NACCHO Aboriginal eye health : Small victories add up to gap closure for Aboriginal health


With a team at the University of Melbourne, we have researched and consulted  widely over the past five years to come up with a plan to “Close the Gap” in  Indigenous eye health.  ‘The Roadmap to Close the Gap for Vision’ presents an  opportunity for another ‘small victory’ by eliminating preventable vision loss  for Indigenous people over the next five years

Professor Hugh Taylor (pictured centre above)

Early this year, then Prime Minister Julia Gillard spoke to Parliament about  some of the positive trends that are emerging in the long-term goal of the  Government to “Close the Gap” for Australian Indigenous disadvantage.

From The AGE

She described Closing the Gap as ‘an accumulation of small victories’ which  can provide ‘the basic public services…delivered at the standard that every  Australian expects’.

The general theme is that some things are improving, albeit slowly, and  others need to get a wriggle on.

With a team at the University of Melbourne, we have researched and consulted  widely over the past five years to come up with a plan to “Close the Gap” in  Indigenous eye health.  ‘The Roadmap to Close the Gap for Vision’ presents an  opportunity for another ‘small victory’ by eliminating preventable vision loss  for Indigenous people over the next five years.

This is the first time  Indigenous eye health has been comprehensively researched to identify the  problems, needs and solutions.

Previous reports on Indigenous eye care have been  limited to reviews and the findings have been implemented incompletely at best.  ‘The Roadmap to Close the Gap for Vision’ has drawn on successful examples and  practices from around the country and extensive community and stakeholder  consultation. Best of all, it is feasible and doable, but each component is  essential for success.

The key to the Roadmap is the comprehensive approach that will improve the  provision and utilisation of eye services by the application of additional  resources to increase the availability of eye care and provide good  co-ordination and case management of patients.

Indigenous Australians experience six times the rate of blindness compared  with the rest of Australia. Vision loss causes 11 per cent of the Gap in health  – it is equal third with trauma, following heart disease and diabetes but ahead  of stroke and alcoholism. The provision of good quality eye care is fundamental  to improving the health of Indigenous Australians and unlike many other  conditions, most vision loss can be eliminated overnight.

The Roadmap provides policy recommendations to eliminate unnecessary vision  loss through 42 interlocking strategies. The recommendations build on previous  reports from the Indigenous Eye Health Unit at the University of Melbourne and  an extensive consultation process with the community-controlled sector, eye  health professionals, governments and other stakeholders.

The Roadmap addresses primary eye care, refractive services, cataract,  diabetic eye disease and trachoma. It includes cost estimates for the  Commonwealth, state and territory governments. It builds on community  consultation and control, the regional delivery of services and the National  Health Reforms. It stresses the assessment of population-based needs, strong  co-ordination, monitoring of performance and national accountability.

A recent Victorian initiative is one example of the difference a co-ordinated  approach that involves all the key partners and addresses one of the concerns  raised as a barrier can make. The Victorian Eyecare Service was augmented in  2010 by the Victorian Government with funds to allow Aboriginal Victorians  access to a specifically designed pair of spectacles for $10. The scheme is  available from optometrists working in Aboriginal Health Services and through a  network of private optometrists in rural Victoria.

There is no requirement for a  health care card or pensioner status to be eligible for access to the scheme.  The introduction of this scheme in 2010 has been followed by a more than twofold  increase in demand. Cost is identified as the most common reason Indigenous  people do not go to a health professional when needed. However, rather than  cost, we found that cost-certainty was the more important issue.  Cost-uncertainty for spectacles was commonly reported to the research team as  the reason for not visiting the optometrist and not having eyes tested. The  Victorian scheme demonstrates that when good quality spectacles are provided at  a low and certain cost, the service is rapidly accepted and taken up.

All Australians reasonably expect to see clearly and comfortably and to have  healthy eyes. We all fear vision loss and blindness given its considerable  potential impact on the quality of our lives. The Roadmap to Close the Gap for  Vision provides opportunity to accumulate yet another small victory to reduce  Indigenous disadvantage. We have the evidence, the strategy and the capacity to  close the gap for vision – the time is right to take this next “small step”.

