ISSUE FOUR / AUGUST 2011 Wangka Pulka...Aboriginal and Torres Strait Islander adults (see p. 19). In the wider health and policy landscape we look at the first meeting of the National

WangkaPulka

'Big Talk'

ISSUE FOUR / AUGUST 2011

CONTENTS / LOWITJA INSTITUTE UPDATE

02EDITORIAL

06RESEARCH ACTIVITIES

08RESEARCH COMMUNICATIONS

13NATIONAL POLICY NEWS

20NEWS IN BRIEF

30

the CTG goals and his particular focus on reducing the high rates of smoking in Aboriginal and Torres Strait Islander communities.

There has also been plenty of activity in our research programs and communications, with new projects starting and a multitude of publications released. Chief among these is Researching Indigenous Health: A Practical Guide for Researchers, which took a dedicated team years of hard work to finalise ahead of its launch on 14 July (see p. 15). The guide is invaluable for anyone involved in Aboriginal and Torres Strait Islander health research and has already been in heavy demand from research institutions across Australia. In subsequent newsletters we will feature some of the guide’s case stories and tips for researchers.

On 16 May 2011 the Medical Journal of Australia published its special Indigenous edition, with several contributions from researchers

Mid-year updateinvolved in our activities (see p. 14). The past few months have also seen important papers from our Program 1 Leader, Professor Ross Bailie, on remote area housing and its effect on children’s health (see p. 18) and by long-time eye health campaigner Professor Hugh Taylor on the scourge of blindness affecting so many Aboriginal and Torres Strait Islander adults (see p. 19).

In the wider health and policy landscape we look at the first meeting of the National Congress of Australia’s First Peoples in June (see p. 20) and the gathering momentum of the Federal Government’s health reform process (see p. 21).

Lastly, our Chief Executive, Dr Kerry Arabena, left the Lowitja Institute on 19 August 2011 to pursue other opportunities. The Board would like to express its sincere appreciation for her contribution to the organisation since joining in August 2010 and wishes her every success in all her future endeavours.

When we last went to press there was apprehension in the research community, with whispers of swingeing Federal Budget cuts to national research programs including funding for the National Health and Medical Research Council (NHMRC). In the event the May budget unveiled by Treasurer Wayne Swan left the NHMRC funding largely intact, and actually increased its medical research allocation by 4.3 per cent to almost $750 million in 2011–12.

This is clearly a good outcome and will help sustain Aboriginal and Torres Strait Islander health research at this critical time, with governments around Australia relying on good research evidence to underpin their commitments to the COAG Closing the Gap targets. It is, therefore, timely that our guest editorial comes from Dr Tom Calma, current co-Chair of the Close the Gap (CTG) Campaign Steering Committee. Dr Calma describes the hard work that went into gaining bipartisan political support for

02 CONTENTS / LOWITJA INSTITUTE UPDATE

INSIDE THIS ISSUE:

02 CONTENTS / LOWITJA INSTITUTE UPDATE

02 Alana takes nutritious route to our door02 Brisbane office on the move – again! 03 Keating revisits Native Title reforms in

Lowitja O'Donoghue Oration03 More appointments to advisory body04 Professor Jackson Pulver awarded AM04 Speeches focus on future challenges05 History made in award of top ANU prize05 Koori Mail – 20 years and 500 editions

06 EDITORIAL

06 Guest Editorial: Dr Tom Calma

08 RESEARCH ACTIVITIES

08 Research activites update09 Core partners in MJA award 10 Teasdale Corti project wraps up11 Workshop helps identity debate11 Discussion paper on genetic research12 Research transfer targets high

incarceration rates in Qld

13 RESEARCH COMMUNICATIONS

13 Link meeting welcomes new faces14 Spreading our message through the

press... and now we're on twitter!15 Institute launches good research guide16 Supporting corporate services16 Follow-up on compliance burden17 Koori youth health and wellbeing17 Time for Australia to listen to its children18 Overcrowding stymies child health18 Paper: scope to improve health centres19 Governments fiddle while eyesight fails

20 NATIONAL POLICY NEWS

20 National Congress welcomes delegates to first annual meeting

21 Health a top priority for Congress21 Gillard seals national health reforms22 Infant mortality rates halve in two years22 NT Intervention Mark II consultations23 Budget delivers boost to health services23 $13m for dialysis hubs in NT24 Aboriginal youth imprisonment tragedy24 CRN funding for Batchelor25 AMA awards 25 AMA Indigenous Health Report Card26 Serious injuries plummet after grog bans26 Combating alcohol's health toll 27 Monash’s School of Indigenous Health27 Toolkit builds ‘care partnership’ between

community and GPs28 AIHW report on disadvantage 28 QUMAX lifts prescription uptake29 Families key support to those with

chronic illness: study29 Thumbs Up! to good nutrition

30 NEWS IN BRIEF

Alana takes nutritious route to our door

'While I did my degree I also worked part-time in a physiotherapy practice, which I loved, but I decided that I really wanted to get into Aboriginal health research where my passion lay. So when the opportunity came up to work at the Lowitja Institute, I jumped at it.

‘I work really closely with Liz (Program 1 Manager Dr Liz Izquierdo) and I’m learning lots of new skills from her, so right now I just couldn’t be happier in my career path.’

Brisbane office on the move – again!

A keen awareness of the importance of diet and proper nutrition to maintaining good health is a key motivator for Alana Gall, our Program 1 Administration Officer who joined the Lowitja Institute in May 2011.

A Palawa woman from Tasmania who grew up in Queensland, Alana says her interest in nutrition was sparked by her mother’s success in treating her father’s diabetes through dietary techniques.

‘Mum got Dad off processed foods and switched instead to whole foods, and the approach worked so well that Dad ended up getting rid of his diabetes altogether,’ Alana says. ‘That led me to want to study alternative approaches to healing and to focus on eating well myself.'

Alana worked for 10 years in a variety of occupations before deciding to embark on a three-year degree in alternative medicine at Brisbane’s Endeavour College of Natural Medicine, which she finished at the end of 2010.

The Institute’s Brisbane office has a new home, ending the period of dislocation that started with the January 2011 Brisbane floods, which forced us into temporary accommodation in the Brisbane CBD.

The new address is: Level 1/147 Wharf Street, Spring Hill, Qld 4000. You can still contact Program 1 Manager Dr Liz Izquierdo and Administration Officer Alana Gall on the same phone number as previously: +61 3 8341 5521.

03Wangka PulkaISSUE FOUR / AUGUST 2011

Keating revisits Native Title reforms in Lowitja O

,Donoghue Oration

One of the highlights of the past few months was undoubtedly the Lowitja O’Donoghue Oration, delivered by former Prime Minister the Hon. Paul Keating in the ornate surrounds of Bonython Hall at the University of Adelaide on 31 May.

Institute staff and management were among the packed audience who listened to Mr Keating deliver a detailed account of the development and implementation of Native Title legislation following the High Court’s historic 1992 Mabo decision.

The Lowitja O’Donoghue Oration is an annual event organised by the Don Dunstan Foundation and Mr Keating told the audience he specifically accepted the invitation to speak out of respect for Dr O’Donoghue as ‘a remarkable Australian leader’. The Native Title legislation was among the signature achievements of the Keating Government, and in his address ‘Time to revisit native title laws’ Mr Keating paid tribute to the role of our Patron in mobilising Aboriginal and Torres Strait Islander support for the laws.

‘As it turned out – only she could do it. She was the chair of ATSIC. This gave her a pulpit to speak

from but no overarching authority, much less power. But this is where leadership matters: she decided, alone decided, that the Aboriginal and Torres Strait Islander peoples of Australia would negotiate, and I emphasise negotiate, with the Commonwealth Government of Australia – and that the negotiators would be the leaders of the Indigenous land councils.

‘This is why I am here tonight: to acknowledge that moment of leadership and to celebrate it.’

Mr Keating lamented the impact of amendments to the Native Title Act and its subsequent narrow interpretation by the courts,

The Hon. Paul Keating delivers the 2011 Lowitja O’Donoghue Oration in Adelaide

More Institute appointments to peak health advisory body

saying the ‘onerous burden of proof’ required to demonstrate continuity of connection to country ‘has placed an unjust burden on those native title claimants who have suffered the most severe dispossession and social disruption’.

However, he also highlighted the success of the Indigenous Land Corporation, which was set up to fund land purchases for Aboriginal and Torres Strait Islander people who had suffered total dispossession and loss of connection to their traditional lands.

Mr Keating presented his signed speech to Dr O’Donoghue at the close of the Oration.

One of our Board members, Dr Sanchia Shibasaki (right), is among the new appointments to the Australian Government’s peak Indigenous health advisory body, the National Aboriginal and Torres Strait Islander Health Equality Council, which was

formerly known as the National Indigenous Health Equality Council or NIHEC. She joins our Research and Innovation Director Professor Ian Anderson, who was reappointed as Chair, and Institute consultant Tanya Hosch, who was reappointed as Deputy Chair.

LOWITJA INSTITUTE UPDATE

04

Professor Jackson Pulver awarded AM Congratulations to Institute Board member Professor Lisa Jackson Pulver, who was made a Member of the Order of Australia (AM) in this year’s Queen’s Birthday Honours List.

Professor Jackson Pulver has a formidable record of achievement in medicine and health, being the first Aboriginal Australian to receive a doctorate in medicine from the University of Sydney and a co-founder and current Director of the Muru Marri Indigenous Health Unit at the University of New South Wales, where she is also a Professor of Indigenous Health.

Her citation in the Honours List lauds her ‘service to medical education, particularly through the Muru Marri Indigenous Health Unit at the University of New South Wales, and as a supporter of educational opportunities for Aboriginal and Torres Strait Islander people’.

Professor Jackson Pulver, who has been a practising Jew since 2004, was also elected in 2010 as the president of her Orthodox synagogue in Newtown, Sydney – the first Aboriginal Australian ever to hold such a post.

Tackling the big issues: speeches focus on change and future challenges Lowitja Institute Chair Pat Anderson was the keynote speaker at the 3rd Aboriginal Health Conference held by the Coalition for Research to Improve Aboriginal Health (CRIAH) from 5–6 May 2011 in Sydney. Entitled ‘Research for a better future’, Ms Anderson spoke about the great changes in the field of Aboriginal health research over the past 20 years and how collaborations with the Aboriginal community and its organisations was now seen as best practice.

However, she said much remained to be done and that it was still a challenge to ensure sound evidence informed public policy rather than hidden assumptions and agendas. Ms Anderson cited the 2007 Northern Territory ‘Intervention’ as an example of flawed policy.

This was a theme built on by Dr Arabena in her Redfern Oration to

the RACP (Royal Australian College of Physicians) Congress in Darwin on 24 May 2011. In her speech ‘Acceptable loss: accomplishing the mission’, Dr Arabena focused on the way negative discourses – particularly the use of military language – had begun to frame discussion of Aboriginal and Torres Strait Islander issues and inform policy responses such as the NT Intervention.

But Dr Arabena said times had changed and Australia’s Aboriginal and Torres Strait Islander people now had the individual qualifications and the collective, institutional strength to ‘push back’ against this misuse of language, particularly with the recent emergence of organisations such as the Lowitja Institute and the National Congress of Australia’s First Peoples.

On 3 June Dr Arabena also had the great honour of delivering the

Mabo Lecture at the 2011 Native Title Conference in Brisbane. In her address she took a wider look at what it means to be an Aboriginal or Torres Strait Islander Australian in our interconnected world, and how Indigenous identity fits with the materialistic, middle-class lifestyle of wider society.

Dr Arabena asked her audience to think about the next 50 years in Native Title, and how this might come to include a broader agenda encompassing ‘the health of ecosystems and all who reside in them’.

Full transcripts of these speeches are available on the Lowitja Institute website at www.lowitja.org.au/speeches.


