1. Aboriginal and Torres Strait Islander People

2. Some statistics 75% of ATSI people live in cities 25% of ATSI live in Rural / remote areas The median age for ATSI is 21 years. The median age for ‘others’ is 36 years

3. Mortality Rates Generally about 3 X the death rates of ‘others’ Infant mortality rates are 3 times higher Life expectancy gap is currently 17 – 20 years - compared to others Males – 57; Females - 62 Death rates for some diseases are:

4. Death Rates (per 100,000) 2001 - 05 ATSI Females ATSI Males ‘Others Females ‘Others’ Males Diabetes517413 CHD87227632 Injury274737 Suicide1046726 Assault112311 Mental ill102412

5. Main Causes of poor health Mental Disorders Circulatory disease – (15 times higher than others) Diabetes ( 10 times higher than others) Respiratory disease Cancer Musculoskeletal Eye and ear infections Kidney ( dialysis rates – significantly higher than other)

6. General Illicit drug use: Twice as many ATSI use illegal drugs More than 50% of population are overweight Poor nutrition – similar to ‘others’, but generally less fruit intake in rural/remote due to availability Physical inactivity – ATSI are more likely to be sedentary.

7. Tobacco use – 50% of ATSI reported to be smokers; most taking it up prior to 13 years of age Alcohol consumption – 1 in 6 have chronic levels of risky drinking Generally – similar levels to non- indigenous; BUT twice as high in ‘binge drinking category

8. Leading causes of hospitalisation Males 1kidney dialysis – 25% 2Injury – 13% 3Respiratory disease – 12% Females 1Kidney dialysis – 25% 2Pregnancy / childbirth – 17% 3Respiratory diseases – 9%

9. High frequency of ear infection in children Hearing loss associated with ear infections

10. Sociocultural, economic and environmental issues Median income is about 55% of ‘others’ Unemployment rate is 16%; compared to 5% ‘others’ Home ownership – 34% own homes Home ownership others – 70%

11. Other socio-cultural issues Inadequate housing Inadequate waste disposal and water in remote areas Lack of access to appropriate health services A medical system that does not cater for aboriginal spirituality / belief systems

12. Socio-cultural issues Communal approaches to family and parenting Lack of role models in society Lack of compatibility with: 1.Our political system 2.Our legal system 3.Our education system

13. Question What do we know about the culture of ATSI that could result in conflict with the ‘traditions and expectations’ of others.

14. Some possible answers Firstly, we need to accept that colonisation resulted in the displacement of indigenous people from their lands into native camps, missions and areas unsuitable for the settlers. Traditional foods which had been in adequate supply, were now taken from them. Loss of land rights

15. Discrimination – ATSI people were not allowed to vote until 1967. The forced removal of ATSI children from their homes, to ‘assist in assimilation’. Traditions – ATSI people believed that sickness was the result of evil magic; medical care was given by tribal elders

16. OATSIH, NACCHO, AH&MRC are organisations working with local ATSI communities together to improve health status. Aboriginal communities run hundreds of local health services – some small, others very large.

17. Government services The first two are Federal Government agencies, while the third is a State Government OATSIH – The office of Aboriginal and Torres Strait Islander Health NACCHO – The National Aboriginal Community Health Organisation AH&MRC – Aboriginal Health and Medical Research Council of NSW

18. Each works with local organisations to support ATSI. OATSIH – provides funds / grants to 245 organisations to support improved health initiatives. NACCHO - Works with Department of Families, Housing, Community Services and Indigenous Affairs to improve health for all ATSI.

19. AH&MRC is the State run organisation, includes many services: 1.Health service delivery 2.Develop and deliver ATSI education 3.Research into ATSI health 4.Collect data and evaluate ATSI health 5.Policy development

20. So what are effective strategies? In order to be successful in making real change, strategies must: 1 work closely with the group affected 2Have cultural relevance and appropriateness 3Ensure that those involved in delivery are credible 4Focus on skills, education and prevention 5Have an effect on social factors 6Set targets that are relevant and achievable 7Involve various sectors to collaborate

21. Community ATSI people do not access facilities to the extent that they should – due to: lack of availability, transport, costs, language, cultural barriers

22. Aboriginal Community Controlled Health Services (ACCHS) and Aboriginal Medical Services (AMS) are operated by local Aboriginal community members aimed at ensuring the delivery of holistic, comprehensive and culturally appropriate healthcare to the community that controls it. Self determination is a focus

23. Individuals The individual has ‘some’ control over their health, depending on issues such as: age, family history, community support, education, role modelling, access to health services and socioeconomic status

24. There is a strong focus on: 1Support for ATSI mothers and children 2Increasing the number of Aboriginal health workers 3Medically trained staff 4Community support workers 5And a recent focus on men’s issues

25. A recent program – The Health for Life (H4L) provides support for local health services and initiatives

26. Education 36% of 18 – 24 year olds completed school ‘Others’ – the rate is 80% 9% of over 50 year olds completed school ‘Others’ – the rate is 35% Poor attendance at school continues to be a major issue

27. Recent Trends Recent trends show a reduction in death rates for all causes of ATSI males – reflecting similar declines for ‘others’. No change for Females Increased death rates from diabetes.

28. Funding rates Some Australians believe that too much money is spent on ATSI health issues, for little or no improvement. The truth – In 1995-96, the health expenditure per person for ATSI people was $2320; while for ‘others’ it was $2163, despite the fact that ATSI health was 3 times worse. Clearly to get equity, more needs to be spent on ATSI health. This has been improved in the last decade.

29. General Many ATSI are also in: 1Low socioeconomic group 2Live in rural and remote areas As a result, they have a ‘multiplying factor’ with regard to their health inequity.