What works? A review of actions addressing the social and economic determinants of Indigenous health

Introduction: The purpose of this paper is to review evidence relating to ‘what works’ to influence the social and economic determinants of Indigenous health, in order to reduce health inequities, and ultimately contribute to closing the life expectancy gap between Indigenous and non-Indigenous Australians. We outline a conceptual framework for understanding how social and economic determinants influence health and wellbeing, and identify a number of key determinants of health. We review evidence relating to how each determinant is associated with Indigenous health and wellbeing, and then consider specific actions designed to improve Indigenous outcomes in each of these areas in order to determine the characteristics of successful initiatives. Based on our conceptual framework, we link successful actions which result in positive outcomes for Indigenous Australians in each of the key determinants to ultimately improving health and wellbeing and contributing towards ‘closing the gap’ in health and wellbeing. We note that many actions we consider only aim to improve the situation for Indigenous Australians in regard to that specific area (for example, education, housing) and were not devised to take direct action to improve health, even though the evidence indicates that those actions may be likely to contribute to improved health over the longer term

Trauma-informed services and trauma-specific care for Indigenous Australian children

This paper examines how childhood trauma experienced by Indigenous children can be overcome by appropriate interventions.IntroductionWhile many Indigenous and non-Indigenous Australian children grow up in safe homes and live in safe communities, there are some who do not. In the case of Indigenous children, some families and communities are unable to, or are still working to, heal the trauma of past events, including displacement from Country, institutionalisation and abuse. The Stolen Generations also represent a significant cause of trauma. In 2008, an estimated 8% of Indigenous people aged 15 and over reported being removed from their natural family and 38% had relatives who had been removed from their natural family. This trauma can pass to children (inter-generational trauma).Indigenous children may also experience a range of distressing life events including illness and accidents, hospitalisation or death of close family members, exposure to violence, family disintegration (with kin networks fragmented due to forced removals, relationship breakdown and possibly incarceration) and financial stress.Experiencing trauma in childhood can have severe and long-lasting effects; effects that can be overcome by appropriate interventions. This resource sheet examines these effects and explores how they can be tackled. It focuses on the design and delivery of trauma-informed and trauma-specific children’s services and care

The impact of information and communication technology on family carers of older people and professionals in Sweden

Government policy in Sweden, as in other developed countries, pays increasing attention as to how best to support the family carers of older people. New and innovative means of support, such as information and communication technology, are emerging. This paper explores the perceived benefits of, and barriers to, information technology as a means of supporting family carers of older people. Following a brief overview of the care-giving literature, with particular reference to the Swedish context, interview and questionnaire data collected from 34 families who took part in the Swedish ACTION project are used to explore the role of user-friendly information and communication technology to inform and enable family carers of older people to exercise choice, to care more effectively and to work in partnership with professionals. Interview data from two groups of professionals that utilised ACTION are also examined to throw light on its potential benefits for both carers and professionals. Consideration is given to the barriers to using information technology, and to identifying those carers most likely to benefit. Areas for further development are the need for practitioners' education and a wider range of programmes to address carers' diverse needs. Clearly, lessons learned from the Swedish project have wider relevance, given that new forms of support are being developed in most technically advanced countries

