Remote Aboriginal Communities Research Articles

“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.

Development of a Tool for Reporting Key Dietary Indicators from Sales Data in Remote Australian Aboriginal and Torres Strait Islander Community Stores.

Reporting key dietary indicators from sales data can help us guide store decision makers in developing effective store policy to support healthier customer purchases. We aimed to develop a web-based reporting tool of key dietary indicators from sales data to support health-promoting policy and practice in stores in geographically remote Aboriginal and Torres Strait Islander communities. Tool development included identifying key dietary indicators (informed by sales data from 31 stores), community consultation (19 Aboriginal and Torres Strait Islander store directors and two store managers) and a web-build. Tool evaluation involved feedback interviews with stakeholders (25 store managers and two nutritionists). Key dietary indicators aligned with Australian Dietary Guideline food groupings and recommendations. An online portal for accessing and customising reports was built. Stakeholder feedback indicated that the strengths of the reports were the visuals, ease of interpretation, providing information that was not currently available and potential to increase capacity to support healthy food retailing. Difficulties were defining healthiness classification with alignment to other nutrition guidelines used and ensuring reports reached relevant store decision makers. This tool may be valuable to support store decision makers in identifying and prioritising nutrition issues and optimising the health-enabling attributes of stores.

“We Need to Run Our Own Communities”

Australian Indigenous student participation rates in higher education are consistently lower than non-Indigenous students, especially in remote contexts. This has manifested in the usurpation of remote Aboriginal community control by ‘more qualified’ external staff. Here we present a reflexive assessment of the development, delivery, outcomes and challenges of the Wuyagiba Bush Uni that was designed to address the paucity of university education in remote Aboriginal communities of Arnhem Land, Northern Territory. From 2018 to 2022, 66 Indigenous students graduated with Wuyagiba Micro-credentials (accredited by Macquarie University), and 28 students proceeded to enrol in Bachelor level degrees at Macquarie University in Sydney, with the first graduate in 2023. Furthermore, the Wuyagiba model has created a successful remote Indigenous business that employs about 50 local Indigenous people annually and is working towards empowering endogenous community development in remote Arnhem Land. Nevertheless, many challenges remain including sustainable funding, remote service delivery, university and bureaucratic structural barriers, and lateral violence in remote communities. Several enabling factors of success are identified, such as the cross-cultural curriculum, strong Indigenous control and leadership, wrap-around support, and longstanding relationships between University staff and community leaders. Such reflections can be used by other remote Aboriginal communities who wish to replicate this model or create their own on-Country higher education programs to empower locally trained leaders of the future.

Using photovoice to generate solutions to improve food security among families living in remote Aboriginal and/or Torres Strait Islander communities in Australia

The right to food security has been recognised internationally, and nationally in Australia by Aboriginal Community Controlled Health Organisations. This study aims to explore food (in)security and solutions for improvement of food security in remote Aboriginal and/or Torres Strait Islander communities in Australia, from the perspective of caregivers of children within the context of the family using photovoice. Participants took part in workshops discussing participant photographs of food (in)security, including solutions. Themes and sub-themes with associated solutions included traditional food use, sharing as a part of culture, the cost of healthy food, energy and transport, and housing and income. Community leaders used these data in setting priorities for advocacy to improve food security in their communities.

Emotional reactions to concepts of racism and white privilege in non-Aboriginal professionals working in remote Aboriginal communities.

This research, conducted by a non-Aboriginal, White researcher, examines how health professionals working in remote Aboriginal communities engage with antiracism as instructed by national standards, whether strong emotions are elicited while reflecting on these concepts, and how these reactions impact on antiracist professional practice. Eleven non-Indigenous allied health professionals were interviewed in a semi-structured format. Interviews were transcribed, thematically analysed and compared to existing literature. Every participant identified overwhelming emotions that they linked to reflecting on racism, White privilege and colonisation. Professionals reported grappling with denial, anger, guilt, shame, fear, anxiety and perfectionism, loss of belonging, disgust and care. They reported that these emotions caused overwhelm, exhaustion, tensions with colleagues and managers, and disengagement from antiracism efforts, and contributed to staff turmoil and turnover. Previously, these emotional reactions and their impact on antiracism have only been described in the context of universities and by antiracist activists. This research identifies for the first time that these reactions also occur in health services in Aboriginal communities. Wider research is needed to better understand how these reactions impact on health service delivery to Aboriginal communities, and to evaluate ways of supporting staff to constructively navigate these reactions and develop antiracist, decolonised professional practice.

