Monitoring realistic and measurable targets key to closing the health gap: Professor Anderson

Ian Anderson

In his first major speech as chair of the National Indigenous Health Equality Council, Professor Ian Anderson said that developing and monitoring realistic national targets for Indigenous health is critical if we are to evaluate the impact of strategies that aim to permanently close the health gap between Indigenous and non-Indigenous Australians.

Addressing the “Measuring Outcomes for Indigenous Australia" session at the recent NatStats08 conference held in Melbourne, Professor Anderson said that targets should be evidence-based and outcome-focused. ‘In monitoring progress towards targets set by the Council of Australian Governments (COAG), valid target setting will require methods that are specific, measurable, achievable, realistic and time bound,’ he said.

The National Indigenous Health Equality Council was established by the Federal Government in mid 2008 to advise it on the development and monitoring of health-related goals and targets to support the Government’s commitments to closing the life expectancy gap.

Professor Anderson argued that the main contributors to the gap in life expectancy are non-communicable diseases and conditions such as respiratory diseases, cardiovascular diseases, and diabetes.

‘Significant opportunities for health gain exist through tobacco control programs and health promotion initiatives addressing obesity, but such programs need to be appropriately resourced,’ Professor Anderson said. ‘Increased capacity is required in the health system in delivering targeted primary health care, especially primary preventative services and health promotion, to Indigenous Australians,’ he added.

‘The health gap is not narrowing because over the past 20 years the causes have shifted to non-communicable diseases from communicable diseases.’

The risk factors contributing most to ill health in Indigenous populations are tobacco and body mass. ‘The primary underlining reason for lower life expectancy is high death rates from chronic diseases in middle age, including cardiovascular disease, lung diseases, cancers, and diabetes, with cardiovascular diseases the biggest killer of Indigenous people – over a quarter of Indigenous deaths.’

Professor Anderson blames the causal shifts to non-communicable diseases on Indigenous disadvantage stemming from social determinants such as low unemployment, poor housing, lack of education, discrimination, social dislocation, and disempowerment.

There is, however, some cause for optimism. ‘Although there is currently no national Indigenous life expectancy trend data, the data that is available indicates that Indigenous life expectancy is improving, but off a very low base.’

The demographic context is that “closing the gap” is still an enormous challenge as Indigenous mortality needs to fall by around 80% to achieve parity of life expectancy with the Australian population. ‘To close the life expectancy gap would require future improvement in Indigenous mortality rates well beyond levels that have been achieved in recent years.’

COAG has set aggressive targets in indigenous health and related social determinants, targets that include closing the life expectancy gap in a generation, halving child mortality gap in 10 years, and halving the literacy and numeracy gap.

To achieve these targets, COAG has established a reporting environment, which includes providing an annual “Closing the Gap” report to Parliament, but Professor Anderson admits that there is still much to achieve on appropriate monitoring, evaluation, and reporting regimes.

NHMRC update on Indigenous health research

Professor Warwick Anderson, CEO of the National Health and Medical Research Council (NHMRC) recently announced that of 688 project grants for 2009, 21 (3%) were in the subject area of Indigenous health, and that Indigenous health will be a priority area for the NHMRC in 2009. 

The NHMRC has also advised that the final consultation report on the NHMRC Road Map was presented to the Council by Professor Cindy Shannon. The report will be provided to consultation participants and placed on the NHMRC website, prior to public consultation on developing an action plan in April and May 2009. Professor Anderson’s full statement published in the CEO newsletter can be downloaded at http://www.nhmrc.gov.au/about/senior_staff/newsletters/index.htm

Signs of improvement in some health and social indicators

A detailed analysis of recently released data has revealed that some key Aboriginal and Torres Strait Islander health and social indicators have improved over the past decade, although significant areas of concern remain.

The Australian Institute of Health and Welfare (AIHW) in January 2009 released its analysis of data contained in the Aboriginal and Torres Strait Islander Health Performance Framework 2008 report, produced last year by the Department of Health and Ageing. The Health Performance Framework (HPF) consists of 70 measures covering health status and outcomes, determinants of health and health systems performance, and plays an important role in informing national health system planning and program implementation.

The AIHW’s analysis of this HPF data reveals that overall Indigenous mortality rates, deaths from circulatory disease, infant mortality and hospitalisations from pneumonia for Indigenous children have all declined over the past decade or more.

