Aboriginal Community Health Research Articles

Empowering communities through data literacy: a qualitative study exploring Indigenous Australian perceptions, engagement and understanding of data

Data literacy is an essential competency needed to use data to inform decisions and participate in contemporary society. Importantly, in the context of Indigenous health it enables engagement with health services and facilitates health management, Indigenous data sovereignty and Indigenous data governance. However, while Indigenous data sovereignty and Indigenous data governance are gaining momentum globally, there are no mechanisms for understanding or enhancing data literacy within Indigenous communities. To explore this, a research project was co-designed between the QUT Centre for Data Science and the Aboriginal and Torres Strait Islander Community Health Service Brisbane (ATSICHS), a community-controlled health service in Queensland Australia, to provide insights into the current state of data literacy, community perceptions of data, and identify community suggestions for enhancing data literacy. Furthermore, by utilizing an Indigenist research design, the project ensured Aboriginal and Torres Strait Islander Peoples’ ways of knowing, being, and doing were privileged and prominent throughout research design, data collection and analysis. The qualitative study included 20 semi-structured interviews with Brisbane Aboriginal and/or Torres Strait Islander Peoples who had accessed or engaged with ATSICHS. This paper presents insights into Aboriginal and Torres Strait Islander Peoples’ perspectives on data and data literacy, which may benefit community-controlled organizations and other Indigenous communities within Australia and around the world.

The impact of rural alimentation on the motivation and retention of Aboriginal community health workers in Jharkhand, India

The impact of rural alimentation on the motivation and retention of Aboriginal community health workers in Jharkhand, India

The experiences of a regional Aboriginal community accessing primary health care during times of crisis.

The importance of primary health care (PHC) to Aboriginal Australians is widely acknowledged, as is the underservicing of the Aboriginal Australian population. Aboriginal People continue to face significant obstacles when accessing and using health care services. This study identifies environmental factors (beyond personal and service delivery) that functioned as barriers and enablers to Aboriginal Australians' experiences accessing PHC during crises and recommends approaches during future events. This research utilised a case study approach. Data were collected through in-depth interviews and analysed using thematic analysis. The study was set in Lakes Entrance, a regional Victorian locality with a sizable Aboriginal community, which was affected by bushfires during 2019/2020 and COVID-19 restrictions during 2020-2021. Participants were 18 Aboriginal People over the age of 18 living in the locality during either bushfires or COVID-19. The barriers identified included the impact on PHC access of priorities other than health, including housing; financial constraints; difficulties with transport; medical bureaucracy and the physical environment of the health care setting, including appointment-making processes; interactions with medical reception staff; and waiting room environments. Enablers identified included the supportive role of the local Aboriginal Community Controlled Health Organisations (ACCHO) and their staff, which was highlighted in participant responses. The preference of many Aboriginal people to access PHC via their local ACCHO, rather than mainstream health care services, appears even more salient during crises than in normal times. This research identified that ACCHOs are ideally placed to promote and protect the health of Aboriginal communities during crises. Results may help direct interventions to improve PHC access and experiences for regional Aboriginal communities both during and outside periods of crisis.

Closing the Gap in Aboriginal health disparities: is there a place for Elders in the neoliberal agenda?

Objective In light of concerns surrounding neoliberal government approaches to addressing Aboriginal disadvantage, this project examined how Elders consider the Closing the Gap programs for improving community health outcomes. Methods A participatory action research project was undertaken in collaboration with eight Elders from a remote Aboriginal community in Australia's island state of Tasmania. The findings emerged from thematic analysis of individual interviews and yarning circles. Results The Closing the Gap programs were seen by Elders as having instrumental value for addressing Aboriginal community disadvantage. However, the programs also represented a source of ongoing dependency that threatened to undermine the community's autonomy, self-determination and cultural foundations. The findings emerged to represent Elders attempting to reconcile this tension by embedding the programs with cultural values or promoting culture separately from the programs. Ultimately, the Elders saw culture as the core business of community well-being and effective program delivery. Conclusion The findings are reflective of tensions that arise when neoliberal policies are imposed on Aboriginal ways of knowing, being and doing. The Elders premised cultural well-being as the key determinant of Aboriginal community health. What is known about the topic? Closing the Gap represents successive neoliberal policy responses of Australian governments to address ongoing Aboriginal disadvantage. What does this paper add? Closing the Gap programs were recognised by Aboriginal Elders for providing the community with improved services, but also a threat to the community's cultural foundations and self-determination. The findings illustrate ongoing tensions between neoliberal principles and Aboriginal cultural values. What are the implications for practitioners? More effective Closing the Gap approaches require greater collaboration between policy stakeholders and community Elders.