National Aboriginal and Torres Strait Islander health plan 2013-2023

In 2008 Australian Governments committed to work with Aboriginal and Torres Strait Islander people on an incredibly important task - to achieve equality in health status and life expectancy between Aboriginal and Torres Strait Islander people and non-Indigenous Australians by the year 2031. The commitment – in the form of the Close the Gap Statement of Intent – creates the platform for this National Aboriginal and Torres Strait Islander Health Plan, which has been developed in partnership with Aboriginal and Torres Strait Islander people and their representatives. This Health Plan provides a long-term, evidence-based policy framework as part of the overarching Council of Australian Governments’ (COAG) approach to Closing the Gap in Indigenous disadvantage, which has been set out in the National Indigenous Reform Agreement (NIRA) signed in 2008. The NIRA has established a framework of national targets and policy building blocks. Two of the Closing the Gap targets, to halve the gap in child mortality by 2018 and close the life expectancy gap by 2031, go directly to health outcomes, while others address social determinants of health such as education and employment. The Health Plan builds on the United Nations Declaration on the Rights of Indigenous Peoples. It adopts a strengths-based approach to ensure policies and programs improve health, social and emotional wellbeing, and resilience and promote positive health behaviours. It emphasises the centrality of culture in the health of Aboriginal and Torres Strait Islander people and the rights of individuals to a safe, healthy and empowered life. The Health Plan also builds on existing strategies and planning approaches to improving Aboriginal and Torres Strait Islander health,

The good practice guide to Child Aware Approaches: keeping children safe and well

Abstract: Child Aware Approaches is a grassroots initiative that engages civil society to develop local approaches, actions and initiatives to keep children safe and well, recognising that protecting children is a shared responsibility. This paper defines Child Aware Approaches, outlines the philosophies and principles underpinning this strategy, and offers case study examples of how the principles can be applied in practice. This paper is intended for service managers and practitioners working with vulnerable children and families, particularly those working in adult-focused service sectors. Key messages: There has been growing awareness that parental problems such as substance misuse, mental illness and family or domestic violence, are often related to negative outcomes for children. This paper is intended as a practical resource for organisations, practitioners and individuals working in social services (particularly services for children, families and adults) to put the needs, views and aspirations of children and young people at the heart of actions to improve child and family wellbeing and safety. The paper explains the five core philosophies and 10 key principles underpinning Child Aware Approaches, to provide practical guidance for those working with vulnerable children and families and to inform policies, procedures and practices within organisations. Each principle can be considered from multiple perspectives (e.g., at the organisational, managerial and practitioner levels). Practice considerations are provided as examples to inspire thought and discussion of the different levels at which action may be required in applying the principles of Child Aware Approaches. Case study examples highlight the diversity of innovative and creative ways in which the principles of Child Aware Approaches have been applied in a variety of settings and situations

Negotiating healthy trade in Australia: health impact assessment of the proposed Trans-Pacific Partnership Agreement

Drawing on leaked texts of potential provisions of the proposed Trans-Pacific Partnership Agreement, this health impact assessment found the potential for negative impacts in the cost of medicines, tobacco control policies, alcohol control policies, and food labeling. Overview The Centre for Health Equity Training Research and Evaluation (CHETRE) has been working with a group of Australian academics and non-government organisations interested in the health of the Australian population to carry out a health impact assessment (HIA) on the Trans-Pacific Partnership Agreement (TPP) negotiations. In the absence of official publicly available drafts of the trade agreement, the health impact assessment drew on leaked texts of potential provisions and formulated policy scenarios based on high priority health policies that could be affected by the TPP. The HIA found the potential for negative impacts in each of the four areas under investigation: the cost of medicines; tobacco control policies; alcohol control policies; and food labeling. In each of these areas, the HIA report traces the relevant proposed provisions through to their likely effects on the policy scenarios onto the likely impact on the health of Australians, focusing particularly on vulnerable groups in the Australian community. The report makes a number of recommendations to DFAT regarding the TPP provisions and to the Australian Government regarding the TPP negotiating process

Collaborating to Create Elder Friendly Communities in New Hampshire: A Scan of the Current Landscape

