tag:theconversation.com,2011:/au/topics/indigenous-health-727/articlesIndigenous health – The Conversation2024-02-18T22:46:53Ztag:theconversation.com,2011:article/2196132024-02-18T22:46:53Z2024-02-18T22:46:53ZNZ is bound by international mental health agreements – statistics for Māori show we’re failing to uphold them<p>Aotearoa New Zealand ranks among the highest in youth suicide rates among <a href="https://www.oecd.org/els/family/CO_4_4_Teenage-Suicide.pdf">OECD countries</a> – and it is Māori youth at the <a href="https://theconversation.com/maori-suicide-rates-remain-too-high-involving-whanau-more-in-coronial-inquiries-should-be-a-priority-217254">forefront of this national crisis</a>. </p>
<p><a href="https://www.tewhatuora.govt.nz/our-health-system/data-and-statistics/suicide-web-tool">Recent statistics</a> show the number of suspected self-inflicted deaths for Māori males is nearly double the rate for non-Māori males. The rate for Māori females is around 1.8 times higher than the rate for non-Māori females. </p>
<p>The alarming discrepancy is most notable in the 15-24 age group, where the rate for Māori is about 2.6 times higher than for non-Māori.</p>
<p>Despite these concerning figures, there is no express right to health in New Zealand law, creating a gap in accountability. And by failing to ensure the health and wellbeing of young Māori, Aotearoa New Zealand is falling short of its international obligations.</p>
<h2>Progress and retreat</h2>
<p>Over the past five years, the government has taken some steps to tackle the country’s mental health crisis. But the priorities of the new government could threaten this already limited progress.</p>
<p>In 2019, NZ$2 billion was <a href="https://www.beehive.govt.nz/release/taking-mental-health-seriously">injected into the mental health system</a> by the then Labour government. And the <a href="https://www.mhwc.govt.nz/">Mental Health Commission</a> was established in 2021 with the aim of contributing to better and equitable mental health and wellbeing outcomes for all people. </p>
<p>Te Aka Whai Ora, the Māori Health Authority, was established under the <a href="https://www.legislation.govt.nz/act/public/2022/0030/latest/LMS575405.html">Pae Ora (Healthy Futures) Act 2022</a>. But while the new coalition government has announced the country’s first ever <a href="https://www.beehive.govt.nz/minister/biography/matt-doocey">minister for mental health</a>, it has also announced plans to <a href="https://www.rnz.co.nz/news/political/507330/reti-confirms-transfer-of-decision-making-to-regions-is-among-health-priorities">scrap the authority</a>.</p>
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<a href="https://theconversation.com/have-you-been-feeling-your-spirit-was-sad-culture-is-key-when-assessing-indigenous-australians-mental-health-119463">'Have you been feeling your spirit was sad?' Culture is key when assessing Indigenous Australians' mental health</a>
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<p>The <a href="https://www.platform.org.nz/assets/WorkDetail/Cross-Party-Report-Under-One-Umbrella-MHAC-Web-Accessible-FINALv.pdf">Under One Umbrella</a> report, published by the cross-party <a href="https://www.mhwc.govt.nz/news-and-resources/priority-on-youth-mental-health-strikes-a-chord/">Mental Health and Addiction Wellbeing Group</a>, presents a comprehensive, integrated approach to mental health, alcohol and addiction for young people. Significantly, it advocates for a holistic “all-of-government” approach. </p>
<p>Submissions from a <a href="https://www.health.govt.nz/our-work/mental-health-and-addiction/mental-health-legislation/repealing-and-replacing-mental-health-act">recent review</a> of the Mental Health Act show strong support for the new legislation to uphold rights in alignment with international conventions, with more focus on tangata whaiora (someone seeking health) and whānau (extended family). </p>
<p>Although these initiatives and pending legislative reform represent a step in the right direction, the statistics related to <a href="https://www.unicef.org.nz/media-releases/poor-mental-health-in-children-and-young-people-cannot-be-ignored-unicef">youth mental health</a> are still cause for concern. </p>
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<h2>International responsibilities to ensure health</h2>
<p>One strategy to address the national mental health crisis for Māori youth would be to embed the human right to health in local policy and law. This would also bring Aotearoa New Zealand’s legislation into line with its international obligations. </p>
<p>In 1946, the <a href="https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1">World Health Organization</a> adopted a broad definition of health:</p>
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<p>Health is a state of complete physical, mental, cultural and social wellbeing and not merely the absence of disease or infirmity. </p>
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<p>Over the course of the next two decades, health was conceived as a human right (in the <a href="https://www.un.org/en/about-us/universal-declaration-of-human-rights">Universal Declaration of Human Rights</a> and later in the <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/international-covenant-economic-social-and-cultural-rights">International Covenant on Economic Social and Cultural Rights</a>). </p>
<p>The <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/international-convention-elimination-all-forms-racial">International Convention on the Elimination of Racial Discrimination</a> also obliged countries to eliminate race discrimination in public health and medical care. </p>
<p>For children, the right to health is further recognised in the <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-child">Convention on the Rights of the Child 1989</a>. And, specifically for Indigenous communities, in the <a href="https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf">United Nations Declaration on the Rights of Indigenous Peoples 2007</a>. </p>
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<p>It is well established within <a href="https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf">international law</a> that the right to health for Indigenous children and youth is linked to their distinct cultural, social and customary practices. </p>
<p>And various UN groups have <a href="https://www.ohchr.org/en/resources/educators/human-rights-education-training/e-general-comment-no-14-right-highest-attainable-standard-health-article-12-2000">repeatedly</a> <a href="https://documents-dds-ny.un.org/doc/UNDOC/GEN/G16/177/09/PDF/G1617709.pdf?OpenElement">emphasised</a> that Indigenous people have the right to receive culturally appropriate healthcare services that respect their traditional practices and medicines. </p>
<p>These groups have also urged countries to provide Indigenous communities with the necessary resources to design, deliver and control their own healthcare services. </p>
<h2>The need for a legal framework</h2>
<p><a href="https://www.justice.govt.nz/justice-sector-policy/constitutional-issues-and-human-rights/human-rights/international-human-rights/">Aotearoa New Zealand is bound</a> by these international agreements, and the rights and obligations that flow from them. Yet the right to health <a href="https://tikatangata.org.nz/human-rights-in-aotearoa/right-to-health">does not appear in our laws</a>, which leaves a void in accountability and enforcement. </p>
<p>This hinders the implementation of effective health policies for tamariki and rangatahi Māori (children and young people), particularly as it limits the legal avenues available for recourse when the system fails. </p>
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Read more:
<a href="https://theconversation.com/its-despair-not-depression-thats-responsible-for-indigenous-suicide-108497">It's despair, not depression, that's responsible for Indigenous suicide</a>
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<p>The disparities in mental health outcomes point to an immediate national challenge facing Aotearoa New Zealand, which is to formulate an effective mental healthcare framework. </p>
<p>The most appropriate starting point is to include the right to health in national policy and legislation. This would align New Zealand’s national policies and laws with international norms. </p>
<p>It would also mandate the government to take active steps to ensure that the highest attainable standards of mental health and wellbeing for tamariki and rangtahi Māori are met.</p><img src="https://counter.theconversation.com/content/219613/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>There is no express right to health in New Zealand law. But international agreements protecting Indigenous rights to health and wellbeing set the standard New Zealand should follow.Claire Breen, Professor of Law, University of WaikatoRobert Joseph, Associate Professor of Law, University of WaikatoThilini Karunaratne, PhD candidate/ Lawyer, University of WaikatoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2185662024-01-09T23:08:30Z2024-01-09T23:08:30ZHearing the voices of Indigenous people with neurodevelopmental disabilities<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/hearing-the-voices-of-indigenous-people-with-neurodevelopmental-disabilities" width="100%" height="400"></iframe>
<p>Indigenous Peoples with neurodevelopmental disabilities (NDDs) and mental health challenges are among the most marginalized groups in the country. NDDs include things like autism and attention-deficit/hyperactivity disorder (ADHD). </p>
<p>Research points to <a href="https://uwaterloo.ca/canadian-index-wellbeing/reports/canadian-index-wellbeing-national-report">persistent health inequities</a>, and <a href="https://doi.org/10.1016/j.socscimed.2017.01.021">mental health research</a> has tended to overemphasize suicide and substance use in Indigenous populations. </p>
<p>Although their stories also tell of strengths, struggles and important community contributions, the voices of Indigenous Peoples with NDDs often go unheard. </p>
<p>A report that includes immediate and long-term calls to action was developed to shed light on the experiences of this under-represented group and create meaningful change in their lives. </p>
<p>“<a href="https://brocku.ca/thomson-lab/wp-content/uploads/sites/209/Forming-the-Circle-Indigeneity-Neurodevelopmental-Disability-Mental-Health-Sept-2023-1.pdf">Forming the Circle: 2023 Gathering on Indigeneity, Neurodevelopmental Disabilities and Mental Health</a>” was informed by a community event held last spring that brought together Indigenous community members, Knowledge Keepers and Elders, service providers, researchers and non-Indigenous allies from across Canada. </p>
<p>The report was authored by researchers from Brock University (Kendra Thomson) and the Centre for Addiction and Mental Health - CAMH (Louis Busch) and reflects the findings from the event and recommendations for future actions. Attendees provided feedback on the report in focus groups after the event and before the report was released.</p>
<h2>The gathering</h2>
<p><a href="https://brocku.ca/thomson-lab/2023-gathering-on-indigeneity-neurodevelopmental-disabilities-and-mental-health-in-ontario/">The gathering</a> explored how colonization, systemic discrimination and determinants of health such as food insecurity, housing and access to cultural safe services impact individuals, families and communities. </p>
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<figcaption><span class="caption">At the 2023 Gathering on Indigeneity, Neurodevelopmental Disabilities and Mental Health at the Centre for Addiction and Mental Health in Toronto, people with lived experience, traditional Knowledge Keepers, clinicians and researchers from across Canada shared knowledge and expertise.</span></figcaption>
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<a href="https://theconversation.com/as-an-indigenous-doctor-i-see-the-legacy-of-residential-schools-and-ongoing-racism-in-todays-health-care-162048">As an Indigenous doctor, I see the legacy of residential schools and ongoing racism in today's health care</a>
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<p>Gathering attendees concluded that the path forward should begin with establishing a national network on Indigeneity, neurodevelopmental disabilities and mental health to take action that will enhance the health and well-being of Indigenous Peoples with NDDs and mental health challenges. </p>
<p>Some of the long-term recommendations within the report call for: </p>
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<li><p>The creation of programs to promote and preserve culture;</p></li>
<li><p>Partnerships between Indigenous and non-Indigenous organizations, with training provided to enhance the cultural safety of programs;</p></li>
<li><p>The development of culturally appropriate assessment tools and supportive programs for Indigenous Peoples with NDDs;</p></li>
<li><p>Examination of the experience of Indigenous Peoples with NDDs within the criminal justice system, youth populations, child welfare system and those impacted by environmental issues; and </p></li>
<li><p>Evaluation of the impact of incorporating traditional teachings and medicines within educational, social and health-related programs.</p></li>
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<h2>JJ’s story</h2>
<p>Among those in attendance was JJ Thunder Bear Man, an Anishinaabe man who travelled almost 2,000 kilometres from Dryden to Toronto to share his story at the gathering. </p>
<p>Born in the early 1980s in a community in northern Ontario, JJ was put into the foster-care system at age five as his parents faced the realities of their experiences at <a href="https://nctr.ca/education/teaching-resources/residential-school-history/">residential schools</a>. </p>
<p>Adolescence came with its own challenges, with JJ getting involved in a gang and struggling with addiction. His journey toward healing and recovery began when he joined Community Living in Dryden at the age of 18. His support team helped him to connect to his culture and to community.</p>
<p>The revelation of his spirit helper, the bear, and his spirit name, Thunder Bear Man, offered a powerful lens into JJ’s path to healing and connection to culture. </p>
<p>His heartfelt desire to reconnect with his family’s language, lost over time, also added a poignant layer to his story. He recalls having to ask his sister what his mother was saying when they finally got to visit years later, as she didn’t speak English, and he couldn’t speak Ojibwe. </p>
<p>JJ’s story, not unlike other young Indigenous Peoples living with NDDs and mental health challenges, highlights the <a href="https://afn.ca/community-services/languages/">dire need for preserving language and tradition</a>. </p>
<h2>Beautiful differences</h2>
<p>JJ’s story is one that contains experiences familiar to many Indigenous Peoples with neurodevelopmental differences and mental health challenges.</p>
<p>During the event, JJ issued a plea for kindness, understanding and companionship for neurodiverse individuals within Indigenous communities, reflecting on the impact acknowledgement and support can have. </p>
<p>The importance of a supportive “strength-based” approach was a theme that emerged again and again at the gathering, stressing the need to recognize individuals’ unique contributions, accomplishments and abilities. Many participants used the term “neurodevelopmental difference” rather than disability or disorder.</p>
<p>This report is intended to mark only the start of a broader discussion, new and strengthened relationships and a collective commitment across the country to take action to improve the lives of Indigenous Peoples with beautiful differences.</p>
<p><em>We would like to acknowledge JJ Thunder Bear Man for bravely sharing his moving story with us, and his helper, Lesley Barreira of Surrey Place, for supporting him in doing so.</em></p><img src="https://counter.theconversation.com/content/218566/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kendra Thomson receives funding from the Canadian Institutes of Health Research.</span></em></p><p class="fine-print"><em><span>Louis Busch receives funding from the Social Sciences and Humanities Research Council (SSHRC).</span></em></p>Although their stories often tell of strengths, struggles and important community contributions, the voices of Indigenous people with neurodevelopmental disabilities often go unheard.Kendra Thomson, Associate Professor in the Department of Applied Disability Studies, Brock UniversityLouis Busch, Community Support Specialist, Shkaabe Makwa Centre for First Nations, Inuit, and Métis Wellness at CAMH, Doctoral Student, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2158052023-12-07T02:51:29Z2023-12-07T02:51:29ZRecommendations to reboot the NDIS have finally been released. 5 experts react<figure><img src="https://images.theconversation.com/files/564063/original/file-20231206-15-wnjah9.jpg?ixlib=rb-1.1.0&rect=54%2C27%2C5952%2C3962&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/geelong-australia-october-14-2018-national-1217324305">Shutterstock</a></span></figcaption></figure><p>Findings from an extensive <a href="https://www.ndisreview.gov.au/resources/reports/working-together-deliver-ndis">review</a> of the National Disability Insurance Scheme (NDIS) have been released with ideas on how to transform it. Led by co-chairs Bruce Bonyhady and Lisa Paul, the review heard from around 10,000 people before making 26 recommendations with 139 supporting actions. Presenting their findings, co-chairs wrote: </p>
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<p>We must return to the principle that NDIS eligibility is based first and foremost on functional impairment rather than medical diagnosis.</p>
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<p>The review <a href="https://www.dss.gov.au/sites/default/files/documents/11_2023/communique3november20232.pdf">identified challenges</a> including greater than expected growth and unclear criteria for reasonable and necessary supports, “which create complexity, stress, inconsistency and mistrust”. </p>
<p>Key <a href="https://www.ndisreview.gov.au/resources/reports/working-together-deliver-ndis/preface/recommendations-and-actions">recommendations</a> include:</p>
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<li>National Cabinet to jointly design and fund foundational disability support outside the NDIS </li>
<li>navigators to help participants get the services they need</li>
<li>providers to be registered and compliant with new standards</li>
<li>needs assessments to gauge the impact of disability rather than lists of diagnoses for access</li>
<li>more consistent housing supports for people with disability</li>
<li>disability support access for older Australians.</li>
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<img alt="The NDIS’s current system is disconnected and has a support gap." src="https://images.theconversation.com/files/564083/original/file-20231207-27-hiqzt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564083/original/file-20231207-27-hiqzt.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=466&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564083/original/file-20231207-27-hiqzt.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=466&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564083/original/file-20231207-27-hiqzt.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=466&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564083/original/file-20231207-27-hiqzt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=585&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564083/original/file-20231207-27-hiqzt.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=585&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564083/original/file-20231207-27-hiqzt.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=585&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">The NDIS’s current system is disconnected and has a support gap.</span>
<span class="attribution"><a class="source" href="https://www.ndisreview.gov.au/resources/reports/working-together-deliver-ndis">NDIS Review</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>The recommendations follow yesterday’s National Cabinet <a href="https://theconversation.com/states-agree-to-do-more-heavy-lifting-on-disability-in-exchange-for-extra-health-and-gst-funding-219321">cost-sharing deal</a> and take in findings from the <a href="https://theconversation.com/au/topics/disability-rc-2023-146083">disability royal commission</a>. The government says it will announce reforms based on the recommendations in 2024. It hopes to constrain annual NDIS growth to 8% by 2026.</p>
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Read more:
<a href="https://theconversation.com/states-agree-to-do-more-heavy-lifting-on-disability-in-exchange-for-extra-health-and-gst-funding-219321">States agree to do more heavy lifting on disability, in exchange for extra health and GST funding</a>
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<p><strong>We asked five experts for their initial reaction to the recommendations:</strong></p>
<h2>Mark Brown – social researcher</h2>
<p>The NDIS review found while the scheme has transformed the lives of thousands of people with disability, it is not efficient or fair. Design flaws in the way the scheme operates mean the NDIS is on its way to being the <a href="https://www.dana.org.au/dana-presents-redesigning-the-ndis-report-launch/">most expensive disability system in the world</a>. </p>
<p>The idea that disability supports are an ecosystem, and that multiple governments, departments, service sectors, and communities must share responsibility reflects the reality that people with disability are diverse and live in the real world, with all its complexities. </p>
<p>There will be some fears the review panel is recommending a more complicated and confusing system. People with the most complex needs may rightly wonder whether they will fall through the cracks in the interfaces between systems. (Unclear responsibilities have been a major cause of young people becoming needlessly <a href="https://theconversation.com/the-budget-includes-7-3-million-to-get-more-young-people-out-of-aged-care-homes-is-it-enough-205383">stranded in aged care</a>.) But the current approach, which relies almost solely on individualised funding, has proven to be very complicated in practice. </p>
<p>The panel’s recommendations seem like a reasonable framework for change, but they aren’t a precise blueprint. The effect on people with disability, families, and support workers will depend on the detail and implementation. There are still many difficult conversations to have. </p>
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Read more:
<a href="https://theconversation.com/what-the-ndis-needs-to-do-to-rebuild-trust-in-the-words-of-the-people-who-use-it-185880">What the NDIS needs to do to rebuild trust, in the words of the people who use it</a>
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<h2>Anne Kavanagh – disability and health</h2>
<p>The NDIS review offers a new vision on how to move to a sustainable NDIS that will serve Australians into the future. The establishment of a new Disability Intergovernmental Agreement to provide supports within the NDIS and outside it is welcome. Many people with disability not on the NDIS are missing out on essential supports.</p>
<p>The establishment of national councils and committees to enable people with disability to advise government and people with disability and other experts to monitor performance and assess evidence should lead to greater accountability and access to better quality support.</p>
<p>After ten years we would expect an evidence base on what works. The proposed Disability Research and Evaluation fund must be adequately resourced to address this evidence gap and implement innovative practice. </p>
<p>The focus on the regulation of unregistered providers will be of concern to many people with disability. This has been the way many of us have been able to access the supports we want. It needs to be remembered regulation does not equate to safety. We have seen many registered providers who have perpetrated abuse and neglect on people with disability. </p>
<p>I welcome the increased flexibility in relation home and living supports but it will be important to make sure the requirement to share home and living supports with two other people does not continue the segregated living environments we have been fighting to prevent for so long. Instead I hope this flexibility enables people with disability to make real choices around who they live with and where.</p>
<p>Ensuring people with disability are part of community, often facilitated by independent support workers, provides natural safeguarding against abuse and neglect.</p>
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Read more:
<a href="https://theconversation.com/ndis-cost-scrutiny-is-intensifying-again-the-past-shows-this-can-harm-health-and-wellbeing-for-people-with-disability-203336">NDIS cost scrutiny is intensifying again – the past shows this can harm health and wellbeing for people with disability</a>
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<h2>Libby Callaway – rehabilitation, ageing and independent living</h2>
<p>There is general agreement the NDIS has become the “oasis in the desert” of disability services. </p>
<p>The NDIS review final report recommends a strong focus on strengthening other mainstream systems or “foundational supports” – like the early childhood, education and health systems – for all people with disability. This is encouraging but it will be important to monitor how the funding agreements negotiated via National Cabinet actually deliver enhanced services for people with disability and their families. </p>
<p>Past redirection of disability funding into the NDIS has left large service gaps. People of all ages and abilities lost programs that benefited them, such as state-based aids and equipment libraries or independent living centres. To address this, the NDIS review highlights the need to increase information and capacity building supports across key areas, including assistive technology and housing options. </p>
<p>It will be important to understand more about the vision for “preferred provider” arrangements referred to in the report. The review makes it clear reforms should be implemented in a staged process over five years. Further engagement and co-design with people with disability and their families will be vital to this.</p>
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Read more:
<a href="https://theconversation.com/government-plans-to-use-ndis-purchasing-power-to-help-save-billions-but-they-shouldnt-put-products-before-people-205577">Government plans to use NDIS purchasing power to help save billions – but they shouldn't put products before people</a>
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<h2>David Trembath – autism and public health</h2>
<p>The review has a lot to say about supports for the 20% of Australian children with developmental differences, delay, and disability. It recommends bolstering mainstream services and supports, such as inclusive childcare. That means the majority of these children could have their needs met outside the NDIS in the coming years. This seems like a sensible approach – meeting children and families where they are at and building more inclusive communities. It will require substantial investment, a big shift in thinking, and a strong focus on community-driven solutions. </p>
<p>Funding for individual supports will still be available, but the review recommends access be determined through a more rigorous assessment of children’s functional needs, not simply diagnoses. The focus is on supports for children with the most complex disability needs. Removing the link between diagnosis and access should return attention to what is most important for planning – children’s functional strengths and support needs. It should reduce the challenges many parents face in accessing timely, affordable and appropriate assessment.</p>
<p>Overall, the recommendations are a step in the right direction, provided children and families are at the centre of every decision and change that affects them. </p>
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Read more:
<a href="https://theconversation.com/new-national-autism-guideline-will-finally-give-families-a-roadmap-for-therapy-decisions-199786">New national autism guideline will finally give families a roadmap for therapy decisions</a>
</strong>
</em>
</p>
<hr>
<h2>Scott Avery – Indigenous disability research</h2>
<p>The barometer for judging the NDIS review is the extent to which it advances a vision for a disability services sector that is anti-ableist and anti-racist, and accommodates a First Nations culture inclusive of people with disability in both word and action.</p>
<p>There is one overarching recommendation that is specific to First Nations people with disability which is for the establishment of an alternative commissioning process to be created in partnership with First Nations representatives, communities, participants and relevant government agencies. This can be read alongside the recommendations of the disability royal commission to make the NDIS more inclusive of First Nations decision-making in its governance and leadership. </p>
<p>What is understated in this report and others is the extent of the organisational change the NDIS and other organisations in the disability sector need to own to give meaningful effect to the dream of an authentically inclusive scheme.</p>
<p>First Nations people with disability have been lending their wisdom and voice to one inquiry or another for what has seemed like a generation. Each inquiry has delved deeply into the trauma stories from our community, but at the same time has placed decision-making on implementation into a holding pattern. Disability community leadership and self-determination seems to be the consensus recommendation both the NDIS review and the disability royal commission have landed on. Can we now just get on with it please?</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/indigenous-people-with-disability-have-a-double-disadvantage-and-the-ndis-cant-handle-that-102648">Indigenous people with disability have a double disadvantage and the NDIS can't handle that</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/215805/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Brown is an Honorary Research Fellow at La Trobe University and a Senior Research Fellow at the Summer Foundation. He is also an NDIS participant.</span></em></p><p class="fine-print"><em><span>Anne Kavanagh receives funding from NHMRC, ARC, MRFF and the Commonwealth government, </span></em></p><p class="fine-print"><em><span>David Trembath receives research funding from Autism CRC for research focused on assessing children's functional strengths and support needs, as well as from the Commonwealth Department of Health, Medical Research Future Fund, and Playgroup NSW Inc. His position at Griffith University is co-funded by CliniKids, Telethon Kids Institute. David has family members who access the NDIS.</span></em></p><p class="fine-print"><em><span>Libby Callaway receives funding from the Commonwealth Government Department of Health and Ageing and Australian Housing and Urban Research Institute. She is the voluntary President of the Australian Rehabilitation and Assistive Technology Association and a voluntary Board Member of the Homer Hack.</span></em></p><p class="fine-print"><em><span>Scott Avery is a profoundly deaf Aboriginal educator and researcher from the Worimi people. This commentary is provided in an independent capacity and are not intended to represent the views of any other person or organisation in any official capacity. Dr Scott Avery receives research funding from the First Peoples Disability Network under the First Nations Disability Sector Strengthening initiative under the National Agreement for Closing the Gap, that is administered by the National Indigenous Insurance Agency. He is a member of the First Nations Advisory Group of the National Disability Insurance Agency. He is a Director on the Board of disability service provider Achieve Australia.</span></em></p>5 disability experts tell us their initial thoughts about plans to reform the NDIS and make it sustainableMark Brown, Senior Research Fellow, La Trobe UniversityAnne Kavanagh, Professor of Disability and Health, Melbourne School of Population and Global Health, The University of MelbourneDavid Trembath, Associate Professor, Menzies Health Institute Queensland, Griffith UniversityLibby Callaway, Associate Professor, Rehabilitation, Ageing and Independent Living Research Centre and Occupational Therapy Department, School of Primary and Allied Healthcare, Monash UniversityScott Avery, Professor Indigenous Disability Health and Wellbeing, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2146412023-11-08T03:04:39Z2023-11-08T03:04:39ZSleep apnoea can be scary. But here’s what happened when First Nations people had a say in their own care<p>Obstructive sleep apnoea is about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623124/">twice as common</a> in First Nations people compared with non-Indigenous Australians.</p>
<p>But the truth is, this sleep-related respiratory disorder is significantly under-reported in First Nations communities.</p>
<p>A <a href="https://issr.uq.edu.au/article/2021/11/let%E2%80%99s-yarn-about-sleep">Let’s Yarn About Sleep</a> program in Queensland hopes to change that, by acknowledging the importance of sleep not just to physical and mental health, but to spiritual health. The program uses traditional knowledge as a key part of its culturally responsive model of care.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1698807144567668999"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-first-sleep-health-program-for-first-nations-adolescents-could-change-lives-206286">The first sleep health program for First Nations adolescents could change lives</a>
</strong>
</em>
</p>
<hr>
<h2>What is obstructive sleep apnoea?</h2>
<p>In obstructive sleep apnoea the upper airway is repeatedly wholly or partially blocked during sleep, resulting in lower blood oxygen levels. The sudden drop in blood oxygen levels, and the body’s frequent waking to restart breathing, affects sleep. These also strain the heart and blood vessels.</p>
<p>People with sleep apnoea often wake up feeling unrefreshed and experience significant daytime sleepiness. Sleep apnoea also <a href="https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(22)00005-0/fulltext">increases the risk of</a> obesity, heart disease, cognitive problems, poor mental health, productivity loss and driving accidents.</p>
<p>We suspect there are significantly more cases in First Nations communities than currently reported. That’s partly because the proportion of First Nations people over 50 has <a href="https://www.aihw.gov.au/reports/older-people/older-australians/contents/population-groups-of-interest/indigenous-australians">grown</a> in recent years and obesity is <a href="https://www.indigenoushpf.gov.au/measures/2-22-overweight-obesity">more common</a> in this population. Both obesity and increased age are risk factors for sleep apnoea.</p>
<p>Another reason why we suspect sleep apnoea is under-reported is the
<a href="https://healthbulletin.org.au/articles/the-tyranny-of-distance-mapping-accessibility-to-polysomnography-services-across-australia/">lack of specialist sleep services</a> in rural and remote areas. Long wait times, plus logistical and financial challenges in accessing services not available locally, means people are not being assessed, diagnosed and treated.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-is-snoring-anything-to-worry-about-68142">Health Check: is snoring anything to worry about?</a>
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</em>
</p>
<hr>
<h2>A growing awareness</h2>
<p>So community members have advocated for expanding the existing Let’s Yarn About Sleep program – which was originally set up to manage sleep problems in First Nations <a href="https://theconversation.com/the-first-sleep-health-program-for-first-nations-adolescents-could-change-lives-206286">teenagers</a> – to cater for people with sleep apnoea.</p>
<p>This builds on insights from community yarns about the impact of poor sleep. These highlighted that dreaming in First Nations culture is considered an important opportunity to connect with ancestors, Country and cultural knowledge. So, poor sleep, through its impact on dreaming, also affects spiritual health.</p>
<p>Let’s Yarn About Sleep project coordinator and Kalkadoon woman Roslyn Von Senden says:</p>
<blockquote>
<p>Dreams are an important part of our life, a medium to connect with our ancestors to be guided, foresee things, connect with others, and get inspiration and ideas to express our artistic talent. Sleep loss deprives us of opportunities to connect with our culture, our ancestors and who we are as traditional custodians of the world’s oldest surviving culture. That leads to poor emotional and mental health, affects our wellbeing and results in chronic conditions.</p>
</blockquote>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sleep coach with program participant showing him how to use CPAP machine" src="https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=335&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=335&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=335&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=421&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=421&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=421&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sleep coach Karen Chong talks about sleep apnoea with program participant Neil Dunne.</span>
<span class="attribution"><a class="source" href="https://stories.uq.edu.au/news/2023/better-sleep-to-improve-health-in-indigenous-communities/index.html">UQ/Let's Yarn about Sleep program</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>The program’s yarn with community members also highlighted the lack of culturally secure services, low awareness of sleep apnoea treatment options and stigma in accessing services as the key contributors to high rates of undiagnosed/untreated sleep apnoea in First Nations communities.</p>
<p>Uncle Neil Dunne, a Pitta Pitta man, who has sleep apnoea and was a member of the program’s community steering group, says: </p>
<blockquote>
<p>Sleep apnoea is very common in our community, but many of our mob don’t get tested. There is still shame in talking about sleep apnoea. Not many people know what it means and how it affects our health. I was tested for sleep apnoea, and the doctor told me I stopped breathing 13 times [per hour] in my sleep. This is scary. It is important to educate our community on how we can get help and why it is important to get help for sleep apnoea.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/my-snoring-is-waking-up-my-partner-apart-from-a-cpap-machine-what-are-the-options-188825">My snoring is waking up my partner. Apart from a CPAP machine, what are the options?</a>
</strong>
</em>
</p>
<hr>
<h2>So what does the program look like?</h2>
<p>The idea was to design a culturally responsive model for local diagnosis and management of, and education about, obstructive sleep apnoea in First Nations communities.</p>
<p>This has involved consultation with 12 First Nations communities, and training Aboriginal health workers and nurses to deliver the program.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1714853480308015614"}"></div></p>
<p>The Aboriginal health workers will educate community members about symptoms of sleep apnoea, its health impacts and pathways to seek clinical care. They’ll also screen for sleep apnoea in the community and start the referral process so people can be treated by GPs and nurses via their local community health service or Aboriginal medical service. </p>
<p>The program uses standard treatments for sleep apnoea, such as <a href="https://www.sleephealthfoundation.org.au/sleep-disorders/cpap-continuous-positive-airway-pressure">continuous positive airway pressure</a> therapy, known as a CPAP machine. This includes a mask you wear at night to help open up your airway and help you breathe while sleeping. </p>
<p>But community Elders also guide the team to integrate cultural practices.</p>
<p>For example, the team will include didgeridoo sessions for men as part of the program. This Aboriginal musical instrument is not only an important part of cultural ceremonies, playing the didgeridoo <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360393/">reduces the severity</a> of sleep apnoea. It strengthens the muscles of the throat and the back of the tongue (key muscles associated with sleep apnoea).</p>
<p>Cultural protocols don’t support offering didgeridoo sessions for women. So we will seek guidance from community members to decide which other wind instruments can be used for women. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man playing didgeridoo outside" src="https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Playing the didgeridoo will be part of therapy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-plays-didgeridoo-garden-697433446">Erich Haubrich/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-the-remarkable-yidaki-and-no-its-not-a-didge-74169">Friday essay: the remarkable yidaki (and no, it's not a 'didge')</a>
</strong>
</em>
</p>
<hr>
<h2>Locally-led, culturally responsive</h2>
<p>It’s early days for us to see any results from the program. But it shows we can develop locally led and culturally responsive models of care.</p>
<p>By co-designing with community members, integrating cultural knowledge into how we manage sleep apnoea, and building the First Nations sleep health workforce, the program aims to transform diagnosis and management for First Nations peoples.</p>
<hr>
<p><em>Timothy Skinner, Professor of Health Psychology, La Trobe University, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/214641/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yaqoot Fatima is a member of the Australasian Sleep Association and is associated with the Sleep Health Foundation.
