tag:theconversation.com,2011:/africa/topics/indigenous-health-package-31054/articlesIndigenous health package – The Conversation2023-05-23T20:11:01Ztag:theconversation.com,2011:article/2049122023-05-23T20:11:01Z2023-05-23T20:11:01ZDrinking fountains in every town won’t fix all our water issues – but it’s a healthy start<figure><img src="https://images.theconversation.com/files/526698/original/file-20230517-19-mq87we.jpg?ixlib=rb-1.1.0&rect=14%2C24%2C3244%2C2418&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/boy-drinking-fountain-61239514">Shutterstock</a></span></figcaption></figure><p>Water plays a significant role in Aboriginal culture. The <a href="https://www.dcceew.gov.au/parks-heritage/heritage/places/national/brewarrina#:%7E:text=The%20story%20of%20Baiame's%20Ngunnhu&text=The%20intricate%20design%20of%20the,high%20and%20low%20river%20flows.">Fish Traps in Brewarrina, Baiame’s Ngunnhu</a>, for example, were built by eight clan groups and continue to sustainably fish the Barwon River. </p>
<p>Respect for and <a href="https://humanrights.gov.au/sites/default/files/content/social_justice/nt_report/ntreport08/pdf/chap6.pdf">understanding of water</a> has enabled Aboriginal people to thrive for millennia in very hot and remote places. The <a href="https://www.tandfonline.com/doi/full/10.1080/07900627.2020.1868980">impacts of colonisation</a> including introduced species of plants and animals, farming and overuse of rivers and ground water, compounded by global warming, has dramatically reduced water access and quality, and in some places threatened the water supply.</p>
<p>Recent coverage of the quality of <a href="https://www.9news.com.au/national/residents-of-nsw-town-forced-to-drink-bottled-water/105752a7-1bec-4ac2-840d-336d74bc2924">drinking water in Walgett</a> in New South Wales again highlights that clean, safe drinking water is not a right in Australia. Walgett residents say the water is unsafe to drink and they’re backed by <a href="https://www.georgeinstitute.org.au/media-releases/aboriginal-organisations-demand-action-walgett-drinking-water-health-threat">scientists from the George Institute</a> who report an urgent need to address drinking water quality. </p>
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Read more:
<a href="https://theconversation.com/countless-reports-show-water-is-undrinkable-in-many-indigenous-communities-why-has-nothing-changed-194447">Countless reports show water is undrinkable in many Indigenous communities. Why has nothing changed?</a>
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<h2>Supply is only half the issue</h2>
<p>The reasons for poor or limited water supply vary. They include river flows and environmental health issues, infrastructure, and insufficient skilled, credentialed staff available to conduct water quality checks. But understanding the causes is one thing. Taking active steps to address them is another. </p>
<p>When clean, safe water doesn’t flow to communities, they are more likely to drink sugar-sweetened beverages. Our 2020 <a href="https://www.cdhjournal.org/issues/37-2-june-2020/1027-outcomes-of-a-co-designed-community-led-oral-health-promotion-program-for-aboriginal-children-in-rural-and-remote-communities-in-new-south-wales-australia">study</a> visited three remote schools with high proportions of Aboriginal students. Our initial results, gathered in 2014, found 64% of children regularly drank sugary drinks. Some 5% thought drinking water was “unhealthy”. In some places in Australia that’s <a href="https://theconversation.com/travelling-around-australia-this-summer-heres-how-to-know-if-the-water-is-safe-to-drink-196294">true at least some of the time</a>. </p>
<p>The availability of safe drinking water impacts tooth decay, obesity and <a href="http://www.fizz.org.nz/pdf/research/6%20Sugar%20Sweetened%20Beverages,%20Obesity,%20Diabetes%20and%20Oral%20Health.pdf">diseases like diabetes</a>. Australia has <a href="https://www.waterquality.gov.au/guidelines/drinking-water">drinking water quality guidelines</a> but they are not mandatory.</p>
<p>We installed cold, filtered water fountains through a structured, collaborative process and, as a result, found in 2018 that 84% of children at those same schools drank water every day. The percentage who regularly drank sugary drinks shrank to 33% in the intervening four-year period. </p>
<p>Our <a href="https://www.publish.csiro.au/PY/PY21119">follow up study</a> found towns of lower socioeconomic status were less likely to have access to community drinking water and more likely to have a high Aboriginal population. So, Aboriginal people are particularly disadvantaged by this issue. It also found that in many towns the cheapest drink is soft drink.</p>
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<a href="https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Outdoor view of river with traditional Indigenous fish traps in the water." src="https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The Brewarrina fish traps in action.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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<h2>Making a difference through codesign</h2>
<p>We have been working with NSW communities to install refrigerated water fountains in rural and remote places. We collaborate with local Aboriginal land councils, traditional owners, and local government using <a href="https://doi.org/10.17061/phrp3222215">codesign principles</a>. Together we confirm the need, identify a suitable location and then select the right model of water fountain. We also negotiate local responsibility for ongoing maintenance and provide water bottles, education resources and spare filters.</p>
<p>In most cases we work with schools and preschools to embed positive health messages and reinforce water as the best drink. As Kim Cooke, Director Little Yuin Preschool in Wallaga Lake says, </p>
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<p>The water fountain is a wonderful asset to the preschool outdoor learning environment. For us, as educators, it is central to the children’s health to be able to hydrate their bodies ready for learning; and having access to fresh water to drink everyday has led to an increase in their independence and learning about the importance of drinking water throughout the day. </p>
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Read more:
<a href="https://theconversation.com/travelling-around-australia-this-summer-heres-how-to-know-if-the-water-is-safe-to-drink-196294">Travelling around Australia this summer? Here's how to know if the water is safe to drink</a>
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<h2>Meeting local need</h2>
