The Federal Government has been urged to extend its 12-month funding lifeline for Indigenous-run health services to give them financial certainty for at least an extra five years.

AMA President Dr Steve Hambleton said confirmation from Health Minister Peter Dutton that the nation’s 150 Aboriginal Community Controlled Health Services will receive $333 million in the Federal Budget to enable them to keep operating until mid-2015 was welcome, but added longer-term financial security was required, urging the Abbott Government to guarantee funding for at least the next five years.

“Aboriginal Community Controlled Health Services deliver the highest quality, culturally appropriate health care to the Aboriginal population,” Dr Hambleton said. “These services make a huge difference to people suffering serious health conditions.”

His comments were supported by the results of a report that found marked improvements in the performance of health services treating Aboriginal and Torres Strait Islander people.

Using data from more than 200 primary health care organisations that mainly treat Aboriginal and Torres Strait Islander people, the Australian Institute of Health and Welfare found that there had been a jump of between 5 and 9 percentage points in key health services, including detailed health assessments of adults, developing team care arrangements for patients with type 2 diabetes and recording baby birth weights.

Nationally, the Institute found, 58 per cent of Indigenous babies born in the 12 months to mid-2013 had had their birth weight recorded by a primary health care provider.

“Government investment in Aboriginal Community Controlled Health Services is money well spent,” Dr Hambleton said. “There is clear evidence that it saves lives and improves quality of life for Aboriginal peoples. It closes the gap.”

Delivering the annual Commonwealth Closing the Gap report in February, Prime Minister Tony Abbott said the gap in rates of child mortality between the Indigenous and non-Indigenous community had halved in the past decade, but admitted there had been almost no progress in narrowing the gap in life expectancy – currently around 10 years – between Indigenous Australians and the rest of the community.

In addition to the 12-month funding lifeline for Aboriginal Community Controlled Health Services, Mr Dutton also approved $98 million to fund five specific Indigenous health programs – Primary Health Care, Healthy for Life, Australian Nurse Family Partnership, New Directions: Mothers and Babies, and Stronger Indigenous Health Services – being delivered by 90 organisations across the country.

A spokesman for the Health Minister told The Australian that “extending the funding to June 2015 provides the continuity for these organisations to deliver important services to Indigenous people over the next 12 months”.

National Aboriginal Community Controlled Health Organisation Chair Justin Mohamed said the extra funding was recognition of the significant contribution Indigenous-led health services were making in closing the health gap.

But Mr Mohamed warned that, welcome though the funds were, more was needed.

“The Aboriginal population is growing, and demand for our services is increasing at a rate of more than 6 per cent a year,” he said. “We need to have surety that we will have the resources to continue to improve the health of our people over the long term to meet this growth.”

Mr Mohamed said funding should grow in line with inflation and should be guaranteed beyond the next financial year.

“We are only now starting to see the results of programs put in place five years ago,” he said. “As such, we need to move to a more secure funding model, moving from the current three-year agreements to five-year agreements.”

It was a call backed by Dr Hambleton, who urged the Government to move to a five-year funding agreement “as soon as possible”.

Adrian Rollins

Earlier this year, the National Mental Health Commission announced a comprehensive review of mental health services and programs across Australia, including in the private, government and non-government sectors.

Although the review is seeking to identify where efficiencies can be made, a major focus is nonetheless to develop measures to support individuals with a mental illness and their families to lead a full life and engage productively in the community.

Aboriginal and Torres Strait Islander peoples are a group identified by the Commission as particularly important in its review.

Aboriginal and Torres Strait Islander peoples are among the most disadvantaged groups in Australia, and experience high levels of mental ill health and low levels of social and emotional wellbeing.

The sources of poor mental health and wellbeing are bound up with the social, economic and cultural circumstances of Aboriginal peoples’ and Torres Strait Islanders’ history and current lives. Suicide rates are high, including among young Aboriginal people and Torres Strait Islanders, and in many communities there are significant levels of substance use, violence and insecurity.

