"I'm running my depression:" Self-management of depression in neoliberal Australia

The current study examines how the neoliberal imperative to self-manage has been taken up by patients, focusing specifically on Indian-Australians and Anglo-Australians living with depression in Australia. We use Nikolas Rose's work on governmentality and neoliberalism to theorise our study and begin by explicating the links between self-management, neoliberalism and the Australian mental health system. Using qualitative methods, comprising 58 in-depth interviews, conducted between May 2012 and May 2013, we argue that participants practices of self-management included reduced use of healthcare services, self-medication and self-labour. Such practices occurred over time, informed by unsatisfactory interactions with the health system, participants confidence in their own agency, and capacity to craft therapeutic strategies. We argue that as patients absorbed and enacted neoliberal norms, a disconnect was created between the policy rhetoric of self-management, its operationalisation in the health system and patient understandings and practices of self-management. Such a disconnect, in turn, fosters conditions for risky health practices and poor health outcomes

The impact of migration on deaths and hospital admissions from work-related injuries in Australia.

OBJECTIVE: The shift from an industrial to a service-based economy has seen a decline in work-related injuries (WRIs) and mortality. How this relates to migrant workers, who traditionally held high-risk jobs is unknown. This study examined deaths and hospital admissions from WRI, among foreign and Australian-born workers. METHODS: Tabulated population data from the 1991 to 2011 censuses, national deaths 1991-2002 and hospital admission for 2001-10. Direct age standardised mortality and hospital admission rates (DSRs) and rate ratios (RRs) were derived to examine differences in work-related mortality/hospital admissions by gender, country of birth, employment skill level and years of residence in Australia. RESULTS: DSRs and RRs were generally lower or no different between Australian and foreign-born workers. Among men, mortality DSRs were lower for nine of 16 country of birth groups, and hospital admissions DSRs for 14 groups. An exception was New Zealand-born men, with 9% (95%CI 9-13) excess mortality and 24% (95%CI 22-26) excess hospital admissions. CONCLUSIONS: Four decades ago, foreign-born workers were generally at higher risk of WRI than Australian-born. This pattern has reversed. The local-born comprise 75% of the population and a pro-active approach to health and safety regulation could achieve large benefits

Social and emotional outcomes of Australian children from Indigenous and culturally and linguistically diverse backgrounds

Objectives: 1) profile the living environments and 2) examine the social and emotional outcomes of Australian children from Indigenous and cultural and linguistically diverse (CALD) backgrounds at school entry. Method: Secondary analysis of cross- sectional data collected in Wave 1 of the Longitudinal Study of Australian Children (n=4,735). Child mental-health outcomes were measured using parent report of the Strengths and Difficulties Questionnaire (SDQ). Results: Significant differences in family and neighbourhood characteristics, including parental income, maternal education, maternal parenting quality and neighbourhood safety, were found in children of Indigenous and CALD backgrounds compared to the reference group of Australian-born, English-speaking children. After controlling for family and neighbourhood characteristics, significant differences in parent-reported SDQ total difficulties were found for Indigenous children. Significant differences in emotional difficulties and peer problems subscales were found for children with overseas-born mothers regardless of English proficiency. Conclusions: Children from Indigenous and CALD backgrounds experience poorer mental health outcomes at school entry than their Australian-born English- speaking peers. They are also more likely to be exposed to risk factors for poor child mental-health outcomes within their family and neighbourhood environments

Building Information Resilience: How do Resettling Refugees Connect with Health Information in Regional Landscapes - Implications for Health Literacy

The study explores how resettling refugees experience a new health environment and develop health literacy practice. The concept of information resilience, which emerges from the grounded experiences of learning to live well is introduced. The study also explores how health narratives are constructed, disseminated and circulated by this particular cohort

'Language Background Other Than English': a problem NAPLaN test category for Australian students of refugee background

Since 2008 Australia has held the National Assessment Program: Literacy and Numeracy (known as NAPLAN) for all students in years 3, 5, 7 and 9. Despite the multilingual character of the Australian population, these standardized literacy and numeracy tests are built on an assumption of English as a first language competency. The capacity for monitoring the performance of students who speak languages other than English is achieved through the disaggregation of test data using a category labelled Language Background Other than English (LBOTE). A student is classified as LBOTE if they or their parents speak a language other than English at home. The category definition is so broad that the disaggregated national data suggest that LBOTE students are outperforming English speaking students, on most test domains, though the LBOTE category shows greater variance of results. Drawing on Foucault’s theory of governmentality, this article explores the possible implications of LBOTE categorisation for English as a Second Language (ESL) students of refugee background. The article uses a quantitative research project, carried out in Queensland, Australia, to demonstrate the potential inequities resultant from such a poorly constructed data category