A qualitative exploration of the experiences of Aboriginal and Torres Strait Islander people using a real-time video-based telehealth service for diabetes-related foot disease.

Diabetes-related foot disease (DFD) is one of the most prevalent causes of global hospitalisation and morbidity, and it accounts for up to 75% of lower-extremity amputations globally. The 5-year mortality rate following any amputation ranges from 53% to 100%. Early identification of wounds and multidisciplinary management can reduce amputation rates by 39-56%. Rural and remote communities and Indigenous populations are disproportionately affected by DFD. This is reflected in amputation rates, which are much higher for Indigenous than for non-Indigenous Australians and for those in very remote areas than for those in major cities or inner regional areas. The large geographical spread of the population in Australia is a substantial barrier for those providing or accessing health services, particularly multidisciplinary and specialist services, which undoubtedly contributes to poorer DFD outcomes in rural and remote communities. A real-time, video-based telehealth service for DFD management was established at the Royal Adelaide Hospital Vascular Services clinic to improve access to specialist services for rural and remote Aboriginal and Torres Strait Islander communities. An exploratory qualitative study that utilised one-on-one, semi-structured interviews was conducted with 11 participants who identified as Aboriginal and who had participated in the telehealth foot service. Interviews were transcribed, de-identified and analysed using thematic analysis, using an inductive approach. Four interrelated themes emerged. 'Practical benefits of staying home' describes the reduced burden of travel and advantages of having local healthcare providers and support people at consultations. 'Access to specialists and facilities' highlights how some participants felt that there was a lack of appropriate facilities in their area and appreciated the improved access telehealth provided. 'Feeling reassured that a specialist has seen their feet' reflects the positive impact on wellbeing that participants experienced when their feet were seen by specialist health staff. 'Facilitates communication' describes how participants felt included in consultations and how seeing a person on screen assisted conversation. The advantages of real-time, video-based telehealth go beyond reduced travel burden and improved access to specialist care. This model of care may facilitate relationship-building, patient wellbeing, and feelings of trust and safety for Aboriginal and Torres Strait Islander DFD patients.

HipHop2SToP a community-led health promotion initiative empowering Aboriginal youth in the Kimberley region of Western Australia: a process evaluation.

For millennia, Aboriginal people's ways of knowing, doing and being were shared through art, song, and dance. Colonisation silenced these ways, affecting loss of self-determination for Aboriginal people. Over the past decade in Australia, hip-hop projects have become culturally appropriate approaches for health promotion. When community led, and Aboriginal worldviews centralised, hip-hop workshops are more likely to be effective. In 2020, during the COVID-19 pandemic, a community-led health promotion hip-hop music video, 'HipHop2SToP' was produced involving young people in Dampier Peninsula communities address healthy skin and healthy living practices. We report here a qualitative process evaluation of the HipHop2SToP project. Participants who had been involved in the planning and production of HipHop2SToP were selected using a purposive approach and invited either by email or face-to-face to participate in semi-structured interviews and share their experiences. Semi-structured interviews ranged from 30 to 60 min in duration and were conducted either face-to-face or virtually over MS Teams. Due to personal time constraints, two participants provided written responses to the semi-structured questions. All interviews were audio-recorded with consent and saved as a digital recording in a de-identified format. All audio recordings were transcribed verbatim and uploaded into QSR NVivo v12 along with written responses. As a health promotion project, the critical success factors were community-ownership and discovering novel ways to collaborate virtually with remote communities using Microsoft (MS) software. Highlights included observing the young people actively engaged in the project and their catchy lyrics and key messaging for environmental health and skin infections. COVID-19 presented some challenges. Gaps in communication, clarification of stakeholder roles and expectations, and post-production outcomes were also identified as challenges. HipHop2SToP validates the need for Aboriginal community led health promotion programs. While creating some challenges COVID-19 also strengthened community ownership and created novel ways of maintaining relationships with remote Aboriginal communities. Future hip-hop projects would benefit from clarity of roles and responsibilities. Strengthening post-production outcomes by including a launch and well-planned, targeted communication and dissemination strategy will ensure the wider translation of important health messages and potential strengthen sustainability.