Dr Kerry Arabena has made history as the first Aboriginal or Torres Strait Islander to receive the Australian National University’s prestigious JG Crawford Prize, which is awarded annually in recognition of the best intellectual contribution of any thesis in the arts, science and interdisciplinary categories.

She was awarded a Doctorate in Environmental Science in the field of human ecology at ANU in 2010 for her thesis entitled Indigenous

to the Universe: A Discourse of Indigeneity, Citizenship and Ecological Relationships. Much of the thesis was informed by her experiences living and working in many different communities across Australia in regional and remote areas.

Dr Arabena completed her thesis with support from AIATSIS (where she worked at the time) and the CRC for Aboriginal Health, which provided travel assistance.

Koori Mail – celebrating 20 years and 500 editionsOur Patron Dr Lowitja O’Donoghue, Chief Executive Dr Kerry Arabena and Media and Marketing Manager Tracey Johnston celebrated with more than 500 guests at the Koori Mail’s Twenty500 event in Sydney on 7 May 2011. The night was a huge success and a fitting tribute to the longevity (20 years and 500 editions) of the ‘Voice of Indigenous Australia’.

The event was hosted by the paper’s editor Kirstie Parker, and comedian Mary G, the ‘Queen of the Kimberley’, kept the laughs coming throughout the night. They were joined by a star-studded line up of entertainment that included Kev Carmody and the Gondwana National Indigenous Children’s Choir, Dan Sultan, Casey Donovan and her band, and contemporary and traditional dance by students from the National Aboriginal and islander Skills Development Association.

To add to the celebratory spirit of the night was a collection of

‘nostalgia shorts’ (films) that reminded the room of some of the significant events in Aboriginal and Torres Strait Islander affairs over the past 20 years.

The spirit brought to the event by all who attended on the night was a clear testament to the high esteem in which the Koori Mail is

held by not only Australia’s First Peoples, but by all Australians with an interest in Aboriginal and Torres Strait Islander issues. Thank you to Kirstie and co for a fabulous night and we look forward to the 30-year celebration!

Enjoying the Twenty500 celebrations (L–R): NSW Governor Her Excellency Professor Marie Bashir, NSW Aboriginal Land Council Chair Bev Manton and our Patron Dr Lowitja O’Donoghue. Photo by Amanda James, courtesy of the Koori Mail

History made in award of top ANU prize

Kerry Arabena receiving her award from ANU Vice-Chancellor Professor Ian Young. Photo by Stuart Hay

EDITORIAL06

Guest Editorial:Dr Tom Calma

DrTomCalmaisaKungarakanElderfromtheNorthernTerritoryandhasalongrecordofachievementinAboriginalandTorresStraitIslanderaffairswithacareerspanningmorethan38yearsasanacademic,publicservant,politicaladviseranddiplomat.Heisfounderandco-ChairoftheClosetheGapCampaignSteeringCommitteeandwastheAboriginalandTorresStraitIslanderSocialJusticeCommissionerandRaceDiscriminationCommissionerfrom2004to2010.MostrecentlyDrCalmawasappointedastheinauguralNationalCoordinatorforTacklingIndigenousSmoking,whereheleadsandmentorsthe$100.6millionCOAGTacklingIndigenousSmokinginitiativetoreducesmokinginAboriginalandTorresStraitIslandercommunities.

The goal of the Close the Gap (CTG) Campaign for Indigenous Health Equality is to close the 10 to 17-year life expectancy gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians within a generation (by 2030).

CTG has its origins in 2005 when, as Aboriginal and Torres Strait Islander Social Justice Commissioner, I released my Social Justice Report calling for the governments of Australia to commit to achieving health and life expectancy equality for Aboriginal and Torres Strait Islander peoples within 25 years, supported by a genuine partnership between all levels

of government in Australia with Aboriginal and Torres Strait Islander peoples and their representatives.

The campaign was formally launched in Sydney in April 2007 with about 20 peak health and related bodies forming a CTG Steering Committee to guide the campaign. Led by Aboriginal and Torres Strait Islander peak health bodies and key stakeholders, the campaign has achieved unprecedented levels of public support. National Close the Gap Day is held each year with 2011 being the biggest yet: nearly 900 community-based events attended by 120,000 Australians took place. The National Rugby


League has also dedicated an annual round of matches to the campaign, ensuring our message reaches millions.

Our major achievement has been securing the agreement of almost all Australia’s governments and opposition parties (including the Greens) to commitments contained in the 2008 Close the Gap Statement of Intent.

The main commitments are to create a comprehensive national plan for the achievement of Aboriginal and Torres Strait Islander peoples’ health equality by 2030, supported by a genuine partnership. This partnership is on a different basis from the way business has been done in the past, when politicians and bureaucrats tried to dictate to Aboriginal and Torres Strait Islander people what was best. In fact, empowerment and partnership are a vital part of the CTG approach – not only do we believe that we are best placed to make decisions about our health and the health of our communities, but numerous studies demonstrate that empowerment is in itself a contributor to better health outcomes. It’s vital for our social and emotional wellbeing that we are in control of our lives and the life of our communities.

The CTG and the Statement of Intent were also formative influences on the funding of $5 billion for Closing the Gap programs that Australian governments have announced since 2008, including $1.6 billion in new funding for health through the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes.

Late in 2010, the CTG leadership group joined with the Lowitja Institute and the National

Congress of Australia’s First Peoples to provide a specialised lobbying voice, complementing the work of CTG, as the Australian Government took the first steps towards developing a national plan for Aboriginal and Torres Strait Islander health equality, as it committed to do in the Close the Gap Statement of Intent.

This brings me to my role as National Coordinator for Tackling Indigenous Smoking. Smoking contributes to between 17 and 20 per cent of smoking-related diseases experienced by Aboriginal and Torres Strait Islander people so it is clearly a vital area to focus on if we are to achieve the COAG target of closing the life expectancy gap by 2030.

The Tackling Indigenous Smoking initiative effectively started on 1 July 2010 and began recruiting an anti-tobacco workforce in October 2010. The program will run for a little over three years, during which time we’ll be rolling out a workforce in 57 locations around Australia. Each location will have six staff including a Regional Coordinator, three Tobacco Action Workers and two Healthy Lifestyle Workers. This allows us to implement a multi-pronged approach, getting the communities to understand the dangers of smoking, working with them to identify ways to give up smoking and to promote the anti-smoking message to both current and non-smokers. The message is particularly important to get through to our young people because smoking is an addiction best avoided in the first place.

All the regions have total flexibility in how they go about reducing smoking. One of the really good things is that once a community has come up with an action plan to combat smoking, we can provide them with $110,000 a year to implement the program without them having to jump through any more hoops. This new way of doing business involves a recognition that combating smoking is not just a responsibility of government; it’s an opportunity for Aboriginal and Torres Strait Islander people as individuals to get involved and to take ownership of issues at the local level. Everywhere I go now people are thanking me for doing something about smoking. We’re raising awareness and we’re getting a lot of support.

Our target is to achieve by 2018 the same levels of smoking among Aboriginal and Torres Strait Islander populations as currently exists in the non-Indigenous population. We’ll see those impacts as our campaign starts to work, especially by not having young kids take up smoking.

All the work I do is focused on trying to create opportunities where the voices of Australia’s Indigenous peoples are heard at the highest levels, and to try and foster an ethos of partnership between Aboriginal and Torres Strait Islander peoples, organisations and government. If we can have a common vision and we’re able to present that, we can have a significant impact on our health, wellbeing and prosperity.

Our major achievement has been securing the agreement of almost all Australia’s governments and opposition parties to commitments contained in the 2008 Close the Gap Statement of Intent.

08 RESEARCH ACTIVITIES

In Program 1 (Healthy Start, Healthy Life), the Chronic condition management strategies in Aboriginal communities project is now underway. Its aim is to develop and demonstrate sustainable care plans in a collaborative endeavour involving three South Australian Aboriginal health services and the Centre for Clinical Research Excellence in Aboriginal Health. Care plans are first developed according to the priorities of each participating health services, then the impact of these interventions is assessed to determine their effectiveness.

Another project about to start is Implementation of innovations in Aboriginal and Torres Strait Islander health, which seeks to identify success factors and barriers to the widespread implementation of innovations in Aboriginal and Torres Strait Islander health care, and to form an evidentiary basis for the implementation component of Program 1. Meanwhile a Phase 1 clinical trial of a vaccine for group A Streptococcus is awaiting approval and is expected to commence within the next few months. Group A Streptococcus (GAS, Streptococcus pyogenes) is a bacterial pathogen responsible for a range of diseases including rheumatic fever and rheumatic heart disease (RHD). A vaccine has been developed and is ready for a phase 1 human clinical trial in healthy adults to assess the safety and immunogenicity of this formulation.

A number of other projects in the area of child and maternal

health and continuous quality improvement are being developed, and Program 1 is also providing support for PhD research into standardising diagnostic protocols for the early detection of RHD, which is expected to start in September 2011.

Program 2 (Healthy Communities and Settings) has undergone a change of Program Leaders from Dr Kevin Rowley and Leisa McCarthy to Dr Rosemary Aldrich and Alwin Chong, and one of the projects they hoped to implement was a Scoping study of constructs of health and relevant indicators. The scoping study went through an expression of interest process but was unsuccessful in finding suitably qualified people to conduct the research. This led to a decision to shift the project focus to health promotion and capacity building, and work has now begun on a series of interlinked projects to identify and develop health promotion tools using a four-stage approach that builds on knowledge already gained. The first stage will identify available tools; the second will develop new tools to fill identified gaps; the third will develop a training program for using the new tools; and stage four will train people in the use of the health promotional tools including implementation and evaluation. The health promotion initiative will be completed by 2014.

Two other projects have recently started in Program 2. The Aboriginal adult literacy campaign – Stage 1 project has emerged out of a CRCAH-sponsored workshop

in Alice Springs in April 2009 that examined the relationship between adult literacy and health, the international experience of the impact of adult literacy campaigns, and the details of how they were conducted to optimise success. Researchers will conduct a pilot Aboriginal Adult Literacy Campaign in two regions, to establish whether or not government should be asked to undertake a national campaign. The Lowitja Institute is supporting the preparatory stage which involves gaining support; securing funding from philanthropic and government sources; establishing an appropriate independent organisation to conduct the campaign; and arranging for parallel research activities, including the development of a relevant dataset to allow impact to be monitored and analysed over time. The Institute is also providing limited support to the Yarning up with Koori kids project, which is a partnership between the Victorian Aboriginal Health Service and the University of Melbourne to gain the perspectives of Koori children, aged 8 to 12, about health and wellbeing.

In Program 3 (Enabling Policy and Systems) a two-stage project looking at planning processes has completed its first phase – The role of planning processes in implementing National Partnership Agreements in Indigenous health – and the second phase – Planning, implementation and effectiveness (PIE) in Aboriginal and Torres Strait Islander health policy reform – has now begun. Stage 2 will build on the results of the first stage by using social network analysis to understand the relationship

A number of new research projects have begun in the past few months and more are close to starting as the Lowitja Institute’s research activity continues to build across all three program areas, with 12 projects now active and one project (the Aboriginal Young Dads project, Program 3) already completed.


between organisations involved in planning at different levels and the effects of this on program implementation. It will particularly focus on planning committees at both a State/Territory level and at a regional level, as these committees provide a critical link in the implementation of agreements with COAG (Council of Australian Governments) and regional planning processes.

As reported in the April edition of Wangka Pulka, the Funding, accountability and results (FAR) for Aboriginal health services – Closing the policy implementation gap? project aims to partner with funders and providers in two Australian States/Territories which are moving to implement primary health care reforms, in order to study them as they develop and generate evidence about what works and why. This project has been endorsed for funding in 2011–12.

Both the FAR and PIE projects went through a combined Quality Assurance workshop in Alice Springs in June 2011, which is part of the Institute’s facilitated development process to enhance research proposals. A good cross-section of representatives from the Aboriginal community controlled sector, the NT Government and

the Federal Department of Health and Ageing (Office of Aboriginal and Torres Strait Islander Health) in Darwin and Canberra attended.

