Month: May 2002

Pap test management review seeks input from Indigenous stakeholders

Issue: Vol 2 No 2 April 2002 - June 2002

The National Cervical Screening Program has begun a review of the National Health and Medical Research Council’s Screening to Prevent Cervical Cancer: Guidelines for the management of women with screen detected abnormalities. The current guidelines were released in 1994 and need to be updated in light of the current evidence on management of cervical disease.

A multi-disciplinary Guideline Review Group involving national experts met on 26 November 2001 to establish the main areas of review. Their terms of reference are:

1. Gain agreement on the terminology to be used for cervical cytology reporting
2. Review the scope and coverage of the current Guidelines to identify the areas that need revision
3. Revise the current clinical practice guidelines consistent with the terminology, best scientific evidence and practice and with regard to cost implications
4. Develop an implementation plan, including a plan for the production of a consumer version of the revised Guidelines

Membership of the group is made up of the following clinical disciplines; Cytologist, General Practitioner, Gynaecological oncologist, Gynaecologist, Pathologist and Virologist while the non clinical areas include Aboriginal and Torres Strait Islander representation, Consumers, Epidemiologists, Health Communication Specialist, Health Economist and Commonwealth Department of Health and Aged Care. In addition the various professional associations and colleges are represented.

The group is being chaired by Dr Ian Hammond, a Gynaecological Oncologist from King Edward Memorial Hospital for Women, Perth WA and Chair of the Gynaecological Oncology Subspeciality committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. The Deputy Chair is Dr Annabelle Farnsworth Director of Cytopathology at Douglass Hanly Moir and Chair of the National Quality Assurance Working Group for the National Cervical Screening Program.

The Review Group welcomes comments from all stakeholders throughout the review process and will be consulting members of the public, health professionals and policy makers. Until 31 May 2002 it is seeking input from stakeholders about the main issues they feel need to be addressed within the terms of reference . If you wish to be part of the consultative process you can register at the web site www.csp.nsw.gov.au where you can also submit any comments or suggestions to the Review Group. For those who can not access the web site you can participate in the process and provide comments and suggestions in writing to the:

Guideline Review Group
C/- NSW Cervical Screening Program
PO Box 533
Wentworthville NSW 2145

Links to Commonwealth Budget 2002-03: information of relevance to Indigenous health and well being

Issue: Vol 2 No 2 April 2002 - June 2002

Federal Treasurer Peter Costello delivered his seventh Commonwealth Budget on Tuesday evening, 14 May 2002. The following links provide information on the Budget and its implications for Indigenous health and well being. They include statements by various ministers, and comments by peak Indigenous bodies before and after the release of the Budget.

Full Budget details
Full Commonwealth Budget details are available at the official Budget website.

Health and Ageing Portfolio Budget 2002 – 2003
2002-03 Portfolio Budget Statements for the Health and Ageing Portfolio are available on the Commonwealth Department of Health and Ageing website. Part C discusses the performance of individual outcomes within the Department, and includes Outcome 7: Aboriginal and Torres Strait Islander Health (PDF – 194KB).

Further details regarding the Health and Ageing Portfolio Budget are available on the following web pages:

Health Budget Ageing Budget
Health Budget at a glance
Health Budget index
Health media releases
Health fact sheets 		Ageing Budget at a glance
Ageing Budget index
Ageing media releases
Ageing fact sheets

Information on the future of the Pharmaceutical Benefits Scheme (PBS) (Health fact sheet No.1: Securing the future of the Pharmaceutical Benefits Scheme) receives special attention and is accompanied by a series of answers, by Minister Kay Patterson, to questions regarding the PBS.

Immigration, Multicultural and Indigenous Affairs Portfolio Budget 2002-03
2002-03 Portfolio Budget Statements (PDF – 1.5MB) for the the Immigration and Multicultural and Indigenous Affairs Portfolio are available on the Department’s website.

