tag:theconversation.com,2011:/us/topics/aboriginal-health-7324/articlesAboriginal health – The Conversation2023-11-08T03:04:39Ztag: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>
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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>
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<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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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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<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>
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<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>
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<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>
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<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>
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<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>
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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>
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<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>
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<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>
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<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>
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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>
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<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>
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<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/2090312023-09-13T20:06:19Z2023-09-13T20:06:19ZThe aged care system has failed Aboriginal people. Here’s what Elders say needs to change<p>The Royal Commission into Aged Care Quality and Safety recognised the aged care system has failed to provide culturally safe care for Aboriginal and Torres Strait Islander people as they age. It recommended major reforms, including active partnership with Aboriginal and Torres Strait Islander people. </p>
<p>The Australian government has also <a href="https://www.health.gov.au/our-work/aged-care-reforms/what-were-doing/equitable-access#more-funding-for-the-national-aboriginal-and-torres-strait-islander-flexible-aged-care-program">committed</a> more funding for Aboriginal and Torres Strait Islander aged care services, with a focus on boosting the role of Aboriginal community-controlled organisations.</p>
<p>So what do older Aboriginal people need to age well? And how can aged care funding and systems enable that?</p>
<p>This was at the centre of our <a href="https://www.cambridge.org/core/journals/ageing-and-society/article/elders-perspectives-and-priorities-for-ageing-well-in-a-remote-aboriginal-community/4EFCAD2A0DCE60F8F641A2E6BDDFBC66">study</a>, led by the <a href="https://www.dharriwaaeldersgroup.org.au/">Dharriwaa Elders Group</a> in its long-term partnership with UNSW, known as <a href="https://www.unsw.edu.au/walgett-partnership">Yuwaya Ngarra-li</a>.
The study involved speaking with 22 Elders in the remote New South Wales town of Walgett about what ageing well means to them.</p>
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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>
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<h2>Elders are the ‘wellspring’ for younger people</h2>
<p>Aboriginal Elders play an important role as community leaders and protectors of cultural heritage. This involves passing down knowledge and stories, leadership, care-giving and safeguarding family, community and intergenerational wellbeing. Supporting this aspect of ageing well is crucial. As one Elder explained:</p>
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<p>Talking about our stories and storylines, and telling those stories […] It’s Aboriginal culture – it’s an oral system of educating people and giving people information. It’s part and parcel of Aboriginal life […] you know your stories, you know where you come from.</p>
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<p>For Elders who have worked away from Walgett in various careers, this means a kind of “active retirement” – returning to Country to bring back knowledge and continue a legacy for future generations.</p>
<p>One said: </p>
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<p>Once you have an education, you take it back to your community.</p>
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<h2>Addressing the ongoing impacts of colonisation</h2>
<p>Elders explained how community health and wellbeing continue to be harmed by dispossession and climate change, drought and water insecurity:</p>
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<p>When I think about ageing and culture, I think one of the big things that is on people’s minds, especially elderly Aboriginal people, is the fact that the rivers have dried up, and how that affects culture. To me, it’s like another wave of destruction of our culture.</p>
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<p>Many Elders described experiencing institutional racism in mainstream services, including aged care services, and identified that current systems are not designed with consideration of the wellbeing of Aboriginal people: </p>
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<p>I think there’s always been a difference in the aged care needs of Aboriginal people. We’re in a system, an English system, and I think our care needs are different. Not that we need to be in a building with four walls and just sit there. They don’t understand the Aboriginal way because they never learn it, we learnt their way.</p>
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<p>Elders highlighted the need to acknowledge the intergenerational trauma of being placed in institutions for Aboriginal people, especially for survivors of the Stolen Generations who were taken from their families and put in government and church-run institutions.</p>
<h2>A holistic concept of wellbeing</h2>
<p>For Elders, wellbeing isn’t just about individual health. It also involves social, mental, physical, cultural, spiritual, political, family and community dimensions.</p>
<p>They saw the Dharriwaa Elders Group Centre – a space used for daily meetings, events, cultural exhibitions and other community activities – as vital: </p>
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<p>People tell jokes, you come in here and have a yarn about different things. Makes you feel good when you come in here and talk to people.</p>
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<p>Another said:</p>
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<p>I think the Elders Group is important, that we have this organisation here, we’ve got people together of the same age group, the same mindset. You see it when older people are just around young people, they aren’t exercising their minds as much because they don’t know what they’re talking about. The older person doesn’t understand, and they’re just left there wondering. So if you’ve got similar age, similar thinking, they can have a conversation.</p>
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<p>Elders saw staying politically engaged and active in the community through Aboriginal community-controlled organisations as crucial to wellbeing.</p>
<h2>A culturally safe model of aged care</h2>
<p>Elders talked passionately about how culturally safe aged care means being truly cared for, not just having your needs met. They described the traditional way of caring as based on being loved, valued, respected and safe. A culturally safe model of aged care would integrate these values into practice. </p>
<p>Elders felt strongly that mainstream models didn’t help show what aged care should look like. One said:</p>
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<p>They’ve had the royal commission, and the report […] They did do some investigation of ageing Aboriginal people, but how do they fully know what to look at? Come and talk to us. What I mean by this is Closing the Gap – well, there is no such thing for ageing […] Because non-Aboriginal people, we can see they’re getting a bad deal.</p>
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<p>Many feared becoming dependent on the aged care system. </p>
<h2>Building community capacity in aged care</h2>
<p>Walgett is a small remote community, which presents service delivery challenges. But enabling Elders to age on and care for Country, and to stay connected to extended family, would bring many benefits and opportunities. </p>
<p>For example, unemployment among Aboriginal people in Walgett is high; family and community members could be trained and employed to provide in-home support and transport for Elders:</p>
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<p>Aboriginal people know their people […] Racism is a big thing and it does rear its head in ageing. Aboriginal people understand the way a person speaks, what they might mean, as opposed to say, a non-Aboriginal person, they wouldn’t understand it. Aboriginal people are closer to the language, to the extended family. They’d be good, to be trained up in aged care.</p>
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<p>Local community-controlled organisations are ideally placed to do this, with appropriate resourcing.</p>
<h2>What now?</h2>
<p><a href="https://www.health.gov.au/our-work/aged-care-reforms/delivering-reforms-to-improve-aged-care">Aged care</a> reform is underway. The Dharriwaa Elders Group and others have <a href="https://www.unsw.edu.au/content/dam/pdfs/unsw-adobe-websites/yuwaya-ngarra-li/2023-06-news/2023-06-37-caring-for-elder-community-culture.pdf">raised concerns</a> about a fee-for-service aged care funding model with NDIS-like individualised entitlements.</p>
<p>Elders’ perspectives could guide a different kind of policy and service design reform.</p>
<p>The Dharriwaa Elders Group is an example of how Aboriginal community-controlled organisations provide places to gather and connect, and share knowledge and humour. They can be a hub for community leadership and advocacy. Governments could resource such organisations across Australia to support Elders to age well on Country.</p>
<p>A whole of system approach is required. Elders told us any policy reform must focus not just on aged care, but also on the health, housing and social sectors. This is vital as a non-medical approach to ageing well, enabling Elders to stay on Country, in their community, connected to peers.</p>
<p>This research is leading to possible solutions already. For example, <a href="https://www.architects.nsw.gov.au/news/622-2023-architects-medallion-winner">an award-winning Masters project</a> arising from this research drew on what Elders said they needed to design a culturally led model of housing that could be built in Walgett and other remote communities. </p>
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Read more:
<a href="https://theconversation.com/aboriginal-people-with-disabilities-get-caught-in-a-spiral-of-over-policing-49294">Aboriginal people with disabilities get caught in a spiral of over-policing</a>
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<img src="https://counter.theconversation.com/content/209031/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ruth McCausland receives funding from the Paul Ramsay Foundation and National Health and Medical Research Council, and is on the Board of the Community Restorative Centre. </span></em></p><p class="fine-print"><em><span>Peta MacGillivray receives funding from the Paul Ramsay Foundation and is affiliated with the Community Restorative Centre (CRC NSW) as Chair of the Board of Directors.</span></em></p><p class="fine-print"><em><span>Sacha Kendall Jamieson receives funding from the National Health and Medical Research Council and through the Westpac Safer Children, Safer Communities grant scheme</span></em></p><p class="fine-print"><em><span>Virginia Robinson is Secretary of the Dharriwaa Elders Group </span></em></p>Aboriginal Elders play an important role as community leaders and cultural knowledge holders. Supporting this aspect of ageing well is crucial.Ruth McCausland, Associate Professor, UNSW SydneyPeta MacGillivray, Senior Research Fellow, UNSW SydneySacha Kendall Jamieson, Lecturer in Social Work and Policy Studies, University of SydneyVirginia Robinson, Secretary of the Dharriwaa Elders Group, Indigenous KnowledgeLicensed 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>
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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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<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>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1689828524939788288"}"></div></p>
<hr>
<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>
</strong>
</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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<hr>
<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/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>
<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</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>
<hr>
<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>
<hr>
<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>
<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>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/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>
<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>
<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>
<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>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>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1532579341556756481"}"></div></p>
<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>
<hr>
<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>
</strong>
</em>
</p>
<hr>
<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>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1467369562790264832"}"></div></p>
<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>
<hr>
<p>
<em>
<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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</em>
</p>
<hr>
<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>
<hr>
<p>
<em>
<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>
</strong>
</em>
</p>
<hr>
<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/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>
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</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>
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</em>
</p>
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<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/1870682022-09-15T02:59:09Z2022-09-15T02:59:09ZHow do we support Indigenous people in Australia living with musculoskeletal conditions?<figure><img src="https://images.theconversation.com/files/481245/original/file-20220826-23-r0mowc.jpg?ixlib=rb-1.1.0&rect=5%2C130%2C3783%2C2545&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/mri-scan-human-spine-168563063">shutterstock</a></span></figcaption></figure><p>There have been national, state and local campaigns to “<a href="https://www.closingthegap.gov.au/national-agreement/targets">Close the Gap</a>” in Australia. Despite this, considerable health gaps still exist between Indigenous and non-Indigenous people.</p>
<p>Musculoskeletal conditions are an area of health where there is a significant difference between Indigenous and non-Indigenous people. Although Indigenous people experience musculoskeletal conditions <a href="https://pubmed.ncbi.nlm.nih.gov/29245188/">more</a>, their access to high-quality and culturally informed support remains low.</p>
<p>Musculoskeletal conditions can have a considerable <a href="https://pubmed.ncbi.nlm.nih.gov/22392923/">effect</a> on people’s lives. Such conditions can affect a person’s ability to walk, complete simple tasks at home without help, and participate in sports or work.</p>
<p>Government health organisations need to provide better support for Indigenous people suffering from these conditions by encouraging culturally safe community-based care.</p>
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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>
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<h2>What are musculoskeletal conditions?</h2>
<p><a href="https://www.health.gov.au/health-topics/chronic-conditions/what-were-doing-about-chronic-conditions/what-were-doing-about-musculoskeletal-conditions#:%7E:text=We%20are%20providing%20%244%20million,and%20training%20for%20health%20professionals">Musculoskeletal conditions</a> include disorders that affect the bones, muscles and joints such as back pain and osteoarthritis. They affect approximately one in three <a href="https://pubmed.ncbi.nlm.nih.gov/35505334/#:%7E:text=In%202019%2C%2022.3%25%20and%2039.8,particular%20females%20and%20older%20Australians">Australians</a>. </p>
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<p>Internationally, low back pain is the leading cause of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30480-X/fulltext">disability</a>, and osteoarthritis is the leading cause of physical activity <a href="https://pubmed.ncbi.nlm.nih.gov/24553908/">limitation</a>. Both of these ailments are more common in <a href="https://pubmed.ncbi.nlm.nih.gov/29245188/">Indigenous people</a>, who are 20-50% more likely to have osteoarthritis and 10% more likely to report current back pain than the non-Indigenous population in Australia. </p>
<p>Musculoskeletal conditions have also been shown to contribute to the development of <a href="https://pubmed.ncbi.nlm.nih.gov/30249247/#:%7E:text=Pooled%20adjusted%20estimates%20from%20these,total%20n%20%3D%202%2C686%2C113%20people">chronic diseases</a> such as diabetes and cardiovascular disease. With 46% of Australia’s Indigenous population having at least <a href="https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/national-aboriginal-and-torres-strait-islander-health-survey/latest-release">one</a> chronic condition, this may lead to even <a href="https://pubmed.ncbi.nlm.nih.gov/22818936/">higher</a> rates of chronic diseases.</p>
<p>Many Indigenous people resign themselves to being in <a href="https://pubmed.ncbi.nlm.nih.gov/15885010/">pain</a> and living with their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808686/">condition</a>. The social impact of living with these conditions is important to consider. For some First Nations people, it has the potential to restrict participation in activities of cultural significance and minimising connection with family and Country. </p>
<p>For example, the ability to care for and connect with extended family, attend community and family gatherings and enjoy activities on Country. These <a href="https://pubmed.ncbi.nlm.nih.gov/22392923/">limitations</a> often have considerable emotional effects on individuals, leading to feelings of anger, depression and fear.</p>
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Read more:
<a href="https://theconversation.com/colonial-ideas-have-kept-nz-and-australia-in-a-rut-of-policy-failure-we-need-policy-by-indigenous-people-for-the-people-188583">Colonial ideas have kept NZ and Australia in a rut of policy failure. We need policy by Indigenous people, for the people</a>
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<h2>Community-based care is needed</h2>
<p>Indigenous people’s <a href="https://pubmed.ncbi.nlm.nih.gov/24127305/">access</a> to health-care services to manage pain is half the expected rate compared to non-Indigenous people. Part of the reason for lower health care access is due to <a href="https://pubmed.ncbi.nlm.nih.gov/25945587/">negative experiences</a> with health-care services due to discriminatory attitudes toward pain from health-care providers. Unfortunately this is a common occurrence for Indigenous people. More than half (53%) of all Indigenous people have <a href="https://www.westernsydney.edu.au/__data/assets/pdf_file/0009/1201203/OMAC1694_Challenging_Racism_Report_4_-_FINAL.pdf">experienced racism</a> when when seeking health care. </p>
<p>Ways to increase Indigenous peoples’ access to health services is for them to have better support with self-managing their condition. In addition, community-based approaches to health care would provide a safer space for these patients. The <a href="https://www.health.gov.au/initiatives-and-programs/indigenous-australians-health-programme">Indigenous Australians’ Health Programme</a> and other funding bodies must work with communities, clinicians, and researchers to deliver programs addressing musculoskeletal conditions and chronic diseases. These programs need to ensure local communities are at their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999419/">centre</a> and cultural safety for participants is a priority. Such programs could be led by community-based allied health clinicians, but should include a range of health professionals to ensure optimal care is provided that addresses all factors related to musculoskeletal conditions.</p>
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Read more:
<a href="https://theconversation.com/indigenous-people-with-disabilities-face-racism-and-ableism-whats-needed-is-action-not-another-report-187528">Indigenous people with disabilities face racism and ableism. What's needed is action not another report</a>
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<h2>Health care needs to include cultural safety</h2>
<p>A whole of system approach is required to improve access to health care for Indigenous people in Australia. National, state, and local services must work together to ensure culturally safe care is provided, placing Indigenous clients and local communities at its <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999419/">core</a>. This shift will likely require changes in how clinicians deliver care, how the services organise care, and how the health-care system supports this care.</p>
<p>Ineffective communication is often sighted as a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808686/">barrier</a> to care for Indigenous people. This is why clinicians building connections and rapport with the Indigenous community they are treating is important. Undertaking training in cultural safety and effective communication strategies is essential to assist clinicians in providing optimal care.</p>
<p>To improve health services, programs providing care for musculoskeletal conditions should aim to partner with Aboriginal Community Controlled Health Organisations and ensure Indigenous people are trained and employed as part of the team. The health system should also ensure <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808686/">policies prioritise</a> these employment opportunities as well as the importance of providing culturally safe care and working with local Indigenous communities.</p>
<p>A person’s musculoskeletal pain and the presence of chronic diseases are often intertwined. We must develop community-based models of care to address these conditions in Indigenous people, and ensure culturally safe care is being provided.
