Socioeconomic inequality is a killer – Marmot tells Fulbright Symposium

The CRCAH and Flinders University recently hosted the 2008 Fulbright Symposium “Healthy People, Prosperous Country”, one of Australia’s largest ever gatherings to examine ways in which health inequities and disparities can be reduced by concerted actions that cut across sectors and act on the social determinants of health and well-being.

Opened by Australian Health Minister, Nicola Roxon, the Symposium saw more than one hundred experts and activists come to Adelaide to listen to latest research around social determinants of health  and to workshop ways of improving policy and practice around these social determinants.

The Symposium program examined the effects of social determinants in the health of Indigenous and non-Indigenous people in Australia and the United States. Key note speaker was Sir Michael Marmot, a leading international researcher who chairs the World Health Organisation’s Commission on Social Determinants of Health.

In a stark example of how social determinants create huge disparities in health outcomes Sir Michael told the Symposium that more than a quarter of the deaths from cardiovascular disease in Australia in 2002 were caused by socioeconomic inequality.

He said action was required on a broad front – from the circumstances in which children are born to the way in which they grow, work and age. “In Australia, if everyone experienced the same death rates as those in the least disadvantaged areas 28 per cent of deaths from cardiovascular disease (CVD), over 3,400 CVD deaths, would have been avoided in 2002,” Sir Michael said.

“These excess deaths are due to socioeconomic inequality,” he said. Citing evidence from the United States, Sir Michael made the case for the positive role to be played by improvements in education. “Medical advances averted 180,000 adult deaths in the US between 1996 and 2002. Addressing educational inequalities in mortality would have saved 1.4 million lives,” he said.

CRCAH executive officer, Mick Gooda told Gwalwa-Gai that it was essential to build a strategic partnership across the country to coordinate government and community efforts to address the social determinants of Aboriginal health.

 “One of the keenest challenges facing us is the way we address the social issues, or determinants, which affect health,” Mick Gooda said. “The challenge is that unless we have a coordinated approach to addressing housing, employment, educational and other disparities and end the political marginalisation of Aboriginal people all our efforts in providing quality primary health care will be undermined.”

 “However, one of the principle obstacles to achieving this is the poor educational services provided to so many Aboriginal kids and the poor educational outcomes that condemn so many of our kids to long term unemployment and poverty.

“Educational disparity is certainly one area that we need to address if we are to really close the health inequity gap,” he said.

Amongst a program littered with talent, one of the Symposium standouts was a forum entitled “Race, health and emergency: social determinants under crisis” presented by Professor Ian Anderson and Dr David Satcher, Director, Center of Excellence on Health Disparities, Morehouse School of Medicine in Atlanta , Georgia and the 16th Surgeon General of the United States. The session explored the impact race has on health interventions using the Northern Territory Emergency Intervention and the lack of effective intervention by US authorities after Hurricane Katrina devastated parts of Louisiana populated mainly by African Americans.

The issue of race, health and inequity was a major theme of the conference with CRCAH PhD graduate Dr Yin Paradies and Paula Braveman, Professor of Family and Community Medicine and the Director, Center on Social Disparities in Health in the School of Medicine at the University of California, San Francisco presenting evidence about the impact of racism on health.

Attending the Symposium were more than thirty “emerging leaders” in the areas of health, research and community development. This is the first time that such an Emerging leaders Program has been part of the Fulbright Symposium.

Symposium organisers believed that it was important to inspire and motivate people who are emerging or potential leaders in their communities, and who are committed to promoting health communities and building a prosperous country to take action to address health inequity and the SDOH in their own communities.

The participants came from a range of skills and backgrounds, and high importance was put on ensuring the program and content was delivered in a participatory way. Apart from attending the main symposium program participants were involved in a daily debriefing session for discussion on their views and thoughts for the day. An additional day was set aside for the emerging leaders to evaluate the symposium and discuss ways they could use what they had learnt in their personal and community life. A positive outcome apart from the learning was the many networks the participants were able to form during the Symposium.

A forum entitled "Health, Hope and Happiness: Creating Prosperous Societies was moderated and recorded by Peter Mares, host of ABC Radio National’s the National Interest program. Forum participants included Sir  Michael Marmot, U.S. academic David Korten, Dr David Satcher, Dr Carmen Lawrence and CRCAH Chair Pat Anderson. The session will be broadcast on the ABC in August. Gwalwa-Gai subscribers will be notified by email.

