Differences in primary health care delivery to Australia's Indigenous population : a template for use in economic evaluations

Background Health economics is increasingly used to inform resource allocation decision-making, however, there is comparatively little evidence relevant to minority groups. In part, this is due to lack of cost and effectiveness data specific to these groups upon which economic evaluations can be based. Consequently, resource allocation decisions often rely on mainstream evidence which may not be representative, resulting in inequitable funding decisions. This paper describes a method to overcome this deficiency for Australia’s Indigenous population. A template has been developed which can adapt mainstream health intervention data to the Indigenous setting.

Methods The ‘Indigenous Health Service Delivery Template’ has been constructed using mixed methods, which include literature review, stakeholder discussions and key informant interviews. The template quantifies the differences in intervention delivery between best practice primary health care for the Indigenous population via Aboriginal Community Controlled Health Services (ACCHSs), and mainstream general practitioner (GP) practices. Differences in costs and outcomes have been identified, measured and valued. This template can then be used to adapt mainstream health intervention data to allow its economic evaluation as if delivered from an ACCHS.

Results The template indicates that more resources are required in the delivery of health interventions via ACCHSs, due to their comprehensive nature. As a result, the costs of such interventions are greater, however this is accompanied by greater benefits due to improved health service access. In the example case of the polypill intervention, 58% more costs were involved in delivery via ACCHSs, with 50% more benefits. Cost-effectiveness ratios were also altered accordingly.

Conclusions The Indigenous Health Service Delivery Template reveals significant differences in the way health interventions are delivered from ACCHSs compared to mainstream GP practices. It is important that these differences are included in the conduct of economic evaluations to ensure results are relevant to Indigenous Australians. Similar techniques would be generalisable to other disadvantaged minority populations. This will allow resource allocation decision-makers access to economic evidence that more accurately represents the needs and context of disadvantaged groups, which is particularly important if addressing health inequities is a stated goal.

Development of the reflexive antiracism scale – indigenous

Purpose – Reflexive Antiracism is an approach to antiracism that seeks to avoid the limitations of essentialism and negative emotional reactions through a focus on racialisation (a concept that encompasses both racism and antiracism) as well as the formation and maintenance of racialised identities. This paper aims to outline the construction and validation of a scale to measure this novel theoretical construct: the Reflexive Antiracism Scale-Indigenous (RAS-I).

Design/methodology/approach – In the context of a cultural training course focused on Indigenous peoples in Australia, 20 items to assess attitudes were developed along with four hypothetical scenarios designed to assess behavioural intentions in specific situations. The survey formed by these items and scenarios was piloted to assess test-retest, concurrent and construct validity as well as item endorsement and internal reliability.

Findings – Findings suggest that an 11-item scale based on this survey forms a valid and reliable measure of Reflexive Antiracism. Further research and applications are discussed.

Originality/value – This paper will prompt further exploration of Reflexive Antiracism as a concept that can be applied in a range of settings where a more nuanced understanding and approach to antiracism may be of benefit. Being aware of their position within a society that is racialised will allow antiracists to be reflexive (and realistic) about their ability as individuals to achieve antiracist ideals while continuing to strive towards them.

Labour market and other discrimination facing Indigenous Australian

This paper uses self-reported data to illustrate how Indigenous Australians experience discrimination and how it is potentially associated with poor labour market outcomes. After giving consideration to what factors may lead people to report being discriminated against, an empirical analysis of self-reported discrimination is presented, utilising data from the 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS). Correlations between discrimination experienced in different settings are identified, and the association of discrimination with human capital and other characteristics is presented. The results suggest that the main process driving the reporting of discrimination is the extent to which an individual is exposed to situations in which they interact with potential discriminators. This could mean that some Indigenous Australians decrease their labour supply in order to avoid potentially adverse (discriminatory) situations. Implications for understanding Indigenous disadvantage are discussed along with recommendations for both addressing discrimination and enhancing the resilience of individuals facing discrimination.

Better off dead? Prices realised for Australian paintings sold at auction

Using auction sales data on Australian paintings over the period 1995 and 2003 we investigate the relationship between artists‟ living status and the price of paintings sold at auction. For deceased artists we consider the time since their death and for living artists their conditional life expectancy. Hedonic regression analysis is applied separately to the data on Indigenous and non-Indigenous paintings. Comparing the modelling results across Indigenous and non-Indigenous paintings we see evidence of two different patterns of response to an artist‟s living status. Both yield non-linear impacts but for Indigenous paintings these are quadratic and for non-Indigenous they are quartic. Thus the response to living status in the more recent market for Indigenous paintings is different to the more established market for non-Indigenous paintings. Whilst the responses differ for the two types of paintings, in answer to the question posed and in terms of the price of a painting at auction an artist is better off long dead or close to death.

