non-Aboriginal People Research Articles

Changes in suicide literacy and intentions to ask about suicide: “Community Linker” training for those supporting Aboriginal people

ObjectiveGatekeeper training programs are widely used with promising results for suicide prevention. However, studies have found that when delivered to Indigenous communities, outcomes can be variable or ineffective. This study is a feasibility trial of a gatekeeper program based on the standardised ‘Question, Persuade and Refer’ (QPR) approach, which was adapted to the cultural needs of local Aboriginal communities in the Shoalhaven region of New South Wales, Australia. The study aims to identify whether 1) knowledge of suicide and intentions to help increase over the course of completing the gatekeeper program; 2) participants of different educational backgrounds have similar outcomes in suicide literacy and intentions to help; and 3) Aboriginal people and non-Aboriginal people have similar outcomes. MethodsOne hundred individuals participated in the research, of which 50% identified as an Aboriginal person. Pre- and post-training questionnaires assessed whether participants experienced an increase in suicide literacy and intentions to support others at risk of suicide. ResultsAlthough pre-test scores for suicide literacy and intentions to help were high, these increased significantly from pre- to post-test. Those with no prior gatekeeper training showed larger changes in both suicide literacy and intentions to ask about suicide compared to those with prior training. ConclusionOverall, this study highlights that delivery of culturally adapted gatekeeper training is associated with improved suicide literacy and intentions to ask about suicide amongst trainees.

“Talking about something no one wants to talk about”—navigating hepatitis B-related work in remote Australian Aboriginal communities: a decade of learning and growth

Abstract Background Chronic hepatitis B (CHB) is one of the leading causes of liver cirrhosis and liver cancer globally. In Australia, Aboriginal and Torres Strait Islander people of the Northern Territory (NT) have the highest prevalence of CHB (6%) and are six times more likely than non-Aboriginal people to be diagnosed with liver cancer. In 2010, a “liver one-stop shop” model of specialised care and research was initiated to address this disparity. Despite many challenges, the program was accepted in NT Aboriginal communities. This study aimed to identify the key elements linked to this success. Methods We conducted a retrospective case study using Stake’s methodology to understand the hepatitis B phenomenon. A constructivist approach allowed a holistic understanding from the real-life perspectives of those involved in the hepatitis B work. Information was sourced from the Aboriginal workforce, patients of remote clinics, interested community members and service providers. Results We identified six elements critical to the successful conduct of our hepatitis B program, which included the essential role of the local Aboriginal workforce, providing health education in a patient’s preferred language, addressing shame and stigma, respecting culture, taking time, and building trust in the community. Conclusions Commitment over the long term was crucial for the success of our hepatitis B program. Adhering to the identified elements was essential to create a culturally safe environment and engage more Aboriginal people in clinical care and research. This study provides powerful lessons and insights that can be applied to other programs and comparable settings worldwide.

WURRANDERRA’S SYMBOLS: AN EXPLORATION AND CONTEXTUALISATION OF THE THURK PETROGLYPH SITE (KINGSTON-ON-MURRAY) ON THE MURRAY RIVER, SOUTH AUSTRALIA

This article describes and contextualises the rock art at the Thurk Petroglyph Site on the Murray River in South Australia using multiple methods. The Thurk Aboriginal engravings comprise at least 524 motifs made up predominantly of geometric line elements as well as a small number of other ‘simple’ geometric motifs, two ‘bird tracks’, one figurative design (a ‘fish’) and a possible anthropomorphous figure. This paper provides the first synthesis of rock art sites/complexes and motifs from other sites on the Murray River as well as visual symbols recorded from senior Aboriginal ‘knowledge carriers’. These syntheses allow us to consider the relationship of Thurk to other cultural places and to highlight and honour the traditional knowledges and beliefs which underpin the rock art. Thurk’s placement within the riverscape, its unique geological canvas, lack of observable ‘domestic’ archaeological evidence combined with it being the likely upstream extent of Murray River rock art in South Australia contribute additional dimensions to its cultural significance. That Thurk’s rock art, and the broader site, have been desecrated by gratuitous graffiti, vandalism and infrastructure brings into sharp focus Australia’s poor record of heritage protection and provides a challenge to current and future generations of non-Aboriginal people to remedy this past.