A six-year descriptive analysis of hospitalisations for ambulatory care sensitive conditions among people born in refugee-source countries

Background: Hospitalisation for ambulatory care sensitive conditions (ACSHs) has become a recognised tool to measure access to primary care. Timely and effective outpatient care is highly relevant to refugee populations given the past exposure to torture and trauma, and poor access to adequate health care in their countries of origin and during flight. Little is known about ACSHs among resettled refugee populations. With the aim of examining the hypothesis that people from refugee backgrounds have higher ACSHs than people born in the country of hospitalisation, this study analysed a six-year state-wide hospital discharge dataset to estimate ACSH rates for residents born in refugee-source countries and compared them with the Australia-born population. Methods: Hospital discharge data between 1 July 1998 and 30 June 2004 from the Victorian Admitted Episodes Dataset were used to assess ACSH rates among residents born in eight refugee-source countries, and compare them with the Australia-born average. Rate ratios and 95% confidence levels were used to illustrate these comparisons. Four categories of ambulatory care sensitive conditions were measured: total, acute, chronic and vaccine-preventable. Country of birth was used as a proxy indicator of refugee status. Results: When compared with the Australia-born population, hospitalisations for total and acute ambulatory care sensitive conditions were lower among refugee-born persons over the six-year period. Chronic and vaccine-preventable ACSHs were largely similar between the two population groups. Conclusion: Contrary to our hypothesis, preventable hospitalisation rates among people born in refugee-source countries were no higher than Australia-born population averages. More research is needed to elucidate whether low rates of preventable hospitalisation indicate better health status, appropriate health habits, timely and effective care-seeking behaviour and outpatient care, or overall low levels of health care-seeking due to other more pressing needs during the initial period of resettlement. It is important to unpack dimensions of health status and health care access in refugee populations through ad-hoc surveys as the refugee population is not a homogenous group despite sharing a common experience of forced displacement and violence-related trauma

A survey of foot problems in community-dwelling older Greek Australians

<p>Abstract</p> <p>Background</p> <p>Foot problems are common in older people and are associated with impaired mobility and quality of life. However, the characteristics of foot problems in older Australians for whom English is a second language have not been evaluated.</p> <p>Methods</p> <p>One hundred and four community-dwelling people aged 64 to 90 years with disabling foot pain (according to the case definition of the Manchester Foot Pain and Disability Index, or MFPDI) were recruited from four Greek elderly citizens clubs in Melbourne, Australia. All participants completed a Greek language questionnaire consisting of general medical history, the Medical Outcomes Study Short-Form 36 (SF-36) questionnaire, the MFPDI, and specific questions relating to foot problems and podiatry service utilisation. In addition, all participants underwent a brief clinical foot assessment.</p> <p>Results</p> <p>The MFPDI score ranged from 1 to 30 (median 14), out of a total possible score of 34. Women had significantly higher total MFPDI scores and MFPDI subscale scores. The MFPDI total score and subscale scores were significantly associated with most of the SF-36 subscale scores. The most commonly reported foot problem was difficulty finding comfortable shoes (38%), and the most commonly observed foot problem was the presence of hyperkeratotic lesions (29%). Only 13% of participants were currently receiving podiatry treatment, and 40% stated that they required more help looking after their feet. Those who reported difficulty finding comfortable shoes were more likely to be female, and those who required more help looking after their feet were more likely to be living alone and have osteoarthritis in their knees or back.</p> <p>Conclusions</p> <p>Foot problems appear to be common in older Greek Australians, have a greater impact on women, and are associated with reduced health-related quality of life. These findings are broadly similar to previous studies in English-speaking older people in Australia. However, only a small proportion of this sample was currently receiving podiatry treatment, and a substantial number stated that they required more help looking after their feet. To address this issue, steps need to be taken to increase awareness of podiatry services among older Greek Australians.</p