Torres Strait Islander Communities Research Articles

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.

A rapid review to inform the policy and practice for the implementation of chronic disease prevention and management programs for Aboriginal and Torres Strait Islander people in primary care

BackgroundMore than 35% of Aboriginal and Torres Strait Islander adults live with cardiovascular disease, diabetes, or chronic kidney disease. There is a pressing need for chronic disease prevention and management among Aboriginal and Torres Strait Islander people in Australia. Therefore, this review aimed to synthesise a decade of contemporary evidence to understand the barriers and enablers of chronic disease prevention and management for Aboriginal and Torres Strait Islander People with a view to developing policy and practice recommendations.MethodsWe systematically searched for peer-reviewed published articles between January 2014 to March 2023 where the search was performed using subject headings and keywords related to “Aboriginal and Torres Strait Islander peoples,” “Chronic Disease,” and “Primary Health Care”. Quality assessment for all included studies was conducted using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. The data were extracted and summarised using a conventional content analysis approach and applying strength-based approaches.ResultsDatabase searches identified 1653 articles where 26 met inclusion criteria. Studies varied in quality, primarily reporting on 14 criteria of the Aboriginal and Torres Strait Islander Quality Appraisal Tool. We identified six key domains of enablers and barriers of chronic disease prevention and management programs and implied a range of policy and practice options for improvement. These include culturally acceptable and safe services, patient-provider partnerships, chronic disease workforce, primary health care service attributes, clinical care pathways, and accessibility to primary health care services. This review also identified the need to address social and cultural determinants of health, develop the Aboriginal and Torres Strait Islander and non-Indigenous chronic disease workforce, support multidisciplinary teams through strengthening clinical care pathways, and engage Aboriginal and Torres Strait Islander communities in chronic disease prevention and management program design and delivery.ConclusionEnabling place-based partnerships to develop contextual evidence-guided strategies that align with community priorities and aspirations, with the provision of funding mechanisms and models of care through policy and practice reforms will strengthen the chronic disease prevention and management program for Aboriginal and Torres Strait Islander people.

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.

Smoke: Enablers and barriers for sustainable engagement with local Aboriginal communities

For many years, activists in Early Childhood Education and Care (ECEC) have called for the sector to engage closely with Aboriginal and Torres Strait Islander families and communities. However, less is documented on how mainstream services might achieve authentic, sustained engagement at a local service level. This paper showcases educators who connect with local Aboriginal community members/Elders as a central plank of their ECEC practice. In sharing their account, we examine what engagement looks like and what makes it possible. We have used Indigenous methodologies and the Theory of Practice Architecture (TPA) as theoretical lenses for exploring the policy, and organisational arrangements that sustained their engagement practices. We discuss the theoretical and practical implications of the research.

Epigenetic science and Indigenous health: key issues and considerations for future research

Environmental epigenetics is a fast-growing field of scientific research attracting interest from key stakeholders in Indigenous health internationally, including researchers, clinicians, policymakers, and advocacy organisations. It is the study of how various external factors, including food, stress, and toxins, alter genetic expression, and could be biologically passed down to children (and potentially grandchildren). This article explores the growing interest in epigenetics in Indigenous health and social policy fields in Australia and identifies the key implications and challenges for Aboriginal and Torres Strait Islander communities. The authors advocate for the urgent development of epigenetic research guidelines in Australia and beyond that centre Indigenous sovereignty.

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.

Demanding Change of Colonial Child Protection Systems Through Good Trouble: A Community‑Based Commentary of Resistance and Advocacy

Aboriginal and Torres Strait Islander communities, led particularly by Grandmothers and Aunties, have persistently challenged statutory child protection systems and the harms they inflict on our children, families, and communities. Reflecting on our own experiences advocating for Aboriginal families and communities at the practice and systems level, this paper explores a reflective commentary approach concerning opportunities and challenges of community-based advocacy toward substantive sustained change. We note how the voices, experiences, and expertise of Aboriginal and Torres Strait Islander people continue to be marginalised or ignored by non-Indigenous authorities, colonial systems, and practice. Despite the apologies and promises of successive governments, contemporary systems continue to reflect “past” approaches. In this context, we honour the strong women who have, and continue, to stand up for their children, families, and communities, further rallying for ongoing resistance and reform.

