Poche Centres for Indigenous Health

Poche Centres for Indigenous Health

Key Thinkers’ Forum

Darwin 11 July 2014

Poche Centres for Indigenous Health

Welcome to country

Poche Centres for Indigenous Health

Overview of the Key Thinkers’ Forum:

format, topic and issues

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• Filming• Briefing paper• “Q and A” meets “Insight”• Everyone participates• Cameo speakers• Poche Opinion

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Steve GutheridgeThe data

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How much?• Average annual per capita alcohol consumption 13.4 litres compared with

national 10.3 litres (15 years & over)NT wholesale alcohol supply & ABS apparent consumption of alcohol, Australia 2012-13 ABS population estimates, 15 years and over

Who?• NT adults aged 18 years and over

• Non-Indigenous population, 90.2% consumed in previous year• Indigenous population, 50.3% consumed alcohol

AIHW NDSHS 2010 & ABS AATSIHS 2012-13

The cost and harms, in 2004/05?• Total social cost, $642 million or $4197 per adult c/w $943 for Australia• 93% of costs are from consuming risk or high risk levelsWhetton S et al. (2009) Harms from and costs of alcohol consumption in the Northern Territory; South Australian Centre for Economic Studies (SACER), Adelaide

Some NT numbers for alcohol

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and some NT numbers for tobacco

Who?NT adults aged 18 years and over

• Australia 18.2% current smokers• NT Non-Indigenous population, 23.6% • NT Indigenous population, 50.3% current smokers

AHS 2011/12 (unpublished data) and AATSIHS 2012/13 (customised report).

The cost, (2005/06)• $764 million, or $5,150 per person aged over 14 years.Whetton S et al (2013) Harms from and costs of tobacco consumption in the Northern Territory. South Australian Centre for Economic Studies (SACER), Adelaide

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Alcohol consumption in pregnancy, 2003 to 2011

NT Midwives Collection, 2003 to 20112003 2004 2005 2006 2007 2008 2009 2010 2011

0

2

4

6

8

10

12

14

16

Indigenous: first antenatal visitIndigenous: 36 weeks gestationNon-Indigenous: first antenatal visitNon-Indigenous: 36 weeks gestation

Percent

Year

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Deirdre LogiePolicy and legislation

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National Drug Strategy 2010 – 2015To minimise the harms of drug use using the 3 pillars approach

– Intergovernmental Committee on Drugs– Collaboration of health, law enforcement with non-government– Supported by sub-strategies eg National Tobacco Strategy

Demand Reduction Supply Reduction Harm Reduction

• Prevent / delay uptake

• Reduce illegal supply • Community safety

• Reduce use • Control legal supply • Reduce harm to family

• Support recovery • Reduce harm to individual

• Promote resilience

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Legislation operates at national and jurisdictional levelIssue Commonwealth Jurisdiction

Alcohol Stronger Futures • Liquor Act • Police Administration• Alcohol Court

Tobacco AdvertisingPlain PackagingTaxation

• Tobacco Control Act

Drugs (Illicit) Narcotic Drugs CustomsSports Anti-Doping

• Misuse of Drugs• Police Administration• Diversions

Medicines Therapeutic GoodsPharmaceutical Benefits

• Medicines, Poisons• Consumer Affairs

Volatile Substances Low Aromatic Fuel • VSA Prevention

AOD Treatment • Health Services• Public Health• Mandatory Treatment

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Demand Reduction• Promote healthy lifestyles, treatment services, diversion programs• Social marketing, change AOD culture• Limit exposure to AOD advertising, sponsorship• Clinical standards for treatment service

Supply Reduction • Strengthen regulatory framework about promotion, sale and supply• Place based approaches eg permit system, point of sale, Accords• Licensing conditions• National principles on liquor licensing

Harm Reduction• Safer communities with effective partnerships – health, police, licensing,

local govt, transport• Child and family sensitive practise, education, culture • Preventative approaches – outlet density, warning labels

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Christine ConnorsPopulation strategies

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• The total cost of grog related harm in the Northern Territory, is about $642 million per year.

• Territorians drink grog at ONE AND HALF times the national average.• Two in three of all domestic violence incidents in the Northern

Territory are alcohol-related.• 60% of all assaults that happen in the NT are grog-related• NT per capita consumption decreasing• Address supply and demand• Limited access to treatment services in PHC• Mandatory alcohol treatment

– Individual treatment– Can reduce pressure on families– 99% clients are Aboriginal people

Alcohol

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Tobacco

• Taxation and social marketing most effective strategies

• Smoke free policies and brief interventions change the “smoking culture”

• Monitoring wholesale data will allow NT to monitor consumption which may be more sensitive to price changes 15-

1718-24

25-34

35-44

45-54

55+0

10

20

30

40

50

60

20022012-13

ATSI smoking prevalence ABS surveys

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• Ganja major concern– Suicidal behaviour– Frequent smoking

• Aerosol inhalants constant vigilance– VSA plans with community

• Prescription abuse: codeine, pseudoephidrine• Other drugs

Drugs

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Pat DudgeonSocial and emotional

well being

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THE NATIONAL EMPOWERMENT PROJECT PHASES

18

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Table 1: What people say are issues confronting individualsThemes RankingHealth/Mental Health 1

Employment 2

Drug and Alcohol 3

Family 4

Children/Young People 5

Violence 6

Personal Issues 7

Housing 8

Racism/Discrimination 9

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Poche Centres for Indigenous Health

Tamara MackeanWorkforce

Cultural Competence

Indigenous CulturesIndigenous Health

• Professionalism• Quality clinical interactions• Appropriate diagnostic

reasoning• Responsive health services• Culturally appropriate

research processes

• Ceremonies• Sorry Business• Languages• Kinships• Responsibilities• Obligations

Multidimensional• Spiritual• Cultural• Social• Psychological• Physical CULTURAL

SAFETY

Sources of work related stress

• Workload• Expectations• Boundaries• Recognition, respect and support• Working conditions• Racism and stigma• Complex personal circumstances• Loss, grief and Sorry Business• Culturally safe ways to work• Funding , job security and salaries.

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Elizabeth ElliottCommunity led programs

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26

Fitzroy Valley: “A community in crisis.” 2007

Alcohol restrictions. 2008

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“FASD is a tragedy that somehow transcends other aspects of grief and trauma. “ June Oscar AO. 2008

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Marulu: A Community-led Strategy to address FASD Three themes: DIAGNOSE, PREVENT, SUPPORT (2008-9)

The Lililwan Project: FASD prevalence (2009-14)

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• Thank you• Next steps• Poche Opinion Paper• Close

Poche Centres for Indigenous Health

Poche Centres for Indigenous Health

Key Thinkers’ Forum

Darwin 11 July 2014