These changes will require ongoing training for health-care staff. </p>
<p>The fundamental shift is the inclusion of local Indigenous communities in all health care initiatives. These improvements will help ensure Indigenous people have the opportunity to self-manage their musculoskeletal pain, general health and well being.</p><img src="https://counter.theconversation.com/content/187068/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Williams receives funding from National Health and Medical Research Council of Australia. </span></em></p><p class="fine-print"><em><span>Jane Linton and Simon Davidson 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>Government health organisations need to provide better support for Indigenous people suffering from musculoskeletal conditions.Simon Davidson, PhD Candidate, University of NewcastleChristopher Williams, Associate Professor, University of SydneyJane Linton, Affiliate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1885302022-08-22T01:29:30Z2022-08-22T01:29:30Z‘Use it or lose it’ – getting NDIS funding is only half the battle for participants<figure><img src="https://images.theconversation.com/files/480012/original/file-20220819-18-8jxot8.jpg?ixlib=rb-1.1.0&rect=844%2C35%2C5137%2C2901&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://images.pexels.com/photos/4058222/pexels-photo-4058222.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2">Pexels/Cliff Booth</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Around <a href="https://www.aihw.gov.au/reports/disability/people-with-disability-in-australia/contents/people-with-disability/prevalence-of-disability">4.5 million Australians</a> live with disability but less than 13% of them are covered by the National Disability Insurance Scheme (NDIS). Getting into the scheme is one thing. But many NDIS participants find using their funding is yet another. </p>
<p><a href="https://disability.unimelb.edu.au/home/projects/collaborative-research/ndis-plan-utilisation">Our research</a> indicates a major issue in terms of the fairness of the scheme is less in the allocation of funding but more about whether people are able to spend their funding. </p>
<p>Some groups – particularly people living in regional or remote areas or Aboriginal and Torres Strait Islander people – are less able to use their budgets. But there are ways to make the NDIS more equitable. </p>
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Read more:
<a href="https://theconversation.com/ndis-fraud-reports-reveal-the-schemes-weakest-points-188746">NDIS fraud reports reveal the scheme's weakest points</a>
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<h2>Using an NDIS plan</h2>
<p>When accepted onto the NDIS, participants develop a plan that sets out the goals they want to work towards, and the supports needed to achieve them. This comes with an associated budget to spend on different supports. </p>
<p>Most plans last around 12 months before they are reviewed, but they can last as long as <a href="https://ourguidelines.ndis.gov.au/your-plan-menu/creating-your-plan/plan-duration-guidance">three years in some cases</a>. </p>
<p>If the funding associated with a plan is not all spent, the funds don’t roll over into the next plan and are returned to the scheme. </p>
<p>At a subsequent review there will be discussion about why the funds weren’t used. If a person <a href="https://ourguidelines.ndis.gov.au/how-ndis-supports-work-menu/reasonable-and-necessary-supports/how-we-work-out-if-support-meets-funding-criteria/what-else-do-you-need-know-about-working-out-if-supports-meet-funding-criteria">consistently doesn’t use</a> all their funds, they might find future budgets are reduced. </p>
<p>Given the <a href="https://theconversation.com/what-we-know-about-the-ndis-cuts-and-what-theyll-mean-for-people-with-disability-and-their-families-179748">widely reported cuts</a> to NDIS plans, some participants are <a href="https://www.smh.com.au/national/more-stress-more-waste-the-fight-for-the-future-of-the-ndis-20220429-p5ah6f.html">concerned</a> under-spending might lead to future plan cuts. </p>
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<h2>Why people don’t spend their allocation</h2>
<p>There are a <a href="https://disability.unimelb.edu.au/home/projects/collaborative-research/ndis-plan-utilisation">range of reasons</a> why people don’t manage to use all their budget allocation. </p>
<p>The NDIS is complex to navigate, and people may not fully understand their plan or the system. There might not be the providers available to meet a person’s needs or it might be difficult to find and secure appropriate providers. Similar schemes overseas show people are unlikely to use their entire budgets – they might hold some portion back “for a rainy day” or their needs might change or not eventuate as anticipated.</p>
<p>The previous federal government argued the NDIS was <a href="https://theconversation.com/dehumanising-and-a-nightmare-why-disability-groups-want-ndis-independent-assessments-scrapped-156941">inequitable</a>, suggesting those in richer areas were receiving larger budgets than those in poorer areas. </p>
<p>It proposed to reform the scheme by introducing Independent Assessments, which it argued would produce fairer plan amounts by assessing each participant using the same suite of functional assessment tools. But this proposed reform <a href="https://theconversation.com/ndis-independent-assessments-are-off-the-table-for-now-thats-a-good-thing-the-evidence-wasnt-there-164163">was dropped</a> after backlash from the disability community who believed the tools would not produce the intended effects and that this might be an attempt to cut scheme costs. </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>Tracking under-use</h2>
<p>One way to measure the under-use of NDIS funding is to explore the utilisation rate. This refers to a comparison of the dollar value of individual budgets against the overall amount expended on supports.</p>
<p>Latest <a href="https://www.ndis.gov.au/about-us/publications/quarterly-reports">NDIS data</a> shows the national average utilisation rate is 75%. </p>
<p>This measure is only an average, and there are many participants with very low utilisation – 32% of participants spend less than 50% of their budgets. People in some areas spend less than others. For example, East Arnhem in the Northern Territory has an average utilisation rate of 47%.</p>
<p>We also see variation in utilisation within budgets. NDIS plans contain three different categories of funding: core supports for everyday activities, capacity building supports to help build independence and skills, and capital supports to purchase equipment and home or vehicle modifications. </p>
<p>While the national average utilisation rate for core supports is 81%, capacity building stands at <a href="https://www.ndis.gov.au/about-us/publications/quarterly-reports">59% and capital at 56%</a>. Many people have reported challenges in getting home modifications and high-cost equipment approved even when these are in their plans. </p>
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Read more:
<a href="https://theconversation.com/people-with-intellectual-disability-can-be-parents-and-caregivers-too-but-the-ndis-doesnt-support-them-186742">People with intellectual disability can be parents and caregivers too – but the NDIS doesn't support them</a>
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<h2>Some groups use more than others</h2>
<p>As part of ongoing research, <a href="https://disability.unimelb.edu.au/home/projects/collaborative-research/ndis-plan-utilisation">we compared</a> groups of NDIS participants to better understand differences in plan allocation and spending. We focused on groups more likely to face inequity in utilisation and where wider social inequities are present. </p>
<p>We looked at plan size and spending separately. We did this because an increase in utilisation could occur if plans are reduced but spending remains the same. </p>
<p>We compared plan size and spending for participants from culturally and linguistic diverse backgrounds, Aboriginal and Torres Strait Islander people and according to where people live. We considered factors such as age to ensure comparisons were “like with like”. </p>
<p>We found participants from culturally and linguistic diverse backgrounds backgrounds and Aboriginal and Torres Strait Islander people received larger plans than other NDIS participants. But they spent a similar amount, despite having bigger budgets. This resulted in lower levels of utilisation. </p>
<p>Inequities also vary by disability group. We found spending and utilisation was low across the board for people with psychosocial disability (such as schizophrenia, bipolar disorder and social anxiety disorders). </p>
<p>In a <a href="https://disability.unimelb.edu.au/home/projects/collaborative-research/ndis-plan-utilisation">study</a> of Victorian NDIS data, we found participants living in regional and remote areas receive less funding. They also spend less of their allocated funding compared to people who live in large urban centres. Some of this may be due to challenges of “thin markets”, where insufficient providers are available in an area. </p>
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<strong>
Read more:
<a href="https://theconversation.com/indigenous-people-with-disabilities-face-racism-and-ableism-whats-needed-is-action-not-another-report-187528">Indigenous people with disabilities face racism and ableism. What's needed is action not another report</a>
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<h2>What can be done?</h2>
<p>One of the <a href="https://theconversation.com/with-a-return-to-labor-government-its-time-for-an-ndis-reset-183628">election commitments</a> of the Labor government was to increase the number of providers in regional areas. This would address “<a href="https://www.ndis.gov.au/community/research-and-evaluation/markets-and-innovations-our-research">thin markets</a>” – where there is a gap between participant needs and their use of funded supports. But it should be done in a meaningful way so providers and services are appropriate to their local communities. </p>
<p>Another way to help participants access services is to increase use of NDIS support coordinators. These workers who are funded via the person’s plan can help participants connect with NDIS providers and understand the scheme. This can act as an additional source of help to be able to find suitable providers and to be able to use their plans in buying services. </p>
<p>Our <a href="https://disability.unimelb.edu.au/home/projects/collaborative-research/ndis-plan-utilisation">modelling</a> shows increasing the use of support coordinators could increase plan utilisation and reduce inequities for Aboriginal and Torres Strait Islander people, culturally and linguistically diverse participants, people from low socioeconomic backgrounds and those with psychosocial disabilities.</p><img src="https://counter.theconversation.com/content/188530/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Dickinson receives funding from Australian Research Council, National Health and Medical Research Council, Commonwealth government, CYDA and WISE.</span></em></p><p class="fine-print"><em><span>George Disney has received funding for commissioned research from the Department of Social Services and the Victorian Department of Families Fairness and Housing. </span></em></p>Some NDIS participants worry if they don’t spend their annual funds, they won’t be offered the same supports in their next plan – and it’s harder for some to use what they’ve been allocated.Helen Dickinson, Professor, Public Service Research, UNSW SydneyGeorge Disney, Research Fellow, Social Epidemiology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1867302022-07-15T01:42:34Z2022-07-15T01:42:34ZFirst Nations people in rural NSW lived with more anxiety and fear about COVID-19 than non-First Nations people<p>At the beginning of the COVID-19 pandemic, the federal government’s pandemic response struggled to include the country’s most minoritised groups, including First Nations people.</p>
<p>Daily press conferences were broadcast, but the messages were not delivered or received equally across the country. Trust in the people delivering the messages and ability to follow health advice varies according to <a href="https://www.tandfonline.com/doi/full/10.1080/13669877.2021.1890637">personal, social and cultural experiences</a>.</p>
<p>Our <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13643-6">study</a> found First Nations people in rural NSW experienced significantly more anxiety and fear about COVID-19 than non-First Nations Australians.</p>
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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>
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<h2>Australia’s bungled response to communities hit hard by COVID</h2>
<p><a href="https://ourworldindata.org/coronavirus/country/australia">At the beginning of the pandemic </a>Australia’s strategy resulted in low numbers of infected people until the Delta variant emerged. Then First Nations rural and remote communities were essentially left to <a href="https://theconversation.com/the-covid-19-crisis-in-western-nsw-aboriginal-communities-is-a-nightmare-realised-166093">fend for themselves</a>. Even though First Nations people were found to be at <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12841-6#Sec1">greater risk</a> of death and illness during past influenza pandemics. </p>
<p>The Aboriginal community-controlled health sector’s strengths based communication strategy led to culturally appropriate <a href="https://www.ahmrc.org.au/coronavirus/">responses</a> including the creation of pandemic tool kits and infection control advice. In some places this included <a href="https://doi.org/10.1016/S0140-6736(20)31545-2">closing</a> remote communities and developing localised social media campaigns for these sites. </p>
<p>However, the Delta variant’s spread through Western NSW revealed limited access to vaccination and government’s failure to consult with hard-hit communities. These problems were compounded by complicated messages and limited attention to rural communities that has been a feature of <a href="https://www.phrp.com.au/issues/december-2020-volume-30-issue-4/health-literacy-and-disparities-in-covid-19-related-knowledge-attitudes-beliefs-and-behaviours-in-australia/">pandemic communications</a> in Australia.</p>
<h2>Research limited with structurally marginalised communities</h2>
<p>The research community responded rapidly to the need to investigate and inform responses to the pandemic. However, there was <a href="https://doi.org/10.1016/S0140-6736(20)31545-2">limited</a> research about rural First Nations people’s perceptions of COVID-19 risks, or their information or communication <a href="https://doi.org/10.1002/ajs4.133">needs</a>. </p>
<p>There was also limited attention to the community needs in NSW where the <a href="https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/estimates-aboriginal-and-torres-strait-islander-australians/latest-release">largest population</a> of First Nations peoples live in Australia.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CbwdHEIueGs","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
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Read more:
<a href="https://theconversation.com/access-to-a-second-covid-booster-vaccine-has-been-expanded-to-people-30-years-and-over-186377">Access to a second COVID booster vaccine has been expanded to people 30 years and over</a>
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<h2>Study reveals how concerning COVID was for rural NSW First Nations communities</h2>
<p>In our <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13643-6">study</a> we tested the links between age, sex, First Nations status, access to healthcare and family situation. We also asked how often First Nations people felt fearful about COVID-19, and how harmful they thought the virus was.</p>
<p>First Nations peoples felt afraid more often than non-First Nations people did. They also felt it was highly likely they would catch the virus, and that it would be very harmful to them and their community.</p>
<p>Nearly 60% of First Nations peoples thought there was nothing they could do about COVID-19, and only 11.6% of the rest of the sample agreed with this statement. This is interesting because when vaccines were first made available in Australia, First Nations people were identified as a <a href="https://www.health.gov.au/news/update-for-aboriginal-and-torres-strait-islander-peoples-about-australias-covid-19-vaccines">high priority group</a>.</p>
<p>Their fears were justified because the Delta variant of COVID-19 quickly took hold in <a href="https://www.abc.net.au/news/2021-08-14/aboriginal-elders-fear-covid-deaths-in-walgett-outbreak/100376186">small communities</a> that have limited healthcare services. The availability of services needed to provide vaccinations was not taken into account in <a href="https://www1.racgp.org.au/newsgp/clinical/nsw-communities-left-high-and-dry-in-vaccine-rollo">vaccine rollout plans</a>. </p>
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Read more:
<a href="https://theconversation.com/natural-disasters-and-the-covid-19-pandemic-reveal-the-crucial-role-of-first-nations-media-178769">Natural disasters and the COVID-19 pandemic reveal the crucial role of First Nations media</a>
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<h2>Fear and mistrust stem from historical trauma</h2>
<p>Our survey results of fear and perceptions of harm from COVID-19 is understandable when previous poor health care experiences and past harmful government practices has to led to distrust in health care by many First Nations Peoples.</p>
<p>Notably, two things that predicted high levels of anxiety in survey respondents were common to First Nations people in rural NSW - living with children under 18 years of age and living in small rural towns more than 20 kilometres away from the nearest health service. </p>
<p>One quarter of the First Nations population in Australia already experienced <a href="https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/national-aboriginal-and-torres-strait-islander-health-survey/latest-release#mental-health">anxiety and depression </a> before the pandemic. Lack of confidence in health services and health communications have been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549174/">identified</a> as things that will make anybody’s existing mental health conditions worse. </p>
<p>Fear of COVID infection has been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158942/">linked</a> to long-lasting post-traumatic stress symptoms. Combined with a shortage of mental health services in rural areas, there is an urgent need to consult with communities about how best to support them.</p>
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<h2>Co-designed health communication necessary</h2>
<p>There were no First Nations representatives in daily government press conferences delivering health advice even though there were frequent <a href="https://www.abc.net.au/news/2021-08-14/aboriginal-elders-fear-covid-deaths-in-walgett-outbreak/100376186">mentions</a> of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31545-2/fulltext">risks</a> to First Nations communities. </p>
<p>Different populations require nuanced communications that address their fears and concerns. To overcome distrust of government and poor health care experiences, including First Nations Australians in health communication design and delivery is essential.</p><img src="https://counter.theconversation.com/content/186730/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julaine Allan receives funding from NHMRC, Ian Potter Foundation and NSW Health. The research in this article was funded by. Charles Sturt University COVID-19 research grant.</span></em></p><p class="fine-print"><em><span>Azizur Rahman receives funding from various organisations, including the Australian Government Department of Education, Department of Infrastructure, Regional Development and Cities, Australian Research Council (ARC) Centre of Excellence for Mathematical and Statistical Frontiers (ACEMS), Statistical Society of Australia (SSA), Institute for Governance and Policy Analysis (IGPA), Australian Mathematical Sciences Institute (AMSI), Australian Commonwealth Department of Health and Aging (DoHA) and Australian Housing and Urban Research Institute (AHURI).</span></em></p><p class="fine-print"><em><span>Jodie Kleinschafer receives funding from Transformative Consumer Research Association</span></em></p><p class="fine-print"><em><span>Jayne Lawrence and Mark Lock (Ngiyampaa) 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 study has found First Nations people in rural NSW experienced more anxiety and fear about COVID than non-Indigenous people. How did government messaging contribute to this?Julaine Allan, Senior lecturer, University of WollongongAzizur Rahman, Associate professor, Charles Sturt UniversityJayne Lawrence, Lecturer in Nursing and Midwifery, Charles Sturt UniversityJodie Kleinschafer, Lecturer, Charles Sturt UniversityMark Lock (Ngiyampaa), Senior Lecturer-Girra Maa Indigenous Health Unit, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1832102022-05-18T03:12:03Z2022-05-18T03:12:03ZFirst Nations people in the NT receive just 16% of the Medicare funding of an average Australian<figure><img src="https://images.theconversation.com/files/463528/original/file-20220517-21-vm1pzz.jpg?ixlib=rb-1.1.0&rect=44%2C4%2C2946%2C1747&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/yuendumu-nt-australie-february-15-2020-1706306305">Shutterstock</a></span></figcaption></figure><p>Medicare, Australia’s universal health insurance scheme, provides financial protection against the cost of medical bills, and makes public hospital care available without any charge to the patient. For the large majority of Australians in urban settings, it is a <a href="https://www.commonwealthfund.org/sites/default/files/2021-08/Schneider_Mirror_Mirror_2021.pdf">brilliant system</a> – providing subsidised access to care. </p>
<p>But subsidised access is only useful for those who have access. If there is no doctor nearby, there is nothing to subsidise. This creates a huge inequity – most of Australia has good access to doctors, but the Northern Territory does not. </p>
<p>And what’s worse, there is no effective policy to redress the inequity that payments flow to areas where there are doctors.</p>
<p>In our <a href="https://www.publish.csiro.au/AH/pdf/AH21276">recently published paper</a>, we found NT residents receive roughly 30% less Medicare funding per capita than the national average (A$648 compared with A$969). </p>
<p>The gap is worse for First Nations Australians in the NT, who attract only 16% of the Medicare funding of the average Australian.</p>
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Read more:
<a href="https://theconversation.com/labors-health-package-wont-strengthen-medicare-unless-it-includes-these-3-things-183093">Labor's health package won't 'strengthen' Medicare unless it includes these 3 things</a>
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<p>We measured the extent of the problem over the years 2010–20. We used the federal government’s published figures on Medicare to explore the impact of this uneven workforce distribution on Medicare billing in the NT. </p>
<p>The differences are stark.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/463812/original/file-20220517-19-rnreyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/463812/original/file-20220517-19-rnreyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/463812/original/file-20220517-19-rnreyj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/463812/original/file-20220517-19-rnreyj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/463812/original/file-20220517-19-rnreyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=511&fit=crop&dpr=1 754w, https://images.theconversation.com/files/463812/original/file-20220517-19-rnreyj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=511&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/463812/original/file-20220517-19-rnreyj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=511&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>The inequitable funding is even worse when the poorer health status of First Nations Australians and the additional costs associated with geographical remoteness are taken into account.</p>
<p>The NT has a younger age profile than the rest of Australia, but this explains only one-third of the gap.</p>
<h2>What’s going wrong with the funding?</h2>
<p>Despite Medicare’s intended universality, the NT is systematically disadvantaged. </p>
<p>People in the Territory have poorer access to primary health care, which includes GP services and those provided by Aboriginal community-controlled health services. </p>
<p>Aboriginal health services receive some special additional funding separate from the Medicare-billing funding. However, even with that extra funding, there is still a <a href="https://www.publish.csiro.au/AH/pdf/AH21276">shortfall</a> to NT residents of about A$80 million each year.</p>
<p>The NT government receives a relatively higher proportion of the GST funding pool in recognition of its challenges with remoteness and Indigenous services. But this is calculated assuming NT residents have the same access to Medicare as all other Australians. As we have shown, they don’t and so the extra GST funding does not result in a fair funding stream to meet NT primary care needs.</p>
<p>The outcome of inadequate primary health care funding is increasing reliance on hospital services. People’s chronic health conditions worsen if they’re not well managed in the community and this increases the risk they will need a hospital admission, especially for “<a href="https://www.aihw.gov.au/reports/primary-health-care/disparities-in-potentially-preventable-hospitalisations-australia/summary">potentially preventable hospitalisations</a>”. NT hospitals experience excessive pressure of workload and complexity as a result. </p>
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<img alt="Woman sits on a hospital bed, her back to the door." src="https://images.theconversation.com/files/463532/original/file-20220517-2769-yuytwg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/463532/original/file-20220517-2769-yuytwg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/463532/original/file-20220517-2769-yuytwg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/463532/original/file-20220517-2769-yuytwg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/463532/original/file-20220517-2769-yuytwg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/463532/original/file-20220517-2769-yuytwg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/463532/original/file-20220517-2769-yuytwg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Poorer access to primary care services results in more hospitalisations.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-view-asian-chinese-female-patient-1459422617">Shutterstock</a></span>
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<p>We have shown previously that effective primary health care for remote patients with chronic, long-term diseases can substantially <a href="https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/1472-6963-13-466.pdf">reduce their use of hospital services</a> and result in better health outcomes at a lower cost.</p>
<p>When visiting the NT in 2000, one of the architects of Medicare, <a href="https://en.wikipedia.org/wiki/John_Deeble">John Deeble</a>, observed the funding failure first hand and suggested another form of health-care financing was needed to adequately support remote primary health care. </p>
<p>In terms of health equity and our national commitment to close the life expectancy gap for First Nations peoples, the status quo is undeniably short-changing our efforts.</p>
<h2>What needs to be done?</h2>
<p>There needs to be a reset in how we finance remote primary health care services in the NT. </p>
<p>The value proposition is excellent. Due to the extreme health needs and vulnerable populations, the <a href="https://www.mja.com.au/journal/2014/200/11/cost-effectiveness-primary-care-indigenous-australians-diabetes-living-remote">return on investment is high</a> – more than A$5 in saved acute care costs for every dollar invested.</p>
<p>The federal government’s Health Care Homes funding reform trial <a href="http://www.amsant.org.au/wp-content/uploads/2020/02/HCH-Forum-Presentation-Laynhapuy-Homelands.pdf">was very successful in remote NT communities</a>. For the first time, service providers received flexible funding to care for patients’ chronic conditions, rather than a fee for each service they provided. It also enabled the provider and patient to develop a relationship. </p>
<p>Unfortunately the <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-care-homes">Health Care Homes program ended in June 2021</a>, and has not been renewed. This program should be reinvigorated for chronic disease care in the NT and extended to include other core programs of mental health and suicide prevention, and child and maternal health.</p>
<p>The federal government should take this opportunity to get remote primary health care financing right and ensure Medicare funds reach those who need them most.</p>
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Read more:
<a href="https://theconversation.com/how-do-the-major-parties-rate-on-medicare-we-asked-5-experts-182230">How do the major parties rate on Medicare? We asked 5 experts</a>
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<p><em>Acknowledgement: Xiaohua Zhang, Jo Wright, and Maja Van Bruggen from the Northern Territory Department of Health are co-authors of the journal article on which this article is based.</em></p><img src="https://counter.theconversation.com/content/183210/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Wakerman receives funding from The Australian Research Council, the Medical Research Future Fund and the NT Primary Health Network.
