Australian Community Research Articles

From Harmful Practices and Instrumentalisation, towards Legislative Protections and Community-Owned Healthcare Services: The Context and Goals of the Intersex Movement in Australia

People with innate variations of sex characteristics (also known as intersex traits or disorders or differences of sex development) have any of a wide range of innate physical traits that differ from medical and social norms for female and male bodies. Responses to these physical differences create experiences and risks of stigmatisation, discrimination, violence, and harmful medical practices intended to promote social and familial integration and conformity with gender stereotypes. As is evident globally, the Australian policy response to the existence and needs of people with innate variations of sex characteristics has been largely incoherent, variously framing the population as having disordered sex development in need of “fixing”, and a third sex/gender identity group in need of recognition, with only recent engagement by intersex community-controlled civil society organisations. This paper presents an overview of the context and goals of the intersex human rights movement in Australia. Australian intersex community organisations have sought to apply human rights norms and develop new infrastructure to address key health and human rights issues, and necessitating new ways of resolving policy incoherence. Together with human rights, mental health, and public health institutions, they have called for significant changes to medical models of care and reform to research and classification systems. Intersex community organising and resourcing have made a tangible difference. The Australian Capital Territory is the first jurisdiction in the country to move ahead with reforms to clinical practice, including a legislative prohibition of certain practices without personal informed consent, oversight of clinical decision-making, and investment in psychosocial support. A national community-controlled psychosocial support service has also commenced.

Attitudes to End-of-Life Care and Voluntary Assisted Dying Amongst Members of the Australian Jewish community.

The implementation of voluntary assisted dying (VAD) in the Australian State of Victoria in 2019 has stimulated discussions about end-of-life care and dying in many communities. Various attempts have been made to represent the attitudes of the Jewish community, a distinct culturally and linguistically diverse (CALD) group, in terms that suggest a unified set of opinions that opposes VAD policies. This research aimed to explore attitudes to VAD in the context of end-of-life care held by members of the Victorian Jewish community. A descriptive qualitative methodological design was employed. Ten Victorians who identify as Jewish were recruited and participated in in-depth, semi-structured interviews. Reflexive thematic analysis was carried out on the transcripts to identify key themes, attitudes and preferences in relation to end-of-life care, death and dying, and VAD. Three themes were identified: "complexity and variation", "similarities", and "factors influencing attitudes to VAD and end-of-life care". A significant degree of diversity was apparent, ranging from highly supportive of VAD to advocacy for a total repeal of the policy. The results indicate that images of how Victorian Jewish individuals feel towards VAD based on essentialised notions about the community and belief systems are not supported by the evidence. In reality, considerable diversity of attitudes exists towards VAD and end-of-life care. We conclude that it is important that policymakers and members of the broader society avoid stereotypes that falsely characterise this specificcommunity and, by implication, other CALD groups, particularlyin terms that ignore internal diversity regarding belief systems, social attitudes and ethical perspectives.

Abstract 993: Comprehensive immunophenotypic strategies to enable equity in remote settings for improved cancer prognosis

Abstract Improved cancer prognosis begins with insights obtained from high quality data during clinical trials. Execution of longitudinal clinical trials in flow cytometry is complex, primarily due to logistical challenges in high quality sample collection. For instance, highly remote indigenous population centers are both disadvantaged in access to healthcare and often underrepresented in clinical trials. This paradox is highlighted in the case of Australian First Nations communities, for which lung cancer prevalence peaks in males at twice the magnitude of the general population. Our group has developed a novel blood “immune signature” that robustly predicts failure to make a clinical response to checkpoint therapies targeting the PD-1/PD-L1 pathway. Encouraged by these groundbreaking findings, which were achieved through applying a comprehensive 38-plex immunophenotyping CyTOF panel to biobanked cancer samples, recent advances in CyTOF technology now give us the opportunity to expand our clinical implementation to remote settings, with a further expanded panel to 50+ markers. CyTOF is the only technology that allows easily implemented remote asynchronous sample collection and the largest immunophenotyping panel that yields reproducible results. Asynchronous collection is uniquely enabled using a stable lyophilized large-scale staining panel and achieving comprehensive marker coverage in one panel minimizes blood sample required. Furthermore, the new technology enables a highly simplified workflow including blood collection and processing in remote locations to enable the simplest clinical trial infrastructure complexity and cost, easily implemented in current hospital lab environments. As such, this study is designed to ultimately demonstrate both clinical impact of the large panel and utility of CyTOF technology for highly simplified and robust workflow for multi-site clinical trials. This project has 3 phases; i) implementation and evaluation of the collection, analysis technique and data management of this new approach across multiple sites, ii) collection of samples for analysis both pre- and post- initiation of therapy to establish efficacy and optimize as necessary, and iii) blinded clinical trial. We will report on the first phase of this project which is implementing new workflow across clinical collection site, data integration and analysis. This workflow would enable highly simplified collection to access indigenous and under-served populations spread across remote sites in Australia. Citation Format: Natalie J. Smith, Michael Cohen, Julie Alipaz, Christina Loh, David King, Barbara Fazekas de St Groth, Helen M. McGuire. Comprehensive immunophenotypic strategies to enable equity in remote settings for improved cancer prognosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 993.

