NACCHO NATSIHP news: $12 billion Aboriginal health plan to be launched today

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Projected funding for health programs specifically designed for and targeted at Aborigines and Torres Strait Islanders is estimated to be about $12 billion to 2023-24.

Aboriginal and Torres Strait Islander community-controlled health services will continue to be supported to fulfil their pivotal role in improving Aboriginal and Torres Strait Islander health outcomes.”

A DRAMATIC expansion of the health system to focus on indigenous children’s health and to include broader issues of child development is the central plank of a 10-year Aboriginal health plan to be unveiled today.

Please note as soon as the report is released

1.You can download it from NACCHO resources

2.Read our Chair Justin Mohamed’s response

The plan, which dictates where state and federal governments should focus their efforts, aims to deliver the policies required to eliminate the indigenous life expectancy gap by 2031.

It commits governments to give more attention to and increase spending on “difficult and distressing issues of violence, abuse and self-harm”.

Indigenous Health Minister Warren Snowdon (pictured below last week opening Male Health Summit) will say today that the health plan places priority on social and emotional wellbeing and the issues that impact on it, including alcohol and other drugs. It also focuses on improving the wellbeing of indigenous people with a disability.

Ross river 2013 086

The Rudd government says the 10-year National Aboriginal and Torres Strait Islander Health Plan is “free of racism and inequality” and provides the “necessary platform to realise health equality by 2031”.

“Importantly, in this health plan we signal the need to expand our focus on children’s health to broader issues in child development,” Mr Snowdon will say. “We have much more work to do in developing robust research and data systems. I am also resolved that we will tackle the difficult and distressing issues of violence, abuse and self harm.” The government will commit to “drive health system improvements and maintain a clear priority on primary healthcare system reform”, he will say. “Aboriginal and Torres Strait Islander community-controlled health services will continue to be supported to fulfil their pivotal role in improving Aboriginal and Torres Strait Islander health outcomes.”

The government will report annually to parliament about measures and targets aligned to the new plan.

“The health plan provides a clear focus on strategies to address racism and to empower people to take control of their own health,” Mr Snowdon will say. “While we need to continue to strengthen healthcare we also need to enhance our focus on specialist care and hospital care in the secondary and tertiary systems.”

A series of 17 nationwide consultations was held with Aborigines and Torres Strait Islanders, communities and groups, with more than 140 written submissions and a series of roundtables to gather expertise on a range of issues relevant to Aboriginal and Torres Strait Islander health. Projected funding for health programs specifically designed for and targeted at Aborigines and Torres Strait Islanders is estimated to be about $12 billion to 2023-24.

Mr Snowdon will also use the launch of the health plan to reiterate his call to state and territory governments to publicly commit their contributions to the new National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes.

NACCHO health news:There is a way forward if government would only listen to NACCHO

There is a way forward if government would only listen to NACCHO

Two reports released last week, one relating to health delivery services and the other on Justice reinvestment program to cut the appalling rate of imprisonment of Indigenous Australians are perfect examples of how government at all levels can deliver meaningful outcomes in addressing the disparity facing our First Nations people.


First health ,The National Indigenous Times has long supported the National Community Controlled Health Organisation or NACCHO as it is more commonly known.

The reason we have long acknowledged the incredible work this organisation performs and the strong fearless leadership with Chair, Justin Mohamed at the front is because what NACCHO has been calling for to improve the standard of health delivery services to Indigenous Australians makes absolute sense.

Even more so because what Mr Mohamed and NACCHO have demonstrated is a way to deliver health service without the terrible waste in funds and therefore outcomes we have all witnessed in the methods used currently.

NACCHO’s approach can be simplified to this : Let Aboriginal Health delivery services control and manage the service to Aboriginal communities and we will all see improvements in outcomes.

Billions have been spent by all levels of government claiming it has evidence of their genuine attempts to address the health issues communities have faced for generations. Despite the enormous sums of money spent there has been little improvement in outcomes.

The myriad of programs launched have largely been driven by governments handing out money to public service bureaucrats to administer the disbursement of funds. There has generally been little interaction with the communities affected and worse still, no acknowledgment or meaningful attempts to provide what the Indigenous communities themselves say is required.

Like so many of the processes government adopts when it comes to Indigenous affairs the outcome ends up with the communities watching on as these government initiatives fail.

Some believe the approach by government is just” the government way” of doing things. Others believe it is a deliberate policy position of government designed to ensure communities are not empowered to achieve the desired outcome. The National Indigenous Times leans toward the latter rather than the former.

But NACCHO has resisted this policy approach and has continued to fight for an approach which empowers community based Indigenous health organisations to take responsibility for delivery of the program.

As Mr Mohamed said last week this is all about delivery of health services “by Aboriginal People for the Aboriginal people”. He is absolutely on the money. We couldn’t agree more with him. We believe the more empowerment given to the reputable and responsible Aboriginal organisations, the more we will see improvements in the Closing the Gap targets.

NACCHO’s position has been further strengthened now with the release of a report by the Institute of Health and Welfare which has found significant improvement in the quality and outcomes of health delivery services when those services are delivered by Aboriginal community based organisations.

This is the salient lesson for all governments if government genuinely wants to see improvements for Indigenous Australians then the best way, the most effective way, the “biggest bang for the buck” way is to empower Indigenous organisations to take responsibility and let them make it happen.

What NACCHO has demonstrated can be achieved also tells us if it can work for NACCHO it can work across the entire spectrum of health services and also for education, housing, employment, and the list goes on.

What NACCHO has said is the way forward and which has been endorsed by this Institute of Health and Welfare report now emerge as the true test of Federal State and Territory governments. NACCHO has shown us all a way forward and how it can work. All it requires is a commitment from government to change its approach on how funding is controlled and delivered across all Indigenous programs.

The report by the Senate committee inquiring into the benefits of Justice Reinvestment is another example. This committee has found the system of jailing Indigenous Australians at an ever increasing rate simply does not work.

All governments are spending billions locking up Indigenous Australians only to find they are more than likely to re-offend after they have been released. It should not take a Rhodes scholar to work out his was always a recipe for the outcomes we are now seeing. Indigenous Australians are more likely to be jailed than any other race of people anywhere in the world. And as the rate keeps increasing so does the rate of re-offending. It is a vicious cycle with no end.

What the Senate committee has found is it would be far more effective to invest in the communities and end the poverty. If that was done then the number of people ending up in jail would decrease.

Justice Re-investment has been shown to work in various countries around the world including of all places in the United States. If it can work there you would have to think it could work anywhere, including Australia.