The AMA, through the work of its Taskforce on Indigenous Health, has recognised for some time that the solutions to these problems must incorporate many different factors, including recognition of the importance of a strong cultural identity as a key lever for healing.

However, the momentum around systematic and strategic national measures to improve things has flagged.

The five-year COAG National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes negotiated in 2009 was a significant step forward in closing the health gap, and the AMA believes that it must be renewed, and must include a greater focus on  mental health and harmful alcohol and substance use.

In order to strengthen the services and opportunities available to improve the mental and emotional health of Aboriginal people, the AMA believes that future COAG Closing the Gap agreements should recognise that Aboriginal people benefit most from health care provided by Aboriginal people. This will particularly be the case regarding their mental and social and emotional health.

The AMA believes, and research shows, that Aboriginal community controlled health services (ACCHS) have a strong capacity to provide comprehensive care that can address drivers of poor mental health. That capacity can be enhanced through:

• setting core funding for the Aboriginal community controlled health sector at a rate which allows existing ACCHSs to attract GPs, health and mental health professionals through appropriate salaries, and to have the infrastructure to accommodate them, particularly in remote locations;
• the development of a capacity-building plan, in partnership with the National Aboriginal Community-Controlled Health Organisation, for the establishment of further ACCHSs in areas of need; and
• the development of more services dedicated to mental health and emotional and social wellbeing, according to the ACCHSs model.

Mental health must be tackled in an integrated and strategic way for Aboriginal people and Torres Strait Islanders. This requires that:

• the National Aboriginal and Torres Strait Islander Suicide Prevention Plan be implemented as soon as possible, with appropriate resourcing;
• the Social and Emotional Wellbeing Framework for Aboriginal people and Torres Strait Islanders be implemented as soon as possible; and
• an alcohol and other drugs strategy for Aboriginal peoples and Torres Strait Islanders be developed.

Finally, imprisonment can exacerbate mental health and substance use issues. One in four people in prison today is an Aboriginal person or Torres Strait Islander.

The AMA strongly believes that rates of incarceration of Aboriginal people and Torres Strait Islanders must be significantly decreased, particularly of young offenders. Those in prison should also have ready access to culturally appropriate mental health and substance use treatment.

The AMA believes that the impetus for improving the mental, social and emotional health of Aboriginal and Torres Strait Islander people needs to be re-invigorated.

The AMA’s Taskforce on Indigenous Health will be contributing to the momentum by developing this year’s Aboriginal and Torres Strait Islander Health Report Card on mental health and social and emotional wellbeing, and making detailed and practical recommendations for change.

The AMA has called for reform of funding for Indigenous health following the release of a report showing that Aboriginal community controlled health services deliver substantial economic and health benefits.

The report Economic value of Aboriginal Community Controlled Health Services found that, in addition to their effectiveness in improving health care, Indigenous-operated health organisations deliver significant economic benefits to the communities they serve, providing well-paid jobs for 3200 Aboriginal people, boosting education with on-site training and offering valuable career paths.

The study was commissioned by the National Aboriginal Community Controlled Health Organisation, and Chair Justin Mohamed said the contribution made by his member organisations should not be underestimated.

“Aboriginal Community Controlled Health Organisations are major contributors to closing the appalling health gap between Aboriginal and non-Aboriginal Australians by providing culturally appropriate primary health care to Aboriginal people,” Mr Mohamed said. “We now know that they are even more valuable – providing employment and training opportunities to our people, which in turn boost local economies and tackle some of the huge barriers to Aboriginal people achieving economic independence and quality of life.”

He said that, ultimately, this resulted in lower health and other costs.

“The ripple effect of healthy Aboriginal communities cannot be overestimated,” Mr Mohamed said. “Healthy communities keep our kids in school, keep our adults in the workforce and provide a greater opportunity for participation in broader society. Ultimately, that means reducing welfare dependency, reducing criminal justice rates and diverting people from the need for more expensive health care.”

The current $300 million funding commitment to Aboriginal community controlled health services expires at the end of June, prompting calls for more robust funding arrangements.