<p>We recently <a href="https://www.publish.csiro.au/py/fulltext/PY21119">conducted a survey</a> of towns across Australia with a population of fewer than 5,000 people and Aboriginal population greater than 3%. We estimated that 222 places out of 612 small towns nationally do not have community drinking water.</p>
<p>Providing drinking water to every Australian town requires a place-by-place approach so that communities get a say about how and where fountains are installed and they meet local needs. Schools and preschools can participate in health promotion too. A national approach that overcomes the policy “ping pong” of responsibility for water safety, quality and infrastructure between local, state and the federal governments is also required. A national approach would enable:</p>
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<li><p>high quality infrastructure to be purchased at reasonable price</p></li>
<li><p>professional and timely installation </p></li>
<li><p>local responsibility for maintenance</p></li>
<li><p>codesign so that each town gets the infrastructure they need, where it’s needed.</p></li>
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<p>We estimate it would cost A$5 million to solve this problem nationally, based on our installation costs in NSW communities to date – a small investment in the prevention of chronic disease. </p>
<p>Water fountains in every town won’t solve all of our water issues. But they could ensure everyone can access free, cold drinks and reduce sugar consumption. </p>
<p>As community member, Brewarrina and Brewarrina Shire Councillor Aunty Trish says: </p>
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<p>Having cold water available after you finish your sports or on our hot days will mean a lot for the community, fresh water helps with the health and wellbeing of the community.</p>
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Read more:
<a href="https://theconversation.com/drinking-water-can-be-a-dangerous-cocktail-for-people-in-flood-areas-178028">Drinking water can be a dangerous cocktail for people in flood areas</a>
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<p><em>The authors wish to acknowledge Uncle Boe Rambaldini and Professor Chris Bourke, our project ambassadors. Aboriginal communities and local government authorities that have participated in our research and the implementation of water fountains. Our partners at the Alliance for a Cavity Free Future, Australian Dental Association NSW Branch, NSW Council of Social Service, Public Interest Advocacy Centre and Australian Red Cross.</em></p><img src="https://counter.theconversation.com/content/204912/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Charles Skinner has consulted to Colgate Palmolive Pty Ltd and the Aboriginal Health and Medical Research Council of NSW. He receives funding from Asthma Australia for research. He is affiliated with Charles Sturt University.</span></em></p><p class="fine-print"><em><span>Kylie Gwynne receives funding from NHMRC and various charities/foundations for research. She is affiliated with the Resolution Institute. </span></em></p><p class="fine-print"><em><span>Tom Calma receives funding from a consultancy on tackling Indigenous smoking from the Department of Health and Aged Care, an academic appointment with the University of Sydney and various other consultancies. He is affiliated with the University of Canberra and University of Sydney. </span></em></p>We estimate more than 200 communities across Australia do not have community drinking water fountains. That must change.John Charles Skinner, Senior Research Fellow, Indigenous Health, Macquarie UniversityKylie Gwynne, Senior Lecturer, Health Leadership, Macquarie UniversityTom Calma, Chancellor, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050162023-05-05T07:04:25Z2023-05-05T07:04:25ZNew funds will tackle Indigenous smoking. But here’s what else we know works for quit campaigns<figure><img src="https://images.theconversation.com/files/524535/original/file-20230504-29-jg5f4w.jpg?ixlib=rb-1.1.0&rect=0%2C88%2C1000%2C562&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-african-american-girl-breaking-cigarette-2280036417">Studio Romantic/Shutterstock</a></span></figcaption></figure><p>Among all the talk this week about a <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping">crackdown on vaping</a> – the most significant <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-for-health-and-aged-care-speech-national-press-club-2-may-2023?language=en">tobacco control reforms</a> in a decade – has been the roll-out of another major document.</p>
<p>The <a href="https://www.health.gov.au/resources/publications/national-tobacco-strategy-2023-2030">National Tobacco Strategy 2023–2030</a> was launched this week.</p>
<p>A key priority of the strategy is Aboriginal and Torres Strait Islander smoking and <a href="https://www.closingthegap.gov.au/">Closing the Gap</a>. We heard the Tackling Indigenous Smoking program would be extended and widened – <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping?language=en">with A$141 million funding</a> – to reduce both vaping and smoking among Aboriginal and Torres Strait Islander people.</p>
<p>Here’s why that’s urgently needed and what needs to happen next to reduce smoking rates among Aboriginal and Torres Strait Islander people.</p>
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Read more:
<a href="https://theconversation.com/we-can-cut-indigenous-smoking-and-save-lives-heres-how-42119">We can cut Indigenous smoking and save lives – here's how</a>
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<h2>Tobacco is still a killer</h2>
<p>Tobacco <a href="https://www.aihw.gov.au/news-media/media-releases/2019/october/tobacco-use-linked-to-more-than-1-in-8-deaths-but">legally kills</a> over 57 Australians a day. That’s equivalent to extinguishing an entire country town of 21,000 every year. </p>
<p>It’s still the single biggest <a href="https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/burden-of-disease/overview">preventable</a> risk factor for disease and premature death. For Aboriginal and Torres Strait Islander <a href="https://www.aihw.gov.au/reports/burden-of-disease/illness-death-indigenous-2018/summary">people</a>, <a href="https://academic.oup.com/ije/article/50/3/942/6118443">more than a third</a> of all deaths are caused by tobacco. Over the past decade we have lost more than <a href="https://academic.oup.com/ije/article/50/3/942/6118443">10,000</a> Aboriginal and Torres Strait Islander lives due to smoking.</p>
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<p><a href="https://healthbulletin.org.au/articles/review-of-tobacco-use-among-aboriginal-and-torres-strait-islander-peoples/">Multiple policy failures</a> beyond health – from poverty, education, employment, housing, family removals, dislocation and the systematic embedding of tobacco as rations <em>in lieu</em> of wages – mean Aboriginal and Torres Strait Islander people are disproportionately impacted by the harms of Big Tobacco. </p>
