Systemic change is needed to address the wide-ranging factors affecting the community’s health, from justice and prison reform to addressing the social determinants of rural and remote health, self-determination for people with disabilities, and the proliferation of junk food marketing to children.
Participants in the recent #AusVotesHealth Twitter festival also called for the next federal government to support the Uluru Statement, health-promoting transport systems and action on poverty.
And the Home to Bilo campaign reminded us powerfully that “none of us are truly healthy while we have children and adults suffering in detention”.
The article below follows the order of the Twitter festival program. See our previous reports here.
Justice health
Dr Megan Williams, Senior Lecturer and Head of the Girra Maa Indigenous Health Discipline at the Graduate School of Health, University of Technology
@MegBastard
It’s Megan Williams of the Wiradjuri nation acknowledging Gadigal people of the Eora nation on whose lands I work and live. I honour your ancestors, your leaders and your young ones and seek to do all I can for justice to be experienced
Firstly, in my #AusVotesHealth best news of the day. My dad and I have this little house ‘n land… Our street was just RENAMED from Queen St to its rightful Aboriginal name! Officially. Nearly 200 years since MARTIAL LAW was proclaimed on our ancestors. #decolonising
There was no way I was gonna say “only 200 years after martial law was proclaimed”. That martial law was ever proclaimed is profound.
Beyond Punishment panel discussion I’m chairing next week. We will discuss role of Commonwealth in prison reform, among other issues including for Aboriginal women
This event is sponsored by the Sydney Institute of Criminology at Sydney Law School and Corrective Services NSW
Another reason prisons ARE a federal election issue AND a health issue: article explains Closing the Gap targets are all affected by people being in prison, children, adults, parents and people who best be in the health care not punishment.
New Oxford Uni Press book on the social determinants of health has chapter on Australia’s first people and multi-level empowerment including justice – an #AusVotesHealth text.
Indigenous Legal Assistance Program to be axed despite affirming evaluation and recommendation to extend and expand. See here.
It’s disappointing that the Government has decided to withdraw the Indigenous Legal Assistance Program… Amnesty joins National Aboriginal and Torres Strait Islander Legal Services (NATSILS) and the Change the Record coalition in urging the Attorney General to retain the program
Christian Porter – Federal Attorney General to axe ILAP. No alternatives put in place. https://www.attorneygeneral.gov.au/Pages/default.aspx
Where is the focus for rural and remote health?
National Rural Health Alliance
@NRHAlliance
My name is Jo Walker, I am the Alliance’s Director of Policy and Strategy and very pleased to be here.
Rural and remote places are diverse. The rural-urban differences are based on aggregates or averages. The more remote the area, the more significant the deficits and challenges.
Risk factors more common among rural people, eg alcohol (see news from FARE, smoking, risky behaviours, occupational injury, poor nutrition, ice, sedentary). Social determinants of health are critical, eg lower levels of education, income, connectivity. Poor access to health services compounds these issues. … rural people are nevertheless relatively resilient.
Rural health service personnel are critical as leaders, spokespersons and workforce participants – as well as service providers. The NRHA is a broad church which tries to faithfully represent this breadth of concern for health and wellbeing.
Rural health services provide employment too. An investment in jobs as well as fairness. By building the rural health, aged care and disability care systems, one builds the rural workforce as well as service access and equity.
At the recent 15th National Rural Health Conference in Hobart, 1200 delegates canvassed many rural health issues. See the priority recommendations here.
The Alliance has published its 2019 Election Charter – Rural Health Matters!
The four priorities are: Indigenous health; access, expand the health research capacity of rural Australia; and a new National Rural Health Strategy.
All Australians should be able to achieve the best health outcomes regardless of where they live. This is not the case for the seven million who live in rural and remote areas. They die younger, have poorer health outcomes and face many disadvantages in accessing health services.
Priority 1. Improve Indigenous health: endorse the Uluru Statement; 3000 additional Aboriginal Health Workers and Practitioners; increase funding for ACCHOs; and eliminate Rheumatic Heart Disease.
Priority 2. Improve access: 3000 additional Allied Health Professionals; 20 rural and remote demonstration sites; community grants program; medicare rebates to GPs and Allied Health Professionals.
Unacceptable stats – Aboriginal people are 69 times more likely than non-Aboriginal people to develop rheumatic fever and 64 times more likely to have rheumatic heart disease. The National Rural Health Alliance calls on the incoming government to END RHD.
Priority 3. Expand the health research capacity of rural Australia. A third of the population deserve a third of the research funds! A stronger focus on rural health research; (rural and remote currently not getting its fair share through MRFF, NHMRC, ARC).
Priority 4. Create a new National Rural Health Strategy that includes targets for improving access to health services, health promotion and for improving social determinants of health for rural people.
Develop and adhere to a new National Rural Health Strategy. Not just a set of principles but a plan with measurable targets, programs, dollars, and public reporting. Including targets for improving access to services, health promotion and for improving the social determinants of health for rural people.