There were also improvements in school retention, school completion, literacy and numeracy levels, access to functional housing in Aboriginal communities and home ownership, while the average unemployment rate fell from 13% to 9% between 1996 and 2006.

In terms of health system performance, the number of Aboriginal and Torres Strait Islander primary health care services has grown with greater availability of staff, immunisation rates for Indigenous children are now similar to overall immunisation rates, and access to prescription medicines for those living in remote locations has improved.

On the downside, low birth weight, ear disease, rheumatic heart disease, end stage renal disease and sexually transmissible infections are all at much higher rates of prevalence among Indigenous populations than in the general community. Indigenous people are also more likely to report high levels of psychological distress than non-Indigenous people.

Overcrowding in homes, imprisonment, child abuse and neglect, smoking, substance abuse, and obesity all occur at much higher rates for Aboriginal and Torres Strait Islanders than for other Australians, while income disparities grew between 1996 and 2006. Indigenous Australians are also much more likely to be victims of violence than other Australians.

The AIHW analysis shows gaps in health service delivery and barriers to access for Aboriginal and Torres Strait Islanders remain widespread in the health system, with health expenditure on Indigenous Australians actually lower on a per capita basis compared with other Australians in 2004-05 than it was in 1998-99.

Aboriginal midwives for Central Australia

Maureen McCormack in her role as Alukura traditional grandmother

CRC for Aboriginal Health core partner, the Central Australian Aboriginal Congress (CAAC) has announced the employment of two Aboriginal trainee midwives for the first time.

The midwives will be employed from a Federal Government allocation to CAAC of $380,000 in recurrent funding for maternity and child health services and follows the medical service’s hugely successful Congress Alukura antenatal health care program.

"They will work in a team with our other three midwives," said Stephanie Bell, CEO of CAAC. “It's going to give that cultural appropriateness from the point of view of the clients, but also in the context of ensuring that our workforce is operating within those parameters of Aboriginal practices and beliefs as well."

Ms Bell says the service sees about 120 antenatal clients a year and two more positions will be a great addition.
She says it is also a great move for the Aboriginal workforce.

"I think the aspirations from young people from here are there, and we need to capture that and provide a supportive role to these Aboriginal women to ensure that they can succeed in things such as becoming trained midwives," she said.
For more information on Congress Alukura: http://www.crcah.org.au/research/alukura_antenatal.html

US study: community-wide Triple P program ‘cuts child abuse’

A five-year US study has shown that a parenting program developed by researchers at CRCAH partner the University of Queensland (UQ) can significantly lower rates of child abuse injuries and foster care placements when offered to all families in a community, not just those deemed at risk.

It is the first large-scale study to show that providing all families with access to proven parenting information and support can reduce rates of child maltreatment.

The Triple P – Positive Parenting Program was developed at UQ’s Parenting and Family Support Centre by Professor Matt Sanders and colleagues and is based on 30 years' clinical research. The program is now used by governments and health authorities in 17 countries – the US, England, Scotland, Ireland, Canada, Sweden, New Zealand, Hong Kong, Iran, Japan, Germany, Belgium, Singapore, Switzerland, The Netherlands, Curacao and Australia.

Results of the US study were published on January 27 in the online edition of the Prevention Science journal, and showed that making Triple P available to all parents led to significantly lower rates of confirmed child abuse, fewer out-of-home placements and fewer hospitalisations from child abuse injuries, when compared to communities without access to Triple P.

Researchers estimate that for every 100,000 children under the age of eight, the results could translate annually into 688 fewer cases of child maltreatment, 240 fewer children in care and 60 fewer children being admitted to hospital or emergency departments with abuse injuries.

The study was funded by the US Centers for Disease Control and Prevention and led by Dr Ron Prinz at the University of South Carolina. It was conducted in 18 counties in the US State of South Carolina, nine of which were chosen randomly to receive Triple P.

Professor Sanders, who co-authored the study, said previous research has already shown that Triple P “can alleviate parents' stress and depression and help prevent and reduce child emotional and behavioural problems".

"Parents are looking for practical solutions to parenting problems that work," Professor Sanders said. "We would expect similar results in Australia if all families here were offered easy access to Triple P.

The online edition of Prevention Science is located at: www.preventionresearch.org/prevscience.php.

Improving the value of health research to Indigenous communities through better ethics

Ethical relationships within the research process with Indigenous peoples must be based on the concepts of mutual recognition, mutual comprehension, reconciliation, and de-colonisation, if research is to have real meaning and purpose for Indigenous communities, CRC for Aboriginal Health research director, and Onemda VicHealth Koori Health Unit director, Professor Ian Anderson said recently.

