tag:theconversation.com,2011:/institutions/menzies-school-of-health-research-1124/articlesMenzies School of Health Research2024-03-21T05:40:53Ztag:theconversation.com,2011:article/2256512024-03-21T05:40:53Z2024-03-21T05:40:53ZBuilding remote Indigenous homes well is hard, but they won’t cost $1.5 million each<figure><img src="https://images.theconversation.com/files/581458/original/file-20240313-30-ejjjpg.jpg?ixlib=rb-1.1.0&rect=247%2C857%2C2129%2C938&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Liam Grealy</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>At the remote Indigenous community of Binjari, south of Katherine in the Northern Territory last week, Prime Minister Anthony Albanese announced a landmark <a href="https://www.pm.gov.au/media/landmark-4-billion-investment-remote-housing-northern-territory-help-close-gap">A$4 billion</a> investment in remote housing across the Territory.</p>
<p>He said the ten-year commitment by the Commonwealth and Territory governments would deliver up to an extra 270 houses per year, a total of 2,700.</p>
<p>At the press conference, Albanese was told $4 billion for 2,700 houses worked out at about <a href="https://ministers.pmc.gov.au/burney/2024/press-conference-binjari-northern-territory">$1.5 million</a> each. He was asked whether each house could possibly cost that much to build.</p>
<p>While it is reasonable to examine the cost of construction, the inference that remote housing is unreasonably expensive is misleading.</p>
<h2>Significant, but less than what’s needed</h2>
<p>The $4 billion will deliver much more housing than is currently available, albeit not as much as is needed.</p>
<p>It is not as much as is needed because the prime minister says it will halve overcrowding in remote Indigenous communities. </p>
<p>The 2021 Census found the proportion of Aboriginal and Torres Strait Islander people in the Northern Territory living in overcrowded dwellings was <a href="https://www.abs.gov.au/articles/northern-territory-aboriginal-and-torres-strait-islander-population-summary#:%7E:text=In%202021%2C%20just%20under%20half,adequately%20house%20the%20usual%20residents.">43%</a>, and Territory government data shows more than <a href="https://www.menzies.edu.au/page/Research/Indigenous_Health/Preventive_health/Healthy_Homes_Monitoring_and_Evaluation_Project">52%</a> of the remote community housing was overcrowded in 2022.</p>
<p>Halving these figures would still leave a significant proportion of the Territory’s remote Indigenous population living in overcrowded housing.</p>
<h2>$4 billion won’t mean $1.5 million per house</h2>
<p>It is true the houses will be expensive to build. Albanese points out that some houses will be in extremely isolated locations and each will have three bedrooms on average. As the ten-year program progresses, labour and materials costs will increase significantly. But the cost won’t average $1.5 million each.</p>
<p>That’s because a fair chunk of the $4 billion will be spent on things other than building houses for remote community residents. </p>
<p>In the most recent (five-year) national agreement, $200 million of the $1.1 billion was allocated to build <a href="https://ourfuture.nt.gov.au/about-the-program/government-employee-housing-for-local-recruits">employee accommodation</a>, for teachers, clinicians, and other workers. </p>
<p>As populations grow, and before building starts, leases need to be secured and land serviced with water, electricity, sewerage, and sometimes roads.</p>
<h2>Houses need maintenance</h2>
<p>The previous agreement allocated <a href="https://ourfuture.nt.gov.au/national-partnership-for-remote-housing-nt">$200 million</a> to repairs and maintenance. But this <a href="https://eresources.hcourt.gov.au/showCase/2023/HCA/31">wasn’t enough</a> to maintain houses at a reasonable standard.</p>
<p>An evaluation found the average spend per remote house was about <a href="https://theconversation.com/high-court-then-what-nt-remote-housing-reforms-need-to-put-indigenous-residents-front-and-centre-216908">$6,000</a> per year. That amount fell far short of the $10,000 per house spent by South Australia in the Aṉangu Pitjantjatjara Yankunytjatjara Lands over the border.</p>
<p>The $4 billion also promises to do something else, in addition to building houses and properly maintaining them.</p>
<p>It promises to create local employment and support Aboriginal businesses, as part of the government’s <a href="https://www.niaa.gov.au/indigenous-affairs/employment/remote-jobs">Remote Jobs and Economic Development Program</a>.</p>
<p>This will be an investment in people, with the potential to build sustainable Aboriginal community-controlled organisations in remote contexts.</p>
<h2>What will matter will be the detail</h2>
<p>Perhaps the most promising things about the new Commonwealth-Territory agreement are its ten-year length and context.</p>
<p>The last time a ten-year agreement was drawn up in the mid-2000s, the so-called Northern Territory <a href="https://www.abc.net.au/news/2023-01-29/what-was-the-northern-territory-emergency-response/101891110">Intervention</a> was underway, dismantling community control over housing.</p>
<p>The Indigenous-run <a href="https://theconversation.com/many-claim-australias-longest-running-indigenous-body-failed-heres-why-thats-wrong-209511">Aboriginal and Torres Strait Islander Commission</a> had been abolished, a for-profit <a href="https://classic.austlii.edu.au/au/journals/AUIndigLawRw/2007/23.html">consultancy’s report</a> had seriously criticised Indigenous-run Indigenous housing organisations, and the Coalition’s Indigenous affairs minister had described Aboriginal homelands as “<a href="https://www.abc.net.au/news/2005-12-09/vanstone-questions-future-of-indigenous-cultural/757866">cultural museums</a>”.</p>
<p>This agreement promises to rebuild rather than demolish Aboriginal control of remote Aboriginal housing. It is an opportunity to significantly reform the sector to increase self-determination. Key to this transition will be the form taken by the <a href="https://www.pm.gov.au/media/landmark-4-billion-investment-remote-housing-northern-territory-help-close-gap">partnership agreement</a> still being drawn up.</p>
<p>It will include the Australian and Territory governments, the peak body for Aboriginal housing in the Territory, and <a href="https://ourfuture.nt.gov.au/national-partnership-for-remote-housing-nt/joint-steering-committee">four Aboriginal land councils</a>. </p>
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Read more:
<a href="https://theconversation.com/high-court-then-what-nt-remote-housing-reforms-need-to-put-indigenous-residents-front-and-centre-216908">High Court, then what? NT remote housing reforms need to put Indigenous residents front and centre</a>
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<p>Of chief importance will be ensuring remote houses are built to the latest energy <a href="https://www.healthabitat.com/news-policy-ministers-agree-to-new-minimum-building-performance/">efficiency standards</a>. A properly-funded preventive and cyclical maintenance program will also be <a href="https://www.ruralhealth.org.au/partyline/article/healthy-homes-remote-nt-communities">especially important</a>.</p>
<p>There is a lot to clarify, but the ten-year agreement provides the foundation for a pipeline of works, the employment of local staff and the development of local skills, including through apprenticeships. It is a historic opportunity to get remote Indigenous housing right.</p><img src="https://counter.theconversation.com/content/225651/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Liam Grealy receives funding from Aboriginal Housing NT for the project 'Investigating Options to Establish Aboriginal Controlled Governance for the Remote Housing System in the Northern Territory'. He receives funding from the NT Government for the 'Homelands Housing and Infrastructure Program Monitoring and Evaluation Project'. </span></em></p>Much of the $4 billion to be spent over ten years will go into maintenance and the preparation of blocks. It will also build Indigenous employment and Indigenous skills.Liam Grealy, Senior Research Fellow, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2252852024-03-11T19:13:13Z2024-03-11T19:13:13ZMother’s little helper: interviews with Australian women show a complex relationship with alcohol<figure><img src="https://images.theconversation.com/files/580616/original/file-20240308-16-prhzxy.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5751%2C3768&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/alcoholism-alcohol-addiction-people-concept-drunk-2187785169">Syda Productions/Shutterstock</a></span></figcaption></figure><p>Men have historically, and still do, <a href="https://pubmed.ncbi.nlm.nih.gov/19686518/">drink more than women</a>. But in recent years there has been an uptick in women’s drinking, particularly among women in their late 30s <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.13428">through to their 60s</a>. </p>
<p>This is concerning, as <a href="https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health">no level of alcohol is considered safe</a> for our health, and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395922001189?via%3Dihub">women are especially susceptible</a> to <a href="https://www.sciencedirect.com/science/article/pii/S0376871615016166">alcohol’s long-term health harms</a> (for example, cancer and heart disease). </p>
<p>We’ve also seen the emergence of the “wine mum” <a href="https://theconversation.com/winemom-humour-and-empowerment-or-binge-drinking-and-mental-health-challenges-161338">in popular culture</a> and <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12215">greater social acceptance</a> of women’s drinking.</p>
<p><div data-react-class="TiktokEmbed" data-react-props="{"url":"https://vt.tiktok.com/ZSFyYHa68/."}"></div></p>
<p>But women still drink differently to men, and there are some important reasons why – particularly for women who <a href="https://doi.org/10.1016/j.drugpo.2022.103699">juggle both paid work and motherhood</a>.</p>
<p>In 2022, we conducted interviews with 22 Australian working mothers aged 36 to 51, to learn more about their daily lives and the role alcohol played. Most of the women were middle-class professionals. Many were partnered to men, some were single, and all had school-aged children they looked after alongside their jobs.</p>
<p>We’ve <a href="https://www.tandfonline.com/doi/full/10.1080/16066359.2024.2314041">recently published</a> two <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2023.2299392">new papers</a> exploring what we found.</p>
<h2>Modern working mothers</h2>
<p>Now, more than ever, <a href="https://www.abs.gov.au/statistics/labour/employment-and-unemployment/labour-force-status-families/latest-release">women are entering the workforce</a> and developing careers. At the same time, many also have to meet the demands of having children. While we like to think we’re moving towards a more equal society, women are still expected to do the <a href="https://www.tandfonline.com/doi/full/10.1080/13668803.2015.1080664">majority of childcare and domestic duties</a>.</p>
<p>This means many women are having to do “<a href="https://www.sciencedirect.com/science/article/pii/S0955395922001189?via%3Dihub">double shifts</a>” of paid and unpaid labour, increasing the chance they’re stressed, and limiting how much time they have to relax, unwind, and pursue hobbies. This is where alcohol comes in.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/oh-well-wine-oclock-what-midlife-women-told-us-about-drinking-and-why-its-so-hard-to-stop-188882">'Oh well, wine o’clock': what midlife women told us about drinking – and why it's so hard to stop</a>
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<p>Most women we talked to felt <a href="https://www.tandfonline.com/doi/full/10.1080/16066359.2024.2314041">over-committed</a> because of their competing roles. Whether they had partners or not, they were often taking on the “default” caregiver role. This involved tasks such as getting kids ready for school, cooking, cleaning, and organising appointments. </p>
<p>At the same time, their jobs could be mentally or emotionally stressful, such as working in health care or project management.</p>
<p>And it wasn’t uncommon for these two worlds to overlap. For example, some women talked about needing to send emails or make calls from home outside work hours, or feeling there was an expectation for them to take time off work to take kids to appointments. </p>
<p>Many women were fatigued, and they felt a sense of guilt at not being able to commit fully to either role. As Mia, a full-time employed, partnered mother said:</p>
<blockquote>
<p>You’ll spend your life feeling compromised, doing a half job as a parent, and a half job as a worker.</p>
</blockquote>
<figure class="align-center ">
<img alt="A woman in the kitchen with two children talking on the phone." src="https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">For many women, work and home life overlaps.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/busy-stressed-mother-talking-on-phone-1584282157">Onjira Leibe/Shutterstock</a></span>
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</figure>
<p>When participants talked about drinking alcohol, it was something accessible they could do alongside their home duties. For example, a glass of wine while cooking dinner was almost ubiquitous. Drinking helped women manage busy days, and the amount they drunk was not always something they had the capacity to be mindful of. As Caroline, a full-time employed, separated mother explained:</p>
<blockquote>
<p>We don’t sit down and stand around like the boys do drinking, with the beer cans round our feet. We drink a glass of wine while we cook tea […] while we’re sitting doing the kids’ homework or arguing with them about, ‘where’s your sock? Where’s your library book?’ […] it makes it very easy to think ‘I’ve only had one glass of wine’ when you’ve had three or four, because you’re not mindful of what you’re doing.</p>
</blockquote>
<p>Many of the women we talked to also described feeling under-supported. This included at work, where they felt there wasn’t always enough flexibility to accommodate their parental obligations, and at home, where their partners were not always around to share the workload. </p>
<p>These stresses and pressures meant alcohol became a “prize” or “reward” for getting through the day. And when participants felt particularly stressed or under-supported (which was often), the reward of a drink at the end of the day was all the more important. According to Penelope, a part-time employed, separated mother:</p>
<blockquote>
<p>I think that I reach out to drinking at the end of the day because I’m really quite overwhelmed, or quite exhausted mentally and physically from the day.</p>
</blockquote>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/did-you-look-forward-to-last-nights-bottle-of-wine-a-bit-too-much-ladies-youre-not-alone-109078">Did you look forward to last night's bottle of wine a bit too much? Ladies, you're not alone</a>
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</em>
</p>
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<h2>What about the pandemic?</h2>
<p>Things became even more complicated during the <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2023.2299392">COVID pandemic</a>. Women suddenly took on “triple shifts” – mothering, working and home-schooling – leaving many feeling even more overwhelmed. As Belle, a partnered mother who worked part time, said:</p>
<blockquote>
<p>We were all working and trying to home school, and it was just so awful […] so I guess my girlfriends were going through that too, the ones with kids, and they were all definitely drinking a lot more.</p>
</blockquote>
<figure class="align-center ">
<img alt="A woman at a kitchen bench drinking a glass of red wine." src="https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The chaos of the pandemic left working mothers feeling even more overwhelmed.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-beautiful-lonely-young-woman-drinking-1802268634">Gorodenkoff/Shutterstock</a></span>
</figcaption>
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<p>Alcohol was classified as an “essential service” during lockdowns (bottle shops remained open while many other retail stores closed), and against this backdrop, participants felt it became even more normalised. They talked about seeing media depictions and advertising of alcohol, including online memes that made wine out as a way to cope with the pandemic. Belle said:</p>
<blockquote>
<p>Everyone would send each other little memes of women just drinking, and it definitely became […] a socially acceptable way of getting through that really shit time.</p>
</blockquote>
<p>Hobbies and exercise activities they would previously turn to to relieve stress were often restricted because of the pandemic. As such, alcohol became one of the few things left. Many women we talked to were either drinking more, more often, or felt an increased desire to drink, especially during the height of the pandemic and when they were home-schooling.</p>
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Read more:
<a href="https://theconversation.com/women-are-drinking-more-during-the-pandemic-and-its-probably-got-a-lot-to-do-with-their-mental-health-139295">Women are drinking more during the pandemic, and it's probably got a lot to do with their mental health</a>
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<p>To understand why and how modern working mothers drink alcohol, it’s also important to consider how the alcohol industry targets women, often framing alcohol as a <a href="https://www.tandfonline.com/doi/full/10.1080/16066359.2024.2314041#:%7E:text=This%20study%20investigated%20the%20social,meanings%20around%20reward%20and%20relaxation.">symbol of relief and relaxation</a> among busy working mothers. </p>
<p>But it’s equally important to realise being a modern working mother is tough, especially as traditional gender expectations of women as carers persist. Almost 60 years ago, the Rolling Stones sang about “<a href="https://en.wikipedia.org/wiki/Mother%27s_Little_Helper">mother’s little helper</a>” in reference to women using substances to manage everyday life. </p>
<p>Until we see changes in the way women are supported at work and home, alcohol may continue being “mother’s little helper” for many working mothers.</p><img src="https://counter.theconversation.com/content/225285/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maree Patsouras receives funding from an Australian Government Research Training Program Scholarship and the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Cassandra Wright receives salary funding from the Australian Research Council. She also receives funding from the Medical Research Future Fund, Northern Territory Motor Accident Compensation Commission, Music NT and Menzies School of Health Research internal grant scheme.</span></em></p><p class="fine-print"><em><span>Emmanuel Kuntsche receives funding from La Trobe University, the Victorian Health Promotion Foundation (VicHealth), the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), and the University of Bayreuth Centre of International Excellence "Alexander von Humboldt". Emmanuel Kuntsche serves as that Secretary of the Australasian Professional Society on Alcohol and other Drugs (APSAD).</span></em></p><p class="fine-print"><em><span>Gabriel Caluzzi receives funding via the Australian Research Council and the Victorian Health Promotion Foundation.</span></em></p><p class="fine-print"><em><span>Sandra Kuntsche receives funding from the Australian Research Council. </span></em></p>Men and women often drink alcohol differently. This is especially the case for women who juggle both paid work and motherhood.Maree Patsouras, PhD Candidate, Centre for Alcohol Policy Research, La Trobe UniversityCassandra Wright, Senior Research Fellow in Alcohol and other Drugs, Menzies School of Health ResearchEmmanuel Kuntsche, Director of the Centre for Alcohol Policy Research, La Trobe UniversityGabriel Caluzzi, Research Fellow, Centre for Alcohol Policy Research, La Trobe UniversitySandra Kuntsche, Associate Professor Family Therapy and Systemic Research, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2171862023-11-16T19:03:55Z2023-11-16T19:03:55Z‘I feel like I’ve been able to create more awareness’: what is it like for Indigenous men at top-ranked universities?<figure><img src="https://images.theconversation.com/files/559231/original/file-20231114-19-hi7iql.jpg?ixlib=rb-1.1.0&rect=8%2C40%2C5439%2C3587&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/a-large-group-of-people-in-graduation-gowns-bOrjvtn7aY0">Emmanuel Offei/ Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>One of the top priorities of the Universities Accord process it <a href="https://theconversation.com/these-5-equity-ideas-should-be-at-the-heart-of-the-universities-accord-203418">to improve access</a> to university in Australia, particularly for those from underrepresented groups. </p>
<p>This is particularly so for Indigenous men, who are among the least likely groups go to university, let alone an elite one. Elite universities are highly ranked, located in metropolitan areas and tend to have <a href="https://theconversation.com/gonski-for-universities-what-if-we-funded-higher-education-like-schools-216898">fewer students from disadvantaged backgrounds</a> (as opposed to regional and lower-ranked universities). </p>
<p>As of 2019, <a href="https://www.education.gov.au/higher-education-statistics/resources/2019-section-6-indigenous-students">about 4.5%</a> of Indigenous men had gone to university. Indigenous women are nearly <a href="https://universitiesaustralia.edu.au/wp-content/uploads/2019/06/20190304-Final-Indigenous-Strategy-Report-v2-2.pdf">twice as likely</a> to apply for an undergraduate degree. </p>
<p>As Prime Minister Anthony Albanese has <a href="https://www.abc.net.au/news/2023-10-05/fact-check-young-indigenous-man-jail-university-anthony-albanese/102932912">pointed out</a>, there is “a greater chance of an Indigenous young male going to jail than university”.</p>
<p>But while politicians talk about how they want to see more Indigenous people attend and graduate from university, we don’t often hear from Indigenous students about their experiences. </p>
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<strong>
Read more:
<a href="https://theconversation.com/what-are-enabling-programs-how-do-they-help-australians-get-to-uni-210269">What are enabling programs? How do they help Australians get to uni?</a>
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<h2>Our study</h2>
<p>We are a group of Indigenous and non-Indigenous researchers <a href="https://www.ncsehe.edu.au/publications/higher-education-aspirations-participation-achievement-australian-indigenous-males/">studying</a> Indigenous men in higher education. We <a href="https://www.tandfonline.com/doi/full/10.1080/00131911.2023.2232559">have interviewed</a> 19 Indigenous current and former students across Australia as part of our research.</p>
<p><a href="https://link.springer.com/chapter/10.1007/978-3-031-22174-3_8">Understanding the experiences</a> of those who are making university work for them can help us understand how to make higher education a better option for other young Indigenous men. </p>
<p>Here <a href="https://www.tandfonline.com/doi/abs/10.1080/13596748.2023.2221118">we focus on</a> four young men – Nullah, Dural, Ricky and Birrani – who were attending an elite Australian university. </p>
<h2>Isolation and homesickness</h2>
<p>Many Indigenous students <a href="https://www.indigenoushpf.gov.au/measures/2-06-educational-participation">grow up in remote areas</a>, which presents a geographical barrier to study. All Australia’s top-ranked universities are in major cities. This means many Indigenous students have to move to go to university. </p>
<p>Nullah studied education, history and maths. He told us he felt homesick during his studies:</p>
<blockquote>
<p>I just didn’t know anyone getting down here. And it was pretty hard. I found it a lot easier to form relationships at the [Indigenous Support Unit] – more so than within my degree and in my classes. </p>