A Workforce project commissioned by the National Aboriginal Community Controlled Health Organisation (NACCHO) and aimed at assessing the funding and policy arrangements for community-controlled providers of training for Aboriginal Health Workers and other health staff is also underway in Program 3. The project will be completed in 2011 and results published in 2012. The next step in developing the workforce research agenda for Program 3 will be the holding of a Roundtable in September 2011. Experts from the practice, policy and research arenas will convene to shape an agenda that is relevant to current needs and policy dilemmas.

All of the active projects are now detailed in a series of Program Fact Sheets available for download at www.lowitja.org.au/lowitja-institute-publishing#factsheets, and these will be regularly updated as current projects finish and new ones begin. A detailed summary of the findings of each project will also be provided in future issues of Wangka Pulka.

Core partners in MJA awardA research team including members from three of our core partners has taken out the Medical Journal of Australia/Pfizer Australia award for the best original research published in the MJA.

The paper – published in the 4 January 2010 edition of the MJA (vol. 192 no. 1, pp. 24–9) and authored by researchers from the Menzies School of Health Research, Charles Darwin University, Flinders University and the Royal Prince Alfred Hospital in Sydney – compared the effectiveness of two antibiotic regimens for the treatment of acute middle ear infection in Aboriginal children.

Researchers Peter Morris, Gaudencio Gadil, Gabrielle McCallum, Cate Wilson, Heidi Smith-Vaughan, Peter Torzillo and Amanda Leach set out to compare the clinical effectiveness of a single dose of azithromycin with a standard seven-day treatment course of amoxicillin for the treatment of acute otitis media (AOM). Between March 2003 and July 2005, they studied 306 Aboriginal children with AOM aged six months to six years in 16 rural and remote NT communities.

The results provide evidence that antibiotics which eradicate otitis media pathogens and reduce bacterial load in the nasopharynx are needed for the successful treatment of AOM. The research has important implications for health outcomes in Aboriginal children, who are prone to AOM.

To download the article go to www.mja.com.au/public/issues/192_01_040110/contents_040110.html.

Professor Judith Dwyer facilitates discussion at the combined QA workshop in Alice Springs

RESEARCH ACTIVITIES

10

Teasdale Corti project wraps up with ‘inspirational’ presentationsThe final meeting of participants in a landmark international study on the role of comprehensive primary health care took place in Ottawa, Canada from 13–17 June 2011, with all the separate global projects presenting their findings. Institute Chair Pat Anderson and Program 2 & 3 Manager Vanessa Harris attended the meeting, along with representatives from the Australian project teams.

The Revitalizing Health for All – Learning through Comprehensive Primary Health Care (CPHC) Experiences study was funded by Canada’s Teasdale Corti Foundation and involved separate research projects in Canada, Aotearoa (New Zealand) and Australia. The study was conceived in 2005 at a meeting of the Peoples’ Health Assembly held in Ecuador as a way of documenting the importance of CPHC as an appropriate and essential system response to improving the health of the world’s Indigenous and marginalised peoples. It brought together an international group of community health practitioners, researchers and activists, under the broad umbrella of the People’s Health Movement and the International People’s Health University.

The aim of the research teams in each project location was to build and strengthen a global CPHC network, and to increase the understanding of and support for CPHC as a basis for health system renewal among researchers, practitioners, policy makers and civil society organisations.

The CRC for Aboriginal Health and now the Lowitja Institute supported the Australian leg of the study, which commenced in 2008–09 at locations in Alice

The Ingkintja Learning From Comprehensive Primary Health Care Experiences project examines how the Central Australian Aboriginal Congress Male Health Program reflects the social determinants of health affecting Aboriginal male health, as articulated by Aboriginal males living in the Alice Springs region.

Aboriginal males identify the need for individuals to take responsibility for their actions, with appropriate support, as this will lead to beneficial changes for their families and then their communities, and build individual and collective capacity to address broader social issues that contribute to community health. These Aboriginal males locate their health within a social and emotional health framework.

The identified strengths of Ingkintja include: a high degree of cultural safety (and being male only); a mix of preventative, health promotion, treatment and rehabilitation services; taking a broad holistic view of health; the drop-in centre approach; multi-disciplinary staffing; advocacy on the social determinants of health; and flexibility and responsiveness in approach and service delivery. This approach has seen a significant increase in access rates by Aboriginal males.

Congress Ingkintja provides a very successful health service program, with strong community support and high utilisation rates, to Aboriginal males in the central Australian region. Utilising community development and comprehensive primary health care principles, Ingkintja staff work sympathetically and effectively with Aboriginal males to empower them to take action to address the social determinants of health. The program balances its focus on developing individual capacity to deal with these issues, with broader advocacy work at the structural and policy level.

Ingkintja – Learning From Comprehensive Primary Health Care ExperiencesClive Rosewarne, Gai Wilson, John Liddle, Steve Lake and Korey Summers

The Victorian Aboriginal Health Service (VAHS), established in the inner Melbourne suburb of Fitzroy in 1973, has been offering a Comprehensive Primary Health Care (CPHC) service to Aboriginal people for nearly 40 years. VAHS has played a vital role in the Aboriginal community controlled health service sector in Victoria and Australia.

This project, based at VAHS, has sought to conduct an historical analysis of CPHC. It explores the ongoing history of VAHS, and its overall role in driving CPHC, via a literature review, interviews and a focus group. The social determinants of health are also considered as part of VAHS’s CPHC approach.

What will be demonstrated is how Aboriginal people have driven the CPHC agenda and addressed the issues that have surfaced over the past 40 years. Furthermore, it will highlight key aspects in the journey and suggest issues for the future. The project has offered a way to revitalise the past and renew enthusiasm for the future.

Within Australia, this project has been supported by the Victorian Aboriginal Community Controlled Health Organisation (VACCHO), the Cooperative Research Centre for Aboriginal Health and The Lowitja Institute.

Revitalising Comprehensive Primary Health Care at the Victorian Aboriginal Health ServiceBronwyn Fredericks, Joanne Luke and Alan Brown

The Urapuntja Health Service is an Aboriginal Community Controlled Health Service located in a remote region of Central Australia. It services a population of about 1000 permanent residents who live in 16 homeland communities. The original Aboriginal nation was spread out over many thousands of kilometres but after colonisation, the massacres and then a ‘buy back’ of their own land the Alyawerr mob decided to cluster in the area of Utopia, with each family group having their own space ‘to keep the peace’.

This has proven to be very successful and the communities live with much of their culture and traditions intact. Alyawerr language is strong and English is always a second or third language.

The Urapuntja Health service has been delivering core primary health care services to the community for more than 30 years; the health board management and community members determine how the service works and as a consequence health statistics at Utopia are better than in many other remote communities.

Employment of local Aboriginal people has been the mainstay of the service, and an exchange of language and ideas has assisted the health service to become what it is today. Although the struggle to remain viable and independent continues, the Urapuntja Health Service’s aim of delivering an holistic service assists the community to make informed decisions about their lives and their health into the future.

Urapuntja Health Service and Utopia community Sarah Doherty, Joyce Jones, Garry Jones, Alex Brown and Kevin Rowley

Springs (managed by CAAC); Utopia in Central Australia (managed by the Urapuntja Health Service); and in Melbourne (managed by the Victorian Aboriginal Health Service). All three projects have now finished and a regional commentary report detailing the outcomes of the three projects is in its final stages of design. Posters presented at the Ottawa meeting summarised the key findings of the three Australian projects, while a map (shown above) provided by the Lowitja Institute highlighted where the sites were in Australia.

The University of Queensland’s Dr Bronwyn Fredericks, who attended the meeting and co-authored the regional commentary report along with La Trobe University Associate Professor David Legge, said the gathering of researchers had been ‘inspirational’.

‘As participants we had the opportunity to hear about the range of projects, tease out specific elements and question and challenge each other on process and praxis,’ Dr Fredericks

said. ‘What I found interesting was the similarities in the day-to-day issues our communities are struggling with, such as poverty, food security, education, housing, conflict, representation and local and governmental politics. There were also differences such as the experiences of colonisation, civil war, resource and land exploitation and the impacts of globalisation on primary producers in third world countries.’

‘Other participants were extremely interested in the three Australian projects and in the Aboriginal community controlled health organisation (ACCHO) model. I think some were surprised by the level of control and say that Aboriginal people have within Aboriginal community controlled health organisations.’

The Australian regional commentary report will be available for download from www.lowitja.org.au in September. In the next issue of Wangka Pulka we will also showcase the fantastic posters developed by the three Australian project teams.

Map of the three Australian sites


Workshop helps frame debate around identityA workshop supported by the Lowitja Institute and dedicated to continued discussions around issues of Aboriginal and Torres Strait Islander identity was held in Canberra on 18–19 April 2011, attracting participants from all over Australia.

The Identity Workshop was convened jointly with the Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) and flowed on from an earlier workshop that discussed the significance and impact of perceptions of identity, authenticity and deficit on the relationships between the many nations, groups and individuals who constitute

Australia’s First Peoples today. This resulted in the publication of the AIATSIS Discussion Paper Will the Real Aborigine Please Stand Up: Strategies for Breaking the Stereotypes and Changing the Conversation.

The second meeting – facilitated by Kerry Arabena, Scott Gorringe, Will Davis and John Davis – continued the discussions around perceptions of identity and notions of ‘authenticity’, and, critically, the development of a framework that will enable change from grass-roots level to public policy.

At the meeting, attended by 55 Aboriginal and Torres Strait

Islander people, it became clear that young people had a great deal to contribute to the debate. In recognition of the importance of their voice and the changing landscape of identity for many of Australia’s First Peoples, there will be a forum at the 2011 AIATSIS National Indigenous Studies Conference (19–22 September) devoted to discussion for young people on this issue.

For details of the conference, including the program, please go to www.aiatsis.gov.au/research/conf2011/conf2011.html. The AIATSIS discussion paper can be downloaded from www.aiatsis.gov.au/research/discussion.html.

Discussion paper tackles thorny issue of genetic researchA discussion paper highlighting issues in genetic research involving Aboriginal and Torres Strait Islander communities has emerged out of a groundbreaking Genetic Research Roundtable convened by the Lowitja Institute in 2010.

Genetic Research in Aboriginal and Torres Strait Islander Communities: Beginning the Conversation is a joint publication by the Lowitja Institute and the University of Melbourne, and was launched by Dr Kerry Arabena at the second Lowitja Institute Genetic Research Roundtable held in late July 2011. It contains the background papers provided to participants in the lead-up to the first Roundtable as well as a summary of the Roundtable discussions and a comprehensive list of reference materials.

‘The issues are difficult and challenging, and we are the first

people in this country to really think about them,’ Dr Arabena said.

In his preface to the discussion paper, Lowitja Institute Director of Research and Innovation Professor Ian Anderson acknowledges the concerns of Australia’s First Peoples around genetic research, including genetic theft or ‘biopiracy’ and the potential for genetics to be used to determine Aboriginality.

‘Although comparable nations such as Canada, the United States and New Zealand have a long history of discussing these issues, in Australia these conversations had not yet taken place [until the Roundtable],’ Professor Anderson said.

He says the Institute is ideally positioned to manage ‘difficult conversations’, such as those about genetic research, with the aim of creating a community of interest

around such research and to foster collaborative genetic research.

The July Roundtable had a much larger and even more diverse group than last year’s, with representatives from Aboriginal and Torres Strait Islander organisations, ethics committees, research institutes, and national bodies including AIATSIS and the NHMRC. The Roundtable heard about current genetic research projects taking place in Aboriginal and Torres Strait Islander communities, and debated the ethical issues associated with this kind of research.

The discussion paper was co-authored by Dr Emma Kowal, Lobna Rouhani and Professor Ian Anderson and is available for download at www.lowitja.org.au/lowitja-institute-publishing.