Professor Anderson was addressing the Ninth Global Forum on Bioethics in Research conference held in Auckland, New Zealand. In his paper, ‘Regulating Ethics and Aboriginal Health Research: An Indigenous Paradigm’, Professor Anderson argued for the establishment of a stronger regulatory framework to improve ethical research engagement with Indigenous Australians.

Currently, Indigenous people have limited formal involvement in institutional Human Research Ethics Committees (HRECs), with most HRECs engaging Indigenous people through informal and ad hoc arrangements (if at all).

Professor Anderson said that existing research guidelines need to be based on values and ethics that can be integrated with Indigenous ethical thinking and enable a shift from a ‘protective’ paradigm to one that is reconciliatory and de-colonising.

In showing reciprocity, for example, Professor Anderson said, researchers and HRECs should consider:

• How the proposed research will contribute to the advancement of the health and wellbeing of participants and communities.

• How the research proposal links clearly to community, regional, jurisdictional or international Indigenous health priorities and/or responds to existing or emerging needs articulated by Aboriginal and Torres Strait Islander Peoples.

• The nature of benefits for Indigenous participants and communities, and evidence of clear and truthful discussions about the potential benefit of the research proposal before approval of the research project.

‘In the Australian Indigenous context, the development of guidelines for research in Aboriginal and Torres Strait Islander health contexts historically has been a highly contested process and has attracted a significant focus within research policy,’ Professor Anderson said.

The establishment of stronger guidelines based on value principles, he acknowledged, would need to be ‘reinforced by institutional reform of current research processes and ethical regulation’.

Mibbinbah Men’s Project: An Interview with Ross Morgan, Drug & Alcohol Worker

Ross Morgan

Ross Morgan, Intake and Assessment Worker in Indigenous Family Violence at the Maya Living Free Healing Centre in Victoria, took time out of his busy community work schedule to talk to Gwalwa-Gai about the CRC for Aboriginal health (CRCAH)-funded national Mibbinbah Men’s project, of which he is a founding member.

For more than 12 years, Ross has been working with people suffering the impacts of alcohol and drug addiction. Through his life experience and work, Ross has a strong belief that trans-generational trauma, grief and loss, are the root cause of many alcohol and drug problems facing the Indigenous community. It is this knowledge that brought him to Mibbinbah, which means ‘men’s place’.

A three-year program, Mibbinbah comes under the umbrella of the Chronic Conditions Program of the CRCAH and consists of two related parts: a men’s spaces pilot project, with 6 sites along the east coast and Darwin, and a Men’s Chronic Conditions project. The research program has been developed and is being deployed under the joint leadership of researchers Jack Bulman and Rick Hayes.

The Mibbinbah project is about Indigenous men in community health organisations getting together in a safe place to talk about ways of supporting each other and their communities to improve health and well-being. Ultimately, the idea is to help make Indigenous and non-Indigenous society a healthier and more secure place for Indigenous men and women. 

‘The connection between the Maya Centre and the Mibbinbah project is that grass-roots people in Victoria were finding it hard getting support from mainstream,’ says Ross, who earlier had helped set up the centre in the Melbourne suburb of Thornbury. ‘Two Mibbinbah organisers, Jack Bulman from the CRC for Aboriginal Health and Rick Hayes from Latrobe University, heard about us from the grapevine, and invited us to be involved in their program, and that’s how Maya became involved in the partnership.’

‘Through the Mibbinbah project, we want to achieve an Australia-wide men’s health network, so that we could really start improving men’s health,’ Ross says. ‘The issue of men’s health has got to be supported at all levels. Indigenous men die at 45 years, minimum age, so the Mibbinbah project is important, very important.’

A Yorta Yorta man, Ross, grew up in Mooroopna, near Shepparton. His family is the Morgan family from the Barmah area. ‘I was concerned about my community; the rate of imprisonment was getting worse, as was the rate of Aboriginal deaths in custody’.

As a young man, Ross worked as a builder’s labourer, in factories and abattoirs, and became interested in improving his health and furthering his own education. ‘With the support of others, I started to do something about my wellbeing. I realised that if I could sustain my own life, I could take this message out to my people, and help others.’

His many qualifications now include Certificate IV Drugs and Alcohol, Diploma of Indigenous welfare studies, Diploma of Indigenous Spiritual and Emotional Wellbeing, and Certificate IV in Business Governance. ‘I still carry on with my education--there are things that I can still learn.’