“Just Get Up and Get on.” Purpose in Later Life

ABSTRACT Although the varied benefits of purpose are increasingly recognized, there is more to learn about the how and why of purpose in later life. Forty older adults (aged 68–96 years) living within the South Australian community participated in a face-to-face interview to further existing understanding of purpose in older age. Conversations with older adults suggest that the majority continues to value and pursue purpose in their lives. Amongst older adults interviewed there was no single perception, definition or experience of purpose. However, through thematic analysis four categories of purpose emerged. Purpose was fulfilled through a drive for life; roles and responsibilities; routine, activity and independence; and faith and spirituality. The outcomes of this study build upon the limited body of evidence defining “purpose” from the perspective of older adults themselves which may in turn help inform future conceptualizations and measurements of purpose, as well as enable the design of interventions intended to promote, sustain or re-introduce purpose across the life span.

The Relations Between Parents’ Gender Equality Values and (co)parenting: Examining Actor-Partner Effects in an Australian Community Sample

In most Western societies, parents’ gender roles and values have shifted significantly over the past decades. However, it is not yet clear whether parents’ gender-related values impact both their own and their partners’ coparenting and parenting practices. This study examined the relations between parents’ gender equality values, their coparenting, and parental warmth and hostility. Drawing 6745 families from an ongoing Australian panel study, we used actor-partner interdependence modeling to estimate the associations between mothers’ and fathers’ equality values and their (co)parenting. Results revealed a significant positive partner effect of mothers’ gender equality values on fathers’ warmth and coparenting, but no significant actor effects for mothers’ or fathers’ values. We also found that mothers’ work status moderated the relationship between parents’ values and coparenting. In conclusion, these findings suggest that it is important to consider mothers’ gender values and its transactional influence on fathers’ involvement for understanding contemporary parenting.

A ‘Vocal Locals’ social network campaign is associated with increased frequency of conversations about mental health and improved engagement in wellbeing-promoting activities in an Australian farming community

BackgroundFarmers face numerous barriers to accessing professional mental health services and instead report a preference for informal support systems, such as lay or peer networks. Farmers also experience barriers to investing time in maintaining or improving their wellbeing, stemming from sociocultural norms and attitudes that are widespread in agricultural communities. The Vocal Locals social network campaign is an ifarmwell initiative that aims to promote conversations about wellbeing and challenge attitudes and behaviours that contribute to farmers’ poor mental health.MethodsThe Vocal Locals campaign was underpinned by the socio-ecological model which explains human behaviour as stemming from interactions between the individual, their closest social circle, the community, and broader society. The campaign ran in Loxton, South Australia, from June to August 2022. Ten community members (8/10 farmers) became ‘Vocal Locals’ and were supported to share ‘calls-to-action’ to encourage people in their social networks to engage in wellbeing-promoting activities. A broader communications campaign reinforced key messages and amplified Vocal Locals’ activities in the community. The intrapersonal and community-level impacts of the campaign were evaluated via pre- and post-campaign surveys of Vocal Locals and community members respectively.ResultsVocal Locals reported significantly lower psychological distress (p = .014), and higher positive mental wellbeing (p = .011), levels of general mental health knowledge (p = .022), and confidence helping someone with poor mental health (p = .004) following the intervention. However, changes in stigmatising beliefs about mental illness, confidence recognising poor mental health, and confidence and comfort speaking to others about mental health were non-significant. Community members who were familiar with the campaign reported having significantly more wellbeing-related conversations post-campaign compared to before (p = .015). Respondents also reported being more comfortable speaking to others about mental health or wellbeing (p = .001) and engaging more in activities to maintain or improve their wellbeing (p = .012) following the campaign.ConclusionsThe Vocal Locals social network campaign is an example of how science and community can be brought together to achieve meaningful outcomes. The campaign may serve as a model for others who wish to challenge attitudinal or knowledge-related barriers to help-seeking and improve engagement in wellbeing-promoting activities in difficult-to-reach communities.