Yaqoot Fatima is supported by funding from the NHMRC Partnership Grant, MRFF Indigenous Health Research Grant, MRFF-EMCR grant, Tropical Australian Academic Health Centre grant and Beyond Blue for sleep health research.
</span></em></p><p class="fine-print"><em><span>Daniel Sullivan is a member of the Australasian Sleep Association and the Australian Psychological Society. Daniel Sullivan receives funding from a Medical Research Future Fund Early-Mid Career Researchers grant. </span></em></p><p class="fine-print"><em><span>Romola Bucks is a member of the Australasian Sleep Association, and the Sleep Health Foundation. Romola has received funding or currently receives funding from sources including the NHMRC, the Tropical Australian Academic Health Centre Seed Funding Scheme, and Indigenous Health Research Fund: MRFF.</span></em></p><p class="fine-print"><em><span>Shannon Edmed receives funding from the National Health and Medical Research Council (NHMRC) 2021 Medical Research Future Fund (MRFF) Early to Mid-Career Researchers Grant.
Shannon Edmed's research is supported partially by the Australian Research Council's Centre of Excellence for Children and Families over the Life Course (Project ID CE200100025).
She has also previously received funding from Government departments such as the Commonwealth Department of Health and Aged Care and the Commonwealth Defence Science and Technology Group.
</span></em></p><p class="fine-print"><em><span>Roslyn Von Senden 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>Poor sleep deprives First Nations people of the chance to connect with culture. So they co-designed a sleep apnoea program they’d actually use.Yaqoot Fatima, Associate Professor, UQ Poche Centre for Indigenous Health, The University of QueenslandDaniel Sullivan, Research Fellow, UQ Poche Centre for Indigenous Health, The University of QueenslandRomola Bucks, Pro Vice Chancellor (Health and Medical Science) & Director of the Raine Study (rainestudy.org.au), The University of Western AustraliaRoslyn Von Senden, Senior Project Officer, UQ Poche Centre for Indigenous Health, The University of QueenslandShannon Edmed, Research Fellow, Institute for Social Science Research, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2151542023-10-16T06:31:14Z2023-10-16T06:31:14ZTuberculosis isn’t just a historical disease. Here’s how it spreads and who is at risk<figure><img src="https://images.theconversation.com/files/553911/original/file-20231016-29-w6zqdm.jpg?ixlib=rb-1.1.0&rect=33%2C6%2C4459%2C2829&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/male-doctor-examining-patient-chest-xray-1929325916">Shutterstock</a></span></figcaption></figure><p>Tuberculosis is often seen as a threat of the past. But it remains a significant concern worldwide, with international travel spreading the disease. </p>
<p>While tuberculous is rare in Australia, and we no longer routinely vaccinate against it, clusters of cases in <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/tuberculosis/tuberculosis+tb+cases+in+aboriginal+communities">South Australia over the past 17 months</a> have put health authorities <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/public+health/alerts/health+alerts/tb+cluster+in+aboriginal+and+torres+strait+islander+south+australians">on alert</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1709416713316708401"}"></div></p>
<p>So what exactly is tuberculosis, how is it treated and what is Australia doing to prevent its transmission? </p>
<h2>It starts as a respiratory infection</h2>
<p>Tuberculosis, caused by the bacterium <em><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/mycobacterium-tuberculosis">Mycobacterium tuberculosis</a></em>, starts as a respiratory infection when inhaled. </p>
<p>Once in the lungs, the immune system responds by forming granulomas, clusters of immune cells (mainly <a href="https://www.news-medical.net/life-sciences/What-is-a-Macrophage.aspx">macrophages</a> and <a href="https://www.news-medical.net/health/What-are-T-Cells.aspx">T cells</a>), in an attempt to contain the infection. </p>
<p>Over time, some granulomas may calcify, with calcium salts accumulating within these structures. </p>
<p>These calcifications are visible on X-rays and indicate latent tuberculosis infection. This means the <em>Mycobacterium tuberculosis</em> are in a dormant state, causing no immediate symptoms but posing a potential risk of reactivation if the host’s immune defences weaken. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tuberculosis-on-the-rise-for-first-time-in-decades-after-covid-19-interrupted-public-health-interventions-and-increased-inequality-207478">Tuberculosis on the rise for first time in decades after COVID-19 interrupted public health interventions and increased inequality</a>
</strong>
</em>
</p>
<hr>
<p>Reactivation can lead to active tuberculosis, characterised by symptoms such as a persistent cough, fever, weight loss and fatigue. </p>
<p>Active tuberculosis is contagious, especially when it affects the lungs, as it primarily spreads through respiratory droplets released during coughing or sneezing.</p>
<h2>Early treatment is key</h2>
<p>Early diagnosis and treatment reduces the infectious period and helps prevent spreading the disease to others. It can also halt the progression of a latent infection to active disease.</p>
<p>Delayed treatment can lead to complications such as lung damage and scarring; damage to the bones, kidneys, lymph nodes and central nervous system; and infection in the brain and spinal cord. Delayed treatment can also be fatal.</p>
<p>Antibiotic <a href="https://www.cdc.gov/tb/topic/treatment/tbdisease.htm">treatment</a>, often involving multiple drugs, is <a href="https://www.who.int/health-topics/tuberculosis#tab=tab_3">highly effective</a> at <a href="https://www.nature.com/articles/s41579-022-00731-y">eliminating the bacteria</a>. </p>
<p>However, it can be <a href="https://www.healthdirect.gov.au/tuberculosis#:%7E:text=Not%20everyone%20with%20latent%20TB,close%20contacts%20should%20be%20tested.">lengthy</a>, lasting several months or more. This can be physically and emotionally challenging for patients, especially as it includes periods of isolation. </p>
<p>Treating tuberculosis can also be a <a href="https://nceph.anu.edu.au/research/projects/australian-tuberculosis-risk-factor-survey#:%7E:text=Australia%20reports%20approximately%201300%20cases,5.5%20cases%20per%20100%2C000%20population.">notable burden</a> on the health system, due to the need for isolation, contact tracing, and specialised care. </p>
<h2>Tackling drug-resistant bacteria</h2>
<p>The <em>Mycobacterium tuberculosis</em> bacteria can quickly become resistant to antibiotics, so routine treatment includes multiple antibiotics which increases adverse effects. </p>
<p>The emergence of <a href="https://www.cdc.gov/tb/topic/drtb/default.htm">drug-resistant tuberculosis</a> strains is a major concern because it makes treatment significantly more challenging and costly. Managing drug-resistant tuberculosis often requires extended treatment courses with second-line drugs, which can lead to more severe side effects and demand close monitoring. </p>
<figure class="align-center ">
<img alt="Doctor listens to patient's chest" src="https://images.theconversation.com/files/553920/original/file-20231016-21-wdi6tm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/553920/original/file-20231016-21-wdi6tm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553920/original/file-20231016-21-wdi6tm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553920/original/file-20231016-21-wdi6tm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553920/original/file-20231016-21-wdi6tm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553920/original/file-20231016-21-wdi6tm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553920/original/file-20231016-21-wdi6tm.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">Treating tuberculosis can sometimes be a long and difficult process.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-doctor-examining-asian-patient-stethoscope-1062549752">Shutterstock</a></span>
</figcaption>
</figure>
<p>Drug-resistant tuberculosis strains are also associated with <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022/tb-disease-burden/2-3-drug-resistant-tb">higher rates of death</a>. </p>
<p>The prolonged and complex treatment regimens increase the risk of treatment non-compliance and failure, posing not only a threat to affected people but also raising concerns about potential community transmission of these drug-resistant strains.</p>
<h2>Who is susceptible to tuberculosis?</h2>
<p><a href="https://www.health.gov.au/sites/default/files/documents/2022/06/tuberculosis-cdna-national-guidelines-for-public-health-units.pdf">The risk</a> of acquiring tuberculosis is higher among people who live in densely populated housing, those with compromised immune systems and people with poor access to health care. </p>
<p>This includes Indigenous Australians, recent migrants and refugees, people with underlying health conditions (such as HIV or diabetes), people in corrections facilities, remote and rural communities, the elderly, and people who are homeless, as well as health-care workers.</p>
<p>Children are also at greater risk of tuberculosis, as their immune systems are still developing.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tb-in-children-isnt-being-controlled-its-key-to-fighting-the-disease-for-everyone-else-201966">TB in children isn't being controlled - it's key to fighting the disease for everyone else</a>
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</p>
<hr>
<p>Tuberculosis often presents differently in children, making it challenging to estimate the true global burden. However, the <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022">World Health Organization estimates</a> 11% of the 10.6 million tuberculosis cases worldwide are in children. Some 14% of all tuberculosis-related deaths occur in children under 15 years old. </p>
<p>Common symptoms of paediatric tuberculosis include prolonged cough, wheezing, weight loss, loss of appetite, respiratory symptoms, failure to thrive, swelling of the lymph nodes, fever and night sweats.</p>
<p>Infants are also at <a href="https://pubmed.ncbi.nlm.nih.gov/35168714/">increased risk</a> of:</p>
<ul>
<li><p>disseminated tuberculosis. This spreads throughout the body via the bloodstream and lymphatic system to the liver, spleen, bone marrow, kidneys and brain </p></li>
<li><p>tuberculous meningitis. This is a life-threatening condition where the infection from the lungs has gone to the brain and spinal cord</p></li>
<li><p>congenital tuberculosis. This is a rare condition where a newborn baby is born with active tuberculosis, transmitted from infected mother to baby.</p></li>
</ul>
<h2>What can we do about TB?</h2>
<p>Despite Australia’s relatively low incidence of tuberculosis, we have a robust control program, targeting efforts to vulnerable populations through culturally sensitive health-care services, public health campaigns, and community engagement. </p>
<p>The Bacille Calmette-Guérin <a href="https://www1.health.gov.au/internet/main/publishing.nsf/content/cda-cdi3001-pdf-cnt.htm/$FILE/cdi3001e.pdf">vaccine</a> provides partial protection, primarily against severe forms of tuberculosis. It’s not routinely given in Australia because we’re not considered a high-risk country, but it’s given in local regions with tuberculosis outbreaks. </p>
<p>Active tuberculosis <a href="https://immi.homeaffairs.gov.au/help-support/meeting-our-requirements/health/threats-to-public-health#:%7E:text=Tuberculosis%20testing,for%20evidence%20of%20active%20tuberculosis.">must be reported to health authorities</a> in Australia. This is important to prevent spread of tuberculosis in the community.</p>
<p>Testing for active tuberculosis is also a part of the immigration process. Visa applicants aged 11 years and over <a href="https://immi.homeaffairs.gov.au/help-support/meeting-our-requirements/health/threats-to-public-health">must have</a> a chest X-ray for evidence of <a href="https://www.racgp.org.au/afp/2012/july/tuberculosis-testing">active tuberculosis</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/AHcHlGdw5Sk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">SA Health is working with Aboriginal Community Controlled Health Organisations and other partners to respond to this outbreak with information and videos.</span></figcaption>
</figure>
<p>Timely and effective tuberculosis control measures help not only in treating individuals but also in preventing further transmission. This reduces the overall impact of the disease on public health and the health-care system.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tb-research-shows-a-good-diet-can-cut-infections-by-nearly-50-211377">TB research shows a good diet can cut infections by nearly 50%</a>
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</em>
</p>
<hr>
<p><em>Dr Ena Husaric, a doctor at The Royal Children’s Hospital Melbourne, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/215154/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>Cases of tuberculosis have been detected in South Australia over the past 17 months. Here’s what you need to know about the disease.Vasso Apostolopoulos, Professor of Immunology, Vice-Chancellors Distinguished Professorial Fellow, Head of Immunology and Translational Research, Victoria UniversityMaja Husaric, Senior Lecturer; MD, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2124592023-09-04T02:09:22Z2023-09-04T02:09:22ZHealth evidence against gas and oil is piling up, as governments turn a blind eye<p>We are seeing <a href="https://public.wmo.int/en/our-mandate/climate/wmo-statement-state-of-global-climate">deadly heat and fires</a> circle the world. The <a href="https://www.ipcc.ch/about/">Intergovernmental Panel on Climate Change</a> <a href="https://www.ipcc.ch/report/ar6/syr/resources/spm-headline-statements/">warns</a> we are fast running out of time to secure a liveable and sustainable future. Without emergency action to stop mining and burning fossil fuels, the world faces an unthinkable 2.8°C temperature rise.</p>
<p>It’s incomprehensible, then, that many of our politicians support “<a href="https://www.industry.gov.au/sites/default/files/January%202021/document/beetaloo-strategic-basin-plan.pdf">unlocking the Beetaloo Basin</a>” in the Northern Territory and developing another <a href="https://www.industry.gov.au/sites/default/files/2022-12/resources-and-energy-major-projects-2022_0.pdf">48 oil and gas projects</a> across Australia. </p>
<p>“Unlocking” means starting large-scale shale gas extraction. After drilling through 3–4km of rock and aquifers, a cocktail of chemicals, sand and water is forced down the well. This process of hydraulic fracturing is commonly known as fracking. This brings to the surface, and then into the atmosphere, carbon that had been securely stored underground for <a href="https://www.eia.gov/energyexplained/natural-gas/">300–400 million years</a>. </p>
<p>Today we have launched a <a href="https://www.sydney.edu.au/content/dam/corporate/documents/about-us/values-and-visions/aboriginal-and-torres-straight-islander-community/risks_of_og_development.pdf">report</a> that demonstrates the many risks of oil and gas development for human health and wellbeing in Australia. Based on a review of over 300 peer-reviewed studies, our report provides the public and decision-makers with a summary of the now-extensive evidence of these risks.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-116-new-coal-oil-and-gas-projects-equate-to-215-new-coal-power-stations-202135">Australia's 116 new coal, oil and gas projects equate to 215 new coal power stations</a>
</strong>
</em>
</p>
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<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1502827728130969601"}"></div></p>
<h2>What is the evidence against oil and gas?</h2>
<p>There is a need to combat widely held misconceptions and repeated misinformation about the safety of the oil and gas industry. We undertook the review at the request of concerned paediatricians in the Northern Territory.</p>
<p><a href="https://iopscience.iop.org/article/10.1088/1748-9326/ace3db">New research</a> clearly shows that “unlocking gas” is at least as harmful to the climate as mining and burning coal. This is largely due to methane leaks at many stages of production. Methane is <a href="https://www.csiro.au/en/news/all/articles/2020/july/emissions-of-methane-are-rising">86 times more powerful</a> than carbon dioxide at trapping heat in the atmosphere over 20 years.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/methane-must-fall-to-slow-global-heating-but-only-13-of-emissions-are-actually-regulated-205941">Methane must fall to slow global heating – but only 13% of emissions are actually regulated</a>
</strong>
</em>
</p>
<hr>
<p>Doors opened for the 49 planned projects in Australia after state reviews of potential impacts. These reviews are flawed and outdated as the volume of published studies has grown rapidly in recent years. Reviews were undertaken, for example, in <a href="https://www.chiefscientist.nsw.gov.au/__data/assets/pdf_file/0003/314382/140930-CSG-Final-Report.pdf">New South Wales</a> in 2014, <a href="https://frackinginquiry.nt.gov.au/inquiry-reports/final-report">Northern Territory</a> in 2017, <a href="https://www.aph.gov.au/DocumentStore.ashx?id=3d33f399-4990-41a4-9513-06612733f7f3&subId=410766">South Australia</a> in 2015 and <a href="https://frackinginquiry.wa.gov.au/sites/default/files/final_report.pdf">Western Australia</a> in 2018.</p>
<p>Our report synthesises recent scientific and public health research on five areas of concern about oil and gas operations: </p>
<ol>
<li><p>threats to biodiversity, water and food security arising from site preparation, drilling, fracking, wastewater handling, gas pipeline transport and processing</p></li>
<li><p>contributions to the climate emergency</p></li>
<li><p>a vast array of potentially harmful chemicals</p></li>
<li><p>contamination of water, soil and air </p></li>
<li><p>physical, social, emotional and spiritual health impacts near oil and gas fields and their sprawling infrastructure. </p></li>
</ol>
<p>Each fracking event to release shale gas uses <a href="https://www.usgs.gov/faqs/how-much-water-does-typical-hydraulically-fractured-well-require">6 million to 60 million litres</a> of fresh water. Fracking is often applied many times to each of hundreds to thousands of wells in a region. This puts <a href="https://www.science.org/doi/10.1126/sciadv.aar5982">water security at risk</a> in arid areas. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mining-vs-rivers-a-single-line-on-a-map-could-determine-the-future-of-water-in-the-northern-territory-192626">Mining vs rivers: a single line on a map could determine the future of water in the Northern Territory</a>
</strong>
</em>
</p>
<hr>
<p>Each step of gas production creates risks of contamination of surface and ground water. With vast quantities of wastewater, it can happen through spilling, leaking, flooding and overflows. Wastewater can even be <a href="https://pubs.acs.org/doi/10.1021/acs.est.8b00716">deliberately spread</a> for so-called “beneficial uses”.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1694471318329229612"}"></div></p>
<p>This wastewater contains <a href="https://www.science.org/doi/10.1126/science.1235009">hundreds of chemicals</a>. Some are naturally occurring. Others are added during drilling and fracking. </p>
<p>These chemicals can include heavy metals, phenols, barium, volatile organic compounds including benzene, toluene, ethylene and xylene, radioactive materials, fluoride, polyaromatic hydrocarbons, salt and many chemicals of unknown toxicity.</p>
<p><a href="https://www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-040218-043715">Air becomes contaminated</a> with volatile organic compounds, polyaromatic hydrocarbons, nitrogen oxides, radioactive materials, diesel fumes, hydrogen sulfide, acrolein and heavy metals. Formaldehyde, particulate matter and <a href="https://online.ucpress.edu/elementa/article/doi/10.1525/elementa.398/112753/Air-quality-impacts-from-oil-and-natural-gas">ground-level ozone</a> are formed and travel long distances, damaging health and agriculture.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/companies-that-frack-for-oil-and-gas-can-keep-a-lot-of-information-secret-but-what-they-disclose-shows-widespread-use-of-hazardous-chemicals-193915">Companies that frack for oil and gas can keep a lot of information secret – but what they disclose shows widespread use of hazardous chemicals</a>
</strong>
</em>
</p>
<hr>
<h2>What are the health impacts?</h2>
<p>People exposed to oil and gas operations experience a long list of harms. These include:</p>
<ul>
<li><p>more severe <a href="https://academic.oup.com/ije/article/49/6/1883/5900868">asthma in children</a> requiring more medical treatment, emergency department visits and hospitalisations </p></li>
<li><p>higher hospitalisation and death rates due to <a href="https://pubmed.ncbi.nlm.nih.gov/33581094/">heart attacks</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/33303076/">heart failure</a>, <a href="https://www.sciencedirect.com/science/article/pii/S0047272722000032">respiratory diseases</a> and <a href="https://www.sciencedirect.com/science/article/pii/S0140988321001286?via%3Dihub">some cancers</a></p></li>
<li><p>higher injury and <a href="https://www.sciencedirect.com/science/article/pii/S0095069620300267">fatality rates</a> due to increased heavy vehicle traffic</p></li>
<li><p>increases in depression, anxiety and social withdrawal, especially among <a href="https://pubmed.ncbi.nlm.nih.gov/35341757/">young</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/35325816/">pregnant</a> women</p></li>
<li><p>increases in <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0194203">sexually transmitted infections</a> associated with the industry’s mobile workforces</p></li>
<li><p><a href="https://pubmed.ncbi.nlm.nih.gov/33039138/">reproductive harms</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/34413223/">interference with development</a> of unborn babies, including higher risks of low birth weight, pre-term delivery and spontaneous abortion </p></li>
<li><p>higher risk of <a href="https://pubmed.ncbi.nlm.nih.gov/37076028/">severe birth defects</a> </p></li>
<li><p>higher risk of <a href="https://ehp.niehs.nih.gov/doi/10.1289/EHP11092">acute lymphoblastic leukemia</a>. </p></li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1688874133793198081"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/land-clearing-and-fracking-in-australias-northern-territory-threatens-the-worlds-largest-intact-tropical-savanna-208028">Land clearing and fracking in Australia's Northern Territory threatens the world's largest intact tropical savanna</a>
</strong>
</em>
</p>
<hr>
<h2>Putting Indigenous people and others in harm’s way</h2>
<p>Many of the 49 planned projects affect Aboriginal land. Some companies have allegedly violated the rights of Traditional Owners to <a href="https://www.accr.org.au/downloads/Jumbunna-FPIC-review-final.pdf">free, prior and informed consent</a>. The <a href="https://nit.com.au/25-06-2021/2087/fracking-inquiry-for-beetaloo-basin">massive disruption</a> of Aboriginal Country and life puts people at great risk of physical, <a href="https://anthrosource.onlinelibrary.wiley.com/doi/full/10.1111/j.2153-9561.2012.01066.x">social, emotional</a>, <a href="https://soe.dcceew.gov.au/indigenous/outlook-and-impact">cultural</a> and <a href="https://nit.com.au/25-06-2021/2087/fracking-inquiry-for-beetaloo-basin">spiritual</a> harm.</p>
<p>The report also issues a loud warning about sexual violence against First Nations <a href="https://www.colorado.edu/program/fpw/2019/03/14/new-report-finds-increase-violence-coincides-oil-boom">Americans</a> and <a href="https://www.mmiwg-ffada.ca/wp-content/uploads/2019/06/Final_Report_Vol_1a-1.pdf">Canadians</a> associated with oil and gas activities. The WA <a href="https://www.parliament.wa.gov.au/Parliament/commit.nsf/(Report+Lookup+by+Com+ID)/EF1DF1A3F5DF74A848258869000E6B32/$file/20220621%20-Report%20No%202.pdf">parliamentary inquiry</a> into women’s experiences of sexual harassment and sexual violence in “fly in, fly out” (FIFO) mines suggests these risks apply equally in Australia. Yet all <a href="https://territorystories.nt.gov.au/10070/898896/0/37">government assessments</a> of oil and gas development in Australia completely ignore these risks. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-beetaloo-drilling-program-brings-potential-health-and-social-issues-for-aboriginal-communities-in-remote-nt-165392">The Beetaloo drilling program brings potential health and social issues for Aboriginal communities in remote NT</a>
</strong>
</em>
</p>
<hr>
<p>In the United States, the industry has grown so vast within two decades that over <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5783652/">17.6 million people</a> live within a mile (1.6km) of oil or gas wells. By 2016, the estimated <a href="https://iopscience.iop.org/article/10.1088/2752-5309/acc886">cost to the community</a> was US$77 billion. This was the cost of illness, extra health care and premature deaths (7,500) from asthma, respiratory and cardiovascular disease due to air pollution alone. </p>
<p>Our report makes clear any further gas development will have serious impacts on the climate, the people living in or near gas fields and the overburdened health services that serve them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/two-trillion-tonnes-of-greenhouse-gases-25-billion-nukes-of-heat-are-we-pushing-earth-out-of-the-goldilocks-zone-202619">Two trillion tonnes of greenhouse gases, 25 billion nukes of heat: are we pushing Earth out of the Goldilocks zone?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/212459/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melissa Haswell has previously received funding from the National Health and Medical Research Council, the National Suicide Prevention Strategy, the Cooperative Research Centre for Aboriginal Health, Queensland Department of Environment and Science, Department of Families, Housing, Community Services and Indigenous Affairs, Australian Red Cross, The Healing Foundation, Queensland Health and Australian Health Ministers Advisory Council. She is affiliated with the Climate and Health Alliance, Australian Public Health Association and the International Society for Environmental Epidemiology. </span></em></p><p class="fine-print"><em><span>Jacob Hegedus is member of NSW Young Labor Party</span></em></p><p class="fine-print"><em><span>David Shearman and Lisa Jackson Pulver 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>A new report spans more than 300 peer-reviewed studies to present a comprehensive summary of the risks the industry creates for people’s health and wellbeing, as well as for the planet.Melissa Haswell, Professor of Health, Safety and Environment, Queensland University of Technology and Professor of Practice in Environmental Wellbeing, Office of the Deputy Vice Chancellor (Indigenous Strategy and Services) and Honorary Professor (School of Geosciences), University of SydneyDavid Shearman, Emeritus Professor of Medicine, University of AdelaideJacob Hegedus, Research Assistant, University of SydneyLisa Jackson Pulver, Deputy Vice-Chancellor, Professor of Public Health and Epidemiology, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2110462023-08-30T04:19:59Z2023-08-30T04:19:59ZToo many young people who’ve been in detention die prematurely. They deserve better<figure><img src="https://images.theconversation.com/files/544694/original/file-20230825-25-a34sg8.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C666&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/hand-jail-147711227">Shutterstock</a></span></figcaption></figure><p>Young people in contact with the criminal justice system – be it under community-based orders or in youth detention – are among the <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(19)30217-8/fulltext">most marginalised</a> in our society. And the health and health-care disadvantage faced by these young people may be evident for years.</p>
<p><a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00144-5/fulltext">Our research</a> found high levels of largely-preventable diseases and avoidable premature deaths for these young people in Australia. This indicates inadequate health care both in youth detention and in the community.</p>
<p>It’s time we provided health care for people in youth detention that’s culturally safe and equivalent to what’s available in the community. That includes access to Australia’s so-called universal health-care scheme, Medicare. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/locking-up-kids-damages-their-mental-health-and-sets-them-up-for-more-disadvantage-is-this-what-we-want-117674">Locking up kids damages their mental health and sets them up for more disadvantage. Is this what we want?</a>
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</p>
<hr>
<h2>Children as young as 10</h2>
<p>Australian courts can sentence children as young as ten who are convicted of a criminal offence to a community-based order, or to youth detention. </p>
<p>During the 2021-22 financial year, <a href="https://www.aihw.gov.au/getmedia/3fe01ba6-3917-41fc-a908-39290f9f4b55/aihw-juv-140.pdf.aspx?inline=true">4,350 young people</a> aged ten to 18 were detained at some point, typically for eight days or less.</p>
<p>Almost 50% of young people under youth justice supervision <a href="https://www.aihw.gov.au/getmedia/3fe01ba6-3917-41fc-a908-39290f9f4b55/aihw-juv-140.pdf.aspx?inline=true">are Indigenous</a>, and they are 24 times more likely than non-Indigenous young people to go into youth detention.</p>
<p>Young people in detention commonly have <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(19)30217-8/fulltext">very poor health</a>. This includes high rates of one or more physical and mental health problems, cognitive and neurodevelopmental disabilities, and substance dependence. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-social-determinants-of-justice-8-factors-that-increase-your-risk-of-imprisonment-203661">The social determinants of justice: 8 factors that increase your risk of imprisonment</a>
</strong>
</em>
</p>
<hr>
<h2>What we found</h2>
<p>In the nearly 25 years of data covered in our study, <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00144-5/fulltext">we found</a> young people with a history of contact with the youth justice system died at a rate more than four times higher than those of the same age and sex in the general Australian population.</p>
<p>We found those most at risk of dying prematurely were Indigenous children, males, and those whose first contact with the youth justice system was before they were 14 years old.</p>
<p>Until now, there’s been a remarkable lack of evidence on the burden of noncommunicable diseases, such as cancers and cardiovascular diseases, among young people during and after contact with the youth justice system. However, we found that compared with their peers, these young people have nearly double the rate of dying from such diseases.</p>
<p>For young Indigenous males, cardiovascular and digestive diseases, including chronic liver diseases, were particularly prominent (and largely preventable) causes of death.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-nations-people-in-the-nt-receive-just-16-of-the-medicare-funding-of-an-average-australian-183210">First Nations people in the NT receive just 16% of the Medicare funding of an average Australian</a>
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</em>
</p>
<hr>
<h2>What we need</h2>
<p>Our findings highlight the need for young people involved with the justice system to access high-quality and holistic health care that’s age- and culturally appropriate. This is essential to identify and manage their complex health conditions, both during periods of supervision and – critically – after return to the community. </p>
<p>Aboriginal Community Controlled Health Organisations are <a href="https://link.springer.com/article/10.1186/s12889-020-09943-4">well placed</a> to provide this and to support continuity of care as these children transition in and out of detention.</p>
<p>But the Northern Territory is the only jurisdiction where they are funded to provide health care in youth detention.</p>
<p>Aboriginal Community Controlled Health Organisations are unable to access Commonwealth funding to support health care in detention elsewhere.</p>
<p>Discriminatory exclusion from access to Medicare, which typically prevents access to Aboriginal Community Controlled Health Organisations in detention, is an example of the “<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00243-9/fulltext">inverse care law</a>”. This is when those most in need of high-quality health care are least likely to receive it.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/victorias-prison-health-care-system-should-match-community-health-care-180558">Victoria’s prison health care system should match community health care</a>
</strong>
</em>
</p>
<hr>
<h2>Progress has been slow so far</h2>
<p>Health-care reform in youth justice is clearly and urgently required, but progress has been slow. One reason is the lack of independent oversight of these systems. </p>
<p>Despite <a href="https://www.ombudsman.gov.au/industry-and-agency-oversight/monitoring-places-of-detention-opcat">ratifying</a> the UN Optional Protocol to the Convention against Torture in 2017, Australia has <a href="https://theconversation.com/australias-twice-extended-deadline-for-torture-prevention-is-today-but-weve-missed-it-again-197793">yet to establish</a> the mechanisms required under this protocol to permit independent scrutiny of places of detention. </p>
<p>As a priority, we need to meet our international obligations – through both permitting unfettered access to all youth detention centres and investing appropriately in <a href="https://www.ombudsman.gov.au/industry-and-agency-oversight/monitoring-places-of-detention-opcat">independent scrutiny</a> – in every state and territory.</p>
<p>Australia is also lagging behind in routine monitoring of health and health care in youth detention. More than five years ago, the Australian Institute of Health and Welfare <a href="https://www.aihw.gov.au/reports/youth-justice/health-justice-involved-young-people-2016-17/summary">recommended</a> producing regular reports on health care in youth justice settings. But there is still no Commonwealth or state/territory funding or mechanism for this critical monitoring.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-twice-extended-deadline-for-torture-prevention-is-today-but-weve-missed-it-again-197793">Australia's twice extended deadline for torture prevention is today, but we've missed it again</a>
</strong>
</em>
</p>
<hr>
<h2>Why we need to lift our game</h2>
<p>Improving the health of this marginalised group is important to improving health equity, closing the gap, and preventing the tragic loss of young lives. </p>
<p>Australia can no longer ignore that some of our most disadvantaged children are dying at a much faster rate than expected, and from causes that are largely preventable. Doing so would amplify cycles of racism and social exclusion. </p>
