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

Solving Colorado's Health Professionals Shortage: Initial Lessons Learned From the Health Professions Initiative Evaluation

Gives an overview of the trust's 2005-08 Health Professions Initiative to address expected shortages in all healthcare professions, its impact so far, and the strategies grantees are implementing to help strengthen the training infrastructure

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 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

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,

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

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

Evaluating Medical Devices Remotely: Current Methods and Potential Innovations

Objective: We present examples of laboratory and remote studies, with a focus on studies appropriate for medical device design and evaluation. From this review and description of extant options for remote testing, we provide methods and tools to achieve research goals remotely. Background: The FDA mandates human factors evaluation of medical devices. Studies show similarities and differences in results collected in laboratories compared to data collected remotely in non-laboratory settings. Remote studies show promise, though many of these are behavioral studies related to cognitive or experimental psychology. Remote usability studies are rare but increasing, as technologies allow for synchronous and asynchronous data collection. Method: We reviewed methods of remote evaluation of medical devices, from testing labels and instruction to usability testing and simulated use. Each method was coded for the attributes (e.g., supported media) that need consideration in usability studies. Results: We present examples of how published usability studies of medical devices could be moved to remote data collection. We also present novel systems for creating such tests, such as the use of 3D printed or virtual prototypes. Finally, we advise on targeted participant recruitment. Conclusion: Remote testing will bring opportunities and challenges to the field of medical device testing. Current methods are adequate for most purposes, excepting the validation of Class III devices. Application: The tools we provide enable the remote evaluation of medical devices. Evaluations have specific research goals, and our framework of attributes helps to select or combine tools for valid testing of medical devices

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

One world connected: an assessment of Australia’s progress in suicide prevention

Overview: This paper provides a detailed assessment of Australia\u27s progress in suicide prevention. Written in response to the landmark World Health Organisation report Preventing Suicide: A global imperative, the National Coalition for Suicide Prevention, led by Suicide Prevention Australia, looks at the report findings in relation to Australia and suicide prevention, it explores what we are doing well and what we need to do differently. This paper offers a brief summary of points of interest from the WHO Report as well as a view on how Australia is performing against some of the criteria set out in this Report as important for a successful national suicide prevention strategy. For ease of reference, we have used a traffic light system so readers can easily identify where Australia is performing well, where we are heading in the right direction but have work to do; and where serious discussion and action is required