The shape of things to come: visions for the future of Aboriginal and Torres Strait Islander health research

This paper presents the results of a project that considered how research might best contribute to Aboriginal and Torres Strait Islander health and wellbeing in the year 2030. Executive summary In late 2012, the Lowitja Institute embarked on a project using ‘futures thinking’ to consider how research might best contribute to Aboriginal and Torres Strait Islander health and wellbeing in the year 2030. The project was motivated by a desire to ‘get ahead of the game’: to anticipate and prepare for the potential research demands of the future. In particular, there was a desire to ‘close the gap’ between the point at which important research needs are identified by policy makers or service providers, and when research findings can be delivered. To think about the research needs of the future, it was necessary to first imagine what life might be like in 2030. What might Australia be like then, and the world? And what might the lives of Aboriginal and Torres Strait Islander people be? Workshops were held around the country to consider issues and trends visible in the current landscape, and how these might play out to influence life in 2030. A range of possible scenarios emerged, clustering around two divergent futures: an inclusive, vibrant Australia in which Aboriginal and Torres Strait Islander cultures are valued and embraced as central to the Australian identity; or an Australia in which economic and/or spiritual poverty drive a rejection of diversity and increase the divide between rich and poor. Participants then grappled with the question: If this (or that) scenario occurs, then what will be needed from research? By thinking about the range of possible scenarios for life in 2030, what capabilities are required to deliver the research that will be needed to address emerging issues and create a healthy future? The inspirational and empowering answer—perhaps not surprisingly—was not simply a list of research topics. Instead, participants articulated a strong and widely shared desire for a profoundly different system of research. A vision emerged of a research system in which research and practice are closely interwoven and which would enable greater integration of health services, policy and research. Such a system would be responsive to changing research demands, but also to changing social, economic, technological and knowledge landscapes. Specific research capabilities were also identified. An urgent necessity to actively address the social determinants of health was articulated in every workshop, along with a growing sense that the health and health research sectors may need to play a facilitating role, inviting other sectors—such as education, justice, local government—to collaborate and maximise the impact of their collective efforts to bring about change. A need for more evidence and evaluation around early childhood development programs (social as well as physical development) was seen as a priority for the immediate future. The Aboriginal and Torres Strait Islander health and health research sectors have played a pioneering role in the reform of research in Australia. The strength of vision articulated by participants in this project, and the desire to see that vision become a reality, suggests the sector will succeed in its drive toward a vision of a more effective research system

Review_of_Councillor_Training.pdf

This national review of councillor training found that there is a range of high quality, relevant training and professional development available for local government councillors. There are, however, some gaps in the training and professional development being offered, with significant differences from state to state. There is also a demonstrated interest in, and a sector-wide desire to see a nationally coordinated approach to providing accredited programs that cover the full range of knowledge and skills required to fulfil the role of a councillor

The characteristics, implementation and effects of Aboriginal and Torres Strait Islander health promotion tools: a systematic literature search

Background: Health promotion by and with Aboriginal and Torres Strait Islander (hereafter Indigenous) Australians is critically important given a wide gap in health parity compared to other Australians. The development and implementation of step-by-step guides, instruments, packages, frameworks or resources has provided a feasible and low-resource strategy for strengthening evidence-informed health promotion practice. Yet there has been little assessment of where and how these tools are implemented or their effectiveness. This paper reviews the characteristics, implementation and effects of Indigenous health promotion tools.\ud \ud Methods: Indigenous health promotion tools were identified through a systematic literature search including a prior scoping study, eight databases, references of other reviews and the authors' knowledge (n=1494). Documents in the peer reviewed and grey literature were included if they described or evaluated tools designed, recommended or used for strengthening Indigenous Australian health promotion. Eligible publications were entered into an Excel spreadsheet and documented tools classified according to their characteristics, implementation and effects. Quality was appraised using the Dictionary for Effective Public Health Practice Project (EPHPP) and Critical Appraisal Skills Program (CASP) tools for quantitative and qualitative studies respectively.\ud \ud Results: The review found that Indigenous health promotion tools were widely available. Of 74 publications that met inclusion criteria, sixty (81%) documented tools developed specifically for the Indigenous Australian population. All tools had been developed in reference to evidence; but only 22/74 (30%) publications specified intended or actual implementation, and only 11/74 (15%) publications evaluated impacts of the implemented tools. Impacts included health, environmental, community, organisational and health care improvements. The quality of impact evaluations was strong for only five (7%) studies.\ud \ud Conclusions: The small number and generally moderate quality of implementation and evaluation studies means that little is known about how tools work to strengthen Indigenous health promotion practice. The findings suggest that rather than continuing to invest in tool development, practitioners, policy makers and researchers could evaluate the implementation and effects of existing tools and publish the results. There is a need for long-term investment in research to review the current use of health promotion tools and the factors that are likely to enhance their implementation

Development of a National Aboriginal and Torres Strait Islander Cancer Framework: A Shared Process to Guide Effective Policy and Practice

Indigenous Australians experience a substantially higher cancer mortality rate than non-Indigenous Australians. While cancer outcomes are improving for non-Indigenous Australians, they are worsening for Indigenous Australians. Reducing this disparity requires evidence-based and culturally-appropriate guidance. The purpose of this paper is to describe an initiative by Cancer Australia and Menzies School of Health Research (Menzies) to develop Australia’s first National Aboriginal and Torres Strait Islander Cancer Framework using a process of co-design with relevant stakeholders. The initiative was guided by three core principles: achieving policy-relevant evidence-based outcomes; engaging and maintaining trust with Indigenous Australians at every phase; and employing best-practice and appropriate research methods. Four components of research comprised the Framework development: evidence review; multifaceted stakeholder consultation and input; triangulation of findings; and direct stakeholder input in drafting and refining the Framework. The evidence review confirmed the increasing burden of cancer on Indigenous Australians, while stakeholder consultations facilitated comprehensive input from those with lived experience. The consultations revealed issues not identified in existing literature, and gave different emphases of priority, thus reinforcing the value of including stakeholder perspectives. This paper focuses primarily on documenting the methods used; findings are presented only in order to illustrate the results of the process. The published Framework is available at www.canceraustralia.gov.au; further description and analyses of findings from the consultations will be published elsewhere. The logistics inherent in large-scale consultation are considerable. However, the quality of data and the foundation for sustained partnership with stakeholders and knowledge translation vastly outweighed the challenges. The process of wide-ranging stakeholder consultation described in this paper offers a model for other areas of national and international Indigenous priority setting and policy and practice development that meets the needs of those most affected. The Framework, through the establishment of an agreed, shared and evidence-based agenda, provides guidance for jurisdictional cancer plans, optimal care pathways, and program and service planning for the multiple players across all levels of the health system