more_vertThere is much research to suggest a considerable overlap between people experiencing precarious housing, and drug and alcohol misuse. Linking client data from specialist homelessness services and alcohol and other drug treatment services, this report provides a picture of the intersection of these two issues on a national scale. It reveals a vulnerable population, in which Indigenous Australians and experiences of domestic and family violence and mental health issues were all over-represented. Their poorer drug treatment and housing outcomes highlight the level of difficulty faced in assisting these people to achieve long-term outcomes.
Preference: Indigenous Health
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Experienced hands hold on to health
Health Minister Sussan Ley and her Opposition counterpart Catherine King have held on to their portfolios following the tight Federal election in which health policy was a key battleground.
In the days following the election there were rumblings in both major parties regarding the performance of their respective health spokeswomen, but both Ms Ley and Ms King were confirmed in their positons when the Coalition and Labor frontbenchers for the new term of Parliament were announced.
AMA President Dr Michael Gannon welcomed the outcome.
“The health sector and patients are very fortunate to have two experienced and consultative operators in Sussan Ley and Catherine King back in charge of health for the Government and Opposition,” Dr Gannon said. “They know the issues, they seek advice from health professionals, and they will be strong voices in the respective parties to ensure Australian voters will be offered positive health policies at the next election.”
While there is stability at the top, there has been a significant change in Ms Ley’s office. She has appointed experienced health bureaucrat and policy adviser Dr Lisa Studdert as her Chief of Staff to replace the recently departed Craig Bosworth.
Dr Studdert was most recently First Assistant Secretary of the Department of Health’s Population Health and Sport Division, and has previously worked in the Therapeutic Goods Administration and as an adviser on public and Indigenous health to former Health Minister Dr Michael Wooldridge.
In a sign that Labor is intent on keeping health and Medicare on the political frontline in the next three years, Opposition Leader Bill Shorten has added “Medicare” to Ms King’s title and has appointed South Australian MP and former national powerlifting champion Tony Zappia as Shadow Assistant Minister for Medicare.
Alert to the threat after Labor’s success in the election campaigning on Medicare, Ms Ley said one of the tasks confronting the Government was “protecting the future of Medicare and ensuring it remains universally accessible to all Australians”.
But, in a taste of things to come, Ms King renewed her attack on the Coalition’s health policy, particularly Medicare.
“The Turnbull Government remains committed to undermining Medicare through its ongoing freeze on GP rebates, and its determination to make further cuts through its attacks on pathology and diagnostic imaging as soon as Parliament resumes,” the Shadow Minister said. “As we did in the last Parliament, Labor will once again resist furiously any attempts to attack bulk billing, increase out-of-pocket costs and undermine the rights of all Australians to access decent, affordable health care.”
Ms Ley will be supported in her portfolio by Western Australian MP Ken Wyatt, who continues in his role as Assistant Minister for Health and Aged Care. Following the promotion of Nationals Senator Fiona Nash to be Minister for Regional Communications, she has been replaced in her rural health role by Dr David Gillespie, who has been appointed Assistant Minister for Rural Health.
On the Labor side, Julie Collins has been appointed Shadow Minister for Ageing and Mental Health, and Senator Helen Polley has been made Shadow Assistant Minister for Ageing.
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Health portfolios |
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Government |
Opposition |
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Minister for Health and Aged Care Sussan Ley |
Shadow Minister for Health and Medicare Catherine King |
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Assistant Minister for Health and Aged Care Ken Wyatt |
Shadow Assistant Minister for Medicare Tony Zappia |
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Assistant Minister for Rural Health Dr David Gillespie |
Shadow Minister for Ageing and Mental Health Julie Collins |
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Shadow Assistant Minister for Ageing Senator Helen Polley |
Adrian Rollins
Royal Commission must shine light on NT juvenile justice and health
The AMA has thrown its support behind the Federal Government’s decision to establish a Royal Commission into the mistreatment and abuse of young people being held in detention in the Northern Territory.
AMA President Dr Michael Gannon said shocking images and revelations broadcast by the ABC’s Four Corners program had sent shockwaves through the community, and reinforced warnings made by the AMA over many years about the treatment of people, particularly children, incarcerated in the NT.
“The cruelty, violence, and victimisation experienced by these young people will have impacts on their mental and physical health for the rest of their lives,” Dr Gannon said.
“The unacceptable abuse that took place at the Don Dale Detention Centre is clearly indicative of broader problems in the detention and prison systems in the Northern Territory. The AMA, at both the Federal and Territory level, has raised concerns over many years based on reports from doctors and other health professionals, including AMA members, about the poor condition and treatment of people in detention in the Territory, especially children – very often Indigenous teenagers.”
