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

Maternal super-obesity and perinatal outcomes in Australia: A national population-based cohort study

Background: Super-obesity is associated with significantly elevated rates of obstetric complications, adverse perinatal outcomes and interventions. The purpose of this study was to determine the prevalence, risk factors, management and perinatal outcomes of super-obese women giving birth in Australia. Methods: A national population-based cohort study. Super-obese pregnant women (body mass index (BMI) >50 kg/m2 or weight >140 kg) who gave birth between January 1 and October 31, 2010 and a comparison cohort were identified using the Australasian Maternity Outcomes Surveillance System (AMOSS). Outcomes included maternal and perinatal morbidity and mortality. Prevalence estimates calculated with 95 % confidence intervals (CIs). Adjusted odds ratios (ORs) were calculated using multivariable logistic regression. Results: 370 super-obese women with a median BMI of 52.8 kg/m2 (range 40.9–79.9 kg/m2) and prevalence of 2.1 per 1 000 women giving birth (95 % CI: 1.96–2.40). Super-obese women were significantly more likely to be public patients (96.2 %), smoke (23.8 %) and be socio-economically disadvantaged (36.2 %). Compared with other women, super-obese women had a significantly higher risk for obstetric (adjusted odds ratio (AOR) 2.42, 95 % CI: 1.77–3.29) and medical (AOR: 2.89, 95 % CI: 2.64–4.11) complications during pregnancy, birth by caesarean section (51.6 %) and admission to special care (HDU/ICU) (6.2 %). The 372 babies born to 365 super-obese women with outcomes known had significantly higher rates of birthweight ≥4500 g (AOR 19.94, 95 % CI: 6.81–58.36), hospital transfer (AOR 3.81, 95 % CI: 1.93–7.55) and admission to Neonatal Intensive Care Unit (NICU) (AOR 1.83, 95 % CI: 1.27–2.65) compared to babies of the comparison group, but not prematurity (10.5 % versus 9.2 %) or perinatal mortality (11.0 (95 % CI: 4.3–28.0) versus 6.6 (95 % CI: 2.6- 16.8) per 1 000 singleton births). Conclusions: Super-obesity in pregnancy in Australia is associated with increased rates of pregnancy and birth complications, and with social disadvantage. There is an urgent need to further address risk factors leading to super-obesity among pregnant women and for maternity services to better address pre-pregnancy and pregnancy care to reduce associated inequalities in perinatal outcomes. Keywords: Super-obesity, Obesity, Perinatal outcomes, Pregnancy, Maternal socio-economic disadvantage, Obstetric complication

Improvement of maternal Aboriginality in NSW birth data

<p>Abstract</p> <p>Background</p> <p>The Indigenous population of Australia was estimated as 2.5% and under-reported. The aim of this study is to improve statistical ascertainment of Aboriginal women giving birth in New South Wales.</p> <p>Methods</p> <p>This study was based on linked birth data from the Midwives Data Collection (MDC) and the Registry of Births Deaths and Marriages (RBDM) of New South Wales (NSW). Data linkage was performed by the Centre for Health Record Linkage (CHeReL) for births in NSW for the period January 2001 to December 2005. The accuracy of maternal Aboriginal status in the MDC and RBDM was assessed by consistency, sensitivity and specificity. A new statistical variable, ASV, or Aboriginal Statistical Variable, was constructed based on Indigenous identification in both datasets. The ASV was assessed by comparing numbers and percentages of births to Aboriginal mothers with the estimates by capture-recapture analysis.</p> <p>Results</p> <p>Maternal Aboriginal status was under-ascertained in both the MDC and RBDM. The ASV significantly increased ascertainment of Aboriginal women giving birth and decreased the number of missing cases. The proportion of births to Aboriginal mothers in the non-registered birth group was significantly higher than in the registered group.</p> <p>Conclusions</p> <p>Linking birth data collections is a feasible method to improve the statistical ascertainment of Aboriginal women giving birth in NSW. This has ramifications for the ascertainment of babies of Aboriginal mothers and the targeting of appropriate services in pregnancy and early childhood.</p