Investment Policy Impacts on the Australian Aboriginal Art Market

AbstractLegislation designed for one purpose may have unrelated side effects. In this article we examine the impact of recent changes in the application of the sole purpose test for artworks to be used as assets in retirement funds on the Australian Aboriginal art market. This is important since art sales represent a significant source of non‐government income for remote Australian Aboriginal communities. In this article we estimate the impact of this change and others on the price index based on the hammer prices paid for 13,555 works by 187 artists at art auctions from 1994 to 2019.

Jandu Yani U (for all families): evaluating Indigenous Triple P, a community-tailored parenting support program in remote Aboriginal communities

ABSTRACT Objectives Although evidence-based parenting programs are widely available, they remain inaccessible to many families of children with social, emotional and behavioural problems, particularly in remote settings. In partnership with Aboriginal communities in the remote Fitzroy Valley, Western Australia, we introduced and evaluated the Indigenous Triple P – Positive Parenting Program, with additional Stepping Stones Triple P strategies (for children with complex needs). Implementation followed community consultation and program adaptation to acknowledge local culture, social complexities and language. The initiative was named Jandu Yani U, meaning “for all families” in the local Bunuba language. Method Local practitioners (parent coaches) were trained to deliver Triple P. Parents and carers (henceforth carers) of children up to 15 years of age were invited to participate. Families attending the program reported on child behaviour, parenting practices, self-efficacy, wellbeing and empowerment pre- and post-intervention and at 8-month follow-up using standardised assessment tools delivered by local community navigators. Results Of 30 participating families, 100% completed Triple P and reported the program was culturally appropriate. Of the index children, 93% were Aboriginal, 63% boys, median age 6.83 years. Following the program, carers reported high levels of empowerment and reaching goals for behaviour change (p < .001) and less use of unhelpful parenting strategies (over-reactivity and hostility; p < .05), and this maintained at 8-month follow-up (p < .001). At follow-up, improvement in carer self-efficacy (p < .001) and reduced anxiety (p < .001) were documented. Significant improvements in prosocial behaviour, reductions in challenging behaviour and decreased intensity and frequency of behavioural problems (all p < .05) were reported in children at follow-up. The average level of goal attainment was 65% at post, which was maintained at follow-up. Conclusion This study demonstrates the feasibility of delivering Indigenous Triple P to Aboriginal families in remote settings, and the importance of partnership with communities. Program tailoring, flexible delivery, use of Aboriginal parent coaches and provision of practical support to families resulted in a culturally acceptable parent support program. With local Aboriginal co-design, this initiative should be generalisable to similar remote communities elsewhere.

James Wigley and the Strelley Mob: Social Realist Painting in an Aboriginal Community

ABSTRACT James Wigley has been historicised by Australian art scholars as a social realist, but the focus of his work through the late 1950s, 1960s and 1970s differed from others who were a part of this art movement. During this time, he returned again and again to join the “strike mob” who had walked off pastoral stations in the Pilbara in 1946 and become independent by mining and purchasing their own pastoral properties. The organiser of the strikers, Don McLeod, invited Wigley to help the strikers with building boats to gather pearl shell, and later to run a printing press at the school in the new settlement of Strelley, on one of their pastoral leases. During his time with the strikes, Wigley drew and painted; he would send work to Melbourne and return there to exhibit work about the Pilbara and the people who lived there. He also illustrated the schoolbooks he was printing for the Strelley Literature Centre in the late 1970s. This article argues that this significant body of work places Wigley alongside other Australian artists who spent substantial time in remote Aboriginal communities, and whose experiences shaped their art.

Costs and benefits of community water fluoridation in remote Aboriginal communities of the Northern Territory.