An appreciative inquiry to identify the continuing education needs of Aboriginal and Torres Strait Islander health practitioners in regional Queensland

Abstract Aboriginal and Torres Strait Islander health practitioners (Practitioners) have a broad scope of practice and play a pivotal role in addressing health disparities for Aboriginal and Torres Strait Islander people. Practitioners are required to maintain knowledge and skill levels to provide ongoing quality care. However, continuing education (CE) opportunities for Practitioners in regional areas are limited and little is known about the types of CE best suited to Practitioners. This study aimed to identify the CE needs of Practitioners working in a South-East Queensland region in Australia. Participatory action research and appreciative inquiry were combined in this multi-staged study. A local Aboriginal and Torres Strait Islander advisory group provided cultural guidance for the study design and implementation. Supervisors and Practitioners from two Aboriginal Medical Services consented to participate. In stage one of this study, the supervisors were interviewed and the Practitioners contributed to focus groups. The Practitioners prioritised their CE needs in the second study stage using a questionnaire. The participants identified Practitioner CE needs and group 2 listed their career aspirations and the best practitioners were described as ‘Deadly’. The Deadly practitioner had diverse practice knowledge, skills and attributes. The Practitioners had career aspirations beyond their role and a desire to learn. However, their career advancement was stifled by a lack of CE opportunities. CE in regional areas is limited. Practitioners are disadvantaged by exclusion. Enhancing CE opportunities for Practitioners will positively impact the health of regional Aboriginal and Torres Strait Islander communities by building social capital. Therefore, future research on Practitioner roles and CE is needed.

Impact of racism and discrimination on the physical and mental health among Aboriginal and Torres Strait Islander peoples living in Australia: a protocol for a scoping review

BackgroundRacism is increasingly recognised internationally as a key factor contributing to health disparities. A comprehensive body of strong research from international authors has reported negative associations between racism and health outcomes. In Australia, although the literature is more limited, available findings follow global trends. Australia has an identified health gap between Aboriginal and Torres Strait Islander peoples and non-indigenous Australians, and despite efforts to bridge this gap, health inequities continue to exist. This scoping review aims to assess, analyse and synthesise the relationship between racism and discrimination on the physical and mental health of Aboriginal and Torres Strait Islander peoples living in Australia.MethodThis is the study protocol for a scoping review. A systematic search will be conducted using five electronic databases: PubMed, CINAHL, Embase, Web of Science and the Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research. The database search will include studies published between 2000 and 2020. Reference lists of the included articles will be searched. Outcome measures will include physical and mental health components including chronic conditions, depression and anxiety, psychological distress, social and emotional difficulties, suicide and health-related outcomes such as wellbeing and life satisfaction. Duplications will be removed, and titles and abstracts will be reviewed to select studies. Full-text screening of preselected studies will be performed by four reviewers independently, to select studies according to inclusion criteria. Included studies will be appraised for quality using appropriate tools tailored for each study design. Data will be extracted, and study findings and characteristics synthesised in a narrative summary.DiscussionOur scoping review will synthesise the evidence on the impacts of racism and discrimination in relation to the physical and mental health of Aboriginal and Torres Strait Islander peoples living in Australia. These findings could guide future health interventions by addressing the exposure of racism and racial discrimination in order to reduce health disparity. It is anticipated the findings to be of interest to policymakers, researchers, Aboriginal and Torres Strait Islander communities and community health organisations and other stakeholders interested in optimising public health interventions for and in partnership with Aboriginal and Strait Torres Islander communities of Australia.Scoping review registrationThe protocol for this review has been registered on the international prospective register of systematic reviews (PROSPERO). The registration ID is CRD42020186193.