</span></em></p><p class="fine-print"><em><span>Paul Burgess has previously received grant funding as an investigator on MRFF, NHMRC and the Digital Health CRC funded projects. No funding was received for the work that led to this publication. Paul works for the NT Government.</span></em></p><p class="fine-print"><em><span>Rus Nasir worked for the NT Government as acting director of Aboriginal health. </span></em></p><p class="fine-print"><em><span>Yuejen Zhao works for the NT Govnernment.</span></em></p><p class="fine-print"><em><span>Stephen Duckett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>NT residents receive approximately 30% less Medicare funding per capita than the national average. The gap is worse for First Nations Australians in the NT.Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice, The University of MelbourneJohn Wakerman, Professor of Remote and Rural Health Services Research, Menzies School of Health ResearchPaul Burgess, Adjunct assistant professor, Flinders UniversityRus Nasir, Policy & Research Unit, Aboriginal Medical Services Alliance Northern Territory, Indigenous KnowledgeYuejen Zhao, Senior Researcher, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1803122022-03-31T04:41:29Z2022-03-31T04:41:29ZDoes the pre-election budget address ways to realistically ‘close the gap’ for Indigenous people?<figure><img src="https://images.theconversation.com/files/455401/original/file-20220331-11-uujsku.jpg?ixlib=rb-1.1.0&rect=19%2C29%2C6521%2C4285&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/single-hand-of-a-young-indigenous-girl-on-the-rocks-royalty-free-image/1215447203?adppopup=true">Getty Images</a></span></figcaption></figure><p>As Treasurer Josh Frydenberg handed down the federal government’s pre-election budget on Tuesday night, I watched in anticipation to see what it would hold for Aboriginal and Torres Strait Islander peoples and communities. </p>
<p>It’s an important issue, particularly in light of the government’s <a href="https://www.abc.net.au/news/2020-07-30/closing-gap-targets-agreement-aboriginal-torres-strait-islander/12506232">2020 commitment</a> to new targets to address the ever-growing disparities between Indigenous peoples and the rest of the population that have yet to be adequately addressed. </p>
<p>It was no surprise to see a strong budget focus on the cost of living. Petrol prices have surged past <a href="https://www.9news.com.au/national/petrol-prices-2-dollars-a-litre-record-14-year-highs-australia/72dc38f7-a292-4221-8280-f4942dd2c5ce">A$2 a litre</a>, and the cost of food is rising because of <a href="https://7news.com.au/news/australia/food-prices-set-to-soar-after-pandemic-heres-what-will-cost-the-most-c-5820307">COVID-19</a>, <a href="https://www.theguardian.com/australia-news/2022/mar/04/weve-run-out-of-lettuce-supermarkets-and-restaurants-face-fresh-food-shortage-after-nsw-and-queensland-floods">floods</a> and <a href="https://www.abc.net.au/news/2022-03-09/higher-food-prices-and-shortages-because-of-climate-change/100894158">climate change</a>.</p>
<p>Opposition Leader Anthony Albanese was quick to criticise the budget, likening it to “fake tan” and claiming that the one-off cost-of-living payments are more about winning the upcoming election than planning for the future. The problem with fake tan, he <a href="https://www.news.com.au/finance/economy/federal-budget/fake-tan-scott-morrison-cops-brutal-budget-sledge-from-anthony-albanese/news-story/d5b3f4e5085a0984a731b5b9885bec60">said</a>, is that “it fades pretty quickly”. </p>
<p>Unfortunately, Indigenous people are used to disappointing budgets that lack the strategic planning needed to address real issues that Indigenous communities themselves constantly raise.</p>
<p>True, the cost of living is soaring for many Australians. But like all things, this is never an even playing field. The cost of living in remote Aboriginal communities beggars belief. It is so outrageous that it <a href="https://www.abc.net.au/news/2020-06-05/gulf-residents-welcome-indigenous-food-price-inquiry/12312150">triggered a federal parliamentary inquiry in 2020</a>. </p>
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<p>Perhaps not unexpectedly, the inquiry <a href="https://www.abc.net.au/news/2022-03-18/remote-queensland-communities-brace-for-skyrocketing-living-cost/100916786">failed to deliver any meaningful results</a>. Petrol prices have also been extremely high in rural and remote locations for a long time, significantly impacting Indigenous communities. For example, petrol prices have reached as high as <a href="https://www.abc.net.au/news/2022-03-10/fuel-prices-rise-in-arnhem-land-to-over-3-dollars-per-litre/100898780">$3 a litre</a> in Arnhem Land.</p>
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Read more:
<a href="https://theconversation.com/theres-1-3-billion-for-womens-safety-in-the-budget-and-its-nowhere-near-enough-180256">There's $1.3 billion for women's safety in the budget and it's nowhere near enough</a>
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<h2>What’s in the budget for us?</h2>
<p>So, what’s in the 2022 pre-election budget that will address the new targets set by the government? Federal Minister for Indigenous Australians Ken Wyatt said in his <a href="https://ministers.pmc.gov.au/wyatt/2022/2022-23-budget-delivering-stronger-future-indigenous-australians">budget-night press release</a> that the Morrison government has embarked on “the most ambitious Indigenous policy reform agendas”. </p>
<p>The federal budget should address the needs in the broader community, but also the targeted commitments that the government makes, such as those outlined in the Closing the Gap scheme. </p>
<p>The government has pledged $636.4 million in the 2022 budget over six years to expand Indigenous land and sea management on Country. This will provide more education and employment opportunities in remote and regional Australia. Given the lack of any real commitment to climate change, I guess the government is hoping Indigenous rangers will do the work so urgently required. </p>
<p>Housing in remote Aboriginal communities in the Northern Territory has been allocated $408 million. The funding will be used for addressing overcrowding, homelessness and much-needed improvements to homes. The government has also allocated $183 million over the next three years to improve economic, social and health outcomes for Indigenous people in the NT.</p>
<p>Although homelessness and affordable housing is a major concern for Indigenous people across Australia, no funding was committed to other locations. Yet most Indigenous people live in urban areas. In Victoria, for example, the number of Indigenous people seeking help from services for housing issues <a href="https://home.kpmg/au/en/home/insights/2022/02/social-housing-aboriginal-homelessness-system-client-story.html">has increased by 33.6% over four years</a> – the highest rate for Indigenous people anywhere in Australia. </p>
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<h2>Is the budget addressing the Indigenous health gap?</h2>
<p>The <a href="https://www.sbs.com.au/nitv/article/2022/03/29/whats-budget-first-nations-people">budget promises an estimated $16.2 million for Indigenous health spending across 2022-23</a>. Specifically, the funding is to combat blood-borne viruses and sexually transmissible infections in the Torres Strait, and improving trachoma control services. Australia is the <a href="https://www.health.gov.au/initiatives-and-programs/addressing-trachoma">only developed country where trachoma still exists</a>. It only impacts Indigenous people, and is directly related to overcrowding and poor housing conditions, including access to clean water and sanitation.</p>
<p>The federal government has also pledged $12 million towards combating rheumatic fever and rheumatic heart disease in Indigenous communities, which continue to have one of the highest rates in the developed world. The ABC 4 Corners report <a href="https://www.abc.net.au/4corners/heart-failure:-an-investigation-into-the-hidden/13787308">Heart Failure</a> highlighted the ongoing impacts of racism in the health system and the appalling lack of healthcare provided.</p>
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<p>The National Aboriginal Community Controlled Health Organisation (NACCHO) has <a href="https://www.naccho.org.au/another-big-spending-budget-short-changes-aboriginal-and-torres-strait-islander-health/">expressed disappointment</a> at what it describes as the budget’s failure to adequately fund Indigenous health, even though the disparities in health between Indigenous peoples and other populations in Australia are supposedly one of the key areas of the government’s commitment. </p>
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<p>The organisation’s chief executive, Pat Turner, said:</p>
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<p>As long as this $4.4 billion funding gap remains and as long as there are funding gaps elsewhere – in particular, in housing – we cannot expect the unconscionable health gap to close. This Budget is an opportunity lost. NACCHO calls upon the government to close the funding gap for Aboriginal and Torres Strait Islander people.</p>
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<p>Last year, Prime Minister Scott Morrison said the “<a href="https://www.abc.net.au/news/2021-08-05/australia-indigenous-closing-gap-strategy-addressed-in-pm-speech/100348748">ultimate test</a>” of closing the gap would be that Aboriginal and Torres Strait Islander children in particular would have the same opportunities as other children in Australia. </p>
<p>On this scale, the federal government has failed miserably. Indigenous children in Australia are ten times more likely to be removed from their families. </p>
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<p><a href="https://www.sbs.com.au/nitv/article/2021/12/09/theyre-unacceptable-rates-removal-indigenous-children-increasing">Catherine Liddle</a>, chief executive of SNAICC, the national peak body for Aboriginal children and families, expressed the frustration Indigenous people have on this issue:</p>
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<p>People have been saying this for a long time, yet the change in investment and transformation to the system that’s required to fix it hasn’t followed through.</p>
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<p>Turner and Liddle both also highlighted the <a href="https://probonoaustralia.com.au/news/2022/03/it-has-not-delivered-first-nations-advocates-condemn-pre-election-budget/">considerable shortfall</a> in the commitment needed to meet the ambitious targets set out in the Closing the Gap agreement. </p>
<p>Overall, the budget falls short of adequate investment across key areas such as health, housing, education and employment. It also fails to provide funding to address the <a href="https://nirs.org.au/news/another-first-nations-death-in-custody/">high number of Indigenous deaths in custody</a> and to support families facing the financial burden of seeking legal justice. </p>
<p>Frydenberg acknowledged the <a href="https://www.abc.net.au/news/2022-03-30/budget-women-safety-violence-national-plan-funding/100950964">women’s safety crisis in Australia</a>, and the government has reiterated its support for a dedicated Aboriginal and Torres Strait Islander Action Plan led by the Aboriginal and Torres Strait Islander Advisory Council on family, domestic and sexual violence. But the budget fails to fund Aboriginal family violence and legal services where resources are urgently needed.</p>
<p>The co-chair of the First Nations-led coalition Change the Record, <a href="https://probonoaustralia.com.au/news/2022/03/it-has-not-delivered-first-nations-advocates-condemn-pre-election-budget/">Cheryl Axleby</a>, said that if a budget was a reflection of a government’s priorities, it’s clear that First Nations’ needs are a long way down the list.</p><img src="https://counter.theconversation.com/content/180312/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bronwyn Carlson 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>The federal government’s pre-election budget has addressed only some of the key issues Indigenous people face. More investment is still required if the government is serious about Closing the Gap.Bronwyn Carlson, Professor, Indigenous Studies and Director of The Centre for Global Indigenous Futures, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772162022-03-24T04:55:51Z2022-03-24T04:55:51ZKava may be coming to a supermarket or cafe near you. But what is it? Is it safe?<figure><img src="https://images.theconversation.com/files/452666/original/file-20220317-8345-1u1tnhk.jpg?ixlib=rb-1.1.0&rect=2%2C1%2C995%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/indian-fijian-pre-wedding-kava-drink-1624592482">Shutterstock</a></span></figcaption></figure><p>You might be hearing more about <a href="https://adf.org.au/drug-facts/kava/">kava</a> over coming months, the psychoactive drink better known in the Pacific, but becoming more widely available in Australia.</p>
<p>How it’s imported and regulated has changed. So you might be able to buy it in the supermarket, health-food shop or go to a kava bar to drink it with your friends.</p>
<p>You might be curious to try it and not sure it’s safe. Here’s what you need to know about kava in Australia.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1491344790700834816"}"></div></p>
<h2>What is kava?</h2>
<p><a href="https://healthbulletin.org.au/wp-content/uploads/2019/04/kava-bulletin-web.pdf">Kava</a> is made from the root of the kava plant (<em>Piper methysticum</em>). This economically significant crop has been grown and consumed for more than 3,000 years across the Pacific. </p>
<p>Traditionally, the root is ground, then soaked in water to make a drink. It is mainly used by men in countries including Fiji, Tonga, Samoa and Vanuatu for ceremonial, recreational and medicinal purposes. </p>
<p>Traditional drinking practices, which usually involve drinking kava with others, <a href="https://europepmc.org/article/med/18181414">moderate</a> kava consumption. Although heavier recreational drinking occurs and <a href="https://www.tandfonline.com/doi/pdf/10.1080/cdar.19.2.217.227">can cause harm</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-discussion-of-kava-imports-reflects-lack-of-cultural-understanding-115662">Australia's discussion of kava imports reflects lack of cultural understanding</a>
</strong>
</em>
</p>
<hr>
<p>Kava is not commonly used in Australia. However, it is used by some Pacific communities, for instance, by some Fijian, Tongan and Samoan Australians.</p>
<p>Kava is also used in a small number of <a href="https://healthbulletin.org.au/wp-content/uploads/2019/04/kava-bulletin-web.pdf">Aboriginal communities</a> in Arnhem Land, in the Northern Territory. Kava was introduced to these communities as an alternative to alcohol in the 1980s. Its use peaked in the 1990s and early 2000s.</p>
<p>In Australia, kava is usually available as a powder, which is then made into a drink.</p>
<h2>What does it do? Is it safe?</h2>
<p>Drinking kava can lead to <a href="https://healthbulletin.org.au/wp-content/uploads/2019/04/kava-bulletin-web.pdf">effects including</a> feeling sociable and at peace. People also report having reduced anxiety and an overall positive mood, while remaining clear-headed. </p>
<p>Increasing levels of intoxication can lead to feelings such as numbness, sedation, a sense of muscle weakness and fatigue. </p>
<p>The World Health Organization considers the risk of kava toxicity “<a href="https://apps.who.int/iris/bitstream/handle/10665/43630/9789241595261_eng.pdf?sequence=1&isAllowed=y">very low</a>”. However, kava use is not harmless.</p>
<p>High levels of kava use <a href="https://healthbulletin.org.au/wp-content/uploads/2019/04/kava-bulletin-web.pdf">causes</a> a scaly skin rash, weightloss, changes in liver enzymes and overall feelings of ill-health.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/451536/original/file-20220311-18-g5uv2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Root of kava plant" src="https://images.theconversation.com/files/451536/original/file-20220311-18-g5uv2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/451536/original/file-20220311-18-g5uv2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451536/original/file-20220311-18-g5uv2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451536/original/file-20220311-18-g5uv2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451536/original/file-20220311-18-g5uv2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451536/original/file-20220311-18-g5uv2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451536/original/file-20220311-18-g5uv2.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">Traditionally, the root of the kava plant is ground and made into a drink, then shared.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/kava-roots-selective-focus-background-1358294918">Shutterstock</a></span>
</figcaption>
</figure>
<p>Heavy kava use <a href="https://healthbulletin.org.au/wp-content/uploads/2019/04/kava-bulletin-web.pdf">is also associated with</a> a number of social harms. These harms are not specific to kava, but the harmful use of any drug. </p>
<p>This includes the impact of time spent accessing, using and recovering from kava use. This impacts someone’s capacity to fulfil family, cultural and workplace roles. There are also financial impacts from missed work, and buying kava. </p>
<p>When people in Arnhem Land used kava heavily, this led to <a href="https://www.mja.com.au/journal/2006/184/2/action-required-reduce-kava-supply-arnhem-land-again">significant community-wide</a> <a href="https://healthbulletin.org.au/wp-content/uploads/2019/04/kava-bulletin-web.pdf">harms</a>. These included a decline in community and cultural activities, and less participation in employment.</p>
<h2>What’s changed?</h2>
<p>Kava has a complicated regulatory history in Australia, with many changes in recent years, including:</p>
<ul>
<li><p><strong>from December 2019</strong> the federal government launched a two-stage “<a href="https://www.dfat.gov.au/geo/pacific/economic-prosperity-in-the-pacific/australia-kava-pilot">kava pilot</a>”, aiming to boost trade with Pacific nations and making it easier for Pacific Australians to access kava for cultural reasons. Incoming passengers were allowed to bring in 4 kilograms per person 18 years or older (up from 2 kilograms per person).</p></li>
<li><p><strong>from December 2021</strong> the <a href="https://www.legislation.gov.au/Details/F2021L01615">second stage</a> of the pilot allowed kava to be commercially imported as a food product, with an import permit. Products need to carry labels saying “Use in moderation” and “May cause drowsiness”; these warnings must also be displayed where kava is sold. These changes bring Australia more in line with other nations with significant Pacific communities (such as the United States and New Zealand). </p></li>
</ul>
<p>Despite these changes at the federal level, it remains illegal to <a href="https://nt.gov.au/law/crime/kava">bring kava food products into</a> the Northern Territory. </p>
<p>The therapeutic use of kava extract – for anxiety, insomnia, and a range of other conditions – is not covered by the recent legislative changes.</p>
<h2>What will these changes mean?</h2>
<p>Under the latest changes, kava will be more widely available in Australia, from places including health-food shops, supermarkets, pharmacies, as well as online. </p>
<p>Kava bars are also starting to emerge, including a <a href="https://www.adnews.com.au/news/fijikava-campaign-to-calm-your-inner-karen-via-publicis-worldwide">pop-up bar in Brisbane</a>.</p>
<p>We don’t know if kava will have a broader appeal outside Pacific communities in Australia, and what the positive and negative implications of greater availability may be. </p>
<h2>Not everyone’s happy</h2>
<p>Previous regulatory changes related to kava <a href="https://healthbulletin.org.au/wp-content/uploads/2019/04/kava-bulletin-web.pdf">did not involve</a> consultation with affected communities, including Pacific communities in Australia, or adequate consultation with Aboriginal businesses, health organisations and communities. </p>
<p>For instance, the initial banning of kava imports to the Northern Territory did nothing to address the social determinants of health and underlying factors related to heavy kava use in some Arnhem Land communities.</p>
<p>Similarly, regulatory changes from 2019 did not occur with adequate Aboriginal community consultation. Community leaders have raised concerns of an increase in kava-related harms, including <a href="https://www.abc.net.au/news/2019-02-04/morrisons-kava-import-plan-flies-in-face-police-evidence-elders/10775068">increased black-market activity</a> in the Northern Territory. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1092297016925802496"}"></div></p>
<h2>What needs to happen next?</h2>
<p>The federal government says the latest changes for Australia will be <a href="https://www.dfat.gov.au/sites/default/files/australia-commercial-kava-pilot-monitoring-evaluation.pdf">monitored and evaluated</a> by the National Drug and Alcohol Research Centre working with the Indigenous owned organisation Ninti One. </p>
<p>This will look at the health, social, cultural and economic effects of increased kava availability. The final report is due in mid-2023 and we don’t know if the results will be publicly reported. </p>
<p>For the evaluation to be of value to all communities impacted by kava, we need genuine collaboration with these communities. This needs to consider the diversity of opinion in both Pacific communities in Australia and Aboriginal communities using kava. </p>
<p>Further research on the benefits and harms associated with kava, including identifying safe levels of consumption, is also needed. </p>
<p>Finally, we need surveillance of known risks. This includes driving under the influence of kava, and black-market activity related to kava entering the Northern Territory.</p><img src="https://counter.theconversation.com/content/177216/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julia Butt, at the National Drug Research Institute, has previously received funding from the Department of Health, Federal Government and Healthway. </span></em></p><p class="fine-print"><em><span>Annalee Stearne receives funding from the NHMRC via the Centre for Research Excellence: Indigenous Health and Alcohol. Annalee is also a board member of Children's Ground (<a href="https://childrensground.org.au/">https://childrensground.org.au/</a>) and the National Centre for Clinical Research into Emerging Drugs (<a href="https://nccred.org.au/">https://nccred.org.au/</a>). </span></em></p>Kava is not commonly used in Australia. But that will change and we need to keep an eye on what happens next.Julia Butt, Lecturer, Clinical Psychologist, Edith Cowan UniversityAnnalee Stearne, Research Associate and PhD candidate, National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1706412022-03-23T02:53:15Z2022-03-23T02:53:15ZBirthing on Country services centre First Nations cultures and empower women in pregnancy and childbirth<figure><img src="https://images.theconversation.com/files/453467/original/file-20220322-23-1il36u9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-feet-moms-hand-on-white-177099479">Shutterstock</a></span></figcaption></figure><p>Many Australian women rely on and trust maternity services to see them through pregnancy, labour and the early stages of new parenting.</p>
<p>But for First Nations women, these same services can be confronting and can result in poor outcomes. Many women must travel far from family and community to birth. And if they don’t, they often feel misunderstood and judged by mainstream health services. </p>
<p>There is another way. <a href="http://www.birthingoncountry.com">Birthing on Country</a> means First Nations women give birth on their ancestral country. It acknowledges First Nation peoples’ continued ownership of land and unique birthing practices.</p>
<h2>What can Birthing on Country services do?</h2>
<p><a href="https://doi.org/10.1016/j.wombi.2019.06.013">Birthing on Country services</a> centre First Nations values, and are designed to meet First Nations people’s social, emotional, cultural and health needs. The services are embedded within larger health service networks.</p>
<p>Our <a href="https://www.cdu.edu.au/mwrc">team</a> works in partnership with First Nations communities to deliver Birthing on Country maternity services that address health inequities. </p>
<p>Our partners in one urban setting saw a <a href="https://doi.org/10.1016/S2214-109X(21)00061-9">profound reduction</a> in preterm birth and increased antenatal attendance and breastfeeding. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/birthing-on-country-could-deliver-healthier-babies-and-communities-31180">Birthing on Country could deliver healthier babies and communities</a>
</strong>
</em>
</p>
<hr>
<p>This was achieved through integrating within a wraparound <a href="https://doi.org/10.1071/PY19038">system of care</a>, designed as a one-stop-shop in an Aboriginal community controlled setting. </p>
<p>It also involved <a href="https://doi.org/10.1016/j.wombi.2019.06.013">redesigning the service</a> using a <a href="https://doi.org/10.1016/j.wombi.2020.09.017">successful blueprint</a> that prioritises investing in the workforce, strengthening families’ capabilities, and embedding First Nations governance and control in all aspects of maternity service planning and delivery. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1354285611528589313"}"></div></p>
<p>However, Birthing on Country services are yet to be trialled in regional and remote Australia. So there is much work to do to ensure all First Nations women can access these services.</p>
<p>Here are five ways to work towards this:</p>
<h2>1. Acknowledge safe childbirth is a human right</h2>
<p>Australia is a signatory to the <a href="https://www.un.org/development/desa/indigenouspeoples/declaration-on-the-rights-of-indigenous-peoples.html">United Nations Declaration on the Rights of Indigenous Peoples</a> which states Indigenous people have the right to:</p>
<ul>
<li>quality, culturally safe health care</li>
<li>be self-determining and participate in the design of health services</li>
<li>include and revitalise cultural practices, languages, and medicines. </li>
</ul>
<p>Birthing on Country services are one example of how this can be achieved. </p>
<p>Commitment to uphold the UN declaration requires resourcing and monitoring to support and celebrate the world’s <a href="https://www.nature.com/articles/nature22968">oldest</a> midwifery practices and cultures.</p>
<h2>2. Acknowledge how health systems fail First Nations people</h2>
<p>First Nations people and cultures are <a href="https://press-files.anu.edu.au/downloads/press/n2140/pdf/ch05.pdf">wrongly blamed</a> as the cause of health inequities, rather than focusing on how the health system <a href="https://doi.org/10.5694/j.1326-5377.2005.tb06891.x">continues to fail First Nations families</a>. </p>
<p>Racial bias has been identified as a <a href="https://www.abc.net.au/news/2021-08-31/naomi-williams-mother-calls-out-ongoing-indigenous-bias-health/100417522">contributing factor in First Nations maternal deaths</a>. This includes health services dismissing women’s concerns and turning them away from hospital when seeking care – even when they have life-threatening symptoms. </p>
<p>This can make First Nations families feel unsafe and uncomfortable accessing maternity health services. </p>
<p>Large organisations make Western ways of “knowing and doing” dominant in every work practice. This often results in institutionalised racism and dismisses other forms of knowledge suggesting we should or could be doing things differently. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/microaggressions-arent-just-innocent-blunders-research-links-them-with-racial-bias-145894">Microaggressions aren't just innocent blunders – research links them with racial bias</a>
</strong>
</em>
</p>
<hr>
<h2>3. Ensure there is ‘nothing about us without us!’</h2>
<p>Australia’s health system was <a href="https://doi.org/10.1080/14443058.2020.1796754">designed</a> to serve those who designed it. </p>
<p>First Nations people have been explicitly excluded from decision-making about the services provided to them. </p>
<p>First Nations people want and need to be at the decision-making table, and ensure “nothing about us” is decided “without us”. </p>
<figure class="align-center ">
<img alt="Woman looks at a screen while having an ultrasound." src="https://images.theconversation.com/files/452678/original/file-20220317-8547-184xk46.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452678/original/file-20220317-8547-184xk46.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452678/original/file-20220317-8547-184xk46.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452678/original/file-20220317-8547-184xk46.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452678/original/file-20220317-8547-184xk46.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452678/original/file-20220317-8547-184xk46.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452678/original/file-20220317-8547-184xk46.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">First Nations people need to be involved in designing health services.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-partner-having-4d-ultrasound-155730335">Shutterstock</a></span>
</figcaption>
</figure>
<p>Participatory action research is <a href="https://www.lowitja.org.au/content/Document/Lowitja-Publishing/LI_Discussion_Paper_P-Dudgeon_FINAL3.pdf">one evidence-based</a> way to work collaboratively with stakeholders to respond to needs identified by the community. </p>
<p>First Nations people value the process as it aligns with principles of self-determination and equity. And it privileges the voices of those often marginalised in research. </p>
<p>Engaging community in design, implementation and evaluation of maternity services brings local knowledge, <a href="https://doi.org/10.1016/j.socscimed.2015.12.019">community activation and investment</a> that leads to lasting change.</p>
<h2>4. Recognise how First Nations peoples can improve health care for everyone</h2>
<p>Our colleagues in Aotearoa (New Zealand) found maternity systems that <a href="https://doi.org/10.1002/ijgo.13855">privilege whiteness</a> cannot provide equitable health care for all. </p>
<p>All people can benefit from ethical knowledge systems that have safely guided childbirth and the flourishing of First Nations people for millennia.</p>
<p>Relationality – being connected with all human and non-human beings – is at the centre of First Nations values, ways of knowing, doing and being. It ensures our responsibility to be in good relations with each other, whether with community, Country or our research partners. </p>
<p>The current system does not embed relationality in its design; rather encourages capitalism and competition for scarce resources over genuine partnership and equitable care. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-we-need-to-support-aboriginal-womens-choice-to-give-birth-on-country-53804">Why we need to support Aboriginal women’s choice to give birth on country</a>
</strong>
</em>
</p>
<hr>
<p>Our task is to re-centre good relations in our everyday work to make health and wellness gains. We do this by:</p>
<ul>
<li>ensuring our work is community-driven</li>
<li>using methodologies that represent First Nations views</li>
<li>presenting and defending findings at community forums</li>
<li>ensuring our research leads to action at the local, state and national level.</li>
</ul>
<h2>5. Share findings in accessible ways</h2>
<p>The <a href="https://www.birthingoncountry.com/caring4mum">Caring for Mum on Country</a> project is a community-driven action research project piloting doula (birthing companion) training and exploring reproductive health literacy. </p>
<p>It has shown the power of grassroots community activation in finding Yolŋu solutions to local needs. </p>
<p>Charles Darwin University researchers Sarah Ireland (a co-author of this article) and Ḻäwurrpa Maypilama (in partnership with the <a href="https://www.australiandoulacollege.com.au/">Australian Doula College</a> and <a href="https://www.yalu.org.au/">Yalu Aboriginal Corporation</a>) used community action research to pilot <a href="https://www.sciencedirect.com/science/article/abs/pii/S0266613819300889?via=ihub">First Nations doula</a> training, locally known as djäkamirr–caretakers of pregnancy and birth. </p>
<p>They made a <a href="https://www.birthingoncountry.com/djakamirr">documentary</a> about their project:</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1408213441760972803"}"></div></p>
<p>Film is an impactful way to discuss research. Finding creative and accessible ways to share research findings is imperative to bringing learnings to people who can benefit from and enact change.</p>
<p>Health inequities in childbirth will persist until health systems relinquish control and acknowledge the value of First Nations knowledge systems centred on relationality and wellness. </p>
<p>We must work in partnership with First Nations communities to redesign health services and work differently with communities in their journeys to implementing Birthing on Country maternity services.</p><img src="https://counter.theconversation.com/content/170641/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Ireland receives funding from NHMRC Partnership Grant 2021: “To Be Born Upon a Pandanus Mat" APP2010289. </span></em></p><p class="fine-print"><em><span>Yvette Roe receives funding from NHMRC .