Ross first became involved in Indigenous health issues, “through the loss of loved ones—friends and relatives”, and then through his work at Victorian Aboriginal Health Service (VAHS), where he dealt with alcohol and drug issues in the community.

His CV certainly shows a person deeply involved and committed to community affairs. He is the Intake and Assessment Worker in Indigenous Family Violence, at Maya, dealing with healing the sicknesses of trans-generational trauma experienced by Indigenous people.

He is currently a board member at the Aboriginal Health Service, and the Violence Action Committee, in Victoria. His previous involvement includes membership of the Victorian Drug Strategy Committee and the Dardee Munwurro Committee.

He is actively involved with the Fitzroy Stars Gym, umpired for the Western Amateur Football League, and was assistant coach for the East Brunswick football team and at Loddon Prison in Central Victoria helps Indigenous prisoners address their drug issues.

Despite relinquishing his role last year as an organiser with the Mibbinbah project, because of his hectic commitments at Maya and elsewhere, Ross continues to act as a researcher for the Mibbinbah project on men’s health, and he plans to become even more involved with the project this year. ‘Maya has a lot of knowledge on men’s health and wellbeing issues it can share with other community groups,’ he says.

But it’s also a two-way street, with benefits, Ross acknowledging, also accruing to Maya. ‘The Mibbinbah project is recognition of what Maya is doing to change, and improve, men’s health,’ he says. ‘The Mibbinbah project is one avenue for helping Maya achieve that end.’

Maya’s goal is to reduce the incidence of addiction, family breakdown, poor health and contact with the justice system by creating a safe environment for people to come to and the implementation of programs that will strengthen the identity and heal the spirit of Aboriginal people.

Regular meetings alternate between sites, the last one held in Queensland late last year to discuss learning about researching men’s issues. ‘Indigenous men from each of these sites bring their own set of skills,’ Ross says. The information shared at these meetings is brought back to the community organisations and from there spreads to the communities they represent.

Ross explains that the partnerships and bonds so created between Indigenous community organisations, and their representative Indigenous practitioners who attend the meetings, empower these men to recruit and train other local health leaders, and thereby build leadership and capacity in community health organisations.

The men’s spaces pilot project, jointly funded by the CRCAH and beyondblue, involves seven sites located mainly on Australia’s eastern seaboard and aims to identify the essential characteristics of existing Indigenous men’s spaces through the employment of local Indigenous male project associates. The second project is partially funded by the CRCAH and seeks to understand if and why participation in chronic conditions programs by Indigenous males is improved through association with safe and well-facilitated Indigenous men’s spaces, and how this might benefit families and communities.

The generally poor health of Indigenous people is well known, with Indigenous men particularly at risk of premature death and disability. ‘Indigenous male spaces may be an effective and culturally supportive way of connecting men with one another,’ says Ross. ‘By going to places where Aboriginal men are confident and strong can make significant contributions to Indigenous communities, which in itself is healthy.’

National Centre for Monitoring Chronic Kidney Disease – new report

The prevalence of chronic kidney disease (CKD) amongst Aboriginal and Torres Strait Islander people is well-documented with 2007 data indicating that 1,213 Indigenous Australians were receiving treatment for their end-stage kidney disease (ESKD) equating to 7.2% of all ESKD treated in Australia.

Despite this prevalence there are many gaps in the information available on CKD in Australia, particularly in relation to the earlier stages of the disease.

In order to address this knowledge gap, the National Centre for Monitoring Chronic Kidney Disease was established at the Australian Institute of Health and Welfare in late 2007 and the Centre has just released the first report of its role and the rationale behind its establishment and operation.

The National Centre monitors and reports on disease levels, burdens and trends associated with chronic kidney disease in all Australians and in specific populations. By reporting patterns and trends of chronic kidney disease the National Centre will complement other initiatives in monitoring the closely linked chronic diseases of cardiovascular disease and diabetes.

The National Centre aims to identify gaps, consolidate previously separate information and undertake or coordinate efforts for new data analysis.

These activities will facilitate information sharing between key stakeholders, and promote community discussion with the ultimate aim of informing efforts to help reduce the health, social and economic burden of CKD for all Australians.

New Aboriginal Health College opens in Sydney

After 10 years in the planning and construction, Sydney’s Aboriginal Health College (AHC) will officially open its new $8 million purpose-built campus at Little Bay in the city’s south on 26 February 2009.

