NSW Aboriginal Vascular Health Program

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