World Health Report calls for new emphasis on primary health care and equity

The recently launched World Health Report 2008 critically assesses the way that healthcare is organised, financed, and delivered around the world.

In a wide-ranging review, the latest report Primary health care – now more than ever found striking inequities in health outcomes, in access to care, and in what people have to pay for care.

Differences in life expectancy between the richest and poorest countries now exceed 40 years. Vast differences in health also occur within countries and sometimes within individual cities. The report notes that in Australia, Canada and New Zealand, among others, health equity gaps between Aboriginal and non-Aboriginal populations have emerged as national issues.

Data set out in the report suggest that health systems in many countries have lost their focus on fair access to care, their ability to invest resources wisely, and their capacity to meet the needs and expectations of people, especially in impoverished and marginalized groups.

As the report notes, conditions of ‘inequitable access, impoverishing costs, and erosion of trust in health care constitute a threat to social stability’.

To steer health systems towards better performance, the report calls for a return to primary health care, a holistic approach to health care formally launched 30 years ago at the Alma-Ata International Conference on Primary Health Care.

This approach is one shared by the CRCAH and the wider Aboriginal health sector. “The CRCAH has placed a high priority on research that will lead to more effective health policy and provide the knowledge necessary to improve access to equitable quality primary health care,” Professor Ian Anderson told Gwalwa-Gai. ‘This investment in developing the capacity of Indigenous primary health care services is a critical component of current national strategy.’

The global report notes that when countries at the same level of economic development are compared, those where health care is organized around the tenets of primary health care produce a higher level of heath for the same investment.

In calling for a return to primary health care, the WHO report argues that in far too many cases, people who are well-off and generally healthier have the best access to the best care, while the poor are left to fend for themselves. Health care is often delivered according to a model that concentrates on diseases, high technology, and specialist care, with health viewed as a product of biomedical interventions and the power of prevention largely ignored.

The report says that specialists may perform tasks that are better managed by general practitioners, family doctors, or nurses. This contributes to inefficiency, restricts access, and deprives patients of opportunities for comprehensive care. When health is skewered towards specialist care, a broad menu of protective and preventive interventions tends to be lost.

In a finding particularly pertinent to the “close the gap” commitment in the country the WHO report estimates that better use of existing preventive measures could reduce the global burden of disease by as much as 70%.

A copy of the full report can be found at: http://www.who.int/whr/2008/whr08_en.pdf

“They want Koori health research to be controlled by Kooris” – new Onemda community report

A report on Victorian Koori attitudes to Aboriginal health research has found that the community believes research would be of higher quality and more relevant to Kooris and health practitioners if Aboriginal people controlled the research agenda.

We Can Like Research… In Koori Hands, published byCRCAH’s partner Onemda VicHealth Koori Health Unit, was launched in October at the Koorie Heritage Trust in Melbourne. This report builds on Onemda’s 1999 report We Don’t like Research… But in Koori Hands it Could Make a Difference by helping to further Onemda’s core research, teaching and community development agenda of ‘by Koori people, for Koori people’.

The report presents findings from a series of community workshops about Koori health research run with Koori Elders, researchers and community representatives around Victoria throughout 2007. It argues that research into Aboriginal health will be improved and made more relevant to both Koori communities and health practitioners if Aboriginal people control the research agenda.

The results of the Onemda report strongly support efforts by the CRCAH and its predecessor the CRC for Aboriginal and Tropical Health to ensure a decisive Aboriginal voice in the prioritisation, design, development and transfer of Aboriginal health research

Aunty Joan Vickery, AO, an Onemda Patron and one of the organisers of the workshops—along with Mark Saunders, Nicole Waddell, Angela Clarke and Paul Stewart—said that the overarching message from the workshop participants was that ‘they want Koori health research to be controlled by Kooris’.

Koori Elders – Aunty Joan Vickery, Aunty Marion Pearce, Aunty Melva Johnson, Aunty Joy Wandin-Murphy, Uncle ‘Jumbo’ Pearce and Uncle Kevin Coombs – attend the launch of Onemda’s Community Report, We Can Like Research… in Koori Hands on 7 October at the Koorie Heritage Trust in Melbourne

For this to happen, Aboriginal community organisations need to play a key role in research and its dissemination, implementation and evaluation, and be resourced to do this.

Many Koori people feel that, historically, health research and its applications have not benefited them. They remain suspicious about mainstream research, its intentions, and impact on communities and populations. There are concerns that without community control over health research, the health gap between Aboriginal and other Australians will continue to widen.