Rates of incarceration among Aboriginal and Torres Strait Islander people are startlingly high – they comprise 28 per cent of all prisoners, and are 13 times more likely to be locked up than other Australians.
Young Indigenous people are even more likely to be imprisoned – they make up half of all children aged between 10 and 17 years held in detention, and are 17 times more likely to be under “youth justice supervision” than children of the same age in the broader community.
Dr Gannon said the Royal Commission would “put a spotlight” on juvenile justice and the health issues that were often involved in getting young people locked up, and called for “brave and creative” thinking about alternatives to imprisonment.
“Health issues – notably mental health conditions, alcohol and drug use, substance abuse disorders, cognitive disabilities – are among the most significant drivers of incarceration. We must also look at the intergenerational effects of incarceration,” the AMA President said.
The revelations of shocking abuse at the Don Dale Centre have also focused attention on police practices that are seen to be contributing to high rates of imprisonment among Indigenous children, particularly the NT’s ‘paperless arrest’ powers that allow police to detain people for up to four hours for minor offences.
“There must be a community debate about alternatives to incarceration, and serious investigation into alternative methods of rehabilitation for young offenders,” Dr Gannon said. “This will require considering new ideas, and brave and creative thinking.”
The health impacts of high rates of Indigenous imprisonment were highlighted by the AMA in its Indigenous Health Report Card 2015 – Treating the high rates of imprisonment of Aboriginal and Torres Strait Islander peoples as a symptom of the health gap: an integrated approach to both released last year.
“The rate of imprisonment of Aboriginal and Torres Strait Islander people is rising dramatically, and is an issue that demands immediate action,” the Report Card said.
The AMA has called for the Federal Government to set a national target to close the gap in imprisonment rates between Indigenous people and the rest of the community, with children and young people the immediate priority.
Adrian Rollins
National Core Maternity Indicators stage 3 and 4 results from 2010–2013
National Core Maternity Indicators (NCMIs) are designed to assist in improving the quality of maternity services in Australia by establishing baseline data for monitoring and evaluating practice change. This report and the data portal covers the period from 2004 to 2013, and includes data for the vast majority of women who gave birth in Australia over that period. The 10 measures previously reported have been updated with 2010–2013 perinatal data, while 2 new measures are reported for the first time. Data are presented by jurisdiction, by Primary Health Network, and at the national level by hospital annual number of births, hospital sector, and mother’s Indigenous status. Some indicators are presented by remoteness
Focus on rheumatic heart disease
As the new President of the AMA I will, like my predecessors, chair the AMA’s Taskforce on Indigenous health. This recognises and emphasises the importance of the AMA’s efforts to improve the health and wellbeing of Aboriginal and Torres Strait Islander people, and our desire to keep ‘Closing the Gap’ initiatives at the top of our agenda.
The Taskforce, which was established in 2000, is comprised of representatives of the AMA Federal Council, AMA members and Indigenous health groups, including the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Australian Indigenous Doctors’ Association (AIDA).
The Taskforce is a robust and dedicated entity which identifies, develops and recommends Indigenous health policy and strategies for the AMA and oversees the AMA’s annual Report Card on Indigenous Health.
This year, the 2016 Report Card on Indigenous Health will focus on rheumatic heart disease (RHD) – a major preventive health issue that significantly affects Indigenous people, particularly those in remote areas. As AMA WA President, I supported legislative change to improve reporting and reduce the burden of disease in Aboriginal communities in Western Australia.
RHD is a classic example of the many preventable chronic diseases that are largely responsible for the health gap between Indigenous and non-Indigenous people, with its burden largely extinguished in other parts of the Australian community. We can no longer allow the prevalence of chronic diseases like RHD to remain unaddressed.
The 2016 Federal election provided an opportunity for the AMA to present all political parties and candidates with the issues that the AMA sees as vital in meeting the challenge of closing the health gap.
While we have seen some recent improvements in Indigenous health, particularly in reducing infant mortality and smoking rates, the AMA wants to see the Commonwealth commit to improving resourcing for culturally appropriate primary health care for Aboriginal and Torres Strait Islander people.
The AMA has repeatedly said that it is not credible that Australia, one of the world’s wealthiest nations, cannot address the health and social justice issues that affect 3 per cent of its citizens. We say this again. The fact that it is our nation’s first people makes it an even greater moral imperative.
With the re-election of the Turnbull Government, the AMA will continue its call for long-term funding and commitments to Indigenous health. We will work closely with key ministers, government departments and other key stakeholders to ensure that appropriate action is taken.