But Justice Re-investment is what the name implies. It requires a re-investment by government into the communities, a willingness to empower the communities, a desire to provide meaningful outcomes on core issues such as housing, employment and education. If government committed to this there would be genuine and meaningful savings in the cost currently borne to lock these people up.

The reason is simple. If people are provided meaningful employment. If they can see they can own their own home and their children provided with a decent education then less will have any desire to commit a crime.

As it stands today many communities are being left to rot and die because of government inaction. If there are no jobs, no houses, no education, what is there ?. Well one alternative is crime and little wonder under those circumstances.

Both these initiatives, NACCHO’s demand for empowerment in the delivery of health services and re-direction of focus toward building and supporting communities so people are not left drifting aimlessly through life and crime are real outcomes. They are meaningful and they can make a difference to what faces so many Indigenous Australians today.

All it requires is government to commit to this change in approach. It seems crazy to even have to contemplate why government wouldn’t change. If delivery of health services can be more effective, therefore saving on the money wasted to date and if we can cut the number of people being jailed, again saving a great deal of money why wouldn’t you ?.

NACCHO Croakey health wrap:politics, policy, research, and developments in Aboriginal health

By Kellie Bisset

FROM CROAKEY Melissa Sweet

A little bit political

As the nation adjusted to the news of a new Prime Minister, it was still unclear at the time of writing whether Health Minister Tanya Plibersek would retain her position. The AMA wasted no time in calling for Kevin Rudd to put health front and centre at the upcoming election, urging him to scrap the Gillard government’s cap on tax deductions for work-related medical education expenses.

But writing on The Conversation and Croakey, Bob Wells suggests that the case for fixing the health system might be harder for Rudd to prosecute second time around and it might not be high on his immediate list of policy priorities.

Dr Lesley Russell’s analysis of the 2013-14 federal health budget, says the challenge for any new government post-election is that “too many Australians are missing out on the care they need … That will require more attention to issues like equity, out-of-pocket costs and quality”.

Before the political storm broke around the leadership, the week was peppered with valedictory speeches from departing members of Federal Parliament, including Liberal moderates Dr Mal Washer and Judi Moylan, whose legacy Michelle Grattan profiles in The Conversation.

And in Queensland, incoming state AMA president Dr Christian Rowan took the opportunity to warn that recent cuts to frontline health staff would place the state under threat of new and infectious diseases.

Some new developments in Aboriginal Health

NACCHO laid out a clear path for change with the launch of its Healthy Futures 10 point plan 2013-2030, a set of priorities and strategies to drive improvements in Aboriginal health outcomes. It also released a Report Card on Aboriginal Community Controlled Health Services compiled with the AIHW that looks at gains made and areas for improvement.

5.Healthy Futures Great

WA announced it would delay signing the Close the Gap Indigenous health agreement with the Federal Government but has provided interim funding to cover services. The deal expires on June 30 and The Guardian reports that all other states have given their in principle agreement to re-sign.

The Guardian’s series of profiles on the guest hosts of the @IndigenousX Twitter account are good reading. This past fortnight has seen profiles of Lisa Briggs and Ebony Allen. Ebony’s live tweets from the Indigenous Digital Excellence Agenda Summit (#IndigenousDX) highlighted innovations and offered some interesting analysis.

It followed a great week of insightful tweets from Lisa, NACCHO’s CEO, who will also sit on a new group set up to advise the Federal Government on improving mental health and suicide prevention programs for Aboriginal and Torres Strait Islander people.

As for blogs, NACCHO featured a post from Don MacAskill, CEO of Awabakal Newcastle Aboriginal Co-operative, which says we must move away from a one-size-fits-all approach to Aboriginal Policy.

And for those with access to The Australian’s paywalled content, Noel Pearson has written an analysis of Peter Shergold’s speech on “personal and systemic failures in Indigenous policy”.

Croakey also showcased the tweeters in action at an Aboriginal and Torres Strait Islander health workshop held in Sydney as part of the APHA 21st national conference.



On matters of policy

The National Health Performance Authority released its latest report, which echoes the comments on access mentioned above and finds a significant number of Australians delay seeing a doctor because of cost. At Croakey, Consumers Health Forum CEO Carol Bennett writes that the report provides the “starkest evidence yet” of considerable variations in Australians’ access to health care, despite our claim to a universal health system.

And Dr Michael Gliksman argues that the evidence on childhood deprivation and later risk of disease supports the view that income support to lift people (especially children) above poverty levels and well-funded public education and health programs are essential.

At KevinMD, Dr Robert Centor argues in a piece about the unintended consequences of well-meaning regulation that we desperately need to develop decision making processes that focus on both benefits and harms and develop logical means for balancing them.  One example of unintended consequences from well-meaning regulation he says, is how the war on drugs has fuelled the hepatitis C epidemic.

The recently released Government Drug Policy Expenditure in Australia also focuses on the war on drugs. According to this SMH report from Amy Corderoy, it finds that while billions have been spent on law enforcement, funding for harm reduction has dropped – a move that does not match the evidence.

Other policies that received some attention include the Federal Government’s Federal Government’s four-year deal with Medicines Australia and its lack of response to PBAC recommendations on statins. Writing about the deal and its aftermath  on The Conversation, Professor Philip Clarke describes the story as “a ripping yarn of non-evidenced-based policy making”.

And while a new report from the Auditor General said super clinics were “generally effective” it criticised the program for lacking rigour and focusing on marginal seats, according to this report by Sue Dunlevy in The Daily Telegraph.

New policy work is needed to combat diabetes, according to Diabetes Australia, which proposed at the National Press Club that a national strategy be established.

But by far the most significant policy speech award can be handed to US President Barack Obama, who declared the climate change debate over and announced plans to regulate carbon emissions from power plants. The timing has interesting ramifications for the Australian political landscape, as this World Today report notes.

Obesity, activity and living in healthy spaces The American Medical Association’s decision to officially label obesity a disease got experts and the broader community talking about the merits of the approach. The news came as a paper was published in the latest issue of Academic Medicine suggesting a widespread anti-obesity bias among medical students.

Meanwhile, the SMH’s Melissa Davey reports that Australian state and federal ministers have agreed to adopt a voluntary star rating system for food labelling – a move described by public health expert Mike Daube as significant. And a new approach to food labelling in the UK will see all major supermarkets sign up to a consistent front-of-pack label that combines traffic light colour-coding and nutritional information and is designed to reduce consumer confusion.