RESEARCH ACTIVITIES

12

Research transfer targets high incarceration rates in Qld

Our University of Queensland Link person, Wiradjuri descendant Megan Williams, has been making progress with research transfer activities stemming from her current PhD research in support of broader efforts to reduce Queensland’s alarmingly high Aboriginal and Torres Strait Islander imprisonment rate.

One of the main ways she has been doing this is through her role as one of the directors of Project 10%, a company campaigning to lower the number of Aboriginal and Torres Strait Islander prisoners in Queensland jails. Project 10% recently won a Premier’s Reconciliation Award and has also released its first set of printed resources including the booklet Wundirra: Standing in the Light of Aboriginal and Torres Strait Islander People, launched by Aboriginal and Torres Strait Islander Social Justice Commissioner Mick Gooda.

Wundirra is the second booklet of stories related to Megan’s strengths-based qualitative PhD research on the role of families and service providers in supporting Aboriginal people released from prison in Brisbane. In Queensland, Aboriginal and Torres Strait Islander people are currently at least 13 times more likely than others to be in prison, a dramatic worsening since the 1991 Royal Commission into Aboriginal Deaths in Custody, and despite well-intentioned past policy.

‘Few people disagree that it makes social and economic sense to understand better programs

that Aboriginal and Torres Strait Islander people access and see as successful,’ Megan said. ‘Wundirra showcases the incredible leadership by Aboriginal and Torres Strait Islander people, and Project 10% is the structure that motivates us and actively distributes our messages.’

‘Feedback received about Wundirra includes how rare it is for mainstream service providers and policy makers to directly hear the voices of Aboriginal and Torres Strait Islander people. It was deliberate that the stories in Wundirra and the previous book were not the end-product of research but the active use of material in an immediate, accessible way. There are many parts of research processes that are transferable to policymakers, service providers and community members.’

Research transfer through Project 10% has also included turning literature reviews into fact sheets for broad distribution; using emerging data analysis to inform submissions to the Queensland Government Draft Justice Strategy; and drawing on a synthesis of literature, research and practice to help conceptualise Project 10%’s five key Action Areas for addressing over-imprisonment in Queensland, which in turn helps to partner with and inform others.

For Megan, the keys to research transfer through Project 10% are relationships, timeliness and perseverance: ‘Relationships within Project 10% help identify needs and opportunities,

develop skills and share the load. Relationships with external stakeholders have been strengthened because of our regular information sharing, follow-up and reinforcement of key messages.’

Megan’s joint directors at Project 10%’s include Ken Georgetown from Murri Watch, Colleen Wall from the Aboriginal and Torres Strait Islander Women’s Legal and Advocacy Service, Kitty Cara and Monique Bond from ANTaR Qld and Norm Clarke from Emergency Services Queensland, along with a working group which has been meeting regularly for almost three years.

To obtain copies of Wundirra, please contact Megan at: [email protected].

Megan’s PhD research on the role of Aboriginal families and service providers supporting people exiting prison in Brisbane is currently funded by a NHMRC Capacity Building Grant on Indigenous Offender Health and by the Lowitja Institute.


Link meeting welcomes aboard new facesThe National Wine Centre in Adelaide was the venue for the second CRC for Aboriginal and Torres Strait Islander Health Link People face-to-face meeting, which was held at the beginning of June 2011 following the Lowitja Institute staff meeting. Representatives from nine of our partner organisations attended and Dr Kerry Arabena presented them with an Institute badge in recognition of the importance of the Link role to the Lowitja Institute.

Dr Arabena also welcomed aboard our new Link person from the Central Australian Aboriginal Congress (CAAC), Tahnia Edwards, who started in her role in May 2011. Tahnia is an Arrernte woman from Alice Springs and a registered nurse who is currently a Research Associate with the South Australian Community Health Research Unit at Flinders University. She is based at Congress where she is assisting with the Exploring Comprehensive Primary Health Care in Local Communities project (www.flinders.edu.au/medicine/sites/sachru/research-evaluation/comprehensive-primary-health-care-in-local-communities.cfm), which includes Congress as one of six primary health care services participating in the study.

‘My Arrernte ancestors and family come from the area where Alice Springs was built and nearby, so I have a large family network in this special part of the country,’ Tahnia said. ‘I’m fairly well known to the people here at Congress and I’ve got a very good understanding of the organisation, having been an employee in the past, and having served as a Congress Board Member for a number of years.’

‘I started my journey in the health sector in the 1980s and my most valued experience was Remote Area Nursing. I had the privilege of working for the Pintubi Homelands Health Service at Kintore for four years, and I’ve since lectured in Aboriginal health in undergraduate and postgraduate programs.’

Tahnia has also previously participated in a variety of health research activities, including projects involving the CRCAH and our long-term partner the Menzies School of Health Research (MSHR).

Another familiar face at the meeting was Linda Quall, who has replaced Normie Grogan as the MSHR Link Person and who many would remember from her four years as an Administrative Support Officer at the CRCAH. Since leaving the CRCAH Linda has been working at MSHR as the Indigenous Administrative and Development Officer, where her duties include filling the secretariat role for MSHR’s Child Health Division Indigenous Reference Group and the Healing and Resilience Indigenous Reference Group.

‘It’s great to be back in touch with the CRC mob,’ Linda told Wangka Pulka. ‘My first face-to-face Link meeting went well and it was really good to see old faces and catch up again.’

Linda and the other Link People at the meeting heard about the Institute’s latest research activities and were provided with an update on the Institute’s branding strategy from Media and Marketing Manager Tracey Johnston.

We were very sad to farewell Normie Grogan as he has provided a valuable and always joyful contribution to the Link role over several years. Prior to the meeting we also said goodbye to Shaun Tatipata, Link Person for Danila Dilba Health Service, and Gail Garvey from the Queensland Institute for Medical Research. Shaun is now with the Fred Hollows Institute working as Senior Eye Health Project Officer (www.hollows.org.au/Page.aspx?ID=2610), while Gail has moved with her research team to MSHR’s Brisbane office. In the next issue of Wangka Pulka we will talk to Gail about her move and the work she is involved in, particularly in cancer research.

We would like to thank Gail, Normie and Shaun for their commitment to the Link role.

Linda Quall (above), new Link Person at MSHR and Tahnia Edwards (below), new Link Person from CAAC

RESEARCH COMMUNICATIONS

14

Spreading our message through the press...The Lowitja Institute is continuing to spread the message about both its research activities and its role in building the participation of Aboriginal and Torres Strait Islander people in the health workforce, with a number of recent articles in the key medical/health press.

Dr Kerry Arabena teamed up with our specialist writer Dave Moodie to contribute an article to the annual Indigenous health issue of the Medical Journal of Australia, published on 16 May 2011 (vol. 194, no. 10). ‘The Lowitja Institute: building a national strategic research agenda to improve the health of Aboriginal and Torres Strait Islander peoples — Research Enterprise’ summarises the development of the Institute’s research agenda from our beginnings 14 years ago and provides an insight into our unique approach to research.

The issue also contained a number of other articles from researchers involved in current and past Institute activities, including Yin Paradies on the impact of racism, David Thomas and Ross Andrews on maternal smoking, and Gail Garvey, Joan Cunningham and Ross Bailie on reducing the burden of cancer. To download articles from the MJA issue, go to www.mja.com.au/public/issues/194_10_160511/contents_160511.html.

In June Dr Arabena again teamed up with Dave Moodie to provide a feature article for RACP News, the official newsletter of the Royal Australasian College of Physicians (vol. 31, no. 3). The article reflects on the power of language to influence the esteem and wellbeing of Aboriginal and Torres Strait Islander people, and how the development of their own powerful institutions is at last allowing Australia’s First Peoples to ‘push back’ against negative

...and now we,re on twitter!

stereotyping. To download this article, go to www.lowitja.org.au/announcements_archive.

The Primary Health Care Research & Information Service (PHC RIS) is an important knowledge broker in the health research space and the Lowitja Institute is continuing its strong links with the organisation. In July we chose the annual PHC RIS Conference to launch Researching Indigenous Health: A Practical Guide for Researchers (see p. 15), and in August our Director of Research and Innovation, Professor Ian Anderson, provided the guest editorial for the online newsletter PHC RIS infonet (vol. 15, issue 6). In his editorial he focuses on Program 1 research activities and how they contribute to improving the standard of primary care delivered by community controlled health organisations. Read the article online at www.phcris.org.au/publications/infonet/2011/august/editorial.php.

So you subscribe to our e-Bulletin and you read our newsletter… how about following us on twitter? We have added twitter to our information arsenal to provide a rich source of up-to-the-minute information on our achievements and events. At the time of writing we have close to 150 followers and we in turn are following our partners, relevant peak bodies and selected media to keep ourselves informed of the very latest developments.

To join the conversation go to our website and click on the ‘follow us’ button on the home page.


Institute launches guide to good research An important resource and contribution to ensuring health research has a real impact on improving the life expectancy of Aboriginal and Torres Strait Islander peoples, and on helping to ‘close the gap’, was launched by Gail Garvey, Deputy Division Head of Epidemiology and Health Services Division at the Menzies School of Health Research at this year’s Primary Health Care Research Conference in Brisbane.

Researching Indigenous Health: A Practical Guide for Researchers was written by Alison Laycock with support from Diane Walker, Nea Harrison and Jenny Brands, and is a companion volume to Supporting Indigenous Researchers: A Practical Guide for Supervisors (CRCAH 2009). It is a hands-on guide that includes step-by-step processes, tips and checklists, and uses plain words and a variety of voices to explain what research principles, values and processes look like in practice.

The guide has been developed in response to a need identified by the Lowitja Institute for resources and advice about how to conduct best practice health research in Aboriginal and Torres Strait islander communities.

‘We wanted to develop a resource that provides existing and potential researchers with information about the history, context, values and changing priorities of Aboriginal and Torres Strait Islander health research in Australia, and guidance in how to design and manage successful research projects,’ said co-author Diane Walker.

The guide is full of stories and advice from researchers, community representatives and health services staff. Contributors

explain, for example, how a researcher might approach community to seek support for research, to engage participants and the users of research in the design and management of research projects, and to ensure that research findings reach the right audiences and are used for change after the project.

Many people were involved in the development of this publication including staff, Board members and Link people in the partner organisations of the CRCATSIH and the Lowitja Institute. But particular thanks go to the 189

people who contributed to developing and reviewing the two guides, along with their 60 employing organisations.

In subsequent newsletters, we’ll be sharing some of the research tips and best practice case stories from the guide, and be encouraging readers to contact us with any new ways of both doing research and disseminating research findings. We would also like to add to the case stories already on our website, so please contact Diane Walker, Research Training and Development Coordinator ([email protected]) with any innovative research and dissemination methods that have worked for you.

Copies of the guide are available for purchase from the Lowitja Institute website at www.lowitja.org.au/resources-researchers.

a practical guide for researchersAlison Laycock with Diane Walker, Nea Harrison and Jenny Brands

researching Indigenous health:

cover_FINAL amended.indd 1 20/07/11 8:21 AM

Two of the authors, Diane Walker and Alison Laycock, with Gail Garvey who launched the guide in Brisbane


16

Supporting corporate services

Follow-up on compliance burden

The corporate support needs of Aboriginal community controlled health services (ACCHSs) was the prime focus of a project begun under the CRCAH and which has now finished its work with the publication of a detailed report, case studies, summary report and the upcoming launch of a web tool.

The aim of the Corporate Services for Indigenous Primary Health Care Services project, carried out by La Trobe University’s Australian Institute for Primary Care and Ageing and the University of Melbourne’s Onemda VicHealth Koori Health Unit, was to gain knowledge about how to support the corporate functions of ACCHSs. Key questions guiding the research included: What are the corporate support needs of ACCHSs, and what factors influence the support required? How do ACCHSs get

the corporate support they need? What organised support structures have been developed to address these needs?