</blockquote>
<p>Dural, who studied clinical psychology, also spoke of feeling isolated in his studies: </p>
<blockquote>
<p>there wasn’t any Aboriginal people around at all. And I was like, yeah I didn’t really sort of know why that was the case or like I said before, felt isolated.</p>
</blockquote>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1676003261034254338"}"></div></p>
<h2>Ignorance and racism</h2>
<p>Interviewees also spoke about encountering ignorance and casual racism at university. </p>
<p>Ricky did an education degree, with a focus on drama and Aboriginal and Torres Strait Islander Studies. He found the Indigenous course he studied to be “watered down and it was so surface-level that it annoyed me”. </p>
<p>He also spoke about how little his fellow students knew about Indigenous culture. He gave the example of needing to explain to other students why another Indigenous student had not looked them in the eye. </p>
<blockquote>
<p>I was like, ‘Well, a lot of Indigenous people believe looking you in the eyes is a form of aggression. And out of respect, they won’t look you in the eyes.’ They were like, ‘Oh, we didn’t know that’ […]</p>
</blockquote>
<p>But Ricky told us casual racism was the “hardest thing”: </p>
<blockquote>
<p>I found it hard when we did education around Indigenous people and some of the casual racism. That was probably the hardest thing to deal with. And it’s not so much like I think they were trying to be racist, but some of the stuff that they’re saying, I was like, ‘Do you realise what you’re saying right now?’ Like do you understand?</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-would-like-to-go-to-university-flexi-school-students-share-their-goals-in-australia-first-survey-193396">'I would like to go to university': flexi school students share their goals in Australia-first survey</a>
</strong>
</em>
</p>
<hr>
<h2>Passion for study and a desire to help</h2>
<p>Despite feelings of isolation and racism, our interviewees spoke of their studies with great passion. As Birrani, who did an advanced science degree, explained: </p>
<blockquote>
<p>I didn’t really think of going to uni as an investment [in my future career] and all that kind of stuff. I just thought of it as doing what I want to do. I just wanted to do science.</p>
</blockquote>
<p>Interviewees spoke about wanting to represent their culture and take their education back to their communities. Dural was highly motivated by what his education would allow him to do: </p>
<blockquote>
<p>knowing that when you go to a psychologist, hoping that they’re culturally sensitive and they can sort of understand your experiences as an Aboriginal person as well.</p>
</blockquote>
<p>Nullah talked about showing people in his community that higher education was an option for them. </p>
<blockquote>
<p>I always, I knew that I was capable of studying at uni. And I kind of wanted to also prove to the people in my own community and mostly I tell my brothers that it can be done.</p>
</blockquote>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1628953982830772225"}"></div></p>
<h2>Change is possible</h2>
<p>Despite the issues with their institutions, our interviewees saw the university environment as malleable and something that could be improved. Ricky spoke about representing his culture at university. </p>
<blockquote>
<p>Like, really my motivation to go to uni is to make sure that Indigenous people get the right education, but it’s also about educating the educators to be able to educate in this topic.</p>
</blockquote>
<p>Nullah similarly talked about helping to “embed” Indigenous perspective in classrooms. </p>
<blockquote>
<p>I feel like that’s my passion and that’s my purpose, is having our people and our culture and our history represented more in the education curriculum and also to have that education there.</p>
</blockquote>
<p>He added he wanted to influence how Indigenous culture was perceived at his university: </p>
<blockquote>
<p>It’s something I’m really passionate about like my background, my culture, and sort of getting that out across into the university.</p>
</blockquote>
<p>Dural was he was the only Indigenous male in his psychology course. But he saw this in positive terms as an opportunity for change:</p>
<blockquote>
<p>So in my cohort, I guess whenever those issues come up, or whenever anyone’s wants to talk about psychology from more of an Aboriginal perspective, then I’m able to sort of share my knowledge and my experiences. And yeah, I feel like I’ve been able to sort of create more awareness around those issues, I guess.</p>
</blockquote>
<h2>A lot more to learn</h2>
<p>Our research shows how young Indigenous men face significant barriers in their university studies. But it also shows how they approach their education with great passion, optimism and pride. </p>
<p>The interviewees told us how their strong sense of connection to culture and their identity inform how they navigate elite universities. They often encountered experiences where they had to educate their fellow classmates who, according to them, had little familiarity with Indigenous cultures.</p>
<p>Policymakers have a lot to learn from students like Nullah, Dural, Ricky and Birrani, especially if we are going to ensure university is a place that genuinely welcomes and supports Indigenous men to study. Our research highlights the importance of taking culture seriously, and what is possible if Indigenous culture is acknowledged, affirmed and incorporated into higher education spaces and learning.</p><img src="https://counter.theconversation.com/content/217186/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Garth Stahl has received funding from the Australian Research Council and the National Centre for Student Equity in Higher Education.</span></em></p><p class="fine-print"><em><span>Braden Hill has previously received funding from the National Centre for Student Equity in Higher Education. </span></em></p><p class="fine-print"><em><span>Himanshu Gupta has received funding from the National Centre for Student Equity in Higher Education.</span></em></p><p class="fine-print"><em><span>James Smith has received funding from the National Centre for Student Equity in Higher Education (NCSEHE); and is a past Equity Fellow and Adjunct Professor with NCSEHE. </span></em></p><p class="fine-print"><em><span>Samuel Moore does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Politicians talk about how they want to see more Indigenous graduates but we don’t often hear from Indigenous students about their experiences. New research talks to four young Indigenous men.Garth Stahl, Associate Professor, The University of QueenslandBraden Hill, Deputy Vice Chancellor (Students Equity and Indigenous), Edith Cowan UniversityHimanshu Gupta, Senior Research Fellow (Lived Experience), Flinders UniversityJames Smith, Matthew Flinders Professor (Health and Social Equity), Flinders UniversitySamuel Moore, Researcher, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2169082023-11-06T22:59:48Z2023-11-06T22:59:48ZHigh Court, then what? NT remote housing reforms need to put Indigenous residents front and centre<p>The relationships between tenants and landlords are often fraught, but it’s fair to expect a house to meet basic standards, like having a back door.</p>
<p>That wasn’t the case for an Aboriginal woman in a remote community, who was part of a successful class action to sue the landlord for failing to provide a habitable house.</p>
<p>Last week, the High Court <a href="https://eresources.hcourt.gov.au/showCase/2023/HCA/31">ruled</a> residents of the community of Santa Teresa (Ltyentye Apurte) could be compensated for the “distress and disappointment” caused by the poor state of their government-managed houses.</p>
<p>So how can such housing be better managed? And what needs to be done to ensure houses in remote communities do not just meet the legal standard, but exceed it?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-back-door-for-5-years-remote-communitys-high-court-win-is-good-news-for-renters-everywhere-216821">No back door for 5 years: remote community's High Court win is good news for renters everywhere</a>
</strong>
</em>
</p>
<hr>
<h2>Big result, but ongoing problems</h2>
<p>Seventy public housing residents in Santa Teresa commenced the legal action against their landlord, the NT government, in <a href="https://www8.austlii.edu.au/cgi-bin/viewdoc/au/cases/nt/NTCAT/2019/12.html">2016</a>.</p>
<p>By the time the High Court decision was handed down in 2023, both lead applicants had died. Just as remote housing tenants must wait prolonged periods for repairs, the lengthy delay for housing justice outlasted them. </p>
<p>Elsewhere in the NT, residents of Laramba have also been pursuing compensation for the landlord’s failure to undertake housing repairs, and arguing for a right to safe drinking water in their homes. </p>
<p>In October this year, the <a href="https://arena.org.au/safe-drinking-water-in-nt/">NT Supreme Court</a> found the landlord, the NT government, is responsible for ensuring safe drinking water at those premises. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1652427646574243840"}"></div></p>
<p>The Santa Teresa High Court decision is <a href="https://theconversation.com/no-back-door-for-5-years-remote-communitys-high-court-win-is-good-news-for-renters-everywhere-216821">potentially significant</a> for tenants across the country. </p>
<p>However, a right to seek compensation for distress and disappointment is not a silver bullet for housing justice. </p>
<p>The challenge is to maintain housing and essential services at such standards that render these types of lawsuits unnecessary.</p>
<h2>When your landlord is the government</h2>
<p>The NT government has not always been responsible for remote community housing.</p>
<p>Most remote communities are located on Aboriginal land owned under the <a href="https://www.austlii.edu.au/cgi-bin/viewdb/au/legis/cth/consol_act/alrta1976444/">Aboriginal Land Rights (Northern Territory) Act 1976</a>. </p>
<p>Through the NT Intervention, the Commonwealth government compulsorily acquired five-year leases over entire communities. </p>
<p>A policy of “secure tenure” made subsequent housing and infrastructure investment contingent on long-term remote community leases to governments. </p>
<p>Indigenous Community Housing Organisations were effectively <a href="https://www.sciencedirect.com/science/article/pii/S0016718522001944">dismantled</a>, and the introduction of “mainstream” tenancy arrangements under a public housing system followed. </p>
<p>One of the unanticipated consequences of this change was the ability of tenants to use the <a href="https://legislation.nt.gov.au/en/Legislation/RESIDENTIAL-TENANCIES-ACT-1999">Residential Tenancies Act</a> as a “<a href="https://search.informit.org/doi/10.3316/INFORMIT.062772924394473">tool of empowerment</a>”.</p>
<p>Residents could now push back against <a href="https://www.academia.edu/44672286/2021_Housing_waste_in_Remote_Indigenous_Australia_In_The_Temporalities_of_Waste_Out_of_Sight_Out_of_Time_eds_F_Allon_R_Barcan_K_Eddison_Cogan_75_86_Routledge_New_York_and_London">entrenched low expectations</a> for the timeliness and quality of remote housing repairs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/think-private-renting-is-hard-first-nations-people-can-be-excluded-from-the-start-192392">Think private renting is hard? First Nations people can be excluded from the start</a>
</strong>
</em>
</p>
<hr>
<h2>Current programs falling short</h2>
<p>In response to the cases at Santa Teresa and Laramba, the NT government has sought to reform its remote housing maintenance program. </p>
<p>In 2021, the NT government introduced its <a href="https://tfhc.nt.gov.au/housing-and-homelessness/healthy-homes">Healthy Homes</a> program. It aims to prioritise cyclical and preventive maintenance to improve the quality of houses as well as health outcomes for tenants.</p>
<p>The reforms reflect many <a href="https://www.niaa.gov.au/resource-centre/indigenous-affairs/remote-housing-review">reviews</a> that have recommended such measures.</p>
<p>If implemented effectively, Healthy Homes can improve <a href="https://www.healthabitat.com/">housing hardware</a> and increase the lifespan of existing housing.</p>
<p>An <a href="https://www.menzies.edu.au/page/Research/Indigenous_Health/Preventive_health/Healthy_Homes_Monitoring_and_Evaluation_Project/#:%7E:text=Healthy%20Homes%20is%20framed%20as,undertake%20'healthy%20living%20practices'">evaluation of Healthy Homes</a> found the average maintenance spend per house to be about $6,000 per year.</p>
<p>While seemingly significant, this is much less than is spent <a href="https://www.ahuri.edu.au/research/final-reports/368">by Housing SA</a> on housing on the Aṉangu Pitjantjatjara Yankunytjatjara Lands in northwest South Australia, where expenditure in 2021 exceeded $10,000 per house.</p>
<p>The key mechanism that underpins the NT’s Healthy Homes is a yearly condition assessment requirement, generating maintenance work without relying on tenant reporting. </p>
<p><a href="https://www.menzies.edu.au/page/Research/Indigenous_Health/Preventive_health/Healthy_Homes_Monitoring_and_Evaluation_Project/#:%7E:text=Healthy%20Homes%20is%20framed%20as,undertake%20'healthy%20living%20practices'">The evaluation</a> found that from July 2021 to February 2023, only 1,315 such inspections had been undertaken across a total of 5,498 houses included in Healthy Homes.</p>
<p>This is equivalent to an inspection of only 23.9% of houses. </p>
<p>The Santa Teresa case also laid bare significant issues with the NT government’s record-keeping, which don’t appear to have been fixed.</p>
<p>The evaluation found:</p>
<ul>
<li><p>NT government datasets cannot distinguish between preventive and responsive maintenance</p></li>
<li><p>reporting requirements mean maintenance data is unreliable for determining how quickly repairs were undertaken</p></li>
<li><p>a significant proportion of maintenance work is coded miscellaneous, meaning it is not possible to determine the proportion of works by trade type.</p></li>
</ul>
<p>The combination of these factors makes it very hard to assess whether and how approaches to remote community maintenance might be improving.</p>
<h2>Bringing remote housing up to scratch</h2>
<p>So a High Court case has reaffirmed the rights of Santa Teresa tenants and the current remote housing maintenance program is inadequate. What happens to NT remote housing now?</p>
<p>The <a href="https://www.niaa.gov.au/indigenous-affairs/land-and-housing/national-partnership-remote-housing-northern-territory-2018-23#:%7E:text=On%2030%20March%202019%2C%20the,for%20Aboriginal%20Territorians%20in%20remote">National Partnership for Remote Housing Northern Territory</a> expired in July 2023.</p>
<p>Commonwealth funding was extended for another year. A new agreement is currently being negotiated.</p>
<p>To meet the needs of remote communities, this agreement must be tripartite. The peak body <a href="https://ahnt.com.au/">Aboriginal Housing NT</a> and Northern Territory land councils require rights to determine funding allocations and policy directions, as well as the territory and federal governments.</p>
<p>This is necessary for the meaningful participation and empowerment of those Aboriginal organisations in key decision-making under the agreement, and to enshrine their place as equal partners in the ongoing governance of remote housing in the NT. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aboriginal-housing-policies-must-be-based-on-community-needs-not-what-non-indigenous-people-think-they-need-162999">Aboriginal housing policies must be based on community needs — not what non-Indigenous people think they need</a>
</strong>
</em>
</p>
<hr>
<p>Federal funding of remote housing is required into the long term. A ten-year funding agreement should support all of remote communities, town camps and homelands.</p>
<p>Because of historical underfunding and neglect, this funding also needs to increase and the Commonwealth Government must remain on the hook.</p>
<p>The Santa Teresa case has shown the ongoing legacy of underinvestment and neglect. </p>
<p>Aboriginal residents of remote communities and their representative organisations must be supported to play a central role in determining the future of the places they call home.</p><img src="https://counter.theconversation.com/content/216908/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Liam Grealy receives funding from the Australian Research Council, the Australian Housing and Urban Research Institute, and the NT Department of Territory Families, Housing and Communities. He is affiliated with Menzies School of Health Research and the University of Sydney. Details related to specific projects are available on his public profiles. </span></em></p><p class="fine-print"><em><span>Kyllie Cripps receives funding from the Australian Research Council, the Australian Government and State Governments to conduct research and evaluations. Details related to this are on her public profiles.</span></em></p>Last week, the High Court ruled the community of Santa Teresa could be compensated for the “distress and disappointment” caused by their poor housing. So how can such housing be better managed?Liam Grealy, Research fellow, Menzies School of Health ResearchKyllie Cripps, Professor, Director Monash Indigenous Studies Centre, School of Philosophical, Historical & International Studies (SOPHIS), School of Social Sciences (SOSS), Faculty of Arts, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2115902023-08-18T06:42:23Z2023-08-18T06:42:23ZMengapa air seni berwarna kuning?<figure><img src="https://images.theconversation.com/files/542657/original/file-20190730-43153-osy3ym.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C2482%2C1696&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Jika kamu minum lebih banyak air daripada yang dibutuhkan tubuhmu, tubuh akan memerintahkan penyaring ginjal untuk membuang air cadangan tersebut. Saat itulah urin akan terlihat lebih pucat.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><blockquote>
<p><strong>Mengapa air seni berwarna kuning? – Ronan, usia 9 tahun, Greenslopes, Brisbane.</strong> </p>
</blockquote>
<hr>
<p>Terima kasih atas pertanyaanmu, Ronan. </p>
<p>Tubuh kita menggunakan nutrisi dari makanan yang kita makan. Namun, proses yang terlibat dalam pencernaan juga menghasilkan apa yang kita sebut “produk sampingan”. Di situlah bahan kimia baru tercipta di sepanjang proses tersebut. </p>
<p>Beberapa produk sampingan dalam tubuh ini adalah limbah, dan tubuh kita memiliki sistem pengolahan limbah yang cerdas untuk membuangnya. </p>
<p>Beberapa limbah keluar melalui kotoran kita. Dan limbah yang dapat larut dalam air akan keluar melalui air seni. Kita menyebutnya limbah “larut dalam air”. Larut dalam air berarti dapat dilarutkan dalam air. </p>
<p>Dan bagian tubuh yang bertugas “membuat” air seni disebut ginjal. Bentuknya seperti kacang merah.</p>
<h2>Keseimbangan yang rumit</h2>
<p>Ginjal bekerja sepanjang waktu untuk memastikan tubuh memiliki keseimbangan yang tepat antara air, garam, dan bahan kimia serta tidak terlalu banyak limbah yang larut dalam air. </p>
<p>Ginjal memiliki filter khusus di dalamnya yang membantu memilah-milah bagian yang berguna dari limbah. Ginjal juga bertugas mengangkut limbah yang larut dalam air dari ginjal menuju dua pipa khusus yang disebut “ureter” dan masuk ke dalam kandung kemih (yang terletak di dekat alat kelamin). </p>
<p>Ketika kandung kemih penuh, kandung kemih akan mengirimkan pesan melalui saraf ke otak yang membuat kita merasa ingin buang air kecil. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ginjal juga bertanggung jawab untuk mengangkut limbah yang larut dalam air dari ginjal, melalui dua pipa khusus yang disebut ‘ureter’ dan masuk ke dalam kandung kemih.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Jadi, …. mengapa warnanya kuning?</h2>
<p>Salah satu produk limbah yang larut dalam air yang dikeluarkan oleh ginjal ke dalam air seni kamu adalah bahan kimia yang disebut urobilin, dan berwarna kuning. </p>
<p>Warna urin bergantung pada seberapa banyak urobilin di dalamnya dan seberapa banyak air di dalamnya. </p>
<p>Jika urin berwarna kuning muda, itu berarti kita telah minum banyak air dan ada banyak air dalam urin. Kita menyebutnya “terhidrasi”.</p>
<p>Jika urin berwarna kuning tua, itu berarti kandungan airnya lebih sedikit, dan jumlah urobilinnya relatif tinggi. Ini mungkin berarti kita belum minum cukup air dan bisa jadi mengalami dehidrasi.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=457&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=457&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=457&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=574&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=574&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=574&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Jika air seni berwarna kuning muda, artinya kamu telah minum banyak air.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Terlalu banyak minum air versus tidak cukup minum air</h2>
<p>Ketika tidak minum cukup air, ginjal akan menerima pesan dari otak untuk mencoba menyimpan lebih banyak air di dalam tubuh (dan keluar dari kandung kemih). Kita juga akan mulai merasa haus. </p>
<p>Jika seseorang tidak dapat minum air (karena menderita penyakit muntah-muntah, misalnya), mereka mungkin membutuhkan air yang dimasukkan langsung ke dalam darah mereka. Hal ini biasanya dilakukan di rumah sakit dengan menggunakan infus (yakni sekantong air garam dimasukkan ke dalam darah melalui jarum di lengan).</p>
<p>Jika kita minum air lebih banyak dari yang dibutuhkan tubuh, tubuh akan memerintahkan penyaring ginjal untuk membuang air yang tidak terpakai. Saat itulah air seni akan terlihat lebih pucat.</p>
<hr>
<p><em>Rahma Sekar Andini dari Universitas Negeri Malang menerjemahkan artikel ini dari bahasa Inggris</em>.</p><img src="https://counter.theconversation.com/content/211590/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Jaqui Hughes adalah seorang wanita Torres Strait Islander, seorang dokter spesialis (dokter ginjal) di Rumah Sakit Royal Darwin, dan seorang peneliti kesehatan ginjal di Menzies School of Health Research di Darwin. Beliau dipekerjakan oleh Top End Health Service sebagai dokter spesialis nefrologi, dan didanai oleh National Health and Medical Research Council untuk memimpin penelitian kesehatan ginjal yang inovatif yang memajukan kesehatan warga Australia.</span></em></p>Warna urin bergantung pada seberapa banyak urobilin di dalamnya dan seberapa banyak air di dalamnya.Jaquelyne Hughes, Senior Research Fellow, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1832102022-05-18T03:12:03Z2022-05-18T03:12:03ZFirst Nations people in the NT receive just 16% of the Medicare funding of an average Australian<figure><img src="https://images.theconversation.com/files/463528/original/file-20220517-21-vm1pzz.jpg?ixlib=rb-1.1.0&rect=44%2C4%2C2946%2C1747&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/yuendumu-nt-australie-february-15-2020-1706306305">Shutterstock</a></span></figcaption></figure><p>Medicare, Australia’s universal health insurance scheme, provides financial protection against the cost of medical bills, and makes public hospital care available without any charge to the patient. For the large majority of Australians in urban settings, it is a <a href="https://www.commonwealthfund.org/sites/default/files/2021-08/Schneider_Mirror_Mirror_2021.pdf">brilliant system</a> – providing subsidised access to care. </p>
<p>But subsidised access is only useful for those who have access. If there is no doctor nearby, there is nothing to subsidise. This creates a huge inequity – most of Australia has good access to doctors, but the Northern Territory does not. </p>
<p>And what’s worse, there is no effective policy to redress the inequity that payments flow to areas where there are doctors.</p>
<p>In our <a href="https://www.publish.csiro.au/AH/pdf/AH21276">recently published paper</a>, we found NT residents receive roughly 30% less Medicare funding per capita than the national average (A$648 compared with A$969). </p>
