Health Outcomes For Aboriginal People Research Articles

Priority setting: Development of the South Australian Aboriginal Chronic Disease Consortium RoadMap for Action.

Aboriginal and Torres Strait Islander (Aboriginal) people in South Australia are overburdened by cardiovascular disease, diabetes and cancer. The South Australian Aboriginal Chronic Disease Consortium (Consortium) was established in June 2017 as a collaborative partnership to lead the implementation of three state-wide chronic disease plans using a strategic approach to identifying key priority areas for action. In 2017-2018, the Consortium Coordinating Centre facilitated a priority setting process, which involved extensive consultation, including a prioritisation survey and stakeholder workshops. The Consortium's Aboriginal Community Reference Group was instrumental in leading the identification of priorities for action. The Consortium RoadMap for Action identified seven across-plan priorities and six condition-specific priorities. It acknowledged that: strengthening social and emotional well-being is central to improving health outcomes; prevention and early detection, acute management and ongoing management are all components of the continuum of care; and improving access to services, strengthening the workforce, and monitoring and evaluation are required across the continuum of care. Widespread implementation failure in the past across the health system and health services implementation and research translation highlights the value of the Consortium approach and its commitment to implementing the state-wide chronic disease plans in a collaborative manner. The Consortium relies on and fosters cross-sectoral alignment, with all key players including all public, private and Aboriginal Community Controlled health services, to progress its priorities and aspirations to improve health outcomes for Aboriginal people using evidence-based strategies. SO WHAT?: Rigorous and transparent priority setting processes that bring together research, clinical practice, health services operations, policy and community perspectives can foster intersectoral collaboration and partnership and support the implementation of shared priorities.

The Progress of the New South Wales Aboriginal Oral Health Plan 2014–2020: A Scoping Review

There are major disparities in oral health between Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander people. The New South Wales (NSW) Aboriginal Oral Health Plan 2014–2020 was developed to improve the oral health of Aboriginal people. This scoping review describes programs that have been undertaken to implement the NSW Aboriginal Oral Health Plan 2014–2020. The methodology by Arksey and O’Malley was used to guide this review. Academic and grey literature were searched using a structured Medline, Lowitja and advanced Google searches. Articles were included if they aligned with the strategic directions of the Plan. Key information, including the aims of the study, methodology and results were recorded in a template on Microsoft Excel software. A total of 31 articles were included in this review. This included 25 articles from the academic literature and six initiatives from the grey literature. Included articles were categorised according to the six strategic directions in the NSW Aboriginal Oral Health Plan. Four studies were related to the first strategic direction, six related to strategic direction two, four related to strategic direction three, six initiatives related to strategic direction four, five related to strategic direction five, and eight related to strategic direction six. While there has been significant progress in achieving the strategic directions of the NSW Aboriginal Oral Health Plan, there is scope for continued collaboration between oral health service providers, universities and Aboriginal communities to improve oral health outcomes for Aboriginal people in NSW.

Preventing Crime and Poor Health Among Aboriginal People: The Potential for Preventative Programming

The purpose of this paper is to examine prevention programs, and discuss their potential for having an impact on reducing crime and poor health outcomes for Aboriginal people. A historical context is first outlined in order to provide a context for understanding the disproportionate amount of crime and related poor health outcomes affecting Aboriginal people. Risk factors for crime and health are identified, demonstrating their interrelatedness and overlapping nature, indicating that risk factors do not existing in isolation from each other. Existing crime prevention programs are subsequently discussed, paying particular attention to the intersection between evidence-based outcomes and programs offered at Aboriginal Friendship Centres. The use of prevention programs for preventing/reducing crime and related health costs (i.e. substance use/abuse, smoking, and/or addictions) has been positively established by existing research. Thus, it is suggested that these programs offered in Aboriginal centres, such as Aboriginal Friendship Centres, should be furtherexpanded and supported.

Experience of providing cultural safety in mental health to Aboriginal patients: A grounded theory study.

The need for mental health clinicians to practice cultural safety is vital in ensuring meaningful care and in moving towards improving the mental health outcomes for Aboriginal people. The concept of cultural safety is particularly relevant to mental health professionals as it seeks to promote cultural integrity and the promotion of social justice, equity and respect. A substantive theory that explained the experience of providing cultural safety in mental health care to Aboriginal patients was developed using grounded theory methodology. Mental health professionals engaged in a social psychological process, called seeking solutions by navigating the labyrinth to overcome the experience of being unprepared. During this process participants moved from a state of being unprepared to one where they began to navigate the pathway of cultural safety. The findings of this research suggest health professionals have a limited understanding of the concept of cultural safety. The experience of providing cultural safety has not been adequately addressed by organizations, health services, governments, educational providers and policy makers. Health services, organizations and government agencies must work with Aboriginal people to progress strategies that inform and empower staff to practice cultural safety.