Part C of the document includes sections on the following:

  • Sound and well-coordinated policies, programs and decision making processes in relation to Indigenous affairs and reconciliation;
  • Aboriginal and Torres Strait Islander Commission;
  • Aboriginal Hostels Limited;
  • Australian Institute of Aboriginal and Torres Strait Islander Studies;
  • Indigenous Business Australia;
  • Indigenous Land Corporation; and
  • Torres Strait Regional Authority

Indigenous Affairs statements released on May 14 include:

Indigenous Affairs statements by other Ministers include:

National Aboriginal Community Controlled Health Organisation (NACCHO)
Prior to the delivery of the Budget, NACCHO raised concerns regarding the impact of proposed changes to the PBS.

Short sighted approach to medicines (9 May 2002)

Aboriginal and Torres Strait Islander Commission (ATSIC)
ATSIC Chairman Geoff Clark has released a background brief outlining ‘ATSIC’s budget, its role and its capacity and responsibility to provide services’ and a statement regarding ATSIC-specific funding for the 2002-03 financial year.

ATSIC Budget background
2002-03 Budget holds the line (media release)

Recipients of the 2002 Puggy Hunter Aboriginal Health Scholarships are announced

Issue: Vol 2 No 2 April 2002 - June 2002

The first recipients of the Puggy Hunter Scholarships for Indigenous students in medicine and nursing were recently announced by Federal Health Minister Kay Patterson in Melbourne.

Speaking at the 5th Wonca World Rural Health Conference (1 – 3 May 2002), Senator Patterson announced that the first round of scholarships had been awarded to five medicine and three nursing students. She described the scholarships as:

‘… a lasting tribute to Dr Hunter and will go part of the way to addressing the under-representation of Aboriginal and Torres Strait Islander people in health professions. The recipients of this award have demonstrated both a commitment to leadership in the health sector and a desire to work in the Aboriginal and Torres Strait Islander communities. These skills are essential for developing a generation of skilled Aboriginal and Torres Strait Islander health professionals to continue the work that Dr Hunter tirelessly dedicated his life to.’

National Aboriginal Community Controlled Health Organisation (NACCHO) Chairperson, Ms Pat Anderson, also highlighted the importance of addressing the shortage of Aboriginal health professionals:

‘The scholarships are a testimony to the late Dr Hunter’s life-long campaign for Aboriginal health. As the [former] NACCHO Chairperson, he was passionately committed to achieving change by empowering Aboriginal people through increasing Aboriginal community control of their health services… The advantages of a strong Aboriginal workforce are obvious. Aboriginal workers in the health profession are more likely to return and provide health care in their home communities. They don’t face the kind of cross-cultural problems of many outsiders. And they can serve as health advocates for their communities, making sure that governments deliver effective and appropriate health policies… They also are important role models for young people in their community. The existence of qualified and successful professionals can be a much needed boost to the ambitions and hopes of young Aboriginal people.’

Funding of $1.23 million over five academic years (2002 – 2006) will provide at least 44 undergraduate scholarships to train Aboriginal health workers and Indigenous students in medicine and nursing. This will include:

  • 10 undergraduate Indigenous medical scholarships;
  • 10 undergraduate Indigenous nursing health scholarships;
  • 12 Aboriginal health worker scholarships for completion of Vocational Educational Training sector courses; and
  • 12 Advanced Tertiary Diploma level Aboriginal health worker training scholarships or articulation into other tertiary level health courses.

The funding will provide students with $10,000 per annum over the term of their enrolment. In addition, it is proposed to provide up to $5 000 per annum to each student as a disadvantage supplement.

Details of the successful applicants for 2002

Nursing students:

  • Emily Hunter, 3rd year student in 2002 at Notre Dame University, Broome Campus;
  • David B Baker, 3rd year student in 2002 at Australian Catholic University, Brisbane;
  • Inawantji Scales, 1st year student in 2002 at the Northern Territory University in Darwin, and the first girl from the Pitjantjatjara Lands to complete year 12.

Medical students:

  • Kiarna Adams, 3rd year student in 2002 at University of WA;
  • Sarah-Jane Gibbons, 3rd year student in 2002 at Newcastle University;
  • Bradley Murphy, 3rd year student in 2002 at James Cook University;
  • Tanya Keane, 4th year student in 2002 at Newcastle University;
  • Olivia O’Donoghue, 5th year student in 2002 at Adelaide University.