The CRCAH Communications Unit recorded many of the sessions and interviewed most of the presenters and these will be available on a website proposed by Symposium organisers. The website will be aimed at informing and inspiring activism around the social determinants of health.

Gwalwa-Gai readers will be notified when the website goes live.

Fulbright Emerging Leader Program – a personal reflection

Megan Williams

Megan Williams attended the Fulbright Symposium as part of the Emerging leaders program. Megan, who works as an Associate lecturer and PhD student at the Indigenous Health Unit, School of Population Health, The University of Queensland offered Gwalwa-Gai her personal reflections on the Symposium…..

Thanks to the Cooperative Research Centre for Aboriginal Health, a number of students and health workers were able to attend the 2008 Fulbright Symposium on Social Determinants of Health as part of the connected “Emerging Leaders” program in Adelaide in mid-July. There were about 30 Emerging Leaders among the Symposium delegates, and the young leaders came from a wide range of backgrounds, cities and towns and work areas.

Content on social determinants of health at the Symposium was quite comprehensive, but presented in terms that were easily absorbed and most often thoroughly enjoyable. We heard directly from some leading thinkers - but often about their own experiences and reflections on past efforts in relation to future efforts, rather than statistics and theory.

Sir Professor Michael Marmot said in relation to his work for the World Health Organisation’s Commission on Social Determinants, he received let’s say, 99 out of 100 great bits of feedback. Then he received one bit of negative feedback that has really affected him - someone claiming that defining and focussing on social determinants is just “old meat reheated”. What a rough term! It’s a bit true… many of us do realise that housing, education, employment and the environment all effect health. However, what Marmot emphasised is that we urgently need to move on from just identifying social determinants that need to be addressed by health departments. More specifically we need to set measurable targets for reducing health inequalities, and communities need to lead the way in this.

Symposium Emerging Leaders have already come together over email to develop a media release, particularly urging governments to unite in an Australian version of a Commission or inquiry into social determinants in health inequity.

My own perhaps too simplistic questions I brought with me to the Symposium were “yeah yeah, social determinants - but how do you research them from an Aboriginal perspective rather than an epidemiological one?” (As if there is going to be a straight answer… at least I tried). I pestered a few of the Symposium speakers and attendees for their recommendations. One suggestion that will continue to stick with me is “you will need to join up some dots”. For example, across Aboriginal systems of knowledge, as well as sociology, anthropology and community…

I came away from the Symposium confirming I know far less than what I thought! I needed that. But at least now I also have a group of “Emerging Leaders” and others to connect with on methodologies, strategies and work-related support.

Address teacher shortage to improve health – Flinders academic

Associate Professor Lester- Irabinna Rigney

One presenter at the recent Fulbright Symposium on social determinants, Healthy People, Prosperous Country, was Flinders University Associate Professor Lester- Irabinna Rigney.

A leading Aboriginal educationalist, Associate Professor Rigney told the Symposium that Australia must address the critical lack of Aboriginal teachers and researchers if gains in Indigenous health are to be achieved.

Drawing the direct link between education and health, Associate Professor Rigney, the Director of the Yunggorendi First Nations Centre for Higher Education and Research, said that a national “intervention” was required to boost the education system.

“Aboriginal health in this country is only going to get better if we start to address, from the very outset, education,” Associate Professor Rigney told the Fulbright Symposium in Adelaide. “South Australia is the only state in Australia that has a curriculum from birth to Year 12 – no other State has this.

“So this as a major intervention that needs to be on a national scale,” he said. “We need to target Aboriginal teachers particularly because there is no other profession in our society that directly impacts upon the next generation. For
instance, only 0.3 per cent of all teachers in Australia are Indigenous – we have an Aboriginal teacher education crisis.

“We need to address this because Aboriginal people are turning away in their droves from the teaching profession yet, to teach an Aboriginal child health skills, teaches a fundamental skill.

“What we do need at this stage is a national transition strategy to be able to take indigenous students to Year 12 and then move them into universities.

“We not only need teachers, educators and medical doctors and nurses. We also need Aboriginal researchers. The concept of reform in this country is built upon research, and Indigenous researchers are needed.

“And we must throw out the poisonous ideology of educating an Aboriginal child out of an Aboriginal education – indigenous languages are fundamental, indigenous pedagogies and literacies are important.