<p>The gap is worse for First Nations Australians in the NT, who attract only 16% of the Medicare funding of the average Australian.</p>
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Read more:
<a href="https://theconversation.com/labors-health-package-wont-strengthen-medicare-unless-it-includes-these-3-things-183093">Labor's health package won't 'strengthen' Medicare unless it includes these 3 things</a>
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<p>We measured the extent of the problem over the years 2010–20. We used the federal government’s published figures on Medicare to explore the impact of this uneven workforce distribution on Medicare billing in the NT. </p>
<p>The differences are stark.</p>
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<img alt="" src="https://images.theconversation.com/files/463812/original/file-20220517-19-rnreyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/463812/original/file-20220517-19-rnreyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/463812/original/file-20220517-19-rnreyj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/463812/original/file-20220517-19-rnreyj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/463812/original/file-20220517-19-rnreyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=511&fit=crop&dpr=1 754w, https://images.theconversation.com/files/463812/original/file-20220517-19-rnreyj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=511&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/463812/original/file-20220517-19-rnreyj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=511&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>The inequitable funding is even worse when the poorer health status of First Nations Australians and the additional costs associated with geographical remoteness are taken into account.</p>
<p>The NT has a younger age profile than the rest of Australia, but this explains only one-third of the gap.</p>
<h2>What’s going wrong with the funding?</h2>
<p>Despite Medicare’s intended universality, the NT is systematically disadvantaged. </p>
<p>People in the Territory have poorer access to primary health care, which includes GP services and those provided by Aboriginal community-controlled health services. </p>
<p>Aboriginal health services receive some special additional funding separate from the Medicare-billing funding. However, even with that extra funding, there is still a <a href="https://www.publish.csiro.au/AH/pdf/AH21276">shortfall</a> to NT residents of about A$80 million each year.</p>
<p>The NT government receives a relatively higher proportion of the GST funding pool in recognition of its challenges with remoteness and Indigenous services. But this is calculated assuming NT residents have the same access to Medicare as all other Australians. As we have shown, they don’t and so the extra GST funding does not result in a fair funding stream to meet NT primary care needs.</p>
<p>The outcome of inadequate primary health care funding is increasing reliance on hospital services. People’s chronic health conditions worsen if they’re not well managed in the community and this increases the risk they will need a hospital admission, especially for “<a href="https://www.aihw.gov.au/reports/primary-health-care/disparities-in-potentially-preventable-hospitalisations-australia/summary">potentially preventable hospitalisations</a>”. NT hospitals experience excessive pressure of workload and complexity as a result. </p>
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<img alt="Woman sits on a hospital bed, her back to the door." src="https://images.theconversation.com/files/463532/original/file-20220517-2769-yuytwg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/463532/original/file-20220517-2769-yuytwg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/463532/original/file-20220517-2769-yuytwg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/463532/original/file-20220517-2769-yuytwg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/463532/original/file-20220517-2769-yuytwg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/463532/original/file-20220517-2769-yuytwg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/463532/original/file-20220517-2769-yuytwg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&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="caption">Poorer access to primary care services results in more hospitalisations.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-view-asian-chinese-female-patient-1459422617">Shutterstock</a></span>
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<p>We have shown previously that effective primary health care for remote patients with chronic, long-term diseases can substantially <a href="https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/1472-6963-13-466.pdf">reduce their use of hospital services</a> and result in better health outcomes at a lower cost.</p>
<p>When visiting the NT in 2000, one of the architects of Medicare, <a href="https://en.wikipedia.org/wiki/John_Deeble">John Deeble</a>, observed the funding failure first hand and suggested another form of health-care financing was needed to adequately support remote primary health care. </p>
<p>In terms of health equity and our national commitment to close the life expectancy gap for First Nations peoples, the status quo is undeniably short-changing our efforts.</p>
<h2>What needs to be done?</h2>
<p>There needs to be a reset in how we finance remote primary health care services in the NT. </p>
<p>The value proposition is excellent. Due to the extreme health needs and vulnerable populations, the <a href="https://www.mja.com.au/journal/2014/200/11/cost-effectiveness-primary-care-indigenous-australians-diabetes-living-remote">return on investment is high</a> – more than A$5 in saved acute care costs for every dollar invested.</p>
<p>The federal government’s Health Care Homes funding reform trial <a href="http://www.amsant.org.au/wp-content/uploads/2020/02/HCH-Forum-Presentation-Laynhapuy-Homelands.pdf">was very successful in remote NT communities</a>. For the first time, service providers received flexible funding to care for patients’ chronic conditions, rather than a fee for each service they provided. It also enabled the provider and patient to develop a relationship. </p>
<p>Unfortunately the <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-care-homes">Health Care Homes program ended in June 2021</a>, and has not been renewed. This program should be reinvigorated for chronic disease care in the NT and extended to include other core programs of mental health and suicide prevention, and child and maternal health.</p>
<p>The federal government should take this opportunity to get remote primary health care financing right and ensure Medicare funds reach those who need them most.</p>
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Read more:
<a href="https://theconversation.com/how-do-the-major-parties-rate-on-medicare-we-asked-5-experts-182230">How do the major parties rate on Medicare? We asked 5 experts</a>
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<p><em>Acknowledgement: Xiaohua Zhang, Jo Wright, and Maja Van Bruggen from the Northern Territory Department of Health are co-authors of the journal article on which this article is based.</em></p><img src="https://counter.theconversation.com/content/183210/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Wakerman receives funding from The Australian Research Council, the Medical Research Future Fund and the NT Primary Health Network.
</span></em></p><p class="fine-print"><em><span>Paul Burgess has previously received grant funding as an investigator on MRFF, NHMRC and the Digital Health CRC funded projects. No funding was received for the work that led to this publication. Paul works for the NT Government.</span></em></p><p class="fine-print"><em><span>Rus Nasir worked for the NT Government as acting director of Aboriginal health. </span></em></p><p class="fine-print"><em><span>Yuejen Zhao works for the NT Govnernment.</span></em></p><p class="fine-print"><em><span>Stephen Duckett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>NT residents receive approximately 30% less Medicare funding per capita than the national average. The gap is worse for First Nations Australians in the NT.Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice, The University of MelbourneJohn Wakerman, Professor of Remote and Rural Health Services Research, Menzies School of Health ResearchPaul Burgess, Adjunct assistant professor, Flinders UniversityRus Nasir, Policy & Research Unit, Aboriginal Medical Services Alliance Northern Territory, Indigenous KnowledgeYuejen Zhao, Senior Researcher, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1774712022-03-28T15:12:55Z2022-03-28T15:12:55ZWar in Ethiopia: addressing mental health needs to be made a priority<figure><img src="https://images.theconversation.com/files/448331/original/file-20220224-23-1r9ngbz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ethiopian refugees fleeing the Tigray region.</span> <span class="attribution"><span class="source">Photo by Yasuyoshi Chiba/AFP via Getty Images</span></span></figcaption></figure><p>The effects of war on the mental wellbeing of people is given much less attention than the physical harms of conflict.</p>
<p>We have been <a href="https://pubmed.ncbi.nlm.nih.gov/27036945/">researching</a> and working on the <a href="https://link.springer.com/article/10.1186/s12889-020-8293-9">mental health challenges faced by different sub-populations</a>.
In a recent opinion piece in The Lancet our group applied some of our earlier findings to the situation in Ethiopia.</p>
<p>The country is the second most populous in Africa. It has a total population of approximately 115 million and 12 administrative regions. <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00013-X/fulltext#bib1">Conflict broke out</a> in late 2020 between the central government and the Tigray People’s Liberation Front. The war has been ongoing ever since, with battles spreading out to the regions of Afar and Amhara.</p>
<p>Mental health problems are major indirect consequences of armed conflicts. They can have short-term and long-term effects on the wellbeing of individuals living in war-affected areas. </p>
<p>In a new report the World Health Organization (WHO) <a href="https://www.sciencedirect.com/science/article/pii/S0140673619309341">estimates</a> a high burden of mental health problems in conflict settings. This includes depression, anxiety, post-traumatic stress disorder, bipolar disorder and schizophrenia.</p>
<p>There has been limited data on the potential mental health consequences of the war in Ethiopia. To try and bridge the gap we applied the WHO’s estimates to the populations in the war-affected regions of Afar and Amhara in the country. </p>
<p>What we found suggests that a minimum of 28, 560 individuals are facing severe forms of mental health disorders that require immediate intervention. Of these 12, 566 are children and 14, 565 are women.</p>
<p>Treatment of these people has been impossible. The war led to <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00337-3/fulltext?dgcid=raven_jbs_etoc_email">the damage and looting</a> of more than 40 hospitals, 453 health centres, 1,850 health posts in Amhara and one hospital, 17 health centres and 42 health posts in the Afar region. </p>
<p>We argue that the burden of mental disorders and their short-term and long-term consequences in communities in the war-affected regions of Amhara and Afar should be a priority in the post-war period. </p>
<p>Given the large population in need of mental health interventions in northern Ethiopia, there is an urgent need to offer effective collaborative care that’s affordable and accessible. </p>
<h2>The impact</h2>
<p>Over 12 months of sustained conflict has resulted in massive internal displacement, homelessness, financial and family loss, and disruption of the culture and values of millions of people living in Amhara and Afar.</p>
<p>Several <a href="https://www.fanabc.com/english/terrorist-tplf-destroys-historical-church-heritage-sites-of-checheho-medhanealem-cathedral/">religious institutions</a> that have been playing a crucial role in maintaining public resilience and the mental wellbeing of the community have been destroyed. This has been in the absence of government and community-based facilities, which have been looted.</p>
<p>Women and children have borne the brunt of the conflict. This can be directly due to violence or indirectly due to various health consequences.</p>
<p>All of these issues exacerbate the mental health problems of individuals living in the war-affected regions and indirectly affect their families and friends. </p>
<p>Another adversity that could increase the risk of mental health problems in the population is gender-based acts of violence and assault. This includes <a href="https://edition.cnn.com/2022/02/15/africa/amnesty-ethiopia-tigray-report-intl/index.html">rape and gang rape</a>. </p>
<p>The intergenerational effects of armed conflict are also of concern. Sexual violence can lead to family breakdown, leaving children unattended, uncared for, and traumatised throughout their childhood and adulthood.</p>
<h2>What can be done</h2>
<p>Awareness raising, psychoeducation, skills training, rehabilitation, and psychological treatments are considered effective interventions in post-war settings. These <a href="https://link.springer.com/article/10.1007/s11920-019-1017-0">could be provided</a> in homes, schools, communities, and religious and health institutions. </p>
<p>In addition: training health care workers, leaders and educators; using social or community support as well as methods that are sensitive to people’s faith and culture, and equipping them with the knowledge and competency to provide trauma-informed care. The engagement of community leaders – such as religious leaders, elders and public figures – and the use of cultural institutions, would further help these interventions to reach the broader population. </p>
<p>Several UN agencies (the UN Population Fund, the UN High Commissioner for Refugees, UNICEF, WHO, and the International Organization for Migration) have been actively working to identify women affected by different types of violence, and training community-based counsellors who provide dignity kits and psychological support such as counselling in the <a href="https://reliefweb.int/sites/reliefweb.int/files/resources/unfpa_extsitrep_15-31_august_tigrayresponse.pdf">Tigray region</a>. </p>
<p>These post-war mental health services should also be scaled up for affected populations in Amhara and Afra regions.</p><img src="https://counter.theconversation.com/content/177471/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Mental health problems are major indirect consequences of armed conflicts and can have short-term and long-term effects on people.Abel Fekadu Dadi, Outstanding Future Researcher, Menzies School of Health ResearchTesfaye B. Mersha, PhD, Associate Professor, UC Department of Pediatrics, Cincinnati Children's, University of Cincinnati Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1645512021-08-16T04:26:12Z2021-08-16T04:26:12Z‘Don’t leave the esky in the sun’: how to get cold vaccines to hot, remote Australia<figure><img src="https://images.theconversation.com/files/416139/original/file-20210814-27-iq6h8f.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C997%2C658&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/off-road-track-outback-683939944">from www.shutterstock.com</a></span></figcaption></figure><p>There’s a <a href="https://www.9news.com.au/national/coronavirus-update-nsw-pfizer-covid-vaccine-shipment-for-walgett-and-other-regional-towns-in-lockdown/78193137-f185-420e-b6d1-88a3f18aa7a2">rush to vaccinate</a> vulnerable remote Aboriginal communities in New South Wales after spread of the coronavirus out of metropolitan areas has led to a state-wide lockdown.</p>
<p>So focus is turning to how quickly we can get COVID-19 vaccines over vast distances, far from vaccine warehouses in the cities, into remote Australians’ arms.</p>
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<p>But transporting vaccines to remote Australia isn’t new. Nor are the challenges that must be overcome to keep vaccines at the right temperature on the long and bumpy journey to remote clinics. </p>
<p>Here are some of the practical issues nurses, Aboriginal and Torres Strait Islander health practitioners, community health workers, pharmacists and others face when vaccines are transported vast distances by road, air or on water.</p>
<h2>It’s a long way</h2>
<p>The vast distances and isolated communities of remote Australia pose significant challenges to transporting vaccines. Then there are the environmental extremes, with freezing winter nights and scorching summer days, plus monsoonal rains and cyclones often interrupting transport services and making regions inaccessible for weeks. </p>
<p>Keeping vaccines at the right temperature over large distances, over days and weeks, can be challenging. But vaccines are temperature-sensitive products, and their effectiveness is dependent on correct storage. If a vaccine is too hot or too cold it may be damaged and not work as well.</p>
<p>So it’s critical to keep vaccines at the right temperature to ensure their safety and efficacy.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1403230641064497153"}"></div></p>
<p>For non-COVID vaccines and the <a href="https://www.health.nsw.gov.au/Infectious/covid-19/vaccine/Pages/az-refrigerator-to-administration.aspx">AstraZeneca COVID vaccine</a>, the recommended cold chain — between 2°C and 8°C — must be maintained from the place of manufacture to administration in the community.</p>
<p>However, transport and storage requirements for the Pfizer COVID vaccine are different. Unopened vials of the vaccine <a href="https://www.tga.gov.au/media-release/wider-storage-and-transportation-conditions-pfizer-covid-19-vaccine-now-approved">need to be stored</a> and transported at domestic freezer temperatures, between -25°C and -15°C, for up to two weeks. </p>
<p>Unopened vials may also be stored at domestic refrigerator temperatures, between 2°C to 8°C, for up to five days. Once a Pfizer vaccine has thawed it should not be re-frozen.</p>
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Read more:
<a href="https://theconversation.com/cracking-the-cold-chain-challenge-is-key-to-making-vaccines-ubiquitous-99329">Cracking the cold chain challenge is key to making vaccines ubiquitous</a>
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<p>Keeping vaccines <a href="https://www.health.gov.au/resources/publications/national-vaccine-storage-guidelines-strive-for-5">in the recommended temperature range</a> over long distances often means styrofoam boxes and regular eskies are inadequate, particularly when the transit time is likely to be three to four days. Transporting vaccines to remote Australia requires special infrastructure, including dedicated <a href="https://www.health.gov.au/health-topics/immunisation/health-professionals/storing-handling-and-administering-vaccines">vaccine fridges and insulated containers</a>.</p>
<p>If there’s a cold-chain breach, when vaccines are exposed to temperatures outside the recommended range, the vaccines may become damaged and might need to be thrown away and replaced. </p>
<p>Such breaches are estimated to have cost the Australian health system <a href="https://www1.racgp.org.au/newsgp/clinical/tip-of-the-cold-chain-iceberg-vaccines-worth-26-mi">at least A$25.9 million</a> in replacement vaccines over a five-year period. This estimate is pre-COVID, so the figure is likely higher if we take into account any cold-chain breaches with COVID vaccines.</p>
<p>There is a significant risk <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-842X.1996.tb01084.x">of this happening</a> in remote Australia.</p>
<h2>All staff need to be aware</h2>
<p>All staff involved in the vaccination process, from manufacture to transport to administration, must understand the need to <a href="https://www.health.gov.au/resources/publications/national-vaccine-storage-guidelines-strive-for-5">maintain the cold chain</a> and the risks associated with cold chain breaches. </p>
<p>This includes knowing the correct way to pack the vaccines in an insulated container (such as a vaccine cold box, esky or styrofoam box), using temperature monitors, and what to do when there’s a cold-chain breach.</p>
<p>However, there are few training materials dealing with vaccine cold chain in remote Australia. And with high staff turnover, it’s difficult to know everyone in the chain has the right training.</p>
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Read more:
<a href="https://theconversation.com/first-nations-people-urgently-need-to-get-vaccinated-but-are-not-being-consulted-on-the-rollout-strategy-164067">First Nations people urgently need to get vaccinated, but are not being consulted on the rollout strategy</a>
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<h2>We made a video</h2>
<p>A team at Flinders University collaborated with Irene Nangala — a Pintupi elder and director of Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation (<a href="https://www.purplehouse.org.au">Purple House</a>), an Aboriginal community controlled organisation in Alice Springs — to make a short educational video called Vaccine Story.</p>
<p>The video depicts the journey a vaccine takes from a supply centre to a remote Australian community in a culturally appropriate manner. </p>
<p>This freely available video is especially useful for non-clinical staff, who may not otherwise receive professional training or updates.</p>
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<figcaption><span class="caption">Vaccine Story follows an esky full of vaccines from the city to remote Australia.</span></figcaption>
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<h2>Transport is important</h2>
<p>The video also looks at the importance of transport in maintaining the cold chain, especially in the “last mile” of <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2100574">vaccine logistics</a>. </p>
<p>For remote Australia, variable and unreliable transport add extra logistical challenges. Freight to remote communities is often limited with infrequent or non-existent services. </p>
<p>So local clinics and supply centres need to be adaptable and resourceful to ensure vaccine supply. The right transport option for one day might not be the best for another. Staff need to ask:</p>
<ul>
<li><p>is there a bus travelling to the community today?</p></li>
<li><p>can the visiting specialist team take the esky with them on the plane?</p></li>
<li><p>can the patient-transport driver pick up the vaccine from the pharmacy?</p></li>
<li><p>how are the roads today?</p></li>
</ul>
<p>Each of these options presents new challenges. Non-clinical staff may have to be trained in how to handle vaccines and the importance of maintaining the cold chain. </p>
<p>For example, the esky needs to be safely secured in the car. If it bounces around, the ice bricks may come into direct contact with the vaccines, which can cause them to freeze (the vaccines are generally separated from the ice with packing materials).</p>
<p>Staff will have to consider the temperature in a car, bus, the hull of a plane or on a barge. Vaccines will have to be handed over to the right person, not left on the runway or on the clinic doorstep in the sun.</p>
<p>There must be good lines of communication so everyone knows where the vaccines are.</p>
<h2>The electricity’s out</h2>
<p>Vaccines need to be stored in dedicated vaccine fridges when they reach the clinic in remote Australia.</p>
<p>However, challenges in maintaining the cold chain don’t stop there. It’s common in remote communities for <a href="https://www.theguardian.com/australia-news/2020/mar/04/power-outages-leave-aboriginal-people-on-nt-islands-with-no-food-fuel-or-phones-for-three-days">electricity outages</a> that mean vaccine fridges go off. Clinic staff <a href="https://www.remotephcmanuals.com.au/">need to be trained</a> in <a href="https://www.health.gov.au/sites/default/files/documents/2020/04/national-vaccine-storage-guidelines-strive-for-5.pdf">how to manage</a> these situations.</p>