CI A Prof Yvette Roe, NHMRC Centre of Research Excellence: 2020 Redesigning maternal, newborn and child health services for the best start in life for First Nations families. APP1197110
CI A Prof Yvette Roe, NHMRC Partnership Grant 2021: “To Be Born Upon a Pandanus Mat”. APP 2010289
</span></em></p><p class="fine-print"><em><span>Sophie Hickey 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>Birthing on Country services acknowledge First Nation peoples’ continued ownership of land and unique birthing practices.Sophie Hickey, Postdoctoral researcher, Charles Darwin UniversitySarah Ireland, Medical anthropologist, nurse, midwife, researcher, Charles Darwin UniversityYvette Roe, Professor of Indigenous Health, Charles Darwin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1673482021-09-16T05:52:14Z2021-09-16T05:52:14ZCOVID in Wilcannia: a national disgrace we all saw coming<figure><img src="https://images.theconversation.com/files/419712/original/file-20210907-27-1tvloa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The town of Wilcannia in the far outback of New South Wales on the banks of the Darling river.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/town-wilcannia-far-outback-new-south-1820784710">shutterstock</a></span></figcaption></figure><p>The COVID-19 crisis in Wilcannia demonstrates how entrenched neglect, combined with a global pandemic, have created a perfect storm impacting the most marginalised people in society.</p>
<p>The treatment of the Barkindji people of Wilcannia is appalling by anyone’s standards and should be unacceptable to every Australian. The stories flooding out of Wilcannia of mistreatment of Aboriginal people should make every person stand up and demand immediate action.</p>
<p>The government needs to take immediate action to address the conditions in which the people in Wilcannia are forced to live, and by providing vaccinations immediately to all those who want to be vaccinated. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/politics-with-michelle-grattan-pat-turner-on-covid-and-god-botherers-stalking-indigenous-communities-167115">Politics with Michelle Grattan: Pat Turner on COVID – and god botherers – stalking Indigenous communities</a>
</strong>
</em>
</p>
<hr>
<h2>Not enough healthcare, too much police involvement</h2>
<p>As part of my research, I spoke to community members over the phone to listen to their experiences of this breakout. Here are just a few stories told to me by the people of Wilcannia:</p>
<ul>
<li><p>a young mother who was made to sit outside a hospital on a cold night, before being sent home due to under-resourcing</p></li>
<li><p>a woman who had police arrive on her doorstep to inform her she had tested positive to COVID-19, and they must take her to the isolation unit. There was no phone call from NSW Health, just police arriving to take her to isolation. Her elderly mother, who is on dialysis, was taken to another town</p></li>
<li><p>Aboriginal people with mental illness or disorders, who require regular treatment and medication, being picked up in police vans and taken to the hospital because they “may” have COVID-19. The people of Wilcannia told me they were told this is because police vans are “easier” to clean.</p></li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1433635693171937310"}"></div></p>
<p>The police or the defence force themselves cannot be blamed. They are doing all they can to assist, much of which NSW Health should be resourced to do. Without the police and the defence force, Wilcannia would be in a much worse situation. However, we need a health and community response, not a law and order response.</p>
<p>Reports have surfaced Aboriginal people in Wilcannia are being fined <a href="https://www.sbs.com.au/nitv/article/2021/08/23/causing-stress-and-anxiety-aboriginal-people-far-west-nsw-copping-hefty-covid">up to $5,000</a> for leaving home to get food. Some of the people being fined are already living on meagre incomes and having to pay those fines will cause significant distress and further financial problems, further entrenching disadvantage. </p>
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<h2>Neglect of Aboriginal people has led us here</h2>
<p>Overcrowded and poor-quality housing already results in <a href="https://apo.org.au/node/310467">poor health outcomes</a>. The effects of overcrowded and poor quality housing during a viral pandemic cannot be overstated.</p>
<p>Aboriginal people have been isolating <a href="https://www.abc.net.au/news/2021-08-30/barkaa-shares-message-as-wilcannia-sees-rising-cases/100412432">in tents</a> during cold desert nights to try to protect their families. They do not choose to live in overcrowded and poor-quality housing; that is all that is available. </p>
<p>NSW Health have since supplied <a href="https://www.abc.net.au/news/2021-09-05/nsw-wilcannia-motorhomes-isolation-hub/100434846">30 motor homes</a> for people diagnosed with COVID so they can isolate away from their families.</p>
<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>
<p>The situation in Wilcannia did not just happen overnight, nor was it unforeseen. The <a href="https://www.abc.net.au/news/2021-08-26/covid-delta-unvaccinated-indigenous-communities-outbreak/100406682">neglect of Aboriginal people</a> by current and successive governments has led us to this point. </p>
<p>Furthermore, <a href="https://www.abc.net.au/news/2021-08-31/letter-warned-government-of-covid-disaster-in-wilcannia/100420052">Aboriginal health services predicted</a> last year that if COVID-19 entered Aboriginal communities, it would be disastrous. Instead of governments taking responsibility for their failures, some have blamed the people suffering the consequences of their failure.</p>
<p>For example, the government demonised the family and community who attended a funeral, making false statements and allegations, despite the funeral occurring <a href="https://www.sbs.com.au/nitv/article/2021/08/21/wilcannia-residents-livid-after-remote-funeral-compared-sydney-lockdown-party">before</a> restrictions and lockdowns outside of the Greater Sydney Region. Those who made negative statements about the funeral attendance have <a href="https://www.abc.net.au/news/2021-08-23/hazzard-says-he-regrets-wilcannia-funeral-comments/100399910">expressed regret</a>, but it’s too little too late.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-covid-19-crisis-in-western-nsw-aboriginal-communities-is-a-nightmare-realised-166093">The COVID-19 crisis in western NSW Aboriginal communities is a nightmare realised</a>
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</em>
</p>
<hr>
<p>Aboriginal people were classified as 1B priority for the vaccines, but in many places, the vaccines were simply not available. This was either because services on the ground did not have the capacity to deliver or there just were not enough vaccines. Many Aboriginal people across the state of NSW have reported <a href="https://www.abc.net.au/news/2021-08-27/awabakal-medical-service-vaccine-indigenous-community/100410252">long waiting lists</a> to get vaccinated. </p>
<p>It must also be noted that those Aboriginal people <a href="https://www.ntnews.com.au/news/alice-springs/nearly-40-per-cent-of-aboriginal-clients-reject-covid-jab-amid-vaccination-blitz-in-central-australia/news-story/9cfc285236c4d80e7e90a6346d300266">wary of vaccines</a> have good reason, based in over 200 years of history, not to trust what the government says. </p>
<p>However, we do not need to go back that far to understand this crisis. We only need to look at the government’s failure to secure enough (timely) vaccines for these vulnerable communities.</p>
<h2>What has to happen now?</h2>
<p>The government firstly must address the immediate needs of the community, by ensuring adequate and appropriate housing for people to isolate in, tents and motor homes are not appropriate in this situation. Vaccinations must be urgently administered and everyone who wants to be vaccinated must be able to do so without a waiting list. </p>
<p>More doctors and nurses need to be sent to regional areas affected by the virus. Social workers must also be sent to ensure people have access to adequate and appropriate health care, food and accommodation as well as programs to allow people to deal with issues worsened by the pandemic and to maintain mental and cultural well-being during times of isolation and lock down.</p><img src="https://counter.theconversation.com/content/167348/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Green receives funding from ARC research funding. She is affiliated with CSU as an academic, AASW, as the Aboriginal and Torres Strait Islander Board member and Visual Dreaming as a board member. </span></em></p>The COVID-19 crisis in Wilcannia demonstrates how entrenched neglect has led to a community devastated by the global pandemic.Susan Green, Professor in Indigenous Australian Studies and GCWLCH Co-ordinator, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1678002021-09-16T00:48:23Z2021-09-16T00:48:23ZVaccinations need to reach 90% of First Nations adults and teens to protect vulnerable communities<p>While some Australians are awaiting the nation reopening after lockdowns with hope and optimism, others are approaching it with dread. This is because a blanket <a href="https://www.pm.gov.au/sites/default/files/media/national-plan-to-transition-australias-national-covid-19-response-30-july-2021.pdf">lifting of restrictions</a> when the vaccination rate reaches 70% will have devastating effects on Indigenous and other vulnerable populations.</p>
<p>At present, vaccination rates in Indigenous populations are very low. Meanwhile international data show the risk of serious illness and death among First Nations populations from COVID and other diseases is <a href="https://doi.org/10.1136/bmj.m1483;%20https://www.ndoh.navajo-nsn.gov/covid-19">up to four times</a> that of the wider population. </p>
<p>Once restrictions are lifted everyone unvaccinated will be exposed to the virus. The outcomes for Indigenous people may therefore resemble the <a href="https://publishing.monash.edu/product/fatal-contact/">early effects of British colonialism</a>, when a high proportion of the population <a href="https://www.tandfonline.com/doi/abs/10.1080/10314618308682899">died from introduced infections</a>. </p>
<p>Aboriginal and Torres Strait Islander adults and teenagers need vaccination rates of 90-95% among First Nations people to protect their communities. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-covid-19-crisis-in-western-nsw-aboriginal-communities-is-a-nightmare-realised-166093">The COVID-19 crisis in western NSW Aboriginal communities is a nightmare realised</a>
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</em>
</p>
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<h2>Additional health challenges</h2>
<p>As with many other medical conditions, the effects of COVID-19 are worse among people with lower socioeconomic status and <a href="https://theconversation.com/the-covid-19-crisis-in-western-nsw-aboriginal-communities-is-a-nightmare-realised-166093">especially among Aboriginal and Torres Strait Islander people</a>. </p>
<p>There are multiple reasons for this, including the greater likelihood of underlying conditions and reduced access to appropriate health care. </p>
<p>We saw a similar situation in 2009, when H1N1 influenza rates among Aboriginal and Torres Strait Islander people were <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272911/">more than five times</a> those of other Australians.</p>
<p>Overseas, COVID-19 has been associated with striking racial disparities, with death rates for African Americans more than triple the rates for Caucasians, and <a href="https://www.ndoh.navajo-nsn.gov/covid-19">more than 4%</a> for Navajo people (compared to 1.6% for the whole population). </p>
<p>Outcomes for other First Nations groups in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249493/">United States</a> and <a href="https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0370#:%7E:text=The%20Disproportionate%20Impact%20of%20Covid-19%20on%20Communities%20of,Why%20are%20we%20surprised%3F%20Because%20we%20are%20complacent.">elsewhere</a> are similar.</p>
<h2>What’s the current vaccination plan?</h2>
<p>On September 9, the <a href="https://www.9news.com.au/national/coronavirus-nsw-update-latest-covid-19-case-numbers-september-9-lockdown-restrictions-to-be-eased-announcement/59c39c25-5f2e-497b-b652-e4701b12de57">New South Wales government announced</a> its intention to lift lockdowns and other public health measures when the state reaches a vaccination target of 70% of the adult population. This equates to a little over 50% of the state’s population. </p>
<p>NSW will reach the 70% target in <a href="https://www.theguardian.com/australia-news/datablog/ng-interactive/2021/sep/15/covid-19-vaccine-rollout-australia-vaccination-rate-progress-how-many-people-vaccinated-percent-tracker-australian-states-number-total-daily-live-data-stats-updates-news-schedule-tracking-chart-percentage-new-cases-today">less than a month in NSW</a> and the nation will reach the target by October 30.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-cant-rely-solely-on-arbitrary-vaccination-levels-to-end-lockdowns-here-are-7-ways-to-fix-sydneys-outbreak-165658">We can't rely solely on arbitrary vaccination levels to end lockdowns. Here are 7 ways to fix Sydney's outbreak</a>
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<p>If such a policy were implemented it would have disastrous consequences for Aboriginal and Torres Strait Islander and other vulnerable populations. </p>
<p>Vaccination rates in Aboriginal and Torres Strait Islander communities are lagging badly behind the remainder of the Australian population. In many places in NSW, Western Australia, Queensland and the Northern Territory fewer than <a href="https://www.health.gov.au/sites/default/files/documents/2021/09/covid-19-vaccination-geographic-vaccination-rates-sa4-indigenous-population-31-august-2021.pdf">20%</a> are fully vaccinated. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1436818061042995203"}"></div></p>
<h2>What should happen instead?</h2>
<p>Aboriginal organisations have called on state and federal governments to delay any substantial easing of restrictions until vaccination rates among Aboriginal and Torres Strait Islander populations aged 12 years and older reach 90-95%.</p>
<p>The organisations calling for such a target include the National Aboriginal Community Controlled Health Organisation, the Aboriginal Medical Services of the Northern Territory and the Central Australian Aboriginal Congress. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1436165732325212164"}"></div></p>
<p>A 90-95% vaccination rate gives about the same level of population coverage for all ages as the 80% target for the entire population. That’s because Aboriginal and Torres Strait Islander communities <a href="https://www.aihw.gov.au/reports/australias-welfare/profile-of-indigenous-australians">are younger</a> than the wider population. </p>
<p>Vaccinating 90-95% of the Aboriginal and Torres Strait Islander population will better protect children and other unvaccinated people in First Nations communities from infection.</p>
<p>This will require an immediate, well-resourced and determined effort to lift vaccination rates. </p>
<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>
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</p>
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<h2>How can this be achieved?</h2>
<p>Many Aboriginal community controlled health services are already running urgent vaccination campaigns with existing resources, but more needs to be done. </p>
<p>The Australian government’s <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/boosting-covid-19-vaccination-support-for-indigenous-australians">announcement this week</a> of A$7.7 million to fast-track vaccinations in 30 priority areas across the country is an important first step. </p>
<p>But the program needs to be expanded to all areas with significant Aboriginal and Torres Strait Islander populations.</p>
<p>Australia’s First Nations vaccination program needs to:</p>
<ol>
<li><p>guarantee a sufficient and reliable source of vaccines to Aboriginal and Torres Strait Islander communities</p></li>
<li><p>ensure health services have the capacity and the workforce to carry out intensive outreach vaccination programs. This includes culturally knowledgeable Aboriginal and Torres Strait Islander workers able to engage with communities, and clinicians</p></li>
<li><p>address vaccine hesitancy. This should start with the recognition there are many reasons for reluctance to be vaccinated. </p></li>
</ol>
<h2>What are the reasons for vaccine hesitancy?</h2>
<p>For some, there is a historical and understandable distrust of the health system. </p>
<p>Others have been confused or made fearful by misinformation spread on social media or through fringe religious groups. </p>
<p>Many others are not fundamentally opposed to vaccination but are adopting a “wait and see” approach. </p>
<p>To overcome this hesitancy we need urgent government support for financial incentives, in the form of food vouchers or other benefits. This <a href="https://www.pnas.org/content/118/36/e2109543118">has been done</a> for vulnerable groups in other countries. </p>
<p>Non-financial incentives requiring full vaccination for travel, entering pubs, clubs, restaurants, sporting venues and so on need to be flagged now with a commencement date in the near future. </p>
<p>Effective health education in Aboriginal languages developed by local Aboriginal community controlled health services need to be in the media daily.</p>
<h2>Don’t leave vulnerable groups behind</h2>
<p>All this is achievable but it requires the combined efforts of government working in partnership with Aboriginal community controlled health services. </p>
<p>Until the 90-95% target is met, rigorous restrictions should remain in place. This is consistent with modelling from the <a href="https://www.burnet.edu.au/projects/467_covasim_modelling_covid_19">Burnet</a> and <a href="https://www.doherty.edu.au/uploads/content_doc/DohertyModelling_NationalPlan_and_Addendum_20210810.pdf">Doherty</a> institutes, which inform the NSW and national policies about reopening.</p>
<p>As the Burnet Institute told the authors of this article, Australia:</p>
<blockquote>
<p>should not move to Phase B and C until vaccination coverage in each jurisdiction’s Aboriginal and Torres Strait Islander communities is as high as, or even higher than, the general community. </p>
</blockquote>
<p>Similar considerations undoubtedly apply to some other vulnerable groups in the population. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1432466382004707328"}"></div></p>
<p>Australia remains burdened by the legacy of centuries of harm and damage to its First Nations people. We are facing the possibility of a renewed assault on Aboriginal and Torres Strait Islander health. </p>
<p>The difference today is the outcomes are foreseeable and we know what needs to be done to avert them.</p><img src="https://counter.theconversation.com/content/167800/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I am a member of the Australian Labor Party </span></em></p><p class="fine-print"><em><span>Donna Ah Chee, Ian Kerridge, and Paul Komesaroff 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>Many Aboriginal community controlled health services are already running urgent vaccination campaigns within their existing resources, but more needs to be done.Paul Komesaroff, Professor of Medicine, Monash UniversityDonna Ah Chee, Central Australian Aboriginal Congress, Indigenous KnowledgeIan Kerridge, Professor of Bioethics & Medicine, Sydney Health Ethics, Haematologist/BMT Physician, Royal North Shore Hospital and Director, Praxis Australia, University of SydneyJohn Boffa, Adjunct Associate Professor, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1668182021-08-30T20:07:49Z2021-08-30T20:07:49ZOpening up when 80% of eligible adults are vaccinated won’t be ‘safe’ for all Australians<p>We’ve all grown tired of lockdowns, border closures and other restrictions. So the promise of a freer life, when 70% and then 80% of Australians aged 16 and older are vaccinated, feels like a beacon on the horizon.</p>
<p>Prime Minister Scott Morrison, some premiers, and leading public servants have promised us at 80% <a href="https://www.theguardian.com/australia-news/2021/aug/26/doherty-institute-urges-caution-in-lifting-australias-covid-restrictions-in-updated-advice-to-government">we can live “safely” with COVID-19</a>, or come out of our “<a href="https://www.theguardian.com/australia-news/video/2021/aug/24/its-like-that-movie-the-croods-scott-morrison-likens-australias-covid-plan-to-cartoon-video">caves</a>” in the PM’s parlance. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1429616315782807554"}"></div></p>
<p>The narrative is one of <a href="https://www.theaustralian.com.au/nation/politics/all-in-this-together-on-covid19-not-anymore-it-seems/news-story/4a30f31b3791147a771430debb700ca2">Team Australia</a> and we are “<a href="https://socialsciences.org.au/socialsciencesweek/event/were-all-in-this-together-social-inequality-in-australia-during-covid19/">all in this together</a>”. But are we really? </p>
<p>Risks of COVID-19 infection, serious disease and death are not equitably distributed. They disproportionally cluster among the most disadvantaged. Vaccine access and uptake is also lower in many disadvantaged groups. </p>
<p>Opening the country at 80% without ensuring these groups have met or exceeded those targets will result in substantial avoidable illness and death.</p>
<h2>Who is most vulnerable to serious disease?</h2>
<p>The risk of serious COVID-19 and death is related to “<a href="https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk/who-is-at-high-risk-from-coronavirus-clinically-extremely-vulnerable/">clinical vulnerability</a>”, such as whether the person has underlying health conditions like diabetes or respiratory disease.</p>
<p><a href="https://www.aihw.gov.au/reports/australias-health/indigenous-health-and-wellbeing">First Nations Australians</a>, <a href="https://www.aihw.gov.au/reports/disability/people-with-disability-in-australia/contents/summary">disabled Australians</a>, <a href="https://www.aihw.gov.au/reports/australias-health/health-of-prisoners">prisoners</a> and people living in <a href="https://www.aihw.gov.au/reports/rural-remote-australians/rural-remote-health/contents/summary">rural and remote Australia</a> have much higher levels of chronic conditions, which have their roots in social and economic disadvantage. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-covid-19-crisis-in-western-nsw-aboriginal-communities-is-a-nightmare-realised-166093">The COVID-19 crisis in western NSW Aboriginal communities is a nightmare realised</a>
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</em>
</p>
<hr>
<p>On top of their clinical vulnerability, these groups face multiple <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999419/">barriers</a> to accessing <a href="https://www.aihw.gov.au/reports/disability/access-health-services-disability/contents/content">quality health care</a>, including intensive care. These barriers might include lack of physical access, discrimination, an inability to access culturally competent care, and/or geographical distance. </p>
<h2>What have we learnt from other countries?</h2>
<p>Across the world, COVID-19 infection rates have occurred at higher rates in <a href="https://alumni.health.org.uk/sites/default/files/upload/publications/2020/20200730-Adult-social-care-and-COVID-19-impact-so-far.pdf">aged-care facilities</a>, <a href="https://www.sciencedirect.com/science/article/pii/S193665742030100X">disability group homes and institutions</a> and <a href="https://jamanetwork.com/journals/jama/fullarticle/2768249">jails</a>.</p>
<p>Besides aged-care residents, Australia hasn’t yet seen the high death rates in clinically vulnerable groups that other countries have witnessed. </p>
<p>In the United States, <a href="https://www.apmresearchlab.org/covid/deaths-by-race">Indigenous Americans</a> have had the highest rate of COVID-19 deaths – dying at three times the rate of white Americans (when adjusting for the fact that Indigenous Americans are younger than non-Indigenous Americans). </p>
