Emeritus Professor Lesley Barclay
20 years of rural and remote health research: the story and the legacy
Panelists include Professors Lucie Walters, David Lyle, Dennis McDermott, Ross Bailie and Judi Walker.
Professor Tom Calma AO
Chairman, Ninti One Limited and Chancellor, University of Canberra
Aboriginal Community Researchers informing policy and practice in remote and rural health
This paper describes the ACR network, the research methodologies employed and outcomes. Case studies demonstrate the impact and diversity of the ACR work undertaken.
The core ACR network exists in Alice Springs because this is where Senior Aboriginal Researchers (SROs) reside and it is centrally located. ACRs engage and consult with the end-user Aboriginal people and communities, using Participatory Action Research. ACRs are trained in research and evaluation methodologies and they have an ongoing role during the design and implementation phases of the research. The ACRs often live in remote or regional communities and they are culturally empathetic and can work bilingually in an inclusive, respectful and genuinely consultative way.
Demand for ACR-type work often comes from planned research applications to NHMRC, for example, through to niche word-of-mouth research components, to situations where other research efforts are failing. Once the research needs are scoped and communities are identified, the SROs co-design the research program with researchers such as Chief Investigators from the sponsoring university, government department, industry or NFP. This is within a solid academic framework. The SROs select and train local ACRs (usually one female and one male for each target community or cluster of communities). In some cases data collection and surveying will be conducted in local language, translated and uploaded onto pre-programmed iPads. The SROs and the Chief Investigators then analyse the information and provide a report on highlights back to the ACRs, who return to the communities and disseminate and discuss the findings. This methodology overcomes the common limitations of ineffective ‘one size fits all’ solutions; and, where fly-in/fly-out researchers acquire erroneous information which inevitably leads to poor policy development and unsuccessful service delivery.
In addition to the enhanced integrity of the research information, the ACRs gain meaningful short-term employment and create role-models for their families and communities. A residual capability is also built in the communities for future research opportunities.
Prof Calma is an Aboriginal Elder from the Kungarakan tribal group and a member of the Iwaidja tribal group whose traditional lands are south west of Darwin and on the Cobourg Peninsula in the Northern Territory of Australia, respectively. He has been involved in Indigenous affairs at a local, community, state, national and international level and worked in the public sector for over 40 years and is currently on a number of boards and committees focussing on rural and remote Australia, health, mental health and suicide prevention, education, justice reinvestment, research, reconciliation and economic development.
Prof Calma was appointed National Coordinator, Tackling Indigenous Smoking in March 2010 to lead the fight against tobacco use by Aboriginal and Torres Strait Islander peoples.
Prof Calma was Aboriginal and Torres Strait Islander Social Justice Commissioner at the Australian Human Rights Commission from 2004 to 2010. He also served as Race Discrimination Commissioner from 2004 until 2009.
Through his 2005 Social Justice Report, Prof Calma called for the life expectancy gap between Indigenous and non-Indigenous people to be closed within a generation and advocated embedding a social determinants philosophy into public policy around health, education and employment in order to address Indigenous inequality gaps. This spearheaded the Close the Gap for Indigenous Health Equality Campaign resulting in COAG’s Closing the Gap response in December 2007.
Prof Calma chaired the Close the Gap Steering Committee for Indigenous Health Equality since its inception in March 2006 and retired as Co-Chair of the Steering Committee in 2010. The Close the Gap Campaign has effectively brought national attention to achieving health equality for Indigenous people by 2030.
Prof Calma is a strong advocate for Indigenous rights and empowerment, and in addition to the Close the Gap Campaign, has been instrumental in establishment of the National Congress of Australia’s First Peoples, development of the inaugural National Aboriginal and Torres Strait Islander Suicide Prevention Strategy, Indigenous enterprise support and promotion of Justice Reinvestment.
Prof Calma has broad experience in the public sector, particularly in national policy development and programme management in the Indigenous health, education, community development and employment arenas. He served as Senior Adviser to the Minister of Immigration, Multicultural and Indigenous Affairs in 2003, and represented Australia's education and training interests as a senior diplomat in India and Vietnam from 1995 to 2002.