To undertake an economic evaluation of community water fluoridation (CWF) in remote communities of the Northern Territory (NT). Dental caries experiences were compared between CWF and non-CWF communities before and after intervention. Costs and benefits of CWF are ascertained from the health sector perspective using water quality, accounting, oral health, dental care and hospitalisation datasets. Remote Aboriginal population in the NT between 1 January 2008 and 31 December 2020. CWF. Potential economic benefits were estimated by changes in caries scores valued at the NT average dental service costs. Given the total 20-year life span of a fluoridation plant ($1.77 million), the net present benefit of introducing CWF in a typical community of 300-499 population was $3.79 million. For each $1 invested in CWF by government, the estimated long-term economic value of savings to health services ranged from $1.1 (population ≤300) to $16 (population ≥2000) due to reductions in treating dental caries and associated hospitalisations. The payback period ranged from 15 years (population ≤300) to 2.2 years (population ≥2000). The economic benefits of expanding CWF in remote Aboriginal communities of NT outweigh the costs of installation, operation and maintenance of fluoridation plants over the lifespan of CWF infrastructure for population of 300 or more.

An outbreak of acute rheumatic fever in a remote Aboriginal community

ObjectivesWe describe the public health response to an outbreak of acute rheumatic fever (ARF) in a remote Aboriginal community. MethodsIn August 2021, the Northern Territory Rheumatic Heart Disease Control Program identified an outbreak of acute rheumatic fever in a remote Aboriginal community. A public health response was developed using a modified acute poststreptococcal glomerulonephritis protocol and the National Acute Rheumatic Fever Guideline for Public Health Units. Results12 cases were diagnosed during the outbreak; six-times the average number of cases in the same period in the five years prior (n=1.8). Half (n=6) of the outbreak cases were classified as recurrent episodes with overdue secondary prophylaxis. Contact tracing and screening of 11 households identified 86 close contacts. ConclusionsThis outbreak represented an increase in both first episodes and recurrences of acute rheumatic fever and highlights the critical need for strengthened delivery of acute rheumatic fever secondary prophylaxis, and for improvements to the social determinants of health in the region. Implications for Public HealthOutbreaks of acute rheumatic fever are rare despite continuing high rates of acute rheumatic fever experienced by remote Aboriginal communities. Nevertheless, there can be improvements in the current national public health guidance relating to acute rheumatic fever cluster and outbreak management.

Connecting In The Gulf: Digital Inclusion For Aboriginal Families On Mornington Island

This essay visually describes an Indigenous research project exploring digital inclusion with Aboriginal families on Mornington Island, a remote Aboriginal community in Queensland, Australia. Yarning, an Indigenous storytelling and conversational research method, was combined with photography (some participant photography, but primarily researcher photography) in a new method termed ‘show and yarn’. This method allowed community members space to show us their devices, have images taken of these devices and then use these images as a prompt for yarns about their experiences using the internet, mobile phones and technology. The author is an Indigenous researcher, who had existing connections with Mornington Island residents and it was through these relationships that the community came to be a partner in this research.

Community-based Aboriginal staff taking the lead in family support: a case study of transforming practices prompted by the COVID-19 pandemic

ABSTRACT The Play to Connect programme is an ongoing action research project investigating implementation of a parenting programme for families and children living in disadvantaged remote Aboriginal communities in Australia’s Northern Territory. The aim of this research was to identify critical skills and supports needed for community staff to deliver family support services in their community. The presented collaborative research project was undertaken by two community-based Aboriginal implementation officers and two visiting practitioners between March 2020 and December 2021. At this time, social service delivery was impacted by COVID-19 lockdown restrictions when visiting staff were temporarily permitted to fly into remote communities. The visiting practitioners interviewed the local Aboriginal community staff after family visits to explore how to build their professional competencies and contribute to the nature of programme delivery. Thematic analysis of the interviews and debriefing notes emphasise three key factors crucial in building professional competencies: experiential and reflective learning; partnership and collaboration; and increased self-efficacy. The promising practices identified have potential for broader application across Aboriginal communities to enhance cross-cultural and multi-disciplinary teamwork for service delivery. These professional development processes can ensure more accessible programmes for Indigenous communities based on cultural relevance and the diverse needs of participating families.

The Kimberley Dental Team: a volunteer-based model of care serving remote Aboriginal communities.