In the US, Starbucks has moved to include calorie counts on its menus. Though a Russian public health official, in a perhaps misguided (or inspired depending on your view) attempt to keep citizens healthy, has urged them to make “patriotic” food choices and avoid “exotic cuisine”.

At the Australian Health Promotion Association Conference, which Croakey has covered extensively, Professor Helen Roberts, of University College London, summed up the inter-relatedness of obesity and environment with this great image: “Trying to change children’s health behaviours without trying to change the food and transport environment is like trying to teach them to swim in a pool full of alligators.”

A paper in the journal Obesity says neighbourhoods that include restaurants and businesses supportive of healthy eating choices can make a “measurable” difference to levels of obesity.

And while it doesn’t seem surprising that living near parks and gardens makes us happy, The Atlantic reports on research published in Psychological Science suggesting this has more of an impact on wellbeing than average neighbourhood income or crime rates.

After the US Environmental Protection Agency released what it described as its most comprehensive review to date on how the built environment directly affects our environment and public health, the 50th International Making Cities Liveable conference kicked off in Portland Oregon (tweet stream at #MCL50th).


Grog and smokes

Smokers cost their companies $3000 each in lost productivity, according to US research in the journal Tobacco Control. Though good news has emerged from the US, with a new report from the Centers for Disease Control and Prevention showing that the adult smoking rate has dropped to 18 per cent. The US FDA has also stepped up on tobacco, the New York times reports, announcing that for the first time it would exercise its power (granted in 2009) to regulate cigarettes and other tobacco products. It has authorised the sale of two new products but rejected four others.

Another tobacco report, from our own Australian National Preventive Health Agency (ANPHA), addresses research priorities for tobacco control and aims to inform future policies and programs and encourage links between researchers policy makers and advocates.

And new guidelines being discussed by the Australian and New Zealand College of Anaesthetists advise that all smokers should be asked to quit before undergoing surgery.

This interesting Science Update blog post looks at the tobacco industry’s role in cigarette smuggling and Professor Simon Chapman argues the case for regulation of e-cigarettes in a BMJ opinion piece.

Croakey addressed the harms of alcohol consumption and advertising with two posts that made for compelling reading. WA Police Commissioner Dr Karl O’Callaghan’s keynote address to the National Alliance for Action on Alcohol’s recent Forum was a blunt assessment of the alcohol industry and where its leading us: if we don’t address our alcohol advertising culture and the relationship between young people and drinking, the police will have no choice but to spend 60% of their budget mopping up the fallout. Professor Mike Daube also shone a light on the unholy alliance between the alcohol industry and sport.


Hospital goings on

GP patients aren’t clogging up hospital emergency departments as much as some might think, says new research published in the MJA and reported on HealthCanal. The paper suggests the AIHW methods used to categorise patients are flawed, which has implications for policy. Following the publication, the AIHW said it would review its methods.

Meanwhile, Sydney’s Prince of Wales Hospital says it is facing “an unprecedented reduction in services” so it can cut its budget by 30%, though Health Minister Jillian Skinner said frontline services were “going up not down”.

Over in the UK, the NHS is in all sorts of strife over allegations that its Care Quality Commission (CQC) covered up underperformance at certain hospitals. The scandal has led to an admission from outgoing NHS chief Sir David Nicholson that the NHS is home to a “culture of denial” when it comes to dealing with patient complaints. This is something Kay Sheldon would no doubt agree with. Her story as told to the Daily Mail is a first-hand account of what it was like to blow the whistle on the CQC.


Overdoing it just won’t cut it anymore

This Croakey piece is worth singling out both for its heart and its important central theme. Written by Dr Justin Coleman, it is based on his plenary address to the Qld RACGP Annual Clinical Update in Brisbane last month, and argues there is an ethical imperative to tackle overdiagnosis and overtreatment. “As a GP, I am a gatekeeper to a most powerful, expensive, superb and dangerous health system and I must never forget that sometimes my job is to shut the gate,” he writes.

In similar vein, Iona Heath’s viewpoint piece in JAMA Internal Medicine, questions how long it will take before a 2012 Cochrane review showing antihypertensive drugs don’t reduce mortality or morbidity in healthy adults with mild hypertension will take to filter through to the real world of clinical practice. This, she says, is an example of waste that does neither the system nor the patients any good.


Genetics law modified

In a landmark decision, the US Supreme Court has ruled that companies cannot patent human genes, overturning a ruling that allowed the company Myriad Genetics to hold patents on genes with links to breast and ovarian cancer.

This useful article in The Conversation analyses the decision and says, while US patent law does not directly affect Australian patent law, the decision is likely to have an impact on an upcoming case to be heard by the Full Federal Court in August.


Trials and tribulations

The Global Mail continues its series on pharmaceutical transparency, with two pieces from Mike Seccombe. One picks apart the workings of how Greens Senator Richard Di Natale’s Therapeutic Goods Amendment (Pharmaceutical Transparency) Bill 2013 was scotched by the major parties. The other looks at how much scrutiny should be placed on small pharma company gifts to doctors.

Looking at pharma activity from another angle, a BMJ analysis piece has called for the results from unpublished or abandoned studies to be made public.

And in other research developments, the Federal Government has released 15 strategic research priorities to focus the national research effort and has grouped them under the five top challenges from Chief Scientist Ian Chubb. They are: living in a changing environment; promoting population health and wellbeing; managing our food and water assets; securing Australia’s place in a changing world; and lifting productivity and economic growth.

Perhaps they should include the growing issue of science denial? This fascinating article from Mother Jones looks at the science behind why people reject science – and offers a glimmer of hope as to how we might appeal to their sensibilities in order to get the point across.

The folks over at the Cochrane Collaboration are doing their bit to get timely research evidence out there. Their new Publish When Ready model will see all Cochrane Reviews and Protocols published on the Cochrane Database of Systematic Reviews eligible for immediate publication, (after pre-publication editorial processes have been followed) rather than waiting for monthly publication dates to roll around.

ANPHA also launched its National Preventive Health Research Strategy (2013-2018) at a symposium hosted in Canberra. And as the countdown to election day begins, the Coalition has released its medical research policy.

Other Croakey reading you may have missed this fortnight: * So you want to make an app? Some helpful hints * Wrapping some tweet-reports from the Australian Health Promotion Association conference * Some big challenges for health promotion (including the “converging crises” of environmental degradation and social injustice) * International conference puts spotlight on corporate power as a health threat – and calls for Health in All Policies * Previewing the Australian Health Promotion Association conference

You can find previous editions of the Health Wrap here.

