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A wealth of suggestions for tackling determinants of health – #AusVotesHealth

Calls to address “high levels of ignorance about Aboriginal health in the public sector”, to progress a Treaty with Aboriginal and Torres Strait Islander people, and to privilege Indigenous knowledge and leadership were made during the #AusVotesHealth Twitter festival.

The festival also heard about the Uluru Statement’s importance for enabling Aboriginal and Torres Strait Islander people to lead their own healing, and calls for a dedicated National Aboriginal and Torres Strait Islander Suicide Prevention Strategy and implementation plan.

Guest tweeters also called for action on climate change and racism, and an end to punitive social policies such as compulsory income management.

Meanwhile, the Consumers Health Forum called for investment in “transformative primary healthcare”, and the Australian Healthcare and Hospitals Association released an election health policy scorecard, prompting health policy analyst and Croakey editor Jennifer Doggett to comment:

If I was the Coalition’s parent getting that report, I would be taking away its electronic devices until it started taking its responsibilities seriously…”


Self-determination matters

Professor Pat Dudgeon, The Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention
@cbatsispep

@Cbpastsisp pays respect to the traditional custodians of the land we live & work on, the Wadjuk people of the Noongar Nation, and their Elders. We acknowledge the culture, strength, and resilience of all Aboriginal and Torres Strait Islander peoples.

@Cbpastsisp supports development and implementation of culturally safe evidence-informed suicide prevention programs, services and research in Aboriginal and Torres Strait Islander communities across Australia.

Suicide is complex and has different causes in Indigenous populations: history, trauma, colonisation, social exclusion. We need culturally safe professional help for people at immediate risk. #communityled #suicideprevention #connectiontoculture

The Aboriginal suicide rate is double the rest of the population and for youth it’s four times as high. We need to invest in youth work and education, support youth leadership and connection to culture. #SuicidePrevention https://www.cbpatsisp.com.au/resources/vidoes/

Both sides are offering new @headspace_aus centres. That’s good, but better mental health for Indigenous youth also needs policies to address disadvantage. Come on @AustralianLabor and @LiberalAus.

Young and deadly, with powerful connection to culture. There is so much strength and resilience in Aboriginal communities. Let’s promote mental health through cultural respect and Indigenous leadership: http://bit.ly/2YbEFWT .

@cbpatsisp urgently calls for a dedicated National Aboriginal and Torres Strait Islander Suicide Prevention Strategy and implementation Plan, as recommended at last year’s national conference: http://bit.ly/2DTjNfo 

Aboriginal Community Controlled Health Services are best placed to offer mental health, social and emotional wellbeing,  alcohol and drug and suicide prevention services, alongside culturally safe mainstream services, #communityled #connectiontoculture

@cbpatsisp calls on government to allocate more program funding to Aboriginal Community Controlled Health Services or organisations, and to communities. It’s Recommendation 2 from last year’s Indigenous suicide prevention conference. http://bit.ly/2DTjNfo

@cbpatsisp supports Elders’ calls for an immediate response to unacceptable rates of suicides of Aboriginal young people, including a Royal Commission or ‘Truth and Reconciliation’ Commission to heal and move forward. Recommendation 3: http://bit.ly/2DTjNfo 


What do election promises mean for consumers’ health?

Leanne Wells, CEO of the Consumers Health Forum of Australia
@LeanneWells63, @CHFofAustralia

So much promised on health but the big hole in the election campaign: no really comprehensive policy on prevention health.

Coming soon: CHF will release its scorecard on election health policies of the three biggest parties. How will the parties stack up?

Three pain points for this election: cost, uncertainty and poorly coordinated care.

Out of pocket costs in Australia high compared to most other countries. Are the down payments to address this problem enough? Doubtful.

Health is more than hospitals. We need to shift the debate and investment to transformative primary health care.

Too much short termism, what Australia’s health needs is a long-term plan for a more sustainable system, preventing chronic illness in future years, and cost-effective care.