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<strong>
Read more:
<a href="https://theconversation.com/how-to-manage-your-essential-medicines-in-a-bushfire-or-other-emergency-127516">How to manage your essential medicines in a bushfire or other emergency</a>
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<h2>It’s a long road</h2>
<p>Despite these significant logistical challenges, vaccines have been successfully shipped to remote Australia for years before COVID vaccines became urgently needed.</p>
<p>But with the latest COVID cases in remote NSW, we’re reminded just how different the vaccine cold chain is in the bush compared with the city.</p>
<p>So all eyes are on looking after this precious cargo, including maintaining the cold chain.</p><img src="https://counter.theconversation.com/content/164551/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tobias Speare received funding from Northern Territory PHN to create Vaccine Story video.</span></em></p><p class="fine-print"><em><span>Suzanne Belton is employed by CARPA to evaluate the Vaccine Story film. </span></em></p>Millions of dollars worth of vaccines are thrown out each year because they are not transported or stored at the right temperature. We made a video to help prevent that.Tobias Speare, Lecturer, Pharmacy Academic, Rural and Remote Health NT, Flinders UniversitySuzanne Belton, Associate professor, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1625152021-06-22T20:02:59Z2021-06-22T20:02:59ZHere’s an approach to mentoring that can help close the leadership gender gap<figure><img src="https://images.theconversation.com/files/407360/original/file-20210621-35447-36u9yj.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5176%2C3453&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/two-women-working-computer-contemporary-office-284518922">Shutterstock</a></span></figcaption></figure><p>Mentoring is known to be a critical component of <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207634">job satisfaction and career development</a>. It is also widely recognised that career advancement in medicine, research and health more broadly remains <a href="https://humanrights.gov.au/our-work/education/face-facts-gender-equality-2018">in favour of men</a>. </p>
<p>Traditional academic mentoring programs rely on a unidirectional mentor-mentee relationship: a senior academic mentors a junior (female) academic. This model has been shown to increase mentees’ <a href="https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-018-1290-3">personal achievement</a>, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207634">career progress and satisfaction with work environment</a>. </p>
<p>While these are important achievements, <a href="https://www.publicanthropology.org/interrogating-model-mentoring-by-simone-dennis-and-alison-behie/">Simone Dennis and Alison Behie</a> <a href="https://theconversation.com/why-mentoring-for-women-risks-propping-up-patriarchal-structures-instead-of-changing-them-157965">argue</a> that “by replicating action of the mentors, junior women are merely trained how to navigate a system that favours men”. Traditional mentoring programs teach women how to work within, rather than change, a system biased against them. This perpetuates patriarchal structures.</p>
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Read more:
<a href="https://theconversation.com/why-mentoring-for-women-risks-propping-up-patriarchal-structures-instead-of-changing-them-157965">Why mentoring for women risks propping up patriarchal structures instead of changing them</a>
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<p>We have established a mentoring program for women scientists that focuses on diversifying and changing the education sector. This program helps equip them to challenge systemic values and culture. </p>
<h2>What’s different about this model?</h2>
<p>The <a href="https://www.hotnorth.org.au/opportunities/catalyse-mentorship-program-women-scientists/">Catalyse Mentorship Program</a> in regional and rural Australia follows a dual-mentorship model. This means each female mentee is matched with an academic mentor and a corporate-sector mentor. </p>
<p>Our <a href="https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-020-02219-w">research</a> found the Catalyse academic mentors provided technical university/ research pathways advice. They advised on explicit and implicit academic growth, such as formal university progression, the types of journals to publish in and how to distinguish one’s specific work. </p>
<p>The corporate mentors, on the other hand, provided advice on strategy, leadership and interpersonal skills. Advice included “how to generate consensus within a team and with external stakeholders”, “how to have difficult conversations”, and “how to build and express your personal brand”. </p>
<figure class="align-center ">
<img alt="Chart showing topics discussed with Catalyse program's academic and corporate mentors" src="https://images.theconversation.com/files/407373/original/file-20210621-22-1mups4y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/407373/original/file-20210621-22-1mups4y.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/407373/original/file-20210621-22-1mups4y.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/407373/original/file-20210621-22-1mups4y.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/407373/original/file-20210621-22-1mups4y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/407373/original/file-20210621-22-1mups4y.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/407373/original/file-20210621-22-1mups4y.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&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"><a class="source" href="https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-020-02219-w">Chart: The Conversation. Data: Championing women working in health across regional and rural Australia – a new dual-mentorship model</a>, <span class="license">Author provided</span></span>
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Read more:
<a href="https://theconversation.com/how-mentoring-improves-the-leadership-skills-of-those-doing-the-mentoring-143668">How mentoring improves the leadership skills of those doing the mentoring</a>
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<p>The Catalyse mentees reported positive “discomfort” at being pushed out of their “comfort zones”. This allowed them to reflect on leadership and impact outside their academic institution. The mentees set the agenda and explored first-time activities such as developing business cases, establishing peer-to-peer networking groups and applying for awards and accolades. </p>
<h2>Group approach has additional benefits</h2>
<p>Group mentoring is a way to go beyond supporting women and enhancing their capacity to manage a patriarchal culture. Bringing women together with a senior (retired) researcher has delivered several additional benefits compared to traditional unidirectional mentoring. </p>
<p>As the group members share their stories and worries, the sense of injustice and the care for each other increase. The women also bring a range of solutions and support to each other. This process strengthens ties within the cohort. </p>
<p>Such solutions are far more likely to be effective than those a single older mentor might suggest. That’s because they come from a contemporary context and a broader set of experiences. </p>
<figure class="align-center ">
<img alt="chart showing outcomes of Catalyse mentorship program" src="https://images.theconversation.com/files/407371/original/file-20210621-62599-u32u50.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/407371/original/file-20210621-62599-u32u50.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/407371/original/file-20210621-62599-u32u50.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/407371/original/file-20210621-62599-u32u50.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/407371/original/file-20210621-62599-u32u50.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/407371/original/file-20210621-62599-u32u50.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/407371/original/file-20210621-62599-u32u50.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&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"><a class="source" href="https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-020-02219-w">Chart: The Conversation. Data: Championing women working in health across regional and rural Australia – a new dual-mentorship model</a>, <span class="license">Author provided</span></span>
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Read more:
<a href="https://theconversation.com/how-to-support-junior-staff-in-a-time-of-turmoil-for-universities-148917">How to support junior staff in a time of turmoil for universities</a>
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<p>In addition, all the groups we have mentored have debated carefully developed strategies aimed at changing the status quo. This would not have happened in one-on-one mentoring. Examples of these strategies are:</p>
<ul>
<li><p>request data on fund-raising within the organisation – and relate that data to gender as well as research area</p></li>
<li><p>demand administrative support for women who are asked to take on additional leadership or other roles – which made organisations look as if they were supporting more women but didn’t give them the capacity to manage those roles without significant impacts on their research time</p></li>
<li><p>present collective suggestions for the organisation to consider </p></li>
<li><p>push for the women to be the leading chief investigator on grant applications and first or senior author on papers, to be considered for national committees and to give keynote presentations at major conferences. </p></li>
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Read more:
<a href="https://theconversation.com/forget-the-ideal-worker-myth-unis-need-to-become-more-inclusive-for-all-women-men-will-benefit-too-156107">Forget the ideal worker myth. Unis need to become more inclusive for all women (men will benefit too)</a>
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<p>One of us (Fiona Stanley) has experience in group mentoring of First Nations health research scholars. The benefits of sharing experiences within these cohorts is that the scholars are able to provide much more solid collective solutions than if in a one-on-one session with a non-Indigenous older researcher. </p>
<p>It was clear from these sessions that racism pervades the health academic sector. However, empowering the group of mentees has resulted in major activities to address racism in their organisations. These include: mentees offering to give major presentations to the executive teams, often bringing in external speakers who have more power; suggesting and running NAIDOC activities; and reviewing reconciliation action plans to make them real rather than a token or box-ticking exercise.</p>
<h2>3 key elements to bring about change</h2>
<p>A <em>strong</em> mentoring model should consider three key elements to close the leadership gap:</p>
<ul>
<li><p>mentees set the agenda and are empowered to initiate change within the organisation</p></li>
<li><p>diversify mentors, include mentors from corporate/business sectors, and do group mentoring to enhance networks </p></li>
<li><p>hold mentor networking events throughout the program, leading to cross-fertilisation between networks and (funding) opportunities.</p></li>
</ul>
<p>Mentoring programs like these provide a more rounded approach to closing the leadership gap. These programs offer participants both discipline-based technical advice and external guidance on personal attributes and the strategic thinking needed to lead. </p>
<p>As <a href="https://www.britannica.com/biography/Mary-Wollstonecraft">Mary Wollstonecraft</a> <a href="http://www.womeninworldhistory.com/lesson16.html">wrote</a> in laying out the first steps toward bringing down the patriarchy for the betterment of all humanity, “I do not wish them [women] to have power over men; but over themselves.”</p>
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Read more:
<a href="https://theconversation.com/its-not-lack-of-confidence-thats-holding-back-women-in-stem-155216">It's not lack of confidence that's holding back women in STEM</a>
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<img src="https://counter.theconversation.com/content/162515/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fiona Stanley received funding from NHMRC and ARC over many years of her research career; she no longer receives funds but is associated with several grants for which she is an unpaid advisor and mentor.</span></em></p><p class="fine-print"><em><span>Teresa Wozniak does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>One criticism of traditional mentoring is that it teaches people how to succeed by playing by existing rules, thus reinforcing the status quo. But mentoring can also be a force for change.Teresa Wozniak, Senior Research Fellow and co-founder Catalyse Mentorship Program, Menzies School of Health ResearchFiona Stanley, Perinatal and pediatric epidemiologist; distinguished professorial fellow, Telethon Kids InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1603612021-05-10T19:51:42Z2021-05-10T19:51:42ZThe NT’s tough-on-crime approach won’t reduce youth offending. This is what we know works<p>Last week the Northern Territory (NT) government proposed <a href="https://newsroom.nt.gov.au/mediaRelease/34423">legislative changes</a> to youth justice, including tightening access to bail and diversion, particularly for re-offenders.</p>
<p>We expect the legislation could go through as early as today. But this tough-on-crime approach runs contrary to what we know works to reduce youth offending and keep children healthy.</p>
<p>Nine national and local health organisations have written an <a href="https://drive.google.com/file/d/11WlbPRgXertvIzGk0UP-_wtu0Q-j_vxb/view">open letter</a> to NT government ministers warning the reforms “pose a significant threat to the health and wellbeing of an already vulnerable cohort of young people”.</p>
<p>Evidence-based solutions recognise youth crime is not solely a justice issue: it’s also health and disability issue. If we want to reduce youth offending, there are better alternatives to this punitive approach.</p>
<h2>The proposed changes are regressive</h2>
<p>If passed, the legislation would reverse changes implemented following the <a href="https://www.royalcommission.gov.au/royal-commission-detention-and-protection-children-northern-territory">Royal Commission into the Detention and Protection of Children in the Northern Territory</a>, particularly around bail.</p>
<p>The presumption of bail will be removed for an expanded list of offences, including unlawful entry and assault of a worker (such as a support worker). There will be automatic revocation of bail for breaches, such as breaking curfew and re-offending. Police will also be able to apply electronic monitoring to children alleged to have committed a crime.</p>
<p>This means, for example, a child running late for curfew, or who forgot to charge an electronic monitoring device, could automatically lose bail.</p>
<p>Diversion, which uses community programs instead of traditional criminal justice mechanisms, will be available to a young person only once (previously, this could be used twice).</p>
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Read more:
<a href="https://theconversation.com/why-are-so-many-indigenous-kids-in-detention-in-the-nt-in-the-first-place-63257">Why are so many Indigenous kids in detention in the NT in the first place?</a>
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<p>Importantly, these changes will increase the number of youth in detention in the NT. The average rate of young people aged 10-17 in detention in the NT is <a href="https://www.aihw.gov.au/reports/youth-justice/youth-detention-population-in-australia-2020/contents/summary">7.9 per 10,000</a> — already more than three times the national average. </p>
<p>Well over <a href="https://www.aihw.gov.au/reports/youth-justice/youth-detention-population-in-australia-2020/contents/data-visualisation/trends-in-the-youth-detention">90% of young people</a> in detention in the NT are Indigenous Australians.</p>
<h2>Punishment and deterrence are not effective</h2>
<p>Evidence tells us <a href="https://www.youthcourt.govt.nz/assets/Documents/Publications/Youth-Court-10-suggested-characteristics.pdf">solely punitive responses</a> in youth justice are largely ineffective in preventing repeat offending. Military-style boot camps and “scared straight” programs (where, for example, youth are taken to prisons to see the possible consequences of their behaviour) don’t work.</p>
<p>Even short periods of detention, with the associated separation from culture and community, can affect a child’s psychological and physical well-being and compromise cognitive development.</p>
<p>Compounding the problem, detention with other young people can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747364/">exacerbate bad behaviour</a>. </p>
<p>Figures provided to us by the NT government show 77% of young people released from detention return within 12 months, but 64% of those who complete a diversion program do not reoffend in the same timeframe.</p>
<figure class="align-center ">
<img alt="A teenage boy leans against a fence, appearing despondent." src="https://images.theconversation.com/files/399653/original/file-20210510-13-hzepzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/399653/original/file-20210510-13-hzepzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/399653/original/file-20210510-13-hzepzm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/399653/original/file-20210510-13-hzepzm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/399653/original/file-20210510-13-hzepzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/399653/original/file-20210510-13-hzepzm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/399653/original/file-20210510-13-hzepzm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Young people released from detention often reoffend.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<h2>Trauma and neurodevelopmental disability are common</h2>
<p>Adolescence is a period of significant development, with changes in brain structure and function. A growing body of evidence shows many young people in the justice system have experienced <a href="https://journals.sagepub.com/doi/full/10.1177/0093854812436957">significant interruptions</a> to healthy brain development. </p>
<p>Childhood abuse or neglect, exposure to domestic violence, or parental mental illness, can induce “<a href="https://developingchild.harvard.edu/science/key-concepts/toxic-stress/">toxic stress</a>”. This affects the development of skills such as emotional regulation, reward-seeking, executive function (including flexible thinking and self-control) and threat perception. </p>
<p>Children exposed to multiple stressors are <a href="https://www.basw.co.uk/resources/adverse-childhood-experiences-and-their-impact-health-harming-behaviours-welsh-adult#:%7E:text=Findings%20show%20that%20ACEs%20have,use%2C%20smoking%2C%20poor%20diets%20and">20 times more likely</a> to be imprisoned in their lifetime. Mental illness and substance use are also <a href="https://www.justicehealth.nsw.gov.au/publications/2015YPICHSReportwebreadyversion.PDF">common issues</a> for young offenders in Australia.</p>
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<p>
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Read more:
<a href="https://theconversation.com/almost-every-young-person-in-wa-detention-has-a-severe-brain-impairment-90695">Almost every young person in WA detention has a severe brain impairment</a>
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<p>Foetal alcohol spectrum disorder (FASD) is brain damage caused by exposure to alcohol before birth. A <a href="https://bmjopen.bmj.com/content/8/2/e019605">study</a> from the Banksia Hill Detention Centre in Western Australia found <a href="https://theconversation.com/almost-every-young-person-in-wa-detention-has-a-severe-brain-impairment-90695?">36% of 99 young people</a> evaluated had FASD.</p>
<p>Some 89% of all participants had severe impairment in at least one area, such as academic achievement, attention, or language. As care providers at Don Dale Youth Detention Centre, we see this frequently in the young people we meet.</p>
<p>As a result of such trauma and disability, young people often have a restricted range of responses to emotional and stressful situations. They’re more likely to resort to aggression, violence, and impulsive behaviour. </p>
<figure class="align-center ">
<img alt="Several young people take part in a group session." src="https://images.theconversation.com/files/399658/original/file-20210510-23-1f258o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/399658/original/file-20210510-23-1f258o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/399658/original/file-20210510-23-1f258o4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/399658/original/file-20210510-23-1f258o4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/399658/original/file-20210510-23-1f258o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/399658/original/file-20210510-23-1f258o4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/399658/original/file-20210510-23-1f258o4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Diversion involves rehabilitating youth in the community.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>So what works?</h2>
<p>We need effective interventions that recognise the developmental stage of adolescence and respond to individual needs. </p>
<p>First, the system needs to promote resolution outside a formal criminal justice process. One method is Family Group Conferences, which have been successful in <a href="https://www.youthcourt.govt.nz/assets/Documents/Publications/Youth-Court-10-suggested-characteristics.pdf">New Zealand</a>. </p>
<p>The conferences bring together the offender, their family, the victim, police and others to discuss and make recommendations for the young person. They’re more likely to be culturally appropriate and empower families and communities, and can also benefit the victim. The Australian Law Reform Commission has <a href="https://www.alrc.gov.au/publication/seen-and-heard-priority-for-children-in-the-legal-process-alrc-report-84/18-childrens-involvement-in-criminal-justice-processes/diversion/">recommended</a> expanding the use of this program in Australia.</p>
<p>Second, we need an <a href="https://research-repository.griffith.edu.au/bitstream/handle/10072/127234/AllardPUB3.pdf?sequence=1">evidence-based</a>, therapeutic approach to rehabilitation that recognises an individual offender’s risk factors and disability. This may mean interventions at home and school, supporting peer relationships or reducing substance use. These approaches <a href="https://www.youthcourt.govt.nz/assets/Documents/Publications/Youth-Court-10-suggested-characteristics.pdf">are targeted</a> at the child’s developmental level and address how they respond to challenges. </p>
<p>One such program is the <a href="https://www1.health.gov.au/internet/publications/publishing.nsf/Content/suicide-prevention-activities-evaluation%7EAppendices%7Eappendixa%7Eproject49">Yiriman Project</a>, which operates in the Kimberley. It uses on-country trips focused on cultural pride, safety, and regeneration for Indigenous young people. </p>
<p>In Spain, the <a href="https://ddhs.org.au/sites/default/files/media-library/documents/Blueprint%20for%20Change%20-%20Diagrama%20Foundation%20Report%20FINAL.pdf">Diagrama Foundation</a> model, which provides a range of rehabilitative programs in detention, has seen repeat offending fall as low as 14%.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/don-dale-royal-commission-demands-sweeping-change-is-there-political-will-to-make-it-happen-86223">Don Dale royal commission demands sweeping change – is there political will to make it happen?</a>
</strong>
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<p>Punitive approaches do not address the issues driving bad behaviour.
