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

The well-being of carers of older Aboriginal people living in the Kimberley region of remote Western Australia: Empowerment, depression, and carer burden

Objective: To describe demographic features and well-being of carers of Aboriginal Australians aged ≥45 years in remote Western Australia. Method: Carer burden, empowerment, and depression were assessed in 124 Aboriginal carers in four remote Aboriginal communities. Results: Carers were aged 38.8 ± 15.0 years, 73.4% were female, and 75.8% were children or grandchildren of the person cared for. The mean Zarit-6 score was 3.7 ± 3.6. Attending high school (odds ratio [OR] = 0.3; 95% confidence interval [CI] = [0.1, 0.7]) and feeling empowered (OR = 0.2; 95% CI = [0.1, 0.8]) were inversely associated with carer burden; female carers were less likely to feel empowered (OR = 0.4; 95% CI = [0.2, 0.9]); and empowerment was inversely associated with depression (OR = 0.3; 95% CI = [0.1, 0.7]). Discussion: Aboriginal carers in remote communities are relatively young and most are children or grandchildren. Carer burden was lower than anticipated. However, existing tools may not adequately measure Aboriginal perspectives. Education and empowerment are key factors which support programs must consider

Investing in Tribal Governments: Case Studies From the American Recovery and Reinvestment Act

Describes examples of job creation in nine Native American communities as a result of the American Recovery and Reinvestment Act of 2009, including funding source, location, project, number of jobs created, and the reservation's unemployment rate

ELEMENTS OF CONTEMPORARY RURAL POLICY

Agricultural and Food Policy,

Behavioral and Mental Health in Nevada

The Nevada Division of Public and Behavioral Health is responsible for providing public and mental health services to people living in or visiting the State. The Division is organized into four branches: Community Services Branch, Regulatory and Planning Services Branch, Clinical Services Branch and Administrative Services Branch. The Clinical Services Branch provides statewide inpatient, outpatient, and community-based public and mental health services. State employees provide mental health services, and contract providers deliver substance use services. Mental health services are additionally organized by age and geography. Adults with mental disorders are treated statewide through the Division of Public and Behavioral Health. Children with mental disorders are served through the Division of Child and Family Services within the populous urban counties (Washoe, Clark and Carson City) and the Division of Public and Behavioral Health across the 14 rural and frontier counties. Services are supported through Medicaid, the Nevada General Fund, and Federal grants. The Division of Public and Behavioral Health is located within the Nevada Department of Health and Human Services, under the Executive Branch of the State, and serves as its Public Health Authority and Mental Health Commissioner. By statute, the Commission on Behavioral Health is responsible for the following: establishing policies to ensure development and administration of services for persons with mental illness, persons with intellectual disabilities and related conditions, and persons with substance use conditions; reviewing programs and finances of the Division; and providing reports to the Governor and Legislature regarding the quality of care and treatment provided to individuals with mental illness, intellectual disabilities, and substance use disorders [Nevada Revised Statutes (NRS) 433.314]. Historically, the governance structure of Nevada’s behavioral and mental health system has been centralized at the state level with limited involvement at regional and local levels. A policy study conducted during 2014 identified Nevada as one of only four states in the country that directly operates community-based mental health services (Kenny C. Guinn Center for Policy Priorities, Mental Health Governance: A Review of State Models & Guide for Nevada Decisions Makers, December, 2014). During that same year, the State began to consider ways to move from its centralized governance structure to a more localized model involving regional, county and city entities. A key consideration was a growing recognition that increasing the State’s responsiveness to the unique needs of individual communities is crucial. Nevada’s plan to restructure the governance of its state mental health system is not without challenges. For example, the numbers of Nevada residents covered by Medicaid benefits almost doubled when Medicaid coverage was expanded by Governor Brian Sandoval under the Affordable Care Act (ACA) during 2014, increasing from 351,315 persons in 2013 to 654,442 individuals in 2015 (Woodard and Nevada Division of Health Care Financing and Policy, 2016). On its face, the increase in numbers of residents covered by Medicaid benefits is a positive outcome. However, the existing mental health provider network was not adequate to serve the increase in numbers of individuals covered. As detailed in later sections in this chapter, the increase in health care coverage appears to have impacted the frequency with which Nevada residents used health care services, most notably hospital emergency departments and inpatient facilities. Thus, the dual influences of increased health care coverage, and limited access to appropriate and optimal mental health services are reflected in the dramatic increase in residents’ utilization of emergency department services for a wide range of mental health-related conditions during 2015, after the expansion of Medicaid during 2014. Also discussed in later sections is the fact that almost all of the State qualifies as a mental health professional shortage area (Health Resources and Services Administration, HRSA). Therefore, moving from a primarily centralized or state control model to a local control model will require accommodation for the shortages in mental health professionals within communities that lie outside the State’s urban centers