Development of a survey tool to assess the environmental determinants of health-enabling food retail practice in Aboriginal and Torres Strait Islander communities of remote Australia

BackgroundEnvironmental factors can impact the ability of food retail businesses to implement best practice health-enabling food retail.MethodsWe co-designed a short-item survey on factors influencing food retail health-enabling practice in a remote Australian setting. Publicly available submissions to an Australian Parliamentary Inquiry into food pricing and food security in remote Indigenous communities were coded using an existing remote community food systems assessment tool and thematically analysed. Themes informed survey questions that were then prioritised, refined and pre-tested with expert stakeholder input.ResultsOne-hundred and eleven submissions were coded, and 100 themes identified. Supply chain related data produced the most themes (n = 25). The resulting 26-item survey comprised questions to assess the perceived impact of environmental factors on a store’s health-enabling practice (n = 20) and frequency of occurrence (n = 6).ConclusionsThe application of this evidence-informed, co-designed survey will provide a first-time cross-sectional analysis and the potential for ongoing longitudinal data and advocacy on how environmental factors affect the operations of remote stores.

Healthy ageing in remote Cape York: a co-designed Integrated Allied Health Service Model.

Allied health services in rural and remote hospitals often work in siloed and solo discipline-specific positions. They are often part of general multi-disciplinary teams without a clearly articulated service model that integrates care for individuals and addresses broader community health needs. Integrated care service models for clients with complex disabilities or chronic health needs have demonstrated improved outcomes, but feasible service models are rarely described in the context of rural, remote and Aboriginal and Torres Strait Islander communities. Integration can support primary health care in remote communities where resources are thin, and the breadth of multidisciplinary service providers is not available. A remote health service, in collaboration with a University Department of Rural Health and community partners, developed a community rehabilitation and lifestyle service for adults who experience chronic disease, disability or were at risk of functional decline due to frailty. Using an integrated approach, this model of care improves access to specialist and primary healthcare services, delivers targeted group-based rehabilitation and preventative activities, and addresses community and workforce capacity to meet the needs of the remote community. This paper describes a remote primary health care, Integrated Allied Health Service Model, developed with a focus on the co-ordination and integration of care and resources between the health service, education and community.

Analysing the inconsistent recognition of Indigenous rights in early childhood policy documents from the Australian Government’s "Closing the Gap" strategy between 2008-2018

We analysed Australian government strategic policy documents related to the "Closing the Gap" (CTG) strategy in early childhood circa 2008-2018 to explore the extent to which Indigenous rights are named and recognised in written policy. Our analysis of the policies was informed by Bacchi’s What’s the Problem approach and showed inconsistency in the recognition of Indigenous rights. These rights are sometimes undermined and ignored, sometimes implied and sometimes named and recognised. Silences within the CTG strategy are discussed and reveal the ongoing nature of colonisation and deficit framing of Aboriginal and Torres Strait Islander people and communities. Findings from this research are relevant for the current era of the "Closing the Gap" strategy.

Governance for health system collaboration: The case of the South-West Queensland Primary Care Alliance, Queensland, Australia.

Background: Internationally, as countries orientate health systems to embrace an integrated, person-centered approach it demands a fundamental shift in the way health services are funded, managed and delivered. Requisite to meeting these challenges given the involvement of multiple organisations, and therefore varying governance arrangements, is strengthening of shared governance with clear and transparent accountability mechanisms, across the health system where initiatives to better integrate care are being implemented.  Governance models to achieve this have been attempted in several countries. The best fit for the Australian system is likely to be the Alliance contracting approach.
 The Alliancing concept was derived from the construction industry, where different organisations work collaboratively to ensure achievement of common goal, to complete a project successfully, on time and within budget. They help one another and, where relevant, share resources. Alliance governance is the set of rules which govern an Alliance. At their core, they are centered around governance that ensures the building of collaboration and a ‘whole of system’ approach to service planning and delivery. This is different and challenging and calls on members to focus primarily on their community rather their individual circumstances / organisations.
 Target audience: Policy makers, health system executives, funders, researchers.
 Alliance Partners: Western Queensland Primary Health Network, South West Hospital & Health Services, Health Workforce Queensland, Charleville & Western Areas Aboriginal & Torres Strait Islander Community Health, Royal Flying Doctor Service, private general practices, and CheckUP.
 What we did: Thematic analysis of a previous SW partnership project, against evidence-based health governance elements for integrated care, to distil learning for the SW Primary Care 5-year plan and conducted a rapid review to identify further evidence base for the alliance governance model in health. This evidence was incorporated into a stakeholder workshop to advise implementation.
 Results/impact: Using an evidence-based governance framework for integrated care, the South-West Primary Care Alliance was developed. An Alliance Charter, outlining the rules of engagement and commitments, has been passed.  A governance framework agreed and an implementation plan adopted.
 Learning for international audience: More recent Australian reform documents identify the importance of a regional approach in bringing together all sources of health funding into one coordinated local service delivery approach. In particular, the ongoing difficulty in aligning Australia’s fragmented Commonwealth and State health systems, mean that for our health system this is the most critical reform step. This is more ambitious than co-commissioning or bilateral project-focused funding. It includes all relevant service delivery organisations making formal governance commitments to work together over time in addressing key areas of service gap or duplication.
 Next steps: Three work programs have been identified by the Alliance Leadership Team for implementation 2023-2025. The first of these, workforce, has an implementation plan set for 2023. As part of the implementation the barriers and critical success factors to implementing and sustaining this model of care will be investigated.