For further information:

OATSIH website: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-oatsih-welco.htm
NACCHO website: http://www.naccho.org.au/Scholorships.html

NSW Aboriginal Vascular Health Program

Issue: Vol 2 No 4 September 2002 - December 2002

The following summary is reproduced with permission of the Program Manager, Margaret Scott.

NSW Aboriginal Vascular Health Program

Suggested citation: Scott M (2002, 13 November) NSW Aboriginal Vascular Health Program. Australian Indigenous HealthBulletin, 2(4), Brief report 3. Retrieved [access date] from http://www.healthinfonet.ecu.edu.au/html/html_bulletin/bull_24/bulletin_brief_reports_cvd.htm

Artist : Bronwyn Bancroft

Overview

The Aboriginal Vascular Health Program was established in July 2000 and is responsible for supporting implementation of the components of the NSW Aboriginal Health Strategic Plan which relate to diabetes, diseases of the circulatory system and renal disease. The NSW Aboriginal Health Strategic Plan (1999) is an initiative under the NSW Aboriginal Health Partnership and the NSW Aboriginal and Torres Strait Island Health Agreement jointly developed by the Aboriginal Health & Medical Research Council(AHMRC), the NSW Department of Health(DOH), the Office of Aboriginal and Torres Strait Islander Health (OATSIH)and the Aboriginal and Torres Strait Islander Council (ATSIC).

The Aboriginal Vascular Health Program is committed to working within the NSW Aboriginal Health Partnership Framework at both state and local levels. An Aboriginal Vascular Health Working Group with representation from the AH&MRC, OATSIH and the NSW Health Department oversees the development and implementation of the program.

Program aim

To work in collaboration with relevant organisations and service providers to improve the provision of high quality prevention and care services and programs to promote the vascular health of Aboriginal and Torres Strait Islander people in New South Wales.

Objectives

  • To facilitate implementation of the components of the NSW Aboriginal Health Strategic Plan which relate to diabetes and diseases of the circulatory system
  • To improve standards of clinical care for Aboriginal people with or at risk of vascular disease ensuring a more consistent approach, support for chronic disease self-management and reduction in hospitalisation for preventable complications
  • To play a key role in facilitating the development of local Chronic and Complex Care projects in relation to cardiovascular disease in Aboriginal people as part of implementation of the NSW Government Action Plan for Health
  • To provide input into implementation of related strategies of the Aboriginal Health Strategic Plan which are pertinent to the delivery of a continuum of prevention and care for Aboriginal people in relation to chronic disease
  • To facilitate and support the implementation of local initiatives aiming to improve the provision of prevention and care programs to the Aboriginal community
  • To facilitate a more coordinated approach to Aboriginal health by directly linking with other related Aboriginal health strategies as appropriate

Reasons for adopting a vascular health approach

The Program has adopted a broad vascular health approach (including diabetes, heart disease, stroke, hypertension and kidney disease) rather than a single disease or body part approach because of the common risk conditions which place Aboriginal people at greater risk for these diseases, and the common approaches needed to prevent and manage these conditions in Aboriginal communities.

It is well known that Aboriginal and Torres Strait Islander people experience excess morbidity and mortality from diseases of the circulatory system; heart, stroke and vascular disease are the biggest cause of excess deaths in Indigenous Australians. Compared with the non-Indigenous population, Aboriginal and Torres Strait Islander populations experience :

  • rates of diabetes which are 2 to 4 times higherrates of heart,
  • stroke and vascular disease which are 2 times higher
  • rates of renal disease which are 10 to 15 times higher;
  • deaths from heart disease at twice the rate, within the 25-64 age groups this rises to 7-10 times higher.

The social and environmental circumstances in which many Indigenous Australians live create risk conditions eg poverty, poor housing, inadequate food supply which predispose them to the development of chronic diseases and the uptake of risk behaviours which may lead to physiological risk factors for chronic disease. (See Fig 1.)