The Indigenous Eye  Health Unit would like to acknowledge support from the following donors; The  Harold Mitchell Foundation, The Ian Potter Foundation, Mr Greg Poche AO, the  University of Melbourne, Dr David Middleton, Mr Peter Anastasiou, Mr Rob Bowen,  Dr Vera Bowen, Mr Noel Andresen, Dr Mark & Alla Medownick, Gandel  Philanthropy, CBM Australia, The Cybec Foundation, The Aspen Foundation and “K”  Line Logistics. Funding for work on the Implementation of the Roadmap to Close  the Gap for Vision has been provided by the Department of Health for 2013 –  2014.

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NACCHO good news story: Global campaigner represents Indigenous voices

Ms Nayuka Gorrie - UNPFII - Youth delegate

Ms Gorrie was chosen to represent Indigenous youth at the UN Permanent Forum on Indigenous Issues (UNPFII) held at the UN headquarters in New York in May.

Gabrielle Murphy Article – The Age

At 22, Nayuka Gorrie is a savvy but certainly not weary global campaigner for Indigenous and environmental rights. Having already attended the United Nations Climate Change Conference last November as an Indigenous representative of the Australian Youth Climate Coalition, Ms Gorrie was again chosen to represent Indigenous youth, this time at the UN Permanent Forum on Indigenous Issues (UNPFII) held at the UN headquarters in New York in May.

With a mandate to discuss Indigenous issues related to economic and social development, culture, the environment, education, health and human rights, the UNPFII representation has given Ms Gorrie a unique opportunity, at the highest levels, to focus her attention on two main areas of interest for her – the rights of Indigenous people and the environment.

“I feel very honoured to have been given this opportunity,” says Ms Gorrie, “particularly at such an interesting time for young Aboriginal people when they actually make up a disproportionate majority of the Indigenous Australian population overall.

“And while I recognise that the honour comes with quite a heavy burden of responsibility, it’s a responsibility I’m happy to embrace. In our culture it’s not common or encouraged for people to talk themselves up and despite how hard this is to do, I think it’s important to aim for the best.”

Nayuka Gorrie grew up in Brisbane and credits her mother’s determination for her children to study, work hard and succeed. As a descendent of the Kurnai and Gunditjmara clans from Lake Tyers on her grandfather’s side, the Gunditjmara people from Lake Condah on her grandmother’s, and with connections to the Wurundjeri and Yorta Yorta people, Ms Gorrie comes from strong and proud traditions, and happily follows in their footsteps.

After completing her secondary education in Brisbane, Ms Gorrie chose to come to Melbourne for university.

“I chose Melbourne because of its reputation,” Ms Gorrie says. “I’ve had so many opportunities by virtue of being at this University and I would have been mad not to have made the most of them.”

These opportunities have included a place with the Career Trackers Indigenous Internship Program. Career Trackers is a national not-for-profit organisation that works with Indigenous university students and private sector companies to create career pathways through structured internship programs.

Through the program, Ms Gorrie has worked during her winter and summer breaks with Australia Post and, as part of a legal team involved in five structured programs including work place relations, acquisitions and mergers, workplace contracts, competition and consumer law, and regulatory requirements.

“I entered the program in first year,” says Ms Gorrie, “and I absolutely love it.

“I’ve become really interested in regulatory affairs, and the multilateral and bilateral agreements corporate Australia has with different countries, so being in a work environment where I am able to apply these interests to meeting defined objectives and making them work in a business sense has been stimulating, challenging and rewarding.”

On a national level, Ms Gorrie has also been involved throughout her undergraduate studies in the Congress Youth Forum of the National Congress of Australia’s First Peoples, the independent and representative post-Aboriginal and Torres Strait Islander Commission voice for Aboriginal and Torres Strait Islander Peoples. In this arena Ms Gorrie has represented Victoria on the Congress’s Youth Committee and in this capacity attended the 2012 annual delegates’ meeting held in Alice Springs in September.

