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Dead, or Deadly: a formidable response to non-communicable diseases, designed by and for Aboriginal women

Introduction by Croakey: The #IndigenousNCDs series of articles at Croakey has been looking at the need for Indigenous peoples worldwide to be included in the upcoming UN High Level Meeting, and the ensuing Political Declaration, that will seek to set the global agenda for the prevention and control of non-communicable diseases for years to come.

In the first article in the series, Summer May Finlay and Kate Armstrong wrote that Indigenous peoples’ right to self determination demands that the solutions to their health problems be Indigenous-led.

Experience in Australia bears out the need for Indigenous leadership in programs targeting the high rates of chronic diseases in Aboriginal and Torres Strait Islander people, if for no other reason than that Indigenous-led initiatives work.

Consider the success of our Aboriginal Controlled Health sector, which leads the way on comprehensive primary care, including health screening and risk factor management.

As well as having much to gain from inclusion in the global discourse on non-communicable diseases (NCDs), Indigenous people have much to contribute.

The NSW-based Aboriginal women’s health program, Dead, or deadly is an example of an initiative that arose from local need, and tackles NCDs from a variety of angles that are only possible through Indigenous leadership. It’s a program by Aboriginal women, for Aboriginal women, that has received deserved recognition nationally.

Croakey has featured the program before. For this series we asked the Program Coordinator, Willow Firth, and Senior Aboriginal Health Worker and Manager, Hayley Longbottom, to provide an update and to consider what it is that makes Dead, or deadly so effective.

In other news, a meeting brochure that was recently made available by the United Nations and World Health Organization, in the lead-up to the High Level Meeting, specifically recommends that  “Heads or senior representatives of relevant United Nations entities, civil society, the private sector, philanthropic foundations, academia, medical associations, Indigenous leadership (our emphasis) and community organizations” should attend the High Level Meeting, along with “Heads of State and Government, Parliamentarians, and Ministers of Foreign Affairs, Finance and Health.”

The brochure also provides a brief guide to the magnitude of the global problem of NCDs, the purpose of the meeting and declaration, and opportunities for action. It’s worth a look if you want to gain a clearer understanding about why non-communicable diseases should and can be tackled as a group.

Croakey will be hosting a Twitter-fest on this issue in the near future, so charge your devices and stay tuned.


Willow Firth and Hayley Longbottom write:

Dead, or Deadly commenced in 2009 at the South Coast Women’s Health and Welfare Aboriginal Corporation (Waminda) in the Shoalhaven region of NSW.

It was designed for and by Aboriginal women, as a health promotion program.

By integrating theory and practice, Dead, or Deadly takes a holistic approach to physical activity, nutrition, smoking cessation, chronic disease prevention and management.

While addressing the complex issues that impact the health and wellbeing of Indigenous women and their families, Dead, or Deadly also targets risks behaviours that create the circumstances for chronic disease. Health education workshops and yarning circles are core to the program.

Dead, or Deadly has been very successful in enabling women to reduce these risks in their lives, by providing support in a safe, culturally appropriate environment that supports healthy choices, physical activity and health information.

Indigenous Australia has a vibrant history of strength, resilience and self-determination. At the same time, ongoing impacts of colonisation continue to manifest in poorer health outcomes for Waminda’s client group.

The data also show extremely high rates of comorbidity between physical and mental health disorders (Dead, or Deadly Report 2017), consistent with what has been observed elsewhere. The high emotional distress is also related to the womens’ experiences of trauma and interpersonal violence.

Holistic responses to chronic disease

Chronic diseases are the leading cause of illness, disability and death in Australia, accounting for 90% of all deaths in 2011.

Many lifestyle behaviours ultimately leading to chronic disease tend to be part of a vicious cycle. For example, inadequate sleep and poor diet leads to fatigue, fatigue leads to inactivity, inactivity leads to weight gain, weight gain to metabolic syndrome, type 2 diabetes and other flow-on effects.

The Dead, or Deadly program attempts to intercept these behaviours using motivational interviewing, positive role modelling and health education.