<p>Under the <a href="https://www.unicef.org.au/united-nations-convention-on-the-rights-of-the-child">UN Convention on the Rights of the Child</a> all children, including those in contact with the youth justice system, have the right to the highest attainable standard of health. We owe it to them to make this a reality.</p><img src="https://counter.theconversation.com/content/211046/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lucas Calais Ferreira receives funding from Suicide Prevention Australia.</span></em></p><p class="fine-print"><em><span>Stuart Kinner receives funding from the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Professor Susan Sawyer is a member of the Youth Justice Act Independent Expert Group for the Victorian Government, Department of Justice and Community Safety.</span></em></p><p class="fine-print"><em><span>Alex Brown 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>Children as young as ten don’t have access to Medicare if detained. And they’re dying of largely preventable diseases.Lucas Calais Ferreira, Postdoctoral Research Fellow, The University of MelbourneAlex Brown, Professor of Indigenous Genomics, Australian National UniversityStuart Kinner, Professor of Health Equity, Curtin UniversitySusan M Sawyer, Professor of Adolescent Health The University of Melbourne; Director, Royal Children's Hospital Centre for Adolescent Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2079732023-07-31T17:08:55Z2023-07-31T17:08:55ZQuébec’s cultural awareness training makes flawed assumptions that do not prioritize the safety of Indigenous people<figure><img src="https://images.theconversation.com/files/538194/original/file-20230719-17-vp87en.jpg?ixlib=rb-1.1.0&rect=31%2C116%2C2964%2C1913&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A protest demanding justice for Joyce Echaquan in Montréal in October 2020.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/quebecs-cultural-awareness-training-makes-flawed-assumptions-that-do-not-prioritize-the-safety-of-indigenous-people" width="100%" height="400"></iframe>
<p>Québec’s Minister Responsible for Relations with the First Nations and the Inuit, Ian Lafrenière, recently introduced <a href="https://www.assnat.qc.ca/en/travaux-parlementaires/projets-loi/projet-loi-32-43-1.html">Bill 32</a>, which aims to “establish the cultural safety approach within the health and social services network.” </p>
<p><a href="https://montrealgazette.com/news/quebec/quebec-bill-to-require-health-network-take-indigenous-cultural-safety-approach">The intent of the bill</a> is for health and social service networks in Québec to adopt a cultural safety approach towards Indigenous people, taking into account cultural and historical realities. </p>
<p>In November 2020, in the aftermath of the <a href="https://www.cbc.ca/news/canada/montreal/joyce-echaquan-systemic-racism-quebec-government-1.6196038">death of Joyce Echaquan</a> at the Centre hospitalier de Lanaudière in Joliette, the Québec government introduced <a href="https://www.ledevoir.com/societe/sante/589272/quebec-sensibilisera-les-travailleurs-de-la-sante-a-la-realite-autochtone">90-minute mandatory Indigenous cultural awareness training</a> for all employees of the province’s ministry of health and social services. </p>
<p>The goal of this training was to quickly sensitize health-care personnel to Indigenous cultures in order to improve the care provided for First Nations and Inuit Peoples in the Québec health and social services system. </p>
<p>It also aims to deconstruct myths and prejudices regarding Indigenous Peoples, to foster effective intercultural communication and to <a href="https://cdn.ciussscentreouest.ca/documents/ciusss-coim/Coin_des_employes/Formations/DAA_FAQ_formation_sensibilisation.pdf?1632505254">allow employees to better work with members of Indigenous communities</a>. </p>
<p>However, since the training program was launched, Indigenous leaders and health professionals have said it <a href="https://www.cbc.ca/news/indigenous/quebec-health-care-cultural-training-1.6593446">fails to improve cultural safety</a> and <a href="https://ici.radio-canada.ca/nouvelle/1917604/joyce-echaquan-formation-critique-realites-autochtones">poses safety risks to Indigenous Peoples</a>.</p>
<p>Legislating individuals and systems to shift behaviours and attitudes is useless without well-developed cultural safety programs developed and delivered by Indigenous Peoples.</p>
<h2>Cultural safety</h2>
<p>In April, we attended a round table on cultural safety organized by the Québe Network Environment for Indigenous Health Research on cultural safety alongside Indigenous scholars, patient partners and other community members in Montréal. Participants at the round table arrived to the same conclusions and supported concerns that the content of the mandatory training is <a href="https://www.cbc.ca/news/indigenous/quebec-health-care-cultural-training-1.6593446">inadequate and contains inaccuracies</a>. </p>
<p>In addition, important results and calls to actions from the <a href="https://www.rcaanc-cirnac.gc.ca/eng/1450124405592/1529106060525">Truth and Reconciliation Commission</a>, the <a href="https://www.cerp.gouv.qc.ca/fileadmin/Fichiers_clients/Rapport/Final_report.pdf">Viens Commission Report</a>, and the <a href="https://www.rcaanc-cirnac.gc.ca/eng/1448633299414/1534526479029">National Inquiry into Missing and Murdered Indigenous Women and Girls</a> are not mentioned during the training. Glaringly absent are also any references to the concept of cultural safety, cultural humility, systemic racism and <a href="https://principedejoyce.com/en/index">Joyce’s Principle</a> — which “aims to guarantee to all Indigenous people the right of equitable access, without any discrimination, to all social and health services.”</p>
<p>In this article, we assert that Québec’s training falls short of its objectives because it is based on three flawed assumptions about the problem at hand.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/538367/original/file-20230719-19444-4i9jfv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man holds a candle and a photo of a woman that reads: Justice pour Joyce" src="https://images.theconversation.com/files/538367/original/file-20230719-19444-4i9jfv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538367/original/file-20230719-19444-4i9jfv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538367/original/file-20230719-19444-4i9jfv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538367/original/file-20230719-19444-4i9jfv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538367/original/file-20230719-19444-4i9jfv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538367/original/file-20230719-19444-4i9jfv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538367/original/file-20230719-19444-4i9jfv.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"></a>
<figcaption>
<span class="caption">A man attends a vigil for Joyce Echaquan, who died in a Québec hospital in September 2020. Indigenous leaders and health-care professionals have said cultural awareness training mandated after Echaquan’s death fails to improve safety for Indigenous people in Québec’s health-care system.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Paul Chiasson</span></span>
</figcaption>
</figure>
<p><strong>1. Racism is an individual problem.</strong> </p>
<p>The focus on mandatory training as a solution to a systemic issue misrepresents the problem of racism as an individual problem of bias, attitudes and knowledge. Discrimination by health-care professionals should not be viewed only as individual acts, but as part of broader patterns of institutional and systemic racism.</p>
<p><a href="https://www.homelesshub.ca/resource/first-peoples-second-class-treatment-role-racism-health-and-well-being-indigenous-peoples">Researchers</a> and <a href="https://doi.org/10.1016/j.socscimed.2013.09.006">scholars</a> in this field assert that racism in health care needs to be understood in the context of past and current colonialism. </p>
<p>It is a fact that colonial policies of assimilation were based on a <a href="https://www.nccih.ca/docs/determinants/FS-Racism2-Racism-Impacts-EN.pdf">racist ideology that presupposed inferiority</a> of Indigenous Peoples. These policies have imprinted racist structures and stereotypes across institutions. </p>
<p>For instance, when analyzing the case of Echaquan, <a href="https://www.coroner.gouv.qc.ca/fileadmin/Enquetes_publiques/2020-06375-40_002__1__sans_logo_anglais.pdf">coroner Géhane Kamel revealed</a> her mistreatment took place in an environment that lacked culturally appropriate resources, was characterized by inequitable practices and tolerated racist attitudes and comments. </p>
<p>Understanding the problem of racial discrimination in health care means we must frankly and openly discuss contemporary colonialist and racist realities. To address systemic racism and its influence on health, we need to go beyond individual racial bias and address <a href="https://doi.org/10.1016/j.socscimed.2013.09.006">structural power inequalities</a>. Systemic racism needs systemic solutions, not individual ones. </p>
<p><strong>2. Racism, bias and stereotypes can be addressed through cultural sensitivity training.</strong> </p>
<p>The educational strategies that underlie the awareness training are insufficient to countering racism and fostering cultural safety. This is because the training program is based on a cultural sensitivity approach. However, numerous studies suggest this kind of training may <a href="https://doi.org/10.1093/intqhc/mzr008">reinforce negative stereotypes</a> of the concerned groups. </p>
<p>Cultural sensitivity tends to focus on having knowledge of a patient’s culture and reducing their experience of the health-care system to a matter of overcoming <a href="https://www.homelesshub.ca/resource/first-peoples-second-class-treatment-role-racism-health-and-well-being-indigenous-peoples">cultural differences</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/538370/original/file-20230719-19-ux8gy.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A seated woman wearing glasses and holding papers speaks into a microphone." src="https://images.theconversation.com/files/538370/original/file-20230719-19-ux8gy.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538370/original/file-20230719-19-ux8gy.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=453&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538370/original/file-20230719-19-ux8gy.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=453&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538370/original/file-20230719-19-ux8gy.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=453&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538370/original/file-20230719-19-ux8gy.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=570&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538370/original/file-20230719-19-ux8gy.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=570&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538370/original/file-20230719-19-ux8gy.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=570&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In her report, Coroner Géhane Kamel called on the Québec government to acknowledge the existence of systemic racism and commit to eliminating it.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
</figcaption>
</figure>
<p>Research shows that cultural <em>safety</em> is a better way to foster change. It compels us to examine the <a href="https://www.inspq.qc.ca/sites/default/files/publications/2870-formations-securisation-culturelle-sante-services-sociaux.pdf">power imbalances and racial inequities underlying the health-care system</a>. Cultural safety promotes an approach to foster change that moves away from simply learning about a culture. Instead, it aims to help staff <a href="https://www.inspq.qc.ca/sites/default/files/publications/2870-formations-securisation-culturelle-sante-services-sociaux.pdf">examine their own beliefs</a> and how these manifest in their interactions with Indigenous patients. </p>
<p>Scholars propose a conception of cultural safety as a systemic approach to health-care transformation, one that goes beyond individual training but engages organizations and society as a whole towards the principles of cultural safety, equity, social justice and decolonization. As such, comprehensive Indigenous cultural safety training programs should explicitly integrate notions of power, privilege, colonialism and racism. </p>
<p><strong>3. Cultural safety can’t be developed without involving the concerned groups.</strong> </p>
<p>The lack of meaningful involvement by Indigenous stakeholders is a critical weakness of the awareness training. However, cultural safety <a href="https://doi.org/10.2182/cjot.2012.79.3.4">privileges the autonomy</a> and self-determination of Indigenous Peoples in relation to their health services, and as such, promotes their empowerment. </p>
<p>The current awareness training does not significantly involve Indigenous stakeholders. <a href="https://www.cbc.ca/news/indigenous/quebec-health-care-cultural-training-1.6593446">It relies on few Indigenous perspectives and voices compared to non-Indigenous professors for instance</a>. This is contrary to the very concept of cultural safety. It also contradicts all the declarations, <a href="https://www.vch.ca/sites/default/files/import/documents/VCH-AH-ICS_Resources_Workbook_JAN21.pdf#:%7E:text=Many%20Indigenous%20communities%20live%20by%20the%20principle%20of,empower%20and%20facilitate%20sustainable%20change%20with%20Indigenous%20communities">protocols and principles</a> established by Indigenous groups in the last decades, which are based on the rallying cry “nothing about us without us.” </p>
<p>Cultural safety should be guided by the people it concerns. They are the only ones with the lived experience to share on the topic of safety and on the <a href="https://www.croakey.org/wp-content/uploads/2017/08/RAMSDEN-I-Cultural-Safety_Full.pdf">nature of the desired care</a>. </p>
<p>This approach to health-care transformation recognizes Indigenous expertise in designing solutions relevant to their needs. <a href="https://cerpe.uqam.ca/wp-content/uploads/sites/29/2016/08/Protocole-de-recherche-des-Premieres-Nations-au-Quebec-Labrador-2014.pdf">Cultural safety</a> is aligned with <a href="https://fnigc.ca/ocap-training/">principles that promote empowerment</a> and rely on values such as respect, equity and reciprocity. </p>
<p>In addition to failing to address the problems Indigenous people face, the training risks further marginalization and continued discrimination, as well as increased distrust of government and institutions among Indigenous populations. </p>
<p>For these reasons, this training should be immediately discontinued. To create a more equal health-care system, Indigenous people, organizations and health-care professionals — Indigenous or not — must have space to develop solutions based on cultural knowledge, lived experiences and their collective expertise. </p>
<p><em>The authors of this piece would like to acknowledge the significant contributions made to the article by the members of the Indigenous patient partner circles of the Unité de Soutien SSA Québec.</em></p><img src="https://counter.theconversation.com/content/207973/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marie-Claude Tremblay receives funding from the Canadian Institutes of Health Research, the Fonds de recherche du Québec - Santé and the Fonds de recherche du Québec - Société et culture. </span></em></p><p class="fine-print"><em><span>Alex M. McComber receives funding from the CIHR for Pathways 3 project, but receives no personal funds.
He is affiliated with the Pathways Indigenous Advisory Committee with Boehringer Ingelheim for which he is compensated.
</span></em></p><p class="fine-print"><em><span>Georgia Limniatis receives funding from McGill University. </span></em></p>Cultural awareness training for health-care workers places focus on individual biases rather than tackling the systemic problems that negatively impact Indigenous patients.Marie-Claude Tremblay, Professeure agrégée, Département de médecine familiale et de médecine d'urgence, Chercheuse à VITAM, centre de recherche en santé durable, Université LavalAlex M. McComber, Assistant Professor of Family Medicine, McGill UniversityGeorgia Limniatis, DMD Candidate, Faculty of Dental Medicine and Oral Health Sciences, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2062862023-06-18T20:07:28Z2023-06-18T20:07:28ZThe first sleep health program for First Nations adolescents could change lives<figure><img src="https://images.theconversation.com/files/530012/original/file-20230605-21-nyuumj.jpg?ixlib=rb-1.1.0&rect=25%2C17%2C5725%2C3811&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com.au/detail/photo/girl-sleeping-on-bed-in-morning-royalty-free-image/1025549880?phrase=teen+sleep&adppopup=true">Getty</a></span></figcaption></figure><p>Adolescence is a sensitive life stage when emerging independence, changing social roles, excessive screen time, academic pressures, and significant biological changes can lead to emotional and behavioural problems. </p>
<p>The current <a href="https://www.penguinrandomhouse.com/books/647334/generation-sleepless-by-heather-turgeon-mft-and-julie-wright-mft-foreword-by-daniel-j-siegel/">generation</a> of teens is chronically sleep-deprived and, unfortunately, considered the most sleep-deprived group in human history.</p>
<p>In teenagers, irregular bedtimes, short sleep duration and poor sleep quality are commonly reported <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301929/">sleep issues</a>. These problems can cause emotional regulation issues, risky behaviour and academic disengagement. In the longer term, <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/teenagers-and-sleep">poor sleep</a> can lead to obesity, health conditions (including diabetes), mental health problems, and risk taking behaviour. </p>
<p>The issue of poor sleep and its impact on life outcomes needs particular attention for Aboriginal and Torres Strait Islander teenagers who experience <a href="https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(22)00005-0/fulltext">disproportionately high rates</a> of poor outcomes in health, social and emotional well-being and education. </p>
<h2>Sleep vulnerability</h2>
<p>The ongoing effects of colonisation, intergenerational trauma, and other <a href="https://www.aihw.gov.au/reports/australias-health/social-determinants-and-indigenous-health">social determinants of health</a> increase the vulnerability of Aboriginal and Torres Strait Islander teenagers to poor sleep. While some poor sleep issues are transient, continued exposure to racism, discrimination, household overcrowding and lack of safe sleeping spaces lead to chronic sleep issues. </p>
<p>Sleep health data for Aboriginal and Torres Strait Islander peoples is limited. Still, some studies suggest one in three young Aboriginal and Torres Strait Islander people struggle with poor sleep, significantly higher than their <a href="https://static.aifs.gov.au/files/r1GpIwOaS7tS/LSAC-ASR-2018-Chap4-sleep.pdf">non-Indigenous counterparts</a>. </p>
<p>The impact of poor sleep on the life outcomes of Aboriginal and Torres Strait Islander young people is a <a href="https://www.sleep.org.au/common/Uploaded%20files/Public%20Files/Latest%20News/ASA%20Sleep%20Health%20in%20Indigneous%20Australians%20REPORT-final.pdf">major concern</a> for community members, service providers and policymakers. </p>
<p>Despite this, services focused on sleep health promotion in Aboriginal and Torres Strait Islander communities are non-existent. This could be because although the need for healthy sleep is universal, the meaning of sleep health is shaped by cultural and societal factors. These include the acceptability of co-sleeping, living in multi-family housing or the role of dreaming.</p>
<p>Mainstream programs that don’t draw together the principles of health and cultural knowledge offer limited effectiveness for sleep health promotion in Aboriginal and Torres Strait Islander communities. But a new program could change that.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1603356879714926592"}"></div></p>
<h2>A co-designed approach</h2>
<p>In response to community needs, Australia’s first sleep health program for Aboriginal and Torres Strait Islander teenagers – Let’s Yarn About Sleep – was co-designed in Mount Isa, Queensland.</p>
<p>Community members were vocal about wanting to harness the potential of sleep as part of efforts to improve health outcomes, reduce teenage contact with the criminal justice system and improve academic engagement. Community yarns also identified the need to strengthen local sleep health service delivery and train Aboriginal and Torres Strait Islander people as “sleep coaches”.</p>
<p>The co-design and evaluation of the program involved consultations with more than 200 community members, integrating Traditional and Western knowledge on sleep health and offering ideas for improving sleep. </p>
<p>The ten-week program includes data collection before and after delivery, including questionnaires, sleep diaries and actigraphy (a non-invasive method of monitoring human rest and activity cycles). </p>
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<strong>
Read more:
<a href="https://theconversation.com/drinking-fountains-in-every-town-wont-fix-all-our-water-issues-but-its-a-healthy-start-204912">Drinking fountains in every town won't fix all our water issues – but it's a healthy start</a>
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<h2>What the program involves</h2>
<p>The program empowers young people to identify their sleep health goals and work with coaches to achieve them. At the beginning of the program, participants identify a group and an individual goal they would like to attain. </p>
<p>The group goal focuses on making sleep health a priority. For example, group members agreeing not to use their phones after 10pm. Individual goals are focused on reponses to personal circumstances. So, individual goals included de-cluttering or going to bed at least 30 minutes earlier. </p>
<p>While the program’s key focus is to improve participants’ knowledge, understanding and awareness of sleep health, one of the key objectives is to support participants in developing sustainable sleep hygiene practices (healthy habits for a good night’s sleep). During the program, participants learn about sleep hygiene practices such as following a consistent bedtime, reducing screen time and practising Indigenous relaxation training before bedtime.</p>
<p>The program has also led to the training of two Aboriginal and Torres Strait Islander people as Australia’s first Indigenous sleep coaches. Clinical staff at the local Aboriginal Community Controlled Health Organisation and hospital have since expressed interest in gaining these skills. </p>
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Read more:
<a href="https://theconversation.com/to-reduce-harm-from-alcohol-we-need-indigenous-led-responses-204030">To reduce harm from alcohol, we need Indigenous-led responses</a>
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<h2>What happened as a result of improved sleep</h2>
<p>So far, 35 teenagers in the community have been enrolled in the program and 13 have graduated. The program has also been integrated into the Emerging Leaders program at the local high school. </p>
<p>The program data shows the majority of the program participants were staying up until very late at the night. However, participants achieved their self-identified goals and believe this program gave them tools to improve their sleep. The program has received support from community Elders, parents and carers, service providers and young people. </p>
<p>The project team and community members are working to co-design a sleep health program for adults and extend the youth sleep program to other communities. </p>
<p>Roslyn Von Senden, a Kalkadoon woman from Mount Isa, who is training to become a sleep coach, reflected on the cultural importance of the program.</p>
<blockquote>
<p>Dreams are an important part of our life, a medium to connect with our ancestors to be guided, foresee things, connect with others, and get inspiration and ideas to express our artistic talent. Sleep loss deprives us of opportunities to connect with our culture, ancestors, and who we are as traditional custodians of the world’s oldest surviving culture.</p>
</blockquote>
<p>While the initial program was funded through the Medical Research Future Fund and focused on Mount Isa, additional funding from the National Health and Medical Research Council and industry partner Beyond Blue supports the program in other remote communities. </p>
<p>The resulting community-led sleep health movement aims to leverage the untapped potential of sleep health in improving academic and sporting performance, reducing crime, improving health outcomes and empowering Aboriginal and Torres Strait Islander young people.</p><img src="https://counter.theconversation.com/content/206286/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yaqoot Fatima is supported by funding from the NHMRC Partnership Grant, MRFF Indigenous Health Research Grant, MRFF-EMCR grant, and Beyond Blue for sleep health research. </span></em></p><p class="fine-print"><em><span>Azhar Potia's research is supported partially by the Australian Research Council's Centre of Excellence for Children and Families over the Life Course (Project ID CE200100025).</span></em></p><p class="fine-print"><em><span>James Ward and Mina Kinghorn 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 issue of poor sleep needs particular attention in the context of Aboriginal and Torres Strait Islander teenagers who have high rates of poor health, social and emotional well-being and education.Yaqoot Fatima, Associate Professor, UQ Poche Centre for Indigenous Health, The University of QueenslandAzhar Potia, Research Fellow, Queensland Brain Institute, The University of Queensland, The University of QueenslandJames Ward, Director of POCHE Centre for Indigenous Health, The University of QueenslandMina Kinghorn, Senior project Coordinator, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1946912023-06-15T12:37:48Z2023-06-15T12:37:48ZAmerican Indians forced to attend boarding schools as children are more likely to be in poor health as adults<figure><img src="https://images.theconversation.com/files/503911/original/file-20230110-24-749og5.jpg?ixlib=rb-1.1.0&rect=13%2C19%2C4341%2C2883&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research reveals what generations of tribes know firsthand: that forced assimilation and unhealthy conditions at compulsory boarding schools takes a permanent toll.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-healthcare-assistance-in-a-home-royalty-free-image/1397246903?adppopup=true">RichLegg/E+ via Getty Images</a></span></figcaption></figure><p>Many American Indians attended compulsory boarding schools in the 1900s or have relatives who did. My family is no different. Three generations of Running Bears – my grandparents, parents and those from my own generation – attended these residential schools over a period stretching from approximately 1907 to the mid-1970s. </p>
<p>American Indians are very resilient, given the harsh history we have endured. Drawing upon the strengths of our spirituality, cultural practices and family and community interconnections, we continue to persevere. </p>
<p>Even so, as a young adult I recognized that – compared with the broader society – my community experienced <a href="https://doi.org/10.1007/s00127-018-1494-1">higher rates of mental</a> and <a href="https://doi.org/10.1371/journal.pone.0242934">physical health problems</a>: depression, anxiety, suicide, diabetes and cancer, to name just a few. I wondered whether attending compulsory boarding school – an experience that sets American Indians apart from other minority groups – contributed to these health disparities. </p>
<p>I’m a <a href="https://und.edu/directory/ursula.runningbear">scholar who studies public health</a>, so this question – and the fact that little quantitative scientific inquiry into it had been undertaken – was at the forefront of my thoughts when I had the opportunity to investigate the health effects of boarding schools on American Indians. </p>
<h2>Truth in the data</h2>
<p>When I embarked on this research in 2014, I began by analyzing a portion of the <a href="https://doi.org/10.1176/appi.ajp.162.9.1723">data collected from</a> the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project. That project focused on the prevalence of mental health disorders and service utilization among Northern Plains and Southwest tribes and collected some data on boarding school attendance and experiences. </p>
<p>For my study, I used the Northern Plains sample that included more than 1,600 randomly selected tribal-enrolled members from the Northern Plains and assessed quality of life – specifically overall physical functioning and well-being. I found that those who attended boarding school had on average <a href="https://doi.org/10.1007/s11482-017-9549-0">statistically significantly lower scores</a> than those who did not attend. </p>
<p>As a researcher, I felt vindicated to find a statistically significant relationship between boarding school attendance and poor physical health – quantitative evidence of what I and many other American Indians already knew instinctively. Yet this finding was also deeply painful. Throughout my life I have sensed the unspoken pain and emotion of my family’s boarding school experiences. </p>
<p>These results made their devastation undeniable and much more tangible. </p>
<h2>Forced assimilation takes a physical toll</h2>
<p>American Indian boarding schools used brutal methods to assimilate their students into the dominant culture and inculcate Christian beliefs and practices. Although <a href="https://theconversation.com/truth-and-healing-commission-could-help-native-american-communities-traumatized-by-government-run-boarding-schools-that-tried-to-destroy-indian-culture-169240">those practices are well documented</a>, quantitative research into whether they had an effect on the long-term physical health of American Indian people who were subjected to them was hard to come by. </p>
<p>Using a subset of the Northern Plains sample, which included more than 700 American Indians who had attended boarding school, I examined the effects of five well-established aspects of boarding school experience. They included an age of first attendance of 7 or younger, rare or nonexistent visits with family, forced church attendance, punishment for use of their native language and a prohibition on the practice of American Indian cultural traditions.</p>
<p>I found that those who endured these experiences during boarding school had worse physical health status than those who did not. </p>
<p>However, the poorest physical health status occurred <a href="https://doi.org/10.1007/s11136-017-1742-y">among people who had been older than 7</a> when they entered boarding school and had also experienced punishment for speaking their tribal language. I am not sure why this is the case, but one possibility is that older children were more proficient in their first, tribal, language, making it more difficult to transition to English, which led, in turn, to more punishment for failure to speak the colonizing language.</p>
<p>Again, although the findings hit me deeply, I was not surprised. Fortunately, today there are efforts to revitalize and restore American Indian languages and culture, such as the <a href="https://sicangucdc.org/wakanyeja-tokeyahci">Wakanyeja Tokeyahci Lakota Immersion School</a>.</p>
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<figcaption><span class="caption">In this 2021 MSNBC report, former attendees of American Indian boarding schools recount experiences of emotional, physical and sexual abuse.</span></figcaption>
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<h2>Chronic health issues</h2>
<p>Recognizing the seriousness of all of this, and its potential effect on my immediate family, I examined whether <a href="https://doi.org/10.1097%2FFCH.0000000000000205">15 chronic health conditions</a> were statistically associated with having attended boarding school. These conditions include diabetes, hypertension, arthritis and kidney disease, among others. I found that former boarding school attendees were 44% more likely to have chronic physical health conditions, with seven out of the 15 chronic conditions statistically related to boarding school attendance. </p>
<p>For example, those who had attended boarding schools were more than twice as likely to <a href="https://doi.org/10.1111/napa.12092">report tuberculosis</a>. This, too, was not surprising, since historical accounts and health reports have <a href="https://narf.org/nill/resources/meriam.html">documented the overcrowded conditions</a>. In addition, windows were often boarded to prevent students from running away, which led to inadequate ventilation. </p>
<p>Boarding school attendees likewise had nearly four times the risk of any type of cancer as those who were not subjected to boarding school. One reason for this could be <a href="https://www.cdc.gov/biomonitoring/DDT_FactSheet.html#">exposure to the pesticide DDT</a>, which was banned in the U.S. in 1972. Upon arriving for the school year, <a href="https://www.npr.org/2022/10/17/1129402172/interior-secretary-haaland-is-documenting-abuse-in-federal-indian-boarding-schoo">students were often coated in DDT powder</a> to target disease-bearing insects like mosquitoes. </p>
<p>I also found higher rates of diabetes, high cholesterol, anemia and gallbladder issues – diseases that can be associated with changing from a whole food diet to one higher in sugars, starches and fats. Given that this shift has been widely reported throughout the American Indian population in recent decades, it is worth noting that these effects appear to be even more pronounced in former boarding school students than in their peers who did not attend.</p>
<h2>Generational effects</h2>
<p>Finally, I examined whether a participant’s mother’s and father’s attendance was related to the number of chronic physical health conditions the person experienced. </p>
<p>I found that someone whose father attended boarding school had, on average, <a href="https://doi.org/10.1097/fch.0000000000000205">36% more chronic physical health conditions</a> than someone whose father did not attend. Notably, I did not find this effect from a mother’s boarding school attendance, although the reasons for that aren’t yet clear.</p>
<p>Although this study did not specifically look at epigenetics – shifts in gene expression that are heritable – <a href="https://doi.org/10.4161/epi.6.7.16222">it points to the possibility of epigenetic effects</a> that can produce biological changes that span generations.</p>
<p>All of this is to say that compulsory residential boarding school education has had profound consequences for several generations of American Indians. As troubling as that is, I have faith that, as evidence mounts on the impacts of boarding school attendance on American Indians, our communities and their allies will develop solutions that improve health and healing for all of our people.</p><img src="https://counter.theconversation.com/content/194691/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ursula Running Bear receives funding from the National Institute of General Medical Sciences of the National Institutes of Health.
Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.. </span></em></p>Native Americans sent to government-funded schools now experience significantly higher rates of mental and physical health problems than those who did not.Ursula Running Bear, Assistant Professor of Population Health, University of North DakotaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2060842023-06-14T20:10:13Z2023-06-14T20:10:13ZFirst Nations women don’t always access health care after head injuries from family violence. Here’s why<figure><img src="https://images.theconversation.com/files/531828/original/file-20230614-21-zf11ko.jpg?ixlib=rb-1.1.0&rect=24%2C12%2C3989%2C2106&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/silhouette-woman-sitting-on-bed-beside-1439614217">Shutterstock</a></span></figcaption></figure><p><em>Please be advised this article contains details of family violence.</em></p>
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<p>Aboriginal and Torres Strait Islander women are <a href="https://www.mja.com.au/journal/2008/188/10/hospitalisation-head-injury-due-assault-among-indigenous-and-non-indigenous">69 times</a> more likely than non-Indigenous women to be hospitalised with head injuries due to assaults. </p>
<p>But some Aboriginal and Torres Strait Islander women <a href="https://www.tandfonline.com/doi/full/10.1080/14461242.2023.2173018">don’t access</a> health care and support services after head injuries from family violence. Our <a href="https://www.tandfonline.com/doi/full/10.1080/0312407X.2023.2210115?src=">research</a>, published this week, explored some of the reasons why – and how these barriers can be overcome. </p>
<p>We found fear of child removal, poverty, coercive control and low awareness of traumatic brain injury related to <a href="https://www.indigenousmhspc.gov.au/publications/dfv">family violence</a> can all impact on when and how Aboriginal and Torres Strait Islander women <a href="https://www.anrows.org.au/project/improving-family-violence-legal-and-support-services-for-indigenous-women/">access health care and support services</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-nations-women-are-69-times-more-likely-to-have-a-head-injury-after-being-assaulted-we-show-how-hard-it-is-to-get-help-194249">First Nations women are 69 times more likely to have a head injury after being assaulted. We show how hard it is to get help</a>
</strong>
</em>
</p>
<hr>
<h2>What is traumatic brain injury?</h2>
<p>Traumatic brain injury is <a href="https://www.archives-pmr.org/article/S0003-9993(10)00650-7/pdf">caused by</a> a blow, jolt or bump to the head. <a href="https://doi.org/10.1080/10926771.2019.1591562">Non-fatal strangulation</a> can also lead to brain injury as the brain is deprived of oxygen. </p>
<p>Traumatic brain injuries vary from mild to severe, and can cause a range of behavioural, emotional, physical and psychological symptoms, <a href="https://pubmed.ncbi.nlm.nih.gov/12924684/">including</a>:</p>
<ul>
<li>poor memory</li>
<li>dizziness</li>
<li>headaches</li>
<li>lack of concentration</li>
<li>slowness to process information or make decisions</li>
<li>emotional dysregulation, such as inability to control anger</li>
<li>anxiety and depression</li>
<li>lack of insight, where the person with the injury does not realise the effect of their injury.</li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1541936693799833600"}"></div></p>
<p>The <a href="https://synapse.org.au/understanding-brain-injury/effects-of-brain-injury/">experience of brain injury</a> is unique to each person.</p>
<p>The degree of recovery is largely determined by the nature and extent of the injury as well as the level of engagement in rehabilitation. For <a href="https://www.braininjuryaustralia.org.au/download-bias-report-on-australias-first-research-into-family-violence-and-brain-injury/">moderate to severe</a> traumatic brain injury, recovery is most rapid in the first six months after the injury. </p>
<p>Even mild traumatic brain injury can have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8773525/">long-term impacts</a> on wellbeing, parenting capacity, relationships and day-to-day living. </p>
<p>Recovery can be maximised by providing education about the short- and long-term management of symptoms as well as the involvement of family in the rehabilitation and recovery phase. </p>
<h2>Listening to First Nations women</h2>
<p>To find out why Aboriginal and Torres Strait Islander women don’t always <a href="https://www.tandfonline.com/doi/full/10.1080/14461242.2023.2173018">access services</a>, we completed interviews and focus discussion groups with 28 women and 90 service provider professionals in Queensland and the Northern Territory.</p>
<p>Our study focused on Aboriginal and Torres Strait Islander women, as their voices are often <a href="https://theconversation.com/she-was-the-most-important-person-to-us-r-rubuntjas-story-shows-society-is-still-failing-first-nations-women-180857">silenced</a> when it comes to women’s safety.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/she-was-the-most-important-person-to-us-r-rubuntjas-story-shows-society-is-still-failing-first-nations-women-180857">'She was the most important person to us' – R. Rubuntja's story shows society is still failing First Nations women</a>
</strong>
</em>
</p>
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<h2>Fear of child removal</h2>
<p>In results similar to those from family violence studies, women told us they avoided health care or minimised the amount of information they shared with health professionals to reduce the risk of contact with child protection authorities. One woman told us:</p>
<blockquote>
<p>We won’t report when there is domestic violence. If there is any words that come from the woman that [her] children were there, children are considered at risk and so they are taken. </p>
</blockquote>
<p>Some women told us their children had been removed following reporting and seeking support following family violence.</p>
<h2>Risks of further violence</h2>
<p>Sometimes women were prevented from accessing health care by manipulation and coercive control. This included partners preventing them accessing a working phone or transport. </p>
<p>One service provider said:</p>
<blockquote>
<p>A lot of users of violence I guess employ such a level of control and coercion that sometimes women are prevented from seeking medical treatment, or attempts to seek medical treatment, or disclose violence, including assaults to the head. It might actually make the situation worse. </p>
</blockquote>
<h2>Women prioritise competing demands</h2>
<p>Community-based service providers recognised the strength and resilience of women in continuing their roles caring for children and other family members after experiencing family violence.</p>
<p>Service providers told us their clients were often also managing financial and housing worries. One service provider told us:</p>
<blockquote>
<p>When a woman arrives here, the most important thing is rest, food, and finding that space to just sit with what’s happened, and then medical attention. I don’t always hear women prioritising medical attention in the first instance. I think that rest definitely, and even hunger, on a real, basic survival level. </p>
</blockquote>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-traumatic-brain-injury-75546">Explainer: what is traumatic brain injury?</a>
</strong>
</em>
</p>
<hr>
<h2>Awareness of brain injury</h2>
<p>Community members and leaders we spoke to had low levels of awareness, knowledge and recognition of the long-term damage violence can have on the brain. One community member said:</p>
<blockquote>
<p>We didn’t know about this brain injury. </p>
</blockquote>
<p>Another participant said:</p>
<blockquote>
<p>I didn’t go to the hospital. I had a bit of [a] headache, didn’t think it was serious enough to [go] and get checked, it [headache] went away. It happened many times. One time I black out, wasn’t aware of the lasting harm that can cause.</p>
</blockquote>
<h2>So what are the solutions?</h2>
<p>There are a range of opportunities to address several of these barriers. </p>
<p>First, service providers (including <a href="https://doi.org/10.1002/ajs4.200">within child protection systems</a>) need to ensure women receive compassionate care, referrals and links to support services for traumatic brain injury in a meaningful, timely and appropriate way.</p>
<p>There are <a href="https://www.familymatters.org.au/wp-content/uploads/2022/11/20221123-Family-Matters-Report-2022-1.pdf">strong calls</a> to have community-controlled organisations deliver child protection services – with many potential benefits to families and communities. </p>
<p>We also need to resource communities to design, implement and evaluate traumatic brain injury prevention and early intervention solutions. </p>
<p>Community-wide and school-based education were among some of the recommendations from community members to help people recognise the signs of traumatic brain injury and the importance of seeking help.</p>
<p>Other strategies to improve access to services include placing supports such as social workers outside of acute, hospital settings – for example, in <a href="https://www.tandfonline.com/doi/full/10.1080/26408066.2023.2202665?src=">GP clinics</a> and Aboriginal Community Controlled Health Services. </p>
<p>Finally, front-line staff and university students need high-quality training and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6645196/">education about traumatic brain injury and family violence</a>, how it presents in parental behaviour, case management and referral pathways. </p>
<p>Any practical solutions must be implemented through local partnerships with Aboriginal and Torres Strait Islander peoples to ensure the measures are community-led, culturally safe and provide an overall benefit, without doing further harm.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-research-reveals-harrowing-stories-of-murdered-indigenous-women-and-the-failure-of-police-to-act-205655">New research reveals harrowing stories of murdered Indigenous women and the failure of police to act</a>
</strong>
</em>
</p>
<hr>
<p><em>If this article raises issues for you or someone you know, contact <a href="https://1800respect.org.au/">1800 RESPECT</a> (1800 737 732) or <a href="https://www.13yarn.org.au/">13YARN</a> (13 92 76). In an emergency, call 000.</em></p>
<p><em>Jody Barney is a co-author on the journal paper on which this article is based. The authors thank the project team, advisory group and participants who shared their time and knowledge.</em></p><img src="https://counter.theconversation.com/content/206084/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Fitts receives funding from the Australian Research Council. </span></em></p><p class="fine-print"><em><span>Jennifer Cullen receives funding from the Department of Social Services and the NDIS. She is the CEO of Synapse Australia.</span></em></p>Some First Nations women who sustain head injuries from family violence don’t access health care and support. We studied why and found one reason is a fear their children will be taken away.Michelle Fitts, ARC DECRA Fellow, Institute for Culture and Society, Western Sydney UniversityJennifer Cullen, Adjunct Associate Professor, College of Healthcare Sciences, James Cook UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2049122023-05-23T20:11:01Z2023-05-23T20:11:01ZDrinking fountains in every town won’t fix all our water issues – but it’s a healthy start<figure><img src="https://images.theconversation.com/files/526698/original/file-20230517-19-mq87we.jpg?ixlib=rb-1.1.0&rect=14%2C24%2C3244%2C2418&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/boy-drinking-fountain-61239514">Shutterstock</a></span></figcaption></figure><p>Water plays a significant role in Aboriginal culture. The <a href="https://www.dcceew.gov.au/parks-heritage/heritage/places/national/brewarrina#:%7E:text=The%20story%20of%20Baiame's%20Ngunnhu&text=The%20intricate%20design%20of%20the,high%20and%20low%20river%20flows.">Fish Traps in Brewarrina, Baiame’s Ngunnhu</a>, for example, were built by eight clan groups and continue to sustainably fish the Barwon River. </p>
<p>Respect for and <a href="https://humanrights.gov.au/sites/default/files/content/social_justice/nt_report/ntreport08/pdf/chap6.pdf">understanding of water</a> has enabled Aboriginal people to thrive for millennia in very hot and remote places. The <a href="https://www.tandfonline.com/doi/full/10.1080/07900627.2020.1868980">impacts of colonisation</a> including introduced species of plants and animals, farming and overuse of rivers and ground water, compounded by global warming, has dramatically reduced water access and quality, and in some places threatened the water supply.</p>
<p>Recent coverage of the quality of <a href="https://www.9news.com.au/national/residents-of-nsw-town-forced-to-drink-bottled-water/105752a7-1bec-4ac2-840d-336d74bc2924">drinking water in Walgett</a> in New South Wales again highlights that clean, safe drinking water is not a right in Australia. Walgett residents say the water is unsafe to drink and they’re backed by <a href="https://www.georgeinstitute.org.au/media-releases/aboriginal-organisations-demand-action-walgett-drinking-water-health-threat">scientists from the George Institute</a> who report an urgent need to address drinking water quality. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/countless-reports-show-water-is-undrinkable-in-many-indigenous-communities-why-has-nothing-changed-194447">Countless reports show water is undrinkable in many Indigenous communities. Why has nothing changed?</a>
</strong>
</em>
</p>
<hr>
<h2>Supply is only half the issue</h2>
<p>The reasons for poor or limited water supply vary. They include river flows and environmental health issues, infrastructure, and insufficient skilled, credentialed staff available to conduct water quality checks. But understanding the causes is one thing. Taking active steps to address them is another. </p>
<p>When clean, safe water doesn’t flow to communities, they are more likely to drink sugar-sweetened beverages. Our 2020 <a href="https://www.cdhjournal.org/issues/37-2-june-2020/1027-outcomes-of-a-co-designed-community-led-oral-health-promotion-program-for-aboriginal-children-in-rural-and-remote-communities-in-new-south-wales-australia">study</a> visited three remote schools with high proportions of Aboriginal students. Our initial results, gathered in 2014, found 64% of children regularly drank sugary drinks. Some 5% thought drinking water was “unhealthy”. In some places in Australia that’s <a href="https://theconversation.com/travelling-around-australia-this-summer-heres-how-to-know-if-the-water-is-safe-to-drink-196294">true at least some of the time</a>. </p>
<p>The availability of safe drinking water impacts tooth decay, obesity and <a href="http://www.fizz.org.nz/pdf/research/6%20Sugar%20Sweetened%20Beverages,%20Obesity,%20Diabetes%20and%20Oral%20Health.pdf">diseases like diabetes</a>. Australia has <a href="https://www.waterquality.gov.au/guidelines/drinking-water">drinking water quality guidelines</a> but they are not mandatory.</p>
<p>We installed cold, filtered water fountains through a structured, collaborative process and, as a result, found in 2018 that 84% of children at those same schools drank water every day. The percentage who regularly drank sugary drinks shrank to 33% in the intervening four-year period. </p>
<p>Our <a href="https://www.publish.csiro.au/PY/PY21119">follow up study</a> found towns of lower socioeconomic status were less likely to have access to community drinking water and more likely to have a high Aboriginal population. So, Aboriginal people are particularly disadvantaged by this issue. It also found that in many towns the cheapest drink is soft drink.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Outdoor view of river with traditional Indigenous fish traps in the water." src="https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526650/original/file-20230516-49756-sd9byh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Brewarrina fish traps in action.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Making a difference through codesign</h2>
<p>We have been working with NSW communities to install refrigerated water fountains in rural and remote places. We collaborate with local Aboriginal land councils, traditional owners, and local government using <a href="https://doi.org/10.17061/phrp3222215">codesign principles</a>. Together we confirm the need, identify a suitable location and then select the right model of water fountain. We also negotiate local responsibility for ongoing maintenance and provide water bottles, education resources and spare filters.</p>
<p>In most cases we work with schools and preschools to embed positive health messages and reinforce water as the best drink. As Kim Cooke, Director Little Yuin Preschool in Wallaga Lake says, </p>
<blockquote>
<p>The water fountain is a wonderful asset to the preschool outdoor learning environment. For us, as educators, it is central to the children’s health to be able to hydrate their bodies ready for learning; and having access to fresh water to drink everyday has led to an increase in their independence and learning about the importance of drinking water throughout the day. </p>
</blockquote>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1658616139377934336"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/travelling-around-australia-this-summer-heres-how-to-know-if-the-water-is-safe-to-drink-196294">Travelling around Australia this summer? Here's how to know if the water is safe to drink</a>
</strong>
</em>
</p>
<hr>
<h2>Meeting local need</h2>
<p>We recently <a href="https://www.publish.csiro.au/py/fulltext/PY21119">conducted a survey</a> of towns across Australia with a population of fewer than 5,000 people and Aboriginal population greater than 3%. We estimated that 222 places out of 612 small towns nationally do not have community drinking water.</p>
<p>Providing drinking water to every Australian town requires a place-by-place approach so that communities get a say about how and where fountains are installed and they meet local needs. Schools and preschools can participate in health promotion too. A national approach that overcomes the policy “ping pong” of responsibility for water safety, quality and infrastructure between local, state and the federal governments is also required. A national approach would enable:</p>
<ul>
<li><p>high quality infrastructure to be purchased at reasonable price</p></li>
<li><p>professional and timely installation </p></li>
<li><p>local responsibility for maintenance</p></li>
<li><p>codesign so that each town gets the infrastructure they need, where it’s needed.</p></li>
</ul>
<p>We estimate it would cost A$5 million to solve this problem nationally, based on our installation costs in NSW communities to date – a small investment in the prevention of chronic disease. </p>
<p>Water fountains in every town won’t solve all of our water issues. But they could ensure everyone can access free, cold drinks and reduce sugar consumption. </p>
<p>As community member, Brewarrina and Brewarrina Shire Councillor Aunty Trish says: </p>
<blockquote>
<p>Having cold water available after you finish your sports or on our hot days will mean a lot for the community, fresh water helps with the health and wellbeing of the community.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drinking-water-can-be-a-dangerous-cocktail-for-people-in-flood-areas-178028">Drinking water can be a dangerous cocktail for people in flood areas</a>
</strong>
</em>
</p>
<hr>
<hr>
<p><em>The authors wish to acknowledge Uncle Boe Rambaldini and Professor Chris Bourke, our project ambassadors. Aboriginal communities and local government authorities that have participated in our research and the implementation of water fountains. Our partners at the Alliance for a Cavity Free Future, Australian Dental Association NSW Branch, NSW Council of Social Service, Public Interest Advocacy Centre and Australian Red Cross.</em></p><img src="https://counter.theconversation.com/content/204912/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Charles Skinner has consulted to Colgate Palmolive Pty Ltd and the Aboriginal Health and Medical Research Council of NSW. He receives funding from Asthma Australia for research. He is affiliated with Charles Sturt University.</span></em></p><p class="fine-print"><em><span>Kylie Gwynne receives funding from NHMRC and various charities/foundations for research. She is affiliated with the Resolution Institute. </span></em></p><p class="fine-print"><em><span>Tom Calma receives funding from a consultancy on tackling Indigenous smoking from the Department of Health and Aged Care, an academic appointment with the University of Sydney and various other consultancies. He is affiliated with the University of Canberra and University of Sydney. </span></em></p>We estimate more than 200 communities across Australia do not have community drinking water fountains. That must change.John Charles Skinner, Senior Research Fellow, Indigenous Health, Macquarie UniversityKylie Gwynne, Senior Lecturer, Health Leadership, Macquarie UniversityTom Calma, Chancellor, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2040302023-05-18T20:01:24Z2023-05-18T20:01:24ZTo reduce harm from alcohol, we need Indigenous-led responses<figure><img src="https://images.theconversation.com/files/526666/original/file-20230517-15-4kdxgg.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C5149%2C3438&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/loving-african-american-foster-care-parent-1653226690">Shutterstock</a></span></figcaption></figure><p>Alcohol management in Aboriginal and Torres Strait Islander communities has been a deeply divisive issue, as seen recently in Alice Springs in the Northern Territory. </p>
<p><a href="https://www.theguardian.com/australia-news/2023/feb/04/we-have-to-come-together-alcohol-bans-alone-wont-fix-alice-springs-problems">Indigenous leaders called for</a> and welcomed emergency restrictions on the sale of alcohol from January 24 2023. </p>
<p>This approach resulted in an immediate decrease in alcohol-related harms, including family violence and emergency department presentations. </p>
<p>But Elders in Alice Springs <a href="https://www.theguardian.com/australia-news/2023/feb/04/we-have-to-come-together-alcohol-bans-alone-wont-fix-alice-springs-problems">have warned</a> these restrictions “should not let governments off the hook” from addressing the underlying social determinants of alcohol-related harm. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1621655313140314112"}"></div></p>
<p>This reflects a long-standing community concern that prohibition alone does nothing to address issues such as intergenerational trauma, poverty, housing, education, unemployment, access to alternative activities, access to adequate health care and racism. </p>
<p>Critics of government-imposed alcohol management argue the allocation of resourcing is <a href="https://newsevents.med.unsw.edu.au/sites/default/files/newsevents/news/Drug%20Budgets%20Mono%2024%20FINAL.pdf">too strongly weighted</a> toward supply reduction – and especially law enforcement – with inadequate funding of demand-reduction and harm-reduction strategies. </p>
<p>Our commentary, published this week in the <a href="https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(23)00092-5/fulltext">Lancet Western Pacific Regional Health</a>, highlights the need for culturally responsive approaches to alcohol in remote communities. Reductions in alcohol use are linked with the strength of culture, empowerment and community. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/want-to-improve-the-nations-health-start-by-reducing-inequalities-and-improving-living-conditions-64434">Want to improve the nation's health? Start by reducing inequalities and improving living conditions</a>
</strong>
</em>
</p>
<hr>
<h2>Incorporating Aboriginal culture</h2>
<p>Australia’s <a href="https://www.health.gov.au/sites/default/files/national-drug-strategy-2017-2026.pdf">National Drug Strategy</a> outlines three ways to address alcohol-related harm, by reducing:</p>
<ol>
<li><p>demand – preventing people taking up drinking or delaying starting, providing education, and offering treatment services</p></li>
<li><p>supply – reducing alcohol availability and greater policing </p></li>
<li><p>harm – encouraging responsible service of alcohol and providing services such as sobering-up shelters that reduce harm for people who are intoxicated. </p></li>
</ol>
<p>But development and implementation of these strategies has overlooked culturally responsive approaches to meet the needs of Aboriginal and Torres Strait Islander peoples. One such approach is the “interplay wellbeing framework”. </p>
<p>The <a href="https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-017-0563-5">interplay wellbeing framework</a> is based on Indigenous concepts of wellbeing and positions risky alcohol use in the context of systemic inequities across all the social determinants of health, including housing, education, employment and wealth. </p>
<p>Such approaches show how government and communities can work together in a shared and respectful space to progress the National Drug Strategy.</p>
<figure class="align-center ">
<img alt="Alice Springs town shot" src="https://images.theconversation.com/files/526697/original/file-20230517-29-a10oqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526697/original/file-20230517-29-a10oqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526697/original/file-20230517-29-a10oqt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526697/original/file-20230517-29-a10oqt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526697/original/file-20230517-29-a10oqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526697/original/file-20230517-29-a10oqt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526697/original/file-20230517-29-a10oqt.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">It’s important to look at risky drinking in the context of all the social determinants of health, including housing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/wide-image-alice-springs-nearby-hill-1655776171">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Non-drinkers and risky drinkers</h2>
<p>Overall, Indigenous Australians are <a href="https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/priority-populations/aboriginal-and-torres-strait-islander-people#Lifetime%20risk">more likely</a> to be non-drinkers (15.4%) compared to non-Indigenous people (7.9%). </p>
<p>But alcohol-related harm has been very destructive for many Indigenous communities. In 2018, alcohol <a href="https://www.aihw.gov.au/getmedia/1656f783-5d69-4c39-8521-9b42a59717d6/aihw-bod-32.pdf.aspx?inline=true">accounted for 10.5%</a> of the total burden of disease and injury for Indigenous Australians. This harm is preventable.</p>
<p>Risky levels of alcohol use for Indigenous Australians are often due to the ongoing <a href="https://link.springer.com/article/10.1007/s12546-016-9159-y">negative impacts of colonisation</a>. This includes intergenerational trauma, which manifests as <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/ajs4.109">poor psychological wellbeing</a> and is sometimes interlinked with risky alcohol consumption. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/life-changing-what-50-years-of-community-controlled-housing-at-yumba-meta-tells-us-about-home-and-health-203907">'Life changing' – what 50 years of community-controlled housing at Yumba-Meta tells us about home and health</a>
</strong>
</em>
</p>
<hr>
<h2>How alcohol harms</h2>
<p>According to the <a href="https://www.health.gov.au/resources/publications/national-alcohol-strategy-2019-2028?language=en">National Alcohol Strategy 2019–2028</a>, many people who drink at risky levels don’t consider themselves as heavy drinkers. Nor do they identify alcohol use as a <a href="https://www.health.gov.au/sites/default/files/documents/2020/11/national-alcohol-strategy-2019-2028.pdf">cause of</a> cancer, heart disease, stroke, liver disease and gastrointestinal disorders. </p>
<p><a href="https://healthbulletin.org.au/wp-content/uploads/2018/02/Alcohol-Review-Bulletin-2018.pdf">Social harms</a> related to alcohol use include physical assaults, injuries, child neglect and abuse, suicidal thoughts, partner violence and crime. Lives are lost prematurely to family violence, homicide, suicide and accidents. </p>
<p>The costs of alcohol-related social harm are estimated at <a href="https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/impacts/economic-impacts">A$66.8 billion dollars</a> in Australia from 2017–2018.</p>
<h2>Alcohol industry is a barrier to reducing harms</h2>
<p>The alcohol industry uses <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5998576/">excessive advertising</a> to promote alcohol as a safe product. The DrinkWise program, for instance, is <a href="https://journals.sagepub.com/doi/abs/10.1177/1329878X16651136">funded by the alcohol industry</a>. It seeks to <a href="https://www.tandfonline.com/doi/abs/10.1080/09581596.2010.529424">blame the consumer</a> as an irresponsible drinker. This reduces the need for the alcohol industry to take responsibility for its harmful product. </p>
<p>Harm-minimisation strategies need the genuine support of the alcohol industry if they are to effectively reduce alcohol use and respond to the impact of <a href="https://journals.sagepub.com/doi/10.1177/1077801217742756">serious injury, violence,</a> illness and disease related to alcohol use. </p>
<p>But to date, the alcohol industry has capitalised on the challenges communities face. It provides easy access <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440301/">alcohol outlets</a> in areas of lower socioeconomic status. This exploitative practice increases the risk of alcohol-related harm to people living in these areas.</p>
<figure class="align-center ">
<img alt="Alcohol shop shelves" src="https://images.theconversation.com/files/526725/original/file-20230517-29-2g9fwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526725/original/file-20230517-29-2g9fwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526725/original/file-20230517-29-2g9fwb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526725/original/file-20230517-29-2g9fwb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526725/original/file-20230517-29-2g9fwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526725/original/file-20230517-29-2g9fwb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526725/original/file-20230517-29-2g9fwb.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">The alcohol industry capitalises on the challenges of low socioeconomic communities.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/blurred-image-wine-shelves-display-supermarket-485979961">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Healing through culture</h2>
<p><a href="https://healingfoundation.org.au/app/uploads/2017/02/Aboriginal-and-Torres-Strait-Islander-Healing-Programs-A-Literature-Review.pdf">Indigenous-led approaches</a> to alcohol-related harm promote holistic wellbeing and draw on the healing qualities that Aboriginal culture offers. This is an effective way of alleviating intergenerational trauma and interrelated alcohol harm. </p>
<p>Community-level healing- and trauma-informed approaches can overcome barriers <a href="https://www.lowitja.org.au/content/Image/Lowitja_PJH_170521_D10.pdf">such as racism</a> that prevent people accessing health and social support systems. </p>
<p>However, they need to be adequately funded and resourced. Culturally responsive healing approaches need to be community-, evidence- and theory-informed and inclusive of both traditional healing and western methodologies.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/treatment-for-drug-and-alcohol-misuse-should-involve-families-and-communities-197536">Treatment for drug and alcohol misuse should involve families and communities</a>
</strong>
</em>
</p>
<hr>
<h2>How the model can work</h2>
<p>The value of culture on Country has been demonstrated through a healing model of care for promoting effective rehabilitation. </p>
<p><a href="https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-017-0135-0">Orana Haven Drug and Alcohol Residential Rehabilitation Service</a> is a three-month program that combines 12-step treatment with residential treatment facility focusing on:</p>
<ul>
<li>healing through culture and Country</li>
<li>emotional safety and relationships</li>
<li>strengthening life skills </li>
<li>improved wellbeing. </li>
</ul>
<p>Information collected <a href="https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-017-0135-0">through semi-structured interviews</a> found that embedding culture and being on Country enhanced participants’ feelings of connection, identity and spirituality.</p>
<h2>Indigenous leadership and self-determination</h2>
<p><a href="https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-022-00813-6">Culturally responsive approaches</a> require <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781315252414-3/indigenist-research-aboriginal-australia-lester-irabinna-rigney">Indigenous leadership</a> and culture to counter the harms associated with alcohol use. </p>
<p>This ensures the healing process can privilege resistance, resilience, interpersonal relationships and strengths. Incorporating a holistic view of community and culture can facilitate mutually respectful collaboration and <a href="https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf">self-determination</a> – and lead to sustained change. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-funds-will-tackle-indigenous-smoking-but-heres-what-else-we-know-works-for-quit-campaigns-205016">New funds will tackle Indigenous smoking. But here's what else we know works for quit campaigns</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/204030/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lorelle Holland receives funding from the National Health and Medical Research Council (NHMRC) Post Graduate Scholarship (PGS) and The Australian Academy of Science Douglas and Lola Douglas Scholarship in Medical Science. </span></em></p><p class="fine-print"><em><span>Andrew Smirnov, Natasha Reid, Nicole Hewlett, and Tylissa Elisara 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>For remote Indigenous communities, reductions in alcohol use are linked with the strength of culture, empowerment and community.Lorelle Holland, PhD Candidate, The University of QueenslandAndrew Smirnov, Senior Lecturer, The University of QueenslandNatasha Reid, Research Fellow, The University of QueenslandNicole Hewlett, Project Manager, The University of QueenslandTylissa Elisara, Senior Aboriginal and Torres Strait Islander Research Officer and Tutor, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050162023-05-05T07:04:25Z2023-05-05T07:04:25ZNew funds will tackle Indigenous smoking. But here’s what else we know works for quit campaigns<figure><img src="https://images.theconversation.com/files/524535/original/file-20230504-29-jg5f4w.jpg?ixlib=rb-1.1.0&rect=0%2C88%2C1000%2C562&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-african-american-girl-breaking-cigarette-2280036417">Studio Romantic/Shutterstock</a></span></figcaption></figure><p>Among all the talk this week about a <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping">crackdown on vaping</a> – the most significant <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-for-health-and-aged-care-speech-national-press-club-2-may-2023?language=en">tobacco control reforms</a> in a decade – has been the roll-out of another major document.</p>