Four different approaches to sharing corporate services were documented as case studies, including from Bila Muuji Health Services Incorporated, Central Australian Aboriginal Congress, Katherine West Health Board and the Queensland Aboriginal and Islander Health Council. The project findings are reported by authors Kate Silburn, Alister Thorpe and Ian Anderson in Taking Care of Business: Corporate Services for Indigenous Primary Health Care Services.

As a result of the knowledge gained from this project a web tool has also been developed to help ACCHSs work through decision-making about obtaining corporate

support. This tool will be uploaded onto the Lowitja Institute website in September 2011.

The three reports are also available electronically at www.lowitja.org.au/lowitja-institute-publishing. If you would like printed copies, please email [email protected] and include your postal address. For further information, contact Kate Silburn (+61 3 9479 3514 or [email protected]) or Alister Thorpe (+61 3 8344 0640 or [email protected]).

A team of researchers led by Professor Judith Dwyer from Flinders University has released a follow-up survey to their 2009 landmark Overburden Report, providing further evidence of the onerous and complex system of accounting and reporting faced by Aboriginal community controlled health services (ACCHSs) around Australia.

In the survey, Aboriginal Community Controlled Health Service Funding – Report to the Sector 2011, Professor Dwyer and her team aimed to update the information from the first study with data from a larger sample and a more recent financial year (2007/08).

‘This is necessary because while individual local, State and Commonwealth Government departments and non-government

organisations (NGOs) have an overview of their own funding and accountability requirements, no agency provides accurate information about the total funding for the ACCHS sector,’ the report says.

The report was funded by the Lowitja Institute and combined the results from a two-part questionnaire sent to ACCHSs with information from the services’ audited reports and financial statements. This enabled a complete financial analysis of 28 ACCHSs, representing 21 per cent of the sector nationally. Further analysis showed there had been little or no change in the compliance burden faced by ACCHSs since the previous report was compiled, with an average of 21 grants per ACCHS.

The report confirmed that ACCHSs are ‘the only sector of the health system that provides a broad range of essential primary health care services from a base of short-term fragmented contracts from multiple sources’. Anecdotal evidence suggests that while there has been some progress on lengthening the duration of contracts (to three years), fragmentation continues and reporting requirements remain onerous.

To download the report please go to www.lowitja.org.au/lowitja-institute-publishing.

TAKING CARE OF BUSINESS | Overview Report 1

OVERVIEW REPORT

TAKING CARE OF BUSINESS:Corporate Services for Indigenous Primary Health Care Services

Kate Silburn, Alister Thorpe and Ian Anderson

Controlled HealthReport to the Sector 2011

Aboriginal Community

Service FundingAngelita MartiniUning MarlinaJudith DwyerJosée LavoieKim O’DonnellPatrick Sullivan


In 1996 the Victorian Aboriginal Health Service (VAHS) in the inner Melbourne suburb of Fitzroy began a longitudinal study known as the Young People's Project (YPP) on the health and wellbeing of young Koori 12–25 year olds living in Melbourne. That year the YPP conducted 15 focus group discussions, followed by 176 completed surveys in 1997–98 and an additional 122 in 2000–01.

The results of the YPP are currently being made available. An article based on the study, ‘Racism and Health among Urban Aboriginal Young People’ by Naomi Priest, Yin Paradies, Paul Stewart and Joanne Luke in the July 2011 BMC Public Health journal, found that racism was reported by a high proportion (52.3 per cent)

Time for Australia to listen to its children

of study participants. It also found that getting angry at racist remarks mediated the relationship between self-reported racism and general health, and that acknowledging and addressing racism was an important determinant of health and wellbeing.

Details of these and other findings can be found in the full report, Victorian Aboriginal Health Service Young People’s Project, which has just been published by the Lowitja Institute. The report presents findings from the many interviews with young Kooris, including information about the study population, health status, social determinants of health, behavioural determinants and access to services.

Victorian Aboriginal Health Service Young People’s ProjectA Study of the Health and Wellbeing of Koori Youth in Melbourne

A launch of the report is being planned by VAHS for the end of September, after which a downloadable PDF of the report will be made available on both the VAHS and Lowitja Institute websites. Please contact Joanne Luke at VAHS on +61 3 9419 3000 for further information.

A report into the current status of Australian children’s rights prepared by non-government organisation (NGO) the Child Rights Taskforce has found there are unacceptable gaps in the legal protection of children’s rights, especially for Aboriginal children.

The report, Listen to Children, was submitted to the United Nations Committee on the Rights of the Child earlier this year in response to a report submitted to the Committee by the Australian Government in October 2008 as part of its reporting obligations under the UN Convention on the Rights of the Child, which Australia ratified in 1991.

The Taskforce is a coalition of Australian organisations committed to the development of child rights, and in December

2010 the Taskforce held a workshop in Melbourne hosted by the Lowitja Institute and the National Children’s and Youth Law Centre, which was a key step in the development of the NGO report.

The report claims that while Australia had made some progress in improving children’s rights in the five years since it last appeared before the UN committee, we had still not effectively incorporated human rights into policy and legislative frameworks to support Australian children.

According to the report:

• 1048 children are currently being held in immigration detention;

• Almost half of all homeless people in Australia are under the age of 18; and

• Aboriginal children aged 10–17 are 24 times more likely to be jailed than non-Aboriginal children, and Aboriginal children are almost 10 times more likely to be in out-of-home care.

For Australia to meet its commitments the report recommends a few core initiatives:

• The Convention should be incorporated into Australian law;

• A comprehensive National Plan of Action for Children and Young People should be created and implemented, in partnerships with children and civil society; and

• An independent National Children’s Commissioner should be established.

To download a full copy of Listen to Children, go to www.childrights.org.au/listen-to-children-reports.

Documenting Koori youth health and wellbeing


18

Better housing, but overcrowding stymies child health benefits: studyA recently published paper looking at how improved housing for Indigenous families living in remote communities impacts on child health has found that, while hygienic conditions did improve, pervasive and persistent high levels of crowding and poor social and environmental conditions meant there was no measurable improvement in the health of children in those communities.

The Impact of Housing Improvement and Socio-environmental Factors on Common Childhood Illnesses: A Cohort Study in Indigenous Australian Communities was co-authored by Professor Ross Bailie – the Lowitja Institute’s Program Leader for Program 1 – and appeared in the 21 June 2011 online edition of the Journal of Epidemiology and Community Health.

Professor Bailie and his fellow researchers, Matthew Stevens and Dr Elizabeth McDonald, studied 418 children aged seven years or younger in 10 Northern Territory communities that benefited substantially from government-funded housing programs between 2004 and 2005.

Previous research has shown that elements of the household and community environment are important underlying determinants of the occurrence of common childhood conditions, which impair child growth and development and contribute risk for chronic disease.

However, the analysis in this paper showed that despite housing improvements and accompanying improvements to household hygiene, there was no consistent

accompanying reduction in carers’ reporting of common childhood illnesses.

Professor Bailie and his team concluded that high levels of household crowding and poor social, economic and environmental conditions in many Australian Indigenous communities appeared to place major constraints on the potential for building programs to impact on the occurrence of childhood illness.

For the full paper go to http://jech.bmj.com/content/early/2011/06/20/jech.2011.134874.abstract?sid=268d19d3-0094-4a41-9a18-32968af0d39a.

Paper finds scope to improve health centresClinical audits on service delivery at 62 Aboriginal community controlled health centres have found substantial room to improve preventive care for well adults, which in turn would assist ongoing efforts to combat the early onset and high prevalence of chronic disease among Aboriginal and Torres Strait Islander Australians.

The results of the audit are contained in a paper published in a recent issue of BMC Health Services Research by a team of researchers led by Professor Ross Bailie.

‘The research was primarily about supporting quality improvement

in Aboriginal and Torres Strait Islander primary health care services, in a way that assists them to identify priorities and implement systematic and evidence-based approaches to enhance client care and service delivery,’ Professor Bailie said.

The paper, Variation in Quality of Preventive Care for Well Adults in Indigenous Community Health Centres in Australia, emerged out of the long-running Audit and Best Practice in Chronic Disease (ABCD) project funded by the CRCAH.

The clinical audits were conducted during 2005–09 on a random sample of records of adults with

no known chronic disease in 62 Indigenous community health centres in four Australian States/Territories. The audits found wide variation in the overall delivery of guideline-scheduled preventive services between health centres. Health centre-level characteristics explained 13–47 per cent of the variation in documented preventive care, and the remaining variation was explained by client-level characteristics.

To download the research paper go to www.biomedcentral.com/1472-6963/11/139, and for more information on One21seventy go to www.one21seventy.org.au/.


Governments fiddle while eyesight fails, survey showsThe very latest nationwide survey of eye health among Aboriginal and Torres Strait Islander people has found that those aged over 40 are six times more likely to be blind than other Australians – despite the fact that 94 per cent of vision loss in Aboriginal and Torres Strait Islander people is preventable or treatable.

One of the most shocking aspects of the survey’s findings is that Aboriginal and Torres Strait Islander children – especially in remote areas – begin life with significantly better sight than their non-Indigenous peers, and their vision loss is five times less common than for other children.

Long-time campaigner for eye health and lead researcher in the 2009 National Indigenous Eye Health Survey, Professor Hugh Taylor of partner organisation the University of Melbourne, said the poor eye health of Aboriginal and Torres Strait Islander adults was the direct result of inadequate government policies. He estimated the situation could be reversed by increasing eye care resources by about four times the present levels and by working in partnership with community-controlled services.

‘This would translate to adding eight ophthalmologists and 40 to 60 optometrists to the national effort,’ Professor Taylor said.

Cataracts are to blame for 32 per cent of blindness among Aboriginal and Torres Strait Islander Australians.

‘Nationally there are 250,000 cataract operations performed each year. It would take only an

additional 3000 operations to eliminate cataract blindness in these communities,’ he said.

The survey found other leading causes of blindness among Aboriginal and Torres Strait Islander adults were refractive error (14 per cent), optic atrophy (14 per cent), trachoma (9 per cent) and diabetic eye disease (9 per cent). It underpinned a May 2011 Australian Institute of Health and Welfare (AIHW) report, Eye Health in Aboriginal and Torres Strait Islander People, which confirmed that Australia was the only developed country to still have endemic blinding trachoma. This report also found that 35 per cent of Aboriginal and Torres Strait Islander adults had never had an eye examination, despite 79 per cent of them self-reporting eye problems.

‘There appears to be a marked under-resourcing of specialist eye services provided to remote and disadvantaged communities

compared to the national average,’ the report says. ‘Research suggests that the provision of eye care by Aboriginal Medical Services is associated with better vision outcomes, and that well-coordinated services are more productive, have shorter waiting lists and save money.’

Federal Indigenous Health Minister Warren Snowdon responded to the survey and AIHW report by pledging in June a further $880,000 for mobile eye health teams operating in remote NT communities, and by offering more resources to support the national network of 23 Regional Eye Health Coordinators.

To download the survey and other reports go to www.iehu.unimelb.edu.au, and for the AIHW report go to www.aihw.gov.au/publication-detail/?id=10737418931.

Liam Jurrah (standing) from the Melbourne AFL team lends a hand while Hugh Taylor checks a patient for trachoma at Yuendumu, May 2010

NATIONAL POLICY NEWS20

The inaugural National Congress of Australia’s First Peoples meeting was held in Sydney from 7–9 June 2011. The meeting saw 120 delegates come together to identify and discuss in depth the policy areas that impact on Australia’s First Peoples and to participate in the first election of the Board of Directors.

It was also the last National Congress occasion presided over by inaugural Co-Chairs Sam Jeffries and Josephine Bourne, who have since handed the baton over to new Co-Chairs Jody Broun (a Yinjibarndi woman from Western Australia) and Les Malezer (a Butchulla man from south-east Queensland) who were elected by Congress members in April 2011.

Six Board members were elected by delegates present at the inaugural meeting: William (Brian) Butler (SA); Venessa Curnow (Qld); Dennis Eggington (WA); Rodney Little (ACT); Tammy Solonec (WA); and Daphne Yarram (Vic.).