Each year, numbers of actively engaged and participating Aboriginal women in Dead, or Deadly continue to increase. Due to this increased community demand, Dead, or Deadly has expanded up and down the coast of NSW. Starting in Nowra/Bomoderry, Jerrinja and Wreck Bay, the program is now delivered in Wallaga Lake, Bega/Eden on the far south coast, plus Coomaditchie to the North.

The success of the Dead or Deadly program in addressing chronic disease for women was recognised by the federal government with an announcement of funding support earlier this year.

Our last 12-month report demonstrated we had 248 ATSI women involved in the program, with 580 group sessions and 3429 episodes of health care. We want to demonstrate that this model of care and service delivery works, and can be replicated.

The holistic, relationship-based model of Dead or Deadly has enabled Waminda to simultaneously address health and related life issues, while creating pathways to Waminda’s other health, wellbeing, case management and clinical services to provide a wrap-around service for these clients.

Research reveals that the Deadly or Deadly program enables Waminda to deliver health services according to a social model of health.

Measurable positive changes

Dead or Deadly has led to measurable, positive changes in Waminda’s clients’ health and wellbeing, including physical health and related factors such as employment, self-esteem, family, education and strengthening cultural identity and connection.

These significant achievements mean Waminda is making a contribution to the broader Indigenous health agenda. The results are promising in light of calls to ‘close the gap’ between Indigenous and non-Indigenous health outcomes.

Some of the key benefits of the program include:

  • Improved access to health checks for all individuals participating in the program and increased understanding about their health status and strategies for managing any health risks; including heart disease, kidney disease and diabetes and stroke.
  • Decreases in cardiovascular markers for most of the women participating in the program.
  • Changes in behaviour that leads to healthier eating and increased physical activity for Aboriginal women on the South Coast and associated reductions in body weight. There is some evidence that Dead or Deadly is more successful than other government initiatives.
  • On average, Dead, or Deadly participants have increased their cardio-vascular fitness and reduced both weight and girth (mean reduction of 6% body weight).
  • We commonly see reductions in HbA1C’s and blood pressure results
  • Opportunities for women to address their smoking through harm minimisation or cessation support. On average the women have reduced their smoking and a number have quit smoking altogether. Opportunities for pregnant Mums to access smoking cessation support, tailored exercise programs and healthy living support, and referral to culturally informed ante & postnatal maternity services.
  • Significant improvements in the social and emotional wellbeing of women, and reductions in stress levels (as shown by the K-10 assessment tool).

Dead, or Deadly has been a catalyst and leader in the development of other programs at Waminda. As well as providing a soft entry to clinical and allied health services at Waminda it has enabled the development of our Young Women’s Program and our Tackling Indigenous Smoking program.

Referral pathways for women into professional services, and to our Primary Health Care services and existing partnerships, lead to improved screening and timely detection for those at high risk of developing chronic conditions. This type of preventative health care is not only important for Indigenous health, but in the wider health care system which is experiencing the enormous pressure of modern day chronic disease.

The less well recognised influences on health, such as stress, anxiety, poor or inadequate sleep, lack of connectedness, loss of meaning and purpose, along with numerous environmental influences, are modifiable, and are key to the success of Dead or Deadly.

Changing the impacts of these influences takes time, thus the need for ongoing support for Indigenous-led programs such as Dead or Deadly to create sustained lifestyle change, to maximise health and wellbeing.

Willow Firth is the  Dead, or Deadly Program Coordinator at Waminda-South coast Aboriginal Women’s Health and Welfare corporation. Hayley Longbottom is a Senior Aboriginal Health Worker and Manager at South Coast Women’s Health and welfare Aboriginal Corporation. On twitter @Deadordeadly1 Instagram @deadordeadly

Funding statement: Funding for Croakey to publish a series of articles on the implications for Indigenous people of the upcoming UN Political Declaration on Noncommunicable Diseases was provided by Caring & Living as Neighbours (CLAN). The Croakey team is independently responsible for the editorial content of the series, which includes an investigative report from Marie McInerney, and is edited by Ruth Armstrong.