The COVID-19 Pandemic and Its Implications for Rural Economies

This paper presents a rapid assessment of current and likely future impacts of the COVID-19 outbreak on rural economies given their socio-economic characteristics. Drawing principally on current evidence for the UK, as well as lessons from the 2001 Foot and Mouth Disease outbreak and the 2007/8 financial crises, it outlines the likely key demand and supply effects, paying attention to the situation for agriculture as well as discussing the implications for rural communities. A distinction is made between the effects on businesses offering goods and services for out-of-home as opposed to in-home consumption. Gendered dimensions are also noted as likely business and household strategies for coping and adaptation. The paper concludes with a brief mapping of a research agenda for studying the longer-term effects of COVID-19 on rural economies

Literature review of the interplay between education, employment, health and wellbeing for Aboriginal and Torres Strait Islander people in remote areas

The availability of timely, comprehensive and good quality data specifically relevant to remote Aboriginal and Torres Strait Islander notions of health and wellbeing has been a significant obstacle to understanding and addressing related disadvantage in a meaningful way. This literature review for the CRC-REP Interplay Between Health, Wellbeing, Education and Employment project explored existing wellbeing frameworks at global and local levels that are relevant to Aboriginal and Torres Strait Islander people in remote Australia.Current government frameworks that collect data about Aboriginal and Torres Strait Islander people often produce a narrative that describes deficit, disadvantage and dysfunction. The frameworks include the Aboriginal and Torres Strait Islander Health Performance Framework, the Overcoming Indigenous Disadvantage Framework, the Australia Bureau of Statistics Aboriginal and Torres Strait Islander Wellbeing Framework and the National Aboriginal and Torres Strait Islander Social Survey. These frameworks gather statistical information for the purposes of policy analysis and program development and therefore use indicators that are important to policy. Increasingly, government frameworks are including holistic measures of health such as cultural health, governance and the impacts of colonisation.This literature review has identified the need to develop a wellbeing framework that not only accurately represents education, employment, health and wellbeing and the interplay between these and other factors, but that also recognises the strengths and resilience of Aboriginal and Torres Strait people as well as reflecting their worldviews, perspectives and values. For example, a definition of ‘wellbeing’ that highlights the importance of physical, social, emotional, cultural and spiritual influences at the level of the individual and the community has been endorsed by Aboriginal and Torres Strait Islander groups and governments alike and sustained for over 20 years. Accordingly, this literature review has been organised along these topics.In addition, the literature suggests that optimal wellbeing occurs when there is strong cultural identity in combination with control, achievement and inclusion at a wider societal level, such as through successful engagement in education and employment. Listening to Aboriginal and Torres Strait Islander people to learn of their conceptual thinking, knowledge and understanding, and responding to their priorities and ideas are crucial parts of the policy equation to improve outcomes across education, employment, health and wellbeing. The challenges in developing an appropriate wellbeing framework, then, are ensuring the active involvement and participation of the Aboriginal and Torres Strait Islander people.One example of how this has worked is provided by the Community Indicators Victoria Project, which used local-level data to address issues that the local community identified as important. A focus on strengths is also important, and is exemplified in the Social and Emotional Wellbeing Framework of the National Aboriginal and Torres Strait Islander Health Council and National Mental Health Working Group. Various existing programs – such as ‘Caring for Country’ – can be adapted to capture data about connection to country, for example, and how that impacts on physical and mental health. Critically, the core domains of education, employment and health need to be extended to include activities and concepts that Aboriginal and Torres Strait Islander people consider important to these areas.Recommendations for the development of a wellbeing framework are proposed here, derived from information available in the literature. Rather than being definitive, these recommendations provide a starting point for consultation and adaption towards establishing a wellbeing framework and operational system for collecting and analysing long-term health and wellbeing data for Aboriginal and Torres Strait Islander people in remote Australia as part of the research conducted by CRC-REP