Alcohol-Attributable Death and Burden of Illness among Aboriginal and Non-Aboriginal Populations in Remote Australia, 2014-2018.

Harmful use of alcohol is a problem in the Northern Territory (NT), Australia. The aim of this study was to assess and compare alcohol-attributable deaths and the contribution of alcohol to the burden of disease and injury (BOD) among the Aboriginal and non-Aboriginal populations in the NT between 2014 and 2018. The alcohol-use data for adults aged 15+ years old in the NT population was taken from the 2016 National Drug Strategy Household Survey. BOD was measured in disability-adjusted life years (DALY) as part of the NT BOD study. Population-attributable fractions were derived to analyse deaths and BOD. Between 2014 and 2018, 673 Aboriginal and 392 non-Aboriginal people died of harmful use of alcohol, accounting for 26.3% and 12.9% of the total deaths in the Aboriginal and non-Aboriginal population, respectively. Alcohol caused 38,596 and 15,433 DALY (19.9% and 10.2% of the total), respectively, in the NT Aboriginal and non-Aboriginal population for the same period. The alcohol-attributable DALY rate in the Aboriginal population was 10,444.6 per 100,000 persons, six times the non-Aboriginal rate. This study highlights the urgent need to reduce harmful alcohol use in the NT, which disproportionately affects Aboriginal peoples in rural and remote areas.

The fraction of life years lost after diagnosis (FLYLAD): a person-centred measure of cancer burden

BackgroundCancer control initiatives are informed by quantifying the capacity to reduce cancer burden through effective interventions. Burden measures using health administrative data are a sustainable way to support monitoring and evaluating of outcomes among patients and populations. The Fraction of Life Years Lost After Diagnosis (FLYLAD) is one such burden measure. We use data on Aboriginal and non-Aboriginal South Australians from 1990 to 2010 to show how FLYLAD quantifies disparities in cancer burden: between populations; between sub-population cohorts where stage at diagnosis is available; and when follow-up is constrained to 24-months after diagnosis.MethodFLYLADcancer is the fraction of years of life expectancy lost due to cancer (YLLcancer) to life expectancy years at risk at time of cancer diagnosis (LYAR) for each person. The Global Burden of Disease standard life table provides referent life expectancies. FLYLADcancer was estimated for the population of cancer cases diagnosed in South Australia from 1990 to 2010. Cancer stage at diagnosis was also available for cancers diagnosed in Aboriginal people and a cohort of non-Aboriginal people matched by sex, year of birth, primary cancer site and year of diagnosis.ResultsCancers diagnoses (N = 144,891) included 777 among Aboriginal people. Cancer burden described by FLYLADcancer was higher among Aboriginal than non-Aboriginal (0.55, 95% CIs 0.52–0.59 versus 0.39, 95% CIs 0.39–0.40). Diagnoses at younger ages among Aboriginal people, 7 year higher LYAR (31.0, 95% CIs 30.0–32.0 versus 24.1, 95% CIs 24.1–24.2) and higher premature cancer mortality (YLLcancer = 16.3, 95% CIs 15.1–17.5 versus YLLcancer = 8.2, 95% CIs 8.2–8.3) influenced this. Disparities in cancer burden between the matched Aboriginal and non-Aboriginal cohorts manifested 24-months after diagnosis with FLYLADcancer 0.44, 95% CIs 0.40–0.47 and 0.28, 95% CIs 0.25–0.31 respectively.ConclusionFLYLAD described disproportionately higher cancer burden among Aboriginal people in comparisons involving: all people diagnosed with cancer; the matched cohorts; and, within groups diagnosed with same staged disease. The extent of disparities were evident 24-months after diagnosis. This is evidence of Aboriginal peoples’ substantial capacity to benefit from cancer control initiatives, particularly those leading to earlier detection and treatment of cancers. FLYLAD’s use of readily available, person-level administrative records can help evaluate health care initiatives addressing this need.