The range of biological and behavioural factors which are common to and increase a person’s risk of developing diabetes, heart, stroke and vascular disease include the following:

Behavioural risk factors

  • Smoking
  • Physical inactivity
  • Poor diet and nutrition
  • Excessive alcohol use

Physiological/metabolic risk factors

  • Elevated lipids (high blood fats)
  • Hypertension (high blood pressure)
  • Hyperglycaemia (high blood sugar)
  • Overweight and central obesity

When several risk factors coexist, the risk of vascular disease is multiplied and having one of these chronic diseases can predispose to another, for example cardiovascular disease is a common complication of diabetes. Many national and state reports and initiatives recommend that a joint approach to chronic vascular disease is likely to be more effective and more efficient.

Advantages of a broad vascular disease approach

Due to the shared risk factors, primary and secondary prevention messages relating to health and lifestyle across the major health issues (ie diabetes, circulatory, renal diseases) are virtually the same. Integration of vascular risk prevention programs and clinical management interventions enables greater efficiency of effort with potentially greater health outcomes. Also a holistic approach is more in keeping with Indigenous concepts of health and illness than a separate body parts or single disease approach. It is anticipated that a coordinated and strategic whole of person approach should over time impact the delay in onset and reduced numbers of adverse health outcomes in vascular disease in Aboriginal people in NSW.

Program guiding principles

  • Implementation through state and local Aboriginal Health Partnerships
  • Adoption of a social model of health
  • Recognition that self-determination and empowerment are central
  • Congruence with national and state strategic directions in health
  • Strategies developed within a primary health care framework
  • A broad chronic disease(vascular) approach
  • Ensuring Aboriginal community support and involvement
  • Ensuring cultural appropriateness of strategies and programs
  • Focus on patient centred services
  • Adoption of an holistic approach
  • Prevention as a priority, with a whole of life course approach
  • Support for chronic disease self-management
  • Utilisation of a capacity building approach
  • Inter-sectoral collaboration to modify identified determinants of health and achieve consistency and synergy of effort
  • Optimum utilisation of all available resources
  • Ensuring transparency and accountability

Current program initiatives

The AVHP has developed a comprehensive Strategic Framework (see Fig 2) and is implementing a broad range of interrelated projects with funds allocated in 2000/2001 and 2001/2002 through Aboriginal Statewide Enhancement Funds. From July 2002 the AVHP has been recurrently funded.

Aboriginal vascular health demonstration site projects

A series of demonstration site Aboriginal vascular health projects has been funded throughout the state, commencing in April 2001. The projects are developed and implemented through local partnerships with service providers and communities to establish programs and models of care to improve the prevention and management of vascular disease in local Aboriginal people. All projects have a strong emphasis on working collaboratively with mainstream and Aboriginal Community Controlled Services to provide the best services possible utilising locally available resources. Aboriginal health workers are working in a range of designated roles; training and support is being provided to increase knowledge and skills in prevention, early detection and management of chronic diseases. The projects are being closely monitored and evaluated to gather evidence and develop a better understanding of effective systems and models of care.

In 2001 projects were funded in 8 Area Health Services (Central Coast, Hunter, South Western Sydney, Western Sydney, Macquarie, Illawarra, Mid-Western, New England) and 3 correctional sites serviced by Corrections Health Service (Broken Hill, Tamworth, Grafton).

In 2002 additional projects are being funded in Mid North Coast, Northern Rivers, Greater Murray, South Eastern Sydney, Far West, Wentworth and 3 additional Correctional Centres (Emu Plains, Mannus, Ivanhoe).

Vascular health project objectives

The projects aim to:

  • improve prevention, early identification, early intervention and ongoing care for Aboriginal people with or at risk of vascular disease
  • increase primary health care utilisation by Aboriginal people
  • promote greater coordination and continuity of care for those with established disease, with an emphasis on community based care and support for disease self-management
  • reduce preventable hospital admissions for complications of vascular disease
  • promote improved environmental and community support for disease prevention and health improvement

Key features of all projects:

  • project development and implementation through local Aboriginal Health Partnerships and with relevant local services providers and other stakeholders
  • recruitment and training of designated Aboriginal Vascular Health Workers
  • close integration with the Chronic and Complex Care Cardiovascular projects in local Area Health Services
  • close monitoring and evaluation
  • a central focus on improved access to early detection of disease and risk, referral for care improved coordination of services and provision of evidence based care and support for disease self-management

Aboriginal vascular health network

A key strategy of the NSW Aboriginal Vascular Health Program has been the establishment of a network for all health professionals involved in work related to Aboriginal vascular health. The AVHN has a wide range of membership including: Aboriginal and non-Aboriginal health professionals, clinicians, and staff from relevant non-government organisations such as Aboriginal Community Controlled Health Services, National Heart Foundation of Australia, Diabetes Australia, and Australian Kidney Foundation. The AVHN aims to provide a support and information and resource dissemination system for those working in Aboriginal chronic disease in NSW. A quarterly bulletin Vascular Health Matters is distributed to members to share information on the NSW Aboriginal Vascular Health projects, other AVHP activities, available resources, funding opportunities, conferences and current programs being conducted around NSW and Australia. All interested health professionals are welcome to join the network.

Aboriginal vascular health resource catalogue

To increase information on available resources, the NSW Aboriginal Vascular Health Program has developed a comprehensive catalogue which includes a description of education and training resources available for cardiovascular disease, diabetes, renal disease, public health and project development which are relevant for Aboriginal and Torres Strait Islander communities. Information on relevant web-sites and available training is also provided.

Aboriginal vascular health workforce development

A strategy to build the capacity of the Aboriginal Health Workforce in the prevention and management of vascular disease is being implemented. A workshop training manual about Aboriginal people and kidney disease Check your kidneys has been produced and similar manuals in cardiovascular disease and diabetes are underway. Other resources will be developed over time according to identified need.

Check your kidneys – training manual

The Check your kidneys training manual was developed in partnership with the Centre for Kidney Research at the Children’s Hospital Westmead and was piloted across the state. The purpose of the training is to increase awareness and knowledge of kidney disease in Aboriginal people and to create an opportunity for health workers and health services to identify steps which can be taken to address kidney disease in their home, community and workplace roles. The training has a strong emphasis on prevention across the continuum of life.

Research initiatives

Improving prevention and care of diabetes and related disease in the Aboriginal community of Wagga Wagga (NHMRC Grant)

This collaborative research initiative involves the implementation and evaluation of an Australian version of a model of systematic diabetes care (Staged Diabetes Management) which has demonstrated significant health improvements following its introduction into American Indian Health Services. The project is being conducted in collaboration with the Riverina Medical and Dental Aboriginal Corporation in Wagga Wagga, NSW.

Models of chronic disease self-management for Aboriginal vascular disease

Specific focussed projects developing and testing appropriate and effective models of disease self-management for Aboriginal people with established vascular disease have been funded in the Illawarra Aboriginal Medical Service at Wollongong and Daruk Aboriginal Medical Service at Mt Druitt.

Aboriginal vascular health indicators framework

A framework is under development to monitor progress in Aboriginal vascular disease prevention and management in NSW. The initial focus will be on measuring changes in local capacity to address prevention and management issues.

Program evaluation

A 12 month evaluation of the AVHP commenced in August 2002 to assess the appropriateness and effectiveness of the overall program strategic approach and of individual project initiatives of the Program. The evaluation has a strong participatory and capacity building approach.

On the web

The Aboriginal Vascular Health Program can be viewed on the NSW Department of Health internal website which also contains details of the 9 demonstration site vascular health projects. Address: http://internal.health.nsw.gov.au/public-health/crcp/ceb/projects/projects.html

Program contacts

For more information about the Aboriginal Vascular Health Program contact:

Margaret Scott
Program Manager Aboriginal Vascular Health Program
Centre for Research and Clinical Policy
NSW Health
LMB 961, N Sydney 2059
Email: mscot@doh.health.nsw.gov.au
Tel: 02 9391 9853
Fax: 02 9391 9556

To join the Aboriginal Vascular Health Network or obtain a copy of the Aboriginal Vascular Health Resources Catalogue forward contact details to:

Samantha O’Connor
Project Officer
Aboriginal Vascular Health Program
Centre for Research and Clinical Policy,
NSW Health,
LMB 961, N Sydney 2059,
Tel: 02 9391 9571
Fax: 02 9391 9556
Email: socon@doh.health.nsw.gov.au

Indigenous palliative care needs study 2002

Issue: Vol 2 No 2 April 2002 - June 2002

The Commonwealth Department of Health and Ageing has initiated a national scoping study into the needs of Aboriginal and Torres Strait Islander peoples in the area of palliative care. The study is being done by consultants Kate Sullivan and Associates and will be conducted throughout 2002.