“I think, at a time when some of my colleagues inside the education discipline are advocating that Aboriginal languages and cultures should stay at the door, that such views are poisonous to the future of Aboriginal health in this country.”

With thanks to Peter Gill and the Flinders University News & media Unit

Ian Anderson to head up new health equality council

The Federal Minister for Health, Ms Nicola Roxon used the recent joint CRCAH/Flinders University Fulbright Symposium to announce the formation of the Rudd Government’s National Indigenous Health Equality Council which will advise the Government on how best to achieve the ‘closing of the health gap’ between Aboriginal and other Australians.

The new Council will be chaired by Cooperative Research Centre for Aboriginal Health research director and director of Onemda VicHealth Koori Health Unit, Professor Ian Anderson.

Reflecting Professor Anderson’s long held emphasis on workforce development; Ms Roxon said one of its first challenges would be increasing the numbers of Aboriginal health professionals. Ms Roxon said that more Aboriginal doctors, nurses and other health workers “may well hold the key to making a lasting difference long term”.

“Closing that gap is what marks us out as a decent, humane, compassionate community, with a commitment to equality which we can be proud of,” she told the audience. “We are determined to do what is necessary. We are investing in health; we are investing in education; in employment; and in housing.

CRCAH executive officer, Mick Gooda, welcomed Professor Anderson’s appointment saying that his decades of commitment to professionalism and intellectual rigour in the Aboriginal health sector meant that he was a “particularly good choice”.

“The continuing state of poor Aboriginal health is an enormous challenge facing this nation and we need the best Aboriginal leadership possible to drive the response,” said Mick Gooda. “Minister Roxon has chosen wisely in picking the new National Indigenous Health Equality Council and the CRC for Aboriginal Health will work closely with the new council in providing evidence of what works and where the gaps are.

Mick Gooda said that the Minister’s commitment of $19 million plan to strengthen the Indigenous health workforce was a good start but the deficit of trained Aboriginal doctors, nurses and other health professionals meant that a substantially larger investment would be needed if the Government’s aims were to be achieved.

“There is no other initiative more important in turning our health around than increasing the Aboriginal health workforce,” said Mick Gooda.

Social Justice Commissioner, Tom Calma also welcomed the announcement but warned the Government to heed the Council’s advice on implementing targets and benchmarks for Indigenous health.

“It is absolutely essential that targets for health equality are embedded in state, territory and federal government policies and programs,” said Commissioner Calma.

“Governments should look to the Council for advice on a fresh national approach to delivering health services that is focused on prevention and primary care if we are to achieve the goal of closing the gap in Indigenous life expectancy.”

Other members of the Council are:

• Deputy Chair, Dr Mick Adams, Chair of NACCHO;
• Paula Arnol, Chair of the Aboriginal Medical Services Alliance of the Northern Territory, CEO of Danila Dilba Health Service in Darwin and CRCAH board member;
• Sally Goold, current Chair and founder of the Congress of Aboriginal and Torres Strait Islander Nurses;
• Dr Tamara Mackean, President of the Australian Indigenous Doctors’ Association;
• Dr Alex Brown, Head of the Centre for Indigenous Vascular Research at the Baker Heart Institute;
• Gregory Phillips, a medical anthropologist with extensive expertise in Indigenous health workforce and medical curriculum issues; and
• Romlie Mokak, experienced Indigenous policy maker and current CEO of the Australian Indigenous Doctors’ Association.

Non-Indigenous experts on the Council are:

• Associate Professor Paul Torzillo, a respiratory physician with particular expertise in child health, and Medical Director of Nganampa Health Council in the APY Lands;  
• Professor Kerin O’Dea, a leading expert on nutrition and diabetes; and
• Dr Ian Cameron, currently the CEO of the NSW Rural Doctors Network, who has extensive experience in rural and remote health.

IKE and Onemda Combine To Develop Indigenous
Public Health Capacity

A joint project between the Institute of Koorie Education at Deakin University and Onemda VicHealth Koori Health Unit at The University of Melbourne aims to improve Aboriginal and Torres Strait Islander health through innovative and creative public health education.

The ongoing Indigenous Public Health Capacity Development project involves:

• The delivery of the Victorian Consortium for Public Health Master of Public Health (MPH) program to Aboriginal and Torres Strait Islander students at the Institute of Koorie Education;
• The expansion of the institutional capacity to deliver nationally-accessible, workforce relevant curricula on Indigenous public health for both the core MPH program and the nationally-accessible MPH specialist stream in Indigenous health; and
• The development of an Indigenous Public Health Network.