We need to see prompt assessment of all young offenders for FASD and other disabilities, ideally as soon as they enter the youth justice system. We also need to expand best-practice diversion programs. These were key findings from a <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/FetalAlcoholSpectrumDi/Report">recent senate inquiry</a> into FASD and will allow responses to improve skills many of us take for granted, such as emotional regulation, developing strong relationships, and an ability to organise daily tasks.</p>
<p>The NT government’s regressive policies will not reduce youth crime. And instead of addressing the poor health of most youth offenders, they will expose some of the most vulnerable and marginalised young people in our society to further trauma and disadvantage.</p><img src="https://counter.theconversation.com/content/160361/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Do we want to punish some of the most vulnerable young people in the community, or do we want to reduce re-offending? The Northern Territory’s proposed youth justice reforms suggest the former.Nicholas Fancourt, Paediatrician & Research Fellow, Menzies School of Health ResearchOlga Havnen, CEO of Danila Dilba Health Service, Indigenous KnowledgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1437412020-07-31T05:56:38Z2020-07-31T05:56:38ZThere are 3 new Closing the Gap education targets: here’s what they miss<figure><img src="https://images.theconversation.com/files/350564/original/file-20200731-29-1pb85px.jpg?ixlib=rb-1.1.0&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/aboriginal-child-australian-bush-novembre2019-yuendumuaustralia-1782087101">Shutterstock</a></span></figcaption></figure><p>The federal government this week unveiled the <a href="https://www.closingthegap.gov.au/sites/default/files/files/national-agreement-ctg.pdf?q=0720">National Agreement on Closing the Gap</a>. Under the strategy, all Australian governments committed to 16 targets, three of which are directly related to early childhood and school education.</p>
<p>They are:</p>
<ul>
<li><p>to increase the proportion of Aboriginal and Torres Strait Islander children enrolled in early childhood education to 95% by 2025.</p></li>
<li><p>to increase the proportion of Aboriginal and Torres Strait Islander children assessed as developmentally on track in all five domains (physical health and well-being, social competence, emotional maturity, language and cognitive skills, communication skills and general knowledge) of the Australian Early Development Census (AEDC) to 55% by 2031. </p></li>
<li><p>to increase the proportion of Aboriginal and Torres Strait Islander people (aged 20-24) with a year 12 or equivalent qualification to 96% by 2031.</p></li>
</ul>
<p>These new targets have been determined by Aboriginal people <a href="https://theconversation.com/new-closing-the-gap-targets-will-cover-attachment-to-land-and-culture-143636">themselves</a>. But there are some things they miss, including the way success is measured.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-closing-the-gap-targets-will-cover-attachment-to-land-and-culture-143636">New 'Closing the Gap' targets will cover attachment to land and culture</a>
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</em>
</p>
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<h2>A blunt instrument</h2>
<p>The population-level data the AEDC provides is supposed to tell us about the school readiness of all Australian children across the five developmental areas outlined earlier. In <a href="https://www.sbs.com.au/news/what-the-16-new-closing-the-gap-targets-will-actually-mean-for-indigenous-australians">2018</a>, 35% of Indigenous children were deemed to be developmentally on track, compared with 57% of non-Indigenous children. </p>
<p>Yet we know the display of developmental traits is complex, situational and subject to cultural bias. Some items in the in the census are subject to individual teacher judgements — such as, “Would you say this child is interested in mathematics?”</p>
<p>These have been critiqued for their focus on “<a href="https://www.aedc.gov.au/resources/aedc-news">culturally white concepts </a>”. We could improve the learning experience for students by <a href="https://www.acsa.edu.au/pages/images/KLowe_article%20(2).pdf">recognising their knowledge, culture and language</a> and incorporating this within teaching. </p>
<p>In measuring mathematical abilities within the AEDC for example, using the natural environment to assess concepts (rather than, say, building blocks) would see more Indigenous children score highly on this indicator.</p>
<h2>Early childhood education</h2>
<p>The enrolment target for preschool is high and some might say, optimistic when we look at the current statistics. In 2018, <a href="https://www.sbs.com.au/news/what-the-16-new-closing-the-gap-targets-will-actually-mean-for-indigenous-australians">84.6% of Indigenous children were enrolled</a> in early childhood education compared with 88.8% of non‑Indigenous children. Based on these figures, not even non-Indigenous children are meeting the target.</p>
<p>Yet continued focus on preschool enrolment is welcome. We know quality early childhood education and care is one of the most effective ways to <a href="https://www.education.vic.gov.au/Documents/about/research/LiftingOurGame.PDF">remediate disadvantage</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-have-16-new-closing-the-gap-targets-will-governments-now-do-whats-needed-to-meet-them-143179">We have 16 new Closing the Gap targets. Will governments now do what's needed to meet them?</a>
</strong>
</em>
</p>
<hr>
<p>A lack of access to quality preschool in remote communities is an ongoing issue. We must ensure high-quality preschool is accessible for families if we are to expect them to attend consistently. Mobilising preschool and school services to communities has been shown to be a <a href="https://www.menzies.edu.au/icms_docs/312411_Mobile_Preschool_Evaluation_Summary_Report.pdf">sound strategy</a> at increasing attendance.</p>
<p>Enrolment in preschool does not guarantee attendance, much less engagement. It matters more than mere enrolment that children and their families are welcomed and included as partners in building children’s success at school.</p>
<h2>Wins must be sustained</h2>
<p>The new targets miss primary school and middle school (Years 6-9) education altogether. Yes, they focus on the all important years before a child turns five and again what happens in the senior years of schooling, but early childhood and economic research shows that “<a href="https://www.educationcounts.govt.nz/__data/assets/pdf_file/0003/24456/Outcomes-of-ECE-Literature-Review.pdf">facilitating environments have to follow facilitating environments</a>” to be most effective. </p>
<p>The cumulative effects of early childhood investment can only be maximised if the attention and investment is continued. According to the <a href="https://www.oecd-ilibrary.org/education/equity-in-education_9789264073234-en">OECD</a>, this becomes especially important in disadvantaged circumstances.</p>
<p>At Charles Darwin University and the Menzies School of Health Research, we have been looking at what happens to Indigenous students in the NT as they move through school. In this yet unpublished study, we have recently discovered almost one-third of Aboriginal children in remote and very remote areas that attended preschool did not participate in Year 3 NAPLAN. </p>
<p>The data suggests this is the same group of children that had poorer preschool literacy and numeracy skills at age 5 on the AEDC. So somewhere, we are missing them. There is little point having a target for school attainment if we have lost them along the way. </p>
<p>To make progress, we need to better understand and address the complexity of factors that undermine educational attainment. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-what-teachers-look-for-when-kids-start-school-116523">Here's what teachers look for when kids start school</a>
</strong>
</em>
</p>
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<p>Schools and preschools must be more than a place to learn by being more responsive to, and inclusive of, <a href="http://familyschool.org.au/files/5113/7955/4822/parents-as-partners-in-indigenous-childrens-learning.pdf">families and elders</a>. They can do this by valuing the learning and teaching they bring to build on what the children already know. </p>
<p>Supporting <a href="https://www.theaustralian.com.au/nation/politics/food-boxes-help-bring-aboriginal-children-to-school/news-story/59a31bcbaa79da4e299bce9de791eacd">the provision of basic needs</a> where necessary, such as access to healthy food and transport to and from school, helps achieve the new targets by recognising that closing the gaps is not possible by one strategy alone.</p>
<p>We also need an approach that integrates services, such as education, health and housing. For example, previous research found that Aboriginal children living in communities with <a href="https://www.menzies.edu.au/icms_docs/293936_Early_Pathways_to_School_Learning_%E2%80%93_Lessons_from_the_NT_data_linkage_study_-_Summary.pdf">overcrowded housing missed seven weeks of schooling each year</a>. </p>
<p>Before we see these targets being met, and the gap truly narrowed, we must address the root causes of the existing inequity and the factors that undermine the educational attainment, engagement and success for Indigenous Australian children.</p><img src="https://counter.theconversation.com/content/143741/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vincent He is supported by the ‘Child and Youth Development Research Partnership’ (CYDRP)' funded by the Northern Territory Departments of Health, Education, Territory Families, Housing, Treasury, Chief Minister, Police, and Attorney General and Justice. Previously, Vincent was supported by a National Health and Medical Research Council (NHMRC) Partnership Grant (#1091491) in which the Northern Territory departments of Health, Education and Territory Families, the Aboriginal Medical Services Alliance of the Northern Territory (AMSANT) and the Menzies School of Health Research
were organisational partners.The funding body had no involvement in the study design, data analysis, interpretation of data, or preparation and publication of research papers.</span></em></p><p class="fine-print"><em><span>Amy Graham and Georgina Nutton do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The new closing the gap targets are ambitious, especially in the area of early childhood education. But this doesn’t mean they can’t be met, with the right approach.Amy Graham, Postdoctoral Research Fellow, UNSW SydneyGeorgina Nutton, Senior Lecturer in Education (Early Childhood), Charles Darwin UniversityVincent Yaofeng He, Senior Research Officer, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1350482020-04-02T03:59:47Z2020-04-02T03:59:47ZThe answer to Indigenous vulnerability to coronavirus: a more equitable public health agenda<figure><img src="https://images.theconversation.com/files/324776/original/file-20200402-23130-1rt4b2d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">mask</span> <span class="attribution"><span class="source">Paul Braven/AAP</span></span></figcaption></figure><p>Among the latest coronavirus <a href="https://www.abc.net.au/news/2020-03-29/public-gatherings-limited-to-two-people-coronavirus-covid-19/12101162">advice from the prime minister</a> was an age-based self-isolation strategy designed to protect those considered most vulnerable in the global health crisis. </p>
<p>The directive was for Indigenous peoples <a href="https://www.pm.gov.au/media/national-cabinet-statement">over the age of 50</a> with existing health conditions to stay home as much as possible, while for non-Indigenous Australians with health conditions, the age cut-off was 60, and those without health conditions, it was 70. </p>
<p>It was still a stark reminder of the ongoing crisis of Indigenous health, and the increasing threat that COVID-19 poses to Indigenous communities. Just this week, five health workers in the Kimberley region have tested positive for the virus.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1245301610462371840"}"></div></p>
<p>As WHO Director-General Tedros Adhanom Ghebreyesus <a href="https://www.who.int/news-room/detail/30-03-2020-who-releases-guidelines-to-help-countries-maintain-essential-health-services-during-the-covid-19-pandemic">points out</a>, </p>
<blockquote>
<p>…COVID-19 is revealing how fragile many of the world’s health systems and services are, forcing countries to make difficult choices on how to best meet the needs of their people.</p>
</blockquote>
<p>Public health directives on things such as hygiene, self-isolation and social distancing have been instrumental in minimising the burden on our health system in the current crisis. </p>
<p>While we should heed these directives, we, too, must learn from the lessons of past public health failures. And there really has been no bigger failure in Australian public health than Indigenous health. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-other-indigenous-coronavirus-crisis-disappearing-income-from-art-134127">The other Indigenous coronavirus crisis: disappearing income from art</a>
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</em>
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<h2>Lack of equity in public health practice</h2>
<p>Australia is a world leader across a range of health domains, from <a href="https://www.tandfonline.com/doi/abs/10.1080/13698575.2012.701274">tobacco cessation</a> to <a href="https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30237-2/fulltext">cervical cancer</a>. But the experiences of Indigenous Australians, including the <a href="https://www.aihw.gov.au/reports/life-expectancy-death/premature-mortality-in-australia-1997-2012/contents/indigenous-premature-mortality">appalling rate of premature deaths</a>, reveal a damning truth about the limitations of public health in protecting our mob. </p>
<p>Public health has proven more capable of describing the gap in Indigenous health equality and vulnerability than in remedying it. This is a <a href="https://www.mja.com.au/journal/2020/closing-gap-needs-more-refreshed-targets">fundamental failure of public health</a> as a discipline, which tends to focus more on quantifying inequalities than in addressing the inequities that cause them. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-will-devastate-aboriginal-communities-if-we-dont-act-now-133766">Coronavirus will devastate Aboriginal communities if we don't act now</a>
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<p>There is often confusion between the concepts of health equality and health equity. Distinguishing between the two, however, is key to a more effective public health response for those deemed most vulnerable. </p>
<p>According to the <a href="https://publichealthonline.gwu.edu/blog/equity-vs-equality/">Milkin Institute School of Public Health</a>, equity
refers to the absence of unfair and avoidable social, economic or environmental differences between groups of people. Lack of equity is what produces inequality in a society.</p>
<blockquote>
<p>In order to reduce the health disparities gap, the underlying issues and individual needs of underserved and vulnerable populations must be effectively addressed.</p>
</blockquote>
<p>As Maori medical doctor and academic Papaarangi Reid <a href="https://twitter.com/TeAoWithMOANA/status/1239696884085616641?s=20">points out</a>, addressing COVID-19 through a lens of equity means thinking about vulnerability in ways that aren’t necessarily limited to age. As she says, </p>
<blockquote>
<p>So I think, while we are very worried about our elderly, we are also worried about our precariat, those who are homeless. We are worried about those who are impoverished, the working poor, those who are in prisons and institutions.</p>
</blockquote>
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<h2>Public health failures in the coronavirus response</h2>
<p>Australian public health, for the most part, remains bound to a utilitarian logic of “greatest good for the greatest number”. This ironically renders minority populations, such as Indigenous peoples, most vulnerable. </p>
<p>Through this logic, strategies for reducing the threats that minority groups face are often overlooked. They are deemed less important or too resource-intensive. </p>
<p>It is in this environment that our Indigenous health experts are forced to work. Much of their labour is spent appealing for a more equitable public health response, instead of focusing squarely on responding to the health crisis in our communities. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-releasing-some-prisoners-is-essential-to-stop-the-spread-of-coronavirus-133516">Why releasing some prisoners is essential to stop the spread of coronavirus</a>
</strong>
</em>
</p>
<hr>
<p>The recently released <a href="https://www.health.gov.au/sites/default/files/documents/2020/03/management-plan-for-aboriginal-and-torres-strait-islander-populations.pdf">Management Plan for Aboriginal and Torres Strait Islander Populations</a>, developed by the Aboriginal and Torres Strait Islander Advisory Group on COVID-19, identifies equity as a core principle. </p>
<blockquote>
<p>Failure to implement an equitable response commensurate with the situation will result in significantly poor outcomes for Aboriginal and Torres Strait Islander peoples.</p>
</blockquote>
<p>Indigenous Australians know that increased vulnerability doesn’t offer a greater sense of safety or protection from the state. </p>
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<p>If it did, we would see those on remand in prisons across the country released during the coronavirus crisis, as called for by a group of health professionals in an <a href="https://croakey.org/wp-content/uploads/2020/03/Open-letter-to-Minister-Wyatt-Covid-19-and-Aboriginal-communities-29th-March-2020.pdf">open letter to Minister for Indigenous Australians Ken Wyatt</a>. </p>
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<p>We would see increased resourcing for Indigenous housing and Indigenous community-controlled health and social services, <a href="https://croakey.org/urgent-calls-for-more-resources-to-protect-aboriginal-and-torres-strait-islander-communities-from-covid-19/">as demanded by NACCHO Chair Pat Turner</a>. </p>
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<p>If we prioritised equity as a way of reducing vulnerability, we would ensure the poorest were among the biggest beneficiaries of economic stimulus packages.</p>
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<p>The introduction of punitive public health measures, such as fines for not complying with social distancing and self-isolation rules, also offers little assurance to Indigenous peoples. It is feared they will be disproportionately targeted, rather than protected, by the increased powers of the state. </p>
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<p>Already, we have seen <a href="https://www.skynews.com.au/details/_6142095151001">calls to deny Indigenous peoples access to coronavirus stimulus payments</a> in the Northern Territory, along with <a href="https://www.sbs.com.au/nitv/article/2020/03/28/aboriginal-and-torres-strait-islanders-face-racism-amid-testing-and-treatment?cid=trending">incidents of overt racism</a> related to coronavirus testing and treatment for Indigenous peoples. </p>
<p>We witnessed a delay in social isolation measures that would benefit Indigenous communities, such as not immediately ending <a href="https://www.theguardian.com/australia-news/2020/mar/17/aboriginal-people-who-work-for-dole-told-to-attend-group-activities-despite-covid-19-risk">group activities for those in the community development program (CDP)</a> in remote communities. </p>
<p>And we have yet to see the <a href="https://www.theguardian.com/australia-news/2020/mar/18/welfare-recipients-on-cashless-debit-card-will-have-750-stimulus-payment-quarantined">suspension of welfare quarantine programs</a>, which would help vulnerable households better respond to this crisis. </p>
<p>But this is the problem with a public health agenda that is empathetic to Indigenous ill health, but indifferent to equity. It doesn’t inspire transformative action or outcomes.</p>
<p>It simply engenders a kind of helplessness and inevitability to the ongoing crisis in Indigenous health. And it blinds the public and policy makers to the capabilities of Indigenous peoples, cultures and communities, including our leading Indigenous health experts. </p>
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<h2>Indigenous control is the cure</h2>
<p>Indigenous opthamologist <a href="https://www.theguardian.com/commentisfree/2020/mar/26/we-should-have-learned-from-past-epidemics-that-the-only-way-through-this-crisis-is-together">Kris Rallah-Baker has referenced the Spanish flu</a> in rightly reminding us this pandemic is not unprecedented. </p>
<p>During that pandemic, Indigenous peoples suffered disproportionately in Australia, <a href="https://eprints.qut.edu.au/10168/1/10168.pdf">accounting for 30%</a> of all deaths in Queensland. However, the extent to which Indigenous people were affected only came to light some 75 years later through the scholarly work of <a href="https://eprints.qut.edu.au/10168/1/10168.pdf">Aboriginal medical doctor Gordon Briscoe</a>. </p>
<p>Alongside every public health failure in Indigenous health there have been Indigenous peoples appealing to be seen and heard, not just counted in death tolls. Indigenous expertise is instrumental to forging a new public health agenda – one that is far more humane and equitable in its commitment to the health of all, rather than the health of most. </p>
<p>But in a nation that steadfastly refuses to meaningfully recognise Indigenous sovereignty, this clearly is a bigger problem than public health and one likely to linger far longer than the coronavirus crisis. </p>