<p>High rates of death have also been seen among:</p>
<ul>
<li><a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html">Black and Hispanic Americans</a></li>
<li>those in <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jrh.12533">rural areas</a> </li>
<li><a href="https://jamanetwork.com/journals/jama/fullarticle/2768249">prisoners</a>, who were three times as likely than the rest of the population to die of COVID-19 (after taking into account the differences in age and sex between the prison and general populations).</li>
</ul>
<figure class="align-center ">
<img alt="Hospital equipment sits in front of clinicians in scrubs." src="https://images.theconversation.com/files/418399/original/file-20210830-13-f8cm3h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/418399/original/file-20210830-13-f8cm3h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418399/original/file-20210830-13-f8cm3h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418399/original/file-20210830-13-f8cm3h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418399/original/file-20210830-13-f8cm3h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418399/original/file-20210830-13-f8cm3h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418399/original/file-20210830-13-f8cm3h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The death rate among clinically vulnerable groups has been up to three times higher in the US.</span>
<span class="attribution"><a class="source" href="https://photos.aap.com.au/">Stacey Plaisance/AP</a></span>
</figcaption>
</figure>
<p>In the United Kingdom, people with intellectual disability were <a href="https://www.theguardian.com/society/2021/jul/15/people-with-learning-disabilities-in-england-have-eight-times-covid-death-rate">eight times more likely</a> than the rest of the population to die of COVID and disabled people <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/coronaviruscovid19relateddeathsbydisabilitystatusenglandandwales/24januaryto20november2020">made up 60% of the deaths</a>. </p>
<p><a href="https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0051">Intellectual disability</a> was second only to age as a risk factor for death from COVID-19 in the US.</p>
<h2>What’s happening in Australia?</h2>
<p>COVID-19 infections are <a href="https://findanexpert.unimelb.edu.au/news/12571-overcrowding-and-affordability-stress--melbourne's-covid-19-hotspots-are-also-housing-crisis-hotspots">more common</a> in disadvantaged areas, both in <a href="https://findanexpert.unimelb.edu.au/news/12571-overcrowding-and-affordability-stress--melbourne's-covid-19-hotspots-are-also-housing-crisis-hotspots">Australia</a> and <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30553-3/fulltext">internationally</a>. </p>
<p>Residents in disadvantaged communities are more mobile, live and work in close proximity to other people, and are more likely to be essential workers who can’t work from home. These areas also tend to have high concentrations of ethnic minority and migrant communities.</p>
<p>Victoria’s second wave included outbreaks among residents and workers in <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-case-numbers-and-statistics#cases-in-aged-care-services">aged-care</a> facilities, along with outbreaks in <a href="https://www.coronavirus.vic.gov.au/healthcare-worker-covid-19-data#source-of-infections-in-healthcare-workers-over-time">health care</a>, <a href="https://www.abc.net.au/news/2020-07-26/coronavirus-covid-19-meatworks-abattoirs-victoria/12490178">meatworks</a>, and <a href="https://www.theage.com.au/national/victoria/coronavirus-fears-rise-in-disability-homes-after-two-deaths-20200811-p55km3.html">disability group homes</a>. </p>
<p>In NSW’s current wave, outbreaks are spreading rapidly <a href="http://theguardian.com/commentisfree/2021/aug/27/the-covid-disaster-unfolding-in-wilcannia-goes-way-past-incompetence-it-is-a-disgrace">in First Nations communities in western NSW</a> and in <a href="https://www.news.com.au/national/nsw-act/news/parklea-correctional-centre-in-nsw-records-31-coronavirus-cases/news-story/d1488405fd61c087dc788b7c3631a05f">prisons</a>.</p>
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<h2>Who is getting vaccinated?</h2>
<p><a href="https://www.health.gov.au/sites/default/files/documents/2021/01/covid-19-vaccination-australia-s-covid-19-vaccine-national-roll-out-strategy.pdf">Australia’s vaccine rollout strategy</a> prioritised people at most risk of serious disease and death from COVID-19.</p>
<p><a href="https://www.health.gov.au/resources/publications/covid-19-vaccination-covid-19-vaccination-phase-1a-rollout-presentation">Phase 1A</a> included aged-care and disability group home residents and the workers who support them. </p>
<p>In <a href="https://www.health.gov.au/sites/default/files/documents/2021/03/priority-groups-for-covid-19-vaccination-program-phase-1b_0.pdf">Phase 1B</a>, First Nations Australians over 55 years and people with disability with chronic conditions were eligible. </p>
<p>People prioritised in these phases were meant to be vaccinated <a href="https://www.pm.gov.au/media/press-conference-australian-parliament-house-12">by April</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-has-not-learned-the-lessons-of-its-bungled-covid-vaccine-rollout-163481">Australia has not learned the lessons of its bungled COVID vaccine rollout</a>
</strong>
</em>
</p>
<hr>
<p>More recently, <a href="https://www.ndis.gov.au/news/6504-covid-19-vaccination-eligibility-extended-all-ndis-participants-and-carers-over-16">all participants</a> in the National Disability Insurance Scheme and Indigenous Australians <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-vaccinated-for-covid-19/covid-19-vaccines-indigenous">12 years and older</a> became eligible. </p>
<p>Prisoners are not explicitly included as a priority population.</p>
<p>But the strategy came without an implementation plan and vaccination levels are appallingly low in many groups. </p>
<p>Vaccination rates are <a href="https://www.theguardian.com/australia-news/2021/aug/25/gap-between-indigenous-covid-vaccination-rates-and-overall-population-widens-in-almost-every-state">substantially lower</a> among Indigenous Australians than the population rates in every state and territory, except Victoria where Indigenous vaccination rates are much higher. </p>
<p>In western NSW, where COVID-19 is rapidly spreading through First Nations communities, <a href="https://www.theguardian.com/australia-news/2021/aug/28/indigenous-communities-being-left-behind-in-nsw-vaccine-rollout-figures-show">11.6% if Indigenous Australians are fully vaccinated</a> compared with 28.9% of non-Indigenous Australians.</p>
<p>Information about vaccination rates among disabled people and workers are not routinely shared and tend to be leaked to the media. On August 22, for example, the <a href="https://www.theage.com.au/politics/federal/people-with-disabilities-not-safe-with-ndis-jab-rollout-months-behind-20210820-p58kgd.html">Sunday Age</a> revealed just 27% of NDIS participants were fully vaccinated, lagging behind the national rate. </p>
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<p>Vaccination of prisoners and prison staff has also <a href="https://www.thesaturdaypaper.com.au/news/politics/2021/06/12/delays-vaccinating-prisoners/162342000011860">been slow</a>. Many states only <a href="https://www.croakey.org/survey-raises-serious-concerns-about-covid-vaccination-rollout-to-prisons/">started their prison vaccination rollout in the last couple of months</a> and data on vaccination coverage in correctional services have not been released (or perhaps even collected).</p>
<h2>No targets yet for vaccinating vulnerable groups</h2>
<p>The <a href="https://www.doherty.edu.au/uploads/content_doc/DohertyModelling_NationalPlan_and_Addendum_20210810.pdf">Doherty-led COVID-19 vaccination modelling</a> is cited as justifying the federal government’s 80% target. The modelling report acknowledges:</p>
<blockquote>
<p>particular attention should be paid to groups in whom socioeconomic, cultural and other determinants are anticipated to result in higher transmission and/or disease outcomes.</p>
</blockquote>
<p>The Doherty Institute’s director, Professor Sharon Lewin, emphasised that we need to achieve <a href="https://www.abc.net.au/7.30/professor-sharon-lewin,-director-of-the-doherty/13512468">80% targets</a> for all Australians including our most disadvantaged citizens. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/opening-with-70-of-adults-vaccinated-the-doherty-report-predicts-1-5k-deaths-in-6-months-we-need-a-revised-plan-166659">Opening with 70% of adults vaccinated, the Doherty report predicts 1.5K deaths in 6 months. We need a revised plan</a>
</strong>
</em>
</p>
<hr>
<p>However, the model itself did not specifically evaluate the potential impact on high-risk groups. Nor does the <a href="https://www.pm.gov.au/sites/default/files/media/national-plan-to-transition-australias-national-covid-19-response-30-july-2021.pdf">Commonwealth National Transition Plan</a> focus on equity.</p>
<p>Disadvantaged Australians face triple jeopardy – low vaccination rates, greater likelihood of being infected with COVID-19, and higher risks of serious disease and death from COVID-19. </p>
<p>These risk factors are significant individually. But some individuals face intersectional disadvantage. Indigenous people, for example, <a href="https://www.aihw.gov.au/reports/australias-welfare/disability-support-for-indigenous-australians">experience disability at a higher level</a> than the general population. And people with <a href="https://www.aihw.gov.au/reports/australias-health/health-of-prisoners">mental health issues</a> are over-represented in prisons.</p>
<p>Until now, we have relied on public health measures to contain the spread of COVID-19. If we relax these and move quickly to rely mainly on vaccination without ensuring equitable delivery, those most at risk will face a disproportionately greater burden of serious illness and death.</p>
<h2>What can be done?</h2>
<p>Thankfully, vaccine supply is improving. Australians are being vaccinated at unprecedented levels, particularly in NSW. </p>
<p>However, unless we explicitly move to an equity-based strategy for vaccination, “at risk” populations will be left even further behind.</p>
<figure class="align-center ">
<img alt="Man in a mask shops for dip." src="https://images.theconversation.com/files/418386/original/file-20210830-15-udlhct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/418386/original/file-20210830-15-udlhct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418386/original/file-20210830-15-udlhct.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418386/original/file-20210830-15-udlhct.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418386/original/file-20210830-15-udlhct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418386/original/file-20210830-15-udlhct.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418386/original/file-20210830-15-udlhct.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">All Australians should have an opportunity to be vaccinated before the nation opens up.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/wcCwqSglagY">Atoms/Unsplash</a></span>
</figcaption>
</figure>
<p><a href="https://www.nature.com/articles/s41591-021-01379-6">Equitable allocation</a> of vaccines requires:</p>
<ol>
<li>defining priority groups and geographical areas</li>
<li>allocating an increased share of vaccines or vaccination appointments</li>
<li>tailoring outreach and communication</li>
<li>offering vaccinations close to or in workplaces and places where people live including private homes, aged-care facilities, and prisons</li>
<li>monitoring vaccination uptake</li>
<li>inclusion of vaccine targets for priority groups in the <a href="https://www.pm.gov.au/sites/default/files/media/national-plan-to-transition-australias-national-covid-19-response-30-july-2021.pdf">national plan</a>.</li>
</ol>
<p>Continuing our current strategy will mean that when we decide the time is right to “live with COVID”, many people who should have been the highest priority for vaccination could die. </p>
<p>We demand a rethink of our vaccine strategy to have an explicit focus on equitable vaccine allocation. Otherwise, it’s simply not “safe” for many Australians to come out of Morrison’s proverbial cave.</p><img src="https://counter.theconversation.com/content/166818/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne Kavanagh receives funding from the NHMRC, ARC, WISE, and the Commonwealth and Victorian governments. She is a member of the Commonwealth Department of Health's Advisory Committee on COVID-19 for People with Disability. This article is written independently of her role on that Committee. </span></em></p><p class="fine-print"><em><span>Helen Dickinson receives funding from the ARC, NHMRC, Commonwealth Governments, CYDA, WISE and is a board member of the Consumer Policy Research Group.</span></em></p><p class="fine-print"><em><span>Nancy Baxter receives funding from the Canadian Institutes of Health Research. </span></em></p>It’s simply not “safe” for many Australians to come out of Scott Morrison’s proverbial cave until vaccination rates increase.Anne Kavanagh, Professor of Disability and Health, Melbourne School of Population and Global Health, The University of MelbourneHelen Dickinson, Professor, Public Service Research, UNSW SydneyNancy Baxter, Professor and Head of Melbourne School of Population & Global Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1648622021-08-01T20:08:27Z2021-08-01T20:08:27ZAboriginal people near the Ranger uranium mine suffered more stillbirths and cancer. We don’t know why<p><em>This article mentions stillbirth deaths in Aboriginal communities.</em></p>
<hr>
<p>The Ranger uranium mine, surrounded by Kakadu National Park in the Northern Territory, operated for 40 years until it <a href="https://www.energyres.com.au/uploads/general/Ch_11_Social__and_Economic_Considerations.pdf">closed in 2021</a>. <a href="https://health.nt.gov.au/__data/assets/pdf_file/0010/951742/Gunbalanya-Kakadu-Disease-Cluster-Investigation-Final-Report.pdf">During this time</a>, Aboriginal people in the region experienced stillbirth rates double those of Aboriginal people elsewhere in the Top End, and cancer rates almost 50% higher.</p>
<p>But a NT government investigation <a href="https://health.nt.gov.au/__data/assets/pdf_file/0010/951742/Gunbalanya-Kakadu-Disease-Cluster-Investigation-Final-Report.pdf">couldn’t explain why</a>. And as I <a href="https://doi.org/10.5694/mja2.51198">write today</a> in the Medical Journal of Australia, we’re still no wiser.</p>
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<p>We owe it to Aboriginal people living near mines to understand and overcome what’s making them sick. We need to do this in partnership with Aboriginal community-controlled health organisations. This may require research that goes beyond a biomedical focus to consider the web of socio-cultural and political factors contributing to Aboriginal well-being and sickness.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/uranium-mines-harm-indigenous-people-so-why-have-we-approved-a-new-one-116262">Uranium mines harm Indigenous people – so why have we approved a new one?</a>
</strong>
</em>
</p>
<hr>
<h2>Investigating the health impacts</h2>
<p>Uranium was mined at Ranger from 1981 until 2012. Processing of stockpiled ore <a href="https://www.environment.gov.au/science/supervising-scientist/ranger-mine">continued until</a> 2021. This is despite community opposition when the mine was proposed and during its operation.</p>
<p>Over the life of the mine, there have been <a href="https://theconversation.com/rangers-toxic-spill-highlights-the-perils-of-self-regulation-21409">more than 200 documented incidents</a>. Diesel and acid spills have contaminated creeks and drinking water.</p>
<p>The <a href="https://www.mirarr.net">Gundjeihmi Aboriginal Corporation</a> represents the Mirarr people of the region. For decades it has <a href="https://www.sciencedirect.com/science/article/pii/S2214790X14000835">expressed grave concerns</a> about continuing incidents and the lack of an effective government response.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-uranium-mine-in-the-heart-of-kakadu-needs-a-better-clean-up-plan-115566">The uranium mine in the heart of Kakadu needs a better clean up plan</a>
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</em>
</p>
<hr>
<p>When Ranger’s operators proposed expanding the mine in 2014, opponents pointed to <a href="https://aiatsis.gov.au/publication/35561">suggestions</a> of higher rates of stillbirth and cancer among Aboriginal people living nearby.</p>
<p>The NT health department then set up an investigation. Investigators began by identifying all Aboriginal people who had spent more than half their lives near the mine between 1991 and 2014. These people were compared with all other Aboriginal people in the Top End.</p>
<p>The investigators considered the worst-case scenario would be if Aboriginal people were exposed to radiation from the mine contaminating bush food, water or air, and this exposure increased stillbirth and cancer rates. </p>
<p>Investigators also looked at smoking tobacco, drinking alcohol and poor diet as possible contributing causes.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-australians-die-cause-2-cancers-58063">How Australians Die: cause #2 – cancers</a>
</strong>
</em>
</p>
<hr>
<h2>Here’s what they found</h2>
<p>Investigators found the rate of stillbirth was 2.17 times higher among Aboriginal women near the mine. Radiation can lead to stillbirth by causing congenital malformations, and some other risk factors for stillbirth appeared more common amongst women near the mine. However the investigation found neither radiation nor other risk factors explained the higher rate of stillbirth.</p>
<p>The rate of cancer overall was 1.48 times higher among Aboriginal people near the mine than elsewhere in the Top End. No rates of single cancers were significantly higher.</p>
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<p>Cancers of the lip, mouth and throat together were the most common cancers. These cancers covered 42% of the excess cancers among people near the mine. The investigators were confident these cancers were not related to radiation from the mine, based on <a href="https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(09)70213-X/fulltext">international evidence</a>. The Ranger mine investigation concluded radiation did not contribute to the higher cancer rates.</p>
<p>However, cancers of the lip, mouth and throat are associated with smoking and drinking alcohol. Health records showed smoking, drinking alcohol and a poor diet were more common among Aboriginal people near the mine. Yet the rates of cancer among people near the mine who smoked, drank alcohol or reported poor diet were no higher than the rates of cancer among other Aboriginal people in the Top End who smoked, drank alcohol or reported a poor diet.</p>
<p>So the investigation <a href="https://health.nt.gov.au/__data/assets/pdf_file/0010/951742/Gunbalanya-Kakadu-Disease-Cluster-Investigation-Final-Report.pdf">concluded</a> neither radiation, smoking, alcohol nor poor diet explained why Aboriginal people near the mine had higher rates of stillbirths and cancer.</p>
<p>The NT government concluded its investigation by recommending initiatives to <a href="https://health.nt.gov.au/__data/assets/pdf_file/0010/951742/Gunbalanya-Kakadu-Disease-Cluster-Investigation-Final-Report.pdf">reduce smoking and drinking alcohol</a> by Aboriginal people near the mine.</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>
<h2>Investigating disease clusters can be hard</h2>
<p>When a cluster of people with a particular disease is identified, affected communities seek an explanation. However studies of disease clusters <a href="https://www.mdpi.com/1660-4601/11/2/1479">rarely explain</a> exactly why the cluster has occurred. Some diseases, such as cancer, have complex origins that may have been experienced decades before the cancer is diagnosed.</p>
<p>Worldwide, communities exposed to <a href="https://www.ncbi.nlm.nih.gov/books/NBK201047/">ionising radiation from mining</a> are often also exposed to dust, diesel, noise and trauma. They also have higher rates of smoking and drinking alcohol. </p>
<p>So, it is understandable the investigation into stillbirths and cancers among Aboriginal people near Ranger uranium mine was inconclusive.</p>
<h2>Where to next?</h2>
<p>While the NT government recommendations appear to show concern for Aboriginal health, they ignore the importance of Aboriginal people’s rights, empowerment and self-determination as contributors to health and well-being.</p>
<p>The development of the Ranger mine brought Aboriginal communities royalty <a href="https://trove.nla.gov.au/work/18964202">money and alcohol</a>. It also contributed <a href="https://www.sciencedirect.com/science/article/abs/pii/S2214790X14000835?via%3Dihub">to loss of</a> traditional livelihoods, dependency and despair.</p>
<p>Inequality <a href="https://trove.nla.gov.au/work/18964202">has also increased</a> among Aboriginal people near the mine, as some can access royalty money and work opportunities, and others cannot. And inequality can contribute to both <a href="https://www.sciencedirect.com/science/article/abs/pii/S1871519220303176?via%3Dihub">stillbirths</a> and <a href="https://www.frontiersin.org/articles/10.3389/fonc.2019.00233/full">cancer</a>.</p>
<p>So these excess stillbirths and cancers may be associated with a web of interrelationships between individuals, communities and wider ecological, sociological and political environments. The NT government’s biomedically focused investigation was not designed to explore these and further research is needed to unravel this web.</p>
<p>Governments also need to consider all the risks Aboriginal communities potentially face from any proposed mining operations <a href="https://www.industry.gov.au/news/the-beetaloo-strategic-basin-plan-released-as-part-of-the-gas-fired-economic-recovery">before they commit</a> to these developments on Aboriginal land. This includes gas drilling proposed in the NT’s <a href="https://nit.com.au/native-title-holders-take-back-power-in-beetaloo-basin-bid/">Beetaloo Basin</a>.</p>
<hr>
<p><em>I’d like to acknowledge Justin O'Brien CEO of <a href="https://www.mirarr.net">Gundjeihmi Aboriginal Corporation</a>, which represents the Mirrar people, who own the land at Ranger, and Michael Fonda, representing the <a href="https://www.phaa.net.au/">Public Health Association of Australia</a>. Both helped ensure the NT government investigation mentioned in this article was conducted, completed and published.</em></p><img src="https://counter.theconversation.com/content/164862/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rosalie Schultz is affiliated with Public Health Association of Australia (PHAA) and Doctors for the Environment Australia (DEA).</span></em></p>We owe it to Aboriginal people living near uranium mines to learn more about what’s making them sick.Rosalie Schultz, Adjunct Senior Lecturer, College of Medicine and Public Health Centre for Remote Health, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1610962021-06-25T00:40:35Z2021-06-25T00:40:35ZNew research shows how Indigenous LGBTIQ+ people don’t feel fully accepted by either community<p>A new Western Australian study, one of the first of its kind, reveals the complex experiences of those living at the intersection of being both Indigenous and part of the LGBTIQ+ community. </p>
<p>Two reports produced as part of this <a href="https://www.ecu.edu.au/centres/kurongkurl-katitjin/research/current-projects-and-past-projects/breaking-the-silence">Healthway-funded Breaking the Silence project</a> are based on data insights from a survey of health care professionals and focus group sessions of health services and 63 Indigenous LGBTIQ+ community members.</p>
<p>This research was conducted by Indigenous LGBTIQ+ researchers and led by Edith Cowan University’s <a href="https://www.ecu.edu.au/centres/kurongkurl-katitjin/overview">Kurongkurl Katitjin Centre for Indigenous Education and Research</a>. </p>
<p>The findings provide valuable insights and recommendations for the health, education and community services sector in supporting Indigenous LGBTIQ+ people.
