs.”

The family of alcohol-related violence victim Thomas Kelly, the teenager who died in 2012 after being punched once in the head, spoke to the media following the reform announcements, describing them as “bittersweet” but “amazing”.

However, the SBS reports legal experts have raised concerns about plans that have been rushed through the State Parliament, fearing they will result in a large increase in the number of Indigenous people jailed. Fines for some drunken violence offences will result in people who are unable to pay being jailed, they report.

While the Australian Medical Association (AMA) welcomed the proposed measures, they also say measures should be tougher. The AMA called on the federal government to convene a national summit bringing together government, councils, police, health experts, teachers, victims and industry to come up with solutions to the alcohol misuse epidemic.

Finally, Croakey reports that The Alcohol and other Drugs Council of Australia – the national peak body for the alcohol and other drugs sector for nearly 50 years – has put in a heartfelt request to present to the Abbott Government’s National Commission of Audit on the impact of its unexpected defunding last November.

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Vaccines, fluoride and vitamins – pushing for best practice

Prominent public health expert and anti-pseudoscience campaigner Dr Ken Harvey quit his job as an adjunct professor with Victoria’s La Trobe University after the University struck a $15 million, six-year deal with vitamins manufacturer Swisse.

The ABC reports the University described the memorandum of understanding with Swisse as an important step towards establishing a complementary medicine centre, which Dr Harvey described as a conflict of interest.

Dr Harvey’s move has been supported by Friends of Science and Medicine, an association that lobbies for evidence-based medicine, The Conversation reports. The organisation has called on La Trobe University to abandon the planned research into Swisse supplements. In his resignation letter, Professor Harvey said he was concerned La Trobe University would be pressured to “produce results that will justify the company’s investment”.

GP and medical writer Dr Justin Coleman has also backed Dr Harvey’s “brave stance”, writing:

“ I am a senior lecturer at two Australian universities and I would also be very troubled if one of them compromised its independence in this way.”

To vaccines, and The West Australian reports more WA doctors are refusing to endorse parents who object to their children being vaccinated, but who need a letter from their GP to get government benefit payments.

New Federal Human Services Department figures reveal an extra 479 WA children were added to the conscientious objectors’ database last year – a 13% increase on the previous year, the piece says.

Meanwhile, experts fear public confidence in vaccination programs could be undermined after dozens of young children were given a flu vaccine despite it being banned for under five-year-olds. The Therapeutic Goods Administration says across the country, 43 children under the age of five were injected with Fluvax last year, the ABC reports.

This excellent map from Mother Jones reveals the high cost of vaccine hysteria across the world, with measles and mumps making a comeback thanks to anti-vaxxers claiming an autism link – a link that has been utterly and thoroughly debunked thanks to evidence and science.

We’ll let Slate have the final say on anti-vaxx nonsense, in this piece which explores what creationists and anti-vaxxers have in common. “Ignorance is curable by education, but wilfully ignoring the facts can be contagious — and even fatal,” they write.

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E-cigarettes – ban or regulate?

In a world where there are one billion smokers and smoking kills almost six million people a year, the regulation of e-cigarettes is a high-stakes debate, writes health journalist Andre Picard for the Globe and Mail.

While research on e-cigarettes and their potential harms and potential benefits is in its infancy, and data on long-term risks and benefits are lacking, he writes that with tobacco causing so many deaths around the world e-cigarettes may be a step in the right direction.

But as this piece for OPB says, a major barrier to policy making on e-cigarettes is the lack of scientific knowledge about the products. A report released this month by the US Surgeon General called for research and regulations on e-cigarettes, as well as other new nicotine-based products being introduced to the market, the piece says.

Meanwhile, tobacco giant Philip Morris has been taken-to-task by the ABC’s Fact Check Unit for saying “the data is clear” that plain packaging has not stopped people smoking. Public health experts and even Philip Morris competitor Imperial Tobacco say it’s too soon to draw conclusions about the long-term impact of plain packaging on smoking, the ABC reports.

Meanwhile, Dr Melissa Stoneham reports for Croakey on research that investigated smoking cessation apps and whether they adhered to evidence-based practice. The researchers found that of the more than 400 apps available, most were missing basic evidence-based practices, such as referral to a Quit line or providing information on approved medications.