A theoretical conceptualisation of connection to culture in Australian First Peoples children

Connection to culture in Australian First Peoples children is an important social determinant of health in child development and wellbeing. The current study draws upon the collective knowledge of Australian First Peoples Elders and community leaders to collaboratively develop the first theoretical conceptualisation of connection to culture in Australian First Peoples children. Through participatory action research, we integrated both Western and Indigenist methodologies. One-on-one qualitative narrative interviews were conducted with six Australian First Peoples Elders and community leaders. Their knowledge was summarised through a process of Western thematic analysis and Indigenist arts-based participatory analysis to identify core concepts and mechanisms of connection to culture in First Peoples children. The outcome was a theory of connection to culture in Australian First Peoples children. By better understanding how children connect to culture, we can better support children in connecting to culture, targeting an important factor of health and wellbeing.

The Social Impact of Creative Arts in Australian Communities, Sandra Gattenhof, Donna Hancox, Helen Klaebe and Sasha Mackay (2021)

Review of: The Social Impact of Creative Arts in Australian Communities, Sandra Gattenhof, Donna Hancox, Helen Klaebe and Sasha Mackay (2021) Singapore: Springer, 142 pp., ISBN 978-9-81167-357-3, e-book, €106.99

Australian Geomechanics – State of the Journal

It is my great pleasure and honour to introduce this issue of Australian Geomechanics. Following the resignation of previous Editor Bre-Anne Sainsbury, I offered to take on the Interim Editor role from the June 2023 issue to ensure continuity of the publication. The task duration has extended and based on the work completed to produce the latter three issues of the 2023 calendar year, this brief note presents some basic journal analytics, discusses current challenges facing Australian Geomechanics and aims to encourage the membership to prepare submissions for the benefit of the readership and the wider Australian geomechanics community. The sections about challenges and initiatives include references to discussions and brainstorming exercises held during my time at the AGS National Committee (2013-2019) and input from past Chairs and committee members during that period is acknowledged.

Surrealism, Counter-Mapping and COVID: Confluences in Contemporary Asian Australian Art

Abstract: COVID-19 originating in China was all it took to destabilize Australia's claim to a proud, multicultural society, and with it, the sense of place and belonging felt by much of the Asian Australian community. Living and working in Melbourne, the most locked-down city in the world during the COVID period, the Asian Australian multimedia and performance artists Eugenia Lim and James Nguyen witnessed firsthand the resurgence of sinophobia, which exposed the ongoing resilience of the government's former White Australia Policy in the national imagination. Working approximately one hundred years after André Breton's Dada excursion (1921), and the surrealist survey on "Irrational Embellishments" of Parisian monuments (1933), Lim and Nguyen's counter-mapping practices echo these reorientations of site that seek to dismantle ideological codifications of space and reestablish them as imaginative and inclusive. As a strategy of spatial contestation and world building, Lim and Nguyen counter-map several historical and culturally significant sites across Australia, offering a decolonial inflexion of the more iconoclastic gestures of their European progenitors. Refracted through the lens of COVID, these Asian-Australian interventions bring the underlying cultural and racial tensions in Australian society into sharp relief. Their work resists reductive narratives of nationhood and renders the Australian landscape permeable to an interplay of hybrid stories and identities.

Social associations and alcohol consumption in an Australian community sample: An egocentric social network analysis.

