Aboriginal health promotion through addressing employment discrimination

The Localities Embracing and Accepting Diversity (LEAD) program aimed to improve the mental health of Aboriginal Victorians by addressing racial discrimination and facilitating social and economic participation. As part of LEAD, Whittlesea Council adopted the Aboriginal Employment Pathways Strategy (AEPS) to increase Aboriginal employment and retention within the organisation. The Aboriginal Cultural Awareness Training Program was developed to build internal cultural competency and skills in recruiting and retaining Aboriginal staff. Analysis of surveys conducted before (pre; n=124) and after (post; n=107) the training program indicated a significant increase in participant understanding across all program objectives and in support of organisational policies to improve Aboriginal recruitment and retention. Participants ended the training with concrete ideas about intended changes, as well as how these changes could be supported by their supervisors and the wider organisation. Significant resources have since been allocated to implementing the AEPS over 5 years. In line with principles underpinning the National Aboriginal and Torres Strait Islander Health Plan 2013-23, particularly the focus on addressing racism as a determinant of health, this paper explores the AEPS and training program as promising approaches to health promotion through addressing barriers to Aboriginal employment. Possible implications for other large organisations are also considered.

Supporting healthy communities through sports and recreation programs

There is some evidence, in the form of critical descriptions of programs and systematic reviews, on the benefits to Aboriginal and Torres Strait Islander communities from participation in sport and recreational programs. These include some improvements in school retention, attitudes towards learning, social and cognitive skills, physical and mental health and wellbeing; increased social inclusion and cohesion; increased validation of and connection to culture; and crime reduction.Although the effects of sports and recreation programs can be powerful and transformative, these effects tend to be indirect. For example, using these programs to reduce juvenile antisocial behaviour largely work through diversion, providing alternative safe opportunities to risk taking, maintenance of social status, as wellas opportunities to build healthy relationships with Elders and links with culture.Although Indigenous Australians have lower rates of participation in sport than non-Indigenous people, surveys suggest that around one-third of Indigenous people participate in some sporting activity (ABS 2010). That makes sports a potentially powerful vehicle for encouraging Indigenous communities to look at challenging personal and community issues.Within Indigenous communities, a strong component of sport and recreation is the link with traditional culture. Cultural activities such as hunting are generally more accepted as a form of sport and recreation than traditional dance. Therefore sport and recreation are integral in understanding ‘culture’ within Indigenous communities, as well as highlighting the culture within which sport and recreation operate.

The economic feasibility of price discounts to improve diet in Australian Aboriginal remote communities

OBJECTIVE: To estimate the cost-effectiveness of fiscal measures applied in remote community food stores for Aboriginal Australians.

METHODS: Six price discount strategies on fruit, vegetables, diet drinks and water were modelled. Baseline diet was measured as 12 months' actual food sales data in three remote Aboriginal communities. Discount-induced changes in food purchases were based on published price elasticity data while the weight of the daily diet was assumed constant. Dietary change was converted to change in sodium and energy intake, and body mass index (BMI) over a 12-month period. Improved lifetime health outcomes, modelled for the remote population of Aboriginal and Torres Strait Islanders, were converted to disability adjusted life years (DALYs) saved using a proportional multistate lifetable model populated with diet-related disease risks and Aboriginal and Torres Strait Islander rates of disease.

RESULTS: While dietary change was small, five of the six price discount strategies were estimated as cost-effective, below a $50,000/DALY threshold.

CONCLUSION: Stakeholders are committed to finding ways to reduce important inequalities in health status between Aboriginal and Torres Strait Islanders and non-Indigenous Australians. Price discounts offer potential to improve Aboriginal and Torres Strait Islander health. Verification of these results by trial-based research coupled with consideration of factors important to all stakeholders is needed.

Science, research and social change in Indigenous health – evolving ways of knowing

History tells us of the overwhelming destructive influence of exotic culture, politics and knowledge forms upon the worldview and wellbeing of Indigenous Australians. The power of dominant culture to oppress, control and dominate traditional Indigenous ways of knowing and being has been identified as a being a crucial influence on the health status, future hopes and aspirations of Indigenous Australians. Fundamental to this assertion is that the alienating effect of the belief in and application of the scientific method in relation to learning and knowing is a phenomenon that is incompatible with the law and cultural ways of traditional Indigenous people. The establishment of the Centre of Clinical Research Excellence (CCRE) is predicated upon and responds to a deep need in our community today to synthesise the ideological and epistemological premises of an increasing range of cultures and world views. It recognises that clinical research, for example, is important to the health of Aboriginal and Torres Strait Islander peoples, but also that the way such research is designed and carried out is also crucial to its potential to effect change in and improve the state of Indigenous health in Australia. This paper examines knowledge principles and processes associated with research in Indigenous communities, explores emerging research trends in science and proposes an epistemological framework for synthesis of traditional approaches with those of the scientific paradigm.

A systematic review of published interventions for primary and secondary prevention of ischaemic heart disease (IHD) in rural populations of Australia

BACKGROUND: Rural Australians are known to experience a higher burden of ischaemic heart disease (IHD) than their metropolitan counterparts and the reasons for this appear to be highly complex and not well understood. It is not clear what interventions and prevention efforts have occurred specifically in rural Australia in terms of IHD. A summary of this evidence could have implications for future action and research in improving the health of rural communities. The aim of this study was to review all published interventions conducted in rural Australia that were aimed at the primary and/or secondary prevention of ischaemic heart disease (IHD) in adults.