Angela Clarke, Deputy Director of Community Programs at Onemda, believes that ‘the workshop series are a crucial part of our work with communities, and a way also for Koori researchers to present how they use Koori methodology in their work, and to highlight positive research stories.’

The new report offers ‘a momentum for positive change’ for the future, as long as Koori people have the resources, research capacity and leadership roles in driving the health research agenda.

We Can Like Research… In Koori Hands, as well as the earlier 1999 report, can be ordered from
onemda-info@unimelb.edu.au or phone (03) 8344 0813.

Make Indigenous health key research priority, says top scientist

Carola Vinuesa Photo courtesy of the ANU website www.anu.edu.au

One of Australia’s leading medical researchers has called for limited research funding to be concentrated in areas of core national interest such as Indigenous health and climatology, rather than being wasted in areas where there is already high-quality research available from overseas.

Carola Vinuesa, who took out this year’s Science Minister’s Prize for Life Scientist of the Year, also took aim at the way science is funded in Australia during a presentation to The Global Foundation’s Australia Unlimited 2008 conference in Melbourne in October 2008.

Dr Vinuesa is a senior research fellow at the ANU's John Curtin School of Medical Research and has made her mark in the field of immunology.

"Science is global and knowledge gained anywhere can be drawn on to solve Australian problems,” she said. “On the other hand, many problems of indigenous health, or issues to do with the drought, are unique to Australia."

"For example, we put dedicated funds towards working out what causes obesity or dementia because there are a lot of fat people and a lot of people with dementia. These problems are not unique to Australia, so there is no need to make them priorities for research unless we have particular strengths in the area.”

Dr Vinuesa said improving the remuneration and job security for researchers would drive innovation and growth. She said increasing numbers of academics were leaving for overseas because of their disillusionment with the constant need to attract funding.

Report highlights new priorities for Indigenous tobacco control research

The Centre for Excellence in Indigenous Tobacco Control (CEITC) has recently released a report from the second National Indigenous Tobacco Control Research Roundtable jointly hosted by CEITC and the CRCAH in Brisbane earlier this year.

This event brought together sixty-six health workers, researchers, state and federal government and non-government representatives to prioritise and discuss a research agenda aimed at tackling the high smoking rates experienced in Aboriginal and Torres Strait Islander communities.

‘The roundtable was about trying to work out what we, as Indigenous researchers, policy makers and community people, can do in our research, implementation and evaluations to advance Indigenous tobacco control,’ said CEITC’s Viki Briggs.

Cigarette smoking is responsible for at least 20 per cent of all deaths in Indigenous families and communities. ‘Each and every one of these deaths has a profound effect on those around them, their families and friends who love them and the communities they are attached to. Giving up the smokes benefits everyone – men, women, children and babies. Tobacco smoking, and its control, in Indigenous families, workplaces, and communities is everybody’s business,’ Viki told Gwalwa-Gai.

The roundtable report suggests pathways to address the issue of tobacco control, comes up with research questions and approaches to guide assessment of priorities, and ends up with some key priorities for further scoping and investigation.

The five priority areas identified by participants as representing gaps in knowledge about Indigenous tobacco control that requires further research and evaluation work are:

• Creating positive environments for smoking cessation. Participants felt that the profile of tobacco use as a serious health issue for Indigenous communities needs to be raised and that leadership needs to be taken on this issue within organisations and communities. Health organisations could, for instance, take leadership in developing smoke-free policies, encourage other sectors to do the same and promote smoke-free behaviours in other spaces, such as homes.

• Improving our understanding of motivations for smoking and not smoking. Participants felt that there is poor understanding of what motivates Indigenous people to take up smoking, or to quit and stay quit. Many participants commented on the impact of social norms within families, social networks and communities that explicitly or implicitly support smoking behaviours.

• Improving our knowledge of best practice interventions. Roundtable participants strongly supported the need to build on, and further develop, evidence on best practice tobacco control interventions and prevention activities, including both individual and population-based initiatives. Considering the impact families may have on smoking patterns, it was felt that appropriate models for family- and community-based interventions should be developed and evaluated.

• Empowering and supporting the health workforce. Key to the effective delivery of smoking cessation programs is a well-trained and motivated health workforce. Considering the high levels of smoking among Aboriginal Health Workers (AHWs) and their central role in tobacco control program delivery, participants felt that a key strategy should be to encourage and support AHWs to give up smoking, and to empower them to deliver smoking cessation advice and programs.