The effect of general practice contact on cancer stage at diagnosis in Aboriginal and non-Aboriginal residents of New South Wales

PurposeOlder age, risks from pre-existing health conditions and socio-economic disadvantage are negatively related to the prospects of an early-stage cancer diagnosis. With older Aboriginal Australians having an elevated prevalence of these underlying factors, this study examines the potential for the mitigating effects of more frequent contact with general practitioners (GPs) in ensuring local-stage at diagnosis.MethodsWe compared the odds of local vs. more advanced stage at diagnosis of solid tumours according to GP contact, using linked registry and administrative data. Results were compared between Aboriginal (n = 4,084) and non-Aboriginal (n = 249,037) people aged 50 + years in New South Wales with a first diagnosis of cancer in 2003–2016.ResultsYounger age, male sex, having less area-based socio-economic disadvantage, and fewer comorbid conditions in the 12 months before diagnosis (0–2 vs. 3 +), were associated with local-stage in fully-adjusted structural models. The odds of local-stage with more frequent GP contact (14 + contacts per annum) also differed by Aboriginal status, with a higher adjusted odds ratio (aOR) of local-stage for frequent GP contact among Aboriginal people (aOR = 1.29; 95% CI 1.11–1.49) but not among non-Aboriginal people (aOR = 0.97; 95% CI 0.95–0.99).ConclusionOlder Aboriginal Australians diagnosed with cancer experience more comorbid conditions and more socioeconomic disadvantage than other Australians, which are negatively related to diagnosis at a local-cancer stage. More frequent GP contact may act to partly offset this among the Aboriginal population of NSW.

Incidence of Stroke in the Aboriginal and Non-Aboriginal Populations of Australia: A Data Linkage Study.

Most estimates of stroke incidence among Aboriginal and Torres Strait Islander (hereinafter Aboriginal) Australians are confined to single regions and include small sample sizes. We aimed to measure and compare stroke incidence in Aboriginal and non-Aboriginal residents across central and western Australia. Whole-population multijurisdictional person-linked data from hospital and death datasets were used to identify stroke admissions and stroke-related deaths (2001-2015) in Western Australia, South Australia, and the Northern Territory. Fatal (including out-of-hospital deaths) and nonfatal incident (first-ever) strokes in patients aged 20-84 years were identified during the 4-year study period (2012-2015), using a 10-year lookback period to exclude people with prior stroke. Incidence rates per 100 000 population/year were estimated for Aboriginal and non-Aboriginal populations, age-standardized to the World Health Organization World Standard population. In a population of 3 223 711 people (3.7% Aboriginal), 11 740 incident (first-ever) strokes (20.6% regional/remote location of residence; 15.6% fatal) were identified from 2012 to 2015, 675 (5.7%) in Aboriginal people (73.6% regional/remote; 17.0% fatal). Median age of Aboriginal cases (54.5 years; 50.1% female) was 16 years younger than non-Aboriginal cases (70.3 years; 44.1% female; P<0.001), with significantly greater prevalence of comorbidities. Age-standardized stroke incidence in Aboriginal people (192/100 000 [95% CI, 177-208]) was 2.9-fold greater than in non-Aboriginal people (66/100 000 [95% CI, 65-68]) aged 20-84 years; fatal incidence was 4.2-fold greater (38/100 000 [95% CI, 31-46] versus 9/100 000 [95% CI, 9-10]). Disparities were particularly apparent at younger ages (20-54 years), where age-standardized stroke incidence was 4.3-fold greater in Aboriginal people (90/100 000 [95% CI, 81-100]) than non-Aboriginal people (21/100 000 [95% CI, 20-22]). Stroke occurred more commonly, and at younger ages, in Aboriginal than non-Aboriginal populations. Greater prevalence of baseline comorbidities was present in the younger Aboriginal population. Improved primary prevention is required. To optimize stroke prevention, interventions should include culturally appropriate community-based health promotion and integrated support for nonmetropolitan health services.

Alcohol and other drug use before custody among Aboriginal and non-Aboriginal people in New South Wales, Australia

ObjectiveAlcohol and other drug (AoD) use is a significant factor in the poor health status of people in prison. Our aim is to explore associations of alcohol consumption with tobacco and illicit drug use among Aboriginal and non-Aboriginal people in prison to inform health services, clinical care and support. MethodsWe analysed the alcohol, tobacco and illicit drug use data of the 2015 Network Patient Health Survey of adults in custody in New South Wales (n=1,132). A comparative analysis of Aboriginal to non-Aboriginal participants including bi-variant and multivariant analysis was undertaken. ResultsSignificantly more Aboriginal than non-Aboriginal participants reported alcohol consumption before prison that was consistent with possible dependence. More Aboriginal than non-Aboriginal participants used cannabis on a daily or almost on daily basis before prison. There was significant association between alcohol and cannabis use among Aboriginal participants. ConclusionsThere are differences in Aboriginal and non-Aboriginal AoD use patterns, which should be considered when providing treatment and support programs within and post-release from prison. Implications for Public HealthSpecific programs are needed to assist Aboriginal people in this population who co-use alcohol and cannabis.