Twitter shout outs this week go to: @bmj_latest, Ebony Allen@IndigenousX, @NACCHOAustralia, @LRussellWolpe, @SimonChapman6, @cochranecollab, @kevinmd, @AboutTheHouse, @sophiescott2, @TIMEHealthland, @amednews,, @RWJF_PubHealth, @preventioninst, @LizSzabo.

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

NACCHO health news:CROAKEY’s new fortnightly HEALTH WRAP feature-June 16


PART 2 of  fortnightly feature at NACCHO Aboriginal Health News Alerts

In partnership Melissa Sweet’s Croakey – The Health Wrap, we  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.

Here is the HEALTH NEWS

Tobacco control was a dominant issue this fortnight, but Closing the Gap on Indigenous health inequality, barriers to evidence-informed policy, patient safety and immunisation were also on the agenda. Here are some highlights.

Towards a smoke-free zone

World No Tobacco Day on 31 May saw accusations levelled at the Queensland Government for simultaneously profiting from tobacco investments and withdrawing funds from smoking prevention programs. Only a week earlier, the state won the AMA’s annual Dirty Ashtray award.

On a positive note, NACCHO provided links  a suite of new No Smokes Health Worker Guides to provide health workers with a culturally relevant toolbox to tackle Indigenous smoking rates.

And at a World Health Organisation meeting in Geneva, Department of Health and Ageing Secretary Jane Halton urged other nations to follow Australia’s lead and defy the tobacco industry.

TIME magazine marked Russia’s new smoking ban with a piece on whether smoking bans have worked internationally. Somehow, it managed to exclude ground breaking Australia from its analysis.

The film industry’s influence over smoking behaviours also attracted attention. This Medpage today article quotes a JAMA Pediatrics study showing that while tobacco’s prevalence in movies has decreased, alcohol has assumed a more prominent role. And public health groups have shamed the hit flick The Great Gatsby, launching a series of print ads noting the film represents smoking more than 150 times compared with only eight mentions in F. Scott Fitzgerald’s classic novel.

The advertising industry has also drawn fire, with US public health groups urging an investigation into a new Camel cigarettes campaign they say targets kids. At home, Mumbrella reports the Department of Health and Ageing has cleared the official V8 Supercars website of breaching advertising laws after it posted historic images of a Winfield branded car.

A study published in the journal Tobacco Control shows there is no evidence that heavy smokers who cut back significantly reduce their risk of premature death. The authors say the finding has implications for health education messages.

And what of electronic cigarettes, touted by some as a quit option? The UK’s National Health Service has announced they will be licenced and regulated as a quit smoking aid from 2016, bringing them under more stringent control. The Australian TGA says it has not authorised any e-cigarettes and outlines its position on its website.

And finally, a World Lung Foundation survey says that tobacco control advocates still have some work to do if they have any hope of counteracting Big Tobacco’s foray into social media.

Closing the Gap – where are we at?

The COAG Reform Council’s latest report card on government attempts to close the gap on Indigenous disadvantage has found there have been some improvements but much more work is needed.

Another report, by Professor Lesley Russell from the Menzies Centre for Health Policy, analyses the 2013-14 Federal Budget and shows that despite the significant monetary efforts to close the gap, in most areas this is yet to show real returns and progress will only come as a result of sustained and concerted effort.

The fifth annual Secretariat of National Aboriginal and Islander Child Care (SNAICC) conference was held in Cairns. A busy tweet stream (#SNAICC13) revealed active discussions around presentations from speakers such as former NZ Children’s commissioner Cindy Kiro and Canadian children’s rights advocate Professor Cindy Blackstock, who told the conference that Governments in Canada and Australia had failed their most vulnerable children.

The Guardian has addressed the issue of Aboriginal inequality with several recent articles, including this one on the modern-day removal of Aboriginal children from their families.

For his part, Tony Abbott has pledged to take personal responsibility for the lives of Indigenous Australians. He says he will make major policy changes if the Coalition wins government, though the ABC notes he has been less precise about their exact nature.

Research-to-policy hurdles

The ‘best possible evidence informs health policy’ but the reality is not so simple, writes Amanda Carne, from the Primary Health Care Research and Information Service. In this Croakey post, Amanda takes a look at a recent Australian Health Review article, which says packaging research for easy policy consumption is something researchers should consider.

The sentiment is echoed in this blunt Scientific American piece, which says if scientists can’t convince the public that their science matters, their work will die as government funding shrinks. The Research to Action website may have some solutions. It is running a blog series on how social media engagement can be used to promote research uptake.

Dr Andrew Clappison writes in a separate piece on the site that argues while the UK Government might say it’s committed to evidence-based policy, it appears to have no strategy for doing so. Wales though, may be up for the challenge. As this BMJ article reports, it is consulting on whether and how to adopt a ‘health in all policies approach’.

Perhaps some insights will emerge from Ireland, where the Irish Medicines Board is hosting the European Risk Summit on research-based policy making. But Sir Michael Marmot has eloquently set out the challenge they face. In a recent JAMA piece he writes that if it’s so difficult to come up with a consensus position on breast cancer screening (with more evidence than many other areas relevant to population health) “then evidence-based policy is a good deal more difficult than many would believe”.

Locally, Professor Andrew Scott takes up the evidence case on Croakey and The Conversation, arguing that for all their good intentions health workforce programs in Australia are suffering from a lack of evaluation, which must be built into program rollout if we want to stop the cycle of spending dollars with no evidence of their effects.

In similar vein, a Sax Institute Evidence Check Review commissioned by the Mental Health Commission of NSW, has found that while the conservative cost of mental illness to the community is more than $10 billion a year, there is little Australian research available on where those taxpayer dollars would be most effectively spent.

Pharma sagas

Always a hot topic, pharmaceutical industry marketing featured in several forums, including the latest in a series from The Global Mail. This piece by Ray Moynihan looks at the pace of Australian plans to increase transparency on marketing to doctors.

At The Conversation, Emeritus Professor Edwin Gale explores the issue of scientists and academics who do battle with the drug industry.

And also on The Conversation, Professor Chris Del Mar gives an update on his and other Cochrane reviewers’ attempts to have Roche make public its complete trial data on the antiviral drug Tamiflu.

Meanwhile, Europe has voted to increase clinical trials transparency, the All Trials website reports, and BMJ US news and features editor Edward Davies blogs about “big bang” scientific meetings and how much they actually contribute to patient care as compared with peer review.