The opening will coincide with the official graduation ceremony for students who successfully completed courses in 2008.

The AHC was established in 2002 by the Aboriginal Health & Medical Research Council of NSW and has been offering a number of courses at its temporary campus in Surry Hills since then. Courses include Aboriginal health work, community services, workplace training and business management, with successful graduates receiving recognised certificate and diploma qualifications.

More courses will become available once the new campus is up and running, with a heavy emphasis on distance learning. For more information, contact the AHC on 02-9212 4777, via email at ahc@ahc.edu.au or visit their website at www.ahmrc.org.au/Aboriginal Health College.htm

Feds release research blueprint into climate change health impacts

The Federal Government has released its research blueprint for tackling the likely health consequences of climate change over coming decades and has promised almost $10 million to fund the initial research effort over the next five to seven years.

The report, Human Health and Climate Change – a National Adaptation Research Plan, was developed by the Government’s National Climate Change Adaptation Research Facility (NCCARF) and released by the Minister for Climate Change and Water, Senator Penny Wong, in January 2009.

The CSIRO and the National Health and Medical Research Council (NHMRC) provided significant input into the report, which identifies heat, extreme weather, vector-borne disease, mental health, healthcare systems and infrastructure, food safety and the factors that influence risk as the key areas for research.

Minister Wong said that by 2020, “the number of heat-related deaths in our capital cities is projected to more than triple to between 4,300 and 6,300 a year”.

“By 2050 we are likely to see up to an additional 80,000 cases of food poisoning each year, and by 2100 dengue fever may have spread south to Brisbane,” she said.

“We need to better understand the diversity of these health risks, who will be most vulnerable, and the action governments, individuals and communities can take to reduce the risks.”

The NHMRC will receive $6 million to underpin its new climate change imperative, while the Australian National University’s National Centre for Epidemiology and Population Health and University of Queensland’s School of Integrative Biology have been selected to lead the three-year, $3.94 million Collaboration Cluster, in partnership with CSIRO.

The Cluster’s research program will focus on air quality, food security and safety, and heat stress, as well as the changing risk posed by vector-borne diseases due to climate change.

The NCCARF report is available at http://www.nccarf.edu.au, while the NHMRC funding guidelines are available at http://www.nhmrc.gov.au/grants/apply/projects/index.htm. Further information on the CSIRO Collaboration Cluster is available at: http://www.csiro.au/org/FlagshipCollaborationFundOverview.html

Understanding health inequities – a simple explanation

“If a rich person and a poor person get cancer at the same time, the poor person will die sooner.”

Dr Mark Ragg is a writer, editor, publisher and medical practitioner who runs a national health and communications consultancy and teaches at the School of Public Health at the University of Sydney where he is an adjunct senior lecturer.

He has worked with the National Health and Medical Research Council, the Commonwealth Department of Health and Ageing, various state and territory governments and a broad range of NGOs and has been a reporter and columnist with The Australian, and a senior writer and editorial writer at the Sydney Morning Herald. 

Perhaps most importantly he is not happy about media coverage of the so-called “health-crisis” in Australia. So unhappy, in fact, that he recently waded through extensive Australian health data to produce a report on inequities in the Australian health system, “Fine but not fair – A report on Australia’s health and health care system”.

Dr Ragg told Gwalwa-Gai that, as a medical practitioner, journalist and teacher he was tired of media misreporting on the real issues of health inequity in Australia’s health system and so produced the concise collection of data to enable journalists and others with an interest in health to see where the real systematic inequities lie.

“I guess I get sick of seeing newspaper reports of a health crisis because someone had to wait six hours in an emergency department,” he said, “There are serious problems, but overall the health and healthcare of most Australians is up there with the best in the world.

He says the real inequities in our health system are generally not well reported in the media and includes Aboriginal health in this category.

“It’s that the problems highlighted are not the ones I see as important. There are real inequalities in health, to do mainly with income, education and geography, and waiting times for surgery is just not one of the big ones.”

The report identifies one of the most critically unfair areas of Australia’s health system is the private health insurance sector which, the report argues, creates “a reverse Robin Hood – it takes money from the poor and gives it to the rich”.

According to the report other areas which demonstrate clear inequity are:

• Indigenous mortality rates - “On any given day, an Indigenous person is roughly twice as likely to die as a non-Indigenous person of the same age and gender”.
• Dental health – “People who are worse off are almost three times as likely to have their teeth pulled out, rather than repaired, when they do see a dentist”.