Improving the oral health of Aboriginal and Torres Strait Islander people has been prioritised by both of the Australian National Oral Health Plans (2004-2013 and 2015-2024). However, providing adequate access to timely dental care to remote Aboriginal communities remains a challenge. The Kimberley region of Western Australia in particular experiences a significantly higher prevalence of dental disease compared to other regional centres. The region covers an area of over 400 000 km2, with 97% of this being classified as very remote and 42% of the population identifying as Aboriginal and/or Torres Strait Islander. The provision of dental care to remote Aboriginal communities in the Kimberley is complex and involves careful consideration of the unique environmental, cultural, organisational and clinical factors at play. The low population densities combined with the high running costs of a fixed dental practice mean that establishing a permanent dental workforce is generally not viable in remote communities in the Kimberley. Thus there is a pressing need to explore alternative strategies to extend care to these communities. In this context, the Kimberley Dental Team (KDT), a non-government, volunteer-led organisation, was established to 'fill the gaps' and extend dental care to areas of unmet need. There is currently a lack of literature around the structure, logistics and delivery of volunteer dental services to remote communities. This paper describes the KDT, its development, resources, operational factors and organisational characteristics of the model of care, including mapping the reach of the program. This article underlines the challenges around dental service provision to remote Aboriginal communities and the evolution of a volunteer service model over the course of a decade. The structural components integral to the KDT model were identified and described. Community-based oral health promotion through initiatives such as supervised school toothbrushing programs enabled access to primary prevention for all school children. This was combined with school-based screening and triage to identify children in need of urgent care. Collaboration with community-controlled health services and cooperative use of infrastructure enabled holistic management of patients, continuity of care and increased efficiency of existing equipment. Integration with university curricula and supervised outreach placements were used to support training of dental students and attract new graduates into remote area dental practice. Supporting volunteer travel and accommodation and creating a sense of family were central to volunteer recruitment and sustained engagement. Service delivery approaches were adapted to meet community needs; a multifaceted hub-and-spoke model with mobile dental units was used to increase the reach of services. Strategic leadership through an overarching governance framework built from community consultation and steered by an external reference committee informed the model of care and its future direction.

The Kimberley Dental Team: A process evaluation of a volunteer dental programme serving remote Aboriginal communities in Australia.

This study aims to conduct a process evaluation of the Kimberley Dental Team (KDT), a not-for-profit, volunteer organization providing care to remote Aboriginal communities in Western Australia. A logic model was constructed to detail the operational context of the KDT model. Subsequently, the fidelity (the extent to which each of the programme's elements were implemented as planned), dose (types and quantity of services provided) and reach (demographic characteristics and communities serviced) of the KDT model were evaluated using service data, deidentified clinical records and volunteer rosters maintained by KDT from 2009 to 2019. Trends and patterns of service provision were analysed using total counts and proportions over time. A Poisson regression model was used to explore changed in the rates of surgical treatment over time. The associations between volunteer activity and service provision was also investigated using correlation coefficients and linear regression. A total of 6365 patients (98% identifying as Aboriginal or Torres Strait Islander) were seen over the 10-year period with services being provided across 35 different communities in the Kimberley. Most services were provided to school-aged children, consistent with the programme's objectives. The peak preventive, restorative and surgical rates occurred among school-aged children, young adults and older adults respectively. A trend was observed indicating a reducing rate of surgical procedures from 2010 to 2019 (p < .001). The volunteer profile showed significant diversity beyond the conventional dentist-nurse structure and 40% being repeat volunteers. The KDT programme maintained a strong focus on service provision to school-aged children over the last decade with the educational and preventive components being central to the care being provided. This process evaluation found that the dose and reach of the KDT model grew with an increase in resources and was adaptive to perceived community need. The model was shown to evolve through gradual structural adaptations contributing to its overall fidelity.

Evaluating the role of asymptomatic throat carriage of Streptococcus pyogenes in impetigo transmission in remote Aboriginal communities in Northern Territory, Australia: a retrospective genomic analysis