<p>So the <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping?language=en">funding</a> to expand the <a href="https://tacklingsmoking.org.au/">Tackling Indigenous Smoking program</a> is urgently needed to have no more than 27% of Aboriginal and Torres Strait Islander smoking by 2030 (5% of all Australians).</p>
<p>There have been huge achievements in reducing Aboriginal and Torres Strait Islander smoking. In <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.13049">2018–19</a>, 40% of Aboriginal and Torres Strait Islander adults smoked daily, down from 50% in 2004–05. A target of 27% is achievable. But to get there we need something “extra” to accelerate those reductions.</p>
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Read more:
<a href="https://theconversation.com/heres-how-to-close-the-gap-on-indigenous-women-smoking-during-pregnancy-62347">Here's how to close the gap on Indigenous women smoking during pregnancy</a>
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<h2>We know what works</h2>
<p>Tobacco campaigns are one of the most <a href="https://www.tobaccoinaustralia.org.au/chapter-14-social-marketing/14-1-social-marketing-and-public-education-campaig">cost-effective</a> <a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/21/2/127.full.pdf">interventions</a> when evidence-based, market-tested, sustained and with support services at the end of the call to action. When they are adequately funded, they can <a href="https://tobaccocontrol.bmj.com/content/31/2/284">impact inequities</a>.</p>
<p>Campaigns must be personally relevant and meaningful <a href="https://www.wiley.com/en-au/Health+Behavior%3A+Theory%2C+Research%2C+and+Practice%2C+5th+Edition-p-9781118629000">to be effective</a>. This makes the case for targeted approaches, including local level campaigns, reinforced by general, national activity. Audiences engage with the message when they can see themselves and their community members (sometimes actually) in the advertising.</p>
<p>We saw this nationally with <a href="https://www.youtube.com/watch?v=0yvjBU-E0aw">Break the Chain</a> starring Aboriginal actor and comedian Elaine Crombie. Originally this was a targeted campaign for Aboriginal and Torres Strait Islander people. But it then aired nationally targeting all Australians in 2014.</p>
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<figcaption><span class="caption">The ‘Break the Chain’ campaign featured Aboriginal actor and comedian Elaine Crombie.</span></figcaption>
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<p><a href="https://www.health.gov.au/resources/collections/campaign-resources-dont-make-smokes-your-story">Don’t Make Smokes Your Story</a> was launched in 2016, as part of the Tackling Indigenous Smoking program. This was created by Indigenous agency Carbon Media, starring musician <a href="https://www.youtube.com/watch?v=878H2fkw3L8">Fred Leone</a> alongside real stories <a href="https://www.youtube.com/watch?v=xCX-ZfopeSE">from community members</a>. </p>
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<figcaption><span class="caption">‘Don’t Make Smokes Your Story’ campaign.</span></figcaption>
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<p>One of the <a href="https://www.phrp.com.au/issues/september-2020-volume-30-issue-3/tackling-indigenous-smoking-a-good-news-story-in-australian-tobacco-control/">most successful</a> and innovative Aboriginal and Torres Strait Islander tobacco campaigns, it included a
<a href="https://www.health.gov.au/resources/publications/dont-make-smokes-your-story-toolkit?language=en">toolkit</a> for Aboriginal and Torres Strait Islander communities to use and adapt the national campaign to their <a href="https://tacklingsmoking.org.au/sharing-our-stories/">local contexts</a>.</p>
<p>An excellent example of this is from the <a href="https://www.apunipima.org.au/tackling-indigenous-smoking/#:%7E:text=The%20Apunipima%20Tackling%20Indigenous%20Smoking,to%20culturally%20appropriate%20quit%20support">Apunipima Tackling Indigenous Smoking team</a> with its local campaign <a href="https://www.youtube.com/watch?v=tohg0QEGVU0">Don’t Make Smokes Your Story Cape York</a>.</p>
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<figcaption><span class="caption">Campaigns can be localised, like this one from Cape York.</span></figcaption>
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<p>When Aboriginal and Torres Strait Islander people lead and promote smoke-free behaviours, communities are <a href="https://www.mja.com.au/journal/2015/202/10/predictors-wanting-quit-national-sample-aboriginal-and-torres-strait-islander">more interested in quitting</a>. </p>
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Read more:
<a href="https://theconversation.com/telehealth-has-much-to-offer-first-nations-people-but-technical-glitches-and-a-lack-of-rapport-can-get-in-the-way-201872">Telehealth has much to offer First Nations people. But technical glitches and a lack of rapport can get in the way</a>
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<h2>What works? Product, price, place and promotion</h2>
<p>Social marketing campaigns, like the ones we’ve mentioned, really work well when they take on the <a href="https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/social_marketing.pdf">Four Ps</a> of product, price, place and promotion.</p>
<p>The beautifully produced ads, the “promotion”, can’t have impact on their own. This is where the rest of the National Tobacco Strategy comes in.</p>
<p><strong>1. Product</strong></p>
<p>We’ve reduced product appeal with <a href="https://theconversation.com/world-first-plain-packaging-for-tobacco-products-a-step-closer-to-becoming-law-3053">plain packaging</a> and graphic health warnings. This will be enhanced with new warnings, including on the sticks themselves, plus greater uniformity of standardised packaging and tightened rules around additives and flavours that make smoking palatable.</p>
<p><strong>2. Price</strong></p>
<p>Price increases <a href="https://www.sciencedirect.com/science/article/pii/S2468266719302038">reduce smoking</a> and we’ll see a tax increase of 5% each year for three years across all different tobacco product types. </p>
<p><strong>3. Place</strong></p>
<p>We have known about the harms of commercial tobacco since at least 1950. Yet we still expect individuals to give up nicotine instead of removing this lethal product from sale at pretty much every supermarket, service station and convenience store. </p>