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Experts are arguing for a cultural approach to health spending in light of high costs and poor outcomes, this piece for Al Jazeera says. According to the World Health Organization, Australia’s 670,000 Aboriginal and Torres Strait Islander people suffer from diseases found nowhere else in the developed world – such as trachoma, a form of preventable blindness.

Meanwhile the National Aboriginal Community Controlled Health Organisation (NACCHO) reports that during the past three years, Aboriginal and Torres Strait Islander suicides reached nearly 400.

Commenting on the crisis, NACCHO chair Justin Mohamed said: “Aboriginal and Torres Strait Islander people experience suicide at around twice the rate of the rest of the population. Aboriginal teenage men and women are up to 5.9 times more likely to take their own lives than non-Aboriginal people.”

Psychiatrist Professor Alan Rosen writes for Croakey that the impact of sustained heatwaves or drought on Aboriginal communities needs further investigation. He referred to this study; ‘The impact of prolonged drought on the social and emotional well-being of Aboriginal communities in rural New South Wales’, published in the Australian Journal of Rural Health in 2011.

It found drought was affecting Aboriginal wellbeing by damaging traditional culture; skewing the population profile in smaller centres; exacerbating underlying grief and trauma; and undermining livelihoods and participation, amongst other things.

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Australians nutritional guidelines need to be tougher

Australian researchers have found controls on food manufacturers are being weakly implemented, as foods continue to contain too many unhealthy ingredients like sugar and fat. Professor Bruce Neal, at The George Institute and The University of Sydney, led a team that evaluated the Federal Government’s Food and Health Dialogue, Health Canal reports. The evaluation was published in the Medical Journal of Australia.

As director of Health Strategies for the Cancer Council NSW, Kathy Chapman, writes in a piece published by Croakey and originally appearing in The Conversation; “most people doing their grocery shopping are blissfully unaware of the industry lobbying and backroom politics that determines what information appears on food labels”.

But attempts to treat obesity are being hampered by flaws in clinical guidelines as well, with the head of clinical obesity research at the Baker IDI Heart and Diabetes Institute, John Dixon, saying Australian obesity guidelines contain inadequate advice on monitoring nutritional deficiencies after bariatric surgery.

National Health and Medical Research Council guidelines released in June last year contained the “potentially dangerous” implication that nutritional problems should only be assessed after symptoms developed, including muscle wastage and bone pain, Professor Dixon tells Fairfax.

However, Australia must be getting at least something right in the war on obesity. New Zealand Prime Minister John Key has announced that Australia‘s obesity prevention program will be adopted there , International Business Times reports. New Zealand Health Minister Tony Ryall visited Victoria and said the children who were part of the obesity prevention program had become more active and lost weight.

Meanwhile, academics and policy experts specialising in medicine and nutrition in the UK have formed a campaign group, Action on Sugar, to convince manufacturers to gradually lower the amount of sugar added to foods – so slowly that it isn’t missed by consumers.

But this piece in New Scientist says using initiatives that have successfully reduced the amount of salt in manufactured foods may not work when it comes to sugar.

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Health sector reforms and health policy

In this piece for Croakey, Australian Healthcare and Hospitals Association CEO Alison Verhoeven reports on a round-table meeting held in Canberra to celebrate Medicare’s 30^th birthday. She asks whether consumer expectations for access to free public hospital services and bulk-billed consultations with doctors are realistic in a time when healthcare costs are increasing. Some thoughtful wishes for a 30^th birthday makeover for Medicare were also shared in this Croakey piece.

Sydney Morning Herald Economics Editor Ross Gittins writes that while therising cost of healthcare is the greatest reason for increasing in budget deficits, it is rarely made clear that this assumes a limit on the growth in healthcare taxation.

And Drs Gemma Carey from the Centre of Excellence in Intervention and Prevention Science and Pauline McLoughlin from the LightHouse Foundation examine the Victorian Government’s recently launched ‘Roadmap for Community and Human Services Reform’, lead by Dr Peter Shergold. Their article for Croakey covers some of the challenges for reformers hoping to tackle ‘top-down’ relationships, service silos, overly complex funding arrangements and legacies of mistrust.

The policy head of Research Assets at the Sax Institute*, Bob Wells, says health policy analysts have spent the first weeks of the year vigorously debating ways to rein in Australia’s rising health budget and to make the system more efficient. His piece for The Conversation examines a couple of the proposals on the table.