“All these experiences have given me access to great Indigenous leadership from influential people like Les Malezer who played such an important role in the formulation and ultimate declaration of the UN Declaration of the Rights of Indigenous People, to mention but one of the elders I have been privileged to learn from and meet,” Ms Gorrie says.

“It’s just amazing to sit back and realise I’ve had the opportunity to represent my people, especially the young people, to get to say something at the United Nations, and have that considered. Crazy!”

NACCHO MJA health news: Future initiatives to improve the health and wellbeing of Aboriginal and Torres Strait Islander peoples

Kerry Arabena _Leadership-opt-620x349

Article by: Kerry Arabena, Director and Chair of Indigenous Health,1 and Chair2 1 Onemda VicHealth Koori Health Unit, University of Melbourne, Melbourne, VIC.2 National Aboriginal and Torres Strait Islander Health Equality Council, Canberra, ACT.

Continuing to close the health gap will require innovation; long-term, systematic approaches that improve the quality and integrity of data; collaborations and partnerships that reflect an ecological approach to health, and recognition of the proper place and contribution of Aboriginal and Torres Strait Islander peoples in Australian society

At long last there are signs that the gaps between the health of Aboriginal and Torres Strait Islander people and non-Indigenous people are closing — but systematic, long-term action needs to continue both within and outside the health system to realise true health equality, and for us to know that we have achieved it.

According to the 2012 report of the Aboriginal and Torres Strait Islander Health Performance Framework, a number of positive trends in Aboriginal and Torres Strait Islander health include:

  • the mortality rate has declined significantly (by 33%) between 1991 and 2010 among people living in Western Australia, South Australia and the Northern Territory combined;

  • deaths due to avoidable causes decreased significantly in WA, SA and the NT combined, down 24% between 1997 and 2010;

  • deaths from respiratory disease decreased significantly from 1997 to 2010, and the gap with non-Indigenous Australians has also narrowed; and

  • mortality among infants aged less than 1 year declined by 62% between 1991 and 2010, perhaps reflecting the benefits of immunisation, improved access to primary health care services, the use of antibiotics and earlier evacuation to hospital for acute infections.1

Of course there remain areas where the gap persists or in some cases has grown, including chronic disease, injury, cancer, disability and low birthweight babies. It appears that in some areas (such as cancer) improvements in the quality, accessibility and impact of treatment are resulting in significantly improved death rates for non-Indigenous Australians, but Aboriginal and Torres Strait Islander people are missing out. The causes of this discrepancy seem to lie in disparities in stage at diagnosis, treatment received and survival rates.

Cutting across these trends are persistent gaps in the quality of data. Our inability to know whether large investments made in recent years in Aboriginal and Torres Strait Islander health are paying off should be a major focus for future strategies. In general, our population does not seem to be benefiting from the same level of sophisticated population-level tracking, health assessment or data integrity that majority populations take for granted.2 Good data are crucial, not just to know the impact of what we have done, but to guide what we are doing.

In this context it is pleasing to see the recent process of developing a new national plan to guide future investments in Aboriginal and Torres Strait Islander health, developed through a collaborative process including Aboriginal and Torres Strait Islander peak bodies, communities, services, researchers, advocates and clinicians.3 The new national plan needs to set directions for the next 10 years and expand and align with an ecological view of health, include concepts important to Aboriginal and Torres Strait Islander peoples and influence other sectors that affect health, such as education, employment, housing and early childhood development. This multifocal approach could have implications for the design, implementation and evaluation of projects, and will necessitate a reconceptualisation of partnerships and collaborations, while fostering innovations and knowledge exchange.

Finally, we will need to redress some of the less palatable aspects of the health system that contribute to inequality, such as racism.4 Embodied in dubious practices, disparities in access and subtle variations in effort within health and other institutions and programs, racism has had and continues to have a real and damaging impact on the health of Aboriginal and Torres Strait Islander people. It is clear that full health equality cannot be achieved until racism and other practices that deny our status and rights as the original and First Peoples of Australia can be overcome. My hope is that not only do we redress racism in health and other systems, but that this nation recognises and enables each and every Aboriginal and Torres Strait Islander person the opportunity to rise to the full potential of our existence.