There is a pressing need to respond effectively to the mental health concerns impacting Indigenous LGBTIQ+ communities nationally.</p>
<h2>Pride despite discrimination</h2>
<p>This research found many Indigenous LGBTIQ+ people feel a strong sense of pride in who they are and their unique position in being able to challenge misconceptions about being Indigenous in queer communities and queer in Indigenous communities. Being able to support younger people as they negotiate these intersections was also fulfilling.</p>
<p>While many queer Indigenous people value the ability to educate others about this complex identity position, this responsibility can also be burdensome. </p>
<p>Participants frequently experienced heterosexism and racism. They often felt invisible or marginalised within the LGBTIQ+ community, Indigenous communities and broader society:</p>
<ul>
<li><p>more than 73% reported experiencing discrimination in the past 12 months </p></li>
<li><p>discrimination included being ignored or teased, maliciously ‘outed’, followed in public, or being victims of physical violence and other crimes </p></li>
<li><p>close to 13% experienced homelessness or housing insecurity because of their sexual orientation or gender identity</p></li>
<li><p>participants experienced both racism and queerphobia, but racism was more frequently observed as being most problematic.</p></li>
</ul>
<p>For Aboriginal and Torres Strait Islander people, including those in the queer community, <a href="https://www.abc.net.au/news/science/2020-07-03/indigenous-dating-app-racism-tinder-grindr/12406402">dating apps also present particular challenges</a>. Many participants indicated they purposefully do not mention they are Indigenous in seeking to form online connections within the LGBTIQ+ community due to a fear of racism.</p>
<h2>Intersection of identities clashing</h2>
<p>More than half of the participants felt little or no sense of connection to the LGBTIQ+ community as Indigenous people. </p>
<p>Participants also reflected on having to endure micro-aggressions from non-Indigenous queer people. Stereotyping and forms of “casual” racism – being told they don’t look Aboriginal or made to feel like a “token” inclusion – were common examples.</p>
<p>A key issue for a third of participants was the sense of invisibility they felt within Indigenous communities due to their sexual and/or gender identity. </p>
<p>Some chose to hide their sexual orientation for fear of not being accepted by Elders and community leaders. Interestingly though, Elders who engaged in the research were very supportive of promoting acceptance.</p>
<p>A desire to form connections with other queer Indigenous people was of great importance. Many participants also described the constant negotiation of identities, surveying risks, or hiding parts of one’s self as being exhausting.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-young-lgbtqia-people-used-social-media-to-thrive-during-covid-lockdowns-156130">How young LGBTQIA+ people used social media to thrive during COVID lockdowns</a>
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</em>
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<h2>Inclusive health care and support is needed</h2>
<p>A main focus of this research was Aboriginal and Torres Strait Islander/LGBTIQ+ peoples’ access to, and experiences with, a range of health, education, and social services.</p>
<p>Participants emphasised the importance of LGBTIQ+ friends, families, GPs, and counselling services in providing responsive care and support in times of need.
Participants also highlighted significant levels of trust in Aboriginal community controlled health organisations. </p>
<p>This indicates more could be done by Indigenous health organisations to include Indigenous LGBTIQ+ people’s needs in their services.</p>
<p>All organisations that were surveyed expressed clear intentions to become better informed about the specific needs of Aboriginal LGBTIQ+ clients. </p>
<p>Community members and health care/support professionals also identified steps to improve care for queer Indigenous people. These included employing and retaining Indigenous LGBTIQ+ staff, using inclusive language, implementing specialist staff training, and initiating conversations on inclusion with boards and executives.</p>
<p>However, broader policy changes are also needed in health practices, including:</p>
<ul>
<li><p>more extensive Indigenous LGBTIQ+ leadership on all Indigenous LGBTIQ+ matters</p></li>
<li><p>inclusive health and support services that welcome Indigenous LGBTIQ+ people proactively as both clients and staff </p></li>
<li><p>better national and state level data collection relating to Indigenous LGBTIQ+ communities and improved data collection within health and support services</p></li>
<li><p>ongoing professional development and training at all levels within an organisation</p></li>
<li><p>greater representation of Indigenous LGBTIQ+ people in public awareness/education campaigns and leadership positions </p></li>
<li><p>implementation of anti-racism strategies in organisations providing support or community connection to Indigenous LGBTIQ+ people</p></li>
<li><p>greater awareness of trans issues and safe referral pathways for Indigenous trans people.</p></li>
</ul>
<p>Both racism and queerphobia must be addressed for Indigenous LGBTIQ+ people to feel a sense of connection and belonging within their communities. Courageous conversations about discrimination in all organisations and the wider Australian society are well overdue.</p><img src="https://counter.theconversation.com/content/161096/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Braden Hill receives funding from a Healthway Exploratory Research Grant. </span></em></p><p class="fine-print"><em><span><a href="mailto:bep.uink@murdoch.edu.au">bep.uink@murdoch.edu.au</a> receives funding from the Australian National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), Australian Government Department of Health, the Society for Research for Child Development, and Healthway. </span></em></p><p class="fine-print"><em><span>Dameyon Bonson is an independent suicide prevention practitioner, in particular Indigenous LGBTIQ+ suicide prevention inclusive practice. He is also the Founder of Black Rainbow, Australia’s first and only national Indigenous LGBTIQ+ suicide prevention charity organisation.</span></em></p><p class="fine-print"><em><span>Jennifer Dodd receives funding from a Healthway Exploratory Research Grant</span></em></p><p class="fine-print"><em><span>Sian Bennett 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>A Western Australian study, one of the first of its kind, reveals the complex experiences of those living at the intersection of being Indigenous and part of the LGBTIQ+ community.Braden Hill, Pro-Vice Chancellor, Edith Cowan UniversityBep Uink, Research fellow, Murdoch UniversityDameyon Bonson, Suicide Prevention, Macquarie UniversityJennifer Dodd, Research Scholar, Kurongkurl Katitjin, Edith Cowan UniversitySian Bennett, Lecturer, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1614122021-06-03T03:31:33Z2021-06-03T03:31:33ZAustralia’s news media play an important role reminding the country that Black lives still matter<p><em>Aboriginal and Torres Strait Islander readers are advised this article contains names of people who have passed away, and descriptions of these deaths.</em></p>
<p>One year has passed since George Floyd’s death under the knee of a Minneapolis police officer. Floyd’s name is imprinted upon our consciousness, as it should be. </p>
<p>However, in Australia we know less about the <a href="https://newsroom.unsw.edu.au/news/business-law/black-lives-matter-movement-australia-first-nations-perspectives">more than 474 Indigenous people who have died in police or prison custody</a> in the 30 years since the Royal Commission into Aboriginal Deaths in Custody.</p>
<p>While Floyd’s death and the Black Lives Matter movement sparked extensive media attention, Australian Indigenous deaths in custody have had a harder time attracting sustained coverage, particularly from mainstream news outlets. Media attention on the issue has been episodic and too often absent.</p>
<h2>The Great Australian Silence continues</h2>
<p>As Darumbal and South Sea Islander journalist Amy McQuire <a href="https://7ampodcast.com.au/episodes/black-witness-white-witness">says</a>, there is a national apathy in response to First Nations deaths in custody. McQuire, who consistently reports on deaths in custody as an independent journalist, says: “When Aboriginal people die in custody there is a national silence”. Some deaths in custody break through, but many more pass unnoticed.</p>
<p>The royal commission stated that to reduce Aboriginal deaths in custody it is critical to reduce imprisonment rates (which have <a href="https://www.ceda.com.au/NewsAndResources/Opinion/Indigenous-affairs/Costs,-consequences-and-alternatives-to-imprisonin">doubled</a> since 1991), and to improve the exercise of the duty of care owed to people in custody. </p>
<p>Two Indigenous deaths in custody, 20 years apart, demonstrate the failure to achieve both.</p>
<p>In 1994, 30-year-old Aboriginal woman <a href="https://communityyarns.com/wp-content/uploads/2016/05/The-girl-in-cell-4.pdf">Ms Beetson</a> died of treatable heart disease in Sydney’s Mulawa women’s prison. </p>
<p>She was admitted to prison unwell; previous open-heart surgery and other concerns were highlighted on her admittance form. She was given a cursory medical examination and her symptoms were put down to drug withdrawal. Over a week, she became weaker and sicker, received no effective medical attention and died alone in a cell.</p>
<p>In 2014, Yamatji woman Ms Dhu, 22, was arrested for unpaid fines, against royal commission recommendations. She was held in a South Hedland, WA, police watch house for three days in intense pain and growing sicker. </p>
<p>The usual assumptions were made about drug withdrawal and that she was “<a href="https://www.theguardian.com/australia-news/2016/dec/16/ms-dhu-endured-inhumane-treatment-by-police-before-death-in-custody-coroner">faking it</a>”. She died of staphylococcal septicaemia and pneumonia.</p>
<p>Twenty years apart, the circumstances around Ms Beetson’s and Ms Dhu’s deaths reflect the same inadequate medical treatment, inhumanity, lack of professionalism and failures. Both medical conditions were treatable and both deaths preventable. </p>
<p>But the story of Ms Dhu’s case broke through, due to local and effective activism, and because the media landscape had started to change.</p>
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Read more:
<a href="https://theconversation.com/not-criminals-or-passive-victims-media-need-to-reframe-their-representation-of-aboriginal-deaths-in-custody-158561">Not criminals or passive victims: media need to reframe their representation of Aboriginal deaths in custody</a>
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<p>The year before Ms Dhu’s death, The Guardian began publishing an online Australian edition. Guardian journalist <a href="https://www.walkleys.com/spotlight-on-calla-wahlquist-and-lorena-allam/">Calla Wahlquist</a> reported at least one story every day from the inquest into Ms Dhu’s death. </p>
<p>The Guardian’s sustained deaths in custody reporting and its “<a href="https://www.theguardian.com/australia-news/series/deaths-inside">Deaths Inside</a>” database have made a difference to deaths in custody coverage.</p>
<h2>Australian media needs to keep addressing deaths in custody</h2>
<p>Media attention was important in helping to <a href="https://wendybacon.com/2021/Deaths">create the conditions</a> for the royal commission’s establishment. Among the more influential and agenda-setting stories were those by Western Australian freelance journalist <a href="https://www.icij.org/journalists/jan-mayman/">Jan Mayman</a> reporting on Roebourne teenager John Pat’s 1983 death for The Age, and a <a href="https://www.abc.net.au/4corners/black-death---1985/2835060">1985 Four Corners program</a> presented by David Marr.</p>
<p>In its report and <a href="https://theconversation.com/not-criminals-or-passive-victims-media-need-to-reframe-their-representation-of-aboriginal-deaths-in-custody-158561">recommendations</a>, the royal commission recognised the important role of the media as a form of “collective conscience”, contributing to the possibility of increased justice for Aboriginal people. </p>
<p>The <a href="https://www.naa.gov.au/sites/default/files/2020-02/research-guide-aboriginal-deaths-in-custody.pdf">release</a> of the royal commission’s final report was a Black-lives-just-could-matter moment in Australia. </p>
<p>Here was the blueprint for transforming the life chances of Aboriginal people, and the relationship between Aboriginal and non-Aboriginal Australians. Implementing the report’s 339 recommendations could reduce imprisonment rates, deaths in custody, inequality and disadvantage.</p>
<p>When the <a href="http://www.austlii.edu.au/au/other/IndigLRes/rciadic/">report</a> was released, the media was again <a href="https://wendybacon.com/2021/Deaths">interested and engaged</a>. Aboriginal people’s points of view were heard, and Aboriginal deaths in custody became an important story that put individual deaths into context. However, this kind of reporting soon fell away.</p>
<p>Four years after the report, governments were claiming successful implementation of the royal commission’s recommendations. However, the <a href="https://www.aic.gov.au/publications/sr/sr21">Australian Institute of Criminology</a> was reporting deaths in prison at record levels. </p>
<p><a href="https://wendybacon.com/uploads/appendix-c_reportage-article.pdf">Research</a> by the Australian Centre for Independent Journalism found the media uncritically reported government implementation claims as if they were true.</p>
<h2>Non-Indigenous journalists need to step up</h2>
<p>While First Nations journalists, such as Amy McQuire, Gamilaraay and Yawalaraay woman <a href="https://www.theguardian.com/profile/lorena-allam">Loreena Allam</a> and Muruwari man <a href="https://www.abc.net.au/news/2020-06-28/covering-black-deaths-in-australia-led-me-to-a-breakdown/12390416">Allan Clarke</a>, are telling stories of injustice meted out to Aboriginal people, non-Indigenous journalists must also keep telling stories about the injustices caused by colonisation.</p>
<p>It took an event in the US to spark the Indigenous lives matter response across Australia. Journalists must continue to report on the chain of events that lead to Black deaths at the hands of the state. </p>
<p><strong>How we can do this:</strong></p>
<p>We can report the facts, for instance, Indigenous adult and youth apprehension and imprisonment rates, Aboriginal youth and adult suicide rates, coronial inquest findings and recommendations.</p>
<ol>
<li><p>We can interview witnesses, family members and representatives, police and prison officers, and other experts and report what they and other informed commentators say about the facts, consequences and causes of those deaths. </p></li>
<li><p>We can investigate and discern the patterns emerging from these deaths; the similar facts and <a href="https://www.theguardian.com/australia-news/2020/jun/11/the-story-of-david-dungay-and-an-indigenous-death-in-custody">common factors</a>, the same systemic failures, the ongoing evidence of institutional racism.</p></li>
<li><p>Through our journalism we need to honour each person who has died, and try to bring some comfort to their affected families and communities.</p></li>
</ol>
<p>As investigative journalist Allan Clarke <a href="https://www.abc.net.au/news/2020-06-28/covering-black-deaths-in-australia-led-me-to-a-breakdown/12390416">says</a>:</p>
<blockquote>
<p>Australia, we can do better and we must do better.</p>
</blockquote>
<p><em>See <a href="https://jeraa.org.au/listen-reporting-black-lives-matters/">here</a> for resources and guides for what we as journalists can do.</em></p><img src="https://counter.theconversation.com/content/161412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bonita Mason 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>George Floyd’s death and the US Black Lives Matter movement sparked extensive media attention. Why aren’t Australian Indigenous deaths in custody getting the same amount of media coverage?Bonita Mason, Senior Lecturer in Journalism, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1601832021-05-05T20:08:02Z2021-05-05T20:08:02ZHere’s why the planned NDIS reforms discriminate against Aboriginal and Torres Strait Islander people<figure><img src="https://images.theconversation.com/files/398798/original/file-20210505-17-n05ttn.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5941%2C3957&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>The National Disability Insurance Scheme (NDIS) is one of the greatest human services reforms in Australia’s history, and holds great promise in improving the lives of hundreds of thousands of people with disability.</p>
<p>But the federal government’s proposed “independent assessments” aren’t the way forward for Aboriginal and Torres Straight Islander people with a disability. </p>
<p>I’m a Koori bloke from the Yuin Nation who lives with disability and has a research career spanning nearly 20 years. The biggest problem I have with the proposed framework is that it’s disrespectful and discriminatory towards Aboriginal and Torres Strait Islander people.</p>
<p>Rather than designing another layer of bureaucracy, I recommend the National Disability Insurance Agency (NDIA) invests more resources into building and up-skilling the current NDIS planning workforce and the Aboriginal community-controlled services sector.</p>
<p>Aboriginal and Torres Strait Islander people with disability have a right to use health specialists with whom they have an established relationship. As such, the government should invest more resources into the health workforce to build consistency in the NDIS planning process.</p>
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Read more:
<a href="https://theconversation.com/dehumanising-and-a-nightmare-why-disability-groups-want-ndis-independent-assessments-scrapped-156941">'Dehumanising' and 'a nightmare': why disability groups want NDIS independent assessments scrapped</a>
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<h2>What are these reforms again?</h2>
<p>Currently, people seeking access to the NDIS are required to work with their health professionals to see if they’re eligible. After this, they work with the NDIS, or an NDIA-funded agency partner, to design a funded package.</p>
<p>The federal government’s proposed independent assessments <a href="https://www.abc.net.au/news/2021-03-11/disability-organisations-against-ndis-independent-assessments/13233838">would see</a> a government-approved health professional unknown to the person with disability visit to determine their eligibility for the NDIS and the amount of funding they would receive. The meetings would take as long as three hours, or longer if there’s a disagreement between the assessor and the applicant’s family.</p>
<p>New NDIS minister Linda Reynolds <a href="https://www.sbs.com.au/news/amid-enormous-backlash-the-government-hits-pause-on-ndis-independent-assessments">put on hold</a> the reforms in April amid widespread backlash, although this week she promised “<a href="https://www.theguardian.com/australia-news/2021/may/03/linda-reynolds-says-coalition-will-keep-some-form-of-independent-ndis-assessments">some form</a>” of independent assessments will go ahead.</p>
<p>The NDIA <a href="https://www.ndis.gov.au/participants/independent-assessments/independent-assessment-pilot">justification</a> for the independent assessments is:</p>
<blockquote>
<p>To decide whether a person is eligible for the NDIS and the kinds of supports they receive, we need to have consistent and reliable evidence that captures detail of their functional capacity, and the environment in which they live.</p>
</blockquote>
<p>Critics say the reforms are a <a href="https://www.abc.net.au/news/2021-03-11/disability-organisations-against-ndis-independent-assessments/13233838">cost-cutting exercise</a> in response to the cost blow-out of the NDIS, and warn the changes will make it harder for people to access the scheme. </p>
<h2>The model is discriminatory</h2>
<p>The proposed independent assessment model is discriminatory to Aboriginal and Torres Strait Islander people.</p>
<p>The model would further disadvantage Aboriginal and Torres Strait Islander people living in remote and rural areas, who rely on visiting professionals and e-health service models. It already takes months or even years to get into the NDIS and complete the planning process. The proposed model adds another hurdle and will likely extend the time frame for NDIS assessments for Aboriginal and Torres Strait Islander families.</p>
<p>The first independent assessment pilot program was conducted in 2018, and <a href="https://www.ndis.gov.au/participants/independent-assessments/independent-assessment-pilot">only 1% of 513 people involved were Aboriginal and Torres Strait Islander people</a>. And during the second pilot, before it was paused in March 2020 due to the COVID-19 pandemic, only 4% of the 99 people involved were Aboriginal and Torres Strait Islander people. This participation rate is inadequate. </p>
<p>None of the <a href="https://www.ndis.gov.au/news/6118-independent-assessment-panel-announced">eight NDIA-funded organisations</a> delivering the independent assessments are Aboriginal community-controlled. Adding salt to the wound, the NDIA <a href="https://www.ndis.gov.au/participants/independent-assessments/independent-assessors">says</a> these agencies:</p>
<blockquote>
<p>[…] understand and have experience of the disability population in their local area, including Aboriginal and Torres Strait Islander and Culturally and Linguistically Diverse (CALD) groups and communities.</p>
</blockquote>
<figure class="align-center ">
<img alt="Aboriginal flag" src="https://images.theconversation.com/files/398801/original/file-20210505-15-46fchc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398801/original/file-20210505-15-46fchc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=458&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398801/original/file-20210505-15-46fchc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=458&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398801/original/file-20210505-15-46fchc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=458&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398801/original/file-20210505-15-46fchc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=576&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398801/original/file-20210505-15-46fchc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=576&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398801/original/file-20210505-15-46fchc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=576&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many Aboriginal and Torres Strait Islander people would prefer to work with health professionals they already have a relationship with, rather than government-approved workers they’ve never met.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Simply giving professionals training in cultural competence or cultural safety isn’t enough to establish a culturally safe NDIS environment. </p>