<p>The National Tobacco Strategy is considering a national licensing scheme, removing online sales and delivery services, and potential for reducing the number, type and location of tobacco outlets.</p>
<p>There will also be more action on smoke-free areas and making sure all health professionals (particularly in remote places) are equipped to support quit attempts.</p>
<p>The strategy states it will explore raising the age you can buy cigarettes and monitor how this works overseas. </p>
<p><strong>4. Promotion</strong></p>
<p>The commitment to close any last promotional loopholes for tobacco and e-cigarettes, particularly online is also important, along with local and national anti-smoking campaigns. But we know these are not enough on their own.</p>
<h2>What we also need</h2>
<p>Addressing all four Ps is what comprehensive tobacco social marketing would look like. It’s what’s required to accelerate the declines to get to the 27% target for Aboriginal and Torres Strait Islander peoples, and 5% nationally.</p>
<p>Targeted approaches are critical and can be effective, but they need to be supported by bigger, whole of population structural changes. The community-led campaigns, supported by national activity, will reinforce and amplify the policy changes that will come through on the tobacco product, its cost and its availability. </p>
<p>That’s how we realise our goals and ultimately eliminate tobacco related disease and death.</p><img src="https://counter.theconversation.com/content/205016/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christina Heris receives funding from the NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (NHMRC GNT1198301), and the Australian Government Department of Health and Aged Care for the Tackling Indigenous Smoking – Regional Grants Impact and Outcomes Assessment.</span></em></p><p class="fine-print"><em><span>Lisa J Whop receives funding from the National Health and Medical Research Council and the Australian Research Council. She is also a member and incoming chair of Cancer Australia's Leadership Group on Aboriginal and Torres Strait Islander Cancer Control.</span></em></p><p class="fine-print"><em><span>Michelle Kennedy receives funding from the National Health and Medical Research Council, Medical Research Future Fund and the National Heart Foundation. </span></em></p><p class="fine-print"><em><span>Raglan Maddox receives funding from from the NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (NHMRC GNT1198301), and the Australian Government Department of Health and Aged Care for the Tackling Indigenous Smoking – Regional Grants Impact and Outcomes Assessment.</span></em></p><p class="fine-print"><em><span>Raymond Lovett receives funding from the NHMRC. </span></em></p><p class="fine-print"><em><span>Tom Calma is the National Coordinator, Tackling Indigenous Smoking (TIS). This position is a consultancy to the Commonwealth Department of Health and Aged Care. </span></em></p>If we are to reduce the numbers of Aboriginal and Torres Strait Islander people smoking we need to consider a whole suite or approaches.Christina Heris, Research Fellow, Australian National UniversityLisa J Whop, Senior Fellow, Australian National UniversityMichelle Kennedy, Assistant Dean Indigenous Strategy & Leadership, University of NewcastleRaglan Maddox, Fellow, National Centre for Epidemiology and Public Health, Australian National UniversityRaymond Lovett, Director Mayi Kuwayu Study, Australian National UniversityTom Calma, Chancellor, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/641652016-09-15T20:14:52Z2016-09-15T20:14:52ZBulging ear drums and hearing loss: Aboriginal kids have the highest otitis media rates in the world<p><em>This article is one in our <a href="https://theconversation.com/au/topics/indigenous-health-package-31054">three-part series</a> on blinding, deafening and sometimes deadly conditions in Indigenous Australian children that have little to no impact on their non-Indigenous counterparts.</em></p>
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<p>Aboriginal children have the highest rates of otitis media, a middle ear infection that causes hearing loss, than any other people in the world. </p>
<p>The main forms of the disease include acute otitis media, also known as a bulging eardrum; otitis media with effusion, commonly known as glue ear; and chronic suppurative otitis media, known as runny ear, which describes the pus discharged when a bulging eardrum bursts.</p>
<p>In 1996 – the most recent year comparative global data is available – the <a href="http://www.who.int/pbd/deafness/en/chronic_otitis_media.pdf">World Health Organisation reported</a> that the prevalence chronic otitis media was highest in the Inuit (Eskimo) and Australian Aboriginal populations: at around 12% to 46%. </p>
<p>This was followed by Native Americans at 4% to 8%; South Pacific Islanders, Africans, Koreans and Indians at around 2% to 6%; and was lowest in United States and United Kingdom, at less than 1%.</p>
<p>The World Health Organisation considers a prevalence of 4% in the population of runny ears or chronic otitis media as a massive <a href="http://www.who.int/pbd/deafness/en/chronic_otitis_media.pdf">public health problem</a> requiring urgent attention. Tragically, <a href="http://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-015-0483-8">almost all Aboriginal children</a> (90%) in remote areas have some form of otitis media: 50% have glue ear, 30% have <em>acute</em> otitis media, and around 15% have runny ears. </p>
<h2>Hearing loss and life trajectory</h2>
<p>Otitis media is caused by multiple <a href="http://www.ncbi.nlm.nih.gov/pubmed/27260611">strains of three bacteria</a>: <em>Streptococcus pneumoniae</em>, non-typeable <em>Haemophilus infleunzae</em> and <em>Moraxella catarrhalis</em>. These are common in the nasal passages of young children. </p>
<p>Indigenous children are at a <a href="http://www.ncbi.nlm.nih.gov/pubmed/17848879">significantly higher risk of otitis media</a> and hearing loss compared to non-Indigenous children. One study found Indigenous children were <a href="http://www.ncbi.nlm.nih.gov/pubmed/17848879">five times more likely</a> to be diagnosed with severe otitis media than their non-Indigenous counterparts. During the eight-year period studied, Indigenous children saw the GP for discharge in their ear 40 times more than non-Indigenous children.</p>
<p>The longer the infection is left untreated, the further risk it poses to hearing. The hearing loss associated with otitis media <a href="https://www.mja.com.au/journal/2009/190/10/middle-ear-disease-aboriginal-children-perth-analysis-hearing-screening-data">causes delayed language and speech</a>, behavioural problems and social isolation; <a href="http://www.voced.edu.au/content/ngv%3A11688">poor school attendance and low levels of literacy</a> and numeracy; poor employment opportunities and increased poverty.</p>