Aboriginal community controlled health services: leading the way in primary care.

The national Closing the Gap framework commits to reducing persisting disadvantage in the health of Aboriginal and Torres Strait Islander people in Australia, with cross-government-sector initiatives and investment. Central to efforts to build healthier communities is the Aboriginal community controlled health service (ACCHS) sector; its focus on prevention, early intervention and comprehensive care has reduced barriers to access and unintentional racism, progressively improving individual health outcomes for Aboriginal people. There is now a broad range of primary health care data that provides a sound evidence base for comparing the health outcomes for Indigenous people in ACCHSs with the outcomes achieved through mainstream services, and these data show: models of comprehensive primary health care consistent with the patient-centred medical home model; coverage of the Aboriginal population higher than 60% outside major metropolitan centres; consistently improving performance in key performance on best-practice care indicators; and superior performance to mainstream general practice. ACCHSs play a significant role in training the medical workforce and employing Aboriginal people. ACCHSs have risen to the challenge of delivering best-practice care and there is a case for expanding ACCHSs into new areas. To achieve the best returns, the current mainstream Closing the Gap investment should be shifted to the community controlled health sector.

Chronic condition management and self-management in Aboriginal communities in South Australia: outcomes of a longitudinal study

This paper describes the longitudinal component of a larger mixed methods study into the processes and outcomes of chronic condition management and self-management strategies implemented in three Aboriginal communities in South Australia. The study was designed to document the connection between the application of structured systems of care for Aboriginal people and their longer-term health status. The study concentrated on three diverse Aboriginal communities in South Australia; the Port Lincoln Aboriginal Health Service, the Riverland community, and Nunkuwarrin Yunti Aboriginal Health Service in the Adelaide metropolitan area. Repeated-measure clinical data were collected for individual participants using a range of clinical indicators for diabetes (type 1 and 2) and related chronic conditions. Clinical data were analysed using random effects modelling techniques with changes in key clinical indicators being modelled at both the individual and group levels. Where care planning has been in place longer than in other sites overall improvements were noted in BMI, cholesterol (high density and low density lipids) and HbA1c. These results indicate that for Aboriginal patients with complex chronic conditions, participation in and adherence to structured care planning and self-management strategies can contribute to improved overall health status and health outcomes. The outcomes reported here represent an initial and important step in quantifying the health benefits that can accrue for Aboriginal people living with complex chronic conditions such as diabetes, heart disease and respiratory disease. The study highlights the benefits of developing long-term working relationships with Aboriginal communities as a basis for conducting effective collaborative health research programs. WHAT IS KNOWN ABOUT THE TOPIC? Chronic condition management and self-management programs have been available to Aboriginal people in a range of forms for some time. We know that some groups of patients are keen to engage with care planning and self-management protocols and we have anecdotal evidence of this engagement leading to improved quality of life and health outcomes for Aboriginal people. WHAT DOES THIS PAPER ADD? This paper provides early evidence of sustained improvement over time for a cohort of Aboriginal people who are learning to deal with a range of chronic illnesses through accessing structured systems of support and care. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? This longitudinal evidence of improved outcomes for Aboriginal people is encouraging and should lead on to more definitive studies of outcomes accruing for people engaged in structured systems of care. Not only does this finding have implications for the overall management of chronic illness in Aboriginal communities, but it points the way to how health services might best invest their resources and efforts to improve the health status of people with chronic conditions and, in the process, close the gap between the life expectancy of Aboriginal people and that of other community groups in Australia.

How can we do things differently in Aboriginal health? The same challenges seen through new eyes