One part of the project involved the development of the Framework document. The Indigenous Public Health Curriculum Framework, published in June 2008,is an outcome of five years of sustained focus on Indigenous public health capacity development. Many people within the Aboriginal and Torres Strait Islander primary health care sector, the health policy sector and academic public health teaching programs contributed to its development.

This document will serve as a guide for university public health teaching programs to include key Aboriginal and Torres Strait Islander health content into their MPH programs. For each of the six core Indigenous public health competencies, there is a suggested set of relevant teaching and learning resources, teaching and learning strategies and assessment strategies. The Indigenous Public Health Curriculum Framework forms one part of the Australian Government's Public Health Education and Research Program National Quality Framework.

The six core Indigenous public health competencies are:

• Analyse key comparative health indicators for Aboriginal and Torres Strait Islanders peoples;
• Analyse key comparative indicators regarding the social determinants of health for Aboriginal and Torres Strait Islander peoples;
• Describe Aboriginal and Torres Strait Islander health in historical context and analyse the impact of colonial processes on health outcomes;
• Critically evaluate Indigenous public health policy or programs;
• Apply principles of economic evaluation to Aboriginal and Torres Strait Islander programs with a particular focus of the allocation of resources relative to need; and
• Demonstrate a reflexive public health practice for Aboriginal and Torres Strait Islanders health contexts.

The launch of this curriculum framework is very timely. The recent change of government at the Federal level provides a new policy context and a host of new opportunities for progress regarding Indigenous health. The implementation of the Indigenous Public Health Curriculum Framework is one step towards ensuring there is the capacity to implement change, in particular, a public health workforce that is well informed and has an understanding of the impacts of history, social determinants and the cultural dimensions of health and how they impact on contemporary Aboriginal health practice and research.

For further information about The Indigenous Public Health Curriculum Framework contact: Bill Genat – genatb@unimelb.edu.au or Janice Jessen – janice.jessen@deakin.edu.au or
Scott Miller – scott.miller@deakin.edu.au

The report can be downloaded from the following website:
http://www.onemda.unimelb.edu.au/publications/reports.html

Master of Public Health students at the Institute of Koorie Education at Deakin University

Holding Men: Addressing Aboriginal Men’s Health

A new book, Holding Men – Kanyirninpa and the Health of Aboriginal Men, by Jesuit priest and medical anthropologist Brian McCoy, tells how Aboriginal men of the Kimberly Western Desert understand their lives, their health and their culture.

In the book’s introduction Brian McCoy writes that while the general poor health circumstances of Aboriginal people is well known, “we actually know little about Aboriginal men and how they perceive well-being and illness”.

This easily readable book aims to remedy that lack of knowledge by using conversations, stories and art to illustrate how Kimberley communities express cultural values and relationships through a term they describe as kanyirninpa or holding. This key value has sustained Aboriginal desert life for centuries.

Through examples as diverse as Aboriginal men’s engagement with Australian Rules football, petrol sniffing and prison time, McCoy reveals the possibilities of how lasting improvements to Aboriginal men’s health might be achieved.

While young Indigenous men’s lives remain vulnerable in a rapidly changing world, McCoy believes that an understanding of kanyirninpa may provide the hope of change and better health for all and offers positive insights for all who want to ‘grow up’ young people.

“Addressing the growing health crisis in Aboriginal men requires understanding the beliefs systems, needs and aspirations of those men, and there is little evidence thus far that our health systems are even listening to Aboriginal men let alone making efforts to understand them,” said Brian McCoy.

“Although this book was written about the specific experiences of Kimberly desert men, Aboriginal men from across the country, in both urban and remote settings, have told me that they share similar views and experiences as their Kimberly brothers.

“While we know the health of Aboriginal men is generally poor, and often worse than Aboriginal women, we do not sufficiently understand the different ways in which Aboriginal men perceive their health. Nor do we understand how a Western model of health might engage more positively with Aboriginal men and their health needs.

“Through this research many of the reasons why desert men do not use clinics became evident. For example, clinics are largely perceived to be female spaces whose confines do not allow for the multiplicity of relationships desert people share. These relationships require recognition and negotiation, especially by young men after they become adult or wati. Thus, men prefer their own clinic space where they can be treated by other men.