<p>In fact, the issue of hearing is the <a href="https://www.nt.gov.au/__data/assets/pdf_file/0020/229016/A-Share-in-the-Future-The-Review-of-Indigenous-Education-in-the-Northern-Territory.pdf">most prevalent barrier to educational attainment</a> for Indigenous children in the Northern Territory. In the NT in 2007 to 2011, 53% of Indigenous children receiving audiology services had some kind of hearing loss and 33% had a hearing impairment.</p>
<p>Shockingly, around 90% of Indigenous people incarcerated in the Northern Territory <a href="http://www.eartroubles.com/attachments/criminal-justice-and-hearing-loss-%20background.pdf">have hearing loss</a>, which may have influenced their trajectory or compromised their communications with the justice system.</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/137329/original/image-20160912-3807-1rux69k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/137329/original/image-20160912-3807-1rux69k.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=482&fit=crop&dpr=1 600w, https://images.theconversation.com/files/137329/original/image-20160912-3807-1rux69k.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=482&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/137329/original/image-20160912-3807-1rux69k.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=482&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/137329/original/image-20160912-3807-1rux69k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=606&fit=crop&dpr=1 754w, https://images.theconversation.com/files/137329/original/image-20160912-3807-1rux69k.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=606&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/137329/original/image-20160912-3807-1rux69k.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=606&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<hr>
<h2>Prevention and treatment</h2>
<p>Overcrowded housing and exposure to tobacco smoke can increase the risk of otitis media. There are several methods of preventing otitis media from occuring. As it is a bacterial infection, hygiene is vital to containing its spread. There are also vaccines to prevent infections caused by particular strains of bacteria.</p>
<p>Many otitis media episodes can be <a href="http://onlinelibrary.wiley.com/doi/10.1111/apa.13151/abstract">prevented by breastfeeding</a> during the first six months of life. Exclusive breastfeeding in this period is associated with around a 43% reduction of acute otitis media in the first two years of life. </p>
<p>Accurate diagnosis is needed to determine the type of otitis media the child has in order to <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/B8A6602C7714B46FCA257EC300837185/$File/Recommendation-for-clinical-guidelines-Otitis-Media.pdf">provide correct management</a>. Preventing perforation of the ear drum in acute otitis media is a key goal of treatment, as this causes a higher level of hearing loss and is very difficult to treat. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/136224/original/image-20160901-8526-1jq3rb7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/136224/original/image-20160901-8526-1jq3rb7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/136224/original/image-20160901-8526-1jq3rb7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136224/original/image-20160901-8526-1jq3rb7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136224/original/image-20160901-8526-1jq3rb7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136224/original/image-20160901-8526-1jq3rb7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136224/original/image-20160901-8526-1jq3rb7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136224/original/image-20160901-8526-1jq3rb7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Preventing perforation of the ear drum in acute otitis media is a key goal of treatment.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Otitis_Media.png">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Perforations can persist for months or years, severely affecting the child’s linguistic, social and academic development. Children under two with the infection in both ears are at greatest risk of progression to the chronic form of the disease.</p>
<p>To prevent this, acute otitis media (a bulging ear drum) in Indigenous children should be treated with antibiotics; specifics depending on the diagnosis and the likelihood of the condition worsening. The <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/B8A6602C7714B46FCA257EC300837185/$File/Recommendation-for-clinical-guidelines-Otitis-Media.pdf">duration and dose of antibiotic</a> (amoxycillin) may need to increase if the infection does not improve. </p>
<p>A child with persistent otitis media for three months or more should have a hearing test. The child may need hearing aids if there are concerns about normal language development or behaviour problems. They may also need surgery, where devices known as tympanostomy tubes (grommets) are inserted into the ear drum to prevent accumulation of fluid.</p>
<p>Perforations with discharging pus are more difficult to treat than other forms of otitis media, due to the extended spectrum of bacteria – nasal as well as those from the external environment – involved. Up to 16 weeks of twice daily cleaning and <a href="http://www.ncbi.nlm.nih.gov/pubmed/18664984">antibiotic drops are needed</a>. </p>
<p>This can cure the infection, but the perforation is unlikely to heal, so the middle ear remains vulnerable to infections. Surgery may repair the tympanic membrane but these procedures have not been rigorously evaluated for Aboriginal children.</p>
<p>The early and persistent disease throughout childhood is depriving children of the opportunity to learn, to have self esteem and to reach their full potential.</p><img src="https://counter.theconversation.com/content/64165/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Leach has received prior funding from Pfizer and GSK, none is current. I have received NHMRC funding for this work including two Fellowships.</span></em></p>Nearly all Indigenous Australian children have some form of otitis media, a middle ear infection that often leads to hearing loss.Amanda Leach, Professor. Leader of the Ear Health Research Program (EHRP), Child Health Division, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/638142016-09-14T20:16:12Z2016-09-14T20:16:12ZWhy are Aboriginal children still dying from rheumatic heart disease?<figure><img src="https://images.theconversation.com/files/135908/original/image-20160830-28253-1dsvhza.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Indigenous Australians in the Northern Territory are more than 100 times as likely to have rheumatic heart disease than their non-Indigenous counterparts.</span> <span class="attribution"><a class="source" href="https://www.youtube.com/watch?v=Prl7t8e8tKM">Screenshot/Take Heart - Strep: Group A Streptococcal Infection</a></span></figcaption></figure><p><em>This article is one in our <a href="https://theconversation.com/au/topics/indigenous-health-package-31054">three-part series</a> on blinding, deafening and sometimes deadly conditions in Indigenous Australian children that have little to no impact on their non-Indigenous counterparts.</em></p>