As outlined in its Key Election Issues statement, the AMA urges the Federal Government to:
- correct the under-funding of Aboriginal and Torres Strait Islander health services;
- establish new, or strengthen existing, programs to address preventable health conditions that are known to have a significant impact on the health of Aboriginal and Torres Strait Islander people, such as cardiovascular disease (including rheumatic fever and rheumatic heart disease), diabetes, kidney disease, and blindness;
- increase investment in Aboriginal and Torres Strait Islander community-controlled health organisations. Such investment must support services to build their capacity and be sustainable over the long term;
- develop systemic linkages between Aboriginal and Torres Strait Islander community-controlled health organisations and mainstream health services to ensure high quality and culturally safe continuity of care;
- identify areas of poor health and inadequate services for Aboriginal and Torres Strait Islander people and direct funding according to need;
- institute funded, national training programs to support more Aboriginal and Torres Strait Islander people become health professionals to address the shortfall of Indigenous people in the health workforce;
- implement measures to increase Aboriginal and Torres Strait Islander people’s access to primary health care and medical specialist services;
- adopt a justice reinvestment approach to health by funding services to divert Aboriginal and Torres Strait Islander people from prison, given the strong link between health and incarceration;
- increase funding for family violence and frontline legal services for Aboriginal and Torres Strait Islander people;
- appropriately resource the National Aboriginal and Torres Strait Islander Health Plan to ensure that actions are met within specified timeframes; and
- support the establishment of a Central Australia Advanced Health Research and Translation Centre. Central Australia faces many unique and complex health issues that require specific research, training and clinical practice to properly manage and treat and this type of collaborative medical and academic research, along with project delivery and working in remote communities, is desperately needed.
Closing the gap in health and life expectancy between Indigenous and non-Indigenous people is an achievable task – it is also an agreed national priority.
The Federal Government must build on existing platforms and ramp up its ambitions to achieve health equality for Aboriginal and Torres Strait Islander people. Without commitment and action from our national leaders, the gap will remain wide and intractable. The Taskforce will inform the AMA’s advocacy in ensuring that this does not remain the case.
[Articles] Indigenous and tribal peoples’ health (The Lancet–Lowitja Institute Global Collaboration): a population study
We systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems.
[World Report] Tackling rheumatic heart disease in Indigenous Australians
Rheumatic heart disease causes a large burden of ill health among Indigenous Australians. More investment is needed to prevent and manage the disease, say experts. Sophie Cousins reports.
[Editorial] Indigenous health: a worldwide focus
If you are a member of the Baka, an Indigenous tribe in Cameroon, you can expect to live until you are aged about 35 years, which is about 12 years less than for the non-Indigenous people there. In Greenland you would be better off, at 73 years, but nonetheless this figure is 9 years less than that for the Danish population. Such discrepancies are recognised, but now we have such data for all regions of the world.
[Comment] Addressing global health disparities among Indigenous peoples
In countries around the world, Indigenous peoples face great social disadvantages and poor health compared with the general population.1,2 In The Lancet, Ian Anderson and colleagues3 have documented significant disparities among 28 Indigenous populations from 23 countries compared with benchmark populations for several variables, including life expectancy at birth, maternal and infant mortality, and frequency of low birthweight and high birthweight infants. They also showed differences for Indigenous peoples in measures related to nutrition (eg, child malnutrition, childhood obesity, and adult obesity), and in key social indicators, including educational attainment and economic status.
News
AMA award winners presented at national conference
At the recent AMA National Conference the following awards were presented: AMA President’s Award in recognition of outstanding contributions to the care of their fellow Australians — Dr Paul Bauert, who for 30 years has fought for better care for Indigenous Australians and, more recently, children in immigration detention, and Vietnam War veteran Dr Graeme Killer, who has devoted his life to improve the care of current and retired Defence Force personnel; Doctor in Training of the Year Award for outstanding leadership, advocacy, and accomplishments of a doctor in training — Dr Ruth Mitchell, a neurosurgery trainee currently in her second year of her PhD at the University of Melbourne, and a neurosurgery registrar at the Royal Melbourne Hospital, and chair of the Royal Australasian College of Surgeons’ Trainee Association; Woman in Medicine Award, presented to a woman who has made a major contribution to the medical profession by showing ongoing commitment to quality care, or through her contribution to medical research, public health projects or improving the availability and accessibility of medical education and medical training for women — Associate Professor Diana Egerton-Warburton, in recognition of her exceptional contribution to the development of emergency medicine, and her passion for public health; Excellence in Healthcare Award recognises ongoing commitment to quality health and medical care, policy, and research, and is awarded to an individual or individuals who have made a significant contribution to improving health or healthcare in Australia — Associate Professor John Boffa and Ms Donna Ah Chee, who have made an enormous contribution to reducing harms of alcohol and improving early childhood outcomes for Aboriginal children.