Aboriginal Health Research : @KenWyattMP #SEARCH a “jewel in the crown” in Aboriginal health research

“Historically, research has tended to be based around academic promotion, not looking at what works and what doesn’t and not designed around the needs of Aboriginal people and by Aboriginal people. That’s where we’ve come from.

But SEARCH was different because it ensured Aboriginal leadership was embedded, Aboriginal people had ownership of the data and the research was culturally appropriate.”

One of the founding Chief Investigators of SEARCH, Sandra Bailey, former Chief Executive Officer of the Aboriginal Health and Medical Research Council-NSW

The SEARCH study into the health and wellbeing of urban Aboriginal children is providing valuable data to inform policy and should be celebrated as one of the “jewels in the crown” in Aboriginal care and research, Federal Minister for Indigenous Health Ken Wyatt told the study’s annual Forum this month.

The SEARCH partners are: The Aboriginal Health & Medical Research Council, the Sax Institute, leading researchers across Australian universities and four NACCHO Aboriginal community controlled health services member : Tharawal Aboriginal Corporation (Campbelltown), Awabakal Ltd (Newcastle), Riverina Medical and Dental Aboriginal Corporation (Wagga Wagga) and Aboriginal Medical Service Western Sydney (Mt Druitt).

Mr Wyatt, who opened the SEARCH (Study of Environment on Aboriginal Resilience and Child Health) Forum in Sydney, said thorough research and data collection was essential in the development of policy.

“We are better off informed by data that comes from our people and often collaborations with research institutes give me guidance,” he said. “It really does inform the way we consider our approach to Closing the Gap”.


SEARCH is Australia’s largest long-term study of the health and wellbeing of urban Aboriginal children, and involves 1600 children and their families.

It is an active partnership between Aboriginal Community Controlled Health Services and researchers, where these health services set the research priorities and guide how data is collected, interpreted and used.

The Forum showcased the achievements of SEARCH and highlighted significant potential for Australia to make even greater gains, both by looking at ways to further build the evidence on the drivers of health and disease in urban Aboriginal children and their families, and by using the necessary tools, systems and partnerships to put that evidence to work to achieve large-scale change.

Mr Wyatt said SEARCH represented a new way forward in Aboriginal health research, because it put Aboriginal people at the centre of the research process, and sought not only to better understand the health of Aboriginal children, but to make a real difference to the lives of Aboriginal people.

“Together, scientists and families have built Australia’s largest source of ongoing information on urban Aboriginal child health. And because of them, those of us who make policy, or design and deliver programs and services can now access knowledge that just wasn’t available before.”

SEARCH was one of the many “jewels in the crown” – or shining examples of life-changing care and research that were leading to healthier children – that should be celebrated, Mr Wyatt said.

“Walking and working with Aboriginal families is the only way to lock in the significant gains we have made, and to accelerate our future progress, with innovative approaches that also address the social and cultural factors influencing health.”

Addressing an evidence gap

One of the founding Chief Investigators of SEARCH, Sandra Bailey, told the Forum that despite most Aboriginal people living in urban areas, at the time SEARCH was established only 11% of Aboriginal health research focused on understanding health and disease in urban communities.

“Historically, research has tended to be based around academic promotion, not looking at what works and what doesn’t and not designed around the needs of Aboriginal people and by Aboriginal people,” said Ms Bailey, former Chief Executive Officer of the Aboriginal Health and Medical Research Council. “That’s where we’ve come from.”

But SEARCH was different because it ensured Aboriginal leadership was embedded, Aboriginal people had ownership of the data and the research was culturally appropriate, she said.

Ms Bailey said Aboriginal Community Controlled Health Services were able to directly apply the data from the Study to their service planning and delivery.

“Most importantly, Aboriginal people are valued and empowered.”

Building blocks to drive change

Sax Institute Chief Executive Officer Professor Sally Redman said SEARCH data was driving real change, including leading to programs such as HEALs, which had used the findings about high rates of ear infections and hearing loss in urban Aboriginal children to deliver improved services.

SEARCH, while already valuable, would prove even more valuable in the future, she said.

“As the children grow older, we can look at the trajectories of change − what helps some children do well, and some not so well, and the data will be valuable for use in evaluating changes in service delivery,” Professor Redman said.

“We’ve got the process to collect better data about what might make a difference, we’ve got the partnerships in place and we’ve got lots of tools for change. The next phase is bringing it all together to try to function as a real catalyst to change in this space.”


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


Introducing a new fortnightly feature at NACCHO Aboriginal Health News Alerts

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


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

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

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


By Kellie Bisset

A big fortnight in mental health

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

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

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

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

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

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

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


Pointed views on display in vaccination debate

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

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


Over-diagnosis, misdiagnosis and unnecessary tests

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

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


Perspectives on risk

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


Food glorious food – or not

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

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

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

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


Politics and Policy

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

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

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


The gaps are getting bigger

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

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

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

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


The smoke wars

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

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


Other Croakey reading you may have missed this fortnight:

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

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