Meanwhile Professor Peter Brooks argues in a piece for Croakey that reform of the fee-for-service payment system must be considered as part of a broader discussion about the future sustainability of the health system.

Also for Croakey, a health policy analyst writing anonymously examines what might be expected from the National Commission of Audit when it comes to health policy. Looking back might help us look to the future, the writer says, speculating about what the Commission might recommend and implement including removing regulatory duplication, and pricing blood products.

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Healthy bloggers

The health blog featured in this Health Wrap comes from NPR. Their comprehensive public health blog includes news about health from around the globe including the latest on prevention, disease outbreaks and the world’s response to health crises.

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Other Croakey reading you may have missed this fortnight:

REVIEWING THE LOCALS

Last year, Health Minister Peter Dutton appointed Professor John Horvath, a former Commonwealth chief medical officer to head the review.

The terms of reference include an investigation into whether the program is actually delivering clinical services and whether it has increased the co-ordination of after hours care.

Nearly half of all GPs surveyed by the AMA last year found the bureaucracy employing 3,000 people was “duplicating existing GP services.

“The starting point for the Review is to change the name — ‘Medicare Locals’ means nothing to the people who need access to quality primary health care services in their communities,’’ Australian Medical Association President Steve Hambleton said in a statement.

“It sounds like another layer of bureaucracy. The name should project an active role in looking after people’s health.”

NACCHO Press Release CTG report: Investment in Aboriginal community controlled health key to closing the gap

The Chair of the National Aboriginal Community Controlled Health Organisation (NACCHO) Justin Mohamed (pictured above) said evidence continues to mount that investing in services run by Aboriginal people for Aboriginal people makes good economic sense.

“Every new Aboriginal Community Controlled Health Organisation (ACCHO) and every new patient attending an Aboriginal Community Controlled Health Organisation, is a step toward closing the appalling health gap between Aboriginal and non-Aboriginal Australians,”

Close the Gap Progress and Priorities report released by the Close the Gap Campaign

DOWNLOAD THE PRIME MINISTER 2014 Closing the Gap Report here

A new report reveals that the expansion of Aboriginal Community Controlled Health Organisations is contributing to closing the shameful health gap, prompting the call for continued investment by all levels of government.

The annual Close the Gap Progress and Priorities report released today by the Close the Gap Campaign shows that investment through national partnership agreements has created 30 new Aboriginal Community Controlled Health Organisations since 2008-9 and delivered 400,000 episodes of care.

DOWNLOAD THE REPORT

The Chair of the National Aboriginal Community Controlled Health Organisation (NACCHO) Justin Mohamed said evidence continues to mount that investing in services run by Aboriginal people for Aboriginal people makes good economic sense.

“We are seeing time and again that the biggest health gains are being made when Aboriginal people have control over their own health.

“And the flow on effects are significant. The ability of our services to provide a platform for the generation of jobs and education cannot be underestimated. ACCHOs train and employ more than an estimated 5000 people, many Aboriginal, so the economic benefits are felt throughout our communities and more broadly.”

Mr Mohamed urged all governments to recommit to a national agreement to provide funding certainty to programs and services that are working and also for the Federal Government to move to implement the most recent health plan.

“The programs targeting maternal and child health, largely delivered by ACCHOs, are having an impact.

“Other services and programs are also showing gains. Generational change comes slowly but the incremental gains being made reinforce the need to maintain focus and investment over the long term.

“A new national partnership agreement is now long overdue and all governments must come to the table and demonstrate their commitment to improving the health of Aboriginal people.

“NACCHO would also like to see the Federal Government commit to delivering on the National Aboriginal and Torres Strait Islander Health Plan. Too much was invested by Aboriginal people in its development to have it be just another report gathering dust on a Ministerial shelf.”

Close the Gap Campaign Press release: action on health will lead change

The Close the Gap Campaign has called on the Government to continue to prioritise and drive action to ensure this is the generation that ends Aboriginal and Torres Strait Islander health inequality.

“We expect the Government to wholeheartedly grasp the opportunity to lead on closing the gap in health equality between Aboriginal and Torres Strait Islander people and other Australians,” said Close the Gap Campaign co-chairs Mick Gooda and Kirstie Parker.

Today, the Close the Gap Campaign releases its progress and priorities report which coincides with the Prime Minister’s release of the Government’s own closing the gap report.