'Bungaree: the first Australian'

This is a long peer-reviewed exhibition review of 'Bungaree: The First Australian', an exhibition curated by Indigenous artist, Djon Mundine. This review discusses the artwork and the historical re-imagining that the artwork and the exhibition as a collection explores, particularly the use of irony and humour. In discussing the curatorship, this article also suggests links with other Indigenous curatorship epistemologies in other places, focusing on the workshops, lectures, artists in residence programs that enabled the artists to work and think in-situ. This article also reveiws the current historiography on Bungaree.

Watching clouds over country : reconsidering Australian indigenous perspectives about environmental change and climate change

This paper considers an Indigenous perspective on the rapidly transforming Australian environment and the impact of world climate change. It is largely based upon a National Climate Change Adaptation and Research Facility (NCCARF) research project, in progress, that is seeking to translate a south-eastern Australian Indigenous perspective of how climate change affects 'country'. The project involves direct community consultation and workshops, framed by a literature review and longstanding author involvements with Indigenous communities in planning, design and native title projects, and will discuss conclusions being raised. Importantly, this discourse is being formulated with peri-urban based Indigenous communities whom are well educated and deeply involved with statutory and strategic planning processes and native title debates.

Words, oral libraries and environmental responses : an Australian indigenous perspective to climate change adaptation

Climate change adaptation and mitigation continues to be a prevalent discourse in this country and internationally in both the sciences and the arts. While various types and degrees of change are evident, the quantification of these changes including their scope and diversity have challenged conventional sciences. This is demonstrated in their inability to succinctly answer key questions about change including the degree of change and associated patterns and consequences. Most of this discourse is nested in a temporal band comprising the last 100-200 years of data and evidence, and very much informed by Western science perspectives and protocols. Little attempt has been made to engage with Australian Indigenous communities whom possess environmental knowledge of some 10,000-100,000 years albeit embedded in their artistic and oral narrative 'histories'. This paper explores the role and values that Australian Aboriginals, the Indigenous peoples of the Australian content, can offer in shedding new light on this discourse While focusing upon a cross-peri-urban Indigenous investigation, it examines this discourse though the lens of their words, terms, sentences as a vehicle to better understand a longitudinal perspective about climate change adaptation pertinent to Australia.

Indigenous landscape change and climate change : the historical transformation of the Port Phillip bay from an indigenous and landscape architectural perspective

Currently there is a dearth of research into Australian Indigenous knowledge and their understanding of climate change especially in regard to how it fits into an Indigenous world view. Recent discussions by the National Climate Change Adaptation Research Facility (NCCARF) have highlighted this deficiency and also the need to source projects that address this perspective, and enable the incorporation of traditional ecological knowledge into the planning of climate change adaption strategies. Within this context, this paper examines the use and understanding of landscape, both urban and regional, surrounding Port Phillip Bay and the risks and opportunities climate change adaptation brings to the local Indigenous communities. This paper comprises a literature review and proposes further research with the Wurundjeri (Yarra Valley), Wathaurong (Geelong-Bellarine Peninsula) & Boon Wurrung (Mornington Peninsula - Westerport - southern Melbourne) which aim to elicit a contemporary and local response to issues raised by NCCARF but importantly to articulate a possible Indigenous position about the formation, change and direction that Port Phillip Bay and its environs should take from their perspectives. The research looks to draw on how these communities have adapted to climate change physically, mentally and spiritually over their long habitation of the region and their perceptions of climate change this century. The project looks to uncover a longitudinal perspective of adaptation focused upon Indigenous views of 'country' and custodial obligations to 'country' including accumulated cultural and environmental histories, and how this can inform the contemporary practice of landscape architecture and the design of resilient and sustainable human environments.