Partnership is a process that must be recognised as a fundamental part of any strategy for improving health outcomes for Aboriginal people. Addressing the inequities in health outcomes between Aboriginal people and other Australians will require a sustained, coordinated and well-informed approach that works to a set of goals and targets developed with input from the Aboriginal community. Partnerships provide the most effectivemechanism for obtaining this essential input from Aboriginal communities and their representative organisations, enabling Aboriginal people to have an influence at all stages of the health-care process. Within the health sector, effective partnerships harness the efforts of governments and the expertise of Aboriginal Community Controlled Health Services, which offer the most effective means of delivering comprehensive primary health care to Aboriginal people. Partnership is a process that must be recognised as fundamental to any strategy for improving health outcomes for Aboriginal people, both in New South Wales (NSW) and Australia as a whole. In 2011, the NSW Government reaffirmed its commitment to Aboriginal health by pledging to work with Aboriginal organisations, communities and advocates to devise a 10-year Aboriginal Health Plan for the State. In many ways NSW is at the beginning of a new era, in which a great deal of attention and energy is being directed across all sectors to close health gaps for Aboriginal people. Addressing the inequities in health outcomes between Aboriginal people and other Australians, however, will require a sustained, coordinated andwell-informedapproach, one which is underpinned by long-term collaborations that work to a set of goals and targets developed in partnership with the Aboriginal community. Partnerships provide the most effective mechanism for obtaining this essential input from Aboriginal communities and their representative organisations, enabling Aboriginal people to have an influence at all stages of the health-care process. Within the health sector, productive partnerships can effect positive change by harnessing the efforts of governments and health providers, along with the experience and expertise of Aboriginal Community Controlled Health Services (ACCHSs). ACCHSs are not only the most effective means of delivering comprehensive primary health care to Aboriginal people but are also a critical component of the overall health system. Such partnerships are designed to bring the experience and expertise of the Aboriginal community to bear at every level of the health-care system, including the identification of key issues, the development of policy solutions and the structuring and delivery of services. However, a practical approach to partnership also means recognising that all parties in a partnership are not the same, that there are different roles and responsibilities – and different accountabilities. With consultations and submissions for the development of the 10-year Aboriginal Health Plan for NSW currently underway, the Aboriginal Health and Medical Research Council of NSW (AH&MRC) believes it worthwhile to highlight in this article some of the key attributes of successful partnerships, both in general and specifically with the ACCHS sector. Advocating a partnership approach A partnership approach has long been advocated by government and ACCHSs as essential to addressing Aboriginal health inequity. In 1989, Australia developed its first National AboriginalHealth Strategy,whichwas the result of extensive consultations with Aboriginal communities and governments around the country. Before the development of this national strategy, the Commonwealth Government had no strategic approach to tackle the challenges surrounding Aboriginal health. The Strategy not only reinforced the important role of ACCHSs in improving Aboriginal health, it also criticised the ad hoc approaches to Aboriginal health which were then prevalent. With a mandate to improve coordination and achieve better health outcomes, the National Aboriginal Health Strategy strongly recommended better partnerships 48 | Vol. 23(3–4) 2012 NSW Public Health Bulletin 10.1071/NB11057 between Commonwealth and state governments, and between the Aboriginal community and government at all levels. Following the recommendations set out in the National Aboriginal Health Strategy, in 1995 theAH&MRC and the NSW Government led the country by establishing the first NSW Aboriginal Health Partnership Agreement. Guided by the principle of self-determination, the Agreement emphasises a partnership approach and the importance of intersectoral collaboration. The Agreement also recommends that the partnership model be replicated at all levels of the health-care process, down to regional and local levels. Launchedwith bipartisan support, theNSWAboriginal Health Partnership Agreement endures today and its founding principles remain unchanged. In addition to the establishment of the NSW Aboriginal Health Partnership Agreement, in 2010 the NSWGovernment signed The Statement of Intent to Achieve Equality in Health Status and Life Expectancy Between Aboriginal and Torres Strait Islander Peoples and Non-Indigenous Australians. As with the NSW Aboriginal Health Partnership Agreement, the Statement of Intent also achieved bipartisan support in committing the NSW Government to work in new, more productive partnerships with Aboriginal people and their representative organisations. Partnerships and self-determination There are sound reasons why such initiatives recommend partnerships with Aboriginal communities and their representative organisations: the benefits of adopting a partnership approach are well documented, both in Australia and internationally. Within a local context, a partnership approach that incorporates proper recognition of the right of self-determination for Aboriginal people offers a solid foundation for improving collaborative efforts in the area of Aboriginal health. The United Nations Declaration on the Rights of Indigenous Peoples lays out the principles of self-determination. Adopted in 2007, the Declaration upholds the rights of Indigenous peoples and calls on states to consult and cooperate in good faithwith the peoples concerned through their own representative institutions in order to obtain their ‘free, prior and informed consent before adopting and implementing legislative or administrative measures that may affect them.’ The Declaration defines the concept of self-determination for Indigenous peoples, in Articles 3, 4 and 5:

Developing an Aboriginal Health Plan for NSW: the consultation process

In partnership with the Aboriginal Health and Medical Research Council of NSW (AH&MRC), the NSW Ministry of Health is developing a 10-year Aboriginal Health Plan for NSW. Recent reports have highlighted the need for significant systemic and structural change, coupled with genuine engagement with Aboriginal people. A whole health-system approach has been adopted and is examining all the interdependent and influencing elements that impede or facilitate effective health outcomes for Aboriginal people. The collaboration will develop a new strategic framework that will provide clear direction concerning how we address Aboriginal health in NSW. We have done this by seeking genuine engagement and partnership with Aboriginal people, organisations and communities. A phased approach has been used to develop the Plan. This paper describes the first phase of a two-phased approach. A discussion paper was released on National Close the Gap Day, 22 March 2012.