In a lesson to agencies delivering health services to Aboriginal men, McCoy argues that Aboriginal men must be heard and the cultural values that determine relationships must be understood.

“Men can find it hard to get non-Aboriginal people to understand and respect their cultural values,” said McCoy. “Programs that are imposed without the development of relationships, and which lie outside a culturally ‘safe’ place for Aboriginal men, prove difficult to develop and sustain.

“We will only witness improvements to Aboriginal health when we learn to recognise and build on the strengths that people already possess.”

Brian McCoy has spent most of his adult life as a priest and with Aboriginal and Torres Strait Islander people. In communities across north and remote Australia, in North Queensland, the Northern Territory and the Kimberley, he has been involved in a variety of roles including priest, ambulance officer, football coach, youth detention and adult prison chaplain and health researcher. 

Author Brian McCoy with George Lee, Western Desert community man, Chair of Balgo Community Council.

Brian McCoy is continuing his research work with the men of the Kimberly desert region as part of the CRC for Aboriginal Health-funded project—‘Developing, sustaining and evaluating health programs for Aboriginal men’.

Brian McCoy’s book was launched in Broome on 27 June by prominent senior Kimberly leader and Founding Chair of the Lingiari Foundation, Patrick Dodson. Patrick Dodson believes there has been a process of undermining the role and status of Aboriginal men within our own society since the early days of Australia’s colonisation and continuing in recent commentary around the Northern Territory Intervention.

“We have been stereotyped as violent drunkards and abusers of our children so as to undermine our strengths, authority and responsibilities within our communities,” said Patrick Dodson. “Brian McCoy has recognised the reality of the role and responsibilities that reside with our men and placed them into a contemporary context, without denying the achievement of thousands of years of protecting families, caring for our lands, rivers and seas as well as sustaining law, language and culture.”

Brian McCoy’s book was also launched in Melbourne by Professor Ian Anderson who is the Research Director at the CRC for Aboriginal Health and also the Director of Onemda VicHealth Koori Health Unit at The University of Melbourne. “It is rare for an academic work to so sensitively and poignantly capture the social realities for Aboriginal men growing up in contemporary desert communities,” Professor Anderson said.

For further information:

http://www.crcah.org.au/research_progam_areas/downloads/114185_mccoyFactSheet-0308.pdf

Holding Men: Kanyirninpa and the Health of Aboriginal Men is published by Aboriginal Studies Press

http://www.aiatsis.gov.au/aboriginal_studies_press/find_a_book/recent_releases/holding_men

The book retails for $34.95 including GST.

Indigenous Successes Highlighted at Population Health Congress 2008

Nearly 90 people came together at one of the satellite events of the Population Health Congress in Brisbane in early July to hear and share Australian Indigenous success stories.

The special Indigenous Health Workshop on Environmental, Social, Emotional & Spiritual Health of Aboriginal and Torres Strait Islanders was a joint initiative of the Australian Health Promotion Association and the International Union of Health Promotion and Education (South West Pacific Region), in collaboration with the Cooperative Research Centre for Aboriginal Health (CRCAH) and the Queensland Aboriginal and Islander Health Council.

The vision and spirit of the workshop was to enhance the design and implementation of policy and programs to work towards closing the gap of the 17-year life expectancy between Indigenous and non-Indigenous Australians. The expected outcomes of the workshop were to share information about critical success factors, capacity building and knowledge transfer, strengthening the interface between research and practice, promoting networking and future collaboration, and developing strategically focussed briefings for policy makers. 

The day opened with an inspiring Welcome to Country from Aunty Delmae Barton which was followed by CRCAH Research Director Professor Ian Anderson’s presentation about the links between spirituality and health. Professor Anderson outlined the necessary holistic approach required for improving the health status of Aboriginal and Torres Strait Islanders.

Griffith University’s Professor Boni Robertson’s presentation was titled ‘A spotlight on progression/regression—where to from here?’ She reminded participants that Prime Minister Kevin Rudd’s Sorry Statement had been a moment waited for so long but would need to be followed by credible action. These presentations set the scene for looking at the critical success factors in exemplary projects that were shared. 

As always, one day never really seems to be enough; however, a number of projects were discussed in detail in working groups and presented to the plenary. The CRCAH plans to publish reports/articles on completed projects.

The day was filled with lots of sharing of programs and projects, and the evaluations reflected that for the majority of people the day was professionally enriching. The next Indigenous Health Workshop will be held as a satellite event at the Australian Health Promotion Association 18th National Conference to be held 17-20 May 2009 in Perth, WA.