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<p><em>This story has been amended to clarify the prime minister’s advice for those who should self-isolate during the crisis. His office has clarified the advice was for Indigenous people over 50 years old with one or more chronic medical conditions.</em></p><img src="https://counter.theconversation.com/content/135048/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chelsea Bond is a board member of Inala Wangarra. She receives funding from the Australian Research Council (DECRA Fellowship).</span></em></p><p class="fine-print"><em><span>Lisa J Whop receives funding from the National Health and Medical Research Council for an Early Career Fellowship (#1142035)</span></em></p>Indigenous people suffered greatly during the last global pandemic – the Spanish flu in 1918-19. They are vulnerable again because we still haven’t addressed inequalities in our public health system.Chelsea Watego, Senior Research Fellow, School of Social Science, The University of QueenslandLisa J Whop, Senior Research Fellow, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1214412019-09-13T03:27:35Z2019-09-13T03:27:35ZPolycystic kidney disease, the most common genetic kidney disorder you’ve probably never heard of<figure><img src="https://images.theconversation.com/files/290811/original/file-20190904-175700-vq8d1k.jpg?ixlib=rb-1.1.0&rect=53%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If one parent has ADPKD, their child has a one in two chance of getting it.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>Autosomal-dominant polycystic kidney disease (<a href="https://pkdaustralia.org/adpkd/">ADPKD</a>) is the most common genetic kidney disorder, and the <a href="https://www.anzdata.org.au/report/anzdata-41st-annual-report-2018-anzdata/">fourth most common</a> cause of kidney failure in Australian adults. It affects about <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.13143">one in 1,000 Australians</a>. </p>
<p>In people with ADPKD, a mutation in one or two genes leads to the development and progressive growth of cysts in the kidneys, causing a decline in kidney function.</p>
<p>Labor senator Malarndirri McCarthy, a Yanyuwa woman, recently spoke publicly about having ADPKD after <a href="https://www.smh.com.au/politics/federal/senator-reveals-kidney-disease-that-saw-her-leave-question-time-for-hospital-20190802-p52d8w.html">she became unwell</a> with a kidney infection and had to leave the Senate. </p>
<p>But a newly available treatment for ADPKD shows promise for people with the disease.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-chronic-kidney-disease-and-why-are-one-in-three-at-risk-of-this-silent-killer-81942">Explainer: what is chronic kidney disease and why are one in three at risk of this silent killer?</a>
</strong>
</em>
</p>
<hr>
<h2>What is ADPKD?</h2>
<p>If one parent has ADPKD, the children have a 50% chance of inheriting the gene (though <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.13143">up to 10%</a> of patients don’t have a family history).</p>
<p>Where it is inherited, the age of diagnosis and rate of progression to kidney failure in the parent gives some indication of how the disease will develop in affected children. </p>
<p>The cysts are like balloons filled with water, which start small in childhood and increase in size over time.</p>
<p>Typically, the cysts don’t start to cause problems until later in life. The average age at diagnosis is <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1402685">27 years</a>. </p>
<p>As the cysts grow, normal working tissue in the kidney is replaced with enlarging cysts. So with time, the kidneys don’t work as well.</p>
<p>For about <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.13143">half of people with ADPKD</a>, their condition will eventually progress to kidney failure, which may be treated with dialysis or a transplant. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/288676/original/file-20190820-170918-1foruju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288676/original/file-20190820-170918-1foruju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=442&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288676/original/file-20190820-170918-1foruju.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=442&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288676/original/file-20190820-170918-1foruju.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=442&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288676/original/file-20190820-170918-1foruju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=556&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288676/original/file-20190820-170918-1foruju.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=556&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288676/original/file-20190820-170918-1foruju.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=556&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cysts grow on the kidneys of a person with polycystic kidney disease, often impacting kidney function.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>While the loss of kidney function is paramount, the cysts may cause other symptoms and complications too. </p>
<p>Symptoms can include high blood pressure and chronic pain or heaviness in the back, sides and abdomen. The growth of cysts means the kidneys can grow to as large as <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2007.07229.x">5-6kg in size</a>.</p>
<p>Blood in the urine, urinary tract infections, kidney stones and infections in the cysts are not uncommon in people with ADKPD, and can all impact quality of life. </p>
<p>Other organs may also be affected. People with ADPKD can develop cysts in the liver, pancreas and bowel, and about 10% will experience balloon dilations of the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26260542">blood vessels in the brain</a>, called aneurysms.</p>
<h2>Treatment</h2>
<p>Until recently, treatment of ADPKD was directed towards early detection, control of blood pressure, lifestyle measures such as quitting smoking, weight control and diet, antibiotics for infections, analgesics for pain and the management of progressive kidney dysfunction via dialysis and transplantation. None of these therapies however directly slowed the growth of cysts. </p>
<p>But on January 1, 2019, tolvaptan <a href="https://pkdaustralia.org/news/">was listed</a> on the Pharmaceutical Benefits Scheme. Australia now joins the United States, the European Union, and several other countries where this drug was already available. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kidney-disease-in-aboriginal-australians-perpetuates-poverty-15031">Kidney disease in Aboriginal Australians perpetuates poverty</a>
</strong>
</em>
</p>
<hr>
<p>Tolvaptan, which is taken in tablet form, slows the growth of cysts by <a href="https://www.ncbi.nlm.nih.gov/pubmed/28379536">blocking a hormone called vasopressin</a>. Vasopressin is critical in triggering the formation of cysts. In this way, tolvaptan prolongs the time to kidney failure.</p>
<p>In one study, three years of treatment with tolvaptan <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1205511">reduced the rate of cyst growth</a> by around 50% in comparison to a placebo treatment. The authors suggested tolvaptan may delay dialysis or the need for a transplant for six to nine years for patients with ADPKD, particularly if started early. </p>
<p>People who took tolvaptan in this study also had lower incidence of ADPKD-related complications including urinary tract infections and kidney pain.</p>
<h2>Kidney disease and Indigenous Australians</h2>
<p>ADPKD is not actually more common in Aboriginal and Torres Strait Islander communities, as other causes of <a href="https://www.menzies.edu.au/page/Research/Indigenous_Health/Diabetes_and_kidney_disease/Kidney/">chronic kidney disease</a> are. This may be because ADPKD is inherited. </p>
<p>The majority of chronic kidney disease develops as a complication of diabetes, which affects Aboriginal and Torres Strait Islander populations more commonly and typically <a href="https://www.menzies.edu.au/page/Research/Indigenous_Health/Diabetes_and_kidney_disease/Diabetes/">at a younger age</a> than the overall Australian population.</p>
<p>Kidney disease, whatever the cause, remains a significant issue for Aboriginal and Torres Strait Islander communities. People in remote Indigenous communities in particular face challenges around accessing treatments in large urban centres, and have poorer access to organ transplants.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-simple-school-sores-often-lead-to-heart-and-kidney-disease-in-indigenous-children-86066">Why simple school sores often lead to heart and kidney disease in Indigenous children</a>
</strong>
</em>
</p>
<hr>
<p>There are several nationally targeted activities and proposals aimed at reducing the burden of chronic kidney disease in Indigenous Australians.</p>
<p>The <a href="https://www.menzies.edu.au/icms_docs/281923_Roundtable_Towards_Roadmap_For_Renal_Health_-_Media_Release.pdf">Renal Health RoadMap</a> is designed to support health systems in early detection and management of diabetes and chronic kidney disease. It also seeks to address the social determinants of poor health in Indigenous communities, including housing quality and availability, and health infrastructure.</p>
<p>In 2018, Minister for Indigenous Australians Ken Wyatt commissioned <a href="https://www.tsanz.com.au/TSANZ%20Performance%20Report%20-%20Improving%20Indigenous%20Transplant%20Outcomes%20(Final%20edited)-1.pdf">a report</a> detailing how access to and outcomes of kidney transplants could be improved among Indigenous Australians. He also established a <a href="https://www.anzdata.org.au/anzdata/for-information-2/tsanz/">National Indigenous Kidney Transplantation Taskforce</a> to implement the recommendations from this report. </p>
<p>Some key recommendations include improving the communication between health-care teams, patients and their families, addressing cultural bias in the delivery of health care, and improving the quality of data around transplant access and outcomes.</p>
<p>Addressing transplant and treatment inequities will benefit Indigenous Australians with kidney failure sustained from ADPKD and chronic kidney disease more broadly. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/to-close-the-health-gap-we-need-programs-that-work-here-are-three-of-them-91482">To close the health gap, we need programs that work. Here are three of them</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/121441/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jaquelyne Hughes receives funding from the National Health and Medical Research Council, is the convener of the Aboriginal and Torres Strait Islander Health Working Group of the Australia and New Zealand Dialysis and Transplantation Registry (ANZDATA), and the Deputy Chair of the TSANZ National Indigenous Kidney Transplantation Taskforce.</span></em></p><p class="fine-print"><em><span>Karen Dwyer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>You might have heard of polycystic ovary syndrome, but what about polycystic kidney disease? This genetic disorder sees cysts growing in the kidneys.Karen Dwyer, Deputy Head, School of Medicine, Deakin UniversityJaquelyne Hughes, Senior Research Fellow, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1177472019-08-06T20:07:46Z2019-08-06T20:07:46ZCurious Kids: why is urine yellow?<figure><img src="https://images.theconversation.com/files/286166/original/file-20190730-43153-osy3ym.jpg?ixlib=rb-1.1.0&rect=11%2C7%2C2486%2C1699&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If you have been drinking more water than your body needs, the body tells the kidney filters to get rid of the spare water. That's when your urine will look paler.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&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="caption"></span>
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<p><em>If you have a question you’d like an expert to answer, send it to curiouskids@theconversation.edu.au.</em> </p>
<hr>
<blockquote>
<p><strong>Why is urine yellow? – Ronan, aged 9, Greenslopes, Brisbane.</strong> </p>
</blockquote>
<hr>
<p>Thank you for your question, Ronan. </p>
<p>Our bodies use nutrients from the food we eat. But the processes involved in digestion also create what we call “byproducts”. That’s where a new chemical is created along the way. </p>
<p>Some of these byproducts in the body are waste and our bodies have clever waste processing systems to get rid of them. </p>
<p>Some of the waste goes out in your poo. And waste that can be dissolved in water goes out in your wee. We call this “water-soluble” waste. Water-soluble means it can be dissolved in water. </p>
<p>And the parts of your body in charge of “making” the wee are called the kidneys. They’re shaped like kidney beans.</p>
<h2>A delicate balance</h2>
<p>The kidneys work around the clock to make sure the body has the right balance of water, salt and chemicals and not too much water-soluble waste in it. </p>
<p>Kidneys have special filters in them that help sort out the useful bits from the waste. They also are in charge of transporting the water-soluble waste from your kidneys, down two special pipes called “ureters” and into your bladder (which is down near the genitals). </p>
<p>When the bladder gets full, it sends a message along your nerves to your brain that makes you feel like you need to wee. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Kidneys also are in charge of transporting the water-soluble waste from your kidneys, down two special pipes called ‘ureters’ and into your bladder.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-we-have-two-kidneys-when-we-can-live-with-only-one-113201">Curious Kids: why do we have two kidneys when we can live with only one?</a>
</strong>
</em>
</p>
<hr>
<h2>So…. why is it yellow?</h2>
<p>One of the water-soluble waste products that your kidneys put into your urine is a chemical called urobilin, and it is yellow. </p>
<p>The colour of your urine depends on how much urobilin is in it and how much water is in it. </p>
<p>If your urine is light yellow, it means you have been drinking a lot of water and there’s a lot of water in your urine. We call this being “hydrated”.</p>
<p>If your urine is dark yellow, that means there’s less water, and a relatively high amount of urobilin. It probably means you haven’t been drinking enough water and could be dehydrated.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=457&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=457&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=457&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=574&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=574&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=574&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If your urine is light yellow, it means you have been drinking a lot of water.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Too much water versus not enough</h2>
<p>When you haven’t been drinking enough water, the kidneys get a message from your brain to try to keep more water in your body (and out of your bladder). You will also start to feel thirsty. </p>
<p>If people can’t drink water (because they have a vomiting illness, for example), they might need water put directly into their blood. This usually happens in a hospital using a drip (which is where a bag of salt water is put into your blood via a needle in your arm).</p>
<p>If you have been drinking more water than your body needs, the body tells the kidney filters to get rid of the spare water. That’s when your urine will look paler.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-what-is-a-headache-is-it-our-brain-hurting-112951">Curious Kids: what is a headache? Is it our brain hurting?</a>
</strong>
</em>
</p>
<hr>
<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p><img src="https://counter.theconversation.com/content/117747/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Jaqui Hughes is a Torres Strait Islander woman, a specialist physician (kidney doctor) at Royal Darwin Hospital, and a kidney health researcher at Menzies School of Health Research in Darwin. She is employed by the Top End Health Service as a specialist nephrologist, and funded by the National Health and Medical Research Council to lead innovating kidney health research which advances health for Australians.</span></em></p>One of the waste products that your kidneys put into your urine is a chemical called urobilin, and it is yellow.Jaquelyne Hughes, Research Fellow, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1006552018-11-22T09:24:04Z2018-11-22T09:24:04ZWords from Arnhem land: Aboriginal health messages need to be made with us rather than for us<p>Australian First Nations people waiting for appointments at Aboriginal Community Controlled Health Organisations around the country will now see culturally relevant and locally produced content on the waiting room TVs. </p>
<p><a href="https://iaha.com.au/australian-government-announces-aboriginal-health-tv-network/">Aboriginal Health TV</a>, which launched in October, provides messages about leading health issues including smoking, eye and ear checks, skin conditions, nutrition, immunisation, sexual health, diabetes and drug and alcohol treatment services. It will also be repackaged for social media sites such as Facebook, Instagram and YouTube.</p>
<p>The program is funded by a <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2018-wyatt100.htm">A$3.4 million government grant</a> over three years, and will be delivered by <a href="http://www.tonichealthmedia.com.au/">Tonic Media</a>, the communications company founded by ABC media journalist Norman Swan.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/well-connected-indigenous-kids-keen-to-tap-new-ways-to-save-lives-30964">Well-connected Indigenous kids keen to tap new ways to save lives</a>
</strong>
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<p>In our small community in Arnhem Land, Yilpara, we have no TV reception. We welcome this opportunity to share our knowledge about how to make and deliver health messaging. But the practical reality is that this network will need to be accessible beyond the reach of TV reception.</p>
<p>The program’s aim – to help close the gap in Indigenous health literacy – is important, and knowledge is the critical first piece of the puzzle. We also need mechanisms in place to support healthy living. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/238291/original/file-20180927-48641-119c006.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/238291/original/file-20180927-48641-119c006.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/238291/original/file-20180927-48641-119c006.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=617&fit=crop&dpr=1 600w, https://images.theconversation.com/files/238291/original/file-20180927-48641-119c006.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=617&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/238291/original/file-20180927-48641-119c006.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=617&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/238291/original/file-20180927-48641-119c006.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=775&fit=crop&dpr=1 754w, https://images.theconversation.com/files/238291/original/file-20180927-48641-119c006.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=775&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/238291/original/file-20180927-48641-119c006.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=775&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Our small community of Yilpara in East Arnhem Land.</span>
<span class="attribution"><span class="source">Google maps</span></span>
</figcaption>
</figure>
<h2>Local content, in language</h2>
<p>The extent to which availability of day-to-day health knowledge is taken for granted in mainstream Australia, and is missing from remote settings, cannot be understated. </p>
<p><a href="http://dx.doi.org.ezproxy.cdu.edu.au/10.1111/ajo.12744">Health education is usually given</a> by busy staff in English, which <a href="https://www.mja.com.au/journal/2008/189/9/all-they-said-was-my-kidneys-were-dead-indigenous-australian-patients">may be the wrong language</a> for the patient. It’s often delivered without the basic principles of two-way learning: empathy and respect. So knowledge about health does not reach us.</p>
<p>The disempowering effect of lack of knowledge, and the downstream impacts on health behaviours and outcomes, <a href="https://www.ncbi.nlm.nih.gov/pubmed/29281990">underpins the disadvantage of First Nations people</a>.</p>
<p>To succeed, the Aboriginal Health TV programming needs to be delivered in our languages. In our community, as in many other remote communities, our traditional Aboriginal languages are still strong – we speak our language every day, in everything we do. </p>
<p>Culturally responsive approaches also must be used when bringing information about issues like smoking, eye and ear checks, immunisation, nutrition and drug and alcohol treatment services. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-origins-of-pama-nyungan-australias-largest-family-of-aboriginal-languages-92997">The origins of Pama-Nyungan, Australia's largest family of Aboriginal languages</a>
</strong>
</em>
</p>
<hr>
<p>We have our <a href="http://www.biomedcentral.com/1471-2458/14/1233">own ways of understanding illness and health</a>. Only by using our own words, metaphors that are meaningful to us, and a communication style that is respectful, can we hear the messaging from health professionals. This means the <a href="https://www.sciencedirect.com/science/article/pii/S0149718918303628?via%3Dihub">health messages need to be made with us</a> rather than for us. </p>
<p>Tailored messaging using local footage offers the best chance of engaging viewers. We need to help make the stories if our communities are to trust and understand the information.</p>
<h2>Respecting First Nations people</h2>
<p>We still also need to go a step deeper than just using simple terms and our languages. </p>
<p>When Aboriginal radio first started in our community, it was all negative health messages that made us feel bad. We wondered what it was there for: why would the people making the programs want the listeners to feel bad? This bad feeling is more than just emotional; it affects us physically and makes us lose confidence. </p>
<p>Health education needs to lift our spirit, give optimism, and focus on “we” not “you”. </p>
<p>We are communal people, and we want to know the data from our community, not focus on what individuals can do for their health. <a href="https://www.aihw.gov.au/reports-statistics/population-groups/indigenous-australians/overview">Such data</a> are regularly reported in mainstream press and Australian Institute of Health and Welfare reports – but those for whom these data are most relevant miss out. </p>
<p>We want to know what we can do as a community, working together with health providers, to understand, be empowered and respond positively to important health knowledge. Giving us population-level data gives us a chance to be in charge of determining both problems and solutions.</p>
<h2>Beyond TV and Aboriginal health centres</h2>