<hr>
<p>It seems far-fetched to think a sore throat or skin sore could take a lasting toll on your health, leading to heart failure and premature death. But this is the reality for many Indigenous children and young people in Australia’s most vulnerable communities. </p>
<p>For these young people, what we might consider a relatively harmless infection with streptococcus bacteria, in the throat or on the skin, can be the start of a tragic pathway towards life-threatening rheumatic heart disease (RHD). </p>
<p>Yet this pathway is completely avoidable; indeed in mainstream Australia, it is usually avoided. Today, most doctors in major Australian cities will not see a case of acute rheumatic fever, the precursor to RHD. Only around 50 years ago, though, children’s hospital wards were full of children with the two conditions.</p>
<p>The reality is different for Indigenous people. Young Indigenous Australians in the Northern Territory are up to <a href="http://www.aihw.gov.au/publication-detail/?id=60129542750">122 times more likely</a> to have rheumatic heart disease than their non-Indigenous counterparts.</p>
<iframe src="https://datawrapper.dwcdn.net/Dk5Il/3/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="400"></iframe>
<p>Rheumatic heart disease is responsible for the <a href="http://www.aihw.gov.au/publication-detail/?id=6442467995">highest gap in life expectancy</a> between Indigenous and non-Indigenous Australians; higher than diabetes or kidney failure.</p>
<p>So why is the condition still prevalent among Indigenous Australians?</p>
<h2>From sore throat to heart disease</h2>
<p>Infection by the <em>Group A Streptococcus</em> bacterium can manifest as either a strep throat or impetigo, commonly known as skin sores.</p>
<p>When fighting a strep infection, around 3% to 6% of people develop an abnormal response which leads to the body’s immune system attacking its own tissues. This happens due to a combination of bacterial, genetic and environmental factors and results in acute rheumatic fever. Symptoms include sore joints, fevers and inflammation of heart valves – which is the most damaging.</p>
<p>When acute rheumatic fever occurs repeatedly, often over many years, valve damage worsens and becomes permanent, resulting in rheumatic heart disease. </p>
<p>Heart valves are like doors in the heart that allow blood to move in one direction only. When they are damaged, the valves allow blood to leak in the wrong direction. This reduces the heart’s ability to pump blood effectively and ultimately leads to heart failure, stroke and sometimes early death. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/136986/original/image-20160908-25272-xvx817.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/136986/original/image-20160908-25272-xvx817.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/136986/original/image-20160908-25272-xvx817.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136986/original/image-20160908-25272-xvx817.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136986/original/image-20160908-25272-xvx817.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136986/original/image-20160908-25272-xvx817.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136986/original/image-20160908-25272-xvx817.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136986/original/image-20160908-25272-xvx817.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Heart valves are like doors in the heart that allow blood to move in one direction only.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>The pathway to rheumatic heart disease and its complications can be stopped at various points along the way. Acute rheumatic fever can be prevented if the original strep infection is accurately diagnosed and promptly treated with the antibiotic penicillin. But even if acute rheumatic fever occurs, it is not too late to intervene. </p>
<p>After even just a single episode of acute rheumatic fever, young people need <a href="https://www.rhdaustralia.org.au/arf-rhd-guideline">monthly injections of penicillin</a> for at least a decade, often longer. This protects them from further strep infections, subsequent episodes of rheumatic fever and further damage to the heart valves. Although this strategy works, it requires painful injections that need to be given on time, every month, for at least a decade.</p>
<p>In addition to these injections, people with rheumatic fever require long-term check-ups. If they have rheumatic heart disease, they require life-long clinical review, regular heart scans and long-term medication to treat heart failure or heart-rhythm abnormalities.</p>
<p>If the heart-valve damage is severe, surgery may be needed to repair or even replace the valve. This can only be done in major hospitals, often thousands of kilometres away from where the person lives. Surgery can be life-saving, although it doesn’t cure rheumatic heart disease.</p>
<h2>RHD in Australia and the world</h2>
<p>Rheumatic heart disease was common until the 1960s in wealthy populations, including major Australian cities.</p>
<p>Since then, improved living standards in high-income countries have reduced the transmission of the bacterial infection. A combination of less crowded housing, improved sanitation and better access to health services also resulted in a dramatic decrease in the incidence of acute rheumatic fever and resultant heart disease. </p>