Planning for this event has already begun and more details will be available via the 2009 Conference link on Association’s website: www.healthpromotion.org.au

1500 new health workers needed as part of
Indigenous health blueprint

Tom Calma

The Close the Gap coalition has presented the federal government and Opposition with a set of National Indigenous Health Equality Targets to address the 17-year life expectancy gap between Indigenous and non-Indigenous Australians.

Aboriginal and Torres Strait Islander Social Justice Commissioner Tom Calma said the targets are the blueprint to achieve the Prime Minister’s goal of closing the gap between Indigenous and non-Indigenous life expectancy in a generation.

 “We look forward to working in partnership with the government to refine the targets, to ensure they are embedded in future policies and to use them to develop evidence-based health programmes targeted to those most in need.”

Tom Calma said the targets build on the positive steps already undertaken with the Government through the Indigenous Health Equality Summit, the signing of the Statement of Intent, and the recent launch of the National Indigenous Health Equality Council.

“For a long time, we’ve known how to improve Aboriginal health. We’re now confident that there is a national commitment from all sides of politics to work in partnership with Aboriginal people to close the gap within our lifetimes,” said Commissioner Calma.

Dr Mick Adams, National Chair of the Aboriginal Community Controlled Health Organisation (NACCHO) emphasised the need to massively increase the Aboriginal health workforce.

NACCHO Chair Mick Adams being interviewed at recent Fulbright Symposium

 “Indigenous people need access to comprehensive primary health care if we are going to be able to halve the rates of premature birth and low birth weight of Indigenous babies over the next decade,” said Dr Adams. “Aboriginal medical services need the level of resources, staffing and 21st century facilities to, for the first time, match the burden of disease in their communities. For example, in the next five years alone we’re going to need an additional 1500 Aboriginal health workers.

Dr Tamara Mackean, President of the Australian Indigenous Doctors’ Association (AIDA), said the targets are also designed to ensure there is adequate infrastructure, including a skilled workforce to deliver the services required.

“We need to immediately implement the National Indigenous Health Workforce Training Plan for Indigenous doctors, nurses, dentists, Aboriginal health workers and allied health workers to build Indigenous capacity and leadership,” said Dr Mackean.

Copies of the National Indigenous Health Equality Targets are available at: www.humanrights.gov.au/social_justice/health/targets

Indigenous health research tops Govt agenda

Research into Indigenous health and wellbeing will become a Commonwealth priority and Australian Research Fellowships will be created for Indigenous researchers under proposals being considered by the Australian Government.

The Federal Minister for Innovation, Industry, Science and Research, Senator Kim Carr, said in July 2008 that the Government “was committed to enhancing support for Indigenous researchers and research”.

His comments followed advice put to him by the Australian Research Council (ARC) and the Australian Institute for Aboriginal and Torres Strait Islander Studies (AIATSIS).

Over the coming year, Senator Carr said he intended to:

• include research into Indigenous health and wellbeing as a priority under the Government’s new Future Fellowships scheme, currently being developed by the ARC.
• introduce new Australian Research Fellowships – Indigenous (more senior than, and in addition to, the existing postdoctoral ARC Indigenous Researcher Fellowships).
• change the status of AIATSIS under ARC Funding Rules to make it eligible for funding under nearly all ARC-administered schemes.

COAG pledges $500 million to tackles Indigenous child health

At its most recent July meeting in Sydney, the Council of Australian Governments (COAG), consisting of the Prime Minister, Premiers, Chief Ministers and the President of the Australian Local Government Association, agreed in principle to a National Partnership with joint funding of around $547.2 million over six years to address the needs of Indigenous children in their early years.

“The National Partnership is based on evidence that improvements in Indigenous child mortality require better access to antenatal care, teenage reproductive and sexual health services, child and maternal health services and integrated child and family services,” COAG said in its communiqué.  

Bilateral plans for implementing the reforms will be agreed between each jurisdiction and the Commonwealth for COAG’s consideration in October 2008. COAG further agreed to consider in mid-2009 a progress report and advice about the contribution of COAG’s broader reform agenda to overcoming Indigenous children’s disadvantage.
“The Commonwealth will continue to explore with the States the role that conditions on benefit payments could play in increasing the take up by vulnerable families, including vulnerable Indigenous families, of early childhood, family support and child and maternal health services,” the communiqué said.