The primary aim of the study is to identify the palliative care services available to Aboriginal people and Torres Strait Islanders, find out how well these services work and whether they can be improved, and determine whether there are areas where needs are not being met. This information will be used to inform and improve the Commonwealth’s National Palliative Care Strategy, and identify areas where resources are most needed. The formal objectives of the scoping study are to identify:

  1. Existing activities in palliative care for Aboriginal and Torres Strait Islander peoples at Commonwealth,State/Territory and community levels, including mainstream programs, which incorporate Indigenous components as well as Indigenous-specific activities.
  2. Areas that could be enhanced or developed under the National Palliative Care Strategy at Commonwealth, State/Territory and community levels.
  3. The particular needs of Aboriginal and Torres Strait Islander peoples for palliative care, taking into account the diversity of Aboriginal and Torres Strait Islander communities and the different needs of rural, remote and metropolitan communities.
  4. Spiritual and cultural practices that relate to death and examine the extent to which these are being implemented in a culturally sensitive way, taking into account the diversity of settings and cultural beliefs.

The project recognises that Aboriginal and Torres Strait Islander communities’ experience of loss and grief is profoundly affected by socioeconomic disadvantage, high death rates, and past policies which have caused separation and loss. It also recognises the central place of family and of the land, and that cultural and spiritual beliefs are particularly important in providing appropriate palliative care services to Aboriginal people and Torres Strait Islanders.

The scoping study is overseen by a Steering Committee which includes Indigenous members from the Congress of Aboriginal and Torres Strait Islander Nurses and the Aboriginal and Torres Strait Islander Research Agenda Working Group. The team of consultants, headed by Kate Sullivan, also includes Indigenous researchers and interviewers with specialist skills and experience in working with Indigenous communities.

The project is being conducted in four parts. The first (stages 1-3), which will be completed in April 2002, includes a literature review and scoping study, conducted by telephone. A series of questions have been developed for state and regional agencies, service providers, and community organisations, to gather information about palliative care services in their regions. The aim of the phone survey is to find out who is doing what (including provision of appropriate training) to enable the Steering Committee and consultants to decide which communities should be visited later in the research.

The second part (stages 4-5, May-June 2002) will focus on methodology development and partnership development with the communities in which the consultants wish to undertake field work. Relevant ethics committees and community organisations will be asked to review the methodology.

Field work will be conducted during stages 6-7 of the project (July-October 2002). The purpose of the field work will be to record from the perspective of Aboriginal and Torres Strait Islander people their experience of existing palliative care services and the unmet needs they identify. The field work will include rural and remote areas and some metropolitan centres where services are often not appropriate to Aboriginal and Torres Strait Islander needs. The field work will be conducted by male and female team members and will provide for remuneration for local Aboriginal and/or Torres Strait Islander assistance. A question sheet will be posted to community organisations in selected communities that cannot be visited.

The final part, stages 8-9, will be the reporting phases. There will be several rounds of reporting and the final report will be in two parts – a detailed report for the Commonwealth Department of Health and Ageing, and a short ‘plain English’ report which will be made available to all communities and organisations that have participated in the study. It is expected that reporting will be finalised by March 2003.

Information about the study and the consultants can be obtained from http://member.telpacific.com.au/ksa/. A newsletter will be posted on the website and distributed to participating communities and organisations.

The consultants are keen to hear from people who are providing palliative care services to Indigenous people, and are particularly interested in examples that are considered good practice.

Kate Sullivan can be contacted at (02) 9810 5755 or 1800 810 575.