The Congress was created in April 2010 to give Australia’s First Peoples a say on issues important to them and to create a national voice for those opinions to be heard by all Australians.

The Lowitja Institute’s Media and Marketing Manager, Tracey Johnston, attended the meeting both to support the Congress media team and to gain experience of the ‘behind the scenes’ workings of an event of this magnitude. This was a great opportunity and occasion that was not lost on Tracey.

‘Not only was I able to gain some valuable knowledge and experience about the operational side of an event like this, but I felt very privileged to be part of this historic moment in the history of Aboriginal and Torres Strait Islander affairs in this country,’ Tracey said. ‘A highlight for me was listening to the inspiring words of our Patron, Lowitja O’Donoghue, as she addressed the delegates on a sunny, but Arctic, Sydney morning and called for unity while spelling out the great hopes she has for the Congress.’

The matters discussed at this first meeting are to be used by the new Board to chart the organisation’s priorities for the year ahead. The Board, including Ms Broun and Mr Malezer, met for the first time on 8 July 2011. We wish them well as they begin their important work.

If you would like more information about the National Congress of Australia’s First Peoples, go to www.nationalcongress.com.au.

National Congress welcomes delegates to first annual meeting

Congress Directors (L–R): Venessa Curnow, Brian Butler, Les Malezer (Co-Chair), Rod Little, Jody Broun (Co-Chair), Dennis Eggington, Daphne Yarram and Tammy Solonec. Photo by Joe Mayers, courtesy of the NCAFP

Congress delegates gather at the inaugural NCAFP meeting in Sydney. Photo by Joe Mayers, courtesy the of NCAFP


Survey shows health a top priority for National Congress

The National Congress of Australia’s First Peoples has released the results of its first survey on policy priorities from its Aboriginal and Torres Strait Islander membership.

More than half of respondents – 55 per cent – chose health, education and sovereignty as their top priority policy areas.

In health, mental health and emotional wellbeing were highlighted as priorities by 42 per cent of respondents while 21 per cent said access to health care was another area that needed urgent attention.

Education concerns focused on early childhood education and transition to work from school.

Recognition of Aboriginal and Torres Strait Islander people in the Constitution was seen as a top priority to address sovereignty issues (nominated by 88 per cent of respondents), along with constitutional protection of Indigenous rights (77 per cent) and constitutional protection against racial discrimination (58 per cent).

To download the full report on the survey results go to www.nationalcongress.com.au.

Gillard seals national health reforms as Medicare Locals, telehealth begin

The Gillard Government has finally signed off on a national health reform agreement with all States and Territories including Western Australia, which had refused to sign up to the original proposal put forward by former Prime Minister Kevin Rudd in 2010.

The deal, which was reached on 2 August 2011, will see the Federal Government invest an extra $19.8 billion in public hospitals through to 2019–20 in return for greater federal oversight of the hospital system and new benchmarking arrangements including set targets for emergency waiting times and elective surgery.

Under the deal, the Commonwealth, States and Territories will share future funding growth for hospitals in an equal partnership and there will be no requirement for the States or Territories to give up any of their GST revenue. To improve the transparency of public hospital funding a single National Health Funding Pool will be established, which will ensure that all hospitals are funded under the same arrangements.

The new investments in hospitals are being supported by significant Commonwealth investments in primary health care (PHC) services – including after hours services, new GP training places, and new GP Super Clinics – to take pressure off public hospitals. A network of Medicare Locals will also support the delivery of better integrated GP and PHC services; the first 19

Medicare Locals began operating on 1 July 2011, with all Medicare Locals to be up and running from July 2012.

Incentives for telehealth videoconferencing for patients in rural, regional and outer metropolitan areas also became available from 1 July, in order to provide more equitable access to health specialists. The measure will allow such patients – over half of Australia’s population – to ‘attend’ consultations with distant specialists via video-conferencing from the convenience of their local GP clinic or other local health care facilities.

The incentives include $620 million in Medicare rebates, a $6000 bonus payment for health practitioners when they use the new technology to provide a consultation for the first time, and $20 every time a telehealth service is bulk-billed in the first year.

For more information on the national health reforms go to www.yourhealth.gov.au.

NATIONAL POLICY NEWS

22

Infant mortality rates halve in two yearsA new report into Aboriginal and Torres Strait Islander health and health determinants has found some significant improvements, although serious concerns remain. The greatest improvement was in infant mortality rates, which more than halved over two years.

The health statistics were contained in the third biennial report (for 2010) from Australia’s State and Federal Ministers for Health against the Aboriginal and Torres Strait Islander Health Performance Framework, which was released by Federal Indigenous Health Minister Warren Snowdon on 4 August 2011.

As well as a 55 per cent decline in infant mortality rates, the report also showed a 29 per cent decline in deaths due to circulatory disease – the leading cause of death for Aboriginal and Torres Strait Islander Australians – a substantial decline in hospitalisation for pneumonia in small children, an increase in antenatal care, and greater immunisation coverage for children.

However, the report also showed that the impact of chronic disease on Indigenous Australians remains high, with 58 per cent of excess deaths caused by chronic disease, and that the health gap for deaths due to cancer is widening.

‘The findings in the report show encouraging improvements in Indigenous health,’ Mr Snowdon said. ‘While this is good news, there is still a long way to go to close the gap between Indigenous health outcomes and those of the general population.’

He said the report highlighted other factors that affected a person’s health such as education and employment; overcrowding in housing; contact with the criminal justice system; and low household incomes. To download the report go to www.health.gov.au/indigenous-hpf.

Govt begins round of consultations over NT Intervention Mark IIThe Federal Government has released a discussion paper and announced a program of consultations with Aboriginal people living in the Northern Territory around continuing the reforms begun with the NT Emergency Response (NTER) under the Howard Government in 2007. The NTER is due to wind up midway through 2012.

Prime Minister Julia Gillard acknowledged the hurt and anger generated through lack of consultation over the original implementation of the NTER, and promised that new policies would be bound by the Racial Discrimination Act with Aboriginal and Torres Strait Islander communities having a voice in shaping them.

‘We know this was started without consultation with Aboriginal people, and we know starting it without consultation

did lead to feelings of hurt and feelings of shame,’ she said. ‘We know that a stronger future can only be built in partnership with Aboriginal people and communities, because the issues we want to tackle are the issues which many Indigenous people confront every single day.’

In a joint statement released on 22 June 2011, the Prime Minister and Indigenous Affairs Minister Jenny Macklin said the government had made significant progress in improving peoples’ lives in the NT over the past four years ‘but the situation for many Indigenous families remains critical’.

‘The Gillard Government will now start consultation on future plans to tackle this unacceptable level of disadvantage with a particular focus on improved education for children, expanded employment opportunities and tackling alcohol abuse,’ they said.

The announcement followed the visit to Australia by a top United Nations human rights official, Navi Pillay, in May 2011, during which she urged a ‘fundamental rethink of the measures being taken under the NTER’.

The discussion paper, Stronger Futures in the Northern Territory, will act as the basis for the consultations. To view a copy of the discussion paper go to www.indigenous.gov.au/index.php/stronger-futures-in-the-northern-territory.

Meanwhile, the latest Closing the Gap in the Northern Territory Monitoring Report – for the period July to December 2010 – was released by the Federal Government on 31 May 2011. To download the report, go to www.fahcsia.gov.au/sa/indigenous/pubs/nter_reports/Pages/default.aspx.


Budget delivers boost to health servicesLeaders of the Close the Gap (CTG) campaign have welcomed the funding boost for Aboriginal and Torres Strait Islander health services contained in the Federal Government’s Budget, handed down on 10 May 2011.

Treasurer Wayne Swan said an additional $526 million had been provided for Aboriginal and Torres Strait Islander education, employment and health, with the health measures including:

• Extra $35 million in Indigenous-specific funding as part of the Government’s National Mental Health Reform program

• $113.4 million for 15 new or expanded Aboriginal and Torres Strait Islander health clinics, and 40 new renal dialysis chairs

• $35 million over four years to improve the safety of health services delivered to Aboriginal and Torres Strait Islander Australians through the Establishing Quality Health Standards program

• $54.4 million over five years to continue counselling, family tracing and reunion services for members of the Stolen Generations.

Aboriginal and Torres Strait Islander Australians will also benefit from $1.8 billion to be spent on health infrastructure in regional and remote areas over the next five years.

Funding for medical research, through the NHMRC’s Medical Research Endowment Account,

will increase from $715.5 million in 2010–11 to $746.1 million in 2011–12 (an increase of 4.3%).

In a statement released on 11 May 2011, Close the Gap Campaign Co-chairs Mick Gooda and Dr Tom Calma welcomed the new funding.

‘The Budget delivers in some major health areas for Indigenous Australians, such as the $113.4 million for 15 new or expanded Indigenous health clinics and 40 new renal dialysis chairs over the next five years. Of course, we welcome these and other initiatives,’ Aboriginal and Torres Strait Islander Social Justice Commissioner Mick Gooda said.

For more information on the Budget go to www.budget.gov.au.

$13m for dialysis hubs in Alice, Tennant Creek

The Federal Government will pump $13 million into expanded accommodation for dialysis patients and their families in the Northern Territory towns of Tenant Creek and Alice Springs.

The funding injection comes in response to a report prepared by the George Institute for Global Health, Central Australia Renal Study, which reveals that some Aboriginal people are either putting off dialysis treatment or deciding against it altogether because of lack of access to facilities close to their remote communities. The study also found that the number of Central Australians receiving maintenance dialysis more than tripled from 62 to 209 between 1999 and 2009, and an extra 35–40 new patients needed the treatment every year.

Indigenous Health Minister Warren Snowdon said the report showed that the best approach to treating patients from remote areas was to bring them to a central location.

‘What the report says is that there ought to be a number of different treatment models but the basic treatment model should be based around a hub-and-spoke model,’ Mr Snowdon said. He added that the main hub would be Alice Springs.

However, both dialysis practitioners and Greens Senator Rachel Siewert questioned this approach, saying more provision of dialysis services in remote areas would be better. Sarah Brown, the manager of Western Desert Dialysis, was reported in the media as saying centralising services ‘is not the answer’.

In July 2011, the government announced the Western Desert Nganampa Walyta Palyantjaku Tjutaku Aboriginal Corporation would receive $2.37 million from the Aboriginals Benefit Account over three years to fund its Return to Country Dialysis Program in Kalkarindji and Lajamanu. Minister for Indigenous Affairs Jenny Macklin said the project would enable dialysis patients to return home for three-to-six week visits, two-to-three times a year, and builds on the success of existing projects in Kintore, Yuendumu and Ntaria.

To access the Central Australian Renal Study go to http://health.gov.au/internet/main/publishing.nsf/Content/A7B443D6D3F55E67CA2578B 100831F9A.


24

Aboriginal youth imprisonment rate ‘a national tragedy’Twenty years after the Royal Commission into Aboriginal Deaths in Custody, imprisonment rates have risen more than 50 per cent for Aboriginal and Torres Strait Islander Australians, who make up 25 per cent of the prison population – despite constituting only 2.5 per cent of Australia’s total population.

The situation is even worse for Aboriginal and Torres Strait Islander child offenders, who are 28 times more likely to be sent to a juvenile detention centre and who comprise 59 per cent of inmates in Australian juvenile detention centres.

That’s according to a report, Doing Time – Time for Doing: Indigenous Youth in the Criminal Justice System, which was released by

the House Standing Committee on Aboriginal and Torres Strait Islander Affairs in June.

‘The over-representation of Indigenous youth in the criminal justice system is a national crisis,’ the report said. ‘This is a national tragedy, and questions must be raised as to why the situation has worsened so dramatically after the sweeping reforms recommended [by the Royal Commission] in 1991.’

The seven-strong bipartisan committee made 40 recommendations that attack many underlying causes for young Aboriginal and Torres Strait Islander Australians getting into trouble with the police. Aboriginal Social Justice Commissioner Mick

Gooda urged the Government to implement the recommendations as soon as possible.