<p>Penicillin has also had an added impact, both in preventing initial episodes of rheumatic fever by treating sore throat, and in preventing recurrences that enable slow disease progression. </p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/137322/original/image-20160912-3766-hibjbz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/137322/original/image-20160912-3766-hibjbz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=493&fit=crop&dpr=1 600w, https://images.theconversation.com/files/137322/original/image-20160912-3766-hibjbz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=493&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/137322/original/image-20160912-3766-hibjbz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=493&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/137322/original/image-20160912-3766-hibjbz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=619&fit=crop&dpr=1 754w, https://images.theconversation.com/files/137322/original/image-20160912-3766-hibjbz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=619&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/137322/original/image-20160912-3766-hibjbz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=619&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The above are critical elements of the Endgame Strategy, currently under development by the END RHD Centre of Research Excellence. See www.rhdaustralia.org.au.</span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
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<p>Over the last few decades, however, an uncontrolled epidemic of rheumatic heart disease has been uncovered in developing countries and our own Indigenous populations, especially those living in rural and remote areas of northern and central Australia.</p>
<p>Today, rheumatic heart disease affects more than 32 million people worldwide and claims more than 275,000 lives each year. Almost all cases <a href="http://rhdaction.org/atlas/">occur in low and middle-income countries</a>, with the greatest burden being among some of the most disadvantaged populations.</p>
<p>Particular hotspots include sub-Saharan Africa, parts of South Asia and the South Pacific. However, the highest rates of rheumatic heart disease are in Australia.</p>
<p>The social, economic and human consequences of the disease are profound. Indigenous Western Australians with rheumatic heart disease die, on average, <a href="http://www.ncbi.nlm.nih.gov/pubmed/25070793">at 40 years old</a>. Children must travel for heart surgery; young adults live with premature disability; and pregnant women face high-risk pregnancies.</p>
<p>Rheumatic heart disease remains an outstanding, preventable blight for a nation committed to closing the life-expectancy gap. Australia has a national approach to acute rheumatic fever and rheumatic heart disease control. We must not only ensure this approach continues, but that it expands, with properly funded, evidence-based interventions.</p><img src="https://counter.theconversation.com/content/63814/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonathan Carapetis receives funding from National Health and Medical Research Council, Austrade, Novartis Institutes for BioMedical Research & Medtronic Foundation.</span></em></p>Rheumatic heart disease is responsible for the highest gap in life expectancy between Indigenous and non-Indigenous Australians; higher than diabetes or kidney failure.Jonathan Carapetis, Professor, Paediatrics, Telethon Kids InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/635262016-09-13T20:18:42Z2016-09-13T20:18:42ZWhy is trachoma blinding Aboriginal children when mainstream Australia eliminated it 100 years ago?<figure><img src="https://images.theconversation.com/files/136397/original/image-20160902-20232-1mhv37j.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Trachoma disappeared from most of Australia 100 years ago as individual and community hygiene improved.</span> <span class="attribution"><span class="license">Author provided</span></span></figcaption></figure><p><em>This article is one in our <a href="https://theconversation.com/au/topics/indigenous-health-package-31054">three-part series</a> on blinding, deafening and sometimes deadly conditions in Indigenous Australian children that have little to no impact on their non-Indigenous counterparts.</em></p>
<hr>
<p>Many people don’t know this, but Indigenous Australian children are <a href="http://www.ncbi.nlm.nih.gov/pubmed/20230347">born with much better eyesight</a> than non-Indigenous children.</p>
<p>Yet, at the population level, Indigenous people at the age of 40 <a href="https://www.mja.com.au/journal/2010/192/6/prevalence-and-causes-vision-loss-indigenous-australians-national-indigenous-eye">have rates of vision loss</a> three times that of non-Indigenous Australians. Rates of blindness are six times higher among Indigenous adults. </p>
<p>The prevalence of vision problems in Indigenous people is a result of cataracts, diabetic eye disease and a disease non-Indigenous children don’t get – trachoma. In fact, trachoma disappeared from mainstream Australia more than 100 years ago with improved hygiene facilities, water infrastructure and living conditions.</p>
<p>Yet, in some areas, 4% of Indigenous children aged from five to nine years old <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4002j.htm">have an active trachoma infection</a>. In the Northern Territory, that rate is 5%, which is considered an endemic level.</p>
<h2>What is trachoma?</h2>
<p>We used to call trachoma sandy blight (the eyes feel gritty, as if full of sand). It is the world’s <a href="http://www.who.int/mediacentre/factsheets/fs382/en/">leading cause of infectious blindness</a>.</p>
<p>Trachoma is caused by the bacterium <em>Chlamydia trachomatis</em>, which <a href="http://www.who.int/mediacentre/factsheets/fs382/en/">creates swelling under the inner eyelid</a> leading to scarring. The scars cause the eyelashes to turn inward and scratch the eye, which is intensely painful and made worse by blinking. </p>
<p>Eventually, if left untreated, all the scratching from the lashes will result in the cornea – the transparent layer at the front of the eye – going cloudy and the person having irreversible blindness.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=485&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=485&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=485&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Trachoma leads to eyelashes turning inwards and scratching the eye, leading to blindness.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/communityeyehealth/8489112594/in/photolist-dW9Vqf-9yyAVm-9yvAMi-dWa7C7-dWa7zd-9yyBq3-dW4vNv-9EAybm-dW4vvH-9wqCPE-njvJid-9yvA22-nAHyF8-nAHu42-9yyBE1-dW4vH8-dWa7SL-9yyB9Y-dQpK97-nB1t5h-njvTie-njvHVj-dW4w8T-dW4jzi-nALUhs-dWa7Vw-dW4vnv-nCMwvt-dWa7Gw-dWa7e3-njvHNK-dW9VqU-9A85We-nB1s3Y-njvBK2-dW4vAD-dWuo2J-9yvAqM-9yvA88-nCMuJx-D4iE3F-CuLJV4-dWdto5-nB1v48-dW4vs2-njvRh1-nB1vCy-nB1rmh-9yyB1w-njvW2k#undefined">Community Eye Health/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Trachoma easily spreads from one child to another through infected eye and nose secretions. </p>
<p>Unlike other infectious diseases, a single episode of trachoma is often not uncomfortable or noticed as being any different from just a runny nose. Nor is a single episode such a problem for the individual child. </p>