This Strategy can integrate the other three elements. And mandate a stronger focus on illness prevention, health promotion etc in rural and remote.
Australia’s current rural health strategy is based on a framework developed in 2011 and needs to be evaluated against this framework’s original objectives and updated to reflect changing workforce demands, connectivity and service delivery.
Since 2011 there has been no demonstrable imp. in health outcomes experienced by the seven million people who live in rural. Nor has the framework been evaluated for its use or to assess whether it’s meeting its objectives and what else is required to progress its intent.
A new strategy would review this framework, its effectiveness, identify how widely it has been used and create a new blueprint for providing effective healthcare & encouraging healthier rural people into the third decade of the 21st century.
What we’re asking for this federal election
El Gibbs, People with Disability Australia
@bluntshovels, @PWDAustralia
Firstly, I live and work on the land of the Darug and Gundungurra people and I pay respect to them. This always was, and always will be Aboriginal land.
Currently, there are consultations about the National Disability Strategy (NDS) going on around Australia. This is the key national document that makes our rights real.
This sets the direction, beyond 2020, about how we make Australia a more inclusive place for disabled people, and is a key ask from all the national peaks.
It is how Australia is going to deliver on the Convention on the Rights of Persons with Disabilities – the CRPD, as it is affectionately known by disabled people. Australia signed up to the CRPD a decade ago.
The NDIS fits inside the national strategy – for the NDIS to work, the Strategy has to be funded, resourced and active. Here’s some background about it from #CripCroakey.
Both the Government and the Opposition have committed to the Strategy as the key way to deliver for people with disability
Disability representative organisations have been working on various election platforms this year, outlining what we would like the next Federal Government to do so make Australia more inclusive, equal and accessible.
From the First Peoples Disability Network Australia – key asks are Reforms of National Disability Agreement, National Disability Advocacy Program, National Disability Strategy and Closing the Gap.
From People Living with Disability Australia – NDIS, employment, income support and preventing violence.
From National Ethnic Disability Alliance – End disability discrimination in immigration, access and equity for CALD communities with the NDIS, representation for CALD people with disability, national plan for refugees with disability.
From Women with Disabilities Australia – Violence prevention, Gender in NDIS, NDS, NDA, employment, sexual and reprductive rights of women and girls with disability, agency and decision making, national assessment of status of women, girls with disability.
And more! Australian Federation of Disability Organisations; Carers Australia; Every Australian Counts; Our Health Counts.
I’m also keen to see how the Federal Government can leverage some movement from the states and territories who are winding back disability services and putting all the disability eggs into the NDIS basket.
Only 10 percent of us will have access to the individualised supports from the NDIS (which was always the plan). This means that have access to mainstream and other disability supports is really important for disabled people.
A really important issue is #OurRoyalCommission, which is long overdue, and a way of driving serious violence prevention, and getting justice for disabled people.
Here’s more about #OurRoyalCommission, with an FAQ and all the latest evidence and data about violence, abuse, neglect and exploitation of disabled people.
Many people with disability have found that they haven’t got justice for violence against them in the past, so #OurRoyalCommission will be important to change that.
We know that there will be terrible stories, because what is happening to us is terrible. The scale of the violence is shocking and terrible.
Key themes from all these platforms are about making sure we have a say over our own lives, in decisions about the supports we need, and have equal access to mainstream services.
Health for all, or high quality health care for some
Dr Tim Woodruff, Doctors Reform Society
@woodruff_tim, @drsreform
What can be done? Copayments: Phase out PBS copayments: neither major party interested.
Increase public hospital specialist services: Labor yes, Greens yes, Coalition asleep
Fund expansion of community health centres as in Victoria.
Prevention/Health Promotion What can be done? Five percent health budget for prevention: neither major party near it. Specific strategies, big areas targeted by Labor, Coalition asleep. Greens have the vision, will push for prevention as central.
Social Determinants of Health and Productivity = SDOHP. What can be done? Health in all policies: Ignored. Labor at least working on income & wealth inequality. Coalition promote inequality.
Dental: Why not universal? My toothless patients. So cruel & wasteful. Ideas for progress: Grattan Institute report. Labor steps forward: all OAPs $1000 capped. DSPs nothing.Much more needed. Greens have vision. Coalition blind
Primary Health Care: almost forgotten, central to better healthcare and health. Hope from Health Reform Commission. No hope from Coalition. Greens fund enrolled patients with chronic disease, will Labor catch up?
Mental health: where to start? Another mental health plan stuffed by fighting stakeholders/fed/state divide.
Private Health Insurance: Coalition promises more inequity. Labor timidly asking Productivity Commission to find ways to improve, not to look at inequity of $11billion going to support public hospital queue jumpers. Greens vision to abolish rebate.
Climate change and health: Greens have the vision, not the power. Labor may have the power, but their vision is short term, chequered. We hope the Coalition will not have the power as they have no vision.