Undertaking One Health Research with Australian Aboriginal and Torres Strait Islander Communities: Implications of a One Health Pilot Study

Abstract This case study presents the research process and learnings from undertaking One Health research within Australian Aboriginal and Torres Strait Islander community settings. One Health is relevant to Australian Aboriginal and Torres Strait Islander communities where people and animals (commonly dogs and cats) live closely together and face health risks due to barriers in accessing animal health care. One Health is an appropriate approach to understanding and addressing health disparities as it aligns with community and cultural contexts that recognise the relationships between the health of people, animals and the shared environment. However, with minimal evidence in this space, the contribution of One Health to Aboriginal and Torres Strait Islander health is not well understood limiting the ability to implement One Health approaches and address the needs of communities, families, animals and the environment. This case study describes the research approach, methodology and implications from a pilot One Health study undertaken with Aboriginal and Torres Strait Islander communities that adopted Indigenous research methodologies within a One Health framework. Information © The Authors 2023

Enabling the context for Aboriginal and Torres Strait Islander Community Controlled Birthing on Country services: Participatory action research

ProblemEstablishment of Birthing on Country services owned and governed by Aboriginal and Torres Strait Islander Community Controlled Health Services has been slow. BackgroundBirthing on Country services have demonstrated health and cost benefits and require redesign of maternity care. During the Building On Our Strengths feasibility study, use of endorsed midwives and licensing of birth centres has proven difficult. QuestionWhat prevents Community Controlled Health Services from implementing Birthing on Country services in Queensland and New South Wales? MethodsParticipatory action research identified implementation barriers. We conducted iterative document analysis of instruments to inform government lobbying through synthesis of policy, economic, social, technological, legal, and environmental factors. FindingsThrough cycles of participatory action research, we analysed 17 documents: 1) policy barriers prevent Community Controlled Health Services from employing endorsed midwives to provide intrapartum care in public hospitals; 2) economic barriers include lack of sustainable funding stream and inadequate Medicare-billing for endorsed midwives; and 3) legal barriers require a medical practitioner in a birth centre. While social barriers (e.g., colonisation, medicalisation) underpin regulations, these were beyond the scope; technological and environmental barriers were not identified. DiscussionFindings are consistent with the literature on barriers to midwifery practice. Recommendations include a national audit of barriers to Birthing on Country services including healthcare practice insurance, and development of a funding stream. Additionally, private maternity facility regulation must align with evidence on safe birth centre operation. ConclusionGovernment can address barriers to scale-up of Aboriginal and Torres Strait Islander Community Controlled Birthing on Country services.

Evaluation of Yantiin Kalabara – 5 Ways to a Healthier You: A primary school-based education program targeting healthy living choices through interactive workshops

The aim of this study was to develop, implement and evaluate the novel one-day, school-based health education program Yantiin Kalabara that embedded Aboriginal and Torres Strait Islander culture and perspectives within a series of interactive learning stations. In consultation with local Aboriginal and Torres Strait Islander community members, the program was designed to encourage healthy lifestyle choices and promote strong, sustainable and mutually respectful relationships between Aboriginal and Torres Strait Islander peoples and non-Aboriginal Australians. It involved five primary schools within the Awabakal, Wonnarua, Darkinjung and Worimi Countries (Australia) in movement-based and culturally rich learning activities. The feasibility of the program for use in primary schools and preliminary efficacy for affecting change in key health behaviours (physical activity, nutrition, screen-time) was assessed using student questionnaires. Yantiin Kalabara was delivered by the Hunter Primary Care team and volunteers. Students reported that it helped them improve their overall health, physical activity, eating habits and screen-time patterns. We have demonstrated that the program can be feasibly delivered in primary schools, and that the program was efficacious in affecting positive changes in key health behaviours of participating children. However, further evaluation in larger and more diverse populations using a randomised controlled trial is warranted.