METHODS: Systematic review of the peer-reviewed literature published between January 1990 and December 2015. Search terms were derived from four major topics: (1) rural; (2) ischaemic heart disease; (3) Australia and; (4) intervention/prevention. Terms were adapted for six databases and three independent researchers screened results. Studies were included if the published work described an intervention focussed on the prevention or reduction of IHD or risk factors, specifically in a rural population of Australia, with outcomes specific to participants including, but not limited to, changes in diet, exercise, cholesterol or blood pressure levels.

RESULTS: Of 791 papers identified in the search, seven studies met the inclusion criteria, and one further study was retrieved from searching reference lists of screened abstracts. Typically, excluded studies focused on cardiovascular diseases without specific reference to IHD, or presented intervention results without stratification by rurality. Larger trials that included metropolitan residents without stratification were excluded due to differences in the specific needs, characteristics and health service access challenges of rural populations. Six interventions were primary prevention studies, one was secondary prevention only and one included both primary and secondary intervention strategies. Two interventions were focussed exclusively on Aboriginal and Torres Strait Islander (Australian Indigenous) populations.

CONCLUSIONS: Few interventions were identified that exclusively focussed on IHD prevention in rural communities, despite these populations being at increased risk of IHD in Australia, and this is consistent with comparable countries, internationally. Although limited, available evidence shows that primary and secondary interventions targeted at IHD and related risk factors can be effective in a rural setting.

Western maps/Yanyuwa meaning: an interview with John Bradley

In July 2003 an important one-volume text, Forget about Flinders: A Yanyuwa atlas of the south west gulf of Carpentaria produced in a limited edition of 14 copies, returned to Yanyuwa country and to the families who collaborated with John Bradley and artist Nona Cameron on the project. Subsequently, a second edition of 20 copies has been released, mainly to institutions. It is the most comprehensive attempt yet to restore Yanyuwa names to country and to produce a multilayered, dynamic, history-rich, and bilingual representation of how country is known in this community, and how the central song cycle texts intersect with Yanyuwa tradition. What follows is a condensed and edited interview with Frances Devlin-Glass, in which John Bradley discusses the motivations, the hybridised methodologies employed, the innovations of this new genre, and the pedagogical ends served by this latest iteration of Yanyuwa song cycles.

Book review : Sin-E-Anne by Cindy Ballard & Samantha Laden

Book Review

Victims of violence among indigenous mothers living with dependent children

Objective: To identify individual and household factors associated with violence among Australian Indigenous women with dependent children.

Design and participants: Univariate and multivariable analysis of data from the 2002 National Aboriginal and Torres Strait Islander Social Survey, stratified by area.

Main outcome measure: Self-reported experience of being a victim of violence in the previous year.

Results: One in four Indigenous women living with dependent children younger than 15 years reported being victims of violence in the previous year; this corresponds to an estimated 24 221 Indigenous mothers (95% CI, 21 507–26 935) nationwide. Violence was more prevalent in regional areas and cities than remote areas. In remote areas, mothers who had been removed from their natural families during childhood had nearly threefold greater odds of being victims of violence (odds ratio [OR], 2.90; 95% CI, 1.82–4.61); in non-remote areas, the odds were 72% greater (OR, 1.72; 95% CI, 1.23–2.39). Older maternal age (≥ 45 years) was associated with lower odds of experiencing violence in both non-remote areas (OR, 0.39; 95% CI, 0.25–0.60) and remote areas (OR, 0.46; 95% CI, 0.30–0.70). Women with partners residing in the household faced lower odds of violence in both non-remote areas (OR, 0.54; 95% CI, 0.41–0.72) and remote areas (OR, 0.46; 95% CI, 0.32–0.67).

Conclusions: The prevalence of violence against Indigenous mothers with young children is alarmingly high across remote and non-remote areas. This study identified distinctive characteristics of victims, but further research is needed to assess potential risk factors, such as history of removal from natural family.

Indigenous higher education student equity : focusing on what works

The rates of higher education access, participation and completion for Indigenous students are much lower than those for non-Indigenous students in Australia. This paper argues for a research-led focus on what works in terms of Indigenous  student equity in higher education. Undertaking independent evaluation of  existing initiatives and leveraging the experience of hundreds of successful Indigenous graduates, it may be possible to articulate some of the ways in which success has been, and can be, achieved, despite the challenges that face Indigenous students. In other words, it may be possible to articulate some aspects of what works for some Indigenous people in relation to higher education. A focus on articulating strategies that Indigenous individuals and communities might adopt in relation to higher education should be developed alongside the management of systemic problems through a range of means. The “successfocused” approach would provide one of a suite of approaches that may be helpful in addressing Indigenous student equity.

What can we say about 112,000 taps on a Ndjebbana touch screen?

This paper reports on the use of touch screens to display simple talking books in a minority Indigenous Australian language. Three touch screens are located in an informal context in a remote Indigenous Australian community. The popularity of the computers can be explained by the form of the touch screen and by the intertextual and hybrid nature of the talking books. The results suggest the Kunibidji choose to transform their own culture by including new digital technologies which represent their societal practice