Attendance at, and experiences of, urban hospital outpatient appointments: informing a new model of care for urban-dwelling Aboriginal and Torres Strait Islander patients.

ObjectivesTo compare outpatient attendance rates for Aboriginal and Torres Strait Islander ('Aboriginal') and non-Aboriginal patients at a large metropolitan health service in Melbourne, Australia, and to describe the barriers and enablers experienced by urban-dwelling Aboriginal patients in attending hospital outpatient appointments.MethodsThis study used a mixed-method approach. Proportions of referred patients who booked and attended outpatient appointments were extracted from a health service database. Aboriginal versus non-Aboriginal cohorts were compared using chi-squared tests. Eleven patients, one parent of a patient and two community nurses were interviewed by telephone to investigate perceived barriers and enablers to attending outpatient appointments among Aboriginal patients.ResultsOutpatient referrals were greater among Aboriginal than non-Aboriginal people; however, referrals were significantly less likely to result in an outpatient clinic booking and attendance for Aboriginal compared to non-Aboriginal people. Interview participants reported several barriers to attending appointments, related to logistical, quality of care and cultural factors. Suggested facilitators to make appointment attendance easier included: provision of transport support, improving clinic scheduling, utilising a variety of appointment reminder formats, providing food in waiting rooms, flexible appointment timing options, outreach services, access to Aboriginal support workers, improving communication and relationships with Aboriginal people, cultural awareness training for staff and the provision of culturally appropriate spaces.ConclusionSome barriers faced by Aboriginal patients in attending hospital outpatient appointments in urban areas can be addressed through implementation of enablers suggested by participants. Data have informed the development of a tailored, inclusive, culturally and consumer-focused appropriate hospital outpatient service model of care.

‘Our people say that they want their children to be able to become doctors, nurses, teachers’: contesting education and schooling for Aboriginal children in south-eastern Australia in the 1930s

ABSTRACT This paper examines how government approaches to education were contested by Aboriginal communities in the late 1930s, through organised political actions designed in part to ensure access to the same standard of education and schooling available to non-Aboriginal people. It explores some of the ways that Aboriginal campaigns for education were enacted, focusing on the Cummeragunja Aboriginal reserve in New South Wales, when, in 1939, hundreds of residents walked off to protest to the New South Wales Aborigines Protection Board over the repressive conditions, the reserve manager, and the teacher and curriculum of the Cummeragunja school. The strike aimed to generate several changes at Cummeragunja, including the appointment of a new teacher, and the delivery of curriculum that was at the same standard as that delivered in other government schools in NSW. These demands were not unique to the Cummeragunja community as, throughout south-eastern Australia, Aboriginal communities were fighting for access to education alongside campaigns for land and greater civil rights.

Augmentative and alternative communication for Aboriginal Australians: Developing core vocabulary for Yolŋu speakers

Yolŋu, Aboriginal people from Arnhem Land, Australia are at risk of Machado-Joseph disease, with progressive loss of speech. Yolŋu are interested in developing augmentative and alternative communication (AAC) systems in their own languages. This research aimed to develop a culturally responsive process to explore and create a core vocabulary word list for Yolŋu adults living with the disease for inclusion in AAC system prototypes. A list of 243 Yolŋu words and morphemes was created. In this highly collaborative, mixed methods, participatory action research, Balanda (the Yolŋu word for non-Aboriginal people) and Yolŋu researchers conducted cycles of transcription and analysis of a language sample, with oral group discussions to identify which words to include, omit, or add, based on Yolŋu perceptions of the structure and use of their languages. A Yolŋu metaphor, Gulaka-buma (“Harvesting yams”), was identified by Yolŋu researchers to represent and share the research process and findings. Three key themes were identified that summarize the main cultural and linguistic considerations related to changes made to the core vocabulary. Study findings emphasized the role of language as an expression of culture and identity for Indigenous peoples and the importance of considering cultural and linguistic factors in selecting vocabulary for AAC systems.