CHF’s big three priorities: childhood obesity, a national dental scheme and primary healthcare reform. Read our election priorities document here https://chf.org.au/publications/making-health-better-priorities-2019-federal-election …

Wellbeing of Australian youth a key priority – CHF welcomes the focus on youth health at this stage of the election campaign Read our media release here https://chf.org.au/media-releases/welcome-focus-youth-health-more-support-needed

PostScript from Croakey: On 10 May, the CHF released its election scorecard. The Greens health policies received the highest rating in an assessment that spans eight domains, including consumer leadership, action on the social determinants of health, prevention, and integrated primary care reform. Next came Labor, while the LNP lagged far behind. (Read more in this Croakey report).


Training the public service

Sally Fitzpatrick, Western Sydney University
@blinkandumissme

I am Research Fellow at @westernsydneyu. I acknowledge the Traditional Owners of the land upon which I work, the Tharawal people, and where I live on Bediagal country. For #AusVotesHealth I want to talk about training the public sector in Aboriginal health

I also belong to the Aboriginal Health and Wellbeing Stream of Maridulu Budyari Gumal, focused on knowledge exchange in engagement, education, methodology and prisoner health. We aim to partner in best practice in Aboriginal and Torres Strait Islander health education.

This training involves increasing numbers of Aboriginal and Torres Strait Islander health professionals; building Aboriginal and Torres Strait Islander health knowledge into the system; and lifting cultural capabilities among Australians generally

Many public sector workers engaged in study are keen to better understand Aboriginal health and wellbeing. Our students have told us how based on their new learning they have fundamentally changed the way they approach program development. http://tiny.cc/httc6y 

But this is just the tip of the iceberg. The public service is hugely influential in the way health business is conducted with Aboriginal and Torres Strait Islander communities

Yet, productive engagement in this space leans on the immense labour by Aboriginal and Torres Strait Islander advocates and community members to educate departmental representatives, leaders and policy makers on Aboriginal health priorities.

Changing current high levels of ignorance about Aboriginal health in the public sector requires national leadership, and Aboriginal and Torres Strait Islander peaks such as @CATSINaM are already leading the charge. Governments also have a leadership role.

Cultural safety is central to our health plans. It involves transformed understanding of continuing impacts and processes colonisation; about the nature and structure of racism; about our unconscious biases; it takes skill in self-reflective practice every day.

As educators, we join students on their learning journey encountering new and difficult knowledge about Australia’s colonial history and strive for ways to be come empowering contributors to more equitable health and justice outcomes for Australia’s First Peoples.

However, this is a team effort. Integrated action at all levels is needed, including sustained support for the work of peak organisations. Current levels of public sector ignorance contribute to the stalled effort to achieve Aboriginal and Torres Strait Islander health equity.

Later today colleagues from @AIDAAustralia will have more to say about cultural safety.

Professor Ian Ring, @UOW, a member of our Stream, has identified the following target groups and knowledge gaps for a national effort. We would be interested to hear from public sector workers what they think? What leadership is required by #auspol? What do we already know works?

Public servants: – health planning, service needs assessment, public health concepts, cultural issues, racism, major clinical topics, management use of information to monitor and improve service quality, etc.

Clinicians embarking on Aboriginal and Torres Strait Islander health: – cultural issues, racism, relevant clinical and public health topics, monitoring and improving quality (CQI), working in teams, how to make best use of MBS/PBS, etc.

Administrators in PHNs and ACCHSs: – working with Aboriginal & TSI communities; assessing service demand, need, access; service inventory & gap analysis; interpreting info to monitor & improve service quality; financial management; funding issues, legislation etc

Our Stream calls on the incoming government to work with the national Aboriginal & Torres Strait Islander health planning partnership with COAG to ensure public sector professionals are better prepared to become part of the solution. Will you join us?


What about policies for the social determinants of health?