This study examined how social associations from a person's social network may be associated with their own alcohol consumption. Alcohol consumption behavior was examined among the social networks of 784 survey respondents (54% female, Mage = 35.3 years), using egocentric social network analysis. Participants (egos) were recruited via a panel aggregator and completed an online survey about the frequency of their alcohol consumption and that of the 20 most influential people in their lives (alters). The survey also explored who these alters were (family, friends, work colleagues) and the interrelationships among these alters. Egos who consumed alcohol, or consumed alcohol more frequently, were surrounded by more alters who also drank alcohol and felt closer (had stronger ties) to these alters. These relationships remained statistically significant when controlling for demographic and other variables. The social networks of those who consumed alcohol more frequently were more densely intertwined. Alcohol may serve to initiate social connections and be a "social glue" that reinforces relationships. These strong social associations present a potential barrier to individuals who wish to reduce their alcohol consumption because they have few close social connections who do not drink alcohol (or who do so infrequently), and their highly interconnected social networks make it difficult to socialize only with those who do not drink frequently. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sea surface temperature driven modulation of decadal co-variability in mean and extreme precipitation

This study investigates the role that sea surface temperature (SST) variability plays in modulating the relationship between decadal-scale mean precipitation and monthly-scale extreme precipitation using the Australian Community Climate and Earth System Simulator Earth System model (ACCESS ESM1.5) climate model. The model large ensemble successfully reproduces the observed strong co-variability between monthly mean rainfall and wet extreme rainfall, defined as monthly rainfall totals above the 95th percentile. Removing SST variability in the ACCESS ESM1.5 model significantly weakens the co-variability between mean and wet extremes over most of the globe, showing that SSTs play a key role in modulating this co-variability. The study identifies Pacific and Atlantic SST patterns as the main drivers of the decadal scale co-variability in mean and extreme wet precipitation. On the other hand, observations and model results show that co-variability between mean and dry extremes is generally weaker than for wet extremes, with highly regional signals. Model experiments also show that SST variability plays a weaker role in modulating the co-variability between the mean precipitation and dry extremes as compared to wet extremes. These results suggest that stochastic atmospheric variability plays a stronger role in generating dry precipitation extremes compared SST forcing.

Enterobius vermicularis infection at time of appendicectomy: is it a neglected risk factor?

Obstruction of the appendiceal orifice is well established as a potential cause of appendicitis. However, it remains debated as to if appendiceal orifice obstruction secondary to Enterobius vermicularis is considered a risk factor for appendicitis or appendiceal colic. Enterobius vermicularis maintains an increased prevalence within lower socioeconomic and human development index regions. Whilst Australia has an overall high human development index it has significant variability in health literacy and socioeconomics. The purpose of this literature review is to evaluate the relationship between Enterobius vermicularis and appendicitis, to review the prevalence of Enterobius vermicularis appendicectomies in lower human development index and socioeconomic status communities, and to review the Australian based Enterobius vermicularis literature available. A comprehensive review of the literature was performed to review the prevalence of Enterobius vermicularis at time of appendicectomy. PubMed, Scopus, and Google Scholar databases were investigated for applicable studies published until December 2023. Enterobius vermicularis within the appendiceal lumen may cause irritation and lymphoid hyperplasia resulting in appendiceal colic with a similar clinical presentation to that of acute appendicitis. An increased association between Enterobius vermicularis, low human development index, and socioeconomic status is suggested. Public health interventions reduce Enterobius prevalence. A single Australian based study from 1994 was identified. Enterobius vermicularis infection is a neglected risk factor for appendiceal colic. A high index of suspicion for Enterobius vermicularis infection should be taken for clinically stable patients with normal inflammatory biochemistry and low human development index. Further research is required to assess if there is a disparity in Enterobius vermicularis in relation to human development index, socioeconomic status, and remoteness within Australian communities.

Oral microbiome research - working in partnership with Indigenous Australian communities.

Microbiome research is currently biased towards populations of European descent, with such populations providing a weak basis upon which to understand microbiome-health relationships in under-studied populations, many of whom carry the highest burdens of disease. Most oral microbiome studies to date have been undertaken in industrialized countries. Research involving marginalised populations should be shaped by a number of guiding principles. In the Indigenous Australian context, one useful framework is the Consolidated Criteria for Strengthening Reporting of Health Research involving Indigenous Peoples (CONSIDER) statement. This paper describes how the microbiome research field is having impacts in the Indigenous Australian health space, and describes a particular project involving Indigenous Australians in which the CONSIDER statement is used as the underlying framework.