COAG agreed that the Working Group on Indigenous Reform (WGIR) should continue to develop reform proposals for improving community safety, remote service delivery and Indigenous economic development and active welfare for consideration in October 2008. In addition, COAG requested the WGIR, in conjunction with other Working Groups, to report to COAG in December 2008 on how COAG’s broader reform agenda will deliver an integrated strategy on closing the gap for all Indigenous people.

COAG re-affirmed its commitment to closing the gap on Indigenous disadvantage while welcoming the substantial progress made so far on Indigenous reform. “Leaders agreed to sustained engagement and effort by all governments over the next decade and beyond to achieve the Closing the Gap targets for Indigenous people.”
For further information: Click Here

Rural doctor shortage cuts life expectancy

If you live out bush, on average you’ll die three years earlier than your city cousins mainly through lack of medical care.

That’s the message from the Rural Doctors' Association (RDA), which says the bush doctor shortage is now at crisis point with 16,000 current vacancies for general practitioners in rural and remote areas.

The RDA estimates at least 1,000 doctors are needed immediately in rural and remote Australia to ensure even the most basic medical coverage.

In July RDA president Peter Rischbieth told media outlets the shortage of doctors was “far, far worse than we initially thought...there are 16,000 vacancies for GPs in rural Australia, excluding the 6,000 vacant nursing positions".

"The health outcomes, including cancer outcomes and heart disease outcomes, are already much worse in the country," Dr Rischbieth said.

In a desperate bid to address the shortage, health organisations and representatives from national farming and Indigenous bodies gathered in Canberra on 22 July 2008 to lobby the Commonwealth for extra funding towards new models of medical practice, which combine nursing, midwifery and doctor services.

Many State governments are already putting emergency measures in place, such as Queensland Health which has offered big cash incentives to overseas trained doctors to fill vacancies in rural south-east Queensland.
 
Dr Rischbieth said the crisis in patient care would also worsen in metropolitan areas until doctor shortages in rural areas were addressed.

"It is worse where we're concerned, because we are competing with doctor shortages in the city, but I ask, 'What is going to happen when there is nothing to compete with? When the cities don't even have doctors to offer?"' he said.

For more information on the bush doctor shortage, go to www.rdaa.com.au and download ‘Rural health – the facts at a glance’.

Free design service for community clinics

"We have a beautiful tree-filled site for our service. The old building is out-of-date, and we are ready for a new clinic. The master-plan for our new building arrived, and it puts the toilets near the trees, and the entrance onto the busy street!!"

 "We were so excited at the prospect of a new clinic, but we were so disappointed when we saw the proposal. It only had one entrance. That makes it hard for people in our community to use. We want everyone to come, but it isn't appropriate for everyone to mix together when they are at the clinic. The designers just don't get it! We need more than one entrance. We need a clinic for our community; that is designed with our needs in mind."

The design and architecture of Aboriginal health clinics has not historically been considered an important influence on health outcomes but the two examples above illustrate that building new health clinics can be very 'hit-and-miss' and that poor design combined with no community input can seriously impede the delivery of quality, culturally appropriate health services.
It was concern about the “hit and miss” nature of clinic design that first saw Melbourne’s RMIT University combine with the Royal Australian College of General Practitioners (RACGP) to produce a workbook, called Rebirth of a clinic, on architectural design for general practices.(see www.racgp.org.au/rebirthofaclinic ).
Both RMIT and the RACGP have now joined forces with the National Aboriginal Community Controlled Health Organisation (NACCHO) to develop a guide for architecture in Aboriginal community controlled health services.
The RACGP’s Ian Watts told Gwalwa-Gai that Aboriginal health services have specific design requirements, and the RACGP and RMIT felt that their experience might help.

“We have begun a journey to explore the issues with Aboriginal communities, and through the RACGP sought expressions of interest from communities who wanted to engage with the initiative,” said Ian.

“It's early in the work, and we are keen to hear stories from communities about their experiences,” he said.

Vanessa Clements – Building Healthier Communities through Research, Education and Sharing Knowledge

Queensland Aboriginal health researcher and mother of two young children, Vanessa Clements, lives and breathes Indigenous health. She is part of the new generation of Indigenous health professionals using research and education to lift the health and well being of the Indigenous people in local communities.