Streptococcus pyogenes, or group A Streptococcus (GAS), infections contribute to a high burden of disease in Aboriginal Australians, causing skin infections and immune sequelae such as rheumatic heart disease. Controlling skin infections in these populations has proven difficult, with transmission dynamics being poorly understood. We aimed to identify the relative contributions of impetigo and asymptomatic throat carriage to GAS transmission. In this genomic analysis, we retrospectively applied whole genome sequencing to GAS isolates that were collected as part of an impetigo surveillance longitudinal household survey conducted in three remote Aboriginal communities in the Northern Territory of Australia between Aug 6, 2003, and June 22, 2005. We included GAS isolates from all throats and impetigo lesions of people living in two of the previously studied communities. We classified isolates into genomic lineages based on pairwise shared core genomes of more than 99% with five or fewer single nucleotide polymorphisms. We used a household network analysis of epidemiologically and genomically linked lineages to quantify the transmission of GAS within and between households. We included 320 GAS isolates in our analysis: 203 (63%) from asymptomatic throat swabs and 117 (37%) from impetigo lesions. Among 64 genomic lineages (encompassing 39 emm types) we identified 264 transmission links (involving 93% of isolates), for which the probable source was asymptomatic throat carriage in 166 (63%) and impetigo lesions in 98 (37%). Links originating from impetigo cases were more frequent between households than within households. Households were infected with GAS for a mean of 57 days (SD 39 days), and once cleared, reinfected 62 days (SD 40 days) later. Increased household size and community presence of GAS and scabies were associated with slower clearance of GAS. In communities with high prevalence of endemic GAS-associated skin infection, asymptomatic throat carriage is a GAS reservoir. Public health interventions such as vaccination or community infection control programmes aimed at interrupting transmission of GAS might need to include consideration of asymptomatic throat carriage. Australian National Health and Medical Research Council.

Elders' perspectives and priorities for ageing well in a remote Aboriginal community

Abstract Aboriginal Elders in Australia are recognised as having an important role as community leaders and cultural knowledge holders. However, the effects of colonisation and institutional racism mean Elders also experience significant social and economic disadvantage and poor health outcomes. There has been a systemic lack of attention to the worldviews and priorities of Aboriginal people as they age. In this article, we detail the findings of a qualitative study using a localised Aboriginal Elder-informed methodology that involved interviews and focus groups with 22 Aboriginal Elders in the remote town of Walgett on what ageing well means to them. This study was undertaken as part of a long-term partnership between a unique community-controlled Elders organisation and a university. The findings illuminate the barriers and enablers to ageing well for Aboriginal people in Walgett and elsewhere, and demonstrate the value to research, policy and service delivery of listening to and learning from Elders, centring Indigenous knowledges and worldviews, and bringing a more holistic conceptualisation of wellbeing to the understanding of what it means to age well.

Food security in Aboriginal and Torres Strait Islander communities in remote Australia during the COVID-19 pandemic: An analysis of print news media and press releases

ObjectiveThis article aims to examine the framing of the issue of food security in very remote Aboriginal and Torres Strait Islander communities in print media and press releases during the beginning of the COVID-19 pandemic in 2020. MethodsNewspaper articles were identified following a systematic search of the Factiva database, and press releases were identified from manual search of key stakeholder websites from January to June 2020 and analysed using a combined adapted framework of the Bacchi’s What’s the Problem Represented to be? Framework and the Narrative Policy Framework. ResultsA food delivery “problem” dominated representations in press releases, and food supply at store level had prominence in print media. Both presented the cause of food insecurity as a singular, identifiable point in time, framed the issue as one of helplessness and lack of control, and proposed policy action. ConclusionsThe issue of food security was represented in the media as a simple issue requiring an immediate fix, as opposed to a complex issue requiring a systems-level and sustained policy response. Implications for public healthThis study will help to guide future media dialogue to impact on both immediate and longer-term solutions to food insecurity in very remote Aboriginal and Torres Strait Islander communities in Australia.

Community-based water demand management: socio-technical strategies for improving water security in Australian Indigenous communities

Sustainable water management in remote Australian communities is a delicate balance between sufficient and acceptable supply options and appropriate and effective demand approaches. This paper focus on the evaluation of community-based water demand management strategies piloted in four remote Aboriginal and Torres Strait Island communities in Australia. Findings of the pilot demonstrate that from a systems perspective, community-based demand management centred around education and encouragement of residents to conserve and use water efficiently, provide greater opportunities for long-term sustainable water management outcomes that support building of social capital. To ensure truly transformative management outcomes, a toolbox of socio-technological strategies should be used including, where possible, smart metering of water consumption and use of water-efficient devices. A key element of this approach to demand management calls for a shift away from business-as-usual policy towards a flexible learning approach that involves genuine collaboration between water managers and Indigenous communities.