All about e-health and using our data

As the Federal Government launched a smart phone app allowing parents to access and contribute to their child’s personally controlled eHealth record, Pulse+IT reported that consumer registrations for the PCEHR have reached a landmark figure of 250,000. While reaching the target of 500,000 registrations by 30 June looks unlikely, hospitals are now coming on board and the Government is rolling out new TV ads promoting the scheme.

It also launched a national strategy for cloud computing, which outlines ways to use cloud technology to boost innovation and productivity across Australia’s digital economy.

But in healthcare we are still in the early stages of innovation, a Sydney roundtable event on technology heard, with healthcare organisations sitting on huge untapped patient data resources. A somewhat larger event on a similar theme was the fourth annual international Datapalooza conference, where more than 2000 technology developers, healthcare professionals, researchers, policy makers and business leaders came together to look at the most innovative uses of health data.

Pulse +IT also reports on research in the Journal of the American Medical Informatics Association that shows while e-prescribing cuts down on errors, it can introduce new types of system errors and reduce the time spent on patient care.

Immunisation still trending

As The Conversation considered numerous immunisation questions, including whether anti-vaccinationists should get their own church in order to qualify for exemptions under new immunisation laws, NSW Health Minister Jillian Skinner told Parliament the Health Care Complaints Commission would investigate the Australian Vaccination Network (AVN).

Dr Melissa Stoneham from the Public Health Advocacy Institute WA, meanwhile, argued on Croakey that the public health community should do more to advocate for vaccination. And Dr Sara Gorman posed the question on the PLOS Medicine blog: Why are we still afraid of vaccines?

Media reporting on immunisation came under scrutiny, with the Australian Communications and Media Authority (ACMA) finding that WIN Television had breached the Commercial Television Industry Code of Practice. The breach related to WIN quoting the AVN’s Meryl Dorey saying medical literature had linked all vaccines with autism.

‘Patients’ is the operative word

The ABC’s World Today program has tackled the issue of patient safety, with an interesting three-part series from journalist Emily Bourke (part one here), who suggests there is a ‘silent epidemic of error’ in the Australian healthcare system. Similar concerns have been raised in the US: a strongly worded editorial in the Journal for Healthcare Quality says patients in most US hospitals may not be much safer today than they were 10 years ago.

A JAMA Internal Medicine paper finds that shared decision making is low for common medical conditions. And at Croakey, Dr Tim Senior argues the case for involving patients in medical education and urges us not to leave the patient behind in the push for more evidence-based medicine.

Wait times or ‘cycle’ times?

As the Bureau of Health Information released its latest report showing NSW hospital ED wait times have fallen despite higher patient numbers, a media debate emerged about the ‘waiting to wait’ list.

The COAG Reform Council also released its first report on the National Partnership Agreement on Improving Public Hospital Services. It found no State or Territory achieved every COAG target, but there were “some good improvements” in all jurisdictions.

From the Canadian perspective, a thoughtful piece from Doug Woodhouse on the Healthy Debate website addresses the merits of how wait times are measured. He argues that cycle time –from the beginning to the end of a treatment process (including treatment of complications) – should replace wait time as a key measure of health system performance.

Other Croakey reading you may have missed this fortnight:
Beyond the “homebirth horror” headlines: some wider questions for the health system (and media)
As the Earth approaches a critical tipping point, a reminder about why our biological wealth is critical for health
Meat vs veg: how does a vegetarian diet stack up?
A simple request: Evidence based alcohol policy – not partisan politics
Weekend reading from the interwebs
Occupy Healthcare – Social media do have the potential to revolutionize medicine

You can find previous editions of The Health Wrap here.

And some Twitter shout outs this week. Thanks for your contribution @NACCHOAustralia, @LRussellWolpe, @SimonChapman6, @JeremyPetch, @AmyCorderoy, @stephenpincock, @Research2Action, @reemarattan, @cochranecollab, @bmj_latest.

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

NACCHO political news alert:Tony Abbott says there is no “one size fits all” solution to Aboriginal policy but new engagement is a must

Tony Abbott

A NEW engagement with Aboriginal people should be one of the  hallmarks of an incoming Coalition government.

From  Tony Abbott Federal Opposition Leader

 Opinion article News limited

 While our forefathers created a country we can be proud of – perhaps the most  magnificent country on earth – there is no escaping the fact that the  dispossession and marginalisation of Aboriginal people is by far the most  troubling feature of our national story so far. News Limited is right to revisit  this essential national issue.

As Paul Keating put it so eloquently over two decades ago, chronic indigenous  disadvantage constitutes a stain on our nation’s soul.  Until the first  Australians can fully participate in the life of our country, we are diminished  as a nation and as a people.

Of course, progress has occurred, but there is still much to do.  There is a  new spirit in this land that reaches out to embrace the indigenous people of our  country, so different from the prejudice that prevailed when I was young. Still  goodwill hardly matters, if adults aren’t going to work and children aren’t  going to school.

Of course, the knowledge, understanding and identification of culture is a  rich foundation for the emotional and spiritual growth of indigenous children  but equally, if it’s not accompanied by a decent education in English and a  secure home life then their growth and emergence as strong, well adjusted and  healthy young adults will not occur.

There can’t be one standard for the Australian community at large and a  different one for Aboriginal people. Adults have to go to work (or work  programs) and kids have to go to school.

That is not to say there is a single mechanism or structure that will suit  every community. As Ken Wyatt, the House of Representative’s first indigenous  member has cautioned, there are no “one size fits all” solutions here.

In this area, more than most, policy makers’ over-riding instinct should be:  “first, do no harm”. Nevertheless, if elected, a Coalition government will  co-operatively work with the states and territories, and offer the communities  ready to try it, a different, less prescriptive type of governance  structure.

To give an example of how it could work, as part of welfare reform in Cape  York, the Family Responsibilities Commission, which is guided by magistrates,  local elders and community leaders, has been working with local and national  agencies to help deal with family dysfunction.

The success of this model has seen dramatic improvements in school attendance  rates and some improvement in the “tone” of several Cape York communities.   There may be other regions that would benefit from their own fit-for-purpose  arrangements.

Idleness and boredom in any community leads to dysfunction, that’s why  getting adults to work and kids to school is so important.

Idleness is never healthy and, inevitably, eats away at self-esteem. It harms  the soul. Idleness, substance abuse and a breakdown in social norms are  inevitably linked.