<p>It’s unknown if there’s a requirement for the independent assessment agencies to have Aboriginal workers or Aboriginal allied-health assistants.</p>
<p>Most of the suite of independent assessment tools haven’t been rigorously tested or evaluated for their application with Aboriginal and Torres Strait Islander families. Assessment tools should be evaluated with Aboriginal and Torres Strait Islander families to ensure they’re applicable for cultural and social norms before they are endorsed by governments.</p>
<p>The <a href="https://www.ndis.gov.au/participants/independent-assessments/independent-assessment-framework">NDIA says</a> some of these tools are linked to the World Health Organization’s International Classification of Functioning, Disability and Health, which is a framework for classifying disability and functioning. <a href="https://search.informit.org/doi/pdf/10.3316/informit.751842945817584">My research</a> shows the framework hasn’t been evaluated with Aboriginal and Torres Strait Islander communities during its development, except <a href="https://www.aihw.gov.au/getmedia/8efcd943-ec2f-48a7-a7c8-c81b887e7dc7/5-icidh-ind.doc.aspx">one small study in the Northern Territory</a>.</p>
<p>In my professional view, the framework needs to be “Indigenised” to ensure NDIS assessment models are respectful for Aboriginal and Torres Strait Islander people.</p>
<h2>A trusting relationship with a health professional is key</h2>
<p>Aboriginal and Torres Strait Islander people <a href="https://www.ndis.gov.au/about-us/publications/quarterly-reports">currently represent</a> nearly 7% of all NDIS package holders. According to Australian Bureau of Statistics data from 2015, the rate of disability in the Aboriginal and Torres Strait Islander population is <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Previousproducts/4430.0Main%20Features802015?opendocument&tabname=Summary&prodno=4430.0&issue=2015&num=&view=">nearly twice</a> that of the non-Indigenous population.</p>
<p><a href="http://healthbulletin.org.au/articles/twelve-factors-that-can-influence-the-participation-of-aboriginal-people-in-disability/">My research</a> found Aboriginal and Torres Strait Islander people often have a high level of distrust of government systems due to a history of racism and child removal, meaning many don’t engage with disability services. However, generally, Aboriginal and Torres Strait Islander people engage with disability service providers if they have an established relationship with a worker in that organisation.</p>
<p>In some cases, Aboriginal and Torres Strait Islander people prefer Aboriginal and Torres Strait Islander workers over non-Indigenous workers. GP Debra Blackmore, who works for the Victorian Aboriginal Health Service, <a href="https://www.sbs.com.au/news/doctor-with-patients-from-stolen-generations-fears-ndis-reforms-will-be-traumatic-and-triggering">explained this perfectly</a> in a submission to a parliamentary inquiry into the independent assessments, stressing:</p>
<blockquote>
<p>[…] the importance of long-term therapeutic relationships in building trust, understanding nuances of communication, creating culturally safe spaces and ensuring patients feel safe and confident enough to appropriately express their needs and concerns.</p>
</blockquote>
<p>The proposed independent assessments are the antithesis of Aboriginal and Torres Strait Islander cultural models of health and disability. The proposed model is purely based on the medical model of disability and it excludes Aboriginal and Torres Strait Islander cultural nuances of the social experiences of disability. What’s more, the independent assessment meetings <a href="https://www.sbs.com.au/news/doctor-with-patients-from-stolen-generations-fears-ndis-reforms-will-be-traumatic-and-triggering">could trigger</a> post-traumatic stress disorder symptoms linked to a history of disablism, racism, stolen generations, and personal anxiety.</p><img src="https://counter.theconversation.com/content/160183/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Gilroy 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>As a Koori bloke who lives with disability, I believe the proposed framework is disrespectful and discriminatory towards Aboriginal and Torres Strait Islander people.John Gilroy, ARC Research Fellow in Indigenous Health, Disability and Community Development, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1369532020-05-14T20:01:58Z2020-05-14T20:01:58ZFriday essay: voices from the bush – how lockdown affects remote Indigenous communities differently<p>What does self-isolation mean when you live in one of Australia’s most remote Aboriginal communities? What does social distancing mean when the average household holds 12-15 people? How do you think through viral vulnerability when people in your community already die too young and too frequently? </p>
<p>These are just a few of the questions that might be asked of Aboriginal people living in remote parts of Australia as the COVID-19 pandemic swirls around them and other Aboriginal communities across the nation. </p>
<p>We work with the communities of Barunga, Beswick, Manyallaluk and Borroloola in the Northern Territory. We have worked with the same communities for up to 30 years. We have recorded many <a href="https://books.google.co.jp/books?id=VSwlddVCxWYC&pg=PA56&dq=Country+kin+and+Culture&hl=en&sa=X&redir_esc=y#v=onepage&q=Country%20kin%20and%20Culture&f=false">changes through time</a> and come to learn something about life in remote communities from Aboriginal people. We have learnt from <a href="https://books.google.com.au/books?id=tegaBgAAQBAJ&printsec=frontcover&dq=cultural+wounding+and+healing&hl=en&sa=X&ved=0ahUKEwiLkZjs7aDpAhXW7HMBHbmDDVgQ6AEIKzAA#v=onepage&q=cultural%20wounding%20and%20healing&f=false">elders, mid and younger generations</a>. </p>
<p>Our new research comes from regular phone conversations with community members about the impact of COVID-19. These phone calls bridge the remote and urban divide, as we discuss what is known about the virus and how long before things get back to normal. By sharing the experiences of Aboriginal families who live in remote NT communities, more voices will find a place in the national conversation. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1252048379439243266"}"></div></p>
<h2>Safe in the bush</h2>
<p>Aboriginal people have talked about feeling safe out bush, about following the rules of lockdown. Locals like Garrwa/Waanyi woman and Borroloola resident Gloria Friday praise their communities for “abiding by the rules, not running around, keeping an eye out and being really careful”. They are fully aware of the threat COVID-19 poses to their old people and those who are sick.</p>
<p>At a time when travel to and from these communities is prohibited, contact with the outside world is important. Barunga Elder and <em>Junggayi</em> (custodian) Narritj, says:</p>
<blockquote>
<p>Phone call. You on that side, us on this side. We need that, too. We want to know what is happening in other places. We want to know the truth about that virus. (April 30 2020)</p>
</blockquote>
<p>For people living in Borroloola, the spread of information has been rapid. As Gloria Friday explains: </p>
<blockquote>
<p>Everyone with TV knows what’s going on. And I listen to news all the time, I’ve got a little radio and I listen to the news about the virus and what’s going on in the world.</p>
</blockquote>
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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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<hr>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/333938/original/file-20200511-31175-oi8614.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/333938/original/file-20200511-31175-oi8614.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/333938/original/file-20200511-31175-oi8614.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=365&fit=crop&dpr=1 600w, https://images.theconversation.com/files/333938/original/file-20200511-31175-oi8614.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=365&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/333938/original/file-20200511-31175-oi8614.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=365&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/333938/original/file-20200511-31175-oi8614.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=458&fit=crop&dpr=1 754w, https://images.theconversation.com/files/333938/original/file-20200511-31175-oi8614.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=458&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/333938/original/file-20200511-31175-oi8614.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=458&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Official health messaging for Indigenous communities.</span>
<span class="attribution"><a class="source" href="https://www.health.gov.au/resources/publications/key-updates-for-aboriginal-and-torres-strait-islander-communities-29-april-2020">Dept of Health</a></span>
</figcaption>
</figure>
<h2>Vulnerable communities, new babies</h2>
<p>Humans are vulnerable to disease for many reasons including age, gender, society, environment and ancestry. We know the COVID-19 risks are <a href="https://theconversation.com/coronavirus-will-devastate-aboriginal-communities-if-we-dont-act-now-133766">magnified for Aboriginal people</a> in remote communities. </p>
<p>This <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/advice-for-people-at-risk-of-coronavirus-covid-19/coronavirus-covid-19-advice-for-aboriginal-and-torres-strait-islander-peoples-and-remote-communities">is due to</a> higher rates of other health issues, limited access to health care, greater reliance on outreach services and movement between communities. </p>
<p>The COVID-19 situation has brought specific health challenges to Aboriginal women in remote areas. For years it has been common for women to leave their communities to give birth in regional or major hospitals. This can bring sadness and a sense of <a href="https://espace.library.uq.edu.au/view/UQ:339527">dislocation from family, country and ceremony</a>.</p>
<p>Because of COVID-19 lockdowns, women and their newborns are away longer from family and culture. They have to be quarantined before returning to country. An alternative approach is to restrict the mother’s movements when she is away from home. Bangirn, a young woman from Barunga who recently gave birth in Darwin, says:</p>
<blockquote>
<p>I couldn’t go anywhere when in Darwin because I have recently had a baby. I wasn’t allowed to go out shopping to buy baby clothes or things for the baby. The doctors rushed me into Katherine hospital but I wasn’t allowed to go and buy baby things. My sister had to give me her daughter’s baby old clothes over the fence. Doctors gave me a paper saying that I didn’t go anywhere while in Darwin and Katherine. The paper shows that me and my partner could go back in the community. I couldn’t do food shopping while leaving Katherine or baby clothes. Barunga store hasn’t got anything for the baby. (May 5 2020)</p>
<p>It’s hard. Right now she’s got no warm clothes and this weather is cold. We’re keeping her warm with a big blanket. We’re safe but it’s hard, really hard. (May 11 2020)</p>
</blockquote>
<p>We hope to understand these experiences and how they shape families, culture and connections into the future. This can help us to plan for any future pandemics and its impact on Indigenous communities.</p>
<p>Recognition of vulnerability for remote Aboriginal communities prompted fast action by <a href="https://www.health.gov.au/resources/collections/coronavirus-covid-19-resources-for-aboriginal-and-torres-strait-islander-people-and-remote-communities">Australian governments</a>, <a href="https://healthinfonet.ecu.edu.au/learn/health-topics/infectious-conditions/covid-19-updates-and-information/">research and information networks</a> and <a href="http://www.amsant.org.au/covid-19/">Aboriginal organisations</a>. In addition to regional lockdowns there was a <a href="https://www.health.gov.au/resources/collections/coronavirus-covid-19-resources-for-aboriginal-and-torres-strait-islander-people-and-remote-communities">multi-million dollar information campaign</a>. </p>
<p>This included <a href="https://www.youtube.com/playlist?list=PLvzNtphHxtRwgyiz1zQf7AZibMGOMJb6x&fbclid=IwAR2TIdbJPqyw6MCS_arv9G-XSg1pixUO3Mk_aF9SejcJ5di1Y-lOh--URjc">YouTube videos</a> in many different Aboriginal languages by the NT government and a <a href="https://www.nlc.org.au/media-publications/nlcs-aboriginal-language-videos-about-coronavirus">video series in 18 languages</a> by the Northern Land Council.</p>
<p>The COVID-19 crisis adds to existing pressures on remote communities. Families already live with regular loss of life, frequent funerals and an overhanging grief that contributes to <a href="https://australianstogether.org.au/discover/the-wound/intergenerational-trauma/">intergenerational trauma</a>. Yet among these hardships communities also display incredible resilience. While COVID-19 poses a threat, this needs to be understood in relation to the hardships and the strengths of remote community life. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-will-devastate-aboriginal-communities-if-we-dont-act-now-133766">Coronavirus will devastate Aboriginal communities if we don't act now</a>
</strong>
</em>
</p>
<hr>
<h2>Responses to being ‘locked up’</h2>
<p>Little attention has been paid to the lived experience of social distancing across cultures. We need to understand how different peoples think about social distancing and isolation. For Graham and Gloria Friday, the best strategy for social distancing is “going out bush”, rather than staying in your house … because country is home. </p>
<blockquote>
<p>If you out bush, you might find that bush medicine to fight it. Also out bush, you don’t have to worry about food in the shops, you can live off your land, fish, dugong, turtle, goanna, you can live off that. (April 9 2020) </p>
</blockquote>
<p>Similarly in Barunga, one community member says their first response to being “locked up” was to go out bush and sit down on country. Anne Marie Lee, chair of the board of the <a href="https://www.sunrise.org.au/">Sunrise Health Service Aboriginal Corporation</a> says:</p>
<blockquote>
<p>More people are going out camping and fishing. People spend maybe a week out there. It’s a really good thing, eating that bush tucker again. People are looking more healthy. (May 11 2020)</p>
</blockquote>
<p>Going bush has had the added effect of strengthening families. As people hunt and fish, they are away from the worries of town. They are well fed and access to alcohol is limited. Young people learn traditional survival skills. The <a href="https://ww2.health.wa.gov.au/%7E/media/Files/Corporate/general%20documents/Aboriginal%20health/PDF/12853_WA_Aboriginal_Health_and_Wellbeing_Framework.pdf">health and well-being</a> effects of being out bush are part of long-standing and culturally defined preventative health-care strategies. </p>
<p>Some aspects of Aboriginal people’s experiences of lockdown are familiar to all Australians: the importance of socialising with extended family for mental and emotional well-being. Also, people seem to be more conscious of their health. Some community medical clinics report an influx of people getting flu vaccinations. </p>
<p>Yet another factor that shapes the COVID-19 experience for Aboriginal people in remote areas is the historical experience of being “locked up” on missions and in prison. </p>
<p>The NT has the highest imprisonment rate of any state or territory. Aboriginal and Torres Strait Islanders <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4517.0%7E2018%7EMain%20Features%7ENorthern%20Territory%7E27">comprise 84% (1,477 prisoners) of the adult prisoner population</a>. In 2018, the national average was 28%. Families in Borroloola have called for people to be returned home during the pandemic to ensure they are safe and away from the threat of virus infection in prison. The investment in family and making sure everyone is safe has been a driving focus for many in these communities.</p>
<h2>Some good things, too</h2>
<p>Perhaps unexpectedly, there have been some positives from the COVID-19 crisis. </p>
<p>One of the first actions was for states and territories to nominate designated biosecurity areas. Travel to these areas was restricted to essential workers. Returning community members have to go into quarantine. This shutdown was sudden but it made some community members feel reassured. Beswick Traditional Owner, Esther Bulumbara says:</p>
<blockquote>
<p>Suddenly everything stopped. It was a great shock to the Northern Territory. We thought only that overseas mob would get that. But police said everything had to close. Government mob, shire. It was lucky it was quick. If they didn’t know about it, it would have gone through the Northern Territory. (April 24 2020)</p>
</blockquote>
<p>The lockdown bolstered trust in government and Aboriginal organisations. Graham Friday is among those “talking with all those big mob government officials” as community in Borroloola are consulted about when and how things might open up again. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/331067/original/file-20200428-110757-7x9fy9.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/331067/original/file-20200428-110757-7x9fy9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/331067/original/file-20200428-110757-7x9fy9.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/331067/original/file-20200428-110757-7x9fy9.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/331067/original/file-20200428-110757-7x9fy9.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/331067/original/file-20200428-110757-7x9fy9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/331067/original/file-20200428-110757-7x9fy9.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/331067/original/file-20200428-110757-7x9fy9.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Designated biosecurity areas near Katherine, Northern Territory.</span>
<span class="attribution"><a class="source" href="https://coronavirus.nt.gov.au/community-advice/remote-work-and-travel/maps">NT Govt.</a></span>
</figcaption>
</figure>
<p>People feel safe because their exposure to COVID-19 has been controlled. Reflecting on the situation in Borroloola, Gloria Friday says:</p>
<blockquote>
<p>It’s amazing cause the virus never hit the community yet or nothing, and it was good because everyone was abiding by the rules. And because they limited the grog sale to six can, six can a day, everything was quiet and there’s been no problems in the town, everyone’s just been go out fishing and hunting. It’s been good. (May 1 2020).</p>
</blockquote>
<p>In some cases, COVID-19 has deepened relationships between Aboriginal people and the wider community. There has been unanticipated support. In the Katherine East region, large quantities of clothing were donated by <a href="https://www.rockmans.com.au/new-arrivals?gclid=EAIaIQobChMIxO2_gN6K6QIVyzUrCh0WvQ1ZEAAYASAAEgKGxfD_BwE">Rockmans</a>. Boxes of food were donated by <a href="https://www.youtube.com/watch?v=asOFh53GQKI">Coles</a>. <a href="https://outbackstores.com.au/">Outback Stores</a> issued food vouchers. Community members were surprised and pleased, reports Esther Bulumbara. She says:</p>
<blockquote>
<p>Fiona from <a href="https://aiggroup.org.au/">AIG</a> donated all the boxes of clothes to Barunga and Beswick and Manyallaluk. It made people feel good. All the ladies they all came and got some clothes. Long sleeved shirts, woolly jumpers and coats. All new. And we got that <a href="https://www.facebook.com/barungaNT/">Mob’s Choice in Bagala Store</a> at Barunga now. Low prices, like at Woolies. (May 14 2020)</p>
</blockquote>
<p>Rachael Kendino of Manyallaluk adds:</p>
<blockquote>
<p>Every house at Manyallaluk got two boxes of food and a $50 voucher from Beswick store […] I like what the <a href="https://ropergulf.nt.gov.au/">Roper Gulf Shire</a> are doing. They pick up [people] every Thursday for shopping from Manyallaluk to Barunga store. Before we had to get taxi to go to Katherine to buy food […] Going in and return is $300 each way. She told me about <a href="https://barunga-store.myshopify.com/">online shopping</a>, too. (May 8 2020)</p>
</blockquote>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/333687/original/file-20200508-49579-1vbiclk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/333687/original/file-20200508-49579-1vbiclk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=416&fit=crop&dpr=1 600w, https://images.theconversation.com/files/333687/original/file-20200508-49579-1vbiclk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=416&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/333687/original/file-20200508-49579-1vbiclk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=416&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/333687/original/file-20200508-49579-1vbiclk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=523&fit=crop&dpr=1 754w, https://images.theconversation.com/files/333687/original/file-20200508-49579-1vbiclk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=523&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/333687/original/file-20200508-49579-1vbiclk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=523&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Food vouchers from Beswick Community Store.</span>
<span class="attribution"><span class="source">Rachael Kendino</span></span>
</figcaption>
</figure>
<p>People are appreciative of the efforts made by local police to keep them safe and connected. The mail is taken 50 kilometres to the Central Arnhem Highway turn-off. It is handed over to police and taken to <a href="https://pfes.nt.gov.au/police/police-station-profiles/maranboy">Maranboy police station</a>, 10 kilometres from Barunga. A community representative comes to the police station to collect it. The letters are wiped down. Jessala McCale of Barunga reports:</p>
<blockquote>
<p>Police officers must make sure that letters, mails are clean before handing it over the person who handles the mail. (May 5 2020)</p>
</blockquote>
<p>Jawoyn Elder Jocelyn McCartney says:</p>
<blockquote>
<p>The policeman are camping out there at the Barunga turnoff. Turn and turn. All day and all night. To make sure people don’t come out of community. People not allowed to come into our community because they might have that virus. (May 12 2020)</p>
</blockquote>
<h2>Getting the right information</h2>
<p>Elsewhere in the world it has been <a href="https://www.nytimes.com/2020/05/05/technology/parking-lots-wifi-coronavirus.html">noted</a> “living without broadband has gone from a mild inconvenience to a near impossibility”. For remote communities, the problem can be how to get information on a global pandemic without internet. </p>