<p>The main issue is that children <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691478/">keep getting reinfected</a>, which keeps the inflammation present. A child may have <a href="http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000462">between 30 and 40 episodes</a> of reinfection during their childhood and around 160 to 180 infections until the resultant scarring causes blindness.</p>
<p>Each episode of infection <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691478/">may last a few months</a>, but repeated reinfection turns into a continuing infection and disease. The longer the inflammation goes on, the worse the discomfort and more severe the scarring. And the more severe the scarring the greater the risk of blindness.</p>
<h2>Where does trachoma exist?</h2>
<p>Australia remains the only high-income country to still have trachoma. Although it doesn’t exist in mainstream Australia, trachoma persists in remote Aboriginal communities that still lack safe washing facilities and have notoriously poor and chronically overcrowded housing. </p>
<p>Young children with constant eye and nose secretions in remote endemic communities <a href="http://iehu.unimelb.edu.au/__data/assets/pdf_file/0009/719649/Trachoma_Book_HRTaylor.pdf">sometimes go unnoticed</a> and washing a child’s face whenever it’s dirty (with eye and nose secretions) is not common.</p>
<p>But Australia is making progress. In 2009, the Australian government committed to eliminating trachoma by 2020. At that time, <a href="http://www.ncbi.nlm.nih.gov/pubmed/20043598">disease rates ranged</a> between 15% and 20%. Data from 2015 show a massive drop, <a href="http://kirby.unsw.edu.au/surveillance/australian-trachoma-surveillance-report-2014">with the national average for children</a> in endemic areas at 4.6%.</p>
<iframe src="https://datawrapper.dwcdn.net/GKWxR/1/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="400"></iframe>
<p>Of equal importance is the dramatic reduction in the number of communities with trachoma. More than 150 of the 200 or so at-risk communities no longer have trachoma and there are only a small number with high rates. These hotpots are mainly in and around Central Australia.</p>
<p>Globally, trachoma affects people <a href="http://www.trachomaatlas.org">in remote and rural communities</a> with poor personal and community hygiene. In 2016, an <a href="http://www.trachomacoalition.org/GET2020/">estimated 200 million people</a> are at risk of trachoma in 42 countries – mainly in sub-Saharan Africa, but also in countries such as Afghanistan, India, Brazil, Colombia and some Pacific Island nations. </p>
<p>The World Health Organisation has set the goal of <a href="http://www.trachomacoalition.org/GET2020/">eliminating blinding trachoma</a> by 2020. Countries such as Morocco, Ghana, Iran, Mexico, Nepal, China and Cambodia have eliminated trachoma over the last ten years.</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/137315/original/image-20160912-13348-1jnvvfv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/137315/original/image-20160912-13348-1jnvvfv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/137315/original/image-20160912-13348-1jnvvfv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/137315/original/image-20160912-13348-1jnvvfv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/137315/original/image-20160912-13348-1jnvvfv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/137315/original/image-20160912-13348-1jnvvfv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/137315/original/image-20160912-13348-1jnvvfv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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</figure>
<hr>
<h2>What are the treatments?</h2>
<p>The World Health Organisation <a href="http://www.who.int/blindness/causes/trachoma/en/">developed the SAFE strategy</a> to eliminate trachoma. This includes: surgery to correct the inward eye lashes (S); antibiotics to reduce levels of infection (A); promotion of facial cleanliness to stop transmission (F); and environmental improvements in water and sanitation (E).</p>
<p>In Australia, the antibiotic <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-trachoma.htm">azithromycin is given every six to 12 months to all household members</a> of someone with trachoma, or everybody in affected communities. </p>
<p>This brings down the level of infection, but without stopping the possibility of transmission, trachoma will bounce back. This is why keeping every child’s face clean is so important. The essential and sustainable strategy of maintaining trachoma elimination comes down to having clean faces, which goes with access to safe and functional bathrooms and washing facilities.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=762&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=762&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=762&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=958&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=958&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=958&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Milpa the Trachoma Goanna mascot features in the materials and is involved in community activities.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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<p>Improved hygiene will also help reduce other common and very serious infections in remote Indigenous communities.</p>
<p>There are currently effective health promotion activities in Australia such as “Clean Faces, Strong Eyes”. Bodies such as the Indigenous Eye Health group at the University of Melbourne continue to work closely with community groups to build on this work. </p>
<p>Milpa the Trachoma Goanna mascot features in educational materials and is involved in community activities, such as the development of music videos, roadshows and football clinics.</p><img src="https://counter.theconversation.com/content/63526/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hugh Taylor receives funding from the Department of Health.</span></em></p><p class="fine-print"><em><span>Emma Stanford receives funding from the Department of Health.</span></em></p><p class="fine-print"><em><span>Fiona Lange is affiliated with The Australian Health Promotion Association. </span></em></p>Trachoma easily spreads from one child to another through infected eye and nose secretions. A person may have up to 40 episodes of reinfection during childhood.Hugh Taylor, Melbourne Laureate Professor, Harold Mitchell Chair of Indigenous Eye Health, Melbourne School of Population and Global Health, The University of MelbourneEmma Stanford, Academic Specialist, The University of MelbourneFiona Lange, Academic Specialist, Indigenous Eye Health Unit, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.