Cultural, sociopolitical, environmental and built assets supporting health and well-being in Torres Strait Island communities: protocol for a scoping review

IntroductionRisks to an individual’s health should be considered alongside the environmental, sociocultural and sociopolitical context(s) in which they live. Environmental mapping is an approach to identifying enablers and barriers to...

Building a Participatory Archive With an Australian Suburb: Case Study of Canberra’s Biggest Bogan Suburb, Kambah

Participatory appraisal and building archives with communities have been discussed amongst archivists across the world for decades. There is reportage on building community resources for and by Aboriginal and Torres Strait Islander communities, but there is less reportage on these endeavours with other communities. This reflection reports on building an archive with the community of Kambah, a suburb with a mixed reputation in the Canberra community.
 A challenge for participatory archives identified through this project was scale – if successful, the volume of content quickly becomes overwhelming. Another challenge is the responsibility that goes with accepting content from contributors. Expectations are set up that the content will be used or shared. And crucially, participation means everyone. Strategies are needed to connect with contributors that go beyond relationships in easy reach for the archivist based on existing connections.
 A final lesson comes from socially engaged art, a practice that focuses on community participation. This calls on the archivist to recognise their standpoint, the worldview they bring. Our sector has recognised that collections and building them is not neutral. For archivists, there remains much to do to work out how to meaningfully share that power and authority as collections are built.

Our Ways, Your Ways, Both Ways - a multi-disciplinary collaboration to develop, embed and evaluate a model of social and emotional wellbeing care for Aboriginal and Torres Strait Islander young people who experience detention - Phase 1.

The National Strategic Framework for Aboriginal and Torres Strait Islander Peoples' Mental Health and Social and Emotional Wellbeing identifies building a strong Aboriginal and Torres Strait Islander led evidence-base to inform care as a key priority. Aboriginal and/or Torres Strait Islander adolescents in contact with the criminal justice system are a highly vulnerable group of Australians, with substantial unmet needs. There is limited evidence to inform culturally appropriate models of care that meet the social and emotional wellbeing needs of justice-involved Aboriginal and/or Torres Strait Islander adolescents. This project aims to develop, implement and evaluate an in-reach and community transitional model of social and emotional wellbeing care for Aboriginal and/or Torres Strait Islander adolescents (10-17 years old) who experience detention through close engagement with Aboriginal and/or Torres Strait Islander youth, Elders, researchers, practitioners and community members, and by drawing on culturally informed practice and knowledge systems. The project is based on a multi-level mixed methods design, with a strong focus on ongoing project evaluation (based on the Ngaa-bi-nya framework) and co-design. Co-design is facilitated through culturally safe and trauma informed participatory processes based on development of strong partnerships from project initiative, design, implementation and evaluation. Application of the landscape domain of the Ngaa-bi-nya framework for Aboriginal and Torres Strait Islander program evaluation will be explored in Phase one. Aboriginal and Torres Strait Islander adolescents with experience in detention will be engaged through one-on-one interviews with data collection through the Growth and Empowerment Measure (GEM) Youth (which will be adapted from the adult version and validated as part of this study), the Kessler Psychological Distress Scale (K-10), questions around alcohol and drug use, and narrative interviews exploring experience. Qualitative data will be analyzed using an inductive thematic approach, structured within the framework of the Ngaa-bi-nya landscape prompts. Quantitative data will be analyzed using descriptive statistics to provide a profile of the cohort. Findings from Phase one will be used to inform the development of a model of social and emotional wellbeing care that will be implemented and evaluated in Phase two.

Safeguarding against Dementia in Aboriginal and Torres Strait Islander Communities through the Optimisation of Primary Health Care: A Project Protocol.

