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Health Priority Areas
Health Priority Areas
Aboriginal HealthAboriginal Health PromotionAboriginal Health WorkforceAdult HealthAlcohol and other drugsChronic DiseaseEnvironmental HealthDefining family violenceBurden of Family Violence:NSW Health Aboriginal Family Health Strategy 2011-2016 Aboriginal Family Health WorkersRelated documents include:Healthy eatingHearing HealthInjuryMaternal and Infant HealthMental HealthOral HealthSexual Health
Aboriginal Health
Aboriginal people suffer a greater burden of ill health than other Australians. This health disadvantage begins in the early stages of life, from before birth continuing into childhood, and extending through adult life. The health conditions which most Aboriginal people experience are multiple and reflect the broader social and economic disadvantages they face. The NSW Government is committed to closing the gap in the health outcomes for Aboriginal people. Note: within NSW Health, the term 'Aboriginal' is generally used in preference to 'Aboriginal and Torres Strait Islander', in recognition that Aboriginal people are the original inhabitants of NSW.
Aboriginal Health Promotion
Health promotion is the process of enabling people to improve their health by increasing their control over their health and the determinants of good health. It's essentially the effort to prevent disease and injury from occurring in the first place, as opposed to traditional health services, which treat disease and injury once it has occurred. Unlike the traditional clinical care provided by health services, health promotion focuses on populations (or communities), as opposed to individuals. Often, health promotion requires the health system to work with non-health sectors, such as schools, child care, workplaces, local government, as they have a powerful influence over health.
Aboriginal Health Workforce
Employment of Aboriginal people in the health workforce benefits NSW Health in the delivery of healthcare services, the Aboriginal person, their community and the health outcomes of Aboriginal Australians in NSW. The NSW Government recently announced a range of important initiatives aimed at strengthening employment opportunities for Aboriginal people. This includes a significant boost to Aboriginal employment in the public sector over the next four years which will ensure that NSW meets its commitment under the COAG National Partnership Agreement on Indigenous Economic Participation. As part of efforts to maintain focus on recruiting and retaining Aboriginal staff, all government agencies are required to develop an Aboriginal Employment Strategy by June 2010 and include the minimum target of 2.6 per cent Aboriginal employment in their workforce development strategies.
Adult Health
Risk behaviours in adulthood affect health and well-being and contribute to premature mortality. Nutrition, alcohol consumption, smoking and use of other drugs and substances, are some of the key health risk factors that contribute to the greater burden of ill health experienced by Aboriginal people when compared with non-Aboriginal Australians.
Alcohol and other drugs
The consumption of alcohol carries a risk of adverse health and social consequences related to its intoxicating, toxic and dependence-producing properties. Excessive alcohol consumption increases the risk of heart, stroke and vascular diseases, liver cirrhosis and several types of cancer (AIHW 2005). It also contributes to disability and death through accidents, violence, suicide and homicide. The impacts of alcohol misuse are far reaching. Apart from directly harming an individual's health, excessive alcohol consumption contributes to workplace-related problems, child abuse and neglect, financial problems (poverty), family breakdown, interpersonal/domestic violence, and crime (WHO 2000,2004). The proportion of Aboriginal people who do not consume any alcohol at all is higher compared with non-Aboriginal people. However Aboriginal people who do drink are more likely to consume harmful quantities of alcohol than the general population (facts about Aboriginal Vascular Health - NSW Health and AH&MRC 2003). Reported rates of risk drinking for Aboriginal people are around 1.4 times the total population rates across all age groups (CHO, 2008).
Chronic Disease
A chronic disease is a serious medical condition or illness that is long lasting or recurrent and includes cardiovascular diseases (CVD), Type 2 diabetes, chronic obstructive pulmonary disease (COPD), cancer and chronic kidney disease. Chronic diseases are a major health concern in Australia, responsible for nearly 80 per cent of the total burden of disease and injury. Aboriginal people living in NSW have a significantly higher incidence of chronic disease, which is responsible for 70 % of the health gap (ill health and mortality) between Aboriginal and non Aboriginal people and 59% of excess mortality for Aboriginal people. Chronic diseases are preventable with major risk factors including unhealthy diet, physical inactivity, obesity, tobacco and harmful alcohol use. Addressing lifestyle risk factors for chronic disease can reduce the impact of chronic disease, enhance population health and improve the sustainability of the health system.