Mr Mohamed wants the funding quarantined from any cuts in the forthcoming Federal Budget, and AMA President Dr Steve Hambleton urged sufficient Commonwealth investment “to secure the future of these important services”.

Dr Hambleton said there was an urgent need for reform of how the sector is funded.

“The AMA believes that an analysis should be conducted to determine needs in Aboriginal and Torres Strait Islander health at a regional level,” he said. “Based on that analysis, Aboriginal community controlled health services should be established and appropriately funded I areas of need, according to the demand for services.

The AMA President said differences in funding between jurisdictions should also be reviewed to ensure there was an equitable distribution of resources, according to need.

The Shadow Parliamentary Secretary for Indigenous Affairs, Warren Snowdon, said it was “unacceptable” that decisions on the future funding of Aboriginal community controlled health services had been left so late in the financial year.

Mr Mohamed lamented the insecurity of funding for the sector, and the fact that often funds earmarked for Aboriginal health were diverted into mainstream services, “which simply don’t have the same runs on the board with Aboriginal health as our services do”.

Adrian Rollins

The nation’s governments must immediately begin to act on measures to boost Indigenous health to ensure the momentum built around recent gains is not lost, AMA President Dr Steve Hambleton has said.

In comments to mark Close the Gap Day, Dr Hambleton said the Commonwealth, State and Territory governments should renew their COAG Closing the Gap partnership agreement for a further five years, backed by same level of funding, as well as develop a clear strategy to implement the National Aboriginal and Torres Strait Islander Health Plan.

“Our governments must make every day a Close the Gap Day,” Dr Hambleton said. “Consistent and coordinated action is needed to increase the momentum and build on the early successes of strategies to close the gap across the health spectrum.”

In a report to Parliament in February, Prime Minister Tony Abbott said the nation was on target to halve the gap in child mortality within a decade, to have 95 per cent of children in remote areas enrolled in pre-school and to halve the gap in year 12 attainment by 2020.

But Mr Abbott said almost no progress had been made in narrowing the 10-year gap in life expectancy.

Dr Hambleton said the existing COAG partnership agreement, which is due to expire in June, had already achieved significant success in reducing smoking rates and improving maternal and child health, and it was important not to let the momentum gained drop away.

He said a renewed partnership agreement needed to be backed by a strategy to implement the Health Plan, including:

·        a comprehensive set of measurable targets to be achieved within a decade;

·        the development of a service model to achieve those targets;

·        the development of a national workforce strategy;

·        funding and resources commensurate with the task; and

·        clear requirements for governments to work with Aboriginal and Torres Strait Islander health leaders and Indigenous communities.

In an encouraging advance in Indigenous-led health, four Aboriginal GPs have established a joint child and family-focused medical centre on Palm Island.

The Palm Island Children and Family Centre, founded by Dr Raymond Blackman and Dr Vicki Stonehouse in November last year, was set up to fill a glaring gap in medical services on the island.

Dr Blackman said that before the Centre was set up, the only option for islanders in need of care was the local hospital.

He said primary health care, underpinned by an on-going relationship between GPs and their patients, was proven to provide better health outcomes over time.

“We have GP skills, an interest and understanding of Aboriginal and Torres Strait Islander health, and in our clinic we have the necessary support structures to enable better outcomes on Palm Island,” Dr Blackman said. “This needs to be replicated throughout the country.”

Dr Blackman received the 2014 Wakapi Anyiku Doctor Oomparani Award in recognition of his leadership and commitment.

Adrian Rollins

Indigenous children living in a remote community in far north Queensland will be able to continue attending holiday and leadership camps run by AMA member Dr Lara Wieland following a successful appeal for funds.

The AMAQ Foundation has reported the Christmas charity drive raised $44,041, which will be used to buy a used 11-seat four wheel drive to transport children from the Gulf of Carpentaria town Kowanyama to and from the camps.