<p>The <a href="https://www.health.gov.au/resources/publications/national-tobacco-strategy-2023-2030">National Tobacco Strategy 2023–2030</a> was launched this week.</p>
<p>A key priority of the strategy is Aboriginal and Torres Strait Islander smoking and <a href="https://www.closingthegap.gov.au/">Closing the Gap</a>. We heard the Tackling Indigenous Smoking program would be extended and widened – <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping?language=en">with A$141 million funding</a> – to reduce both vaping and smoking among Aboriginal and Torres Strait Islander people.</p>
<p>Here’s why that’s urgently needed and what needs to happen next to reduce smoking rates among Aboriginal and Torres Strait Islander people.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-can-cut-indigenous-smoking-and-save-lives-heres-how-42119">We can cut Indigenous smoking and save lives – here's how</a>
</strong>
</em>
</p>
<hr>
<h2>Tobacco is still a killer</h2>
<p>Tobacco <a href="https://www.aihw.gov.au/news-media/media-releases/2019/october/tobacco-use-linked-to-more-than-1-in-8-deaths-but">legally kills</a> over 57 Australians a day. That’s equivalent to extinguishing an entire country town of 21,000 every year. </p>
<p>It’s still the single biggest <a href="https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/burden-of-disease/overview">preventable</a> risk factor for disease and premature death. For Aboriginal and Torres Strait Islander <a href="https://www.aihw.gov.au/reports/burden-of-disease/illness-death-indigenous-2018/summary">people</a>, <a href="https://academic.oup.com/ije/article/50/3/942/6118443">more than a third</a> of all deaths are caused by tobacco. Over the past decade we have lost more than <a href="https://academic.oup.com/ije/article/50/3/942/6118443">10,000</a> Aboriginal and Torres Strait Islander lives due to smoking.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1654018018169753600"}"></div></p>
<p><a href="https://healthbulletin.org.au/articles/review-of-tobacco-use-among-aboriginal-and-torres-strait-islander-peoples/">Multiple policy failures</a> beyond health – from poverty, education, employment, housing, family removals, dislocation and the systematic embedding of tobacco as rations <em>in lieu</em> of wages – mean Aboriginal and Torres Strait Islander people are disproportionately impacted by the harms of Big Tobacco. </p>
<p>So the <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping?language=en">funding</a> to expand the <a href="https://tacklingsmoking.org.au/">Tackling Indigenous Smoking program</a> is urgently needed to have no more than 27% of Aboriginal and Torres Strait Islander smoking by 2030 (5% of all Australians).</p>
<p>There have been huge achievements in reducing Aboriginal and Torres Strait Islander smoking. In <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.13049">2018–19</a>, 40% of Aboriginal and Torres Strait Islander adults smoked daily, down from 50% in 2004–05. A target of 27% is achievable. But to get there we need something “extra” to accelerate those reductions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-how-to-close-the-gap-on-indigenous-women-smoking-during-pregnancy-62347">Here's how to close the gap on Indigenous women smoking during pregnancy</a>
</strong>
</em>
</p>
<hr>
<h2>We know what works</h2>
<p>Tobacco campaigns are one of the most <a href="https://www.tobaccoinaustralia.org.au/chapter-14-social-marketing/14-1-social-marketing-and-public-education-campaig">cost-effective</a> <a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/21/2/127.full.pdf">interventions</a> when evidence-based, market-tested, sustained and with support services at the end of the call to action. When they are adequately funded, they can <a href="https://tobaccocontrol.bmj.com/content/31/2/284">impact inequities</a>.</p>
<p>Campaigns must be personally relevant and meaningful <a href="https://www.wiley.com/en-au/Health+Behavior%3A+Theory%2C+Research%2C+and+Practice%2C+5th+Edition-p-9781118629000">to be effective</a>. This makes the case for targeted approaches, including local level campaigns, reinforced by general, national activity. Audiences engage with the message when they can see themselves and their community members (sometimes actually) in the advertising.</p>
<p>We saw this nationally with <a href="https://www.youtube.com/watch?v=0yvjBU-E0aw">Break the Chain</a> starring Aboriginal actor and comedian Elaine Crombie. Originally this was a targeted campaign for Aboriginal and Torres Strait Islander people. But it then aired nationally targeting all Australians in 2014.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/0yvjBU-E0aw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The ‘Break the Chain’ campaign featured Aboriginal actor and comedian Elaine Crombie.</span></figcaption>
</figure>
<p><a href="https://www.health.gov.au/resources/collections/campaign-resources-dont-make-smokes-your-story">Don’t Make Smokes Your Story</a> was launched in 2016, as part of the Tackling Indigenous Smoking program. This was created by Indigenous agency Carbon Media, starring musician <a href="https://www.youtube.com/watch?v=878H2fkw3L8">Fred Leone</a> alongside real stories <a href="https://www.youtube.com/watch?v=xCX-ZfopeSE">from community members</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/1_dS1sYkLiQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">‘Don’t Make Smokes Your Story’ campaign.</span></figcaption>
</figure>
<p>One of the <a href="https://www.phrp.com.au/issues/september-2020-volume-30-issue-3/tackling-indigenous-smoking-a-good-news-story-in-australian-tobacco-control/">most successful</a> and innovative Aboriginal and Torres Strait Islander tobacco campaigns, it included a
<a href="https://www.health.gov.au/resources/publications/dont-make-smokes-your-story-toolkit?language=en">toolkit</a> for Aboriginal and Torres Strait Islander communities to use and adapt the national campaign to their <a href="https://tacklingsmoking.org.au/sharing-our-stories/">local contexts</a>.</p>
<p>An excellent example of this is from the <a href="https://www.apunipima.org.au/tackling-indigenous-smoking/#:%7E:text=The%20Apunipima%20Tackling%20Indigenous%20Smoking,to%20culturally%20appropriate%20quit%20support">Apunipima Tackling Indigenous Smoking team</a> with its local campaign <a href="https://www.youtube.com/watch?v=tohg0QEGVU0">Don’t Make Smokes Your Story Cape York</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/tohg0QEGVU0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Campaigns can be localised, like this one from Cape York.</span></figcaption>
</figure>
<p>When Aboriginal and Torres Strait Islander people lead and promote smoke-free behaviours, communities are <a href="https://www.mja.com.au/journal/2015/202/10/predictors-wanting-quit-national-sample-aboriginal-and-torres-strait-islander">more interested in quitting</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/telehealth-has-much-to-offer-first-nations-people-but-technical-glitches-and-a-lack-of-rapport-can-get-in-the-way-201872">Telehealth has much to offer First Nations people. But technical glitches and a lack of rapport can get in the way</a>
</strong>
</em>
</p>
<hr>
<h2>What works? Product, price, place and promotion</h2>
<p>Social marketing campaigns, like the ones we’ve mentioned, really work well when they take on the <a href="https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/social_marketing.pdf">Four Ps</a> of product, price, place and promotion.</p>
<p>The beautifully produced ads, the “promotion”, can’t have impact on their own. This is where the rest of the National Tobacco Strategy comes in.</p>
<p><strong>1. Product</strong></p>
<p>We’ve reduced product appeal with <a href="https://theconversation.com/world-first-plain-packaging-for-tobacco-products-a-step-closer-to-becoming-law-3053">plain packaging</a> and graphic health warnings. This will be enhanced with new warnings, including on the sticks themselves, plus greater uniformity of standardised packaging and tightened rules around additives and flavours that make smoking palatable.</p>
<p><strong>2. Price</strong></p>
<p>Price increases <a href="https://www.sciencedirect.com/science/article/pii/S2468266719302038">reduce smoking</a> and we’ll see a tax increase of 5% each year for three years across all different tobacco product types. </p>
<p><strong>3. Place</strong></p>
<p>We have known about the harms of commercial tobacco since at least 1950. Yet we still expect individuals to give up nicotine instead of removing this lethal product from sale at pretty much every supermarket, service station and convenience store. </p>
<p>The National Tobacco Strategy is considering a national licensing scheme, removing online sales and delivery services, and potential for reducing the number, type and location of tobacco outlets.</p>
<p>There will also be more action on smoke-free areas and making sure all health professionals (particularly in remote places) are equipped to support quit attempts.</p>
<p>The strategy states it will explore raising the age you can buy cigarettes and monitor how this works overseas. </p>
<p><strong>4. Promotion</strong></p>
<p>The commitment to close any last promotional loopholes for tobacco and e-cigarettes, particularly online is also important, along with local and national anti-smoking campaigns. But we know these are not enough on their own.</p>
<h2>What we also need</h2>
<p>Addressing all four Ps is what comprehensive tobacco social marketing would look like. It’s what’s required to accelerate the declines to get to the 27% target for Aboriginal and Torres Strait Islander peoples, and 5% nationally.</p>
<p>Targeted approaches are critical and can be effective, but they need to be supported by bigger, whole of population structural changes. The community-led campaigns, supported by national activity, will reinforce and amplify the policy changes that will come through on the tobacco product, its cost and its availability. </p>
<p>That’s how we realise our goals and ultimately eliminate tobacco related disease and death.</p><img src="https://counter.theconversation.com/content/205016/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christina Heris receives funding from the NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (NHMRC GNT1198301), and the Australian Government Department of Health and Aged Care for the Tackling Indigenous Smoking – Regional Grants Impact and Outcomes Assessment.</span></em></p><p class="fine-print"><em><span>Lisa J Whop receives funding from the National Health and Medical Research Council and the Australian Research Council. She is also a member and incoming chair of Cancer Australia's Leadership Group on Aboriginal and Torres Strait Islander Cancer Control.</span></em></p><p class="fine-print"><em><span>Michelle Kennedy receives funding from the National Health and Medical Research Council, Medical Research Future Fund and the National Heart Foundation. </span></em></p><p class="fine-print"><em><span>Raglan Maddox receives funding from from the NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (NHMRC GNT1198301), and the Australian Government Department of Health and Aged Care for the Tackling Indigenous Smoking – Regional Grants Impact and Outcomes Assessment.</span></em></p><p class="fine-print"><em><span>Raymond Lovett receives funding from the NHMRC. </span></em></p><p class="fine-print"><em><span>Tom Calma is the National Coordinator, Tackling Indigenous Smoking (TIS). This position is a consultancy to the Commonwealth Department of Health and Aged Care. </span></em></p>If we are to reduce the numbers of Aboriginal and Torres Strait Islander people smoking we need to consider a whole suite or approaches.Christina Heris, Research Fellow, Australian National UniversityLisa J Whop, Senior Fellow, Australian National UniversityMichelle Kennedy, Assistant Dean Indigenous Strategy & Leadership, University of NewcastleRaglan Maddox, Fellow, National Centre for Epidemiology and Public Health, Australian National UniversityRaymond Lovett, Director Mayi Kuwayu Study, Australian National UniversityTom Calma, Chancellor, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2039072023-04-28T03:43:31Z2023-04-28T03:43:31Z‘Life changing’ – what 50 years of community-controlled housing at Yumba-Meta tells us about home and health<figure><img src="https://images.theconversation.com/files/522946/original/file-20230426-197-jw8pwz.jpg?ixlib=rb-1.1.0&rect=16%2C0%2C5447%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://media.gettyimages.com/id/1189063984/photo/father-and-little-daughter-enjoying-jumping-on-trampoline.jpg?s=2048x2048&w=gi&k=20&c=Gfpl6yvhURPib6wYAFvwjZy7Ksb4stKypZk7CXg3eY0=">Getty/Attila Csaszar</a></span></figcaption></figure><p>How does having a safe, reliable place to call “home” affect the health of people and communities across generations? We spoke to staff and families at <a href="https://yumba-meta.com.au/">Yumba-Meta Ltd</a> in Townsville, Queensland to find out. </p>
<p>Yumba-Meta is a community-controlled organisation that has delivered comprehensive support <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12977-5">programs</a> for 50 years to Aboriginal and Torres Strait Islander people. This includes short-term accommodation, such as for people experiencing homelessness, domestic violence, or people at risk of incarceration due to intoxication. Medium to long-term housing options include community <a href="https://iba.gov.au/2021/11/new-research-shows-funding-indigenous-australians-home-ownership-benefits-us-all-2/">home ownership</a>, seniors’ housing, and transitional housing to facilitate employment, education or to <a href="https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/yale-study-examines-people-housing">break the cycle of addiction</a>. </p>
<p>Our collaborative research project with Yumba-Meta, which will be released mid-year for Yumba-Meta’s 50th anniversary, explores the power of <a href="https://www.aihw.gov.au/reports/housing-assistance/indigenous-people-focus-housing-homelessness/contents/summary">home</a> and how services can support intergenerational <a href="https://www.aihw.gov.au/reports/indigenous-australians/housing-strategies-that-improve-indigenous-health/summary">wellbeing</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/treatment-for-drug-and-alcohol-misuse-should-involve-families-and-communities-197536">Treatment for drug and alcohol misuse should involve families and communities</a>
</strong>
</em>
</p>
<hr>
<h2>What we did</h2>
<p>We interviewed Yumba-Meta staff and used <a href="https://espace.curtin.edu.au/bitstream/handle/20.500.11937/37083/154944_32184_Bessarab_Yarning%20about%20Yarning.pdf?sequence=2">yarning</a> and <a href="https://eprints.qut.edu.au/213920/">photoyarning</a> with Yumba-Meta residents and Elders to hear about the history and evolution of Yumba-Meta. Photoyarning draws on Indigenous storying and conversation. Photographs are used as both prompts and a way for participants to share their thoughts and ideas. </p>
<p>One staff member described the <a href="https://nacchocommunique.com/tag/aboriginal-housing/">generational change</a> she has seen at Yumba-Meta over time:</p>
<p><em>[…] young kids, they see you’ve got a home, Mum or Dad, or both […] being able to […] improve their lives […] then those kids are the next ones. The importance of education, the importance of having a job. We do see that […] someone who’s been chronic homeless for ten years and then is able to sustain a tenancy, that’s when changes it for some of their families to go, “oh, I think I might be able to do that too!” You do see it. That’s a long process…before you actually see that happening, I think.“</em></p>
<p>Yumba-Meta has grown from managing eight houses, to <a href="https://yumba-meta.com.au/wp-content/uploads/2022/12/YUMBA-META-2022-ANNUAL-REPORT.pdf">now managing</a> over 203 tenancies. This includes homes under the <a href="https://yumba-meta.com.au/about/program/employment-and-education-housing/">employment and education program</a>, <a href="https://yumba-meta.com.au/about/program/dale-parker-place/">supported accommodation</a>, <a href="https://yumba-meta.com.au/about/program/flora-house-womens-shelter/">women’s shelters</a> and <a href="https://yumba-meta.com.au/about/program/reverend-charles-harris-diversionary-centre/">diversionary places</a>. Yumba-Meta has also developed a housing estate, <a href="https://yumba-meta.com.au/about/completed-projects/hillside-gardens-residential-estate/">Hillside Gardens</a> with 41 privately-owned lots.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/521429/original/file-20230417-20-m5zz7h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older man gestures to aerial view of housing on projector screen." src="https://images.theconversation.com/files/521429/original/file-20230417-20-m5zz7h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521429/original/file-20230417-20-m5zz7h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=335&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521429/original/file-20230417-20-m5zz7h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=335&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521429/original/file-20230417-20-m5zz7h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=335&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521429/original/file-20230417-20-m5zz7h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=421&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521429/original/file-20230417-20-m5zz7h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=421&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521429/original/file-20230417-20-m5zz7h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=421&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Participant photoyarning about housing developments undertaken by Yumba-Meta.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-nations-children-are-still-being-removed-at-disproportionate-rates-cultural-assumptions-about-parenting-need-to-change-169090">First Nations children are still being removed at disproportionate rates. Cultural assumptions about parenting need to change</a>
</strong>
</em>
</p>
<hr>
<h2>Safe at home</h2>
<p>Our research found a sense of pride is instilled when families and individuals have a home – somewhere grandchildren can visit, a place where young people can learn from Elders, and a <a href="https://www.abc.net.au/news/2023-03-20/queensland-homelessness-up-22-per-cent/102113366">safe place to go</a>. </p>
<p>We found health improves over time with <a href="https://aifs.gov.au/resources/policy-and-practice-papers/strengthening-aboriginal-family-functioning-what-works-and-why">safe and affordable housing</a>, especially for older generations who have struggled in the past with housing issues such as chronic overcrowding, and <a href="https://www.tandfonline.com/doi/abs/10.1080/02673037.2017.1374357?journalCode=chos20">racism</a> that prevents Indigenous people renting and purchasing homes in Townsville. </p>
<p>Those we spoke with talked of a "new normal” being conveyed to children. Young people saw that having their <a href="https://www.aihw.gov.au/reports/children-youth/australias-children/contents/housing/overcrowding">own bed</a> and <a href="https://nirs.org.au/news/work-to-do-conference-to-look-for-housing-solutions/">homes with less people</a> allowed better sleep and space for learning and study. Reliable <a href="https://pursuit.unimelb.edu.au/articles/to-improve-indigenous-health-we-must-improve-indigenous-housing">sanitation</a> practices and facilities (including bathrooms and toilets) along with healthy and sufficient nutrition had direct health benefits.</p>
<p>Overcrowded housing has been <a href="https://www1.racgp.org.au/newsgp/racgp/overcrowding-a-key-determinant-of-poor-health-outc#:%7E:text=The%20National%20Guide%20reveals%20that,and%20close%20contact%20with%20others.">linked</a> to chronic eye and ear infections, skin problems, gastroenteritis, respiratory infections, exacerbation of family violence and mental health issues.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-nations-mothers-are-more-likely-to-die-during-childbirth-more-first-nations-midwives-could-close-this-gap-182935">First Nations mothers are more likely to die during childbirth. More First Nations midwives could close this gap</a>
</strong>
</em>
</p>
<hr>
<h2>Before and after</h2>
<p>One interviewee said sustainable housing was transformative for families. </p>
<p><em>Seeing […] people coming from the park and getting into house, like, the pride they have in there […] it’s life changing for them […] and they say, ‘Oh, my grandkids are coming over on the week’, their faces are lit up like this [smiling]</em></p>
<p>For residents who had experienced homelessness and addiction, having a safe and affordable home was spoken of as a major achievement. Descriptions of life living <a href="https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-017-0564-4">rough</a> with little ability to <a href="https://www.sbs.com.au/food/article/2020/05/26/devastating-impact-malnutrition-homeless-and-disadvantaged-children">eat healthy food</a> were juxtaposed with their new life in a stable home: having food in the fridge and cupboard, and making good personal choices. </p>
<p>These yarns showed the impact organisations like Yumba-Meta can have, by providing supports on multiple fronts while people heal and make <a href="https://www.tandfonline.com/doi/abs/10.1080/02673037.2015.1092504">positive changes</a> in their lives.</p>
<p><em>A bit of money I made […] to buy more, more stuff for my little place […] to do it up, and I take pride in my place […] Furniture you know, and things that are needed. A bed and washing machine, and fridge and all that sort of stuff and few other things to brighten my place up, you know […] and I got ornaments, you know […] and make it comfortable for me. That I call ‘home’.</em></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/521430/original/file-20230417-16-8cl0ls.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman at table with photos on it" src="https://images.theconversation.com/files/521430/original/file-20230417-16-8cl0ls.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521430/original/file-20230417-16-8cl0ls.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=385&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521430/original/file-20230417-16-8cl0ls.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=385&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521430/original/file-20230417-16-8cl0ls.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=385&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521430/original/file-20230417-16-8cl0ls.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=484&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521430/original/file-20230417-16-8cl0ls.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=484&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521430/original/file-20230417-16-8cl0ls.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=484&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Participant photoyarning with Dr Rogers (author), sharing memories of her Yumba-Meta home.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>What ‘home’ means</h2>
<p>So, “home” was about physical resources: access to washing, showers, toilets, health care providers, medicines and opportunities to <a href="https://www.homelesshub.ca/about-homelessness/topics/substance-use-addiction">remain sober</a> and access healthy food. But it was also <a href="https://www.indigenousmhspc.gov.au/Topics/Housing-homelessness#:%7E:text=For%20Indigenous%20Australians%2C%20homelessness%20can%20be%20spiritual%20and,%28Brackertz%20et%20al.%202018%3B%20Memmott%20et%20al.%202004%29.">spiritual</a>: feeling connected, strong in spirit, good about one’s self. It fulfilled emotional needs with space to grieve loss, talk about feelings, heal from relationship breakdown and <a href="https://chp.org.au/wp-content/uploads/2022/06/Homelessness-and-Domestic-and-Family-Violence.pdf">domestic violence</a>, pass on culture and stories and a place to hold photos of family and ancestors. </p>
<p>Home was described as somewhere family can be raised with continuity and stability, where children do not need to move <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2780351">schools</a> all the time and where neighbours become friends. These things might be taken for granted in other communities, but previously for Yumba-Meta residents, this stability was often out of reach.</p>
<p>Yumba-Meta continues to have a lasting positive impact on the Townsville community, through provision of safe, secure and affordable housing and “wrap-around” services. Support for community-controlled housing like Yumba-Meta will help more Aboriginal and Torres Strait Islander families remain strong and connected, through improved intergenerational wellbeing.</p>
<figure>
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</figure><img src="https://counter.theconversation.com/content/203907/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessa Rogers is a First Nations Senior Research Fellow in the Digital Media Research Centre at Queensland University of Technology (QUT). She receives funding from the Australian Research Council as a DECRA Fellow. Jessa is a board member of Wesley Mission Queensland. </span></em></p><p class="fine-print"><em><span>Vicki Saunders is a Gunggari woman and Senior Research Fellow in the Jawun Research Centre at Central Queensland University (CQU). She currently receives funding from the Medical Research Futures Fund (MRFF) and from The Centre for Research Excellence: Stengthening Systems for Indigenous Health Care Equity (CRE-STRIDE) Research Fellow. </span></em></p><p class="fine-print"><em><span>Janya McCalman 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>We used yarning and photoyarning to gather insights from staff and residents about the changes five decades of housing stability and support can bring about.Jessa Rogers, First Nations Senior Research Fellow, Queensland University of TechnologyJanya McCalman, Professorial Research Fellow, Jawun Research Centre, CQUniversity AustraliaVicki Saunders, Postdoctoral research fellow, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1975362023-04-24T20:05:31Z2023-04-24T20:05:31ZTreatment for drug and alcohol misuse should involve families and communities<figure><img src="https://images.theconversation.com/files/520696/original/file-20230413-20-wbj5o4.jpg?ixlib=rb-1.1.0&rect=36%2C18%2C6049%2C2010&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Alcohol and other drug treatment in Australia is generally only provided for individuals, often away from their families. </p>
<p>Treatment can include withdrawal from the substance, counselling and residential rehabilitation. <a href="https://www.health.gov.au/sites/default/files/new-horizons-review-of-alcohol-and-other-drug-treatment-services_0.pdf">All these treatments</a> work to improve health and wellbeing and reduce the harms from substances.</p>
<p>But people’s families and communities can <a href="https://pubmed.ncbi.nlm.nih.gov/21707469/">influence</a> substance use and have the potential to <a href="https://www.tandfonline.com/doi/abs/10.1300/J160v06n01_01">aid the healing journey</a> of people in treatment.</p>
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Read more:
<a href="https://theconversation.com/why-do-some-people-struggle-to-make-healthy-decisions-day-after-day-147666">Why do some people struggle to make 'healthy' decisions, day after day?</a>
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<p>For a lot of First Nations peoples, health and wellbeing is not just about the individual. It’s <a href="https://www.telethonkids.org.au/globalassets/media/documents/aboriginal-health/working-together-second-edition/working-together-aboriginal-and-wellbeing-2014.pdf">interconnected</a> with family, culture, belonging and Country. </p>
<p>That’s why treatment services such as <a href="https://qnada.org.au/location/pinangba-cape-york-family-centre/">Pinangba</a> in Queensland – a First Nations alcohol and other drug service whose approach we have been researching – includes families, culture and Country in treatment. </p>
<p>This way of pursuing treatment should be available for everyone.</p>
<h2>The role of families in treatment</h2>
<p>Families and community can play an essential role in giving up alcohol and other drugs and avoiding relapse. <a href="https://vsu.mhc.wa.gov.au/media/1301/dha-2.pdf">Research shows</a> advice or encouragement from family members is an important reason for giving up or reducing problematic substance use.</p>
<p>However, some people who attend treatment facilities alone often <a href="https://www.tandfonline.com/doi/abs/10.1080/0312407X.2010.508841?journalCode=rasw20">have limited support</a> back home in their communities to maintain sobriety or reduced consumption. </p>
<p>Family and communities do not always have the right tools to support the individual in treatment, and some family members may experience problematic substance use themselves.</p>
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<img alt="Couple hugging" src="https://images.theconversation.com/files/520704/original/file-20230413-14-qb9cml.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520704/original/file-20230413-14-qb9cml.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520704/original/file-20230413-14-qb9cml.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520704/original/file-20230413-14-qb9cml.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520704/original/file-20230413-14-qb9cml.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520704/original/file-20230413-14-qb9cml.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520704/original/file-20230413-14-qb9cml.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">
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<span class="caption">Family members may not have the tools to support a loved one after treatment.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/loving-couple-sitting-together-garden-party-2117549252">Shutterstock</a></span>
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<h2>What happens at Pinangba?</h2>
<p>Pinangba is an Indigenous-led residential rehabilitation service in Queensland. It’s one of a small number of alcohol and other drug treatment services in Australia that take in the entire family unit of adults and children for the residential stay. </p>
<p>Pinangba adopts a <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1752-0606.2011.00280.x?casa_token=RNglVnXOJ0gAAAAA:0e99cXjUl_DDP_Kp_j-R2dxlJ1TUFQm2TY4BPHh2uPN57D5trUPmr-4h28hjyKY47e1P1o4GNWt7giIt">systemic family therapy model</a>. The therapist is invited to consider not only the context of the individual within their family but also consider the context of the family in relation to the broader social, political and historical systems.</p>
<p>There is an emphasis on building, strengthening and repairing relationships as part of the healing work of the client. </p>
<p>Pinangba also considers the environments most influential in a client’s life (social services, work, court) that may impact their healing journey. </p>
<p>Its family-based approach helps clients to engage and stay in treatment, stay abstinent and improve relationships. This approach also positively impacts the alcohol and other drug use of other family members and improves the functioning of their children. </p>
<p>Pinangba family therapy approach to addiction has been <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.13537">positively received</a> by clients, families, community, and other health and social service providers.</p>
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<p>
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Read more:
<a href="https://theconversation.com/alcohol-problems-arent-for-life-and-aa-isnt-the-only-option-8-things-film-and-tv-get-wrong-about-drug-and-alcohol-treatment-180946">Alcohol problems aren't for life, and AA isn't the only option. 8 things film and TV get wrong about drug and alcohol treatment</a>
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<p>Non-Indigenous people also benefit from this model. Family-focused interventions for non-Indigenous people with substance use issues have <a href="https://www.tandfonline.com/doi/abs/10.1080/1533256X.2019.1659068?journalCode=wswp20">been effective</a> for both young people and adults. Not only do these interventions reduce substance use, they also improve family functioning compared to individual-based treatment. </p>
<p>Despite these positive outcomes, family-focused interventions within alcohol and other drug services is still uncommon. </p>
<p><a href="https://www.tandfonline.com/doi/abs/10.1080/1533256X.2019.1659068?journalCode=wswp20">Barriers to implementation</a> are not only related to the individualised treatment focus, but also to issues such as difficulties of involving family in treatment, limited staff time, lack of experience and insufficient training. </p>
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<img alt="Corridor" src="https://images.theconversation.com/files/520708/original/file-20230413-16-yujzdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520708/original/file-20230413-16-yujzdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520708/original/file-20230413-16-yujzdr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520708/original/file-20230413-16-yujzdr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520708/original/file-20230413-16-yujzdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520708/original/file-20230413-16-yujzdr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520708/original/file-20230413-16-yujzdr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A number of barriers need to be overcome to roll it out more widely.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hospital-interior-corridor-bue-greece-1256860270">Shutterstock</a></span>
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<h2>Expanding access 3 ways</h2>
<p>For this family-focused model of care to be incorporated into both Indigenous and non-Indigenous alcohol and other drug services we need better data collection and better funding. Here are three important steps towards this implementation: </p>
<p><strong>1. Careful evaluation of programs with family engagement, family therapy and holistic treatment.</strong> </p>