<p>Television is an effective medium for conveying public health knowledge, including to Indigenous populations and children. </p>
<p>In New Zealand, a <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/rheumatic-fever/rheumatic-fever-resources/rheumatic-fever-campaign-tv-commercials">series of culturally-appropriate television commercials</a> providing public health education about rheumatic fever (a bacterial infection which often leads to rheumatic heart disease) are screened, targeting the most at-risk Māori and Pasifika populations. The health messaging is effective, with <a href="https://www.berghahnjournals.com/view/journals/aia/25/1/aia250104.xml">research finding</a> the commercials to be the primary source of knowledge about rheumatic fever among at-risk children.</p>
<p>But in remote Aboriginal communities, where some of the <a href="https://www.smh.com.au/lifestyle/health-and-wellness/the-disease-affecting-australians-that-should-have-disappeared-by-now-20180601-p4ziy0.html">greatest disparities in health outcomes</a> such as rheumatic heart disease (a chronic disease where there is damage to the heart valves) are experienced, knowledge is craved but hard to come by. </p>
<p>In our home community we have one radio station, but no TV, no internet in our homes, no newspapers. We want to be able to access the new Aboriginal Health TV – but we will need the information in the right way. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-aboriginal-children-still-dying-from-rheumatic-heart-disease-63814">Why are Aboriginal children still dying from rheumatic heart disease?</a>
</strong>
</em>
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<p>Social media is likely to be an effective strategy for Aboriginal Health TV programming. </p>
<p>Social media, such as Twitter, Facebook and YouTube, has <a href="https://academic.oup.com/heapro/advance-article/doi/10.1093/heapro/day018/4973719">great potential</a> for targeted health messaging; Indigenous Australians have a strong presence on social media in areas where internet is accessible. Lessons from using social media to convey <a href="https://www.menzies.edu.au/page/Research/Projects/Smoking/Social_media_Indigenous_tobacco_control/">stop smoking messaging</a> will be informative for the Aboriginal Health TV network.</p>
<p>But it’s important that messaging on social media also be positive and lift our confidence.</p>
<p>Another factor affecting the reach of Aboriginal Health TV network is type of clinic that broadcasts its content. If the network only reaches community-controlled health care services, as was originally proposed, half the Aboriginal population will miss out because they are serviced by government clinics. </p>
<p>Aboriginal Health TV programming should be rolled out in all Aboriginal health centres, whether government- or community-controlled. </p>
<h2>Better food and housing</h2>
<p>Knowledge is only one cog in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096582/">behaviour change wheel</a>. The wheel won’t turn without other core elements to support healthy living. If opportunities are limited to eat well, exercise, or avoid the transmission of infections, no amount of knowledge or motivation will work. </p>
<p>Effective messaging that leads to local motivation to advocate for improved resources must then be supported by external agencies: <a href="https://academic.oup.com/heapro/article-abstract/33/1/38/2555390?redirectedFrom=fulltext">better food</a> in the shops; enough houses for the number of people; and improved access to building maintenance to <a href="http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006577">combat the ill health effects</a> of crowding. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/indigenous-voices-are-speaking-loudly-on-social-media-but-racism-endures-94287">Indigenous voices are speaking loudly on social media but racism endures</a>
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<p>When researchers from Menzies School of Health Research <a href="https://www.rhdaustralia.org.au/news/on-track-watch">started working with us on rheumatic heart disease</a>, we explained that the children needed better nutrition. We started a lunch club to provide healthy lunches to our school children, supported by the local employment program and our health service. Now we’re working with the local store owner to improve food supplies. </p>
<h2>Health behaviour change is a long-term strategy</h2>
<p>For knowledge to pass into culture, become embedded as a culturally owned phenomenon and passed on to others, it takes years, if not generations.
In the western world, it took <a href="https://books.google.com.au/books/about/Spreading_Germs.html?id=9WzQPQRnR8sC&redir_esc=y">around a century</a> from the discovery of germs as the cause of disease until communicable disease rates reached their modern-day lows. </p>
<p>Rheumatic fever, caused by human-to-human transmission of streptococcal infection, remained a <a href="https://trove.nla.gov.au/newspaper/page/1016974">leading cause of child hospitalisation</a> for all families in Australia into the 1940s. It is now rare in mainstream Australia, while First Nations communities have <a href="https://www.ncbi.nlm.nih.gov/pubmed/23242849">world-leading rates</a> of rheumatic fever in 2018. </p>
<p>We need <a href="https://www.ncbi.nlm.nih.gov/pubmed/30067382">culturally-appropriate knowledge</a> in language of how to stop rheumatic fever – and the programming of Aboriginal health TV could help deliver this information to First Nations people.</p>
<p>The Aboriginal Health TV network also presents opportunities for:</p>
<ul>
<li>community members to share testimonials</li>
<li>public health officials to provide alerts about outbreaks</li>
<li>health care providers to give education about prevention and management of common conditions</li>
<li>researchers to share outcomes of studies; especially local research which community members themselves many have participated in. </li>
</ul>
<p>We want the Aboriginal Health TV network to be a way for knowledge to reach us in a way that builds our confidence. We look forward to working out solutions together. We want our children to understand how to stay strong.</p><img src="https://counter.theconversation.com/content/100655/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alice Mitchell previously received an Australian Postgraduate Award scholarship to undertake a PhD study, completed 2017.</span></em></p><p class="fine-print"><em><span>Associate Professor Anna Ralph receives funding from the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Barungun Marawili, Emma Haynes, Makungun Marika, and Minitja Marawili do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The disempowering effect of lack of knowledge, and the downstream impacts on health behaviours and outcomes, underpins the disadvantage of First Nations people.Makungun Marika, Yilpara Elder; Researcher, Menzies School of Health ResearchAlice Mitchell, Research Fellow, Menzies School of Health ResearchAnna Ralph, Associate Professor; Director, Global and Tropical Health, Menzies School of Health ResearchBarungun Marawili, Yilpara Elder; Researcher, Menzies School of Health ResearchEmma Haynes, PhD candidate, Telethon Kids InstituteMinitja Marawili, Yilpara Elder; Researcher, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/976992018-06-24T19:50:49Z2018-06-24T19:50:49ZGetting a heart check early can prevent heart attack and stroke in Indigenous Australians<figure><img src="https://images.theconversation.com/files/222928/original/file-20180613-153638-iftah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Only around half of at-risk Indigenous Australians are taking preventative medication for heart disease. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Most heart attacks and strokes can be prevented with appropriate treatment. Yet heart disease, including heart attacks, <a href="https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia/cardiovascular-risk-profile-of-aboriginal-and-torres-strait-islander-peoples">causes 13%</a> of deaths among Australia’s Aboriginal and Torres Strait Islander peoples and is a major contributor to the gap in life expectancy with non-Indigenous Australians. </p>
<p>New findings from a study published today in the <a href="http://dx.doi.org/10.5694/mja17.00897">Medical Journal of Australia</a> show vast room for improvement in heart health among Aboriginal and Torres Strait Islander peoples.</p>
<h2>Who is at risk?</h2>
<p>This <a href="http://dx.doi.org/10.5694/mja17.00897">new research</a> found 10% of Aboriginal and Torres Strait Islander people aged 35-74 years old have heart disease (<a href="https://www.mja.com.au/system/files/issues/204_08/10.5694mja15.01004.pdf">compared to 9%</a> aged 45-74 in the general population). Another 16% are at high risk of getting heart disease (<a href="https://www.mja.com.au/system/files/issues/204_08/10.5694mja15.01004.pdf">compared to 11%</a> aged 45-74 in the general population), defined in Australia as a greater than 15% chance of getting heart disease in the next five years.</p>
<p>A heart check involves calculating how likely a person is to develop heart disease over a specific time period (five years in Australia). This involves gathering information from multiple factors including a person’s age, sex, smoking status, whether they have diabetes and their blood pressure and cholesterol levels.</p>
<p><a href="https://www.heartfoundation.org.au/images/uploads/publications/Absolute-CVD-Risk-Full-Guidelines.pdf">Australia’s national guidelines</a> recommend all Aboriginal and Torres Strait Islander peoples aged 35-74 have a heart check. But this <a href="http://dx.doi.org/10.5694/mja17.00897">new research</a> found the “high risk” category starts much earlier than this. </p>
<p>Around 1.1% of Aboriginal and Torres Strait Islander 18-24 year olds and 4.7% of 25-34 year olds were at high risk of heart disease. This is around the same as the proportion of <a href="https://www.mja.com.au/system/files/issues/204_08/10.5694mja15.01004.pdf">non-Indigenous Australians</a> aged 45-54 who are at high risk. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/222929/original/file-20180613-153682-1e0hhab.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/222929/original/file-20180613-153682-1e0hhab.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/222929/original/file-20180613-153682-1e0hhab.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222929/original/file-20180613-153682-1e0hhab.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222929/original/file-20180613-153682-1e0hhab.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222929/original/file-20180613-153682-1e0hhab.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222929/original/file-20180613-153682-1e0hhab.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222929/original/file-20180613-153682-1e0hhab.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Too few Indigenous peoples are having heart checks.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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</figure>
<h2>Potential to prevent events through medication</h2>
<p>Heart disease risk can be lowered through lifestyle changes, including giving up smoking, losing weight and exercising more, as well as using medications that lower blood pressure and cholesterol levels. Generally, all people who have heart disease and those at high risk should be prescribed <a href="https://www.heartfoundation.org.au/images/uploads/publications/Absolute-CVD-Risk-Full-Guidelines.pdf">preventative medications</a>.</p>
<p>Yet this latest evidence shows only 53% of Aboriginal and Torres Strait Islander peoples with existing heart disease and 42% of those at high risk were using cholesterol-lowering medications. We don’t know the exact reasons for this. It could be due to a number of things including people not getting a heart check in the first place, and not continuing to use medications when they have been prescribed. </p>
<p>We don’t know the exact number of Aboriginal and Torres Strait Islander people receiving a heart check, but we do know overall numbers are low and it varies by region. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781864/">Estimates</a> among Aboriginal and Torres Strait Islander people with diabetes found rates of heart checks ranged from about 3% of people in participating health centres in Queensland, South Australia and Western Australia to around 56% in the Northern Territory. </p>
<p>This highlights the huge potential to prevent future heart attack and stroke in these communities by improving treatment in people at high risk.</p>
<h2>What can we do?</h2>
<p>These findings highlight multiple actions that can be taken to improve heart disease prevention. First, this new evidence suggests the age to start doing heart checks should be lowered in Australian guidelines. This decision would need to be jointly undertaken with Aboriginal and Torres Strait Islander communities. </p>
<p>GPs and nurses should be proactive in identifying Aboriginal and Torres Strait Islander patients, providing heart and overall health checks, and following up with patients. </p>
<p>The Northern Territory is a good example. There, the number of Aboriginal and Torres Strait Islander peoples receiving a heart check <a href="https://www.heartlungcirc.org/article/S1443-9506(14)00771-9/pdf">more than doubled</a> after improvements in reporting, monitoring and follow-up. Improving the rate of health checks for adolescents and young adults is particularly important so discussions and treatment decisions can take place early.</p>
<p>Programs aimed at prevention should also be co-designed with Aboriginal and Torres Strait Islander peoples, taking into account social and cultural barriers that impact access and ongoing treatment.</p>
<p>The good news is, we know heart attacks and strokes can be prevented and we have effective treatments to achieve this. Within Aboriginal and Torres Strait Islander communities there is huge potential to prevent heart attacks and stroke. </p>
<p>Many people don’t receive a heart check and could be at high risk without knowing it. Prevention starts with getting a heart check and continuing to use any medications prescribed to you by your doctor to lower your risk.</p><img src="https://counter.theconversation.com/content/97699/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ellie Paige is an investigator on a project on Aboriginal and Torres Strait Islander absolute cardiovascular disease risk funded by the Commonwealth Department of Health.</span></em></p><p class="fine-print"><em><span>Sandra Eades receives funding from National Health and Medical Research Council.</span></em></p><p class="fine-print"><em><span>Vicki Wade is an investigator on a study looking at absolute risk in Aboriginal and Torres Straight Islander peoples funded by the Commonwealth Department of Health.</span></em></p>A new study has found too few Indigenous people are getting health checks, despite their elevated risk of heart problems.Ellie Paige, Research Fellow, Australian National UniversitySandra Eades, Professor and Head: Aboriginal Health, Baker Heart and Diabetes InstituteVicki Wade, Senior Cultural Advisor, Rheumatic Heart Disease Australia, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/749922017-03-24T00:15:21Z2017-03-24T00:15:21ZDecriminalisation in the NT signals abortion is part of normal health care<figure><img src="https://images.theconversation.com/files/162301/original/image-20170324-4967-qhypgk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The long road to abortion reform in the NT has been made possible by community campaigns, and gender parity in the lower house.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/yewenyi/239043861/">Brian Yap/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The Northern Territory parliament this week passed <a href="http://www.austlii.edu.au/au/legis/nt/bill/toplrb2017373/">a bill</a> decriminalising abortion up to 24 weeks’ gestation, removing the requirement of parental approval for abortions in teenagers and providing early medical abortions with tablets. </p>
<p>Decriminalisation is important as it signals to the community that abortion is part of gynaecological care and should not be treated differently to any other form of health care. Abortion remains in the <a href="http://www.abc.net.au/news/2017-02-28/abortion-decriminalisation-bills-withdrawn-from-parliament/8309788">criminal codes</a> of Queensland and New South Wales despite recent reform attempts. </p>
<p>A majority of countries have liberalised access to safe abortion as opposed to risky illegal abortion. The Centre for Reproductive Rights has a useful <a href="http://worldabortionlaws.com/map/">comparative map</a> of abortion laws although it is not nuanced for Australia. </p>
<p>Data on abortion is poorly collected and analysed in the Northern Territory, but the new bill will ensure data will be collected for public health policy purposes.</p>
<h2>Choices in women’s health</h2>
<p>Previously NT women had no legal access to early medical abortion using the abortion medications mifepristone and misoprostol up to nine weeks and were only offered surgical abortions in three hospitals. </p>
<p>Early medical abortion has been legal in all <a href="http://www.westlaw.com.au/maf/wlau/app/document?docguid=Iacf32374839511e6881a84759648e093&isTocNav=true&tocDs=AUNZ_AU_JOURNALS_TOC&startChunk=1&endChunk=1">other states and territories</a>. The old <a href="https://legislation.nt.gov.au/Legislation/MEDICAL-SERVICES-ACT">Medical Services Act</a> from 1974 that regulated abortion, stipulated that two doctors needed to be involved in the management, one of them being a specialist. This limited service was inadequate and out of step with modern gynaecology. </p>
<p>NT women and doctors will be able to use early medical abortion in general medical practices, health clinics and home settings. Women seeking termination services in regional, rural and remote areas face <a href="https://www.ncbi.nlm.nih.gov/pubmed/26987999">barriers to health care</a> including finding a doctor, stigma, financial costs, and lack of privacy. </p>
<p>The bill enables significant improvements to women’s reproductive health, especially in a jurisdiction that struggles with health service provision and a challenging geography. </p>
<p>The bill also places safe access zones around clinics for health staff and women in a similar way to <a href="https://theconversation.com/state-by-state-safe-access-zones-around-clinics-are-shielding-women-from-abortion-protesters-51407">Victorian and Tasmanian legislation</a>. The safe access zone will protect women and staff from intentional harassment, intimidation, obstruction or invasion of privacy. This also includes the recording of people leaving or entering health clinics and has penalties attached to this type of behaviour. </p>
<p>The bill also specifically references conscientious objection and the need for a health practitioner who holds anti-abortion beliefs to refer the woman to another health practitioner who does not. This is similar to <a href="https://theconversation.com/explainer-is-abortion-legal-in-australia-48321">Victorian and Tasmanian legislation</a> and the national <a href="https://ama.com.au/position-statement/conscientious-objection-2013">Australian Medical Association position statement</a>. </p>
<h2>Indigenous women’s health needs</h2>
<p>The NT has a large minority (30%) of Aboriginal women who have <a href="http://www.rrh.org.au/publishedarticles/article_print_1383.pdf">higher maternal rates of death and illness</a> than other women. During <a href="https://parliament.nt.gov.au/parliamentary-business/hansard-debates-and-minutes-of-proceedings/draft-daily-hansard,-questions-and-minutes/DEBATES-DAY-4-21-MARCH-2017.pdf">debate in parliament some members</a> suggested that providing access to termination choices would be unsafe for Indigenous women in remote communities and that Indigenous women would not be able to understand aspects of their reproductive health. </p>
<p>The paternalistic and racist attitudes were called out by Mr Chansey Paech, Ms Selena Uibo and Ms Ngaree Ah Kit, Indigenous members of the legislative assembly who <a href="https://parliament.nt.gov.au/parliamentary-business/hansard-debates-and-minutes-of-proceedings/draft-daily-hansard,-questions-and-minutes/DEBATES-DAY-4-21-MARCH-2017.pdf">argued for legal equity</a>.</p>
<p>This bill took four and a half years of public advocacy to be passed and there were several reasons for its success in 2017. The first is overwhelming public support for equity in health care and a <a href="https://www.facebook.com/WhatRU4NT/">strong community campaign</a>. </p>
<p>The second reason is 50% of the members of the <a href="http://www.ntnews.com.au/news/northern-territory/northern-territory-parliament-to-contain-record-number-of-female-politicians/news-story/756669971495352038c2ec6e8a592d0e">13th Legislative Assembly are women</a>. No state or federal parliament in Australia has this level of female representation. Women are better placed to understand women’s health needs and women in the NT were lacking this representation until gender parity in the lower house of parliament in 2016.</p>
<h2>Addressing discrimination in health care</h2>
<p>This legislation will reduce discrimination against women and go some way to meeting Australia’s obligations under the <a href="http://www.un.org/womenwatch/daw/cedaw/">United Nations Convention of Elimination of all forms of Discrimination Against Women</a>. </p>
<p>Termination of pregnancy enables women to manage their <a href="http://apps.who.int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf?ua=1">health and fertility, decreases maternal disability and death</a>, and reduces unwanted motherhood. All of which are positive outcomes.</p>
<p>However, unwanted, mistimed and unviable pregnancies are not welcome events in women’s lives and may be indicators of poor health, genetic or contraceptive chance, social disadvantage, poor sexual and reproductive literacy, low reproductive autonomy, or lack of access to quality sexual and reproductive health staff and services. Some of these precursors to unwanted pregnancy need attention if abortion rates are to be reduced in Australia.</p><img src="https://counter.theconversation.com/content/74992/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Suzanne Belton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond the appointments above.Suzanne Belton is the President of Family Planning Welfare Association NT and is Adjunct staff at Menzies School of Health Research. She is a member of the Public Health Association NT and the Health Alliance NT.