This protocol describes the methodology and methods for a collaborative project with eight Aboriginal and Torres Strait Islander primary health care (PHC) organisations, across three Australian states and one territory, to increase clinical service performance and access to preventive health and health promotion services for preventing, identifying, treating, and managing dementia risk in Aboriginal and Torres Strait Islander communities. Aboriginal participatory action research (APAR) methodology will be the framework for this project, incorporating continuous quality improvement (CQI), informed by research yarning with stakeholder groups, comprising community members and PHC staff and service providers and data collected from the auditing of client health records and the mapping of existing clinical processes and health services at each partnering PHC organisation. The qualitative and quantitative data will be summarised and discussed with stakeholder groups. Priorities will be identified and broken down into tangible PHC organisation deliverable strategies and programs, which will be co-developed with stakeholder groups and implemented cyclically over 24 months using the Plan, Do, Study, Act model of change. Key project outcome measures include increased clinical service performance and availability of preventive health and health promotion services for safeguarding against dementia. Project implementation will be evaluated for quality and transparency from an Indigenous perspective using an appropriate appraisal tool. The project processes, impact, and sustainability will be evaluated using the RE-AIM framework. A dementia safeguarding framework and accompanying tool kit will be developed from this work to support Aboriginal and Torres Strait Islander PHC organisations to identify, implement, and evaluate dementia safeguarding practice and service improvements on a broader scale.

A hydrogen supply-chain model powering Australian isolated communities

This article proposes a supply chain-based green hydrogen microgrid modelling for a number of remote Australian communities. Green hydrogen can be used as an emissions-free fuel source for electricity generation in places where large-scale renewable energy production is impossible due to land availability, population, or government regulations. This research focuses on the Torres Strait Island communities in northern Australia, where the transition from diesel to renewable electricity generation is difficult due to very limited land availability on most islands. Due to geographical constraints, low population and smaller electrical load, the green hydrogen needs to be sourced from somewhere else. This research presents a green hydrogen supply chain model that leverages the land availability of one island to produce hydrogen to supply other island communities. In addition, this research presents a model of producing and transporting green hydrogen while supplying cheaper electricity to the communities at focus. The study has used a transitional scenario planning approach and the HOMER simulation platform to find the least-cost solution. Based on the results, a levelised cost of energy range of AU$0.42 and AU$0.44 was found. With the help of a green hydrogen supply chain, CO2 emissions at the selected sites could be cut by 90 %. This study can be used as a guide for small clustered communities that could not support or justify large-scale renewable generation facilities but need more opportunities to install renewable generation.

Exploring self-determined solutions to service and system challenges to promote social and emotional wellbeing in Aboriginal and Torres Strait Islander people: a qualitative study.

Many Aboriginal and Torres Strait Islander people living on Kaurna Country in northern Adelaide experience adverse health and social circumstances. The Taingiwilta Pirku Kawantila study sought to understand challenges facing Aboriginal and Torres Strait Islander communities and identify solutions for the health and social service system to promote social and emotional wellbeing. This qualitative study applied Indigenous methodologies undertaken with Aboriginal and Torres Strait Islander governance and leadership. A respected local Aboriginal person engaged with Aboriginal and Torres Strait Islander community members and service providers through semi-structured interviews and yarning circles that explored community needs and challenges, service gaps, access barriers, success stories, proposed strategies to address service and system challenges, and principles and values for service design. A content analysis identified the breadth of challenges in addition to describing key targets to empower and connect communities and optimize health and social services to strengthen individual and collective social and emotional wellbeing. Eighty-three participants contributed to interviews and yarning circles including 17 Aboriginal community members, 38 Aboriginal and Torres Strait Islander service providers, and 28 non-Indigenous service providers. They expressed the need for codesigned, strengths-based, accessible and flexible services delivered by Aboriginal and Torres Strait Islander workers with lived experience employed in organisations with Aboriginal and Torres Strait Islander leadership and governance. Community hubs and cultural events in addition to one-stop-shop service centres and pre-crisis mental health, drug and alcohol and homelessness services were among many strategies identified. Holistic approaches to the promotion of social and emotional wellbeing are critical. Aboriginal and Torres Strait Islander people are calling for places in the community to connect and practice culture. They seek culturally safe systems that enable equitable access to and navigation of health and social services. Aboriginal and Torres Strait Islander workforce leading engagement with clients is seen to safeguard against judgement and discrimination, rebuild community trust in the service system and promote streamlined access to crucial services.