Environmental Health
A wide range of factors influence people's health and well-being including environmental elements. Some of the key environmental influences on health include:
• Access to clean water
• Functional sewerage
• Appropriate housing conditions
• Air quality
• Noise pollution
• Occupational health
• Food quality
• Pest control
Environmental health conditions in Aboriginal communities are often identified as being poor, and below the standards found in the wider community, Hospitalisation data indicates that diseases associated with poor environmental health are much more common among Aboriginal people than non-Aboriginal people.
Defining family violence
Family violence describes all forms of violence – including physical, emotional, sychological, sexual, sociological, economic and spiritual – in intimate, family and other relationships of mutual obligation and support (Aboriginal Child Sexual Assault Taskforce 2006). The term “family violence” takes place within the extended nature of Aboriginal families. Responses need to take account of the diversity and complexity of kinship ties in Aboriginal
communities, and this holistic definition recognise that family violence in Aboriginal communities impacts on a wide range of kin and community members.
In the case of an Aboriginal person or a Torres Strait Islander, a person has a “domestic relationship” with another person if the person is, or has been part of the extended family or kin of the other person according to the Indigenous kinship system of the person’s culture.
Crimes (Domestic and Personal Violence) Act 2007
Burden of Family Violence:
In 2008 the rates of reported victims of domestic violence were 6 times higher for Aboriginal females than non-Aboriginal females (3,148 per 100,000 and 511 per 100,000, respectively), and 4 times higher in Aboriginal males than non-Aboriginal males. (NSW Bureau of Crime Statistics and Research, 2010).The number of child protection reports made to Community Services for Aboriginal children and young people has increased by more than 3 times in the past 8 years, from 18,348 in 2001/02 to 59,375 in 2008/09. During the same period the increase for the non-Aboriginal population was 1.7 times, from 141,295 reports made in 2001/02 to 250,301 in 2008/09. (NSW Department of Community Services, 2007a and 2007b) see aboriginal Family Health Strategy for this and more information.
NSW Health Aboriginal Family Health Strategy 2011-2016
The NSW Health Aboriginal Family Health Strategy 2011-2016 has been developed to provide a response to family violence in Aboriginal communities. The Strategy provides a framework for dealing with these concerns within a culturally competent family based context with a focus on healing. The goal of the Strategy is to ensure that all Aboriginal people in NSW live safe and healthy lives free of family violence.
To achieve this goal, the Strategy sets out a model of care that will guide the implementation of specific actions by Local Health Districts, Aboriginal Community Controlled Health Services (ACCHSs) and other non-Government organisations (NGOs) over the next five years. This Strategy will contribute to the provision of an integrated response to family violence in Aboriginal communities based on collaboration between services. The Strategy describes a model of care and presents positive action based solutions which aim to:
- Reduce the incidence and impact of family violence in Aboriginal communities.
- Build the capacity and strength of individuals and communities to prevent, respond to and recover from family violence.
- Nurture the spirit, resilience and cultural identity that builds Aboriginal families.
See http://www.health.nsw.gov.au/pubs/2011/aboriginal_family_health_.html
Aboriginal Family Health Workers
Aboriginal Family Health Workers play a major role in the implementation of the Aboriginal Family Health Strategy . The Operational Guidelines for Aboriginal Family Health Workers describes this role. See http://www.health.nsw.gov.au/policies/gl/2009/GL2009_001.html
Related documents include:
Healthy eating
Diet and nutrition play an important role in health. Diet is linked to a variety of health problems including cardiovasular disease, stroke and type 2 diabetes.
Diet and nutrition during pregnancy and a child's early life may have life-long effects (Facts about Aboriginal Vascular Health - NSW Health, AH&MRC, 2003). There is increasing evidence that poor nutrition prenatally and in the first years of life leads to slower mental and physical growth as well as greater risk of disease later in life. The incidence of many nutrition-related diseases is higher in Aboriginal people compared with their non-Aboriginal counterparts.
Nutrition problems in Aboriginal communities will not be alleviated by nutrition education alone as many other factors contribute to food choice in Aboriginal communities including around the availability and affordabiltiy of food. Nutrition intervention programs have evolved throughout the years from a medical approach to a social model to ensure better outcomes for Aboriginal people.