• Best use of resources to support tobacco control. Participants raised cost–benefit analysis of various interventions as an important tobacco control issue.

Mick Gooda, NACCHO Chair Mick Adams  and Viki Briggs at the tobacco control roundtable

According to CRCAH CEO Mick Gooda, mainstream smoking cessation campaigns have worked well in the general population but generally have had little or no effect on Indigenous people. “The job now is to develop real solutions that will help Indigenous people quit the smokes,” he said. “This report represents one small, but important, step in the fight against tobacco smoking in Indigenous communities.”

Tobacco smoking linked to Aboriginal life experiences: Postgraduate research

A CRCAH in-kind researcher has told the recent 2008 Australian Sociological Association conference in Melbourne, about her research into why there is an ethnic influence in smoking prevalence when the socioeconomic status and level of deprivation is similar for non-Indigenous and Indigenous people.

"By reviewing studies that have compared the association between socioeconomic factors and smoking prevalence for Indigenous and non-Indigenous people, I have postulated the primary causal association that is resulting in a higher Indigenous smoking prevalence," graduate researcher Penny Azzato at the School of Public Health, La Trobe University, told conference participants.

Other published research has supported this primary causal association that is defined by the known social determinants of health. This new association lies within the Indigenous social experience of daily living. Sociology research, therefore, can unpack this most interesting piece of the Indigenous smoking disparity jigsaw.

The research is an in-kind project for the CRCAH. Penny would like to acknowledge her supervisors: Dr Brendan Gibson of OATSIH, Dept of Health and Ageing; Dr Priscilla Robinson and Prof Vivian Lin, La Trobe University.

Prisoner’s fight taken up by Public Health Association

The Public Health Association of Australia (PHAA) has written to health minister, Nicola Roxon, urging that she overturn a policy that denies access to Medicare and the Pharmaceutical Benefits Scheme (PBS) to Australians who are in prison.

Pointing out that prisoners “endure a myriad of health problems including psychiatric illness, infectious diseases (hepatitis and HIV), sexually transmitted infections, poor dental health, and other chronic health conditions such as cardiovascular disease and diabetes” the PHAA wrote that by depriving them of access to Medicare and the PBS “prisoners generally receive sub-optimal health care based on what is made available by the States and Territories.”

Prisoner access to Medicare and PBS were identified as priorities at last year’s Aboriginal Prisoner Health Industry Roundtable hosted by the CRCAH in partnership with the Public Health Association of Australia (PHAA) and the Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS). 

The PHAA letter reminded Minister Roxon that Australia has one of the highest
incarceration rates of Indigenous people in the world. Aboriginal and Torres Strait Islanders are 13 times more likely to be imprisoned than non-Aboriginal people (21 times more likely in Western Australia) and around 24% of Australia’s prisoners are Aboriginal or Torres Strait Islanders.

The PHAA argued that such extraordinarily high rate of incarceration meant that Aboriginal and Torres Strait Islander prisoners and communities were disproportionately impacted by their exclusion from Medicare and the PBS while in prison.

The letter, signed by PHAA CEO Michael Moore, PHAA President Mike Daube and Convener of the PHAA Justice Health Special Interest Group, Associate Professor Tony Butler, argued that the policy was counter-productive and ultimately costly to the community in terms of both health and dollars.

 “On release from prison the burden of health is transferred back to the community,” the PHAA wrote. “Given their extraordinarily high rate of incarceration, Aboriginal and Torres Strait Islanders in particular are disproportionately impacted by their exclusion from Medicare and the PBS while in prison.

“The health of those in prison could be improved significantly were prison health services able to utilise Medicare and the PBS as occurs with other Australians.
To deny prisoners access to Medicare and the PBS is a breach of human rights and condemns this group to sub-standard health care.”

The letter pointed out that, with optimum health care while inside, the health of prisoners’ could be improved before release but instead…”the community ultimately bears the cost of the poor health of prisoners in terms of the direct health costs on release back into the community and indirectly in terms of their wider impact on the health of others. Access to Medicare and the PBS could also assist in the transition from prison, with wide ranging benefits to the broader community.”

CRCAH chief executive Mick Gooda congratulated the PHAA for their initiative and pledged support for efforts to improve the health and wellbeing of Australia’s prison population.