Editors' Foreword

Editors' Foreword Mark G. Brett and Susan E. Hylen This issue of JBL was produced under extraordinary circumstances. The world was in lockdown in response to the COVID-19 pandemic, and each day we woke to news of rising infection rates and death tolls around the globe. There have been significant variations among the international reports, although a relentless unveiling of inequalities has been typical in many different contexts. In the United States and the United Kingdom, the infection statistics are disproportionately high; in Vietnam and Kerala, remarkably low. Remote Aboriginal communities in Australia have so far been spared, in part because their leaders saw the potential dangers very early and exhorted people to retreat to their traditional lands away from the centers of industry. Because Aboriginal people have suffered from imported diseases many times in the past, the communal memory was sensitized to the signs of danger.1 Amid these very pressing global concerns, academic journals have reported a dramatic fall in the number of submissions written by women. But as Gale Yee made clear in her Presidential Address to the Society of Biblical Literature last year, there are many other intersectional factors that need to be considered: race, color, and class would need to be added to our statistics before the dynamics of inequality could be understood in all their layered complexity. And even if some institutions in the United States can celebrate the participation of nonwhite faculty, there are researchers from universities in many other parts of the world who have never contributed to JBL. Most of us will be all too aware that patterns of inequality have steadily increased since the 1980s, and even the dismal science of economics has managed to produce bestsellers on the theme. Most recently, in Capital and Ideology, Thomas Piketty has delivered a one-thousand-page challenge to all of us who worry about [End Page 231] the problems generated by inequality in education.2 That book was written before the coronavirus pandemic, so there is already a new genre of revelation upon us. In the September issue of JBL this year, we are aiming to provide a forum on the topic "Biblical Studies in a Pandemic," and an international group of scholars has been asked to offer their brief reflections. We hope that this will just be one example of a lively debate in years to come. [End Page 232] Footnotes 1. Amy McQuire, "Aboriginal Community Health's Success with Covid-19," The Saturday Paper 298 (2020), https://www.thesaturdaypaper.com.au/news/health/2020/04/25/aboriginal-community-healths-success-with-covid-19/15877368009740. 2. Thomas Piketty, Capital and Ideology, trans. Arthur Goldhammer (Cambridge: Harvard University Press 2020). Copyright © 2020 Society of Biblical Literature

Aboriginal people with chronic HCV: The role of community health nurses for improving health-related quality of life

IntroductionThere is a lack of knowledge about Health-Related Quality of Life (HRQL) of Aboriginal Australians with self-reported hepatitis C infection in Western Australia. This marginalised group of people is disproportionally affected by the hepatitis C virus (HCV) for which there is no preventative vaccine. This study provides data that help understand the long-term consequences of living with HCV infection within the Aboriginal community. It outlines opportunities for nursing interventions for hepatitis care that focus on supporting mental health and drug and alcohol issues within this population. MethodsWe surveyed 123 Aboriginal people living with HCV in a community setting. Survey data included demographics, drug use history, length of time since diagnosis, changes in lifestyle since diagnosis, fatigue, social support, alcohol consumption, and physical and mental health measures. ResultsMost participants reported amphetamine injecting frequently in the last six months and their duration of injecting drug ranged from 8 to more than 11 years. Additionally, half of the participants were classified as high-risk alcohol users. Overall 52% of participants were in poor physical and 60% of participants were in poor mental health. DiscussionThis survey of Aboriginal people with self-reported hepatitis C infection indicates substantial problems of mental and physical comorbidities among this population. ConclusionThere is a need for the development of HCV community clinics in Aboriginal health care settings with trained Aboriginal community health nurses to reduce problematic alcohol consumption, assess liver health and subsequently provide HCV treatment in a culturally appropriate way.

Making space for Aboriginal and Torres Strait Islander community health workers in health promotion.

Despite a clear need, ‘closing the gap’ in health disparities for Aboriginal and Torres Strait Islander communities (hereafter, respectfully referred to as Aboriginal) continues to be challenging for western health care systems. Globally, community health workers (CHWs) have proven effective in empowering communities and improving culturally appropriate health services. The global literature on CHWs reflects a lack of differentiation between the types of roles these workers carry out. This in turn impedes evidence syntheses informing how different roles contribute to improving health outcomes. Indigenous CHW roles in Australia are largely operationalized by Aboriginal Health Workers (AHWs)—a role situated primarily within the clinical health system. In this commentary, we consider whether the focus on creating professional AHW roles, although important, has taken attention away from the benefits of other types of CHW roles particularly in community-based health promotion. We draw on the global literature to illustrate the need for an Aboriginal CHW role in health promotion; one that is distinct from, but complementary to, that of AHWs in clinical settings. We provide examples of barriers encountered in developing such a role based on our experiences of employing Aboriginal health promoters to deliver evidence-based programmes in rural and remote communities. We aim to draw attention to the systemic and institutional barriers that persist in denying innovative employment and engagement opportunities for Aboriginal people in health.

Qualitative perspectives on the sustainability of sexual health continuous quality improvement in clinics serving remote Aboriginal communities in Australia

ObjectivesTo examine barriers and facilitators to sustaining a sexual health continuous quality improvement (CQI) programme in clinics serving remote Aboriginal communities in Australia.DesignQualitative study.SettingPrimary health care services serving remote Aboriginal...