<p>There is currently little knowledge about the effectiveness of this model for First Nations people. That is exactly what we are doing with Pinangba: with funding from the <a href="https://www.qmhc.qld.gov.au/sites/default/files/qmhc_2020-21_annual_report_accessible_web.pdf">Queensland Mental Health Commission</a> we are building an evaluation integrated into routine service delivery, to demonstrate how such holistic, family-oriented treatment works. </p>
<p>It is vital that data are collected as part of routine practices so an evidence-base can be built up.</p>
<p><strong>2. Routine data collection practices that does not rely on external funding.</strong> </p>
<p>Organisations that fund alcohol and other drug treatment for First Nations peoples (including the Commonwealth, Primary Health Networks and state governments) should ensure funding levels adequate so services can spend time collecting and entering data on client progress and outcomes. </p>
<p>This is currently not the case. Collecting evaluation data is seen as an added extra, not as an essential part of ongoing service delivery. This needs to change.</p>
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<strong>
Read more:
<a href="https://theconversation.com/what-is-success-in-drug-rehab-programs-need-more-than-just-anecdotes-to-prove-they-work-76081">What is 'success' in drug rehab? Programs need more than just anecdotes to prove they work</a>
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<p><strong>3. Funding that looks beyond individual models of care.</strong></p>
<p>Newer ways of working, where families become the “treatment unit” will involve new costs, new buildings, new ways of working, new data collection, and will require more funding and planning. </p>
<p>If we were really thinking about families, we need to think about treatment with a family, not an individual. This shift in thinking needs to occur across all levels of the system.</p><img src="https://counter.theconversation.com/content/197536/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katinka van de Ven receives funding from state and territory governments including the Queensland Mental Health Commission.</span></em></p><p class="fine-print"><em><span>Alison Ritter receives funding from the NHMRC, the ARC, and state/territory governments. </span></em></p><p class="fine-print"><em><span>Erin Cunningham receives funding from Queensland Mental Health Commission for the Pinangba Research Project. </span></em></p>Alcohol and drug addiction impacts families as well as the people afflicted. Some First Nations-led centres involve families in their patients’s treatment, with beneficial outcomes.Katinka van de Ven, Alcohol and other drug specialist, University of New South Wales &, University of New EnglandAlison Ritter, Professor & Specialist in Drug Policy, UNSW SydneyErin Cunningham, Pinangba Support Officer, Indigenous KnowledgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2018722023-03-30T20:24:38Z2023-03-30T20:24:38ZTelehealth has much to offer First Nations people. But technical glitches and a lack of rapport can get in the way<figure><img src="https://images.theconversation.com/files/516837/original/file-20230322-18-s2jlq3.jpg?ixlib=rb-1.1.0&rect=0%2C5%2C1000%2C577&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">Di Vincenzo/Shutterstock</a></span></figcaption></figure><p>Telehealth has been a game changer for many First Nations people <a href="https://journals.sagepub.com/doi/10.1177/1357633X231158835">globally</a>, including in Australia.</p>
<p>It has allowed First Nations people to access health care close to home – whether that’s screening for health issues, diagnosing illness or monitoring existing conditions. It has done this while minimising exposure to COVID.</p>
<p>But a <a href="https://journals.sagepub.com/doi/10.1177/1357633X231158835">recent review</a> of telehealth for First Nations people – in Australia, Canada, New Zealand and the United States – shows we could do better.</p>
<p>Unreliable internet access, services designed without meaningful First Nations’ input, and concerns about establishing rapport with health workers were some of the concerns.</p>
<p>Here’s where we could lift our game to ensure reliable, equitable and culturally safe telehealth for First Nations people in Australia, whether living remotely or in our cities.</p>
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<strong>
Read more:
<a href="https://theconversation.com/video-and-phone-consultations-only-scratch-the-surface-of-what-telehealth-has-to-offer-146580">Video and phone consultations only scratch the surface of what telehealth has to offer</a>
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<h2>What exactly is telehealth?</h2>
<p>Telehealth uses information and communication technology to deliver health care at a distance. In Australia, this is mainly via phone and video consultations.</p>
<p>Telehealth can be delivered by any health-care provider including doctors, nurses, and allied health or ancillary health providers. Telehealth is not a complete replacement for in-person care. But it can be used instead of some face-to-face appointments.</p>
<p><a href="https://www.naccho.org.au">Aboriginal Community Controlled Health Organisations</a> have traditionally provided primary (initial) health care and some specialist care for First Nations people in Australia. Telehealth allows them to provide a <a href="https://www.mja.com.au/journal/2019/210/6/telehealth-game-changer-closing-gap-remote-aboriginal-communities">greater range of specialist services</a>. So, this allows First Nations people access to care close to home, with optional support from an Indigenous health worker.</p>
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<strong>
Read more:
<a href="https://theconversation.com/first-nations-people-in-the-nt-receive-just-16-of-the-medicare-funding-of-an-average-australian-183210">First Nations people in the NT receive just 16% of the Medicare funding of an average Australian</a>
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<h2>Where it’s working well</h2>
<p>Telehealth services for First Nations people have <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12600">improved</a> social and emotional wellbeing, clinical outcomes, access to health services, and boosted screening rates. </p>
<p>During COVID, telehealth <a href="https://www1.racgp.org.au/ajgp/2021/november/aboriginal-community-telehealth-during-covid">increased the number</a> of First Nations people able to access health care, while reducing the potential for transmission of the virus. For clients, telehealth reduces time away from usual activities, travel and associated out-of-pocket expenses. </p>
<p>Telehealth can contribute to <a href="https://journals.sagepub.com/doi/10.1177/1357633X18795764">culturally safe health care</a>. Practically, this means care that does not challenge identity or experience of First Nations people. It’s when both the provider and the person receiving the care communicate with respect, to share knowledge and to improve overall health. </p>
<p>It allows a person to stay on Country while accessing some health-care services. Telehealth can also reduce the trauma associated with travel, reduce the disruptions to family and reduces stress associated with using health care. </p>
<p>Telehealth also allows family and other supports such as an Indigenous health worker to attend specialist consultations, and for the person to receive care in a supportive environment.</p>
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<h2>But First Nations communities need a bigger say</h2>
<p>But for telehealth services to be provided in a culturally safe manner that improves health, it is essential services are co-designed with First Nations people. First Nations communities also need to have ownership of the services. </p>
<p>Co-designing is a highly collaborative approach where researchers, industry stakeholders and Aboriginal communities work together to achieve a goal, and where there is sustained and equitable engagement with the community. </p>
<p>True co-design puts Aboriginal voices and lived experiences first, aiming to empower communities through shared decision making toward goals defined by the community. When done well, co-design leads to services and outcomes <a href="https://www.mdpi.com/1660-4601/19/23/16166">authentically aligned</a> with the needs and preferences of the community. </p>
<p>Co-designing culturally safe telehealth solutions would mean Aboriginal people working closely with industry and researchers to determine what currently works, what doesn’t work well and where gaps lie. This is so solutions – simple or highly innovative – can be developed for the community.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aboriginal-maori-how-indigenous-health-suffers-on-both-sides-of-the-ditch-48238">Aboriginal – Māori: how Indigenous health suffers on both sides of the ditch</a>
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<h2>… and more reliable internet</h2>
<p>Access to reliable internet is a barrier to providing videoconsultations, particularly for remote communities. Investment in infrastructure by government, NGOs and private industry could resolve such connectivity issues.</p>
<p>However, solutions are often expensive. So centralising telehealth services at Aboriginal Community Controlled Health Organisations may provide economies of scale. </p>
<p>Investing in training Indigenous health workers in telehealth may also increase the uptake and scope of telehealth appointments.</p>
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<h2>First Nations people want that connection</h2>
<p>One barrier to telehealth for First Nations people is concerns about establishing trusting therapeutic relationships with their health provider via telehealth. </p>
<p>Evidence suggests rapport can be improved by the <a href="https://journals.sagepub.com/doi/10.1177/1357633X231158835">provider visiting communities</a> and conducting the initial consultations in-person. </p>
<p>Providers should familiarise themselves with local services available in the communities they are providing care for, as this will improve their ability to integrate care with local services. </p>
<p>Cultural awareness training for all providers is also desirable.</p>
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<strong>
Read more:
<a href="https://theconversation.com/birthing-on-country-services-centre-first-nations-cultures-and-empower-women-in-pregnancy-and-childbirth-170641">Birthing on Country services centre First Nations cultures and empower women in pregnancy and childbirth</a>
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<h2>It’s not just about rural communities</h2>
<p>Gone are the days of telehealth being used exclusively for rural and remote people. So providers should offer telehealth to First Nations people regardless of where they live. </p>
<p>The benefits of telehealth – such as cultural safety, reduced travel, ability to involve family – are just as relevant for First Nations people living in metropolitan areas as they are for those in rural and remote locations.</p>
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<strong>
Read more:
<a href="https://theconversation.com/urban-aboriginal-people-face-unique-challenges-in-the-fight-against-coronavirus-136050">Urban Aboriginal people face unique challenges in the fight against coronavirus</a>
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<img src="https://counter.theconversation.com/content/201872/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Centaine Snoswell receives funding from UQ and NHMRC. </span></em></p><p class="fine-print"><em><span>Jonathan Bullen receives funding from WA Department of Health's Future Health Research and Innovation fund. </span></em></p><p class="fine-print"><em><span>Liam Caffery receives funding or has received funding from the NHRMC, the Commonwealth Department of Health, Queensland Health, Cooperative Research Centre for Developing Northern Australia and from the University of Queensland. Liam Caffery is the Vice President of the Australian Telehealth Society.</span></em></p>Here’s where we could lift our game to ensure reliable, equitable and culturally safe telehealth for First Nations people in Australia, whether living remotely or in our cities.Centaine Snoswell, Senior Research Fellow Health Economics, The University of QueenslandJonathan Bullen, Associate Professor, Curtin UniversityLiam Caffery, Associate Professor in Telehealth and Director of Telehealth Technology, Centre for Online Health, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2006562023-03-07T19:04:50Z2023-03-07T19:04:50ZHealth care offered to women in prison should match community standards – and their rights<figure><img src="https://images.theconversation.com/files/513093/original/file-20230302-28-lwt15j.jpg?ixlib=rb-1.1.0&rect=0%2C95%2C8000%2C5233&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/close-womans-hand-cell-prison-psychiatric-2208373333">shutterstock</a></span></figcaption></figure><p>On this <a href="https://www.un.org/en/observances/womens-day">International Women’s Day</a>, let’s not forget women in prison.</p>
<p>There are 3,088 women <a href="https://www.pc.gov.au/ongoing/report-on-government-services/2023/justice/corrective-services">imprisoned in Australia</a> on any given day, representing 7.5% of the prison population. Aboriginal and Torres Strait Islander women are <a href="https://www.abs.gov.au/statistics/people/crime-and-justice/corrective-services-australia/latest-release#:%7E:text=The%20Aboriginal%20and%20Torres%20Strait,from%20423%20persons%20last%20quarter.">over-represented</a> in these numbers.</p>
<p>Australia spends <a href="https://www.pc.gov.au/ongoing/report-on-government-services/2023/justice/corrective-services">$4.44 billion</a> on prisons. Despite this, reproductive health care equivalent to that in the community is often not available where women are being detained.</p>
<p>This includes care related to <a href="https://search.informit.org/doi/abs/10.3316/ielapa.727381003357278">menstruation</a>, <a href="https://journals.lww.com/menopausejournal/Documents/Experiences%20of%20menopause%20during%20incarceration.pdf">menopause</a>, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.14837">contraception</a>, preventive health care such as <a href="https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-020-1155-3">cervical screening tests</a>, and <a href="https://www.osce.org/files/f/documents/f/b/427448.pdf">access to abortions</a>. </p>
<p>Adequate health care <a href="https://www.ohchr.org/sites/default/files/Documents/ProfessionalInterest/BangkokRules.pdf">during pregnancy</a>, <a href="https://www.justiceinspectorates.gov.uk/hmiprisons/wp-content/uploads/sites/4/2021/08/Womens-Expectations-FINAL-July-2021-1.pdf">birth</a> and <a href="https://www.justiceinspectorates.gov.uk/hmiprisons/wp-content/uploads/sites/4/2021/08/Womens-Expectations-FINAL-July-2021-1.pdf">after birth</a> is often unavailable in these prisons.</p>
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Read more:
<a href="https://theconversation.com/the-un-committee-against-torture-has-found-australia-still-has-work-to-do-195420">The UN committee against torture has found Australia still has work to do</a>
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<h2>Protecting women’s dignity and health</h2>
<p>Reproductive health care must be delivered in appropriate ways to those who require it. Aboriginal and Torres Strait Islander people require <a href="https://www.ahpra.gov.au/About-Ahpra/Aboriginal-and-Torres-Strait-Islander-Health-Strategy/health-and-cultural-safety-strategy.aspx">culturally safe</a> health care, free from racism. There must also be inclusive care for <a href="https://yogyakartaprinciples.org/principle-9/">non-binary and transgender people</a>.</p>
<p>Failing to provide access to sanitary pads and tampons is a form of degrading treatment, according to the <a href="https://rm.coe.int/1680696a74">European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment</a>. It can leave women and people who menstruate <a href="https://www.wcl.american.edu/impact/initiatives-programs/center/documents/gender-perspectives-on-torture/">vulnerable to exploitation</a>. For example, limited access to sanitary pads can lead to them being traded for favours. </p>
<p>In addition to menstrual items, underwear also needs to be available for people in prison. A 2019 consultation by the <a href="https://www.qhrc.qld.gov.au/__data/assets/pdf_file/0003/17139/2019.03.05-Women-In-Prison-2019-final-report-small.pdf">Queensland Human Rights Commission</a> reported one woman’s experience of being detained in a Brisbane watch-house. The woman had to stick a menstrual pad to her tracksuit, because she was not given underwear. “There was blood everywhere,” the woman’s cellmate recalled. “They eventually gave her an incontinence nappy, and a clean pair of pants.” </p>
<p>The <a href="https://www.ics.act.gov.au/reports-and-publications/critical-incident-reviews/critical-incident-reviews/use-of-force-to-conduct-a-strip-search-at-the-alexander-maconochie-centre-on-11-january-2021">ACT Inspector of Correctional Services</a> conducted a review into the Alexander Maconochie Centre, a prison in Canberra. The review investigated the use of force during a strip search on an Aboriginal woman. The woman had become distressed after being advised she was not allowed to attend her grandmother’s funeral and participate in Sorry Business. She was menstruating at the time, and was a victim-survivor of sexual assault.</p>
<p>The woman described her experience: </p>
<blockquote>
<p>At this time I was menstruating heavily due to all the blood thinning medication I take on a daily basis. Here I ask you to remember that I am a rape victim. So you can only imagine the horror, the screams, the degrading feeling, the absolute fear and shame I was experiencing [during the strip search].</p>
</blockquote>
<p>On another issue at the same prison, the ACT office <a href="https://www.ics.act.gov.au/__data/assets/pdf_file/0011/2111888/11432RR-ACT-ICS-Healthy-Prison-Review-Nov-2022_Full-report_FA-tagged.pdf">recommended</a> “condoms, water-based lubricants and dental dams be made freely available in the units so detainees can access them without having to make a request to staff”. </p>
<p>In its prison review, the inspector had been told detained people in the Alexander Maconochie Centre wanting to practice safe sex were “making do” by “cutting open latex gloves”.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-some-context-missing-from-the-mparntwe-alice-springs-crime-wave-reporting-199481">Here's some context missing from the Mparntwe Alice Springs 'crime wave' reporting</a>
</strong>
</em>
</p>
<hr>
<h2>Access to terminations and care following miscarriages</h2>
<p>The <a href="https://www.ohchr.org/sites/default/files/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf">United Nations Special Rapporteur on Torture</a> has stated “denial of legally available health services such as abortion and post-abortion care” amounts to “mistreatment of women seeking reproductive health services”. Forcing people to continue their pregnancy is a form of <a href="https://www.osce.org/files/f/documents/f/b/427448.pdf">sexual and gender-based violence</a>. </p>
<p>The <a href="https://rm.coe.int/1680696a74">European Committee for the Prevention of Torture</a> has affirmed that respect for a detained “woman’s right to bodily integrity” requires they have the same access to the “morning after pill and/or other forms of abortion at later stages of a pregnancy” as “women who are free.”</p>
<p>It is also crucial for <a href="https://www.justiceinspectorates.gov.uk/hmiprisons/wp-content/uploads/sites/4/2021/08/Womens-Expectations-FINAL-July-2021-1.pdf">people who miscarry</a> to be provided with the appropriate mental health and physical care.</p>
<p>Increased transparency and oversight is needed to ascertain whether minimum standards for reproductive health care are being met in Australian prisons. However, accounts from women in prison have <a href="https://apo.org.au/sites/default/files/resource-files/2020-04/apo-nid306852.pdf">indicated</a> access to even basic healthcare is often a challenge.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1589480262156447745"}"></div></p>
<h2>Birth and separation</h2>
<p>In Australia, there have been instances of an Aboriginal woman <a href="https://www.oics.wa.gov.au/wp-content/uploads/2018/12/Birth-at-Bandyup-Media-release.pdf">giving birth</a> alone in a locked prison cell while staff observed through the hatch. Another example featured attempts to remove a baby from their Aboriginal mother <a href="https://www.hrlc.org.au/news/2018/4/27/aboriginal-baby-to-stay-with-her-mother-at-bandyup-womens-prison">against medical advice</a> due to insufficient capacity at the prison. And an Aboriginal woman was <a href="https://www.vals.org.au/wp-content/uploads/2022/05/VALS-Submission-to-Inquiry-into-Children-of-Imprisoned-Parents-FINAL-version.pdf">denied</a> the right to bond with her newborn and breastfeed them.</p>
<p>Yet the UN <a href="https://www.ohchr.org/sites/default/files/Documents/ProfessionalInterest/BangkokRules.pdf">Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders</a> state women “shall not be discouraged from breastfeeding their children, unless there are specific health reasons to do so”. </p>
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<h2>We need more transparency in prisons, so we can fix these issues</h2>
<p>Implementation of the <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/optional-protocol-convention-against-torture-and-other-cruel">UN Optional Protocol</a> to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment could bring attention to what is happening in Australian prisons. </p>
<p>This protocol calls for <a href="https://theconversation.com/why-has-a-un-torture-prevention-subcommittee-suspended-its-visit-to-australia-193295">regular visits</a> to places of detention by independent bodies to prevent ill-treatment of detained people, including denial of reproductive health care.</p>
<p>But <a href="https://theconversation.com/australias-twice-extended-deadline-for-torture-prevention-is-today-but-weve-missed-it-again-197793">in January</a> Australia missed its implementation deadline. Australia is currently at risk of being added to the <a href="https://www.ohchr.org/en/treaty-bodies/spt/non-compliance-article-17">UN list of non-compliant countries</a>. Australian commonwealth, state and territory governments have some work to do before this tool can be effectively used to prevent mistreatment of incarcerated women.</p>
<p>And while shining a light in the dark corners of prisons is essential, there are concrete steps governments can take now to improve reproductive health care and provide community-equivalent care. </p>
<p>These include ending the <a href="https://www.theguardian.com/australia-news/2023/jan/20/people-before-profits-victoria-to-ditch-private-health-providers-in-womens-prisons">privatisation of prison health care</a>, having <a href="https://www.coronerscourt.vic.gov.au/sites/default/files/2023-02/COR%202020%200021%20-%20Veronica%20Nelson%20Inquiry%20-%20Form%2037%20-%20Finding%20into%20Death%20with%20Inquest%20-%2030%20January%202023%20-%20Amended.pdf">accessible health services</a> provided by Aboriginal Community Controlled Health Organisations, and reducing the number of women who are incarcerated in the first place.</p><img src="https://counter.theconversation.com/content/200656/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andreea Lachsz is currently contracted to the ACT government as the ACT National Preventive Mechanism (NPM) Coordination Director. The opinions expressed herein are those of the author and do not necessarily reflect those of ACT government, ACT NPM or any extant policy.</span></em></p>Despite Australia spending so much money on prisons, incarcerated women’s reproductive health care is lacking to the point of being degrading.Andreea Lachsz, PhD Candidate, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1996732023-02-16T01:36:23Z2023-02-16T01:36:23ZFetal alcohol spectrum disorder is tragic but not new. How should fresh funding tackle it in the NT?<figure><img src="https://images.theconversation.com/files/510246/original/file-20230215-16-crz0to.jpg?ixlib=rb-1.1.0&rect=45%2C15%2C5051%2C3400&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com.au/detail/photo/pregnant-woman-holding-glass-of-red-wine-royalty-free-image/167457231?phrase=alcohol%20pregnancy&adppopup=true">Getty/Jamie Grill</a></span></figcaption></figure><p>In recent weeks, the Australian and Northern Territory governments <a href="https://theconversation.com/alcohol-bans-return-to-nt-indigenous-communities-with-250-million-federal-assistance-199258">announced</a> new funding to address the longstanding, much-publicised challenges facing Central Australia.</p>
<p>The promised A$250 million adds to an earlier commitment of $48 million and aims to tackle problems faced by residents in Alice Springs and Central Australia from many angles, including strategies to reduce alcohol-related violence, harms and crime. </p>
<p>Included is a <a href="https://cmc.nt.gov.au/news/2023/$298-million-landmark-package-for-central-australia">commitment</a> to “improve the response to fetal alcohol spectrum disorder (FASD) by the health and justice sectors”.</p>
<p>This is an important goal, but it is a big ask – the problems are complex and they are not new. FASD often goes undiagnosed and can cause severe and lifelong problems.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/alcohol-warning-labels-need-to-inform-women-of-the-true-harms-of-drinking-during-pregnancy-134049">Alcohol warning labels need to inform women of the true harms of drinking during pregnancy</a>
</strong>
</em>
</p>
<hr>
<h2>The heart of many problems</h2>
<p>Alcohol is behind or has been linked to many of the current problems in Central Australia, including the recent wave of crime and violence. Some believe this <a href="https://www.sbs.com.au/news/article/a-crime-wave-has-sparked-emergency-measures-in-alice-springs-heres-whats-going-on/3qcqvrkip">followed the relaxation</a> in July 2022 of the <a href="https://www.dss.gov.au/sites/default/files/documents/09_2012/stronger-futures-booklet-jul2012.pdf">Stronger Futures</a> laws that limited access to alcohol in many NT communities for more than a decade. </p>
<p>In communities where alcohol use is high, a focus on <a href="https://www.cdc.gov/ncbddd/fasd/facts.html#:%7E:text=Fetal%20alcohol%20spectrum%20disorders%20(FASDs)%20are%20a%20group%20of%20conditions,a%20mix%20of%20these%20problems.">FASD</a> is warranted. In Alice Springs, communities are <a href="https://www.abc.net.au/news/2023-02-04/fasd-fetal-alcohol-aboriginal-youth-crime-alice-springs/101854566">calling for action</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1623524633658925057"}"></div></p>
<h2>Alcohol and pregnancy</h2>
<p>FASD is a <a href="https://www.fasdhub.org.au/fasd-information/assessment-and-diagnosis/guide-to-diagnosis/">condition</a> that affects people exposed to alcohol before birth and causes problems with motor skills, behaviour or learning, or a mix of these. </p>
<p>FASD is a result of alcohol’s ability to cross the placenta, so maternal and fetal blood alcohol concentrations rapidly reach the same level. Prenatal exposure to alcohol may disrupt development of the brain (neurodevelopment) and other organs in the unborn child. People born with FASD can <a href="https://pubmed.ncbi.nlm.nih.gov/26777270/">have</a> severe neurodevelopmental problems that may be accompanied by birth defects and have lifelong ramifications. </p>
<p>Worldwide, rates of FASD in the general population are <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2649225">estimated</a> at 1–5%, but we lack data in the general Australian population. Internationally, several identifiable groups are at <a href="https://pubmed.ncbi.nlm.nih.gov/30831001/">high risk</a> of FASD – children in foster and adoptive care, in orphanages, mental health facilities, juvenile justice, and some Indigenous groups. </p>
<p>Consistent with these data, <a href="https://pubmed.ncbi.nlm.nih.gov/28499185/">high rates</a> of FASD have been recorded in remote Australia (one in five) and in <a href="https://bmjopen.bmj.com/content/8/2/e019605">juvenile detention</a> (one in three). </p>
<p>But FASD is not selective. It <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2649225">occurs</a> across all socioeconomic levels and racial groups in society. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/factcheck-qanda-does-australia-have-some-of-the-highest-rates-per-capita-of-fetal-alcohol-syndrome-in-the-world-57736">FactCheck Q&A: does Australia have some of the highest rates per capita of fetal alcohol syndrome in the world?</a>
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</em>
</p>
<hr>
<h2>Often underdiagnosed</h2>
<p>Alcohol use in pregnancy is common throughout Australia. In cohort studies from our major cities, <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3354-9">about 60%</a> of pregnant women report drinking alcohol – often before realising they are pregnant. A pattern of <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.12232">high-risk drinking</a> is reported in some remote communities. However, the Australian household survey suggests more educated, more affluent mothers are <a href="https://ada.edu.au/national-drug-strategy-household-survey-2019-5/">more likely to drink</a> throughout their pregnancy.</p>
<p>FASD has significant <a href="https://pubmed.ncbi.nlm.nih.gov/31628757/">economic costs</a> – through its impact on health, education, out-of-home care and justice systems. However, its <a href="https://doi.org/10.1093/oxfordhb/9780199935291.013.78">social impacts</a> are immeasurable.</p>
<p>Children born with FASD are <a href="https://pubmed.ncbi.nlm.nih.gov/26777270/">often slow</a> to develop the social skills and language, motor skills and attention, academic skills and impulse control that would otherwise help them achieve at school and contribute in their community.</p>
<p>They may strive to keep up with their peers but are often easily led and may be unable to distinguish right from wrong. With <a href="https://learningwithfasd.org.au/classroom-strategies/">good support</a> at home and school, children with FASD can thrive. Without it, children and young people <a href="https://bmjopen.bmj.com/content/8/2/e019605">may</a> drop out of school and some fall into a pattern of crime. </p>
<p>It is telling that many incarcerated children and youth have <a href="https://bmjopen.bmj.com/content/8/2/e019605">never had</a> a thorough medical and psychosocial assessment, and many have undiagnosed FASD. So, their strengths and needs have too long gone unrecognised and they have missed opportunities for vital early treatment. </p>
<p>The challenges of FASD are <a href="https://edmontonfetalalcoholnetwork.files.wordpress.com/2018/12/fasd_2nd_ed-2018.pdf">compounded</a> by early-life trauma. We must revert from a punitive to a therapeutic approach for these vulnerable children.</p>
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<figcaption><span class="caption">Every moment matters in your pregnancy.</span></figcaption>
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<h2>The focus so far</h2>
<p>For more than a decade, the Australian government has partnered with clinicians, researchers and others and has made a major contribution to addressing FASD.</p>
<p>After two <a href="https://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=spla/fasd/report.htm">national</a> <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/024357/toc_pdf/Effectiveapproachestoprevention,diagnosisandsupportforFetalAlcoholSpectrumDisorder.pdf;fileType=application%2Fpdf">inquiries</a>, we have a <a href="https://aodknowledgecentre.ecu.edu.au/healthinfonet/getContent.php?linkid=613544&title=National+Fetal+Alcohol+Spectrum+Disorder+%28FASD%29+Strategic+Action+Plan+2018-2028&contentid=35916_1">National Strategic Action Plan for FASD</a> and a national <a href="https://www.fasdhub.org.au/fasd-information/about-us/governance/">FASD Advisory Group</a> to monitor implementation of its recommendations. The <a href="https://www.fasdhub.org.au/fasd-information/assessment-and-diagnosis/guide-to-diagnosis/">Australian Guide to the Diagnosis of FASD</a> has bolstered clinicians’ skills, and the <a href="https://www.fasdhub.org.au">FASD Hub website</a> is a valuable resource. </p>
<p>Local resources for <a href="https://learningwithfasd.org.au/">primary</a> and <a href="https://www.nofasd.org.au/service-providers/education/through-different-eyes/">early childhood educators</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/13218719.2020.1780643?journalCode=tppl20">justice professionals</a>, funded <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/372-million-for-foetal-alcohol-spectrum-disorder-support-and-awarenes">multidisciplinary clinics</a>, the <a href="https://www.nofasd.org.au/contact-us/">National Organisation for FASD</a> website and helpline, a FASD <a href="https://fasdregistry.org.au/">registry</a> to monitor trends, and a vibrant <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1754.2003.00281.x">research network</a> have collectively raised awareness and improved diagnosis and support for people living with FASD and their families.</p>
<p>However, FASD is still inadequately managed within the health and justice sectors in remote regions, including the NT, which are overwhelmed by the needs. </p>
<h2>What the new funds could achieve</h2>
<p>We need a systematic approach to identify all children with developmental and learning vulnerability and offer them treatment at the earliest possible opportunity. In any such child, we need to consider FASD and explore whether there might be a history of prenatal alcohol exposure. </p>
<p>We must increase our screening and diagnostic capacity – not only in specialised services, but in the places of first contact with health services: primary care, midwifery and community paediatric practices, in remote regions.</p>
<p>We also need trained professionals, available locally, to assist families to join the National Disability Insurance Scheme. But there is also a need for <a href="https://theconversation.com/use-it-or-lose-it-getting-ndis-funding-is-only-half-the-battle-for-participants-188530">accessible services</a>, including <a href="https://cdn.shopify.com/s/files/1/1613/1919/files/MWRC_NDIS_Report_2021.pdf?v=1649468403">where remote families live</a>, so they can spend the support funds they are allocated.</p>
<p>The need for culturally appropriate and trauma-informed services to support people with FASD and their families goes without saying. Training of more Aboriginal and Torres Strait Islander health workers is essential.</p>
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<h2>Prioritise prevention</h2>