Melding language and image: Kaytetye Indigemoji as a language learning project

ABSTRACT Purpose In recent years, digital projects have created tools for learning languages, such as mobile applications (apps). In contexts where the language has low prestige, innovative digital learning tools can support language revitalisation. This article takes the Australian Kaytetye Indigemoji app as a case study in community resource development. It aims to do two things: (1) show how resource development can be a vital forum for language teaching and learning; and (2) assess the affordances of digital images—fundamental to the Indigemoji app—for Indigenous language learning. Methodology Taking an ethnographic approach encompassing informal conversation and participant observation embedded in relevant literature, we analyse the community workshop where the Kaytetye Indigemoji app was developed. Findings We find that the development process can provide an essential language-learning activity. We also find that visual opportunities presented by the app harness existing multimodal practices in central Australian Indigenous communities, including symbolic art and a highly developed alternate sign language. We show that effective digital learning resources can be built through community development processes which engage with local learning methods. Value This research identifies how digital resource development can be harnessed to be maximally useful for Indigenous language learning in a small and relatively disadvantaged area in Australia.

Evaluating a peer-to-peer health education program in Australian public housing communities during the COVID-19 pandemic

BackgroundThe cohealth Health Concierge program operated in Melbourne, Australia from July 2020 to 30 June 2022. It provided peer-to-peer support to culturally and linguistically diverse residents of high-rise public housing. During this time, the COVID-19 public health response changed frequently and included movement restriction, testing and vaccination. We conducted a mixed-methods evaluation to determine the Health Concierge program’s impact on residents’ engagement with health services and public health activities.MethodsThe evaluation, informed by a Project Reference Group, used the RE-AIM framework. We analysed data from 20,901 routinely collected forms describing interactions between Concierges and residents from August 2021 to May 2022. Additional evaluation-specific data were collected between March and May 2022 in four housing estates; we surveyed 301 residents and conducted 32 interviews with residents, Concierges and program stakeholders.ResultsConcierges promoted COVID-safe behaviours; linked residents with support, testing and vaccination services; and disseminated up-to-date information. Of the 20,901 recorded interactions, 8,872 (42%) included Concierges providing support around COVID-19 vaccination. Most surveyed residents (191/301, 63%) reported speaking with a Concierge in the previous six months. The self-reported two-dose COVID-19 vaccine uptake was 94% (283/301). Some residents described having meaningful, appreciated conversations with Concierges, and some described superficial interactions. While residents initially welcomed the program, many felt it failed to evolve. Poorly defined management and hiring criteria led to variable program implementation. A need for bicultural workers to continue linking residents with services was discussed.ConclusionsConcierges’ impact on residents may have contributed to high community uptake of COVID-19 testing and vaccination, and had benefits beyond the COVID-19 remit. We recommend the program be revised and continued to inform further preparedness planning and support service access generally. Program models such as this have potential to inform and reassure high-risk communities during a pandemic. In addition, such programs can help overcome vaccine hesitancy and promote protective health behaviours, regardless of whether a pandemic is currently occurring. Ensuring these programs remain responsive to the changing needs of end-users needs over time is imperative.

Community Practices, Published Guidelines, and Evidence Base Surrounding Breast Milk Handling and Storage: A Qualitative Study.

Background: Expressed breast milk (EBM) is the best alternative to direct breastfeeding. However, expressing breast milk requires good milk handling and storage practices to preserve EBM safety and integrity. Mothers require handling and storage guidance, and many seek this from the internet and online support groups. Aim: This study aimed at exploring EBM handling and storage practices within an online exclusively expressing community and comparing these with both internet resources and evidence-based research. Methods: A naturalistic observational design was used. Content analysis was undertaken on 10,000 posts from an Australian Facebook peer-support community for women who exclusively express breast milk. Women's questions, reported practices, and advice for EBM handling and storage were analyzed thematically and compared with both guidelines and evidence-based research. Findings: There were 460 posts on EBM handling and storage. Three key themes emerged: "How should I store my EBM?," "How long can I store my EBM?," and "How do I use my EBM?" The greatest consistency and agreement between recommendations and community practices were found for storage methods, whereas the least was found for storage times. EBM handling and storage practices were influenced by factors such as EBM value, convenience, and cost, leading to occasional deviations from consistent practice recommendations. Conclusion: To facilitate safe EBM handling and continuation of expression, guidelines should be updated so they are consistent, align with current evidence, and cater to mothers' cost, convenience, and milk wastage concerns. Health care providers can partner with women to evaluate online information to empower mothers in their decision making.