Dr Wieland, who is a member of the AMA Indigenous Health Taskforce, has spent the past 13 years living and working in Indigenous communities in far north Queensland, and established the Out There Kowanyama holiday and leadership camps program to provide a positive experience for local children, many of whom come from difficult backgrounds and live in a community with high levels of social dysfunction.

Dr Wieland said Kowanyama was very remote, and the surrounding terrain was harsh, meaning that transport is a huge issue.

She said the appeal’s success had allayed concerns that the camps program would need to be wound up.

 “These camps are vital for educating the children about hygiene, healthy food choices, budgeting, shopping and behaviour in preparation for boarding school and life outside the community,” Dr Wieland said. “But they get so much more out of it than that. It goes beyond the learning, health promotion and sports activities. The program instils confidence, resilience and self-belief in these kids.”

She paid tribute to the generosity and compassion of all those who contributed to the appeal.

“What we’re able to provide for the kids and teach them while they’re with us is truly life changing for them, and you can be proud that you’re now a part of that,” she said.

Adrian Rollins

Dr Kelvin Kong, an ear, nose and throat specialist who made history when he became Australia’s first Indigenous surgeon, says he is filled with hope that ear disease in Aboriginal communities can be brought back to the levels experienced by the wider community.

Dr Kong is dedicated to improving access and resources to remote communities to tackle ear disease and prevent a life of disadvantage for children.

“The amazing thing looking at ear disease in this country is that we live in a dichotomy,” he told SBS TV’s Living Black program.

“The dichotomy is that in Aboriginal Australia our ear health status is at fourth-world status. Not third-world status. So we are looking at countries like Africa where their health system is deplorable. We’re actually getting worse statistics than them.”

But Dr Kong said he is hopeful that Government initiatives, such as the Prime Minister’s Indigenous Advisory Council, along with efforts by the medical profession working in conjunction with the wider community, can make a difference.

“I really hope we’re moving forward and we can decrease the burden of ear disease in Australia and we can see that [the prevalence of] ear disease in Aboriginal communities is back to [that of] the normal population,” he said. “Then you’re going to see all these kids coming through school and taking on the world.”

Dr Kong was inspired to become a doctor by his mother Grace, a nurse, and by his two sisters, who are also doctors. His Chinese father is a general practitioner, working in Malaysia.

“Mum’s probably the biggest inspiration for me,” he said. “She always has been. She’s very humble. She comes from a very humble background. She struggled most of her life … and led by example. She went to university and did a nursing degree.

“She was always driving into us, my sisters and I, saying ‘do what you want to do. Don’t let anybody hold you back’. “

Dr Kong said he was also influenced in his career by a couple of surgeons he had contact with early in his career.

“They were role models, they were leaders in the community and they led not by bravado but by the work they did and giving back to the community,” he said. “And more importantly, the reward that you saw was not so much in what you did but it was in seeing the results for the kids that you operated on, and the experience they got in normalising themselves into the society where they could do whatever they wanted to do.”

Apart from his surgical work, Dr Kong is committed to taking up mentoring opportunities with young Aboriginal children.

“Health is one of those big disparities that we see in this country, so we want to make sure that we encourage them,” he said. “So, going to primary schools, talking to kids, letting them see that there are Aboriginal doctors out there … going to talk to and mentor these kids. Some of these kids, the talent is incredible. I think I’ve met our first Aboriginal prime minister in some of these kids I’ve looked after.”

Dr Kong, a strong supporter of the National Aboriginal Community Controlled Health Organisation and Aboriginal Medical Services, has also been a driving force in the introduction of mobile ear surgery units that go to Aboriginal communities.

“To set up a hospital with an ear, nose and throat department at every location is expensive … so why not make it mobile so that you can put all the resources into one establishment, put it on wheels and move it around?”

In the seven years since he first started as a doctor, the number of Aboriginal and Torres Strait Islander doctors has increased from a handful to close to 160, a statistic that Dr Kong warmly welcomes.