NACCHO chair welcomes Professor Kerry Arabena as the newly appointed Chair of Indigenous Health

Kerry Arabena _Leadership-opt-620x349

Mr Justin Mohamed, Chair of NACCHO representing over 150 Aboriginal Community Controlled Health Organisations throughout Australia today welcomed the annoucement that Professor Kerry Arabena  has been appointed Chair of Indigenous Health at the  Melbourne School of Population and Global Health

Our thanks to the Melbourne AGE for sharing photo  (Photo: Sarah Anderson) and story in which Kerry spoke about the challenges  facing Indigenous Australians, and why local and global leadership is critical  for Indigenous affairs

Strong, charismatic and decisive leadership within Aboriginal and Torres  Strait Islander communities is something Kerry Arabena identifies as crucial to  improving Indigenous health outcomes in Australia.

“Since 1970, Aboriginal and Torres Strait Islander people have taken our  rightful place in discussions about health service delivery, the health and  wellbeing of families and the positive transformation of our communities,” she  says.

“Our role as leaders has been to learn to navigate and operate in complex  health service, government and community systems to represent the issues we’ve  heard from people in our communities.”

A descendant of the Meriam People of the Torres Strait, Professor Arabena is  the first Torres Strait Islander woman to achieve and receive a professorial  position. She has had many senior appointments: as well as recently being  appointed Chair of Indigenous Health at the Melbourne School of Population and  Global Health, it was announced in April that Professor Arabena would be taking  on the role of Chair of the National Aboriginal and Torres Strait Islander  Health Equality Council.

A social worker by profession, Professor Arabena began her career in  community services and case management in the Northern Territory over 20 years  ago, where she worked in one of the most remote Aboriginal medical services in  Australia at Kintore, 600km west of Alice Springs.

“I think I’m the only Torres Strait Islander woman who’s ever lived out in  the desert like that,” she says.

She transitioned from social work into human ecology, community-controlled  health organisations, co-ordination of national public health initiatives and  finally into academia. At the University of Melbourne her role involves  community engagement and capacity-building.

She notes that the role of leadership within the Aboriginal and Torres Strait  Islander community is constantly changing.

“Some of us have been in our fields for at least 20 years and are in  positions to mentor others. We are modern intellectuals with ancestral and  cultural connection to country. This type of leadership is now critical for all  our affairs.

“Our role is to look to the next generation, to ensure we are supporting and  creating spaces for them. We need to unify on matters affecting us all, and  engage in conversations about our affairs on a local and global scale.”

These conversations are much needed. Many disparities still exist between  Indigenous and non-Indigenous population health status and outcomes,  determinants of health and health system performance.

While Professor Arabena is wary of “simplifying, stereotyping and amplifying”  the difficulties of life for people in some Aboriginal and Torres Strait  Islander communities, she says “The reality of life is grim” for many of  them.

“Life is such that some children would choose to end their lives before they  get a chance to live it. Life is such that we have young people who have  completed year 12 but who are unable to read or write.”

Professor Arabena believes negatively framed discussion of Indigenous issues  in policy environments is, however, deeply problematic, directly impacting  health outcomes for Aboriginal and Torres Strait Island people.

In many public conversations, Indigenous people are viewed as “disadvantaged”  and “in poverty” and all of these other terms we use so loosely.

“What we forget to see and know is that people can change, people can empower  themselves, and that given information and opportunity, people can transform  their lives from what might have been incredibly difficult circumstances.”

Professor Arabena identifies several strategies she will focus on during her  time at the University, including helping build recognition of the rights of  Indigenous families and communities to live self-determining lives, free from  discrimination; and creating and advancing knowledge of the contributions  Indigenous Australians have made, and continue to make, to Australian  society.

“I get excited about what we can do together. Despite difficult  circumstances, there have been eight Aboriginal and Torres Strait Islander  Australians of the Year, and I think That’s something we can all be proud  of.

“We get described as “disadvantaged” and not able to do things: actually we  can, and we are, and we will. Whether people recognise that or not ” we know  what we do, we know what we can achieve. And to me, that is worth  celebrating.”

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