<p>Prevention efforts must be <a href="https://www.phrp.com.au/issues/march-2015-volume-25-issue-2/fetal-alcohol-spectrum-disorders-in-australia-the-future-is-prevention/">at the fore</a> in the effort to address FASD. We must <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-584">understand</a> that disadvantage and historic trauma, addiction, and partner drinking and violence are among the most <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.13330">common drivers</a> of alcohol use in pregnancy, and shift the blame away from women. In turn, the drivers of disadvantage – inadequate housing, education and vocational opportunities, transport and access to good-quality education and health care – must be addressed. Australians must also relinquish their tolerant attitudes to binge drinking. </p>
<p>From July 2023, <a href="https://www.foodstandards.gov.au/industry/labelling/Pages/pregnancy-warning-labels-downloadable-files.aspx">pregnancy warning labels</a> will feature on all Australian alcohol products. Importantly, Australia’s first public awareness campaign – <a href="https://everymomentmatters.org.au/about/">Every Moment Matters</a> – is currently being rolled out nationally. It includes resources for the public, women at risk, and health professionals. And the <a href="https://twitter.com/catgiorgi/status/1625706451481268224">Strong Born</a> resources will be launched next week for Aboriginal and Torres Strait families and service providers.</p>
<p>All these efforts must be underpinned by legislation and strategies proven to reduce alcohol harms. Although unpopular, we must continue to push for restrictions on advertising and promotion of alcohol, appropriate taxation and pricing, and limit-setting on the number and opening hours of liquor outlets, especially in our most vulnerable communities.</p><img src="https://counter.theconversation.com/content/199673/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Elliott receives grant funding from the NHMRC, MRFF, the Ian Potter Foundation, Healthway WA, the NDIS, the Australian Government, NSW Health. She is on a number of committees related FASD including government, NGO and academic committees. </span></em></p>Fetal alcohol spectrum disorder can cause problems with movement, behaviour or learning or a mix of these. In communities where alcohol use is high, a focus on FASD is warranted.Elizabeth Elliott, Professor of Paediatrics & Child Health and Director of the Australian Paediatric Surveillance Unit, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1991862023-02-07T01:45:18Z2023-02-07T01:45:18ZThe cancer gap between First Nations and non-Indigenous people is widening – but better data could help<figure><img src="https://images.theconversation.com/files/508285/original/file-20230206-13-g1khbo.jpg?ixlib=rb-1.1.0&rect=41%2C98%2C5395%2C3671&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://media.gettyimages.com/id/959597978/photo/man-working-at-home.jpg?s=1024x1024&w=gi&k=20&c=OMrTB8eY1mE_pj-cJdLM1D0Ce8rNQEokhBo0dDRyxbA=">Getty/Marianne Purdie</a></span></figcaption></figure><p>Cancer figures provide stark evidence of the gap between the health of Aboriginal and Torres Strait Islander people and non-Indigenous people in Australia. The difference is confronting – and it’s increasing over time. </p>
<p>Cancer is the leading broad <a href="https://www.indigenoushpf.gov.au/measures/1-08-cancer">cause of death</a> for Aboriginal and Torres Strait Islander people, accounting for 3,612 deaths (23% of deaths). Indigenous Australians are <a href="https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2021/summary">14% more likely</a> to be diagnosed with cancer. They are 20% less likely to survive at least five years beyond diagnosis. </p>
<p>While the likelihood of dying from cancer in the general population declined by 10% from 2010 to 2019, it <a href="https://www.indigenoushpf.gov.au/measures/1-08-cancer">increased</a> by 12% for Aboriginal and Torres Strait Islander people.</p>
<p>These figures highlight major challenges for the federal government’s stated aim to <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/BriefingBook44p/ClosingGap">close the life expectancy gap</a> in a generation. But data will also be critical to meeting this goal.</p>
<h2>Accurate and relevant data</h2>
<p>There continues to be limited visibility in the needs of Aboriginal and Torres Strait Islander people with cancer.</p>
<p>The recent <a href="https://www.worldcancerday.org/">World Cancer Day</a>, with its theme to “Close the care gap”, comes at a pivotal moment in our nation’s history, with momentum building towards a Voice to Parliament. </p>
<p><a href="https://ulurustatement.org/our-story/makarrata/">Makarrata</a> – treaty or agreement-making – has the potential to have a profound and positive impact on the health and healing of Aboriginal and Torres Strait Islander communities. At both the federal and state levels, the dialogue, yarning and truth-telling arising from this process acknowledges the history and trauma of dispossession, and its impact on generations of Aboriginal and Torres Strait Islander people.</p>
<p>Much of this discussion is embedded in the need for constitutional recognition of Aboriginal and Torres Strait Islander peoples’ unique and enduring cultures, and better supporting leadership in their own affairs.</p>
<p>Viewing these aspirations through the <a href="https://www.cdc.gov/cancer/health-equity/racism-health-disparities.htm">prism of cancer care</a> reveals a complex array of barriers to recognition and leadership. Systemic racism and limitations in appropriate, culturally safe health-care services continue to negatively impact Aboriginal and Torres Strait Islander peoples’ experiences and outcomes. </p>
<p>Aboriginal and Torres Strait Islander people experience limited access to health services within Western systems, as well as discrimination within those systems. This results in a <a href="https://equityhealthj.biomedcentral.com/articles/10.1186/1475-9276-12-47">lack of trust</a> when dealing with governments and service providers.</p>
<p>Part of the solution will be gaining a more accurate picture of cancer outcomes. While statistics tell us the proportion of Aboriginal and Torres Strait Islander people with cancer who die is increasing, the reality is likely far worse. <a href="https://doi.org/10.1186/s12874-020-01152-2">Research shows</a> Aboriginal and Torres Strait Islander cancer reporting is underestimated. One reason is the lack of identification of Aboriginal and Torres Strait Islander people in official health data.</p>
<p>A New South Wales study found 16% of Aboriginal and Torres Strait Islander people were <a href="https://doi.org/10.1186/s12874-020-01152-2">not reported</a> on official hospital admissions data. There is a range of reasons for this, including whether or not services ask the required <a href="https://www.aihw.gov.au/getmedia/502680f6-b179-42fa-be71-8fd5d793d8d8/indigenous-identification-DLbrochure.pdf.aspx#:%7E:text='Are%20you%20%5Bis%20the%20person,exactly%20as%20it%20is%20worded.">Standard Indigenous Question</a> and the propensity or <a href="https://doi.org/10.3233/SJI-180491">willingness</a> for Aboriginal and Torres Strait Islander people to identify in the services they attend.</p>
<p>There have been a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12114">range of efforts</a> to improve Aboriginal and Torres Strait Islander identification within the data, including linking multiple official data sources. But this is still yet to be appropriately implemented by governments.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508286/original/file-20230206-25-ilmot5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="people getting chemo treatment" src="https://images.theconversation.com/files/508286/original/file-20230206-25-ilmot5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508286/original/file-20230206-25-ilmot5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508286/original/file-20230206-25-ilmot5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508286/original/file-20230206-25-ilmot5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508286/original/file-20230206-25-ilmot5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508286/original/file-20230206-25-ilmot5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508286/original/file-20230206-25-ilmot5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Patients may not be asked whether they are Indigenous – or be unwilling to share this information on hospital admission.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cancer-patients-receiving-chemotherapy-treatment-hospital-529109200">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-first-indigenous-covid-death-reminds-us-of-the-outsized-risk-nsw-communities-face-166888">The first Indigenous COVID death reminds us of the outsized risk NSW communities face</a>
</strong>
</em>
</p>
<hr>
<h2>Tracking everyone’s cancer experiences</h2>
<p>Appropriate measures that reflect the experiences and needs of Aboriginal and Torres Strait Islander people with cancer are desperately needed. </p>
<p>There have been some <a href="https://doi.org/10.1186/s12913-018-3780-8">promising developments</a> in this area, including the <a href="https://www.mdpi.com/1660-4601/18/12/6193">What Matters 2 Adults</a> study, which identifies factors important to the wellbeing of Aboriginal and Torres Strait Islander people. There’s also been work to measure the <a href="https://pxjournal.org/journal/vol8/iss2/9/">cancer care experiences</a> of Aboriginal and Torres Strait Islander people. But these tools are not used routinely in health-care services, which limits culturally relevant assessment of patients to improve their care. </p>
<p>Bridging the care gap requires health and cancer care services to provide culturally competent and safe health-care systems.</p>
<p>There have been some notable developments since the <a href="https://link.springer.com/article/10.1023/A:1023064400004">first review</a> into Aboriginal and Torres Strait Islander cancer research and reporting in 2003. These include Cancer Council Australia convening the first ever round table on Aboriginal and Torres Strait Islander cancer in 2004, followed by the first <a href="https://www.lowitja.org.au/page/research/research-categories/health-policy-and-systems/aboriginal-and-torres-strait-islander-leadership/completed-projects/a-national-approach-to-improving-cancer-outcomes">national round table</a> on Priorities for Aboriginal and Torres Strait Islander Cancer Research in 2010.</p>
<p>The latter brought together leading experts, Aboriginal and Torres Strait Islander cancer survivors and community members, and representatives from Aboriginal and Torres Strait Islander-controlled organisations.</p>
<p>At the policy level, the <a href="https://www.cancer.org.au/assets/pdf/optimal-care-pathway-for-aboriginal-and-torres-strait-islander-people-with-cancer#:%7E:text=For%20Aboriginal%20and%20Torres%20Strait%20Islander%20people%2C%20optimal%20patient%2Dcentred,about%20treatment%20and%20ongoing%20care">Optimal Care Pathways for Aboriginal and Torres Strait Islanders</a> was released in 2018 along with an implementation plan in 2020. </p>
<p>The ongoing development of the <a href="https://engage.australiancancerplan.gov.au/#:%7E:text=The%20Australian%20Cancer%20Plan%20is,all%20Australians%20affected%20by%20cancer.">Australian Cancer Plan</a> by Cancer Australia is informed by the Leadership Group on Aboriginal and Torres Strait Islander Cancer Control. The National Aboriginal Community Controlled Organisation is also developing a national cancer plan, and there are state and territory plans in development to better support the community-controlled sector.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1622418919213654017"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aboriginal-people-near-the-ranger-uranium-mine-suffered-more-stillbirths-and-cancer-we-dont-know-why-164862">Aboriginal people near the Ranger uranium mine suffered more stillbirths and cancer. We don't know why</a>
</strong>
</em>
</p>
<hr>
<h2>Embedding equity</h2>
<p>If we are going to change the trend and close the cancer care gap, we need to embed equity as a core element within health systems and services. This will ensure appropriate resources are allocated to identify Aboriginal and Torres Strait Islander people in the data, as well as developing measures important to their cancer care. </p>
<p>We need to work to better understand and eliminate the barriers and challenges Aboriginal and Torres Strait Islander people face. We can do this through supporting Aboriginal and Torres Strait Islander voices and leadership in research, education and health.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-are-cancer-clusters-24623">Explainer: what are cancer clusters?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/199186/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kalinda Griffiths receives funding from the National Health and Medical Research Council and the Australian Research Council. She is also Thinker in Residence at the Australian Health Promotion Association. She is Research and Education Lead, Aboriginal and Torres Strait Islander Health at the Victorian Comprehensive Cancer Centre Alliance. </span></em></p>While statistics tell us the proportion of Aboriginal and Torres Strait Islander people with cancer who die is increasing, the reality is likely worse.Kalinda Griffiths, Scientia lecturer, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1938582023-01-31T00:51:29Z2023-01-31T00:51:29ZFirst Nations people often take on the ‘cultural load’ in their workplaces. Employers need to ease this burden<figure><img src="https://images.theconversation.com/files/501193/original/file-20221215-15677-jzr4tt.jpg?ixlib=rb-1.1.0&rect=44%2C377%2C5946%2C3610&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com.au/detail/photo/aboriginal-business-woman-talking-in-a-meeting-royalty-free-image/506549660?phrase=aboriginal%20office&adppopup=true">Getty Images</a></span></figcaption></figure><p>It’s good practice for employers to consult staff when forming policies or guidelines. However, for some staff from diverse backgrounds, this creates extra <a href="https://www.hrmonline.com.au/diversity-and-inclusion/addressing-cultural-load/">work</a> and pressure. </p>
<p>“Cultural load” in the context of the workplace is the <a href="https://www.dca.org.au/topics/aboriginal-and-torres-strait-islander-peoples/leading-practice-principles">invisible workload</a> employers knowingly or unknowingly place on Aboriginal and Torres Strait Islander employees to provide Indigenous knowledge, education and support. This is <a href="https://community.hrdaily.com.au/profiles/blogs/cultural-load-is-it-time-to-evaluate-the-load-and-who-is-bearing">often done</a> without any formally agreed reduction or alteration to their <a href="https://pubmed.ncbi.nlm.nih.gov/35852387">workload</a>. </p>
<p>Consultation and transparency around policies which relate to and impact on First Nations voices is essential for reconciliation. However this should be built on reciprocity and respect, and not create additional staff burden or burnout. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/attention-managers-if-you-expect-first-nations-staff-to-do-all-your-indigenous-stuff-this-isnt-support-its-racism-176143">Attention managers: if you expect First Nations' staff to do all your 'Indigenous stuff', this isn't support – it's racism</a>
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</em>
</p>
<hr>
<h2>Increasing understanding</h2>
<p>Aboriginal and Torres Strait Islander employees <a href="https://cdn.csu.edu.au/__data/assets/pdf_file/0006/851415/Working-with-Indigenous-Australian-Staff.pdf">commonly bear</a> the cultural load <a href="https://www.dca.org.au/research/project/gari-yala-speak-truth-centreing-experiences-aboriginal-andor-torres-strait-islander">in their workplaces</a>. They are in high demand to act as role models, mentors, members on committees and be a point of contact for enquiries around <em>any</em> First Nations matters from other staff. </p>
<p>A <a href="https://www.dca.org.au/research/project/gari-yala-speak-truth-centreing-experiences-aboriginal-andor-torres-strait-islander">2020 survey</a> of more than 1,000 Aboriginal and Torres Strait Islander workers found 78% of respondents felt it important to identify as Indigenous at work. </p>
<p>But almost two-thirds (63%) reported high levels of identity strain. This meant feeling different to or not meeting expectations of the dominant culture in the workplace.</p>
<p>Some 39% said they carried the burden of “high cultural load”, which came in the form of extra work demands and the expectation they would educate others. </p>
<p>Aboriginal and Torres Strait Islander people constitute <a href="https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/estimates-aboriginal-and-torres-strait-islander-australians/latest-release">3.8%</a> of Australia’s total population, with around <a href="https://www.aihw.gov.au/reports/australias-welfare/indigenous-employment">half</a> in employment. As First Nations issues increase in prominence in the lead up to the referendum to constitutionally recognise Aboriginal and Torres Strait Islander people through a First Nations Voice, it’s important we address the toll of the invisible work of educating and explaining. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/10-ways-employers-can-include-indigenous-australians-149741">10 ways employers can include Indigenous Australians</a>
</strong>
</em>
</p>
<hr>
<h2>It takes a toll</h2>
<p>The additional cultural workload increases risk of inducing <a href="https://www.phrp.com.au/issues/march-2021-volume-31-issue-1/the-impact-of-vicarious-trauma-on-aboriginal-andor-torres-strait-islander-health-researchers/">vicarious trauma</a>. Continually revisiting intergenerational trauma takes its toll on Aboriginal and Torres Strait Islander staff, who are already working between two worlds. </p>
<p>It can also be difficult switching off from being in education mode or from First Nations advocacy. This additional cultural load, and the cumulative effects of empathetic engagement with non-Indigenous staff and management, can result in burnout or “compassion fatigue”.</p>
<p>Culturally unsafe environments (that discriminate against, diminish or disempower someone’s cultural identity), workload stress and physiological stress are all <a href="https://community.hrdaily.com.au/profiles/blogs/cultural-load-is-it-time-to-evaluate-the-load-and-who-is-bearing">workplace hazards</a>. Employers have a duty of care to remove or minimise any hazard that can be detrimental to a <a href="https://www.safework.sa.gov.au/workers/health-and-wellbeing/psychological-hazards">worker’s health and safety</a>. </p>
<figure class="align-center ">
<img alt="Officer worker talks to Blak colleague at a conference table" src="https://images.theconversation.com/files/501200/original/file-20221215-14534-kb1zgn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501200/original/file-20221215-14534-kb1zgn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501200/original/file-20221215-14534-kb1zgn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501200/original/file-20221215-14534-kb1zgn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501200/original/file-20221215-14534-kb1zgn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501200/original/file-20221215-14534-kb1zgn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501200/original/file-20221215-14534-kb1zgn.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">Employers have a duty to minimise workplace hazards.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/focus-asian-ethnicity-middleaged-woman-mentor-1751484326">Shutterstock</a></span>
</figcaption>
</figure>
<h2>So what can employers do?</h2>
<p>To ensure Aboriginal and Torres Strait Islander staff aren’t <a href="https://community.hrdaily.com.au/profiles/blogs/cultural-load-is-it-time-to-evaluate-the-load-and-who-is-bearing">overburdened</a>, employers can implement practical measures to reduce their cultural load. </p>
<p><a href="https://www.emerald.com/insight/content/doi/10.1108/ARCH-08-2021-0231/full/html">Research</a> shows an organisation’s culture can thrive by adopting a management framework of continuous evaluation and improvement. Organisations can appoint <a href="https://www.proquest.com/docview/2670092220?pq-origsite=gscholar&fromopenview=true">diversity leaders</a>, to promote accountability and buy-in from all levels of leadership, and ensure their initiatives have the support of HR departments. </p>
<p>Organisations can also employ <a href="https://www.igi-global.com/chapter/the-new-chief-diversity-officer/304639">diversity officers</a> to help staff to support inclusion efforts and anti-racism. </p>
<p>Implementing a <a href="https://www.reconciliation.org.au/reconciliation-action-plans/">reconciliation action plan</a> is another way to increase awareness of cultural load among employers and staff. Run by <a href="https://www.reconciliation.org.au/reconciliation-action-plans/">Reconciliation Australia</a>, the plans are a framework for organisations to be inclusive and contribute to national reconciliation.</p>
<p>Since 2006, <a href="https://www.reconciliation.org.au/wp-content/uploads/2022/11/Annual-review-2021-22-singles.pdf">more than 2,000 organisations</a> have formalised their commitment to reconciliation with a <a href="https://www.flinders.edu.au/reconciliation-action-plan">reconciliation action plan</a>, including at Flinders University, where we work. </p>
<p>The Flinders University reconciliation action plan has several smaller working groups. Our working group aims to:</p>
<ul>
<li><p>ensure any Aboriginal-related work is Aboriginal-led and informed</p></li>
<li><p>recognise identity strain and educate non-Indigenous staff about how to interact with First Nations colleagues in ways that reduce this</p></li>
<li><p>recognise and remunerate cultural load as part of an employee’s workload</p></li>
<li><p>provide support and workload management to alleviate cultural load (by advocating for management to allocate extra workload “points” to Aboriginal and Torres Strait Islander colleagues so this work is no longer “invisible”)</p></li>
<li><p>recognise the importance of celebrating cultural identities and supporting First Nations staff and students to engage in significant community events. </p></li>
</ul>
<p>Our working groups comprise both First Nations and non-Indigenous members and are guided by <a href="https://www.tandfonline.com/doi/full/10.1080/15528030.2019.1669515?casa_token=FgPTQEg3JEYAAAAA%3AMSwcOQ3C64baPAFy_OLASsCV_QZRwfq7DoCvM9DiJAmo1EedTb0JxD1ZXj0WbQAfbQ7W5RhujTd7Mg">two-eyed-seeing</a>. This means bringing together both Indigenous and non-Indigenous peoples, ways of being, knowing and doing, to achieve collaboration and partnership. </p>
<p>Since we ratified our first plan in 2020, we have worked to increase:</p>
<ul>
<li>engagement with Aboriginal and Torres Strait Islander students, staff and community</li>
<li>respect for First Nations knowledge systems and perspectives</li>
<li>Aboriginal and Torres Strait Islander advancement in education, research, employment and wellbeing. </li>
</ul>
<p>Sometimes reconciliation action plans aren’t <a href="https://www.linkedin.com/pulse/fundamental-flaws-reconciliation-action-plans-dean-foley/">taken seriously</a> because they lack accountability. Although there’s not much evidence they create change, supporters of reconciliation highlight their <a href="https://www.aph.gov.au/About_Parliament/Senate/Powers_practice_n_procedures/pops/Papers_on_Parliament_66/Reconciliation_Action_Plans-Creating_Shared_Value">ability to create shared values</a> in workplaces.</p>
<p>Non-Indigenous staff have a duty to ensure their work doesn’t perpetuate trauma from centuries of colonisation. Everyone can be a cultural ally and advocate for change. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-universities-are-on-unceded-land-heres-how-they-must-reconcile-with-first-nations-people-155966">Australia's universities are on unceded land. Here's how they must reconcile with First Nations people</a>
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</em>
</p>
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<p><em>Acknowledgement: thanks to our Aboriginal colleagues who generously share their time and cultural knowledge, especially Kristal Matthews, Larissa Taylor, Sharon Watts and David Copley.</em></p><img src="https://counter.theconversation.com/content/193858/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>Cultural load is the invisible workload Aboriginal and Torres Strait Islander people take on in addition to their regular work. It’s often not formally recognised or remunerated.Nina Sivertsen, Senior Lecturer (Nursing), Flinders UniversityCourtney Ryder, Discipline Lead Injury Studies, Flinders UniversityTahlia Johnson, Cultural Navigator and Community Researcher, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1921672022-12-15T02:22:36Z2022-12-15T02:22:36ZFirst Nations kids are more active when their parents are happy and supported<p>For Aboriginal and Torres Strait Islander people, being physically active has been a part of culture for many thousands of years, through traditional active lifestyles. </p>
<p>These activities are still relevant today. Having a spiritual connection to Country, or <a href="https://aiatsis.gov.au/sites/default/files/research_pub/benefits-cfc_0_2.pdf">caring for Country</a>, provides opportunities for physical activity. This is essential for health and wellbeing. </p>
<p>Physical activity guidelines <a href="https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-children-and-young-people-5-to-17-years">recommend</a> children do at least 60 minutes of moderate-to-vigorous activity every day. This means activity that makes their heart beat faster and might include teams sports like football or netball as well as cycling, swimming, or active play.</p>
<p>First Nations children tend to be more active <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4727.0.55.004main+features12012-13#:%7E:text=non%2Dremote%20areas-,In%202012%2D13%2C%20results%20for%20Aboriginal%20and%20Torres%20Strait%20Islander,in%20non%2Dremote%20areas%20showed%3A&text=four%20in%20ten%20(38%25),over%20a%20seven%20day%20period">than non-Indigenous children</a>. Around half of Aboriginal and Torres Strait Islander children <a href="https://www.health.gov.au/health-topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-children-and-young-people-5-to-17-years">do at least 60 minutes</a> of physical activity a day, compared with <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4727.0.55.004main+features12012-13#:%7E:text=non%2Dremote%20areas-,In%202012%2D13%2C%20results%20for%20Aboriginal%20and%20Torres%20Strait%20Islander,in%20non%2Dremote%20areas%20showed%3A&text=four%20in%20ten%20(38%25),over%20a%20seven%20day%20period">one-third</a> of non-Indigenous children. </p>
<p>But evidence from <a href="https://www.sciencedirect.com/science/article/pii/S0140673621012599?via%3Dihub">international studies</a> and our <a href="https://pubmed.ncbi.nlm.nih.gov/29702468/">previous research</a> shows physical activity levels tend to drop during teenage years for both Indigenous and non-Indigenous children, leading to lower levels in adulthood. So it’s important to provide children with opportunities to be active as they get older. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sport-and-physical-activity-play-important-roles-for-aboriginal-and-torres-strait-islander-communities-but-there-are-barriers-to-participation-168263">Sport and physical activity play important roles for Aboriginal and Torres Strait Islander communities, but there are barriers to participation</a>
</strong>
</em>
</p>
<hr>
<h2>Helping kids grow up strong</h2>
<p>The <a href="https://www.dss.gov.au/about-the-department/longitudinal-studies/footprints-in-time-lsic-longitudinal-study-of-indigenous-children">longitudinal study of Indigenous children</a>, Footprints in Time, aims to help Indigenous children “grow up strong”. The study collects annual data from around 1,700 Indigenous children, who were 0-5 years at the start of the study in 2008, in urban, rural and remote areas of Australia. </p>
<p>Most of the data are collected through a survey competed by the child’s parent, usually their biological mother. Early on, parents were asked culturally relevant questions about their <a href="https://www.menzies.edu.au/page/Resources/Strong_souls_assessment_tool/">social and emotional wellbeing</a>, their child’s engagement with culture and community, screen time and family circumstances such as employment and source of income. </p>
<p>Parents’ postcode was also used to calculate the socioeconomic status of where they lived and how remote it was.</p>
<p>In 2016, parents were asked whether their child (who was then aged 8-13 years) did at least 60 minutes each day of moderate-to-vigorous physical activity. Half the children met the physical activity guidelines. </p>
<figure class="align-center ">
<img alt="Young Indigenous men play AFL on a grassy field" src="https://images.theconversation.com/files/500954/original/file-20221214-415-pip23r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500954/original/file-20221214-415-pip23r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500954/original/file-20221214-415-pip23r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500954/original/file-20221214-415-pip23r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500954/original/file-20221214-415-pip23r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500954/original/file-20221214-415-pip23r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500954/original/file-20221214-415-pip23r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Half the children in our previous study met the physical activity guidelines.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/northern-territory-australia-february-1-2009-628445531">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Out latest study</h2>
<p>In <a href="https://www.sciencedirect.com/science/article/pii/S1440244022004157">our most recent study</a>, we looked at what was happening in the children’s lives aged 0-5 and whether this was linked to their physical activity at age 8-13. </p>
<p>In <a href="https://www.menzies.edu.au/page/Resources/Strong_souls_assessment_tool/">assessing parental wellbeing</a> when the children were aged 0-5, parents were asked about a range of factors, including their level of connection with their family and community, loneliness, having interests, and feelings of anger and worry.</p>
<p>We found that when the parent (who was usually the birth mother) had high levels of wellbeing when the child was aged under five, their child was more likely to do at at least 60 minutes each day of moderate-to-vigorous physical activity at age 8-13. This was regardless of family employment status, income or the socioeconomic or geographical area they lived in. </p>
<p>So higher parent wellbeing during the early years was linked to higher physical activity of their child eight years later. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kids-screen-time-rose-by-50-during-the-pandemic-3-tips-for-the-whole-family-to-bring-it-back-down-193955">Kids' screen time rose by 50% during the pandemic. 3 tips for the whole family to bring it back down</a>
</strong>
</em>
</p>
<hr>
<p>Children were more likely to meet the physical activity guidelines at age 8-13 if they hadn’t played electronic games as a family between age 0-5 years. Again, this was regardless of the family’s employment status, income, or their socioeconomic or geographical area. But the study didn’t ask about the amount of time spent playing electronic games. </p>
<figure class="align-center ">
<img alt="Girl uses bubble wand" src="https://images.theconversation.com/files/500955/original/file-20221214-5615-7n01ee.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500955/original/file-20221214-5615-7n01ee.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500955/original/file-20221214-5615-7n01ee.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500955/original/file-20221214-5615-7n01ee.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500955/original/file-20221214-5615-7n01ee.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500955/original/file-20221214-5615-7n01ee.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500955/original/file-20221214-5615-7n01ee.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">Greater parental wellbeing when a child was young correlated with more physical activity later on.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-runs-soapfilled-wand-making-large-1429517966">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Boosting parents’ welling pays dividends for kids</h2>
<p>Finding ways to promote parent wellbeing and reduce levels of family screen time during the early years is important for Aboriginal and Torres Strait Islander children’s future physical activity levels. </p>
<p>There may be stronger benefits from family cultural engagement, particularly in cultural practices that involve physical activity such as hunting and fishing. </p>
<p>A number of programs are already <a href="https://theconversation.com/are-sports-programs-closing-the-gap-in-indigenous-communities-the-evidence-is-limited-120413">doing this across Australia</a>. But they need careful evaluation, including hearing about Aboriginal and Torres Strait Islander people’s experiences of them. First Nations families should also be included in the design and implementation of future programs. </p>
<p>While our study didn’t examine the drivers of wellbeing among parents, it’s clear we need to find ways to improve parent wellbeing, which could impact physical activity levels among children in early adolescence. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-sports-programs-closing-the-gap-in-indigenous-communities-the-evidence-is-limited-120413">Are sports programs closing the gap in Indigenous communities? The evidence is limited</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/192167/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rona Macniven receives funding from the Heart Foundation (Post-Doctoral Fellowship 105211)</span></em></p><p class="fine-print"><em><span>John Evans has previously received funding from the ARC.</span></em></p>Higher levels of parental wellbeing while children were young was linked with children being more physically active as they got older.Rona Macniven, Research Fellow, UNSW SydneyJohn Evans, Professor, Indigenous Health Education, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1942492022-11-10T04:09:03Z2022-11-10T04:09:03ZFirst Nations women are 69 times more likely to have a head injury after being assaulted. We show how hard it is to get help<figure><img src="https://images.theconversation.com/files/494551/original/file-20221110-17-4yfpkn.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C664&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/woman-sitting-on-ground-arm-holding-461451844">Shutterstock</a></span></figcaption></figure><p><em>First Nations people, please be advised that the following article mentions family violence and assault.</em></p>