In 2007 Prof Calma was named by Bulletin Magazine as the Most Influential Indigenous Person in Australia; in 2008 he was named GQ Magazine’s 2008 Man of Inspiration for his work in Indigenous Affairs.
Professor Alan Cass
Director, Menzies School of Health Research
"The main message we want to send to government is we want to have treatment on our own country”: listening to the voices of Indigenous Australians with kidney disease
Patterns of health and wellbeing are shaped by multiple dimensions of inequality. What is it about socioeconomic status, where we live, our education and housing that gets under our skin to damage our kidneys? Rigorous research is fundamentally important to explore patterns of health and disease; tease out causative factors for the development and progression of disease; examine access to and utilisation of health services; and design, implement and evaluate new treatments and innovative models of care. Without evidence about what works to improve kidney health and wellbeing, the kidney disease epidemic will continue unabated.
Emeritus Professor John Humphreys
The rural and remote health policy impasse: why hasn’t research evidence generated policies to improve rural and remote health services?
Dr Judith Katzenellenbogen
Heart Foundation Future Leader Fellow, University of Western Australia
Cardiovascular disease in Aboriginal Western Australians: findings from a decade of research and current initiatives
Professor Leonie Segal
Professor Health Economics at the School of Population Health, University of South Australia
The role for economics in studies of rural and remote health: costing, outputs, outcomes, efficiency, funding, access and equity
The presentation will draw on wide-ranging research experience, to highlight the diverse contribution health economics can make. I plan to cover i) economic evaluation – drawing on an evaluation of the Central Australia Aboriginal Congress infant home visiting program and of a far North Queensland evaluation of up-skilling of Indigenous health workers to improve diabetes management in Aboriginal and Torres Strait Islander people with poorly controlled diabetes, ii) needs-based workforce and service planning – to better address the mental health needs of infants, children and adolescents; iii) social policy research using linked administrative data into the causes and consequences of child maltreatment.
Ms Claire Sparke
Unit Head, Australian Institute of Health and Welfare
Coordination of Health Care Study: local level reporting on patient experiences of coordination and continuity of care
In the second component of the Study, the Survey is linkable to administrative datasets including Medicare and pharmaceutical claims (Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS) including RPBS, and hospital and emergency department (ED) data to enable cause and effect analyses for a broad range of health care related research and policy questions. This presentation will focus on the methodology of the study and national results of the Survey, with potential local level results pending availability.
Melbourne Laureate Professor Hugh Taylor AC
Harold Mitchell Professor of Indigenous Eye Health, University of Melbourne
Eye care for Indigenous Australians
Following extensive consultation with community and providers the sector-endorsed Roadmap to Close the Gap for Vision was launched in 2012. It has 42 recommendations for appropriate and accessible eye care services.
It builds on coordinated regional models bringing together the Aboriginal Community Controlled Organisations, hospitals and local health department, Primary Health Networks and eye care providers –optometrists and ophthalmologists. These stakeholders need to map the gap in services, arrange the appropriate coordination and provision of care and regularly assess progress.
Eye care for those with diabetes is a key starting point for regional services. Those with diabetes form 75% of those needing annual eye exams and the referral pathways for glasses and cataract surgery can be used by all. The new Medicare funding for retinal photography and the provision of retinal cameras for AMS are game changes
Trachoma, a blinding eye infection in young children leads to scarring and blindness in adults remains a problem in outback areas. However, trachoma rates in children have fallen from 21% in 2008 to less than 5%. Screening and antibiotic treatment of children and families and the health promotion messages about “Clean Faces, Strong Eyes” continue. However, all children need to have safe and functional washing facilities to keep their faces clean.
In the last 5 years some remarkable progress has been made, two thirds of the intermediate steps in the Roadmap have been done and 16 of the 42 recommendations fully implemented. Further, in 2016 the National Eye Health Survey reported the gap between Indigenous and non-indigenous rates of blindness had been halved and was now “only” three times. Although this is still not acceptable and there is more work to be done, clearly eye health is one area where the Gap can be closed.
So why spend all this time and effort on eye care? Showing how to provide proper eye care serves demonstrates how to effectively link primary care with specialist services. The lessons from providing eye care provide a template for the development and linkage of other specialist services. What works for eyes will work for ears or hearts or lungs or kidneys.