Understanding Australian Pharmacists’ Perceptions on the Utilisation of Oral 5-HT3 Antagonists as Pharmacist-Only Anti-Emetics in Comparison to Oral D2 Antagonists

Objectives: To investigate the perception of community pharmacists on the down-scheduling of 5-HT3 antagonists to pharmacist-only-medicine for treatment of acute nausea and/or vomiting in Australia. Methods: A nationwide anonymous survey targeting Australian community pharmacists was conducted from April to May 2023. Responses were collected and analysed quantitively or qualitatively, where appropriate. Key findings: Participants reported that 5-HT3 antagonists were effective at treating nausea and/or vomiting and would likely recommend their use. Training is required to manage supply due to concerns related to their side effects. Conclusion: Participants supported down-scheduling of 5-HT3 antagonists for the treatment of nausea and/or vomiting in Australia. A pilot study on the provision of 5-HT3 antagonists by pharmacists is recommended as is the development of guidelines for pharmacist-only supply before down-scheduling is considered.

Are SMART goals fit-for-purpose? Goal planning with mental health service-users in Australian community pharmacies.

Goal planning is an important element in brief health interventions provided in primary healthcare settings, with specific, measurable, achievable, realistic/relevant, and timed (SMART) goals recommended as best practice. This study examined the use of SMART goals by Australian community pharmacists providing a brief goal-oriented wellbeing intervention with service-users experiencing severe and persistent mental illnesses (SPMIs), in particular, which aspects of SMART goal planning were incorporated into the documented goals. Goal data from the PharMIbridge Randomized Controlled Trial (RCT) were used to investigate how community pharmacists operationalized SMART goals, goal quality, and which SMART goal planning format aspects were most utilized. Goals were evaluated using the SMART Goal Evaluation Method (SMART-GEM) tool to determine how closely each documented goal met the SMART criteria. Goals were also categorized into five domains describing their content or purpose. Descriptive analysis was used to describe the SMART-GEM evaluation results, and the Kruskal-Wallis H test was used to compare the evaluation results across the goal domains. All goals (n = 512) co-designed with service-users (n = 156) were classified as poor quality when assessed against the SMART guidelines for goal statements, although most goals contained information regarding a specific behaviour and/or action (71.3% and 86.3%, respectively). Less than 25% of goals identified how goal achievement would be measured, with those related to lifestyle and wellbeing behaviours most likely to include measurement information. Additionally, the majority (93.5%) of goals lacked details regarding monitoring goal progress. Study findings raise questions regarding the applicability of the SMART goal format in brief health interventions provided in primary healthcare settings, particularly for service-users experiencing SPMIs. Further research is recommended to identify which elements of SMART goals are most relevant for brief interventions. Additionally, further investigation is needed regarding the impact of SMART goal training or support tools on goal quality.

Supporting People Seeking Asylum in the Australian Community: A Service Provider Perspective

Deterrence of asylum seekers, including via restrictive refugee determination processes, is increasingly common in many countries. In Australia, people who sought asylum by sea between 13 August 2012 and 1 January 2014 (the ‘legacy caseload’), have been subject to increasing restrictions on their social and economic rights. As a result, these people rely on support from non-government organisations, whilst they progress through Australia’s refugee determination process. This research explored service providers’ role in mediating the impacts of asylum policy on the legacy caseload. Findings from 20 in-depth, semi-structured interviews, conducted between December 2018 and February 2020, highlight how service providers in both statutory and community sectors in Victoria challenge and subvert deterrence policies, even as the policy environment constrains their ability to support people seeking asylum. To redress these constraints, increased availability of social supports for people seeking asylum, continuing and additional funding for non-government organisations, and increased support for workers across sectors are recommended by this study. Service providers play a crucial role in enabling the effective engagement of people seeking asylum with the refugee determination process. These findings serve as a further warning from countries seeking to emulate the ‘Australian model’ of harm.