‘We must act now before we lose another generation to the criminal justice system,’ he said.

Federal Attorney General Robert McClelland responded on 29 June 2011 with a $3.2 million boost for key programs for Aboriginal and Torres Strait Islander Australians in the criminal justice system, and he urged his State and Territory counterparts to work together on a range of prevention and early intervention measures.

To download a copy of the Parliamentary report, go to www.aph.gov.au/house/committee/atsia/sentencing/report.htm.

CRN funding to power Batchelor Institute’s Indigenous researcher capacity The Batchelor Institute of Indigenous Tertiary Education (BIITE) is set to receive an infusion of funding through the Federal Government’s new Collaborative Research Networks (CRN) program, which is designed to help smaller and less research-intensive regional universities strengthen their research capacity by teaming up with other institutions.The first CRN round runs from 2010/11 to 2013/14 and was announced by the Minister for Innovation, Industry, Science and Research, Senator Kim Carr, on 31 May 2011.

BIITE will use its $1.53 million funding to establish a world-leading

research development partnership – with Monash University, Charles Darwin University, Australian National University and Australian Institute of Aboriginal and Torres Strait Islander Studies – the Australian Indigenous Research and Researcher Development project.

The partnership will advance mutual research strengths in Aboriginal and Torres Strait Islander education, language and linguistics and the creative arts. Together, the partners aim to increase Aboriginal and Torres Strait Islander researcher participation and output and secure critical mass and capacity

within BIITE to maintain a nationally and internationally recognised Centre for Indigenous Languages, Education and the Arts.

For more information, go to www.innovation.gov.au/Research/CollaborativeResearchNetworks.

Batchelor Institute. Courtesy of BIITE


AMA Indigenous Health Report Card highlights ‘unmet need’An emphasis on Aboriginal and Torres Strait Islander control of health services and increasing the number of Indigenous-run health centres in major cities are among the recommendations of the annual Indigenous Health Report Card 2010–11 issued by the Australian Medical Association (AMA) on 13 May 2011.

The Report Card, the ninth since 2002, examines models of best practice in primary care for Aboriginal and Torres Strait Islander people and makes a number of strong recommendations to governments to greatly improve health outcomes.

In launching the report, AMA Vice President and Chair of the AMA Indigenous Health Taskforce, Dr Steve Hambleton, said the latest data showed there was ‘significant unmet need in Aboriginal and Torres Strait Islander peoples’ access to primary care’.

In 2008–09, just over half (54.5 per cent) of the Aboriginal and Torres Strait Islander population accessed Australian Government-funded Indigenous-specific primary care services in major cities – but only 13 per cent of these services were actually located in major cities.

‘Aboriginal and Torres Strait Islander peoples do not currently have a level of access to health care that matches their greater need. They experience a range of barriers in accessing the appropriate care in a timely way. Any reform of Australia’s primary health care system must place a greater priority on improving access to the right model of care in the right place at the right time for Indigenous Australians,’ Dr Hambleton said.

To access the AMA Indigenous Health Report Card 2010–11 go to http://ama.com.au/aboriginal-reportcard2010-11.

AMA rewards Indigenous medical achievementThe Australian Medical Association has underscored its commitment to building the capacity of the Aboriginal and Torres Strait Islander health workforce and providing support to Indigenous health care with two key awards delivered in May 2011.

Murray Haar was the winner of the AMA’s Indigenous Peoples’ Medical Scholarship for 2011, which provides support and encouragement for Aboriginal and Torres Strait Islander students studying medicine and is valued at $9000 for each year of study.

A descendant of the Wiradjuri people from New South Wales’ Riverina district, Mr Haar is a third-year Bachelor of Medicine, Bachelor of Surgery, and Bachelor of Science student at the University of New South Wales. His goal is to work in cardiology or

mental health, as these are areas where he feels he can make the most difference to improve the health of Australia’s First Peoples

High-profile Aboriginal doctor Mark Wenitong was the winner of the AMA Excellence in Health Care Award for 2011 in recognition of his work in developing Aboriginal and Torres Strait Islander health workforce policy. Dr Wenitong is from the Kabi Kabi tribal group of South Queensland and was the sixth Aboriginal doctor ever to graduate in Australia.

He is a past president and one of the founders of the Australian Indigenous Doctors Association and was instrumental in providing advice on the Committee of Deans of Australian Medical Schools Aboriginal and Torres Strait Islander undergraduate curriculum framework. He is

currently Senior Medical Officer for the Apunipima Cape York Health Council and a member of the COAG Australian Health Workforce Advisory Council.

Dr Mark Wenitong, winner of the AMA Excellence in Health Care Award for 2011


26

Rates of serious injury requiring aeromedical retrieval by the Royal Flying Doctor Service (RFDS) are at their lowest recorded level in four remote Queensland Aboriginal and Torres Strait Islander communities, according to research published in the Medical Journal of Australia. These low injury rates have occurred after government restrictions on access to alcohol in these communities.

An alcohol supply-reduction strategy (SRS) was introduced in 2002–03 in remote Aboriginal and Torres Strait Islander communities in Queensland. After the success of this strategy, a second SRS was introduced in 2008 with even tighter alcohol restrictions, ranging from limited access to total prohibition, across all 19 discrete Indigenous communities in Queensland.

Associate Professor Stephen Margolis at the Education

and Research Unit for the RFDS in Cairns and co-authors documented the changes in rates of serious injuries after the second SRS in four of the communities.

‘After the second SRS in these four Indigenous communities, there were substantial, significant and consistent decreases in serious-injury rates by 53 per cent to historically low levels, and coincidental decreases in the proportions of serious injuries in all retrievals,’ Prof Margolis said. ‘The overall rate of serious injury has dropped by 78 per cent since 2002.’

Professor Margolis acknowledges that his study has limitations, and that, without measuring blood- alcohol levels, he cannot confirm that the alcohol restrictions are the reason for the lower serious injury rates. He also points out the complexity of strategies to minimise substance-related

harm and that SRS is one strategy within a comprehensive approach.

In an accompanying comment, Professor Peter d’Abbs, from Lowitja Institute partner the Menzies School of Health Research, said alcohol restrictions have an important place in any strategic approach to preventing and managing alcohol problems in Indigenous communities.

‘Such strategies, however, raise at least two further questions. First, what processes will do most to ensure that the restrictions genuinely enhance community capacity to manage alcohol, and second, what additional measures, apart from supply reduction, are required?’ Prof d’Abbs said.

To download the article and comment piece go to www.mja.com.au/public/issues/194_10_160511/contents_160511.html.

Serious injuries in Qld communities plummet after grog bans, research finds

Combating the health toll caused by alcohol In related developments, a new floor price of $8 has been set by supermarket chain Coles for bottles of wine bought in its Alice Springs outlets, and sales of two-litre casks have been banned. The new regime, designed to ensure alcohol always costs at least $1.14 a standard drink, came into effect in July 2011. The move has been strongly endorsed by Lowitja Institute partner the Central Australian Aboriginal Congress.

The alcohol industry has also had to review its health warnings for pregnant women only days after they were unveiled in July 2011 after a Perth expert on foetal-alcohol syndrome complained about the warnings.

Dr Carol Bower from the Telethon Child Health Research Institute and the University of Sydney’s Professor of Paediatrics and Child Health Elizabeth Elliott told

DrinkWise that the voluntary warnings on alcohol and the group’s website played down the seriousness of alcohol harm during pregnancy.


Monash’s new School of Indigenous Health Monash University has launched a new School of Indigenous Health. The School, made possible by a transformational gift of $10.5 million from the Harvest Alliance Foundation, will train and up-skill both Indigenous and non-Indigenous health workers, and establish community training sites where students can gain first-hand clinical experience in Aboriginal and Torres Strait Islander settings.

‘In Australia there is a significant gap between the health of Indigenous people and [other Australians],’ Professor Steve Wesselingh, Dean of the Faculty of Medicine, Nursing and Health Sciences at Monash, said when announcing the new School.

‘We feel quite passionate about the fact that our work in developing the workforce and our efforts in research, should be aimed at reducing that gap.’

In conjunction with research, the development of curriculum and community engagement, there will be opportunities for scholarships and postgraduate study. The Harvest Alliance School for Indigenous Health will begin taking students in 2012.

For more information, go to www.monash.edu.au/news/releases/show/improving-indigenous-health-outcomes.

Toolkit builds ‘care partnership’ between community and GPsA new Cultural Respect Program and Toolkit (CRP&T) has been pilot tested in Melbourne and the preliminary results are positive according to Dr Phyllis Lau, one of the lead researchers in the team that developed the toolkit.

The Chronic Disease and Equity team at the General Practice and Primary Health Care Academic Centre at the University of Melbourne has worked with the University’s Onemda VicHealth Koori Health Unit and the University of New South Wales to develop the CRP&T in a project funded by the National Health and Medical Research Council (NHMRC). The Victorian Aboriginal community was also closely involved in the project.

The CRP&T aims to improve access to general practice for Aboriginal people through a supporting cultural and clinical ‘care partnership’ involving general practice, community-controlled health agencies and Divisions of General Practice. It uses a staged approach to embed

four levels of clinical redesign activities (community; reception; consulting room; professional organisations) according to the practice’s readiness.

‘Preliminary findings from the pilot test highlighted the roles, responsibilities, strengths and tensions within the partnerships,’ said Dr Lau, a senior researcher in the Department of General Practice at the University of Melbourne. ‘There was increased identification of Aboriginal patients and the toolkit appeared well-accepted by providers and patients.

‘An Aboriginal colleague, who initially had a lot of reservations about participating in the project, summed it up by saying: “I really enjoy being in the care partnership. As a Koorie worker in an Aboriginal Medical Service I am able to identify some issues relevant to our people’s access to mainstream services and I can bring some of this information to the table when discussing equity in, and access to, mainstream services for our people”.’

A current pilot of the CRP&T is underway in New South Wales, with the next phase of a multi-centre effectiveness trial in Victoria and NSW planned for 2012.

Meanwhile, another initiative that the Academic Centre is involved in is a beyondblue-funded project that aims to explore, design and pilot an appropriate Care Model for Aboriginal Melbournians with co-morbid chronic disease and mental illness. This is a joint project with the Wurundjeri Tribe Land Cultural Heritage Council and the Heart Research Centre.

The community-driven initiative started with an unmet need that developed into a collaborative funding application between the three organisations. The funding application was successful and the project commenced earlier this year. Researchers are currently conducting interviews with community elders, members and service providers to determine the relevant factors required for a successful and sustainable care model.


28

AIHW report: disadvantage still entrenchedThe latest report from the Australian Institute of Health and Welfare (AIHW) presents a stark statistical portrait of Aboriginal and Torres Strait Islander disadvantage, although there are some encouraging signs of progress in areas such as smoking, education and accessing medical services.

Average health expenditure for each Aboriginal and Torres Strait Islander Australian during 2008–09 was $6787 compared with $4876 for each non-Indigenous Australian. The amount being spent on Aboriginal and Torres Strait Islander health also increased on the previous financial year, costing $3.7 billion in 2008–09 compared with $3.1 billion in 2007–08. Community

health services accounted for just over 22 per cent of all Aboriginal and Torres Strait Islander health expenditure, compared with 4.5 per cent of non-Indigenous health spending.

Smoking rates in Aboriginal and Torres Strait Islander communities declined from 49 per cent to 45 per cent between 2002 and 2008, while Year 12 retention rates for Aboriginal and Torres Strait Islander students rose from 29 per cent in 1996 to 47 per cent in 2010.

However, the incidence rate for end-stage renal disease for Aboriginal and Torres Strait Islander Australians more than doubled between 1991 and 2008, from 31 to 76 per 100,000 people, and more than a quarter

reported having some form of respiratory disease.

Babies born to Aboriginal and Torres Strait Islander mothers were twice as likely as babies born to other mothers to have a low birth weight. Aboriginal and Torres Strait Islander infant mortality rate declined between 1991 and 2008 but remains almost twice the rate for other infants.