“We are just starting to see reductions in smoking rates and improvements in maternal and childhood health. We need to build on these successes,” said Mick Gooda, who is also the Aboriginal and Torres Strait Islander Social Justice Commissioner at the Australian Human Rights Commission.

“This is a national effort that can achieve generational change. It is critical that Close the Gap continues as a national priority. We need to stay on track.

“All political parties and almost 200,000 Australians have committed to end the health equality gap by 2030.

“The Prime Minister’s closing the gap report released today continues the bipartisan tradition of reporting publicly on progress to achieving health equality by 2030,” Mr Gooda said.

“We know that empowering Aboriginal and Torres Strait Islander health services has broader benefits. Health services are the single biggest employer of Aboriginal and Torres Strait Islander people,” Ms Parker, who is also the Co-Chair of the National Congress of Australia’s First Peoples, said.

“Community controlled health services create jobs as well as train people in real vocations.

“We call on the Government to renew the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (NPA) and forge ahead with implementing the Aboriginal and Torres Strait Islander Health Plan in partnership with our people.

“This is the support needed for Aboriginal and Torres Strait Islander people to continue to exercise responsibility for their health.

“We can make real inroads in the national effort to close the gap if we continue to place a high priority on it.”

Have you registered your CLOSE THE GAP event

NACCHO Aboriginal health and racism :How do we build a health system that is not racist?

“But that’s the risk in the medical context, where doctors and health care workers are often rushed and stressed and don’t have the mental space to make a considered decision. “So they fall back on prevailing and persistent stereotypes of Aboriginal people as lazy or ignorant.”

Aboriginal and Torres Strait Islander leaders recently contributed to a “festival of ideas” at this public symposium in Melbourne today, Closing the Credibility Gap: Implementation of the National Aboriginal and Torres Strait Islander Health Plan 2013- 2023.

ALSO READ : Article from Ms PAT Anderson former NACCHO chair

NACCHO NATSIHP health plan news: Racism a driver of Aboriginal ill health

The article below investigates a key theme of the event – how health services and professionals can help tackle racism.

Journalist Marie McInerney covered the event for the Croakey Conference Reporting Service (you can read her preview, an interview with Professor Kerry Arabena here.) Our Thanks to Melissa Sweet for her continued support of NACCHO.

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How do we build a health system that is not racist?

Marie McInerney writes:

That’s one of the challenges being discussed at the Closing the Credibility Gap conference on implementing the National Aboriginal and Torres Strait Islander Health Plan which articulates, for the first time, a health system free of racism and inequality.

A good start at an individual level, says Associate Professor Yin Paradies – for any profession working with Aboriginal and Torres Strait islander people – is to test our own stereotypes and preconceptions by taking the Implicit Association Test developed by United States researchers.

The test aims to detect implicit bias on race, colour, age, gender, sexuality and weight. Its race test has an Australian version, asking online participants to press different keys to associate particular words with white and Aboriginal faces.

It has famously found people are more likely to associate black people with words like ‘bad’ and ‘failure’ and white people with ‘happy’ and ‘joy’. Interestingly it comes with a warning:

“If you are unprepared to encounter interpretations that you might find objectionable, please do not proceed further. You may prefer to examine general information about the IAT before deciding whether or not to proceed.”

The IAT has its share of critics, but it’s been clicked on more than five million times and is an excellent teaching tool to show people if they have an implicit racial bias or not, says Paradies, who is a Principal Research Fellow at the Centre for Citizenship and Globalisation at Deakin university.

“One of the biggest ways to address a bias is to be aware of it,” he says. “The next biggest is having the motivation to stop it from happening, and the third is to really combat those associations in your mind that are driving it by finding counter-stereotypical and positive examples.”

“There’s a lot of evidence of the success of just being mindful,” he says. But that’s the risk in the medical context, where doctors and health care workers are often rushed and stressed and don’t have the mental space to make a considered decision. “So they fall back on prevailing and persistent stereotypes of Aboriginal people as lazy or ignorant.”

The implications of such bias at both an individual and institutional level in health care will be the subject of Paradies’ ‘virtual’ presentation on Friday to the symposium on: ‘A culturally respectful and non-discriminatory health system’. He is also presenting in Adelaide at a symposium on health services, racism and Indigenous health.