The fact that the population of the United States is aging is no surprise; the demographic projections are well documented. There have never been as many older adults living as there are today, and this number will only increase. Northern New England is aging more rapidly than the rest of the country, with Vermont, Maine, and New Hampshire having the oldest populations in term of median age (U.S. Census, 2014). New Hampshire is expected to be the fastest aging state in New England through 2030, with nearly one-third of its population being over the age of 65 (Norton, 2011). This phenomenon is anticipated to place substantial pressure on publicly-funded health programs and long-term services and supports in the Granite State. But the story of the aging of the population is not only about increased numbers. As longevity increases, the average age of the older population will see a dramatic increase. The number of persons over the age of 85 in the United States is expected to increase five-fold by 2040. As the possibility for functional limitations and disability increases with age, the need for long-term, formal, and informal supports is expected to increase as the number of older adults, particularly those over the age of 85 increases. In addition, women continue to live longer than men; on average, life expectancy for women is three years longer than for men. These factors create a complex picture of aging, which includes a growing population of older adults, a majority of whom will be women; and a growing number of those over the age of 85, who are more likely to require some type of assistance as they age. It is a mistake to look at our aging population in a singular way. Although we tend to make generalizations about older adults, as a group, they are more physiologically and socially diverse than any other age group (Brummel-Smith & Mosqueda, 2003). As we age, we become more and more diverse, as there are no two people who have had the same life experiences, shaping who we are over our lifetimes. The baby boomers (those born between 1946 and 1964) are likely to be the most diverse cohort of older adults we have seen to date, and it is likely that they will redefine our conception of age and aging. Older adults bring a diverse set of skills, talents, and knowledge that should be tapped as a significant natural resource to support a new and exciting vision of aging

Leveling the Playing Field: Attracting, Engaging, and Advancing People with Disabilities

People with disabilities experience significant challenges in finding employment. The participation of people with disabilities in the workforce and their median income are both less than half that of the civilian workforce. They work part time 68 percent more frequently than people without disabilities. These disheartening results persist despite the enactment of significant federal legislation aimed at making the workplace more supportive and accessible to people with disabilities. The Conference Board Research Working Group (RWG) on Improving Employment Outcomes for People with Disabilities was convened to address how to overcome these disparities. It was sponsored by the Employment and Disability Institute at Cornell University, under a grant from the National Institute on Disability and Rehabilitation Research of the U.S. Department of Education. The RWG members focused on four questions: 1) The business case: Is it advantageous for organizations to employ people with disabilities? 2) Organizational readiness: What should organizations do to create a workplace that enables people with disabilities to thrive and advance? 3) Measurement: How can success for both people with disabilities and the organization itself be determined? 4) Self-disclosure: How can people with disabilities, especially those whose disabilities are not obvious, be encouraged to identify themselves so that resources can be directed toward them and outcomes can be measured

Fetal alcohol spectrum disorders: current issues in awareness, prevention and intervention

This paper reviews the research and current policy surrounding prenatal alcohol exposure and fetal alcohol spectrum disorders (FASD). Alcohol use during pregnancy is linked to a spectrum of adverse fetal outcomes. This spectrum of abnormalities is collectively termed fetal alcohol spectrum disorders and may include physical, cognitive and/or developmental symptoms. The aim of this paper is to inform practitioners and other professionals working in a range of fields about the implications of FASD for children and their families. Current research on interventions or programs to work with families affected by FASD is also explored. Key messages Prenatal alcohol exposure can cause a range of cognitive and physical abnormalities in embryos that can lead to impairments in a range of functions: sensory systems, language and communication, processing pace, learning and memory, abstract thinking, and executive functioning. Misunderstanding and labelling of those with FASD can lead to a poor self-concept, disrupted peer relationships, fractured educational and placement experiences and contact with youth justice services. The prevalence of FASD is likely to be underestimated by current measures. Certain populations, including children in out-of-home care and children in contact with youth justice services are thought to include an over-representation of individuals living with an undetected FASD. Tackling FASD requires focused and coordinated multidisciplinary and cross sector approaches. More information about the prevalence and nature of FASD will allow for improved service planning and implementation. Policy directions are needed that prioritise the screening and prevention of FASD in the community. Current and future professionals, including those in traditionally adult-focused services, need awareness and knowledge about the significance of FASD and prenatal alcohol exposure on children\u27s lives