The report also found that almost one-third of young Aboriginal and Torres Strait Islander people aged between 16 and 24 years have high or very high levels of psychological distress.

To download the report, go to www.aihw.gov.au/publication-detail/?id=10737418989.

QUMAX lifts prescription uptake: NACCHOA program designed to improve the availability and uptake of prescription medicines by Aboriginal and Torres Strait Islander people has been hailed a success by the National Aboriginal Community Controlled Health Organisation (NACCHO).

NACCHO and the Pharmacy Guild of Australia jointly developed and manage the QUMAX (Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander peoples) Program, which is funded by the Federal Government under the 4th Community Pharmacy Agreement.

QUMAX works by subsidising the cost of medicines to eligible disadvantaged clients of ACCHSs. The program also supports local ‘quality use of medicines’ initiatives, including

providing dose-administration aids, transport assistance, and increased local collaboration with community pharmacies.

NACCHO Chair Justin Mohammed said a recent consultant’s report into QUMAX showed it had been an ‘unprecedented success’.

‘In a six-month period, the number of medicines dispensed to clients of urban and regional ACCHSs rose by 14 per cent and outstripped the increase in medicines dispensed to all other Australians, by a factor of at least five times,’ he said.

Mr Mohammed said that for every $1 spent by non-Aboriginal Australians on medicines covered by the Pharmaceutical Benefits Scheme (PBS), only 60 cents is spent on Indigenous Australians.

‘We aim to ensure that Aboriginal peoples have access to the PBS at least equal to that of other Australians,’ he said.

The QUMAX Program involves 69 Aboriginal Community Controlled Health Services in rural, regional and urban areas with strong participation by community pharmacists and Aboriginal consumers. Nearly 34,000 Aboriginal patients were registered to the program, and pharmacists dispensed 271,000 medicines where the PBS co-payment was waived.

To download a copy of the QUMAX report, go to www.health.gov.au/internet/main/publishing.nsf/Content/5B1B138DA00BB9C7CA2578150083984E/$File/Final%20Report%20QUMAX%20Evaluation%20April%202011.pdf.


Families key support to those with chronic illness: studySharing stories and health information with friends and families gives strength to Aboriginal and Torres Strait Islander Australians living with chronic illness, a new study has found.

Conducted by the Menzies Centre for Health Policy based at the Australian National University and the University of Sydney, People I Can Call On examined the experiences and views of Aboriginal and Torres Strait Islander people living with heart disease, diabetes and chronic obstructive pulmonary disease. Director of the Menzies Centre, Mr Bob Wells, said the study’s report provides important insight into the real-life issues and day-to-day realities of Indigenous people living with chronic illness.

‘People I Can Call On describes the great strength of family and community networks that support Indigenous people with chronic illness. It shows the importance of family in motivating people to better care for themselves and to be an example to their children and grandchildren so that they grow up knowing and practising good health behaviours.

‘It also reveals the importance of health services that provide safe and culturally appropriate services and treat their consumers with respect. Sadly, the report also chronicles the long-term effect of disrespectful and racist experiences that deter Indigenous people from using services that could otherwise offer help.’

The report tables nine key recommendations including the creation of support programs for Aboriginal and Torres Strait Islander Australians which build health literacy, the implementation of specific carer health programs and training more Aboriginal and Torres Strait Islander health workers.

To download a copy of the report, go to www.menzieshealthpolicy.edu.au where you will find the link in the News and Upcoming Events sidebar.

Thumbs Up! to good nutrition

Over the past three years, the Jimmy Little Foundation (JLF) has been working in partnership with key stakeholders across Australia to fulfil the dream of its patron, legendary performer Uncle Jimmy Little, AO, to provide a healthier future for Aboriginal and Torres

Strait Islander Australians through its Thumbs Up! program.

The program, which includes school nutrition workshops and a local stores program, has visited more than 25 communities over the past two years, across the Northern Territory, Western Australia, Queensland and New South Wales. Thumbs Up! signage has also been adopted by more than 60 stores to date including Outback Stores and ALPA in the NT, plus the Retail Stores Group in Queensland and a number of independent grocery outlets in various States. Most of these stores also support Uncle Jimmy’s Recipe of the Month, a healthy, simple-to-prepare recipe made available to shoppers in the store.

An interactive workshop program uses music and new media for

schoolchildren to create their own healthy food anthem that reflects their land, bush tucker, language and promotes Uncle Jimmy’s core message: Good Tucker – Long Life. A music film clip is then delivered back to the school or community group keeping the messages alive long after the JLF team has left.

For more information about Thumbs Up! and other Jimmy Little Foundation programs, go to www.jlf.org.au.

Thumbs Up! for Uncle Jimmy’s Recipe of the Month

30 NEWS IN BRIEF

$9.6mcampaigntoimprovehearing

The Federal Government has launched a $9.6 million campaign to encourage Aboriginal and Torres Strait Islander families to have their children’s ears checked regularly and to learn about the signs and symptoms of ear disease. This is part of a wider strategy to cut the high prevalence of hearing deficits among Aboriginal and Torres Strait Islander children and the resulting impact on their education, with research showing that up to 91 per cent of children in some communities suffer from middle ear infection. The campaign began in July 2011 and includes partnerships with local Aboriginal and Torres Strait Islander media organisations, DVDs and resources for teachers and health professionals.

Kimberley suicide spike prompts govt action

A recent spike in suicides among young Aboriginal people living in Western Australia’s Kimberley region has prompted the Federal Government to bring forward $6 million in regional funding targeted at suicide prevention interventions under the Supporting Communities to Reduce Risk of Suicide program. Federal Indigenous Health Minister Warren Snowdon said the boosted services would operate in partnership with the local Aboriginal Medical Services. National figures show that 4.2 per cent of Aboriginal and Torres Strait Islander deaths result from suicide, compared with 1.5 per cent for other Australians.

Health and wellbeing focus of new UQ research hub

Examining what works for improving Aboriginal and Torres Strait Islander health and wellbeing in Queensland will be among the top priorities of the new Queensland Centre for Social Science Innovation (QCSSI), a State Government-backed research hub to be based at the University of Queensland with nodes at participating universities including Queensland University of Technology, Griffith University, James Cook University and Central Queensland University. Beginning in 2012, the QCSSI will analyse data in the areas of education, employment, crime control, community wellbeing and disaster preparedness to see which programs are effective and where improvements can be made. The centre will receive initial funding of $10 million over five years.

Review of access to higher education

A review into Aboriginal and Torres Strait Islander access to higher education aims to address the under-representation of Australia’s First Peoples in tertiary education both as students and staff. The review was announced by the Federal Government in April 2011 and will be led by Professor Larissa Behrendt from the University of Technology in Sydney. Record numbers of Aboriginal and Torres Strait Islander people are enrolling in university courses across Australia, with participation increasing by 25 per cent between 2005 and 2009. However, Aboriginal and Torres Strait Islander Australians still make up just 1.29 per cent of all students in higher education. The review will report back to the Government with its findings by April 2012.

Eliminating syphilis from communities now ‘a viable option’

The notification rate for infectious syphilis in remote Aboriginal and Torres Strait Islander communities has fallen so low that researchers now believe it may be possible to eliminate the sexually transmitted disease entirely from such communities. In a paper published in the Medical Journal of Australia on 16 May, lead researcher James Ward from the University of NSW and his co-authors said national data from 2005 to 2009 showed a significant decline in notifications. ‘The relatively small numbers of notifications in Indigenous remote communities, their geographical concentration and recent sustained decreases make [elimination] a viable option,’ the researchers said. To download the MJA paper go to www.mja.com.au/public/issues/194_10_160511/contents_160511.html.

Remote NT health services rated with best

Five of Australia’s most remote Aboriginal health organisations have been given the highest health care accreditation standard. The body representing Australia’s general practitioners, the Royal College of General Practitioners (RACGP), formally certified the services at Mutitjulu, Ampilawatja, Urapuntja, Kintore and Mpwellere at Santa Teresa, all of which are in the Northern Territory. The RACGP's Professor Jenny Reath said the accreditation may make the postings more attractive to doctors. ‘A lot of doctors wishing to work in different general practices or Aboriginal medical services will look at an accreditation standard as a marker of a high-quality service,’ she said.


Torres Strait TB clinics given short-term reprieve

Two Queensland Health-operated tuberculosis clinics in the Torres Strait have been granted extra Commonwealth funding to stay open for another three months after fears their imminent closure could lead to drug-resistant TB spreading from Papua New Guinea (PNG) into Australia. The clinics are used primarily to treat PNG nationals who are unable to access treatment for the contagious lung disease in their own country. The Commonwealth is shifting its TB funding to PNG-based clinics but critics say not enough has been done to train PNG clinicians to take over, arguing that another 12 months is needed to ensure a smooth transition.

Support for Aboriginal dads and granddads

Aboriginal men will be given extra encouragement to engage in the lives of their children and grandchildren through the $7.4 million Strong Fathers Strong Families program, a series of antenatal projects currently being rolled out via 13 organisations in New South Wales, South Australia, Queensland and the Northern Territory as part of the Federal Government’s male health policy. According to the government, the program will give men culturally appropriate information about fatherhood and grandfatherhood to strengthen their role in nurturing the development of children and providing, in return, a motivating factor for their own self-care.

More funding to cut violence, build safer communities

More funding has been provided to help reduce the incidence of violence within Aboriginal and Torres Strait Islander families and to build safer communities as part of the Federal Government’s evolving Indigenous Family Safety Agenda, which began in 2007. Some $8 million has been provided to deliver seven new projects and extend another 33 successful projects in more than 100 communities across the country, according to a government statement on 22 June 2011. Projects funded include counselling and mediation services, anger management courses and men’s, women’s and youth groups.

Qld health advocate honoured with AM

Queensland Aboriginal health advocate Mary Martin has been made a Member of the Order of Australia (AM) in the Queen’s Birthday Honours List for her 35 years’ work in the health sector. She began work as a nurse in 1971 and later played a key role in the establishment of the Queensland Aboriginal and Islander Health Council (QAIHC) in 1990, where she still works, and the creation of a national curriculum on Aboriginal and Torres Strait Islander health issues that is now a required part of training for doctors.

Warning over pneumococcal disease vaccine

The Therapeutic Goods Administration (TGA) has issued a safety alert on a vaccine used to provide increased protection against a bacterial infection that can cause meningitis, pneumonia and sepsis. Pneumovax 23 is available free to Aboriginal and Torres Strait Islander people over 50 years of age and is administered once every five years. However, the TGA said it was concerned over recent reports of a higher number of adverse reactions among people receiving a second dose of the vaccine.

Scholarship for UQ physio student

Kylie Dunn, a University of Queensland (UQ) final year physiotherapy student, has received UQ’s first Artius Health Scholarship, which provides financial support to final year Bachelor of Physiotherapy students of Aboriginal and Torres Strait Islander descent. Ms Dunn is a former student representative on the National Association of Aboriginal and Torres Strait Islander Physiotherapists and aims eventually to deliver physiotherapy services in remote communities.

First of new family centres opens in Canberra

The first of a planned series of 38 child and family centres targeting Aboriginal and Torres Strait Islander people has opened in the Canberra suburb of Belconnen. The $8 million centre provides everything from playgroups, early learning activities and parenting programs to maternal, child and allied health services. Funded through the Federal Government’s National Partnership Agreement on Indigenous Early Childhood Development, it will be followed by a national roll-out.

179 Grattan Street, Carlton Victoria 3053 AUSTRALIA

PO Box 650, Carlton South Victoria 3053 AUSTRALIA

+61 3 8341 5555 +61 3 8341 5599 [email protected]

www.lowitja.org.au

Documents

ISSUE FOUR / AUGUST 2011 Wangka Pulka...Aboriginal and Torres Strait Islander adults (see p. 19). In the wider health and policy landscape we look at the first meeting of the National