Online survey of AOD workers’ wellbeing

A national online survey aims to find out the levels of stress, burnout and wellbeing experienced by both Indigenous and non-Indigenous health workers dealing with alcohol and other drug (AOD) issues affecting Indigenous clients right across Australia.

The two-year survey is being run by National Centre for Education and Training on Addiction (NCETA), located at Adelaide’s Flinders University, which has been working on the Commonwealth-funded research program since mid-2007.

The survey’s findings will ultimately lead to the development of an information base to inform strategies to improve worker wellbeing and reduce stress and burnout for those people working in the Indigenous AOD field.

To participate in the survey, visit http://www.nceta.flinders.edu.au and click on the survey link.

NCETA is also conducting a series of focus groups and one-on-one interviews across the country, and is looking for contacts which could be used to obtain invitations to speak with appropriate people. If you can help, email Aboriginal Project Officer Donna Weetra at donna.weetra@flinders.edu.au or call her on 08-8201 7535.

AMA Highlights children’s health in latest Indigenous health report card

The Australian Medical Association released its seventh AMA Indigenous Health Report Card  Ending the Cycle of Vulnerability: The Health of Indigenous Children in November – focusing on Indigenous children and the discrepancies in their health outcomes.
AMA President, Dr Rosanna Capolingua, said tackling the poor health outcomes experienced by Aboriginal and Torres Strait Islander children was the foundation for any solution designed to close the 17-year life expectancy gap between Indigenous and non-Indigenous people within a generation.
“This Report Card presents a snapshot of the health of Indigenous children. It presents a disturbing picture of health conditions and outcomes more commonly associated with the Third World than with a wealthy nation such as ours,” she said.
According to the Report Card, compared with their non-Indigenous Australian counterparts, Indigenous children were:

• More likely to be stillborn, to be born pre-term, to have low birth weight, or die in the first month of life;
• Two to three times more likely to die in the first year of life;
• 11 times more likely to die from respiratory causes;
• At a much higher risk of suffering from infectious and parasitic diseases, respiratory and circulatory problems, hearing loss, rheumatic fever, dental caries, injuries and clinically-significant emotional and behavioural difficulties;
• Nearly 30 times more likely to suffer from nutritional anaemia and malnutrition up to four years of age; and
• Cared for by substantially fewer adults, who had serious health risks themselves.

 “Australia needs to develop a substantial national investment strategy in Indigenous health, involving proper resourcing, community support and social capital building,” said Dr Capolingua
“The AMA believes that a national network of Aboriginal community-controlled primary health care services needs to be established specifically for Indigenous mothers and their children.”
Other initiatives recommended in the AMA Report Card include the establishment of culturally appropriate services addressing mental health and social and emotional well-being to respond to the mental health needs of Indigenous children and carers.
The report also argues for increased development of the Indigenous health and medical workforce, a national audit to measure quality of housing, access to clean water and sanitation and for the Australian Government to coordinate  improvements in national data management regarding Indigenous identification and health status.
To download a copy of the 2008 AMA Indigenous Health Report Card go to:
http://www.ama.com.au/web.nsf/doc/WEEN-7LQVQP

The Report includes a Good News and Best Practice insert which contains case studies of successful local health initiatives that have been developed and sustained by Indigenous people in their local communities.

Indigenous male researchers set up second meeting

The interim Aboriginal and Torres Strait Islander Men’s Research Council, formed at a meeting of senior Indigenous male researchers in February 2008, will hold its second meeting in Alice Springs on 23-26 February 2009.

One of the tasks of this next meeting is to plan the shape of the Council over the coming years and its efforts to support the capacity of Aboriginal and Torres Strait Islander men involved in research.

The agenda includes a welcome to country on 23 February, followed by presentations on 24 February and a discussion of key issues affecting Indigenous male researchers.  On 25 February these themes will be gathered and the direction of the proposed National Aboriginal and Torres Strait Islander Men’s Research Council will be clarified, decided and mandated.

Men's health advocates Rick Hayes, Jack Bulman and Brian McCoy

Men’s Research Council Steering Committee member Jack Bulman, who is also the Project Leader for the CRCAH’s Mibbinbah project, says that in the lead-up to the next meeting the Council wants as many Aboriginal and Torres Strait Islander male researchers as possible to take part in a survey.