That’s why we’ll work in the Northern Territory and elsewhere with local  authorities and communities to best determine how we can create safer  communities and help local people access jobs and education opportunities –  because education and jobs are antidotes to idleness.

Making indigenous communities safer and stronger has to start at the top of  government.  That’s why, if elected, a Coalition government will see indigenous  affairs handled within the Department of Prime Minister and Cabinet.  This means  that along with Nigel Scullion as minister, there will be, in effect, a Prime  Minister for Aboriginal Affairs.

It’s also why I have pledged, should I become prime minister, to spend at  least a week every year in a remote indigenous community. If these places are  good enough for Australians to live in they should be good enough for a prime  minister and senior officials to stay on.

I do however want to add a few words of caution.  It would be presumptuous,  even arrogant to thank that any incoming government could swiftly overcome two  centuries of comparative failure.

If elected, it would be equally complacent, even neglectful, for a new  government not to commit from day one, to redressing the most intractable  difficulty our country has ever faced.

A flurry of activity from any new government lapsing into  business-more-or-less-as-usual won’t be good enough. A new cycle of  enthusiasm-turning-into cynicism will not do.

We must steadfastly address this urgent national challenge, so that  indigenous Australians fully share in the bounty of being part of one of the  most free, fair, and prosperous countries on earth.

Tony Abbott is Federal Opposition Leader

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


Introducing a new fortnightly feature at NACCHO Aboriginal Health News Alerts

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


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

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

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


By Kellie Bisset

A big fortnight in mental health

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

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

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

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

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

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

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


Pointed views on display in vaccination debate

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

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


Over-diagnosis, misdiagnosis and unnecessary tests

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

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


Perspectives on risk

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


Food glorious food – or not

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

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

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

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


Politics and Policy

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

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

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


The gaps are getting bigger

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

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

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

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


The smoke wars

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

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


Other Croakey reading you may have missed this fortnight:

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

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

NACCHO Closing the Gap report: Analysis of provisions in the 2013-14 budget of the Indigenous Chronic Disease Package


Total government expenditure on Indigenous health has risen significantly since the commencement of the National Partnership Agreement (NPA) on Closing the Gap in Indigenous Health Outcomes in 2009-10 and now represents about 5.1% of total government health expenditure.


An analysis of provisions in the 2013‐14 Budget and implementation of the Indigenous Chronic Disease Package

Russell, Lesley
Menzies Centre for Health Policy


This paper presents the author’s analysis of the Indigenous provisions in the Australian Government’s 2013-14 Budget in the context of current and past strategies, policies, programs and funding support. It also looks at the implementation and impact of the Commonwealth’s Indigenous Chronic Disease Package. This work has been done using only materials and data that are publicly available. The opinions expressed are solely those of the author who takes responsibility for them and for any inadvertent errors. This work does not represent the official views of the Menzies Centre for Health Policy, the Australian Primary Health Care Research Institute (APHCRI) or the Commonwealth Department of Health and Ageing which funds APHCRI.

Report summary

This amounted to $4.7 billion in 2010-11; of this, the Commonwealth provided about one-third ($1.6 billion).

However while there is a significant effort underway to close the gap in Indigenous disadvantage and life expectancy, in most areas this effort has yet to show real returns on the investments. The disadvantages that have built up over more than 200 years will not disappear overnight, and sustained and concerted efforts are needed to redress them.

Chronicdiseases, which account for a major part of the life expectancy gap, take time to develop, and equally, it will take time to halt their progress and even longer to prevent their advent in the first place. Programs will need to be sustained over decades if they are to have an impact on improving health outcomes.

On this basis, it is worrying to see that continued funding for the NPA on Closing the Gap in Indigenous Health Outcomes, as announced in April, will be less over each of the next three years than in 2012-13.

At the same time, the Budget Papers show that expenses in the Aboriginal and Torres Strait Islander health sub-function will decline by 2.7% in real terms.

This comes as states such as Queensland and New South Wales have made damaging cuts to health services and Closing the Gap programs.

Education is a significant determinant of health status so it is also concerning to see a reduced level of funding provided for Indigenous education over the next six years, especiallywhen efforts to close the gap in education for indigenous students have stalled. These cuts inhealth and educations commitments cannot be justified by saying that Indigenous Australianscan access mainstream programs. In many cases these are absent, inappropriate, or perceived as culturally insensitive, despite recent efforts to improve these deficits.

It is a strength of the COAG commitment to close the gap on Indigenous disadvantage that it recognises that a whole-of-government approach is needed to deliver improvements in the lives of Indigenous Australians.

However tackling disadvantage is about more than building houses, providing job training, implementing welfare reform, community policing andincreasing access to health services; it requires that governments recognise and respect the complex social and cultural relationships that underlie the housing, economic, health and societal issues present in many Aboriginal


NACCHO social policy news:Indigenous Australians a quarter of Australia’s prisoner population. It’s a social policy disaster.But could there be solution!


Firstly though, politicians and the public alike need to understand and admit that the current policy ethos, and its reliance of incarceration, is a failure, both socially and economically.

Australia spends $2.6 billion a year incarcerating adults

But could there  be  solution!

We invite our members to make comment see below

Reproduced from the DRUM : Paul Simpson and Michael Doyle

The continual rise in incarceration rates of Indigenous Australians represents nothing short of social policy disaster.


If reducing the numbers of those in prison is to be achieved, then we need to end the reliance on incarceration and invest more into new thinking and rigorous research on non-incarceration alternatives.

Marking 20 years of monitoring since the Royal Commission into Aboriginal Deaths in Custody, the Australian Institute of Criminology finally released its ‘deaths in custody‘ report last Friday and the figures reaffirm the increasing over-representation of Indigenous persons in custody.

In 20 years rates have gone from one Indigenous person in seven incarcerated to one in four.

Indigenous persons make up 26 per cent of the prisoner population yet only constitute 2.5 per cent of the Australian population.

The over-representation of Indigenous persons in Western Australian prisons is the highest of any Indigenous group in the OECD.

Addressing Indigenous over-representation in custody requires new thinking and tested approaches to the offender population.

Firstly though, politicians and the public alike need to understand and admit that the current policy ethos, and its reliance of incarceration, is a failure, both socially and economically.

Australia spends $2.6 billion a year incarcerating adults. Punitive penal policies cost Australia big time.


While happy to scrutinise the effectiveness and efficiencies of all other sectors and services, political authorities seem quite content to overlook the billions poured into the prison system.

The return on this ‘investment’ amounts to very little. It simply does not prevent re-offending.