Designing augmentative and alternative communication systems with Aboriginal Australians: vocabulary representation, layout, and access

Yolŋu (Aboriginal Australians of northeast Arnhem Land) are interested in developing augmentative and alternative communication (AAC) systems in their own languages to support communication opportunities and participation for their family members living with Machado–Joseph disease. Designing AAC systems in Aboriginal languages requires consideration of unique linguistic and cultural elements. Participatory action research in strength-based communication contexts was carried out by Yolŋu and Balanda (the Yolŋu word for non-Aboriginal people) researchers working together through a collaborative intercultural process. Culturally responsive literacy, language, and AAC activities were used to develop four prototype Yolŋu AAC sytems for Yolŋu with varied literacy skills. Data were coded using gerunds to identify and focus on action in the data. Reflective and analytical collaborative, oral group discussions were used to identify key considerations and, ultimately, a Yolŋu metaphor for the research. Yolŋu language, culture and worldview impacted all aspects of prototype design and decision making. Salient considerations related to representation, organization, layout, and access, are presented. Clinical implications and future research considerations are outlined.

Improved metabolic parameters of people with diabetes attending an Aboriginal health service in regional Victoria.

Aboriginal and Torres Strait Islander people have higher rates of diabetes and its complications than non-Aboriginal people. Rumbalara Aboriginal Co-operative is the major primary healthcare provider for Aboriginal people in the Greater Shepparton region. To evaluate the baseline metabolic parameters and presence of diabetes complications in people with type 2 diabetes attending Rumbalara Aboriginal Co-operative in 2017 and compare it with other Aboriginal and Torres Strait Islander studies and Australian specialist diabetes services. Clinical and biochemical characteristics, including diabetes type, age, weight, body mass index (BMI), blood pressure, micro- and macrovascular complications, glycosylated haemoglobin (HbA1c), haemoglobin, renal function, lipid profile, urine albumin:creatinine ratio, diabetes medications, renin angiotensin system inhibition therapies, HMG-CoA reductase inhibitors and antiplatelet agents, were determined. One hundred and twenty-six individuals had diabetes, 121 had type 2 diabetes. One hundred and thirteen identified as Aboriginal and/or Torres Strait Islander. Median age was 57.5 (48-68) years, median HbA1c was 7.8% (6.8-9.6) and median BMI was 33.4 kg/m2 (29-42.3). Compared with other Australian Aboriginal and Torres Strait Islander populations, this population was older and had more obesity, but with better glycaemia management. Compared with specialist diabetes services, this population was of similar age, with greater BMI but comparable HbA1c. Aboriginal people living with type 2 diabetes attending this regional Aboriginal health service have comparable glycaemic management to specialist diabetes services in Australia, managed largely by primary care physicians with limited access to specialist care for the past 5 years.

Pancreatitis and post-pancreatitis diabetes in Central Australia.

Pancreatitis and diabetes are common among Aboriginal people of Central Australia. The contribution of pancreatitis to the development of post-pancreatitis diabetes mellitus (PPDM) is not known. To describe among Aboriginal and non-Aboriginal people living in Central Australia, (i) the prevalence and aetiology of acute (AP) and chronic pancreatitis (CP), and (ii) diagnosis of new onset diabetes after pancreatitis. Retrospective medical record review of patients ≥15 years admitted to hospitals in the Central Australia Health Service between 2009 and 2018 with pancreatitis. Prevalence as a proportion of the resident population and aetiology of AP and CP were determined. Diagnosis of new onset diabetes after admission with pancreatitis was assessed. Of the 638 patients assessed, 73% were Aboriginal and 48% female. The annual prevalence in 2009 and 2018 for AP was 171 and 203 per 100 000 persons, and for CP was 206 and 114 per 100 000 persons respectively. Rates were high in Aboriginal people. Alcohol aetiology was most common in Aboriginal people (66%) and biliary aetiology in non-Aboriginal people (37%). A diagnosis of diabetes after pancreatitis was detected in 125 (29%) of 438 patients who did not have a diabetes diagnosis previously recorded, and 20 of the 22 tested for diabetes-associated antibodies were negative, fitting criteria for PPDM. Prevalence of AP and CP in Central Australia was higher in Aboriginal than non-Aboriginal people. Few patients with diabetes recorded after pancreatitis had appropriate PPDM diagnostic testing. Interdisciplinary education on the diagnosis of PPDM is required.