The survey aims to gauge how many Indigenous male researchers there are in Australia, what type of projects they are involved in, and how they can be better supported. To obtain a copy of the survey, email Jack at jack.bulman@crcah.org.au

All those interested in attending the February Council meeting should notify organisers Scott Winch or Brian McCoy before the end of November 2008. The organisers also want to know which attendees would like to make presentations, and what topic they will be speaking on.

For registrations and more info, contact:

Scott Winch at scott.winch@menzies.edu.au or 0434 550 589

Pilot study paves way for national prisoner health checks

A pilot study of prisoner health in two WA prisons aims to pave the way for a regular program of health checks throughout WA prisons and, ultimately, in prisons right across Australia.

The HoPE (Health of Prisoner Evaluation) project began in 2007 as an initiative of Edith Cowan University criminologists Sharan Kraemer and Natalie Gately, who took their inspiration from a 2006 Australian Institute of Health and Welfare (AIHW) report which found that there was no consistent or regular State or national health audit of prisoners despite prisoners being recognised as a high-risk group.

The principal researchers developed a mental and physical health questionnaire based on existing NSW surveys, and have since completed pilot surveys of 91 male and 55 female prisoners in WA’s Casuarina and Bandyup prisons. Both remote and urban Indigenous and non-Indigenous prisoners were interviewed to reflect the current prison population.

The questionnaires included sections on such things as: general health and wellbeing; dental health; history of illness and vaccinations; exercise and injury; psychiatric and psychological history; suicide and self harm; alcohol and gambling; drug use and drug treatments; contact with family; sexual behaviour and attitudes; history of sexual assault; sexual abuse and sexual violence; smoking; tattooing; and body piercing.

The data was collected by independent researchers, as past research has indicated that data collected in this way will be more accurate as interviewees will feel more comfortable with a non-custodial interviewer. Data is now being analysed and compiled into a report, and flaws with the questionnaire have also been identified and are being rectified.

The principal researchers also wish to assist the process of prisoners maintaining contact with their families and helping families affected by incarceration. This is in response to previous research, which indicates that prisoners who maintain contact with and return to families may be less likely to return to prison.  So further to the HoPE project, this has prompted a new proposal to develop a conceptual framework to examine the impact of incarceration on prisoners' family members.

Understanding and responding to Indigenous men’s anger

A new book, Anger and Indigenous Men: Understanding and responding to violent behaviour by editors Andrew Day, Martin Nakata and Kevin Howells, looks at culturally appropriate and effective programs for reducing anger-related violence perpetrated by Indigenous men.

Written for social work and criminal justice practitioners, the collection of articles places cultural context at the heart of any intervention, broadening the focus from problematic behaviour to a more holistic notion of well-being.

Contributors to the book include psychologists, counsellors, educationalists and academics from both Indigenous and non-Indigenous backgrounds.

The book is structured in three parts, which: explore Indigenous perspectives on anger and violence, on both sociological and psychological levels; outline methodologies and processes for collecting meaningful data on anger and Indigenous men; and present ideas for developing and delivering anger management programs that meet the needs of Indigenous men.

The 250-page book published by The Federation Press
Copies are available by phoning (02) 9552 2200 or  contacting info@federationpress.com.au

Handy guide to Closing the Gap

A handy guide to the events leading up to and including the National Indigenous Health Equality Summit in Canberra in March 2008 has been published by the Human Rights and Equal Opportunity Commission (HREOC).

Called Close the Gap: National Indigenous Health Equity Targets, the publication features an explanatory overview from Social Justice Commissioner Tom Calma of the broad-based health equity campaign which resulted in the Summit, and a photo gallery of key events and people at the Summit.

At the heart of the publication is the Summit’s Statement of Intent, which sets out the Federal Government’s key commitments to reduce and ultimately eliminate the existing 17-year life expectancy gap between Australia’s Indigenous and non-Indigenous peoples.

Much of the publication is taken up by a detailed summary of the key health equality targets, with a set of timetables running over some 20 pages. It is the clear intention of the publication that these timetables should serve as a reference for years to come for anyone with an interest in Aboriginal and Torres Strait Islander health.

Close the Gap ends with the text of a speech delivered by Mr Calma to the IQPC Collaborative Indigenous Policy Conference in Brisbane on 11 June 2008, in which the future challenges facing policymakers and health professionals alike are summarised.

To download a copy of the publication, visit: www.humanrights.gov.au/about/publications/index.html or contact HREOC’s Publications Officer on (02) 9284 9600