In its conclusion the report mirrors previous studies and finds that wealth, ethnicity and gender all impact on the quality of care you will receive in the Australian health system.

“You do much better in Australia’s health care system if you’re wealthy, if you’re well educated, if you live in the city and if you’re not Indigenous. Otherwise, it seems, you receive a lesser standard of care. If you have a chronic condition such as diabetes or heart disease, you’ll end up in hospital where someone better off will manage to stay home and get the care they need. And if a rich person and a poor person get cancer at the same time, the poor person will die sooner.”

Targeting Indigenous smoking – the NT Tobacco Summit

Tobacco smoking is the single largest preventable cause of death and disease in Australia. It is a major risk factor for heart attack, stroke, cancer, diabetes and low birth weight babies and the Northern Territory has the dubious distinction of having  the highest rates of smoking in Australia. 

Alice Springs-based Health Promotion Officer with the Heart Foundation, Nina Nichols is focusing her efforts on Indigenous Tobacco Control and is currently coordinating a Northern Territory Tobacco Summit in Darwin on 23 and 24 of March this year. 

Research from the NT Department of Health and Community Services in 2006 showed that almost 65 per cent of Indigenous men and 50 per cent of Indigenous women in the Northern Territory are daily smokers.

Although there has been some progress in the Northern Territory to reduce harm caused by tobacco use, there remains an urgent need for further work in this area.  Recent CRCAH research conducted by the University of Queensland’s Associate Professor Theo Vos found that smoking accounts for 17% of the health gap between Indigenous and other Australians and 20% of all Indigenous deaths

More than 60 key stakeholders representing Indigenous communities, health professionals, researchers and policy makers, from inside and outside of government, will come together from across the NT.

“I am excited by the level of knowledge and experience that participants will bring to the Summit. I’m also pleased that two NT youth representatives have been invited to attend. It is important for our young people to be involved in decision making processes” says Nina.

The Summit will also consider the effects of second hand smoke. We now know that breathing other people’s smoke – second hand smoke - is harmful.  Breathing second hand smoke can cause lung cancer and heart disease.  It is also harmful to children and can cause SIDS (sudden infant death syndrome).

Nina’s aim is that “together, through many voices, we will develop a Tobacco Action Plan for the NT that is well advised, inclusive and supportive.”  The Northern Territory Action Plan will provide a blueprint for tackling the burden of ill health in the community and the need for hospitalisation as a result of tobacco use.

Summit organiser the Heart Foundation’s Nina Nichols

The Heart Foundation is a not for profit, non government organisation with the mission of reducing suffering and death from heart, stroke and blood vessel disease in Australia.

Nina can be contacted at Nina.Nichols@heartfoundation.org.au

For more information on Aboriginal smoking see: http://www.crcah.org.au/research/tobacco_control.htmlhttp://www.crcah.org.au/research/exploring_resilience_smoking.html

Or visit the website of the Centre for Excellence in Indigenous Tobacco Control: www.ceitc.org.au

Social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples – AIHW Report

A new report from the Australian Institute for Health and Welfare provides current national data on the social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples and makes recommendations for improving measures of social and emotional wellbeing.

The concept of social and emotional wellbeing that underpins the analyses in this Report attempts to capture an Aboriginal and Torres Strait Islander holistic and whole-of-life view of health. It includes mental health, but also considers the impact of other factors on emotional well being, such as life stressors, removal from family, discrimination and cultural identification.
Until recently, the majority of national data on the social and emotional wellbeing of Aboriginal and Torres Strait Islanders centred on the use of mental health services.

The interim social and emotional wellbeing module was developed to collect national data on this topic in the 2004-05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) including the following key findings:

• Over one-quarter (27%) of Aboriginal and Torres Strait Islander adults reported high or very high levels of psychological distress.
• Aboriginal and Torres Strait Islander people were twice as likely to report high or very high levels of psychological distress as non-Indigenous Australians.
• Almost one in 10 Aboriginal and Torres Strait Islander people had visited a doctor or health professional in the 4 weeks prior to interview due to feelings of psychological distress.
• In relation to life stressors, four in 10 Aboriginal and Torres Strait Islander adults indicated that they or their family or friends had experienced the death of a family member or close friend in the previous year, 28% reported serious illness or disability and 20% reported alcohol-related problems.

To download the AIHW report: www.aihw.gov.au/publications/ihw/msewatsip/msewatsip.pdf