Lyn Morgain, SDOH Alliance, cohealth
@MsLynM, @SDOHAlliance, @cohealth_au

I am @MsLynM chief exec at @cohealth_au, we’re passionate about health equity, and tweeting from Wurundjeri and Boonwurrung land.

cohealth acknowledges the traditional custodians of the land and their ancestors on which our offices stand and pay respect to Elders past and present. We acknowledge the sorrow of the Stolen Generations and the impacts of colonisation on Aboriginal and Torres Strait Islander ppl

We also recognise the resilience, strength and pride of Aboriginal and Torres Strait Islander communities

Best buys for addressing determinants of health are – addressing climate change – Progressing a Treaty with Aboriginal and Torres Strait Islander people – Urgent increase to Newstart Allowance. #AusVotesHealth #raisetherate #climateemergency #treaty

We urgently need also to address race based discrimination and ensure those impacted have access to culturally safe service responses

In addition we need to recognise the cost and cease the punitive and demeaning treatment of people receiving income support payments through removing compulsory income management; Robodebt; ParentsNext, etc.

It is essential that we have health policy that includes an equity lens. It’s poor economic sense and causes untold unnecessary suffering.

We urgently need to reorient health system to provide more care in the community, as soon as they need it and close to where people live, to keep people health and move away from acute and costly hospital care.

this requires an Increased investment in community health services where people can access health services recognise and respect their social context

Individuals, families and communities need integrated, wrap around holistic care, particularly for people with multiple and complex needs

They also need increase access to affordable and appropriate quality housing. Poor quality and inadequate housing drives poor health outcomes. #makerentingfair

At the end of the day we have a choice in the forthcoming election. Do we want a planet to live on and are we content to allow people to become sick and die earlier because of their income and access to support?


Healing for the future

Richard Weston, CEO of the Healing Foundation
@RichJWeston

I’m CEO at @HealingOurWay I’m a Meriam man of the Torres Strait.

Healing and trauma are identified priority issues in the Closing the Gap Refresh. Healing is a priority in our communities.

We have also received strong commitments on healing and tackling intergenerational trauma from the Labor side.

Early childhood trauma is a strong predictor of a lifetime of adversity. The higher the levels of trauma the greater the risk of developing chronic diseases and engaging in risky health behaviours.

A better understanding of trauma and application of this knowledge is critical across the social determinants to archieve improvement in Indigenous health.

Our work with Stolen Generations points strongly to the need for a seismic shift needed to focus on public health approach focused on prevention of illness and privileging Indigenous knowledge.

Children and families must be central to the design of healing-informed, trauma-aware approaches to strengthening our communities.

There are no magic bullets, game changers or white knight solutions to our health and wellbeing challenges. It’s all hard slog.

The Uluru Statement represents an opportunity to create a stronger enabling environment for our people to lead their own healing.

We cannot simply service our way out of the challenges we face. Both sides of government supporting regional governance is critical to sustainable change.

Make sure you use your vote to support Indigenous people having more say over the policy and program effort affecting our lives.

Our focus has to be on root causes as well as the symptoms of our powerlessness.

Richard Weston also joined the online discussions at #MyMum in the wake of a newspaper’s “grubby” attack on Bill Shorten’s mother.


For a healthy Australia, vote #1 health

Alison Verhoeven, CEO of the Australian Healthcare and Hospitals Association
@AlisonVerhoeven, @aushealthcare

The @AusHealthcare health policy scorecard shows there is still much work to do to address growing out of pocket costs. And no party has truly committed to value-based health care.

While there have been some tentative baby steps towards value-based care, more needs to be done to move away from measuring and funding healthcare by the number of chargeable services and treatments.

We need to move to results that matter to patients using high quality, value-for-money models of care, eg team-based care, minimising unnecessary interventions and costs, focusing on what is clinically appropriate and valued by patients

There’s a big #AusVotes19 promised spend on investing in research and emerging technologies and treatments. But will these be equitably accessible to all? And will they be affordable or a driver of more out of pocket costs?

Thanks for following me as I share views on #AusVotesHealth #AusVotes19Please follow @AusHealthcare @DeebleInstitute @aushealthvalue for more on what’s needed for a stronger, healthier Australia for all Australians.


Read our previous stories from #AusVotesHealth Twitter Festival:

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