The issue also arose at a Health Workforce Australia conference in Adelaide. HWA has funded Curtin University to develop the Aboriginal and Torres Strait Islander Health Curriculum Framework project which, among other things, will consider issues of cultural competence for health professionals.

Having begun his career as a cadet at the Australian Bureau of Statistics, Paradies’ work has explored the health, social and economic effects of racism, as well as anti-racism theory, policy and practice.

He has just won a $830,000 Future Fellowship grant from the Australian Research Council to look at understanding and addressing racism in Australia. With both Aboriginal and Asian heritage, he acknowledges his own understanding is not just theoretical.

While there has been growing awareness of racism as a determinant of health, he says most focus has remained directly on disadvantage without considering the various factors that produce and reproduce disadvantage. Having the role of racism in health and the health system front and centre in the National Health Plan is, he says, a big move forward.

“I think people are not really willing yet to turn their gaze back to the mainstream, to institutions and organisations, and the general populace and their attitudes and how they might be a driver of disadvantage,” he said.

“People are more comfortable with the ideas of past transgressions, the Apology for the Stolen Generations being a prime example. It’s easier to focus on the people who are disadvantaged, who are ‘victims’, and we’ve seen that with things like the Northern Territory Emergency Intervention.”

How racism affects health

The impact of racism on the health of Aboriginal and Torres Strait Islander people can be seen in:

inequitable and reduced access to the resources required for health (employment, education, housing, medical care, etc)
inequitable exposure to risk factors associated with ill-health (junk food, toxic substances, dangerous goods)
stress and negative emotional/cognitive reactions which have negative impacts on mental health as well as affecting the immune, endocrine, cardiovascular and other physiological systems
engagement in unhealthy activities (smoking, alcohol and drug use)
disengagement from healthy activities (sleep, exercise, taking medications)
physical injury via racially motivated assault.

The second layer comes through health care provider racism. As Symposium organiser Professor Kerry Arabena pointed out in a preview of today’s event, one in three Aboriginal Victorians surveyed by VicHealth reported experiencing racism in a health care setting.

Such experiences, Paradies says, can lead to:

· poorer self-reported health status

· lower perceived quality of care

· under-utilisation of health services

· delays in seeking care

· failure to follow recommendations

· societal distrust

· interruptions in care

· mistrust of providers

· avoidance of health care systems.

Unconscious healthcare provider bias has more complex implications, including being found in the United States to lead to poorer clinical decisions for African Americans.

Australian studies have shown disparities in medical care experienced by Indigenous patients, including that they are a third less likely to receive appropriate medical care across all conditions, as well as for lung cancer and coronary procedures. Another study showed Indigenous patients were only one-third as likely to receive kidney transplants.

“In the US studies, doctors recommend different courses of action in hypothetical cases of patients who are the same in essence, except that one is black and one white,” Paradies says. “A lot of the time in Australia this is driven by implicit, very unconscious kinds of views about Aboriginal people and their capacity to benefit from certain treatments, or whether they in fact have conditions that require further investigation.”

It’s an issue seen often in other service areas, not least in racial profiling by police, which led recently in Victoria to a breakthrough when police settled a Federal Court racial harassment case brought by a group of African Australians. Paradies, who acted as an expert witness in the proceedings, notes that, despite this landmark case, police still denied evidence of a racist culture.

Yet he sees scope for optimism and points to organisations like Hunter New England Health as showing the way.

HNE Health has the largest Aboriginal population of any New South Wales local health district and has committed to a long-term approach “to address individual and institutional racism”, noting its impact on Aboriginal health and its own capacity to recruit and retain Aboriginal staff.

An article in the NSW Public Health Bulletin points to three specific strategies: leadership, consultation and partnership with local Aboriginal groups, and staff training, which it says is “deliberately challenging and confronting”. (See the overview of its approach in the diagram below – click on image to see in more detail).

While health is a very busy space with many competing priorities, Paradies says its high regulation “in some ways makes it easier to bring in new ideas and change.”

• For conference coverage, follow @CCGSymposium and #CCGap.

• Croakey’s coverage is compiled here.

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“But that’s the risk in the medical context, where doctors and health care workers are often rushed and stressed and don’t have the mental space to make a considered decision. “So they fall back on prevailing and persistent stereotypes of Aboriginal people as lazy or ignorant.”

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