Indigenous Health – Australia, Canada, New Zealand and the United States - Laying Claim to a Future that Embraces Health for Us All.

Improving the health of all peoples has been a call across the globe for many decades and unfortunately remains relevant today, particularly given the large disparities in health status of peoples found around the world. Rather than differences in health, or health inequalities, we use a different term, health inequities. This is so as mere differences in health (or inequalities ) can be common in societies and do not necessarily reflect unfair social policies or practices. For example, natural ageing implies older people are more prone to illness. Yet, when differences are systematic, socially produced and unfair, these are considered health inequities. Certainly making judgments on what is systematic, socially produced and unfair, reflects value judgments and merit open debate. We are making explicit in this paper what our judgments are, and the basis for these judgment

Managing madness: mental health and complexity in public policy

Abstract This paper explores the concept of collaborative care, particularly in relation to a range of new models of organisation and service that are emerging in response to one of the most problematic areas of public policy – mental health. These emerging models of coordinated mental health care are testing the limits of the evidence supporting coordinated care, and require critical evaluation. Myriad concepts of collaborative or coordinated care in health, including mental health, have created multiple definitions. Once definitional issues have been surmounted, however, the evidence for coordination of health care is reasonably strong. There is considerable research about which treatments and programs are best for people with a mental illness. There are few areas seemingly as complex as mental health, given that responsibility for policy and service lies across all three tiers of Australian government and across multiple jurisdictions. It also engages public, private and non-government sectors. Co-morbidities are commonplace, particularly drug and alcohol problems among younger people. Governments in Australia have traditionally taken responsibility for policy, programs and services, either as direct service providers or through contracting outputs from others. Yet the evidence indicates that for people with a mental illness, the best solutions are often not found in government but in the community and in organisations outside of government. New organisations and new structures are attempting more holistic management approaches, combining clinical care, community support, housing, employment and other services. This paper considers some of these new models in the light of existing evidence. The key challenge facing continued reform in mental health is not uncertainty regarding programs or services, but rather how to drive coordinated care for consumers across departments, governments and providers. This review will highlight the key changes that must be made for the benefit of the millions of Australians with a mental illness. Such changes need to empower users of care systems to choose options that actively support coordinated and efficient care delivery systems

Improving Information Sharing for Effective Social Outcomes

The research project focused on the following questions: To what extent and how is personal information of individuals with complex social needs collected, managed, and shared across government and other organisations? What are barriers and enablers to cross-government information sharing? What are existing strategies and arrangements for enabling cross-government information sharing in other jurisdictions? What can New Zealand learn from other jurisdictions in that respect? How, and under what conditions, can cross-government information sharing be improved in order to achieve more effective social outcomes

Delivery of advice to marginalised and vulnerable groups: the need for innovative approaches

Knowledge, capacity, capability and understanding are the key pre-requisites to access to justice.4 If legal aid services are to be effective in reaching people who are disadvantaged, disempowered or marginalised, then integrated, connected service delivery, outreach and relationship building, community development and education play a vital role. This article presents selected research findings from England and Wales, and Australia, illustrating the advice needs of disadvantaged groups. It further presents four delivery models from around the world, which all aim for innovation and flexibility. The article concludes with a number of key issues to consider when delivering advice to marginalised and vulnerable groups