Scenario planning in Indigenous health

There is a need to nurture multidisciplinary health professionals who have the capacity to contribute to the complex challenges of addressing Indigenous health inequalities. This was recently acknowledged in the National Indigenous Public Health Framework, which sets out core competencies for working in Aboriginal health for postgraduate public health programs. This paper outlines a pilot project prompted by the framework, in the Master of Public Health at the University of New South Wales and its approach using scenario-based learning

Case Study of the 2011 Garma Festival Youth Forum: Strengths, Challenges and Implications for Policy and Practice

This case study was nested within a larger project commissioned by the Commonwealth Department of Families, Housing, Community Services and Indigenous Affairs (FaCHSIA) that aims to facilitate better policy and practice in the promotion of social and emotional wellbeing among Aboriginal and Torres Strait Islander youth. The need for improvement in this area is clearly evident in their much higher prevalence of negative outcomes across most measures of health, education, employment and involvement in the justice system. These measures indicate a higher exposure of Indigenous youth to the causes and consequences of low social and emotional wellbeing, as well as a lack of opportunity to recognise and build on personal strengths and capacity to achieve their full potential. A systematic literature, policy and program review revealed both a need and an enormous opportunity to enhance understanding of the strengths and challenges faced by those working on the ground, to share their knowledge and ideas on what kind of supporting mechanisms would maximise their growth and sustainability. Six case studies were completed to harvest this information across a range of program contexts and provide practical, useful and highly supported recommendations for policy, resource allocation and practice about what works, how and why. This report describes findings from the 2011 Garma Festival Youth Forum, one of the six case studies that collectively contribute to better understanding of how the universal strengths and positive potential of young Aboriginal people, whatever their circumstances, can be successfully and sustainably fostered

The Social and Emotional Wellbeing of Indigenous Youth: Reviewing and Extending the Evidence and Examining its Implications for Policy and Practice

The aim of this project was to obtain a deeper and broader understanding of current knowledge in this area and translate this understanding into practical and useful information to enhance policy, resource allocation decisions and practice. The project involved four components with each informing the next, namely: a systematic review of the existing published and grey literature covering research on Aboriginal and Torres Strait Islander youth SEWB up to 2010; a review of current policies at national and jurisdictional levels and a review of programs and services specifically addressing Aboriginal and Torres Strait Islander youth SEWB; completion of in-depth case studies of six programs with evidence of success and capacity to inform across a range of settings and groups. These studies utilized a structured, focussed comparison and appreciative inquiry approach to capture insightful explorations by those with hands on experience. The data included program-specific documents, interviews with program participants, developers, deliverers, managers and stakeholders and participant observations; and cross-case analyses identifying themes and variations across the six case studies and a metasynthesis generating four sets of key distilled and cohesive messages to advance theory and assist policy and practice to foster program strength and impact

Change starts from within us

Aboriginal and Torres Strait Islander concepts of social and emotional wellbeing have long informed national policy and medical practice guidelines (NATSILMH 2018). However, little attention has been given as to how public health educators can best instil in multidisciplinary groups of professionals an understanding of, and the skills to apply, such concepts. According to Delany and others, transformative approaches that stimulate an examination of different perspectives and values are required (Delany et al. 2016; NHMRC 2018). This case study describes the application of such an approach through embedding Stage One of the Family Well Being (FWB) program in the 13-week postgraduate ‘Aboriginal Health and Wellbeing Across the Lifespan’ (Lifespan) course delivered by the School of Public Health and Community Medicine at UNSW Sydney each year between 2011 and 2015. It explores students’ responses to FWB as a transformative learning tool, and its role in ‘changing the lens’ through which students viewed Aboriginal social and emotional wellbeing

Case study of the Balunu Indigenous Youth Healing Program: Strengths, Challenges and Implications for Policy and Practice

This report documents a case study of a residential healing camp program, the Balunu Indigenous Youth Healing Program, set on the Land of the Larrakia people in the Northern Territory. The Larrakia people are, and will always remain, the Traditional Owners of the Land and Sea at Talc Head. The Larrakia people are famous for the 1972 GWALWA DARAWIKI: THIS IS OUR LAND petition, which had over 1,000 signatures and inked thumbprints and was torn on its way to Buckingham Palace. On behalf of the case study team, we pay our deepest respects to Larrakia Elders past and present