Longitudinal studies show that two-in-five people are re-imprisoned within two-to-five years of release.

Those who advocate for new thinking beyond the current social policy failures have hailed Justice Reinvestment (JR) as one new approach.

Justice Reinvestment was introduced to the US in 2003 by the Open Society Institute and has subsequently been adopted in eleven US states.

It involves identifying geographic areas from where significant numbers of the incarcerated population emanate and investing in services in these areas.

Importantly, at the policy level JR aims to divert funds that would be spent on criminal justice matters (primarily incarceration) back into local communities to fund services that are said to address the underlying causes of crime, thus preventing people from engaging with the criminal justice system.

Detention under this model is seen as a last resort – for only the most dangerous and serious offenders.

The goal is to shift the culture away from imprisonment and to restoration within the community through restorative health, social welfare services, education-employment programs and programs to prevent offending.

The effectiveness of JR was reported on at the First National Summit on JR in Washington in 2010, where lawmakers from several American states discussed how they had enacted policies to avert projected prison growth, saving several hundred million dollars, while decreasing prisoner numbers and recidivism rates.

Australian scholars have reservations about the type of JR model adopted in some US states, specifically querying who controls and receives the funding. Is it the community-sector or another state agency?

Former Aboriginal and Torres Strait Islander Social Justice Commissioner Dr Tom Calma commended JR as a possible solution to Indigenous over-representation in Australia’s criminal justice system. Several other Australian commentators have followed suit.

Despite the increasing popularity of JR, Australia so far lacks evidence to support it beyond its appealing rhetoric and, some might argue, simplistic notion as a viable policy alternative.

Members of the Indigenous Offender Health Research Capacity Building Group (IOHR-CBG) and the Australian Justice Reinvestment Project based at the University of NSW have begun research efforts to address this paucity of information, .

Following two national Justice Reinvestment forums convened by IOHR-CBG member Dr Jill Guthrie, a three-year JR research project has begun at National Centre for Indigenous Studies.

Using a case study approach, the research explores the conditions, governance and cultural appropriateness of reinvesting resources otherwise spent on incarceration, into services to enhance juvenile offenders’ ability to remain in their community.

The Australian Justice Reinvestment Project is currently is examining JR models from overseas in order to provide a sound theoretical and practical foundation for the future development of JR strategies in Australia.\

There is also a Citizens’ Jury research project being run this year by IOHR-CBG researchers aimed at eliciting the values and priorities of a critically informed Australian community with respect to JR.

Citizens’ Juries have been used in various policy fields internationally, including in health in Australia. They involve bringing together group of randomly selected citizens, giving them a variety of evidence-based information on the issues to hand and asking them, as representatives of the community, about their preferences for certain policy options or priorities for resource allocation.

The project also assesses how the results of the Citizens’ Juries might influence the decision making of government policy makers.

Research of this nature is critical in order to imagine and test new and viable alternatives to incarceration. Unfortunately, the current amount invested in such research is minute.

As the recently-emerged adage says, a ‘tough on crime’ approach needs to be replaced by a ‘smart on crime’ approach. A new policy platform to justice is well overdue.

This platform must be informed by evidence and not the tired political populism that exploits the fears of the electorate if we are to ever make inroads in reducing the hugely disproportionate Indigenous incarceration rate in Australia.

Paul Simpson and Michael Doyle are research fellows with the Justice Health Research Program at the Kirby Institute, University of NSW, and are also members of the Indigenous Offender Health Research Capacity Building Group.

NACCHO workforce news : Download the Independent Review of Health Workforce Programs Released


W force

Minister for Health Tanya Plibersek today released the final report of the independent review into Australian Government’s health workforce programs.

The report makes 87 recommendations covering Commonwealth programs that target the medical, dental, allied health, nursing and midwifery and Aboriginal and Torres Strait Islander health workforces.

If you would like to make comment about this report there is a feedback section at ther bottom of this page

Download Mason Review of Australian Government Health Workforce Programs

NACCHO comments

Upon reading chapter 5, NACCHO has  noted that it contains much information provided to the various contributors of this review, from our sector.

NACCHO has participated in various degrees with some of the contributors: for example but not limited to:

  • National Health and Hospital Reform
  • The Workforce Roundtable consultation
  • The Aboriginal and Torres Strait Islander Health Worker Project
  • CS&HISC environmental Scan
  • The Battye Review (subsequent report)
  • National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework 2011-15
  • Lowitja Report

 It was pleasing to see that these consultations had value.

 The chapter highlights achievements but also addresses many of the challenges that still need to be addressed and recommendations that cannot be ignored if the Australian government are to significantly increase the Aboriginal and Torres Strait Islander Health workforce.

It addresses pay equity and funding of RTO’s. It promotes the continued funding of peak Aboriginal bodies.

The Review identifies the Blueprint for Action (the Pathways Paper) and some of the key recommendations within the Pathways Paper namely;

  •  The  need to provide training in career guidance to Aboriginal and Torres Strait Islander education workers and roles to supplement those of existing careers advisors;
  •  Education institutions and Aboriginal and Torres Strait Islander health  personal and communities should work in partnership to develop a culturally–inclusive Aboriginal and Torres Strait Islander Health curriculum in a multidisciplinary manner; and
  •  Tertiary education providers should consult with Aboriginal and Torres Strait Islander communities on a whole-of-institution strategy to increase the number of Aboriginal and Torres Strait Islander students in health courses. Strategies should include student support and curriculum matters.

The recommendations at the conclusion of chapter 5, if taken up by Government (namely the Commonwealth), will be the some key steps in building the workforce within our sector: i.e. (abbreviated recommendations)

Recommendation 5.1: must be coordination of activities aimed at building the capacity of theAboriginal and Torres Strait Islander health workforce..

Recommendation 5.2: continuation of funding to peak Aboriginal and Torres Strait Islander bodies/networks…

Recommendation 5.3: continue consultation with National Congress of Australia’s First people’s National Health Leadership Forum….

Recommendation 5.4:build on the success of LIME by reconfiguring this group to include support and mentoring for all Aboriginal and Torres Strait Islander tertiary level health professions including nurses, midwives, dentists and allied health professions….

Recommendation 5.5: develop and implement a new program aimed at; increasing Aboriginal and Torres Strait Islander health student enrolment and graduate numbers, and pursuing the development of culturally appropriate curriculum into all health courses…

Recommendation 5.6:  compliment 5.5 by the development of Aboriginal and Torres Strait Islander academic leaders/champions and Aboriginal and Torres Strait Islander student support networks that would provide culturally appropriate mentoring, counselling….