HITECH Revisited

Assesses the 2009 Health Information Technology for Economic and Clinical Health Act, which offers incentives to adopt and meaningfully use electronic health records. Recommendations include revised criteria, incremental approaches, and targeted policies

Comparative analysis of spring flood risk reduction measures in Alaska, United States and the Sakha Republic, Russia

Thesis (Ph.D.) University of Alaska Fairbanks, 2017River ice thaw and breakup are an annual springtime phenomena in the North. Depending on regional weather patterns and river morphology, breakups can result in catastrophic floods in exposed and vulnerable communities. Breakup flood risk is especially high in rural and remote northern communities, where flood relief and recovery are complicated by unique geographical and climatological features, and limited physical and communication infrastructure. Proactive spring flood management would significantly minimize the adverse impacts of spring floods. Proactive flood management entails flood risk reduction through advances in ice jam and flood prevention, forecasting and mitigation, and community preparedness. With the goal to identify best practices in spring flood risk reduction, I conducted a comparative case study between two flood-prone communities, Galena in Alaska, United States and Edeytsy in the Sakha Republic, Russia. Within a week from each other, Galena and Edeytsy sustained major floods in May 2013. Methods included focus groups with the representatives from flood managing agencies, surveys of families impacted by the 2013 floods, observations on site, and archival review. Comparative parameters of the study included natural and human causes of spring floods, effectiveness of spring flood mitigation and preparedness strategies, and the role of interagency communication and cooperation in flood risk reduction. The analysis revealed that spring flood risk in Galena and Edeytsy results from complex interactions among a series of natural processes and human actions that generate conditions of hazard, exposure, and vulnerability. Therefore, flood risk in Galena and Edeytsy can be reduced by managing conditions of ice-jam floods, and decreasing exposure and vulnerability of the at-risk populations. Implementing the Pressure and Release model to analyze the vulnerability progression of Edeytsy and Galena points to common root causes at the two research sites, including colonial heritage, unequal distribution of resources and power, top-down governance, and limited inclusion of local communities in the decision-making process. To construct an appropriate flood risk reduction framework it is important to establish a dialogue among the diverse stakeholders on potential solutions, arriving at a range of top-down and bottom-up initiatives and in conjunction selecting the appropriate strategies. Both communities have progressed in terms of greater awareness of the hazard, reduction in vulnerabilities, and a shift to more reliance on shelter-in-place. However, in neither community have needed improvements in levee protection been completed. Dialogue between outside authorities and the community begins earlier and is more intensive for Edeytsy, perhaps accounting for Edeytsy's more favorable rating of risk management and response than Galena's

Diffusion of e-health innovations in 'post-conflict' settings: a qualitative study on the personal experiences of health workers.

BACKGROUND: Technological innovations have the potential to strengthen human resources for health and improve access and quality of care in challenging 'post-conflict' contexts. However, analyses on the adoption of technology for health (that is, 'e-health') and whether and how e-health can strengthen a health workforce in these settings have been limited so far. This study explores the personal experiences of health workers using e-health innovations in selected post-conflict situations. METHODS: This study had a cross-sectional qualitative design. Telephone interviews were conducted with 12 health workers, from a variety of cadres and stages in their careers, from four post-conflict settings (Liberia, West Bank and Gaza, Sierra Leone and Somaliland) in 2012. Everett Roger's diffusion of innovation-decision model (that is, knowledge, persuasion, decision, implementation, contemplation) guided the thematic analysis. RESULTS: All health workers interviewed held positive perceptions of e-health, related to their beliefs that e-health can help them to access information and communicate with other health workers. However, understanding of the scope of e-health was generally limited, and often based on innovations that health workers have been introduced through by their international partners. Health workers reported a range of engagement with e-health innovations, mostly for communication (for example, email) and educational purposes (for example, online learning platforms). Poor, unreliable and unaffordable Internet was a commonly mentioned barrier to e-health use. Scaling-up existing e-health partnerships and innovations were suggested starting points to increase e-health innovation dissemination. CONCLUSIONS: Results from this study showed ICT based e-health innovations can relieve information and communication needs of health workers in post-conflict settings. However, more efforts and investments, preferably driven by healthcare workers within the post-conflict context, are needed to make e-health more widespread and sustainable. Increased awareness is necessary among health professionals, even among current e-health users, and physical and financial access barriers need to be addressed. Future e-health initiatives are likely to increase their impact if based on perceived health information needs of intended users