Enabling cultural safety in Indigenous primary healthcare.

The Aboriginal Health Access Centre (AHAC) and Aboriginal Community Health Centre Model of Wholistic Health and Wellbeing is critical to addressing inequities and barriers that limit access to comprehensive primary healthcare for Indigenous people. Even with this model in place, there are multiple points of intersection with mainstream healthcare service providers across health sectors. Further, there is considerable cultural diversity among Indigenous healthcare staff and professional groups. These factors place Indigenous people at risk of culturally unsafe experiences causing harm. Given this, it is essential that leaders focus on cultural safety education to address both intercultural frictions within the Indigenous centres and systemic and structural racism widespread within the broader healthcare system. This article explores how one AHAC has undertaken to examine these complex challenges, while offering some direction on leadership within the sector.

Drawing the threads together: How emerging technologies can help integrate the health care needs of children and young people in out-of-home care

Introduction: This presentation describes the progress of the and Young People in Out-of-Home Care Innovation Fund Integrated Care project currently being undertaken by Children's Health Queensland.Children and young people in out-of-home care (OOHC) are subject to many levels of disadvantage including socio-economic disadvantage and trauma. In comparison to the general population, they experience poorer mental and physical health outcomes in childhood and adolescence, which continue into adulthood. There are more than 8000 children and young people in OOHC in Queensland. There is a recognised lack of coordination in their health care. The young people, their carers and the Child Safety workers negotiate a fragmented system - primary versus specialist care, and public versus private services - without clear roles and responsibilities among providers, and lacking oversight of each young person's health management. Paediatricians have historically taken a lead role in advocating for this vulnerable group of young people, however, the health needs of this group are diverse and primary care is positioned to be the first site of comprehensive assessment in a tiered approach, supported by the expertise of paediatricians and other staff within Hospital and Health Service child protection units. Practice Change: This project is developing an integrated system of health assessment and management for children and young people in OOHC that maximises the input of the primary sector, while allowing efficient digital communication between primary and tertiary care providers. The specific innovative elements of this project are: Pioneering collaboration between primary health care and Queensland Health settings at a level of engagement that has not been attempted or achieved previously. Development of a secure, shared digital platform for the documentation of the young person’s health status, with integrated multi-user management planning capability. Scalability of the piloted system to other groups of paediatric patients and across the State. Aim and Theory of Change: The aim of this project is to create an infrastructure and clinical tools to support the co-ordinated health assessment and management of children and young people in out-of-home care. Targeted Population: Children and Young people in out-of-home care residing in the Brisbane region are being targeted for this study. Stakeholders: Key Stakeholders include Department of Communities, Child Safety and Disability Services; Aboriginal & Torres Strait Islander Community Health Service; participating general practices and individual practitioners; and hospital Child Protection Units and Paediatricians. Timeline: the project commenced January 2017 and has a projected end date of June 2019. Sustainability: After initial set-up costs, efficiencies in health service utilisation and worker capacity will be immediate, and sustainable over the long term. Transferability: The platform will be built with the view to scaling the project across the state. Furthermore, the integrated information technology system will be scalable to many different groups of clients across the health system. Conclusions: Project progress will be discussed including the successful collaboration between the stakeholders and early development of the clinical tools. Delays include the complexities involved in building the integrated information technology system. A successful parallel project will also be highlighted.

A program to respond to otitis media in remote Australian Aboriginal communities: a qualitative investigation of parent perspectives

BackgroundIndigenous infants and children in Australia, especially in remote communities, experience early and chronic otitis media (OM) which is difficult to treat and has lifelong impacts in health and education. The LiTTLe Program (Learning to Talk, Talking to Learn) aimed to increase infants’ access to spoken language input, teach parents to manage health and hearing problems, and support children’s school readiness. This paper aimed to explore caregivers’ views about this inclusive, parent-implemented early childhood program for 0–3 years in an Aboriginal community health context.MethodsData from in-depth, semi-structured interviews with 9 caregivers of 12 children who had participated in the program from one remote Aboriginal community in the Northern Territory are presented. Data were analysed thematically. Caregivers provided overall views on the program. In addition, three key areas of focus in the program are also presented here: speech and language, hearing health, and school readiness.ResultsCaregivers were positive about the interactive speech and language strategies in the program, except for some strategies which some parents found alien or difficult: such as talking slowly, following along with the child’s topic, using parallel talk, or baby talk. Children’s hearing was considered by caregivers to be important for understanding people, enjoying music, and detecting environmental sounds including signs of danger. Caregivers provided perspectives on the utility of sign language and its benefits for communicating with infants and young children with hearing loss, and the difficulty of getting young community children to wear a conventional hearing aid. Caregivers were strongly of the opinion that the program had helped prepare children for school through familiarising their child with early literacy activities and resources, as well as school routines. But caregivers differed as to whether they thought the program should have been located at the school itself.ConclusionsThe caregivers generally reported positive views about the LiTTLe Program, and also drew attention to areas for improvement. The perspectives gathered may serve to guide other cross-sector collaborations across health and education to respond to OM among children at risk for OM-related disability in speech and language development.