“It makes a huge difference (to the life of indigenous Australians),” he said. “An Aboriginal doctor serves as more than just a doctor. An Aboriginal doctor serves a purpose in terms of providing health care, educating the general public, and breaking down professional barriers. You’ve got to remember that a lot of people grow up in society, particularly the middle class, where they haven’t even met an Aboriginal person. So to actually get into the system and permeate through the system is a wonderful experience … and when you times that by 160 or 170 people, it’s incredible.”

Debra Vermeer

The AMA is inviting applications for its $9000 Indigenous Peoples’ Medical Scholarship for 2014.

AMA President Dr Steve Hambleton said increasing the number of Aboriginal and Torres Strait Island doctors and health professionals was integral to closing the gap between Indigenous health and life expectancy and that of the rest of the population.

Dr Hambleton said the Scholarship had helped many Indigenous men and women to complete their medical training since its inception in 1995, and was contributing to the growth in the number of medical students from Aboriginal and Torres Strait Island backgrounds.

“There is evidence that there is a greater chance of improved health outcomes when Indigenous people are treated by Indigenous doctors and health professionals,” the AMA President said. “The numbers of Indigenous doctors are steadily increasing, but every effort needs to be made to help make it possible for Indigenous people to study medicine.”

The scholarship is open to students who are currently enrolled full time at an Australian medical school, and who are eligible for ABSTUDY.

Applications for the scholarship close on 30 January, 2014.

For details on how to apply, visit:

indigenous-peoples-medical-scholarship-2014

Indigenous adults are cutting out smoking in increasing numbers, but many remain dangerously overweight and suffer significantly higher rates of cardiovascular disease and blood pressure problems compared with the rest of the community.

The latest official survey of Aboriginal and Torres Strait Islander health, prepared by the Australian Bureau of Statistics, shows that although significant progress is being made in convincing Indigenous people to quit smoking, they are more likely than most to suffer from a range of serious mental health problems and physical ailments.

The findings reinforce calls by the AMA, National Aboriginal Community Controlled Health Organisation (NACCHO), and other groups for governments to sustain their efforts to close the health gap between the Indigenous community and the rest of the population.

In an encouraging result for health campaigners, the ABS survey of 13,000 Aboriginal and Torres Strait Islander people, conducted in 2012-13, found that 41 per cent of adults used tobacco on a daily basis, down from 51 per cent in 2002 and 44.6 per cent in 2008.

Just as significant, young Indigenous people are increasingly deciding not to take up the habit at all – the proportion of 15 to 17 year-olds who have never smoked has risen from 61 to 77 per cent.

NACCHO Chair Justin Mohamed said the result showed that “investment in programs to stop Aboriginal and Torres Strait Islander people from smoking is reaping rewards”.

But Mr Mohamed added that the Indigenous smoking rate remained more than double that of the broader community, meaning there was no room to slacken the effort to encourage more people to quit the habit or resist taking it up in the first place.

The pressing need for sustained effort is amply clear when looking at other measure of health.

The ABS found that two-thirds of Indigenous adults were overweight or obese (as defined by their body mass index), one-and-a-half times the rate of the general population, while almost a third of Aboriginal and Torres Strait Islander children were overweight or obese.

Linked to this, Indigenous adults were, on average, more sedentary than adults in the broader community, with three out of every five defined as physically inactive.

In keeping with these and similar factors, Aboriginal and Torres Strait Islander adults were three times as likely to have diabetes or high blood sugar levels, one in five had high blood pressure, and 12 per cent had cardiovascular disease – 20 per cent more than the general population.

Inaugural Chair of Indigenous Health at the University of New South Wales, Professor Lisa Jackson Pulver, said that, while the results were concerning, they were not cause for despair.

Writing for the ABC’s The Drum website, Professor Jackson Pulver said high rates of diabetes and cardiovascular disease in the Indigenous community were the accumulated outcome of a broad range of determinants of health over a significant period of time, and the effect of more recent efforts, such as the Closing the Gap agreements at COAG would take time to be apparent.

“It is too early,” she said. “More importantly, the severe disadvantage many of these data reflect reinforces the argument for concerted action and sustained funding over the longer term.”

Adrian Rollins