Successful partnerships are the key to improving Aboriginal health

Partnership is a process that must be recognised as a fundamental part of any strategy for improving health outcomes for Aboriginal people. Addressing the inequities in health outcomes between Aboriginal people and other Australians will require a sustained, coordinated and well-informed approach that works to a set of goals and targets developed with input from the Aboriginal community. Partnerships provide the most effective mechanism for obtaining this essential input from Aboriginal communities and their representative organisations, enabling Aboriginal people to have an influence at all stages of the health-care process. Within the health sector, effective partnerships harness the efforts of governments and the expertise of Aboriginal Community Controlled Health Services, which offer the most effective means of delivering comprehensive primary health care to Aboriginal people.

Perinatal HIV transmission and pregnancy outcomes in indigenous women in Western Australia

Implementation of obstetric and neonatal interventions has reduced mother to child transmission of HIV. Health outcomes for Aboriginal people are often worse than for non-Aboriginal people; was this the case for HIV infection in pregnancy? To compare the management and outcomes of pregnancy in Aboriginal and non-Aboriginal HIV-positive women in Western Australia (WA). A retrospective study of all pregnancies delivered in WA to HIV-infected women from 1991 until 2005. Managed pregnancies were compared in Aboriginal and non-Aboriginal women. Outcome measures were HIV status of the babies, birthweight, rates of caesarean delivery and perinatal mortality. Fifty-six pregnancies occurred in 41 HIV-infected women resulting in 54 live births. Of the 41 women, 16 (39%) were Aboriginal. In regard to birthweight, perinatal mortality, rates of caesarean section and rates of HIV perinatal transmission, there was no significant difference between babies born to Aboriginal and those born to non-Aboriginal mothers. In contrast, of the eight pregnancies, with no contact with the multidisciplinary team, five babies (63%) were infected with HIV (2% vs 63%P = 0.001). There was no case of perinatal HIV infection in 22 pregnancies of the Aboriginal women that received care through the multidisciplinary team; perinatally acquired HIV occurred in the first pregnancy of one of these women before she was aware of her status when she was not managed by the team. Similar outcomes can be achieved in both HIV-positive Aboriginal and non-Aboriginal women, through intensive, culturally appropriate, multidisciplinary care and without elective caesarean delivery.

It's only a mistake if you make it twice.

Improved health outcomes for Aboriginal people involves bringing together stakeholders to develop partnerships in research that lead to practical, sustainable solutions. Strengthening the capacity of Aboriginal people to achieve full participation in services and appropriate means of control of these services is critical to tackling Aboriginal health deficits. Partners need to take a holistic view of health which includes addressing social and emotional wellbeing as well as absence of disease. (non-author abstract)

The Centre of Clinical Research Excellence in Aboriginal and Torres Strait Islander Health: An Operational Rationale and Some Reflections on Progress so far

The Centre of Clinical Research Excellence (CCRE) in Aboriginal and Torres Strait Islander Health was established in late 2003 through a major National Health and Medical Research Council (NHMRC) grant involving collaboration between the Aboriginal Health Council of South Australia (AHCSA), Flinders University, and Aboriginal Health Services. Our foundation research communities are the Aboriginal communities served by these Aboriginal Health Services in the Spencer Gulf / Eyre Peninsula region. In recent years a number of collaborative research programs involving chronic illness management, self-management and coordinated care have been implemented in these communities and this work is the basis of the initial CCRE activities. Key objectives of the CCRE are to improve the health status of Indigenous people through conducting relevant and meaningful Aboriginal controlled health research, providing formal training for Indigenous health researchers and developing innovative approaches to health care that can be readily translated and applied to support communities. The inclusion, empowerment and engagement of Indigenous people in the process of managing community health represent tangible strategies for achieving more equitable health outcomes for Aboriginal people. This paper outlines the CCRE operational rationale and presents early activities and outcomes across the three strategic areas of CCRE operations: research, education and training, and translation. Some critical reflections are offered on the progress and experience of the CCRE thus far. A common obstacle this CCRE has encountered is that the limited (especially staff) resources available to the Aboriginal Health Services with which we are collaborating make it difficult for them to engage with and progress the projects we are pursuing.

NSW Health Aboriginal Health Impact Statement

Health outcomes for Aboriginal people remain significantly poorer than those for the general population. For example, the average life expectancy is 56 years for Aboriginal men and 64 years for Aboriginal women. This is approximately 20 years less than the life expectancy for the general population.