Vanessa Clements

Vanessa Clements has just successfully completed the very hands-on Masters in Applied Epidemiology (MAE) at CRCAH partner Queensland Institute of Medical Research (QIMR), and sees her research studies as an important ingredient in understanding and improving the health of Indigenous peoples at the local level.

“Local Aboriginal medical services (AMSs) have got a lot of their own health data now, which, if analysed and managed, can help them better understand what health services, resources and funding are needed for their community,” says Vanessa.

During her two years as a Masters of Applied Epidemiology scholar Vanessa, whose post-graduate research study was sponsored by the CRCAH, participated in a wide range of public health projects, and her more than 200-page projects report on the four projects yielded considerable research results and findings.

Her Masters projects covered topics such as skin infections in Indigenous children, paediatric asthma in the Torres Strait, rubella in Queensland, and a salmonella outbreak involving chicken eggs in Brisbane restaurants. “All of these projects were interesting and I have learnt valuable lessons from each of them, including data collection, interviewing, analysis, and evaluations,” she says. “Being exposed to broader public health issues and methodologies, I can now also see how these issues and methods impact, and relate to, Indigenous health issues.”

The first Indigenous project that she worked on as part of her Masters at QIMR was the Wuchopperen Healthy Skin Study, Cairns. In this CRCAH-sponsored research, Vanessa showed a strong correlation existed between the incidences of Group A Streptococcus infections in Indigenous children and their skin infections of scabies and school sores. These bacterial infections in children are thought to contribute to heart problems later in life. “It’s important that we have an educational program to alert parents to these conditions in Indigenous communities, and that we treat these skin conditions early, so we can stop these other problems from occurring later in life.”

In the second Indigenous project, Vanessa reported on some preliminary findings of QIMR researchers on their Paediatric Asthma Project in Torres Strait Islander communities. The research shows that the condition of asthma in children is higher in Torres Strait and more severe than among the general Australian population. “Parents’ knowledge about their kids’ condition and medication was so poor that I suggested the development of individual “Asthma Action Plan” for every child.” This also led her to help develop culturally appropriate material in the local community, and to help test whether they made any improvement in doctor visits, which they did.

Vanessa is currently working part-time at QIMR in the Indigenous Health Research Program, helping out with some research projects and tying up loose ends. Her longer term ambition, however, is to work on a research project with her local AMS. “Having successfully completed my Masters, I can now go back to my community, and offer much more because my research skills and experience is so much better. I will be able to ask and help determine what are the greatest needs of the community.”

Vanessa acknowledges her practical experience as an Aboriginal Health Worker at Kambu Medical Service in Ipswich from 1996 to 1999. “My work then underpinned my knowledge now of Indigenous health issues and how they apply to my local community.” Vanessa was initially trained in the clinical area of the service before gaining further experience in the areas of Diabetes and Nutrition, Community Care and Hearing Health.

Vanessa understands her local AMS because she knows the community she works and lives in. “I started working there as an Aboriginal Health Worker when I was 17, and I’ve also been a board member for seven years, including some time as its president,” Vanessa says. “I’ve experienced many facets of Aboriginal health, at the community level, the research level, organisationally, and management-wise.”

Vanessa leads a very busy and full life. Between her time spent as an AHW at Kambu and completion of her Masters, she had worked for Queensland Health, and was one of the first students to go through the block release (distance education) program in Bachelor of Applied Science in Indigenous community health care at WA’s Curtain University. Currently, she is looking after her two very young girls, as well as three children from her extended family. Her husband, also Indigenous, is studying for his nursing degree.

A determined and disciplined community health researcher, Vanessa finds time helping other students. Vanessa tutors other undergraduate Indigenous students enrolled in the block release program at Curtain University. She is part of an informal network of Indigenous people who are helping each other handle health courses and education. “In particular, many Indigenous women are studying health, while they are having children and working, and it’s great that we can support each other. Like others, I’ve put myself out there, showing that if one person they know can get through, others like them can as well.”

“There are other people like me, doing the same thing, with the same experience, but who never had the same educational opportunities,” she adds. “I would like to put my education and research in practice, and make some difference to Aboriginal health at the local level.”

Contact: Vanessa Clements, Assistant Co-ordinator, Indigenous Health Research Program, Queensland Institute of Medical Research, Royal Brisbane Hospital, Brisbane 4029. T: (07) 3362 0256 F: (07) 3845 3502 E: Vanessa.Clements@qimr.edu.au