Indigenous health: We need more than targets, strategies, apologies. We need to empower our Indigenous brothers and sisters. Expand funding for ACCHCs (consider model for other community health centres!). Act on Uluru Statement from the Heart. 
Congrats to the many at the front line developing and working in projects/programs trying to make a difference, working against tide of divisions of power/self interest/history. We need system change. Please demand it.
Coalition: health care if one can afford. Privatise. Labor: the vision yes, then policies which both support and deny vision. How far will they push reform against stakeholders? Will they cross state/fed divide? Greens: the vision, power to influence.
After the divisiveness of an election, we have to find common ground, work together, for our grandchildren, children, communities, Australia, and the world – (see this video).
Cultural safety and health workforce
Australian Indigenous Doctors Association
@AIDAAustralia
Cultural safety is vital for effective delivery of Indigenous health services. AIDA urges government support to enable understanding and commitment to cultural safety training for all involved in development or delivery of Indigenous health policy and services.
AIDA endorses the Uluru Statement, including need for establishing First Nations Voice enshrined in Constitution. Vital for self-determination, which impacts positively on health and wellbeing of Indigenous peoples. We urge next Australian Government to understand, respect and accept what our people have said.
AIDA calls for all current policy documents relating to Indigenous health, such as the Implementation Plan of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 and associated frameworks, to be fully costed and funded.
Aboriginal and Torres Strait Islander doctor mental health and emotional wellbeing in the health care system continues to be an ongoing challenge for our workforce.
AIDA calls on the next Australian Government to commit to funding for:
- coordinated leadership across workforce to address doctors’ mental health and prioritisation of mental health and wellbeing for doctors through measures, for example reasonable working hours, reducing stigma re mental health and providing resources and services for staff;
- ensure Indigenous doctors are supported in workplaces free of racism, bullying and harassment. Includes respect for and acknowledgement of culture through cultural leave for community obligations (eg to attend funerals) and leadership on cultural safety
- support development of doctor-specific wellbeing programs. See AIDA position paper.
Prioritise prevention to reduce chronic disease risk factors
Australian Chronic Disease Prevention Alliance
@ACDPAlliance
ACDPA brings together chronic disease groups to advocate for prevention and address risk factors with a unified voice.
Shared chronic disease risk factors include poor diets, unhealthy weight & physical inactivity. These three risk factors increase risk of diabetes, stroke, many cancers, heart disease and chronic kidney disease.
Politicians often speak of individual responsibility BUT we need public health policies and environments that support and empower people to make healthy choices.
Children are particularly vulnerable to marketing. The World Health Organization says there is “unequivocal evidence that the marketing of unhealthy foods and sugar-sweetened beverages is linked to childhood obesity.”
Key prevention priorities ACDPA:
- Protect children from junk food marketing – Improve food labelling & reformulation – Create environments that encourage activity and movement – Increase health checks to assess & manage chronic disease risk.
- Voluntary industry self-regulations are insufficient & ineffective. Recent research found children can watch around 800 junk food advertisements on TV in a year.
The Federal Opposition recently committed to a review of marketing to children. It’s a good start and needs to be followed by action to protect children from rampant and ubiquitous food and drink advertising
Marketing restrictions are one of the most cost-effective approaches to reduce obesity.
Food labels provide a space to communicate nutrition information at the point of sale & consumption. The Government’s Health Star Rating system uses a simple star rating to help people compare similar products at a glance.
Research by the George Institute found that only one-third eligible products display the Health Star Rating, limiting its effectiveness and usability. We support improvements and making it mandatory to help people make informed choices.
Transport for health
Dr Graeme McLeay, member, Doctors for the Environment Australia
@Gmac45Graeme, @DocsEnvAus
The Government is denying that emissions are rising. Transport is a major contributor to rising emissions yet the Ministerial Forum has failed to address vehicle emissions since it was established in 2015. Diesel exhaust is carcinogenic and our kids are breathing it every day.
The answer to “congestion busting” is not bigger roads which attract more cars. We need better public transport and to encourage people to walk and cycle as much as possible…better for health, lower toxic and greenhouse emissions.
The World Health Organization estimates that poor outdoor air quality is responsible for over four million deaths per year. Australia is not immune, with 3,000 deaths per year from air pollution due mostly to vehicle pollution and coal fired power.
The latest UN report tells us again that a warming climate is exacerbating the effects of overfishing, pesticide use, pollution and urban expansion in the natural world.
Doctors for the Environment Australia are advocating for a better world for our kids. Support climate action.
Morrison wants to “cut green tape” a day after a UN report which says that the world environment is in deep trouble with biodiversity loss and climate change.
Electric vehicles are not the total answer to rising transport emissions but they will help and the zero tailpipe emissions benefit all road users. Highly efficient, cheap to run, lower emissions – why would government not support that?
Back to Bilo
The Home to Bilo campaign and better health for asylum seekers and refugees
@HometoBilo