Hearing Health
Aboriginal people reported higher rates of hearing loss in all age groups from 0-54 years of age. (AIHW)
Aboriginal children are reported as having ear and hearing problems approximately twice as often as non-Aboriginal children. This is due in part to high rates of otitis media (middle ear infection) among children in many Aboriginal communities (Couzos et al. 2001) (AIHW).
Otitis media is more prevalent in Aboriginal communities because of poverty, crowded housing conditions, inadequate access to water and functioning sewerage and waste removal systems (increasing the risk of bacterial and viral infections), passive smoking, nutritional problems and lack of access to primary health care and treatment. Aboriginal children living in remote communities have the highest internationally published prevalence rates for otitis media.
Hearing loss can lead to linguistic, social and learning difficulties and behavioural problems in school, which reduce educational achievements that have life long consequences for employment, income and social success.
Injury
Injury causes a range of physical, cognitive and psychological disabilities that seriously affect the quality of life of individuals, people and their families. A variety of factors affect a person's risk of being injured, including age, sex, alcohol use and socioeconomic status. Injury and poisoning are large contributors to Aboriginal morbidity, particularly for younger people (ABS and AIHW, 2008). In 2006-07 in NSW, the overall hospitalisation rate for injury and poisoning among Aboriginal people was 50% higher than among non-Aboriginal people.
Maternal and Infant Health
Maternal health is important both for mothers and their children. Good health during pregnancy contributes to reduced perinatal and infant mortality and smaller proportions of low birth weight babies. Good maternal health also reduces the likelihood of maternal death. COAG anticipates that improved maternal health will contribute to the achievement of its target to 'halve the gap in mortality rates for Indigenous children under five within a decade'. NSW Health is investing in good maternity and infant health services.
Mental Health
Traditionally, Aboriginal people perceive their health not only in terms of the physical health of the individual, but rather in regard to the social, emotional and cultural wellbeing of the whole community (National Aboriginal Health Strategy 1989).
Mental health is 'the capacity of individuals and groups to interact with one another and the environment, in ways that promote subjective well-being, optimal development and the use of cognitive, affective and relational abilities'.
A diverse range of social, environmental, biological and psychological factors can impact on an individual's mental health. In turn, people can develop symptoms and behaviours that are distressing to themselves or others, and interfere with their social functioning and capacity to negotiate daily life. These symptoms and behaviours may require treatment or rehabilitation, including hospitalisation.
Available data indicate that Aboriginal people suffer a higher burden of emotional distress and possible mental illness than that experienced by the wider community.
Oral Health
Oral Health is fundamental to overall health, wellbeing and quality of life. The prevention and early treatment of tooth decay is central to the maintenance of healthy teeth. Left untreated, tooth decay may result is pain, infection and destruction of soft tissue in the mouth contributing to the development or exacerbation of other diseases. Co-morbidity with oral disease is common in Aboriginal people (NACOH, 2004).
Untreated tooth decay is more prevalent in Aboriginal children and adults. Poor dental health can affect speech and language development, as well as school attendance and performance, self-esteem, employment and social wellbeing (NACOH 2004).
Oral health in Aboriginal communities, particularly in rural and remote areas, is affected by a number of factors, including water quality and fluoridation, diet, smoking, alcohol consumption, stress, infection, the cost and availability of oral hygiene systems, the availability of dental services and transport over distance to those services that exist.
Improving access to appropriate and affordable dental health services among Aboriginal people is an important initiative and is addressed in Healthy Mouths Healthy Lives: Australia's National Oral Health Plan 2004 - 2013 (NACCOH 2004).
Sexual Health
The burden of disease study (Vos et al. 2007) attributed 1.2% of the total burden of disease in the Aboriginal population to unsafe sex, primarily through cervical cancer, chlamydia and HIV/AIDS.
Unsafe sexual practices involve the failure to take precautions during sex, which may result in sexually transmitted infections (STIs), reproductive tract infections (RTIs) and a range of adverse reproductive health consequences such as unintended pregnancy, abortion, infertility and cancer resulting from STIs, sexual dysfunction and certain aspects of mental health (WHO 2006). STIs are more common among Aboriginal Australians than for non-Aboriginal Australians.
The consequences of unsafe sexual practices can be high and the impact on individuals, families and communities can continue long after the unsafe sexual practices have ceased.
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