Minahasan indigenous perspectives on place planning and management : tracing the indigenous culture through the lens of local wisdom

Indigenous cultures draw upon many thousands of years of residency and environmental adaptation offering unique knowledge resources to better understand our landscapes and environment. The Minahasan society, on the island of Sulawesi in the Indonesian archipelago, is one such Indigenous community. The Minahasan are the Indigenous community of northern Sulawesi, before the Portuguese and Dutch 1500-1900 colonization of this island, and the later nationalist cultural assimilation following post Indonesian independence. Thus, some 500 years of post-European contact and management can be contrasted against over I 00,000 years of Minahasan society. Further, the majority of this colonisation has been focused upon the coastal fringes resulting in a relatively intact Minahasan cultural landscape within the interior of northern Sulawesi focused upon the Tondano Lake catchment. This paper considers the importance of the Minahasan-formed cultural landscape, its importance to this culture, and the role and influence it continues to have in settlement formation and planning in northern Sulawesi despite conventional Indonesian and Western-informed sustainable urban and regional planning traditions and knowledge. It draws upon intensive qualitative research using 14 different villages, to analyse and compare local knowledge and land-relationships developed by the respective communities to manage and curate their unique characteristics as well as ensuring adaption without compromising their cultural, social and economic values. The research embodies this ethnoecological information in seeking to analyse historical and contemporary land use planning systems, and to offer a future planning perspective that will respect and endure this relationship and environmental management regime.

Indigenous knowledge and climate change : the Wathaurong and Gadubanud narrative for the Great Ocean Road region

For more than forty thousand years Aboriginal people of Australia have been confronted with major climate, ecological and geological changes as well as annual seasonal variations. Many of these changes have been captured in the cultural traditions of Maar (the people) of the south-west Victorian coast and the knowledge has been transferred from generation to generation through Dreaming stories. Many Dreaming stories recount the forming of the coastal landscape and Sea Country. Weather patterns and climate change were gauged by the occurrence of natural events such as the tidal changes, sea level rise, landscape changes, behaviour of animals, and the availability of food sources. Can this ancient knowledge provide answers for adaptation and resilience to a rapid changing climate? Drawing upon recent literature on coastal climate change in the Great Ocean Road Region (GORCC, 2012), literature review of indigenous environmental planning (Kooyang Sea Country Plan, 2004), and investigation of settlement patterns of the Wathaurong and Gadubanud people, this paper reviews the changes in the landscape due to climate change and explores traditional knowledge as input to a potential design based adaptation model for coastal settlements of the Great Ocean Road Region.

Mechanisms linking affective reactions to competition-related and competition-extraneous concerns in male martial artists

The main aim of this study was to examine affective linkages between competition-related and competition-extraneous concern domains. A secondary purpose was to establish the contributions of pre-competition affects to post-competition performance appraisals, independent of pre-competition performance expectations. Thirty-nine highly skilled male martial artists were assessed at five random times a day for a week and 1 h before a major competition on affective states and sources of concern. They also reported their performance expectations and post-competition performance appraisals. Affective states triggered by competition-related and competition-extraneous concerns persisted in time. Carry-over effects were stronger after reports of competition-related concerns, emphasizing the subjective importance of the competitive event. Although positive (enjoyment and surprise) and negative (sadness and guilt) affective spill-over was observed from competition-extraneous to competition-related concerns, the reverse held true only for disgust. These findings may be due to the athletes' ability to regulate affective reactions within a sporting setting, in particular. Spill-over from competition-extraneous to competition-related concerns is indicative of a lesser degree of control over work/study and family life. Given that average weekly negative affects and anger/disgust were independent predictors of post-competition performance appraisals, the phenomenon of spill-over and other affective linkage mechanisms in sport warrant further investigation.

Predictors of pre- and post-competition affective states in male martial artists : a multilevel interactional approach

The aims of this study were to examine (a) the effects of competition-related and competition-extraneous concerns on affective states; (b) the relationships of primary and secondary appraisal with affective states and (c) the main and moderating effects of personality traits on pre- and post-competition affects. Thirty-nine male elite martial artists were assessed on 12 affective states, concerns and dimensions of primary and secondary appraisal at five random times a day across 1 week before and 3 days after a competition. On the competition day, they were assessed 1 h before and immediately after the contest. Competitive trait anxiety, neuroticism and extraversion were measured at the start of the study. The competition was the most significant and stressful event experienced in the examined period and had a pervasive influence on athletes' affective states. All examined appraisal and personality factors were somewhat associated with pre- and post-competition affective states. Competitive trait anxiety was a key moderator of the relationship between cognitive appraisal and affective states. This study supports the idea that cognitive appraisal and situational and personality factors exert main and interactive effects on athletes' pre- and post-competition affects. These factors need to be accounted for in planning of emotion regulation interventions.