Smoking behaviour and preferences for cessation support among clients of an Indigenous community-controlled health service.

Reducing smoking prevalence among Indigenous Australians is a vital part of closing the health gap between Indigenous and non-Indigenous Australians. Community-controlled health clinics are an important setting for delivering smoking cessation advice and assistance. This study measured tobacco and e-cigarette use, knowledge of smoking-related health effects, motivations to quit and interest in cessation aids. Clients of Aboriginal & Torres Strait Islander Community Health Service dental clinics in Southeast Queensland (n = 421) completed a brief written questionnaire while in the waiting room. Nearly half (n = 184, 47%) of the participants currently smoked daily, of which 9% (n = 7) currently used e-cigarettes. Few smokers (8%, n = 13) had no intention to quit smoking. For current smokers, previously used quit methods were abrupt cessation (42%, n = 78), nicotine replacement therapies (NRT; 25%, n = 45), prescription medications (23%, n = 43), e-cigarettes (9%, n = 17) and other methods (3%, n = 6). Current smokers were most interested in cutting down (85%, n = 110), abrupt cessation (75%, n = 98) and free NRT (72%, n = 101). Fewer (34%, n = 36) were interested in purchasing NRT for smoking cessation. Our study found there was interest in accessing smoking cessation aids among the clients of this community-controlled health clinic, particularly if provided free of charge. Embedding smoking cessation advice and assistance into a range of community-controlled health clinics could provide opportunities for addressing the high smoking prevalence among Indigenous Australians.

Building Online Academic Community: Reputation Work on Twitter

Building Online Academic Community: Reputation Work on Twitter

Food and beverage price discounts to improve health in remote Aboriginal communities: mixed method evaluation of a natural experiment

Objective:Retrospectively evaluate food price discounts in remote Aboriginal community stores. Methods:Four price discount strategies of 10% were designed in 2010, aiming to influence grocery, fruit, vegetables and diet soft‐drink sales. This natural experiment across a group of stores was evaluated using an explanatory, sequential mixed method design through analysis of store point‐of‐sale, document, observation and interview data. The outcome was measured by change in: 1) percentage of grocery sales to total food and beverage; 2) fruit and vegetable sales; and 3) diet soft‐drink sales. Qualitative data enabled the interpretation of outcomes through understanding perceived success and benefits, and enablers and barriers to implementation. Results:Eighteen community stores and 54 informants participated. While targeted price discounts were considered important to improving health, no discernible effect was evident, due to inadequate design and communication of discount promotion, and probably inadequate magnitude of discount. Conclusions:Strategy impact on food and beverage sales was limited by promotion and magnitude of discount. Implication for Public Health:This study demonstrates key factors and commitment required to design, communicate, implement and monitor strategies to improve health in this challenging remote retail context. Evaluation of natural experiments can contribute evidence to policy‐making.

Talking about the not talked about: use of, and reactions to, a DVD promoting bowel cancer screening to Aboriginal people

ObjectiveTo examine a) the implementation and use of a DVD developed to educate Aboriginal people about bowel cancer and bowel cancer screening; and b) broader aspects of Aboriginal participation in the National Bowel Cancer Screening Program. MethodsQualitative methods and descriptive approaches were used. Data were collected using face‐to‐face and telephone interviews and focus group discussions. There were 67 participants, including those involved in the development and distribution of the DVD, health professionals and Aboriginal community members. ResultsAlthough the DVD received a positive reaction from participants, fewer than half the DVDs had been distributed. Furthermore, the small number of DVDs that had been distributed were under‐utilised. ConclusionThe weaknesses do not appear to lie with the resource itself but can be attributed partly to poor distribution and promotion. This may have been compounded by the structure of the National Bowel Cancer Screening Program, which limited the engagement of Aboriginal community members and health providers whose focus is largely directed towards more pressing health care issues. ImplicationsInterest in the resource may increase once the Aboriginal component of the screening program is more closely linked with primary care.