</span></em></p>Decriminalisation is important as it signals to the community that abortion is part of gynaecological care and should not be treated differently to any other form of health care.Suzanne Belton, Associate professor, Menzies School of Health ResearchLicensed 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>
<hr>
<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">
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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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<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/468102015-08-31T03:26:21Z2015-08-31T03:26:21ZFood price gap shows need for subsidies and promo deals for remote areas<figure><img src="https://images.theconversation.com/files/93383/original/image-20150831-17756-2bpq0d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Imagine spending an extra $68 every time you did a $100 shop -- and getting nothing extra for it. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/galant/890670192/in/photolist-2mGVdC-cRfEGy-cCVL1J-xAgPqz-eg1Fx3-ccTDeG-eg1NUs-7gn8Gw-ouAPBb-6KuuUa-s85waN-rYXCKX-dkHDiH-eM1mhP-5jcWrG-nJBr1a-5j8ENr-oXk91q-2mCB5x-9FawFo-2mGVwG-8dSMEr-nJByMy-efV5AF-cCUpaE-nrRYFV-9xVtxH-6UrDvo-prFjnm-2mGVTw-m7HhnW-a9n6M9-ahS81G-a3dyBq-rBpqxi-ov3sjp-5eCZJ6-926ToM-2htkjG-oHfcYh-ayGuYw-4ptCoT-5XFL7J-9WkGC4-ooUMzx-7nCs1J-dT1FAH-6SGQCr-6wpuuz-iBU4Ly">thebittenword.com/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Following his visit to Australia’s Northern Peninsular Area, Prime Minister Tony Abbott <a href="http://www.abc.net.au/am/content/2015/s4301739.htm">told</a> the ABC’s AM program that:</p>
<blockquote>
<p>I would very much counsel people in remote areas against expecting the Government to subsidise fresh food. Yes, it’s more expensive than in Sydney and Melbourne but it’s not outrageously more expensive and to be honest, the supermarkets - IBIS and others - do a very good job in getting high quality food to very, very remote places. </p>
</blockquote>
<p>But the <a href="http://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/616/2/Northern%20Territory%20%20Market%20Basket%20Survey%20report%202014.pdf">evidence shows</a> that it’s not just fresh food that is more expensive in remote communities. On average, all food is 53% more expensive in remote communities, with the price increasing annually by approximately 5%, compared to an annual rise of only about 1% in Darwin supermarkets.</p>
<h2>What the data shows</h2>
<p>Every year in the Northern Territory, government and non-government public health nutritionists gather <a href="http://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/616/2/Northern%20Territory%20%20Market%20Basket%20Survey%20report%202014.pdf">data</a> on the cost of a standardised basket of food. </p>
<p>This basket is sufficient to provide foods for a hypothetical family of six for a fortnight.</p>
<p>It comprises of a mix of tinned and fresh food items including flour, bread, breakfast cereal, apples, oranges, tinned fruit, orange juice, potatoes, pumpkin, carrots, mixed vegetables, canned meat, fresh red meat, chicken drumsticks, eggs, powdered milk, cheese, sugar and margarine. Data on the availability, variety and quality of fruit and vegetables are also collected. </p>
<p>In 2014, the Northern Territory government <a href="http://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/616/2/Northern%20Territory%20%20Market%20Basket%20Survey%20report%202014.pdf">surveyed</a> 79 stores and found the average basket cost was $824. This amount ranged from $795 in Darwin remote district stores to an average of $866 for remote East Arnhem district stores; compared to $538 in a Darwin supermarket. </p>
<p>Staples like flour, bread and breakfast cereals cost 23% more, basics like meat were 45% more, fresh fruit and vegetables cost 51% more, goods like margarine and sugar were 79% more, while dairy was 98% more in price.</p>
<p>When we considered food costs in relation to actual food purchases – as opposed to the hypothetical basket – this price difference was even higher. </p>
<p>When we then compared these prices to those in southern cities such as Adelaide, we found the price difference was higher again. </p>
<p>We demonstrated this using food expenditure <a href="http://www.ncbi.nlm.nih.gov/pubmed/25902766">data</a> collected from 20 remote stores across the Northern Territory. </p>
<p>Foods purchased in these stores cost 60% more, on average, than Darwin supermarkets and 68% more than Adelaide supermarkets. To understand what this is like, imagine adding another $60 or $68 to a grocery shop of $100 next time you’re at the supermarket – but getting no extra groceries for it. </p>
<p>A further advantage for urban shoppers is access to cheaper generic brand options which are generally limited in remote community stores. When we added these to the mix, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/25902766">price difference</a> for grocery type foods was 136%. </p>
<p>The Northern Territory government is the only jurisdiction in Australia that annually monitors remote community food prices. </p>
<p>In 2010, <a href="https://www.health.qld.gov.au/ph/documents/hpu/hafb-2010.pdf">the Queensland government found</a> prices in Queensland were 26% higher in very remote areas compared with major cities and 38% higher in remote areas more than 2000km from Brisbane. </p>
<p>In 2010 in remotes communities of the Northern Territory, prices were found to be <a href="http://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/616/2/Northern%20Territory%20%20Market%20Basket%20Survey%20report%202014.pdf">43% higher</a> compared to the current 53%. This finding suggests the Queensland price difference may now be higher than the recorded 38% of 2010.</p>
<p>Over the <a href="http://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/616/2/Northern%20Territory%20%20Market%20Basket%20Survey%20report%202014.pdf">last few years</a>, the average number of varieties and the proportion of quality of fresh fruit and vegetables has increased in the Northern Territory. </p>
<h2>Remote shops are playing their part to help</h2>
<p>Many stores in remote Australia are locally owned and have improved nutrition alongside generating profit as a policy goal. In the Northern Territory, 70% of stores are Indigenous owned, 61% have a store committee and 51% report to have a <a href="http://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/616/2/Northern%20Territory%20%20Market%20Basket%20Survey%20report%202014.pdf">nutrition policy</a>. </p>
<p>Two major store associations in the Northern Territory, the Arnhemland Progress Aboriginal Corporation (ALPA) and Outback Stores, have pricing initiatives which exempt fresh fruit and vegetables from freight charges. The pricing policies have also resulted in some of the cheapest prices for bottled water in the country. It’s likely there are other similar initiatives to reduce the price of healthier foods for independently run stores. Despite this, the price difference between remote community stores in the Northern Territory and Darwin supermarkets has widened. </p>
<p>This <a href="http://www.ncbi.nlm.nih.gov/pubmed/25902766">price gap</a> indicates that not all consumers equally benefit from the competing food prices between the major Australians supermarkets and the promotional deals they have with manufacturers. Socially disadvantaged Australians whether in remote or non-remote Australia experience more <a href="http://www.ncbi.nlm.nih.gov/pubmed/12372160">barriers</a> to eating healthy food, and cost is one of these. One concern is that a <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737422169">socio-economic gradient</a> we have not previously observed has now emerged as being a <a href="http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/0FBE203C1C547A82CA257529000231BF/$File/commpaper-hlth-equity-friel.pdf">prevalent</a> for overweight and obesity in Australia.</p>
<p>Indigenous Australians are also more likely than non-Indigenous Australians to experience higher rates of <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/510C5DA8D5AE7916CA257C2F00145BAC?opendocument">obesity</a> and <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/4727.0.55.003">related conditions</a> such as type 2 diabetes, cardiovascular disease and chronic kidney disease. At current food prices, a diet following the Australian dietary guidelines is not possible within an estimated $13 per person per day food spend in remote communities; a food spend that is more than that for other <a href="http://www.ncbi.nlm.nih.gov/pubmed/24391790">Australians</a>. </p>
<h2>A role for subsidies and promo-deals</h2>
<p>There is <a href="http://www.ncbi.nlm.nih.gov/pubmed/23122423">mounting evidence</a> that price subsidies <a href="http://www.ncbi.nlm.nih.gov/pubmed/25877492">can encourage</a> healthier food purchases and are more cost <a href="http://www.ncbi.nlm.nih.gov/pubmed/23122423">effective</a> than nutrition <a href="http://www.ncbi.nlm.nih.gov/pubmed/25877492">education</a>. </p>
<p>Remote stores are playing their part; a leg-up from either government or major supermarkets and food manufacturers could go a long way to closing the price gap and disadvantage gap for Indigenous Australians living in remote communities. </p>
<p>That “leg-up” could extend to subsidies on food transport costs and facilities like refrigerators needed to make fresh food last. But it may also include manufacturers providing promotional deals to remote stores, as they do to urban supermarkets.</p>
<p>In the end, it is cost of all core foods – not just fresh food – that needs to come down for people in remote areas.</p><img src="https://counter.theconversation.com/content/46810/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Brimblecombe is supported by a Future Leader Fellowship from the National Heart Foundation of Australia.</span></em></p><p class="fine-print"><em><span>Megan Ferguson is supported through a NHMRC Postgraduate Scholarship. The contents of the published material are solely the responsibility of the individual authors and do not reflect the views of NHMRC.
</span></em></p>On average, all food is 53% more expensive in remote communities, with the price increasing annually by approximately 5%, compared to an annual rise of only about 1% in Darwin supermarkets.Julie Brimblecombe, Senior Research Fellow, Menzies School of Health ResearchMegan Ferguson, Research officer, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/421192015-05-31T20:03:56Z2015-05-31T20:03:56ZWe can cut Indigenous smoking and save lives – here’s how<p>More and more Aboriginal and Torres Strait Islander smokers are quitting and fewer young people are taking up smoking. In ten years, the proportion of former smokers who have successfully quit has jumped from 24% to 37%. </p>
<p>In recent years, Indigenous families, Aboriginal Community Controlled Health Services and governments have increased attention on tackling smoking. Most notably, in 2009, the previous federal government launched the four-year A$100.6 million <a href="https://theconversation.com/indigenous-smoking-program-cuts-risk-widening-the-gap-29051">Tackling Indigenous Smoking program</a>. </p>
<p>Falling Indigenous smoking rates have been among the most optimistic stories in annual <a href="http://www.healthinfonet.ecu.edu.au/closing-the-gap">Closing the Gap</a> reports. </p>
<p>But at 42%, the daily Aboriginal and Torres Strait Islander smoking rate is still 2.6 times that of <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4727.0.55.006%7E2012%E2%80%9313%7EMain%20Features%7ETobacco%20smoking%7E13">other Australians</a>. Smoking is estimated to cause one in five Indigenous <a href="https://www.lowitja.org.au/sites/default/files/docs/Indigenous-BoD-Report.pdf">deaths</a> and accounts for one-sixth of the health gap.</p>
<p>Despite this, last year’s budget announced a review of and <a href="https://theconversation.com/indigenous-smoking-program-cuts-risk-widening-the-gap-29051">cuts</a> to the Tackling Indigenous Smoking program. After a long period of uncertainty, the <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2015-nash025.htm">Commonwealth government announced on Friday</a> that organisations funded under the previous program will be able to apply for funding as part of a redesigned program. But details of the new program remain sketchy.</p>
<h2>What’s working?</h2>
<p>While the size of the smoking problem and the slow progress has been reasonably well documented, it has been less clear what is working and what is not. This has changed with the release today of 15 scientific papers in the Medical Journal of Australia from the national <a href="https://www.mja.com.au/journal/2015/202/10/supplement">Talking About The Smokes</a> project.</p>
<p>We worked with 34 Aboriginal Community Controlled Health Services across the country and in the Torres Strait to interview 2,522 community members to find out what is helping smokers to quit.</p>
<p>We found encouraging news: The majority of Indigenous smokers, as with smokers in the wider community, want to quit. Most know about the worst health effects of smoking, and wish they had never started.</p>
<p>About half of daily smokers had made a quit attempt in the past year (48%) and said smoking was never allowed inside their home (53%). But fewer Aboriginal and Torres Strait Islander smokers than all Australian smokers had been able to quit for a month or longer (47% vs 63%).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/84311/original/image-20150609-27440-78363g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/84311/original/image-20150609-27440-78363g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/84311/original/image-20150609-27440-78363g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1273&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84311/original/image-20150609-27440-78363g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1273&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84311/original/image-20150609-27440-78363g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1273&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84311/original/image-20150609-27440-78363g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1599&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84311/original/image-20150609-27440-78363g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1599&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84311/original/image-20150609-27440-78363g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1599&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>Dedicated tobacco control resources or positions at Aboriginal Community Controlled Health Services helped. We found that more of the smokers whose local health service had dedicated tobacco control resources (from any funding source) had tried to quit than of those whose health service did not.</p>
<p>Higher proportions of Indigenous smokers than all Australian smokers recalled a health professional advising them to quit in the past year (75% vs 56% of those seen). </p>
<p>We’re now analysing how many of the smokers made quit attempts and successfully quit in the year after these baseline surveys. These longitudinal analyses will provide more definitive causal interpretations than the cross-sectional associations reported today.</p>
<p>There were some differences within the Aboriginal and Torres Strait Islander population. Often more socioeconomically advantaged smokers were more likely to quit or report behaviours or beliefs along the pathway to quitting, but this was not consistent across all comparisons.</p>
<h2>Worth the investment</h2>
<p>Our new information shows much is working and continued government investment in the Tackling Indigenous Smoking program is justified, even in a tight budgetary environment.</p>
<p>This evidence can guide the evolution of that program, but also reminds readers that this is only part of the necessary comprehensive approach needed. Indigenous smoking is also being tackled by mainstream tobacco control activities (advertising campaigns, pack warnings and plain packaging, and smoke-free regulation) and activities already incorporated into routine health care (brief advice and individual cessation support).</p>
<p>Aboriginal and Torres Strait Islander communities would welcome more government support to reduce smoking. We found that 80% of daily smokers agreed that the government should do more to tackle the harms caused by smoking.</p>
<p>This is not just another case of asking for more government dollars in the long line of requests on the health budget. Aboriginal and Torres Strait Islander smokers themselves are already making changes to often entrenched behaviours caused by an addictive product. </p>
<p>But now is the time for the government to provide some certainty that it will support the comprehensive list of activities that should assist more Indigenous smokers to quit.</p>
<p>Smokers are already being well-supported by their local Aboriginal Community Controlled Health Services. Staff at these health services can go further, especially helping smokers to sustain their quit attempts for longer, confident that their messages about quitting will be understood and welcomed.</p><img src="https://counter.theconversation.com/content/42119/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Thomas leads the Talking about the Smokes project in partnership with a team from the National Aboriginal Community Controlled Health Organisation and all its Affiliates, the University of Melbourne, and Cancer Council Victoria. The project is funded by the Australian Government Department of Health.</span></em></p>The daily smoking rate among Aboriginal and Torres Strait Islanders is falling, but at 42%, it’s still 2.6 times that of other Australians.David Thomas, Head, Tobacco Control Research Program, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.