<p>Crisis communication must be tailored to different needs and in many forms. While Indigenous youth are savvy with social media, many older people watch television or listen to the radio to get information. Our community contacts spoke about President Trump and laboratories in Wuhan. Like all of us, Aboriginal people judge leaders and feel sadness for those who have died. As one community member made clear:</p>
<blockquote>
<p>He’s a real mongrel that Trump, he just sits there while those bodies all pile up. (May 1 2020) </p>
</blockquote>
<p>Aboriginal people in remote communities are well aware of what is happening across the world. The sense this problem is big and concerns all of us is not lost on them. Another community member from Borroloola reveals: </p>
<blockquote>
<p>I’ve got family all round – Doomadgee, Normanton, Mt Isa, Townsville, Borroloola – and we really worry for all of them. We all worry about each other and ring each other all the time. All of them, everybody is quarantined all over the world, from Burketown, Mt Isa, Mornington Island, Italy, even America … the lot. (May 1 2020) </p>
</blockquote>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/B-MZu4rAIh4","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>White man’s disease</h2>
<p>Remote communities are not all the same. While many challenges are shared, each community has its own history and culture which shapes the present. Our preliminary research suggests COVID-19 messages are understood slightly differently across communities. </p>
<p>In some communities, <a href="https://theconversation.com/5-reasons-the-coronavirus-hit-italy-so-hard-134636">reports from Italy</a> and <a href="https://www.abc.net.au/news/2020-03-24/spain-elderly-people-dead-in-beds-coronavirus-worsens/12084892">Spain</a> seem very distant and of little relevance. In others, Aboriginal people of all ages watch television and trawl social media, sad for the “poor Italians” and “bodies piling up in the United States”. </p>
<p>Some talk about COVID-19 as a “white man’s disease”. Others, such as Graham Friday and members of his family (Gloria Friday and Adrianne Friday), see it as “everybody’s problem and everybody’s responsibility”. </p>
<p>One shared factor has been the pressure of acute <a href="https://www.theguardian.com/australia-news/2020/apr/08/stores-in-remote-indigenous-communities-ask-city-dwellers-to-stop-hoarding">food shortages in community stores</a>. In the early days, some people responded by breaking quarantine restrictions to access local towns via back roads and dirt tracks. This placed their community at increased risk. The community and police responded in tandem. A Barunga community member says:</p>
<blockquote>
<p>A couple of young boys tried to go into town. The policeman came and warned them. They going to get a fine. I told that boy ‘You got to stop that. No more. I can’t pay that fine for you’. (April 24 2020)</p>
</blockquote>
<p>Police also set out clear social distancing expectation in Borroloola, as Gloria Friday explains: </p>
<blockquote>
<p>Well the police only went and said they didn’t want to see no gambling, like ten people only in one place. But in the community they’re bored, they got nothing to do. Policeman went and told them once, and I think everybody listened. (May 1 2020).</p>
</blockquote>
<h2>A bullet dodged</h2>
<p>At this time, Aboriginal people in the NT seem to have <a href="https://www.abc.net.au/news/2020-05-04/coronavirus-nt-aboriginal-outcomes-show-lessons-for-future/12188762">dodged a bullet</a>. This is because swift and culturally appropriate action was taken <a href="https://www.niaa.gov.au/indigenous-affairs/coronavirus-covid-19">by governments</a>, Aboriginal organisations and communities themselves. The <a href="https://www.nlc.org.au/">Northern Land Council</a> and the <a href="https://www.clc.org.au/">Central Land Council</a>, in particular, provided outstanding coordinated leadership in the fight against COVID-19. </p>
<p>There is a lesson for Australia’s efforts to <a href="https://ctgreport.niaa.gov.au/">Close the Gap</a>: trusted Aboriginal leadership is essential to successful outcomes for Aboriginal communities. </p>
<p>COVID-19 is the <a href="https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020">first global pandemic caused by a coronavirus</a>. It may not be the last. This crisis presents a unique opportunity to learn what success looks like in Aboriginal remote community health. </p>
<p>The United Nations has called for all member states to include the <a href="https://www.un.org/development/desa/indigenouspeoples/covid-19.html">specific needs and priorities of Indigenous peoples</a> in COVID-19 response planning. Population-based approaches are logical scientific steps to prevent the spread of a virus. However, they need to be compatible with the everyday cultural lifeways of remote Aboriginal communities. </p>
<p>The COVID-19 pandemic is a watershed moment. Old and enduring problems can be reassessed. The current crisis can be mined for fresh, action-oriented perspectives of Aboriginal people’s needs in preventative health care. This time of calamitous infection and threat of illness is not foreign to remote Aboriginal communities and culture bearers. Many have lived through previous flu epidemics and live with the scourge of chronic conditions. </p>
<p>While COVID-19 is presented as a health and an economic problem, it is also a social and a cultural challenge. Our research calls for attention to understanding Aboriginal people’s knowledge of the pandemic and their vulnerability and strengths at this time. Remote communities are full of intellectuals and people coming to terms with a challenge we all face. Yet they are making sense of this global crisis in their own local and culturally nuanced ways.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/333945/original/file-20200511-49569-rvi912.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/333945/original/file-20200511-49569-rvi912.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/333945/original/file-20200511-49569-rvi912.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=744&fit=crop&dpr=1 600w, https://images.theconversation.com/files/333945/original/file-20200511-49569-rvi912.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=744&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/333945/original/file-20200511-49569-rvi912.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=744&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/333945/original/file-20200511-49569-rvi912.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=935&fit=crop&dpr=1 754w, https://images.theconversation.com/files/333945/original/file-20200511-49569-rvi912.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=935&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/333945/original/file-20200511-49569-rvi912.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=935&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.facebook.com/AMSANTMedia/photos/a.101082387910226/224205175597946/?type=3&eid=ARAGG3iN7wuAA-Jlfiw_YEhXo2iwJQ_FIdZx8rV-zfPFRMSMp9mIxrlSMVPWZ_EPPHFT-3DCsHPi8aYK&__xts__%5B0%5D=68.ARCT_EuWsMLuxFHvxJ0-usQviOou0zfhppmRbLu7wfPmt6ctjjTVKDH6UV1RNVxHU2R1Km5NhaBQ4DAmBqK9jkud0nwEaegpsEij9gwQtbyPEcMnIMc4pWL4FlCGHfoQjMxhbUXM6ZeKQDBshaxXOAGjr5XLdq94Gp44HNQHCg0wTwE_UNbJlVblRN74XGJIgPFxpgIgm7NQyLkxPMpIt9J3tW0v_ctW77CG6OQ9jXZDU8jECxTA0hpaQj5_Mu9dN6RXX9rnRUL6714PGSw3PkUoSprcCGpWYp-9l7UG4D0wxAAKgsVu9vp0pa2djFEwMclY78fZbQC5RedjLVvdNZ2YGfonG-cHQlIS2FJnbjJZGz5dhAsAO6nSTcwhKXTIbk7uftO_RzxOjXPNUhZxV4AB12FAPt0lnsyKeZLAZ2qKrGDAMYHrUZtH17wT1KVMImqv2UUrGk2sTLezDSkiZ8sCJ4Vv4YViF3reeGYjRZtvEORq3Ck&__tn__=EEHH-R">Aboriginal Medical Services Alliance Northern Territory</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>While we have focused on remote communities, all Aboriginal and Torres Strait Islander communities are at risk.</p>
<p>Community wisdom and cultural strengths are powerful starting points for effective and empowering health promotion. We need to identify <a href="https://www.youtube.com/watch?v=axhRTPGI4qc">local innovations and community solutions</a> for dealing with COVID-19, and harness their drivers and logic. We need to develop <a href="http://kams.org.au/covid19-resources/">culturally-driven, community-specific</a> tools and strategies that can help protect Aboriginal communities from pandemics and provide lasting benefits.</p><img src="https://counter.theconversation.com/content/136953/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claire Smith receives funding from the Australian Research Council and received funding from Flinders University for this research.</span></em></p><p class="fine-print"><em><span>Amanda Kearney receives funding from the Australian Research Council and received funding from Flinders University for this research.</span></em></p><p class="fine-print"><em><span>Christopher Wilson receives funding from the Australian Research Council and Centre for Australian Biodiversity and Heritage</span></em></p><p class="fine-print"><em><span>Julian Grant receives funding through approved disbursements from the Medical Research Future Fund (MRFF) Rapid Applied Research Translation Program.</span></em></p><p class="fine-print"><em><span>Anna M. Kotarba-Morley, Jasmine Willika, Kellie Pollard, and Udoy Saikia 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>Researchers report on how COVID-19 is affecting isolated Indigenous communities. Their voices bridge the urban divide, reveal challenges and describe some unexpected bonuses.Claire Smith, Professor of Archaeology, College of Humanities, Arts and Social Sciences, Flinders UniversityAmanda Kearney, Matthew Flinders Fellow, Professor of Australian and Indigenous Studies, Flinders UniversityAnna M. Kotarba-Morley, Lecturer, Archaeology, Flinders UniversityChristopher Wilson, Senior Lecturer, Flinders UniversityJulian Grant, Professor of Nursing, Charles Sturt UniversityKellie Pollard, Research lecturer, Charles Darwin UniversityUdoy Saikia, Associate Professor, College of Humanities Arts and Social Social Sciences, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1360502020-04-24T05:28:11Z2020-04-24T05:28:11ZUrban Aboriginal people face unique challenges in the fight against coronavirus<figure><img src="https://images.theconversation.com/files/329974/original/file-20200423-47847-159ad33.jpg?ixlib=rb-1.1.0&rect=34%2C23%2C3825%2C2291&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/flag-australian-aboriginal-painted-on-brick-233717194">Shutterstock</a></span></figcaption></figure><p>There seems to be a myth in Australia that Aboriginal and Torres Strait Islander people mostly live in remote communities. But the <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0%7E2016%7EMain%20Features%7EAboriginal%20and%20Torres%20Strait%20islander%20Population%20Article%7E12">vast majority</a> (79%) live in urban areas.</p>
<p>The federal government has rightly decided the best policy to protect Indigenous people from COVID-19 is to socially isolate remote communities.</p>
<p>Now the government needs to turn its attention to the risks Indigenous people face in urban and rural areas.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-will-devastate-aboriginal-communities-if-we-dont-act-now-133766">Coronavirus will devastate Aboriginal communities if we don't act now</a>
</strong>
</em>
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<h2>Greater risk of harm</h2>
<p>So far SARS-CoV-2, the coronavirus that causes COVID-19, has <a href="https://coronavirus.jhu.edu/map.html">infected more than 6,600 Australians and killed 75 people</a>. The elderly and those with underlying conditions are most at risk of severe illness and dying from the virus. </p>
<p>Chronic diseases such as respiratory diseases (including asthma), heart and circulatory diseases, high blood pressure, diabetes, kidney diseases and some cancers <a href="https://healthinfonet.ecu.edu.au/">are more common</a> in Indigenous people, and tend to occur at younger ages, than in non-Indigenous people. </p>
<p>These diseases, and the living conditions that contribute to them (such as poor nutrition, poor hygiene and lifestyle factors such as smoking), dramatically <a href="https://theconversation.com/coronavirus-will-devastate-aboriginal-communities-if-we-dont-act-now-133766">increase</a> Indigenous people’s risk of being infected with coronavirus and for having more severe symptoms.</p>
<p>So Elders and those with chronic disease are vulnerable at any age.</p>
<p>We know from past pandemics, such as swine flu (H1N1), Indigenous Australians are <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3402c.htm">more likely to become infected</a> with respiratory viruses, and have more serious disease when they do.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-what-the-2009-swine-flu-pandemic-can-tell-us-about-the-weeks-to-come-134076">Coronavirus: what the 2009 swine flu pandemic can tell us about the weeks to come</a>
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<p>So far, there have been <a href="https://doi.org/10.33321/cdi.2020.44.34">44 cases</a> of coronavirus among Indigenous people, mostly in our major cities. We’re likely to see more in coming months.</p>
<p>This suggests the decision to close remote communities has been successful so far. But we also need to now focus on urban centres to prevent and manage further cases.</p>
<p><a href="https://www.pm.gov.au/media/national-cabinet-statement">Current Australian government advice</a> is for Aboriginal and Torres Strait Islander people 50 years and over with existing health conditions to self-isolate. General government health advice tells all Australians to maintain good hygiene and seek health care when needed. </p>
<p>But this advice is easier said than done for many urban Indigenous people. </p>
<p>So what unique family and cultural needs and circumstances so we need to consider to reduce their risk of coronavirus?</p>
<h2>Large households</h2>
<p>Many urban Indigenous households have large groups of people living together. So <a href="https://www.abs.gov.au/ausstats/abs@.nsf/mf/4714.0">overcrowding and inadequate accommodation</a> poses a risk to their health and well-being. </p>
<p>This is particularly the case when it comes to infectious diseases, which thrive when too many people live together with poor hygiene (when it’s difficult for personal cleanliness, to keep clean spaces, wash clothes and cook healthy meals) and when people sleep in close contact. </p>
<p>Crowded accommodation also means increased exposure to passive smoking and other shared risky lifestyles.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fix-housing-and-youll-reduce-risks-of-coronavirus-and-other-disease-in-remote-indigenous-communities-136049">Fix housing and you'll reduce risks of coronavirus and other disease in remote Indigenous communities</a>
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<p>Households are also more likely to be intergenerational, with many children and young people living with older parents and grandparents. This potentially increases the chances of the coronavirus spreading among and between households, infecting vulnerable older members.</p>
<p>Immediate solutions to prevent infection are, with guidance from Aboriginal organisations, to house people in these situations in safe emergency accommodation. But it is also an opportunity to work with Aboriginal organisations in the longer term to improve access to better housing to improve general health and well-being.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/329972/original/file-20200423-47784-13or9q5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329972/original/file-20200423-47784-13or9q5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329972/original/file-20200423-47784-13or9q5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329972/original/file-20200423-47784-13or9q5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329972/original/file-20200423-47784-13or9q5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=564&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329972/original/file-20200423-47784-13or9q5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=564&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329972/original/file-20200423-47784-13or9q5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=564&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Most Indigenous people live in our cities, not in remote Australia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/adelaide-australia-april-26th-2014-street-189983462">Shutterstock</a></span>
</figcaption>
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<h2>Poor health literacy</h2>
<p>Indigenous Australians don’t always have access to good information about the coronavirus in formats that are easily understood and culturally appropriate.</p>
<p>The <a href="https://www.niaa.gov.au/">National Indigenous Australians Agency</a> (a federal government agency) has developed some <a href="https://www.niaa.gov.au/indigenous-affairs/coronavirus-covid-19#resources">excellent videos</a> in languages and in Aboriginal English, using respected First Nations leaders, as have others in <a href="http://www.truestorycovid19.com.au/">Western Australia</a>.</p>
<p>The challenge is to get these distributed in urban centres urgently. These health messages should also be distributed in Aboriginal Medical Services waiting rooms and on Indigenous television and radio.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-as-culture-moves-online-regional-organisations-need-help-bridging-the-digital-divide-135050">Coronavirus: as culture moves online, regional organisations need help bridging the digital divide</a>
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</em>
</p>
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<h2>Inadequate access to soap and vaccines</h2>
<p>Poverty will limit some families’ ability to buy hand sanitiser, face masks, disinfectant and soap. </p>
<p>Although there are provisions for Indigenous Australians to receive <a href="https://www.health.gov.au/health-topics/immunisation/immunisation-throughout-life/immunisation-for-aboriginal-and-torres-strait-islander-people">free vaccines</a> against the flu and pneumococcal disease to protect against lung disease, not all age groups are covered.</p>
<h2>Scepticism of mainstream health services</h2>
<p>Due to policies and <a href="https://theconversation.com/ms-dhu-coronial-findings-show-importance-of-teaching-doctors-and-nurses-about-unconscious-bias-60319">racism</a> that have <a href="https://theconversation.com/my-mob-is-telling-their-story-and-it-makes-me-feel-good-heres-what-aboriginal-survivors-of-child-sexual-abuse-told-us-they-need-122645">marginalised</a> Indigenous people, many do not use health and other services.</p>
<p>This is why Aboriginal Controlled Health Services are so important and successful in providing culturally sensitive and appropriate care. </p>
<p>However, <a href="https://www.theguardian.com/australia-news/2020/apr/07/lack-of-ppe-forces-aboriginal-health-groups-to-stop-testing-for-coronavirus">there is concern</a> these health services are not adequately funded or prepared to manage a coronavirus pandemic in urban centres. </p>
<p>They need more personal protective equipment (including masks). They also need more Aboriginal health workers, community nurses and others for testing and contact tracing.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/329976/original/file-20200423-47832-vre5zz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329976/original/file-20200423-47832-vre5zz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329976/original/file-20200423-47832-vre5zz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329976/original/file-20200423-47832-vre5zz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329976/original/file-20200423-47832-vre5zz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329976/original/file-20200423-47832-vre5zz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329976/original/file-20200423-47832-vre5zz.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">Not everyone can afford to buy soap and hand sanitiser to limit the spread of the virus.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hygiens-concept-african-womans-hands-using-409352542">Shutterstock</a></span>
</figcaption>
</figure>
<h2>What do governments need to do?</h2>
<p>Some regions’ responses have been better than others. </p>
<p>In Western Australia, the urban-based Aboriginal Community Controlled Health Services (ACCHS) are working with key state government departments to coordinate the COVID-19 response. This includes guidance about how best to prevent and manage cases.</p>
<p>In Southeast Queensland, the <a href="https://www.iuih.org.au/">Institute for Urban Indigenous Health</a>, which manages 21 ACCHS, is coordinating health and social government services.</p>
<p>It’s time for other governments to set up collaborative arrangements with ACCHS and other Aboriginal controlled service organisations in urban centres to better manage the COVID-19 pandemic. </p>
<p>This should include more staff to:</p>
<ul>
<li>provide care</li>
<li>help people self-isolate</li>
<li>explain and embed the digital COVID-19 media messages about hand washing, use of sanitisers and social distancing</li>
<li>enable accommodation that is acceptable and safe, especially for Elders and homeless people.<br></li>
</ul>
<p>These services should also provide free flu and pneumococcal vaccinations. </p>
<p>Getting Indigenous health experts to lead this defence is clearly the way to go. We must listen and respond to these leaders to implement effective strategies immediately. If ever there was an opportunity to demonstrate that giving Indigenous people a voice to manage their own futures is effective, it is this. </p>
<p>Our hope is that, after this pandemic, the value of Aboriginal control will be recognised as the best way to improve Aboriginal health and well-being.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-answer-to-indigenous-vulnerability-to-coronavirus-a-more-equitable-public-health-agenda-135048">The answer to Indigenous vulnerability to coronavirus: a more equitable public health agenda</a>
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<p><em>This article was co-authored by Adrian Carson, Institute for Urban Indigenous Health; Donisha Duff, Institute for Urban Indigenous Health; Francine Eades, Derbarl Yerrigan Health Service; and Lesley Nelson, South West Aboriginal Medical Service.</em></p><img src="https://counter.theconversation.com/content/136050/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fiona Stanley has received funding from the ARC and NHMRC in the past and has some current funding.</span></em></p><p class="fine-print"><em><span>Sandra Eades has received and currently holds NHMRC and MRFF funding in the area of Indigenous health.</span></em></p><p class="fine-print"><em><span>Daniel McAullay 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>Large households, poor health literacy, not enough soap and vaccines, scepticism of mainstream services. These are some of the reasons urban Aboriginal people face increased risks.Fiona Stanley, Perinatal and pediatric epidemiologist; distinguished professorial fellow, Telethon Kids InstituteDaniel McAullay, Associate Professor, Edith Cowan UniversitySandra Eades, Dean, Medical School, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.