Improving healthcare for Aboriginal Australians through effective engagement between community and health services

BackgroundEffectively addressing health disparities between Aboriginal and non-Aboriginal Australians is long overdue. Health services engaging Aboriginal communities in designing and delivering healthcare is one way to tackle the issue. This paper presents findings from evaluating a unique strategy of community engagement between local Aboriginal people and health providers across five districts in Perth, Western Australia. Local Aboriginal community members formed District Aboriginal Health Action Groups (DAHAGs) to collaborate with health providers in designing culturally-responsive healthcare. The purpose of the strategy was to improve local health service delivery for Aboriginal Australians.MethodsThe evaluation aimed to identify whether the Aboriginal community considered the community engagement strategy effective in identifying their health service needs, translating them to action by local health services and increasing their trust in these health services. Participants were recruited using purposive sampling. Qualitative data was collected from Aboriginal participants and health service providers using semi-structured interviews or yarning circles that were recorded, transcribed and independently analysed by two senior non-Aboriginal researchers. Responses were coded for key themes, further analysed for similarities and differences between districts and cross-checked by the senior lead Aboriginal researcher to avoid bias and establish reliability in interpreting the data. Three ethics committees approved conducting the evaluation.ResultsFindings from 60 participants suggested the engagement process was effective: it was driven and owned by the Aboriginal community, captured a broad range of views and increased Aboriginal community participation in decisions about their healthcare. It built community capacity through regular community forums and established DAHAGs comprising local Aboriginal community members and health service representatives who met quarterly and were supported by the Aboriginal Health Team at the local Population Health Unit. Participants reported health services improved in community and hospital settings, leading to increased access and trust in local health services.ConclusionThe evaluation concluded that this process of actively engaging the Aboriginal community in decisions about their health care was a key element in improving local health services, increasing Aboriginal people’s trust and access to care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1497-0) contains supplementary material, which is available to authorized users.

A cross-sectional survey of environmental health in remote Aboriginal communities in Western Australia

Introduction: The Australian Aboriginal population experiences significantly poorer health than the non-Aboriginal population. The contribution of environmental risk factors in remote communities to this health disparity is poorly understood.Objective: To describe and quantify major environmental risk factors and associated health outcomes in remote Aboriginal communities in Western Australia.Methods: The association between environmental health indicators, community infrastructure and reported health outcomes was analysed using linear and logistic regression of survey data.Results: Housing/overcrowding was significantly associated with increased reports of hearing/eyesight (OR 3.01 95 % CI 1.58–5.73), skin (OR 2.71 95 % CI 1.31–5.60), gastrointestinal (OR 3.51 95 % CI 1.49–8.26) and flu/colds (OR 2.47 95 % CI 1.27–4.78) as health concerns. Dust was significantly associated with hearing/eyesight (OR 3.16 95 % CI 1.82–5.48), asthma/respiratory (OR 2.48 95 % CI 1.43–4.29) and flu/colds (OR 3.31 95 % CI 1.88–5.86) as health concerns.Conclusion: Poor environmental health is prevalent in remote Aboriginal communities and requires further delineation to inform environmental health policy.

A systematic review of the evidence that swimming pools improve health and wellbeing in remote Aboriginal communities in Australia

ObjectiveTo provide an overview of the evidence for health and wellbeing benefits associated with swimming pools in remote Aboriginal* communities in Australia. MethodsPeer‐reviewed and grey literature from 1990 to 2014 was searched to identify studies set in remote Australia that evaluated health and wellbeing benefits that have been associated with swimming pools. Studies were categorised using an evidence classification scale. ResultsTwelve studies met our search criteria. All prospective studies that collected data on skin infections found access to swimming pools to be associated with a drop of skin sore prevalence and ‐where measured‐ severity. Studies documenting ear and eye infections showed mixed outcomes. Many wider community and wellbeing benefits were documented in various studies, although many of these were primarily anecdotal in nature. ConclusionsAlthough a case can be made regarding skin infections and the broader wellbeing benefits that swimming pools may bring to remote Aboriginal communities, the benefit to ear and eye health remains unresolved. ImplicationsThe decision to provide swimming pools to remote Aboriginal communities should not hinge on the demonstration of direct health benefits alone. Equity considerations and the potential broader benefits such amenities may entail are equally important.