Recommendation 5.7: take action to implement those recommendations directed to the RTO as outlined in the Battye Review……

Recommendation 5.8: consider options for the establishment of an Aboriginal and Torres Strait Islander Nursing and Midwifery Policy Adviser role…

Recommendation 5.9: the NT Medical Program Indigenous Transitions Pathway program to be evaluated to assess outcomes

Recommendation 5.10:  is a DWEER program responsibility re investigating the connectivity of education and training sectors from school through the VET sector and onto undergraduate studies, with multiple entry points for younger and mature students

Minister for Health Tanya Plibersek

“I commissioned this review of our health workforce programs to ensure that Australian communities have access to a highly qualified health workforce now and into the future,” Ms Plibersek said.

“As a first step in responding to the review, I have accepted the report’s recommendations to provide a more advanced system for classifying rural locations and areas of workforce need to determine eligibility for support and funding through many Commonwealth workforce programs.

“This will build on and update the Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) system, providing customised enhancements to current methods of determining eligibility for program support.

“I have announced the formation of the Rural Classification Technical Working Group to guide the implementation of the improved classification system that will deliver a fairer and more sustainable method of determining the level of support doctors in each community receives. We will also consider the recommended reforms to the Districts of Workforce Shortage system as part of this process.”

Ms Plibersek said the Government will also develop a model for a new and more integrated rural training pathway for medical graduates, with the potential to extend this approach to other health disciplines.

“This model will be designed to build on the Government’s existing rural health training initiatives so that students who are interested in a career in rural health have a more seamless transition between their education, training and employment.

“The training model will be designed to improve the distribution of health professionals to rural areas, and if successful it will help deliver new doctors to areas of significant workforce shortages.”

The report was led by former Director General of the NSW Departments of Human Services and Community Services, Ms Jennifer Mason, and was informed through an extensive consultation process.

“I’d like to thank Ms Mason for delivering this important report, and for the health community’s involvement to help guide its development,” Ms Plibersek said.

“The report has raised a number of critical issues covering our health workforce programs and key reform areas. We will now carefully consider all the recommendations and any potential implications they may have,” she said.

The Australian Government has invested more than $5.6 billion into training the nation’s health workforce to deliver more doctors, nurses and other health professionals to where they are needed.

Download Mason Review of Australian Government Health Workforce Programs

NACCHO 2013 budget press release:Lack of detail leaves a question mark over Aboriginal health


 The $777 million commitment to Close the Gap initiatives in the 2013 Federal Budget is welcome however the Aboriginal health Community Controlled sector remains concerned about the lack of detail on how and where the money will be spent.

National Aboriginal Community Controlled Health Organisation (NACCHO) Chair, Justin Mohamed, said it was critical that adequate funding was dedicated to support and grow Aboriginal Community Controlled Health services where the biggest gains were being made in improving Aboriginal health.

Download the Aboriginal Health Budget here also see executive summary below

Download Federal Government Press release on Aboriginal spending here

“The lack of clarity in the Budget around how funding will flow to Aboriginal primary Community Controlled Health services is very concerning,” Mr Mohamed said.

“Aboriginal Community Controlled Health services need to be at the forefront of any comprehensive primary health care model.

“It is these services – run by Aboriginal people, for Aboriginal people – that are making the biggest improvements to the health of their communities.

“The Federal Government also needs to put greater effort into getting the states and territories to re-commit to the National Partnership Agreement – due to expire in just over a month.

“It is simply not OK to leave the fate of Aboriginal health hanging while everyone plays politics up to the 11th hour.”

Mr Mohamed said NACCHO was disappointed that the Budget did not spell out how the upcoming National Aboriginal and Torres Strait Islander Health Plan would be funded.

“The Health Plan will not work unless it is properly resourced and after yesterday we are no clearer on how much of the $777 million will be directed to this critical initiative.

“It is also disappointing to again see the focus on Medicare Locals in the Budget. Medicare Locals are yet to prove their effectiveness in the Aboriginal health space where the community controlled model has made positive health gains.

“If we’re serious about closing the appalling gap in life expectancy between Aboriginal and non-Aboriginal Australians, then Aboriginal health needs to be given the attention it deserves and community controlled services better supported.”

Mr Mohamed said NACCHO would be consulting widely with the Aboriginal Community Controlled sector and providing further comment upon further analysis of the budget papers in the coming days.

Media contact: Colin Cowell 0401 331 251,


Through Outcome 8, the Australian Government aims to improve access for Aboriginal and Torres Strait Islander people to effective health care services essential to improving health and life expectancy, and reducing child mortality.

The Australian Government, through the National Indigenous Reform Agreement, is committed to ‘closing the gap’ between Indigenous and non Indigenous Australians in health, education and employment. This requires a concerted and coordinated effort from all Government agencies and two of the targets in the agreement relate directly to the Health and Ageing Portfolio: to close the gap in life expectancy within a generation; and to halve the gap in mortality rates for Indigenous children under five years of age within a decade.

In 2013-14, the Government will work with states and territories through a renewed National Partnership Agreement (NPA) to consolidate and embed the reforms implemented under the current NPA on Closing the Gap in Indigenous Health Outcomes, including continuing implementation of the Indigenous Chronic Disease Package. This commitment will provide a continued framework for working collaboratively to close the gap in life expectancy within a generation.

The Australian Government is also developing a National Aboriginal and Torres Strait Islander Health Plan, which will build on the gains already being achieved through the Australian Government’s Closing the Gap initiatives. The Health Plan is being developed as a collaborative effort and after extensive consultation with Aboriginal and Torres Strait Islander people and their representatives and is being informed by advice from the National Aboriginal and Torres Strait Islander Health Equality Council. It will involve building links with current initiatives and strategies, identifying gaps for further action and expanding existing initiatives where appropriate.

The Australian Government recognises that closing the gap in life expectancy in the Northern Territory continues to present a significant challenge. The Stronger Futures in the Northern Territory – health initiative focusses on this challenge by providing ongoing funding to deliver a comprehensive health package for Aboriginal and Torres Strait Islander people in the Northern Territory.

The Department is working with Aboriginal and Torres Strait Islander people and organisations, as well as in collaboration with state and territory government agencies to implement these programs.

The Office for Aboriginal and Torres Strait Islander Health leads the work for Outcome 8 by funding the delivery of primary health care services and other

Download the Aboriginal Health Budget here also see executive summary below

Download Federal Government Press release on Aboriginal spending here