<hr>
<p>Aboriginal and Torres Strait Islander women are <a href="https://www.mja.com.au/journal/2008/188/10/hospitalisation-head-injury-due-assault-among-indigenous-and-non-indigenous">69 times more likely</a> than non-First Nations women to go to hospital with a head injury because of an assault.</p>
<p>But not all First Nations women get the support they need.</p>
<p><a href="https://www.mdpi.com/1660-4601/19/22/14744">Our new study</a> shows how health and support services working in remote areas are not equipped with the tools to identify the potential of a head injury for women who experience violence.</p>
<p>Not only are service workers not asking women about a potential traumatic brain injury, there’s a lack of referral options, and often no diagnosis, limiting women’s access to services and supports for recovery.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/four-corners-how-many-more-reveals-the-nations-crisis-of-indigenous-women-missing-and-murdered-193216">Four Corners' 'How many more?' reveals the nation's crisis of Indigenous women missing and murdered</a>
</strong>
</em>
</p>
<hr>
<h2>What is traumatic brain injury?</h2>
<p>Head injuries after an assault range from cuts and bruises to the type that can cause longer-term damage, known as traumatic brain injury. </p>
<p>Traumatic brain injury <a href="https://www.sciencedirect.com/science/article/pii/S0003999310006507">is defined as</a> damage to, or alteration of, brain function due to a blow or force to the head. Non-fatal strangulation can also lead to <a href="https://www.biausa.org/public-affairs/media/strangulation-domestic-violence-and-brain-injury-an-introduction-to-a-complex-topic">brain injury</a> as the brain is deprived of oxygen.</p>
<p>Such injury can have short-term (acute) effects or cumulative effects (over months or years). Changes vary from person to person but can include memory loss, difficulty with motivation, impaired awareness, sensory problems, mood changes and anxiety. </p>
<p>Some types of traumatic brain injury are also a <a href="https://theconversation.com/having-a-brain-injury-does-not-mean-youll-get-dementia-97254">risk factor</a> for early onset dementia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-traumatic-brain-injury-75546">Explainer: what is traumatic brain injury?</a>
</strong>
</em>
</p>
<hr>
<h2>We’re talking about family violence</h2>
<p>Our work tries to understand the needs and priorities of First Nations women who have experienced a traumatic brain injury due to family violence.</p>
<p>Timely and culturally safe care, and support, following such brain injury is vital. But not all First Nations women <a href="https://theconversation.com/aboriginal-australians-want-care-after-brain-injury-but-it-must-consider-their-cultural-needs-115128">get access</a> to it.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1542331369497366533"}"></div></p>
<p>So, in early 2022, we spoke to 38 professionals from various sectors – including health, crisis accommodation and support, disability, family violence, and legal services – working across remote areas of the Northern Territory.</p>
<p>The data offers insights into the barriers that can prevent people asking First Nations women about possible brain injury, and women’s access to health care afterwards.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aboriginal-australians-want-care-after-brain-injury-but-it-must-consider-their-cultural-needs-115128">Aboriginal Australians want care after brain injury. But it must consider their cultural needs</a>
</strong>
</em>
</p>
<hr>
<h2>Often, there’s no follow-up</h2>
<p>Participants told us that while the more severe cases were evacuated from a remote community to a hospital, less-severe cases were not always followed up.</p>
<p>One participant told us: </p>
<blockquote>
<p>Women are often not evac-ed out following a head injury, if it’s assessed to not be an urgent thing, so might not necessarily be getting CT scans.</p>
</blockquote>
<p>CT scans can help inform diagnosis, treatment and support. </p>
<p>Service providers were also often unaware of follow-up pathways to identify and connect women with the right supports, should they have ongoing symptoms.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1541936693799833600"}"></div></p>
<h2>A fly-in, fly out workforce</h2>
<p>Participants told us that high workforce turnover and <a href="https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-017-0229-9">fly-in, fly-out health services</a> in remote regions could also affect identification of traumatic brain injury.</p>
<p>They told us short-term staff can lack knowledge and familiarity of working in remote communities, and in building community relationships.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fly-in-fly-out-heath-care-fails-remote-aboriginal-communities-7948">Fly-in, fly-out heath care fails remote Aboriginal communities</a>
</strong>
</em>
</p>
<hr>
<h2>Lack of referral, diagnosis, training</h2>
<p>Not all women were referred to neuropsychologists (health professionals who might assess symptoms), which led to gaps in medical reports and formalised assessments. One participant told us: </p>
<blockquote>
<p>I don’t know any who actually have a confirmed diagnosis.</p>
</blockquote>
<p>This has implications for how women are managed and the supports they receive.</p>
<p>None of the staff we interviewed had completed training about traumatic brain injury. One told us:</p>
<blockquote>
<p>We get ADD [attention-deficit disorder] workshops, we get domestic and family violence workshops, disability support workshops, but nothing around brain injury.</p>
</blockquote>
<p>Other than some legal services, service providers did not ask specific questions of women who had experience violence and assaults about possible traumatic brain injury. </p>
<p>One participant said: </p>
<blockquote>
<p>We’ll screen for domestic violence, but we don’t screen for specific injuries.</p>
</blockquote>
<h2>What can we do about it?</h2>
<p>As our research shows, First Nations women with traumatic brain injury need better access to support and services, which is critical for their long-term recovery. </p>
<p>Here’s how we support frontline staff:</p>
<ul>
<li><p>design and roll out education about traumatic brain injury to develop staff knowledge and confidence. This education needs to be tailored to the type of frontline staff (remote area nurses will clearly need different education to housing staff), be designed with First Nations input and be culturally appropriate</p></li>
<li><p>ask women about the possibility of traumatic brain injury as part of existing family violence and health assessments</p></li>
<li><p>ask culturally appropriate questions that are not meant to diagnose traumatic brain injury, but help to identify cognitive impairment and complex disability </p></li>
<li><p>explore different ways of delivering rehabilitation for mild traumatic brain injury, and whether telehealth might be appropriate under some circumstances.</p></li>
</ul>
<p>Giving a voice to First Nations women living with traumatic brain injury is also crucial to providing the necessary supports during their rehabilitation and recovery.</p>
<hr>
<p><em>If this article raises issues for you or someone you know, contact <a href="https://1800respect.org.au">1800 RESPECT</a> (1800 737 732) or <a href="https://www.13yarn.org.au/">13YARN</a> (13 92 76). In an emergency, call 000.</em></p>
<hr>
<p><em>Dr Gail Kingston (Townsville Hospital and Health Service) and Elaine Wills (Western Sydney University and Menzies School of Health Research) are co-authors of the journal paper on which this article is based. The authors would like to thank members of the project advisory group and all participants who shared their time and knowledge.</em></p><img src="https://counter.theconversation.com/content/194249/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Fitts receives funding from the Australian Research Council and the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Jennifer Cullen receives funding from the Department of Social Services and the NDIS. She is the CEO of Synapse Australia.</span></em></p><p class="fine-print"><em><span>Karen Soldatic receives funding from the Australian Research Council and the National Health and Medical Research Council. </span></em></p>Health and service workers are not asking women about a potential traumatic brain injury, there’s a lack of referral options, and often no diagnosis.Michelle Fitts, ARC DECRA Fellow, Institute for Culture and Society, Western Sydney UniversityJennifer Cullen, Adjunct Associate Professor, College of Healthcare Sciences, James Cook UniversityKaren Soldatic, Professor, School of Social Sciences & Institute Principle Fellow, Institute for Culture and Society, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1901442022-11-08T04:32:49Z2022-11-08T04:32:49ZIt’s after-hours and I need to see a doctor. What are my options?<figure><img src="https://images.theconversation.com/files/492919/original/file-20221102-26769-rn9s3s.jpg?ixlib=rb-1.1.0&rect=0%2C361%2C5506%2C3371&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/35bnMbid2rQ">Shane/Unsplash</a></span></figcaption></figure><p>There are times when medical care can’t wait until 9am or first thing Monday. Perhaps your COVID has worsened and you’re becoming short of breath. Or your baby has a fever that’s worrying you. Or your elderly parent’s pain can’t be relieved with over-the-counter medications.</p>
<p>When last asked in 2020, <a href="https://chf.org.au/ahpafterhoursprimarycare">two-thirds of Australians</a> had accessed after-hours health services in the previous five years. But how do you access health care on weekends and after 5pm in 2022? </p>
<p>Many GP Super Clinics continue to operate beyond business hours, accept walk-ins and provide access to onsite pharmacy services. You can find their locations <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/pacd-gpsuperclinics-locations">here</a>, though opening hours and costs vary between clinics.</p>
<p>Search engines such as <a href="https://www.hotdoc.com.au/find/doctor/australia">HotDoc</a> and <a href="https://www.healthdirect.gov.au/australian-health-services">Healthdirect</a> can help you find local health services such as GPs, COVID testing clinics, emergency departments, and allied health services. You can filter search results by “open now”, bulk-billing and accessibility requirements such as building access ramps. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/emergency-departments-are-clogged-and-patients-are-waiting-for-hours-or-giving-up-whats-going-on-184242">Emergency departments are clogged and patients are waiting for hours or giving up. What's going on?</a>
</strong>
</em>
</p>
<hr>
<p>The COVID pandemic accelerated investment in virtual care for non-life-threatening emergencies, which can be less stressful for patients and families than attending an emergency department. </p>
<p>Here are some options for in-person and virtual after-hours care.</p>
<h2>Nurse helplines</h2>
<p>If you’re not sure whether you need medical care, or if you need basic information or advice, a useful starting point is to call a <a href="https://www.healthdirect.gov.au/nurse-on-call">free nursing helpline</a> such as <a href="https://www.health.vic.gov.au/primary-care/nurse-on-call">Nurse-on-Call</a> in Victoria, <a href="https://www.qld.gov.au/health/contacts/advice/13health">13HEALTH</a> in Queensland, or <a href="https://www.healthdirect.gov.au/nurse-on-call">Healthdirect</a> in other states.</p>
<p>In some cases, nurses may offer a <a href="https://about.healthdirect.gov.au/after-hours-gp-helpline">call-back from a GP</a> using phone or video consultation. </p>
<figure class="align-center ">
<img alt="Doctor talks on phone" src="https://images.theconversation.com/files/492920/original/file-20221102-26775-8kxbwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492920/original/file-20221102-26775-8kxbwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492920/original/file-20221102-26775-8kxbwh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492920/original/file-20221102-26775-8kxbwh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492920/original/file-20221102-26775-8kxbwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492920/original/file-20221102-26775-8kxbwh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492920/original/file-20221102-26775-8kxbwh.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">In some cases, the nurse may offer a call back from a GP.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/doctor-talking-on-the-cellphone-5207089/">Pexels/Karolina Grabowska</a></span>
</figcaption>
</figure>
<h2>Getting a doctor to visit you at home</h2>
<p>The <a href="https://homedoctor.com.au">National Home Doctor service</a>, which can be booked using telephone (13 74 25) or its mobile app, provides bulk-billed doctor home visits. </p>
<p>Telehealth consultations can also be booked through this service, though they may incur a fee.</p>
<h2>Video consultation with a GP</h2>
<p>A range of companies offer GP telehealth consultation after hours, for a fee. It doesn’t have to be an emergency, and can be used for things like last-minute repeat prescriptions.</p>
<p>Search engines <a href="https://www.hotdoc.com.au/find/doctor/australia">HotDoc</a> and <a href="https://www.healthdirect.gov.au/australian-health-services">Healthdirect</a> can direct you to these services through the “accepts telehealth” or “telehealth capable” options.</p>
<h2>Virtual emergency departments</h2>
<p>Virtual emergency departments in <a href="https://www.vved.org.au">Victoria</a>, <a href="https://metronorth.health.qld.gov.au/hospitals-services/virtual-ed">Queensland</a> and <a href="https://www.wacountry.health.wa.gov.au/Our-services/Command-Centre">Western Australia</a> allow people in these states to virtually connect with emergency doctors and nurse practitioners for treatment and advice on non-life-threatening emergencies. </p>
<p>In Victoria, the establishment of the <a href="https://www.vved.org.au/">virtual ED program</a> has <a href="https://www.prnewswire.com/news-releases/northern-health-using-the-clinicians-digital-health-platform-to-expand-their-victorian-virtual-emergency-department-statewide-301557186.html">decreased wait times</a>, with an easy-to-use platform, triage and waiting room. After the consultation, instructions can be emailed, or e-scripts sent to your local pharmacy. This service is currently covered by Medicare with no out-of-pocket costs, though that may change in the future.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/video-and-phone-consultations-only-scratch-the-surface-of-what-telehealth-has-to-offer-146580">Video and phone consultations only scratch the surface of what telehealth has to offer</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://www.myemergencydr.com">My Emergency Doctor</a> is a private service with a hotline and web-based consultations with expert emergency doctors, for patients across Australia. Typically consultations cost A$250-$280, however people living in <a href="https://www.myemergencydr.com/patients/patients-within-primary-health-networks/">certain Primary Health Networks</a> can receive free after-hours telehealth consultations through this platform. </p>
<h2>Children’s health services</h2>
<p>In South Australia, free paediatric emergency services are available through the Women’s and Children’s Hospital’s <a href="https://www.wch.sa.gov.au/patients-visitors/emergencies/virtual-urgent-care">Child and Adolescent Virtual Urgent Care Service</a>, though similar services aren’t available across the country. </p>
<p>However, on-demand services such as <a href="https://www.kidsdoconcall.com.au">KidsDocOnCall</a> and <a href="https://www.cubcare.com.au">Cub Care</a> provide telehealth paediatric services after-hours to people in all states and territories, for a fee. </p>
<figure class="align-center ">
<img alt="Small baby's hand" src="https://images.theconversation.com/files/492924/original/file-20221102-12-2rqzk2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492924/original/file-20221102-12-2rqzk2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492924/original/file-20221102-12-2rqzk2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492924/original/file-20221102-12-2rqzk2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492924/original/file-20221102-12-2rqzk2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492924/original/file-20221102-12-2rqzk2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492924/original/file-20221102-12-2rqzk2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Paediatric telehealth is available after-hours for a fee.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/N-VEeMnm7gE">Baby Abbas/Unsplash</a></span>
</figcaption>
</figure>
<h2>Pharmacies</h2>
<p>If you need to see a pharmacist or buy medicine after-hours, the <a href="https://www.findapharmacy.com.au">Pharmacy Guild of Australia</a> and <a href="https://nationalnurse.com.au/late-night-pharmacies">National Home Nurse</a> pharmacy finders might be helpful. </p>
<p>In Victoria, <a href="https://www.chemistwarehouse.com.au/supercare-24-hour-chemist">Supercare Pharmacies</a> are also open 24/7, with nurses available from 6pm to 10pm.</p>
<p>Under the Pharmaceutical Benefits Scheme Continued Dispensing Arrangements, approved pharmacists may supply <a href="https://www.pbs.gov.au/info/general/continued-dispensing">eligible medicines</a> to a person in time of immediate need, when the prescribing doctor can not be contacted, once in a 12-month period.</p>
<h2>Medical chests in remote areas</h2>
<p>The Royal Flying Doctor service runs a <a href="https://www.flyingdoctor.org.au/sant/what-we-do/medical-chest-sant/">Medical Chest program</a>, to provide emergency and non-emergency, pharmaceutical and non-pharmaceutical treatments for people in remote areas, such as antibiotics, pain relief and first-aid. </p>
<p>Medical chests are provided for communities which are located more than 80 kilometres from professional medical services and maintained by a designated local medical chest custodian. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/our-study-found-after-hours-gps-actually-do-reduce-visits-to-emergency-rooms-79108">Our study found after-hours GPs actually do reduce visits to emergency rooms</a>
</strong>
</em>
</p>
<hr>
<h2>Mental health support</h2>
<p>Some mental health supports are available after-hours. Free options include:</p>
<ul>
<li><a href="https://healthability.org.au/services/after-hours-mental-health-nursing-service/">HealthAbility</a></li>
<li><a href="https://www.beyondblue.org.au/get-support/talk-to-a-counsellor">Beyond Blue</a></li>
<li><a href="https://www.suicidecallbackservice.org.au">Suicide Call Back Service</a></li>
<li><a href="https://www.lifeline.org.au">Lifeline</a> (13 11 14)</li>
<li><a href="https://kidshelpline.com.au">Kids Helpline</a>.</li>
</ul>
<p>You can also access paid psychologist services via platforms such as <a href="https://virtualpsychologist.com.au">Virtual Psychologist</a> and <a href="https://www.mymirror.com.au">MyMirror</a>. </p>
<figure class="align-center ">
<img alt="Woman waits in hospital waiting room" src="https://images.theconversation.com/files/492927/original/file-20221102-26784-d2poox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492927/original/file-20221102-26784-d2poox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492927/original/file-20221102-26784-d2poox.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492927/original/file-20221102-26784-d2poox.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492927/original/file-20221102-26784-d2poox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492927/original/file-20221102-26784-d2poox.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492927/original/file-20221102-26784-d2poox.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">Hospital emergency departments can be hectic places.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/patient-sitting-hospital-ward-hallway-waiting-1085218841">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Indigenous health and wellbeing</h2>
<p><a href="https://www.vahs.org.au/yarning-safenstrong/">Yarning SafeNStrong</a> is a free, confidential, culturally suitable counselling service for Aboriginal and Torres Strait Islander people. This service offers support with social and emotional wellbeing, financial wellbeing, medical support including COVID testing, drug and alcohol counselling and rehabilitation services. </p>
<p>Other Indigenous health services include <a href="https://www.13yarn.org.au/contact-us-13yarn">13YARN</a>, <a href="https://supportact.org.au/get-help/first-nations-support-2/">Support Act</a>, and <a href="https://www.dardimunwurro.com.au/brother-to-brother/">Brother to Brother</a>. </p>
<h2>For people with communication needs</h2>
<p>Access to after-hours care is often dependent on people’s ability to communicate over a phone. </p>
<p>The <a href="https://www.infrastructure.gov.au/media-communications-arts/phone/services-people-disability/accesshub/national-relay-service">National Relay Service</a> can assist hearing- or speech-impaired people with changing voice to text or English to AUSLAN. </p>
<p>Non-English speaking people can access interpreter assistance for telehealth via the <a href="https://www.tisnational.gov.au">National Translating and Interpreting Service</a>. This service is typically free of charge, covers 150 languages, and can be accessed after-hours. </p>
<h2>Life-threatening emergencies</h2>
<p>Of course, none of the options above should replace the Triple Zero (000) service for life-threatening emergencies <a href="https://www.betterhealth.vic.gov.au/health/servicesandsupport/calling-an-ambulance">such as</a> difficulty breathing, unconsciousness and severe bleeding. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/looking-online-for-info-on-your-childs-health-here-are-some-tips-97701">Looking online for info on your child's health? Here are some tips</a>
</strong>
</em>
</p>
<hr>
<p>This handy infographic shows some of your options for after-hours care. Click on the hand icon on top right to activate interactive elements. Then press the + button to learn more:</p>
<div style="width: 100%;"><div style="position: relative; padding-bottom: 56.25%; padding-top: 0; height: 0;">
<iframe title="" frameborder="0" width="100%" height="675" style="position: absolute; top: 0; left: 0; width: 100%; height: 100%;" src="https://view.genial.ly/633e428a5edcf7001226ef91" type="text/html" allowscriptaccess="always" allowfullscreen="true" scrolling="yes" allownetworking="all"></iframe>
</div> </div>
<hr>
<p><em>We would like to acknowledge the following people for their input to this article: Dr Loren Sher (Director of Victorian Virtual ED at the Northern Hospital), A/Prof Michael Ben-Meir (Director of Emergency Department, Austin Health), Ms Karen Bryant (Senior Aboriginal Liaison Officer, Northern Health) and Dr Kim Hansen (Director of Emergency, St Andrew’s War Memorial Hospital).</em></p><img src="https://counter.theconversation.com/content/190144/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>Sometimes you just can’t wait to see a doctor. With the addition of more virtual services during COVID, these days you have more options.Mahima Kalla, Digital Health Transformation Research Fellow, The University of MelbourneFeby Savira, Alfred Deakin Postdoctoral Research Fellow, Deakin UniversityKara Burns, Digital Health Program Manager at the Centre for Digital Transformation of Health, The University of MelbourneSathana Dushyanthen, Academic Specialist & Lecturer in Cancer Sciences & Digital Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1928422022-10-25T23:51:38Z2022-10-25T23:51:38ZWhat does the budget mean for Medicare, medicines, aged care and First Nations health?<figure><img src="https://images.theconversation.com/files/491775/original/file-20221025-20664-bzssus.jpg?ixlib=rb-1.1.0&rect=17%2C898%2C5973%2C3089&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/coronavirus-hospital-covid-19-woman-medical-1721906755">Shutterstock</a></span></figcaption></figure><p>Labor’s first health budget in almost a decade has few surprises – and that is a good thing. </p>
<p>The budget foreshadows <a href="https://budget.gov.au/2022-23-october/content/bp2/download/bp2_2022-23.pdf">additional annual health and aged care spending of more than A$2.3 billion</a> when initiatives are fully implemented in 2025–26, the end of the four-year forward estimates. The bulk of this is for policy initiatives foreshadowed in the election campaign. </p>
<p>It should not be a surprise that governments promise one thing before an election and stick to it after, but unfortunately that has <a href="https://www.smh.com.au/national/then-and-now-the-abbott-governments-broken-promises-20140514-zrcfr.html">not been the case</a> over the past decade.</p>
<p>There are four big spending commitments in this budget: aged care, Medicare reform, pharmaceuticals, and First Nations’ health.</p>
<h2>Steps towards aged care reform</h2>
<p>Aged care in Australia is a <a href="https://grattan.edu.au/report/next-steps-for-aged-care/">renovator’s opportunity</a>. The system is understaffed and poorly regulated, with policy-making often captured by providers. </p>
<p>The consequences were laid bare by the aged care royal commission, which <a href="https://agedcare.royalcommission.gov.au/publications/final-report">reported in March 2021</a>. The previous government made a <a href="https://theconversation.com/budget-package-doesnt-guarantee-aged-care-residents-will-get-better-care-160611">down payment on reform</a>, but left much undone. </p>
<p>As promised in the election campaign, the 2022-23 budget provides for a major uplift in spending, with the “fixing the aged care crisis” spending line adding $1.2 billion in a full year. But that will only be the start.</p>
<figure class="align-center ">
<img alt="Older man looks at phone" src="https://images.theconversation.com/files/491782/original/file-20221025-11-75oyvi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/491782/original/file-20221025-11-75oyvi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/491782/original/file-20221025-11-75oyvi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/491782/original/file-20221025-11-75oyvi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/491782/original/file-20221025-11-75oyvi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/491782/original/file-20221025-11-75oyvi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/491782/original/file-20221025-11-75oyvi.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">Aged care facilities will employ more nurses.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/smiling-elderly-man-using-smartphone-communicate-1709172556">Shutterstock</a></span>
</figcaption>
</figure>
<p>Key recommendations from the royal commission are being implemented, including funding the novel idea of requiring nursing homes to employ nurses. Funding is also provided for a <a href="https://www.health.gov.au/sites/default/files/documents/2022/10/budget-october-2022-23-restoring-dignity-to-aged-care.pdf">specified minimum number of care minutes</a> for each resident.</p>
<p>There is still much to do, especially in addressing the care workforce shortfall.
The Fair Work Commission is currently <a href="https://theconversation.com/when-aged-care-workers-earn-22-an-hour-a-one-off-bonus-wont-help-176136">reviewing minimum pay rates</a> in the aged care industry, and the outcome will be a significant uplift. The question is, how significant? At present, a burger flipper gets paid more than the person who cares for our grandmothers; this will at last be reversed. </p>
<p>The cost of the Fair Work Commission case is as yet unknown.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-aged-care-workers-earn-22-an-hour-a-one-off-bonus-wont-help-176136">When aged care workers earn $22 an hour, a one-off bonus won’t help</a>
</strong>
</em>
</p>
<hr>
<h2>Medicare reform underway, but no funds for hospitals</h2>
<p>In response to health system pressures, Labor promised several reform initiatives before the election. One of these – the development of <a href="https://theconversation.com/labors-urgent-care-centres-are-a-step-in-the-right-direction-but-not-a-panacea-181237">urgent care clinics</a> – is slated for implementation starting in 2022-23, at a full-year cost of $37 million. </p>
<p>Although there has been some criticism that the policy initiative is <a href="https://www.crikey.com.au/2022/10/25/budget-2022-doctors-sceptical-labors-urgent-care-clinics/">still not finalised</a> in every minute detail, Labor has only been in office for six months.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/labors-urgent-care-centres-are-a-step-in-the-right-direction-but-not-a-panacea-181237">Labor’s urgent care centres are a step in the right direction – but not a panacea</a>
</strong>
</em>
</p>
<hr>
<p>Broad system reform also awaits the conclusions of the Strengthening Medicare Taskforce (of which I am a member). This was established to provide advice on a further $250 million initiative that will be announced in the 2023-24 budget.</p>
<p>Dashing the aspirations of states, there is no provision in the budget for additional funding for state public hospitals, but of course there was no election commitment to do so.</p>
<h2>Price of medicines to drop</h2>
<p>In addition to the expected cost of new listings on the Pharmaceutical Benefits Scheme, the budget allocates $230 million in a full year to reduce the mandatory Pharmaceutical Benefits Scheme co-payment, from the current level of $42.50 per prescription for general beneficiaries to $30. </p>
<p>More than half a million Australians <a href="https://theconversation.com/last-year-half-a-million-australians-couldnt-afford-to-fill-a-script-heres-how-to-rein-in-rising-health-costs-178301">miss out on filling prescriptions</a> each year because of cost, and hopefully this budget initiative will reduce that number. Other people, who might have had to make hard choices to fill prescriptions by foregoing buying new school clothes, will also benefit.</p>
<figure class="align-center ">
<img alt="Pharmacist pulls medicine off a shelf" src="https://images.theconversation.com/files/491780/original/file-20221025-11305-4kv01p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/491780/original/file-20221025-11305-4kv01p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/491780/original/file-20221025-11305-4kv01p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/491780/original/file-20221025-11305-4kv01p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/491780/original/file-20221025-11305-4kv01p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/491780/original/file-20221025-11305-4kv01p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/491780/original/file-20221025-11305-4kv01p.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">Some prescriptions will drop from $42.50 to $30.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/byGTytEGjBo">National Cancer Institute</a></span>
</figcaption>
</figure>
<p>However, the reduction in the official co-payment will lead to reduced discounts from the low-cost pharmacy chains, so the net impact of the budget change is probably <a href="https://medicalrepublic.com.au/whos-the-pharmacy-guild-scheme-really-helping/68992">less of a benefit to patients</a> than the headline $230 million cost to government.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/last-year-half-a-million-australians-couldnt-afford-to-fill-a-script-heres-how-to-rein-in-rising-health-costs-178301">Last year, half a million Australians couldn't afford to fill a script. Here's how to rein in rising health costs</a>
</strong>
</em>
</p>
<hr>
<h2>Funds to expand First Nations health services</h2>
<p>The disparity in health outcomes for First Nations Australians is a tragedy. Medicare is <a href="https://theconversation.com/first-nations-people-in-the-nt-receive-just-16-of-the-medicare-funding-of-an-average-australian-183210">not delivering as it should</a>, with First Nations people in the NT receiving just 16% of the Medicare funding of an average Australian, due to poor access to doctors.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-nations-people-in-the-nt-receive-just-16-of-the-medicare-funding-of-an-average-australian-183210">First Nations people in the NT receive just 16% of the Medicare funding of an average Australian</a>
</strong>
</em>
</p>
<hr>
<p>It is pleasing to see an additional investment of $95 million in a full year to improve the health of First Nations Australians. The commitment appears well designed and includes improved infrastructure, expanded training and new health clinics.</p>
<h2>A broader view of health and wellbeing</h2>
<p>The budget signals the first steps towards adopting a new <a href="https://theconversation.com/the-beginning-of-something-new-how-the-2022-23-budget-does-things-differently-192850">health and wellbeing framework</a> for measuring societal progress, incorporating broader aspects of everyday life into <a href="https://budget.gov.au/2022-23-october/content/bp1/download/bp1_bs-4.pdf">budget reporting</a>.</p>
<p>Although the media obsession with the budget deficit and gross domestic product as the only measures of note will probably continue, future budget documents will begin to take a more holistic view.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-beginning-of-something-new-how-the-2022-23-budget-does-things-differently-192850">‘The beginning of something new’: how the 2022-23 budget does things differently</a>
</strong>
</em>
</p>
<hr>
<p>A range of potential indicators were foreshadowed in this budget, including a climate-related one (related to threatened species) and public trust in government, both areas where Australia is not performing well.</p>
<p>In terms of climate, the budget includes a very welcome, albeit tiny, commitment to assist the Commonwealth Department of Health provide leadership on the health impact of climate change by establishing a National Health Sustainability and Climate Unit.</p>
<p>The budget itself builds public trust by providing no real surprises, but gets on with the job of implementing what was already promised.</p>
<p><em>* Update: This article previously said the cost of the Fair Work Commission case was not included in this budget. Since publication, The Conversation has been advised that an unspecified amount has been included in the budget’s contingency reserve section.</em></p><img src="https://counter.theconversation.com/content/192842/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett is a member of the board of directors of the Brotherhood of St Laurence, an aged care provider, and is also a member of the Strengthening Medicare Task Force.</span></em></p>The budget gets on with the job of implementing the health policies already promised. But there’s still more to do to get the new government’s policy settings right.Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.