The Indigenous Adolescent Oral Health Partnership Study: A Co-Design Study Protocol.

Background: in this protocol we outline a method of working alongside Aboriginal communities to learn about and facilitate improvement in the oral health habits in Aboriginal adolescents. By facilitating positive oral health in Aboriginal adolescents, we hope to achieve lifelong improvement in oral health and general wellbeing. Methods: this paper outlines a co-design methodology through which researchers and Aboriginal communities will work together to create a custom oral healthcare program aimed at Aboriginal adolescents. Researchers, a youth advisory group, Aboriginal community-controlled health services and three regional NSW communities will together devise an oral health strategy focused on five components: application of topical fluoride, increasing water consumption, improving nutrition, daily toothbrushing, and enhancing social and emotional wellbeing. Capacity building is a key outcome of this program. Discussion: as the gap in health status between Aboriginal and non-Aboriginal people remains wide, it is clear that new approaches and attitudes are needed in Aboriginal public health research. This protocol is representative of this shifting approach; giving power to Aboriginal communities who seek to have sovereignty and self-determination over their healthcare. Trial registration: TRN: ISRCTN15496753 Date of registration: 20 October 2021.

Community Book Projects: A Case Study of Place-based Collaborations

This case study centres on projects instigated by the University of Wollongong’s Batemans Bay campus which engaged other community entities in collaboration to produce a cultural and educational resource in book form. These projects occurred between 2017 and 2019 with more planned for the future. While this work is not a how-to guide, the analysis contained within will allow a broad application of principles in other contexts to increase community engagement and collaboration. The broad principles for success of such projects are identified as Place, Relationships, and Communication. These key elements are evaluated from a researcher/participant perspective and the inter-play between these crucial elements in an educational framework is described as Nourishing Pedagogy. The conceptualisation of Country as Teacher, a framework in which both Aboriginal and non-Aboriginal people can learn from Country, was a crucial element as the On Country Learning (OCL) experiences were the primary sites where the Nourishing Pedagogy practice was manifest. While there are many factors that contributed to the success of the projects it was clear that the privileging of Aboriginal perspectives and the yielding of institutional power, taking the form of the decampment of institutional buildings for the purpose of participating in the projects, was critical.

Aboriginal peoples’ perspectives about COVID-19 vaccines and motivations to seek vaccination: a qualitative study

IntroductionAboriginal and Torres Strait Islander (Aboriginal) people compared with non-Aboriginal people in Australia have higher rates of chronic conditions. These conditions increase the risk of poorer health outcomes if infected...

Suicides in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm: A retrospective cohort data linkage study from the Northern Territory.

This study aimed to explore risk factors for suicide in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm in the Northern Territory, Australia to help clarify opportunities for improved care and intervention for these population groups. Individuals with at least one hospital admission involving suicidal ideation and/or self-harm between 1 July 2001 and 31 December 2013 were retrospectively recruited and followed up using linked mortality records to 31 December 2014. Survival analyses stratified by Indigenous status identified socio-demographic and clinical characteristics from index hospital admissions associated with suicide. Just over half of the 4391 cohort members identified as Aboriginal (n = 2304; 52.4%). By 2014, 281 deaths were observed comprising 68 suicides, representing a 2.6% and 2.0% probability of suicide for Aboriginal and non-Aboriginal people, respectively. After adjusting for other characteristics, a higher risk of suicide was associated with male sex (Aboriginal adjusted hazard ratio: 4.14; 95% confidence interval: [1.76, 9.75]; non-Aboriginal adjusted hazard ratio: 5.96; 95% confidence interval: [1.98, 17.88]) and repeat hospital admissions involving self-harm (Aboriginal adjusted hazard ratio: 1.37; 95% confidence interval: [1.21, 1.55]; non-Aboriginal adjusted hazard ratio: 1.29; 95% confidence interval: [1.10, 1.51]). Severe mental disorders were associated with a four times higher risk of suicide (adjusted hazard ratio: 4.23; 95% confidence interval: [1.93, 9.27]) in Aboriginal people only. The findings highlight non-clinical risk factors for suicide that suggest the need for comprehensive psychosocial assessment tailored to Aboriginal and non-Aboriginal people hospitalised with suicidal ideation or self-harm. Implementing appropriate management and aftercare within a broader public health framework is needed to support recovery and reduce long-term suicide risk in the community, especially for Aboriginal people and males.

On Taungurung Land Sharing History and Culture by Uncle Roy Patterson and Jennifer Jones

Reviewed by: On Taungurung Land Sharing History and Culture by Uncle Roy Patterson and Jennifer Jones Julia Hurst On Taungurung Land Sharing History and Culture By Uncle Roy Patterson and Jennifer Jones. Canberra: Australian National University Press, 2020. Readers are advised that this writing contains the names of Aboriginal people who are deceased. I attempted a number of times to find my way into the rhythm and knowing of Uncle Roy Patterson and Jennifer Jones’s book On Taungurung Land Sharing History and Culture. My last and final attempt was on 26 January this year as social media pinged with calls to “Change the Date” (of Australia Day) and with pictures of the Aboriginal flag finally “freed.” So, with a heavy critique already instilled in my heart, I began to read through the opening chapters. I must admit for a while I could not find my way into the narrative. I wondered, is this all there is? As I continued though, the story became clear and the deep knowledge, reciprocity and care taken to create this book became evident. I am so glad I persisted. I do, however, have some concerns. Historian Jennifer Jones was approached to co-author this book with Uncle who died before their work was complete. Uncle wanted to secure his knowledge for future generations: “I want this book to get out to people that I don’t teach and schools I don’t get near, to museums and universities that know nothing about it. It will be something to show about our culture” (4). As Jones described, Uncle believed that encounters with significant Aboriginal places and place-based knowledge could be transformative for both Aboriginal and non-Aboriginal people. I agree with this sentiment. The book is divided into two sections. The first section (chapters one to five) detail Taungurung history since invasion. Written in Jones’ scholarly voice, her focus is on the settler policies of “protection” that affected Taungurung people and Uncle’s ancestors, highlighting the decisions of relevant white settlers and officials. As Jones explains, her aim was to contextualise the knowledge that Uncle shared with her by developing a biographical and historical picture of the settlers with whom Taungurung people interacted, and to provide a foundation for the full appreciation of Taungurung survival. Intermittently, the ghostly voice of Uncle interrupts the archive to verify the history being shared against his generational oral knowledge. The brief interceptions of Uncle’s voice remind the reader that there is indeed more going on here than meets the archive and this story. The second section (chapters six to eight) focuses on Taungurung cultural knowledge as passed down to Uncle. Written in his voice, this section offers a keen and welcome departure from the first. His storytelling relates to his generational and cultural knowledge of bush tucker, bush medicine and Taungurung cultural practices. This section is richly descriptive and generous. However, the writing was left to Jones and when people asked her whether she could finish the book without Uncle, she reflected, “perhaps the answer should have been ‘no’” (7). I do not believe that this should have been the case although I do wonder why she persisted if this is what she thinks. I can imagine, if Uncle was still alive, the structure of the book might be very different, and here there is an important point to make. Uncle had no control over the final product, his legacy. Jones’ aim was to provide a foundation for Uncle’s story to rest. She presents the reader with an archival history of Aboriginal protection, greed and power on Taungurung land and a separate account of Uncle’s generational Aboriginal Knowledge. This structure sits uneasily with me because it sustains a status quo whereby the very active making of Aboriginal history, storytelling and handing-down of his generational knowledge at the time of invasion, colonisation and making of the archive still remains. Why does the archive of his scholarly work (as Aboriginal expert) sit outside of the “scholarly archive” of Jones’ historical writing? Is Uncle’s generational knowledge not considered part of history-making? What is so obvious about this work, is that Taungurong people were handing on...

Vaccine success and challenges in northern Australia

Aboriginal and Torres Strait Islander people living in rural and remote Australia have lower vaccine coverage rates and experience higher rates of notification and hospitalisations for vaccine preventable diseases than non-Aboriginal people. This paper explores important public health and research activities being undertaken in the Northern Territory to reduce this disparity in vaccine program performance, with a particular focus on rotavirus, meningococcal, human papilloma virus and COVID-19 vaccines.