An Australian national survey of First Nations careers in health services

A strong First Nations health workforce is necessary to meet community needs, health rights, and health equity. This paper reports the findings from a national survey of Australia’s First Nations people employed in health services to identify enablers and barriers to career development, including variations by geographic location and organisation type. A cross-sectional online survey was undertaken across professions, roles, and jurisdictions. The survey was developed collaboratively by Aboriginal and non Aboriginal academics and Aboriginal leaders. To recruit participants, the survey was promoted by key professional organisations, First Nations peak bodies and affiliates, and national forums. In addition to descriptive statistics, logistic regression was used to identify predictors of satisfaction with career development and whether this varied by geographic location or organisation type. Of the 332 participants currently employed in health services, 50% worked in regional and remote areas and 15% in Aboriginal Community-Controlled Health Organisations (ACCHOs) with the remainder in government and private health services. All enablers identified were associated with satisfaction with career development and did not vary by location or organisation type. “Racism from colleagues” and “lack of cultural awareness,” “not feeling supported by their manager,” “not having role models or mentors,” and “inflexible human resource policies” predicted lower satisfaction with career development only for those employed in government/other services. First Nations people leading career development were strongly supported. The implications for all workplaces are that offering even a few career development opportunities, together with supporting leadership by Aboriginal and Torres Strait Islander staff, can make a major difference to satisfaction and retention. Concurrently, attention should be given to building managerial cultural capabilities and skills in supporting First Nations’ staff career development, building cultural safety, providing formal mentors and addressing discriminatory and inflexible human resources policies

Tumor growth-promoting cellular host response during liver atrophy after portal occlusion

Background/Aims: Clinical observations suggest cancer progression after preoperative segmental portal vein occlusion, a procedure to prevent liver failure after major hepatic resections. The aim of this study was to determine whether portal occlusion induces host reactions which promote cancer invasion and angiogenesis. Methods: The rat model of portal branch ligation (PBL) was compared with partial hepatectomy (PH) and sham operation (SO) and evaluated for the expression of heat shock protein-70 (hsp70), heme oxygenase-1 (hmox1), early growth response gene-1 (Egr-1) and urokinase-type plasminogen activator (uPA), its inhibitor (PAI-1) and receptor (uPAR). Results: Portal deprivation after PBL was associated with a regression of liver tissue to 25% of its original mass within 8 days with only modest fibrotic changes. During the progression of atrophy, there were significant inductions of hsp70-, hmox1- and Egr-1-mRNA in comparison with regenerating liver tissue. PAI-1-specific mRNA was transiently elevated at 3-48 h after PBL in the atrophying lobes, whereas uPA and uPAR were unaffected in comparison with PH or SO. Conclusion: Hepatic atrophy caused by PBL is associated with increased expression of genes known to promote tumor growth. These host events represent a possible explanation for the tumor progression after portal occlusion and require further evaluation

We Are working for our People: Growing and Strengthening the Aboriginal and Torres Strait Islander Health Workforce: Career Pathways Project Report

Expanding and strengthening the Aboriginal and Torres Strait Islander health professional workforce is recognised as crucial for improving the health and wellbeing of Aboriginal and Torres Strait Islander communities. The Career Pathways Project took a national perspective and aimed to provide insights and guidance to enhance the capacity of the health system to retain and support the development and careers of Aboriginal and Torres Strait Islander people in the health workforce. The research incorporated a mixed-methods design, gathering and synthesising qualitative and quantitative data from primary and secondary sources. The main research activities included a literature review, national stakeholder consultations and a survey of the workforce, secondary data analysis, individual career trajectory interviews, locally situated case studies (focus groups and interviews) and data synthesis. The Aboriginal and Torres Strait Islander health workforce is made up of individuals who are passionate about what they do and motivated by a commitment to improve the wellbeing and health of their communities. To fulfil this commitment, they are willing to embark on a lifelong journey of learning to address the issues they see facing their families and broader communities, even if this involves significant challenges, changes in career goals, isolation or working in a health system that is not always flexible or responsive to community needs. Aboriginal and Torres Strait Islander health professionals’ unique skill set, which comes from their lived cultural experiences and ways of being and doing, makes them powerful advocates and agents of change to improve health outcomes. A holistic model of health works for Aboriginal and Torres Strait Islander people and communities. The community-controlled sector works from a platform of respect and connection within comprehensive primary healthcare, which promotes a holistic approach and integrates the cultural and social determinants of health into the planning and delivery of health services. This model acknowledges and engages with community structures, allowing culture to guide service delivery strategies and enabling innovative approaches to care, and includes the participation of consumers, their families and broader communities in defining their healthcare needs. All sectors can benefit by considering this model of care in order to improve the health and wellbeing of their Aboriginal and Torres Strait Islander consumers and local communities, and their Indigenous health workforce. The Aboriginal and Torres Strait Islander health workforce delivers a holistic model of care services that is culturally informed and has its own networks and complexities. Without the dedication of the local Aboriginal and Torres Strait Islander health workforce in remote communities, it would be impossible to deliver effective local health promotion and healthcare services that reinforce positive community attitudes to health. Jobs and careers are restricted by funding strategies that constrain the types of services and employment contracts that can be offered and do not reflect local needs or collective decision-making processes. The Aboriginal and Torres Strait Islander health workforce brings an intuitive understanding of cultural safety and competence to an organisation. This understanding is often structurally embedded in the community-controlled sector’s way of operating but is not always reflected in the operational approach across all organisations in the health sector, where Aboriginal and Torres Strait Islander workers experience racism and often do not have the support of other Aboriginal and Torres Strait Islander peers and colleagues, or influence over management of services to Aboriginal and Torres Strait Islander consumers. In terms of career development, encouragement and support makes all the difference. Training and further studies may be stalled for Aboriginal and Torres Strait Islander health workforce members by organisational constraints and personal financial circumstances. Community ties to location or the absence of family support can make it difficult for individuals to participate in educational and professional development activities, such as university work placements and internships. The Aboriginal and Torres Strait Islander health workforce is boosted by individuals’ early experiences of the health system and the presence of role models and mentors, both in the community and in the workplace. Opportunities to enter the health workforce at a junior level or as a paid trainee are very influential. These experiences form the building blocks upon which further supported career progression can be built. Mentoring by respected managers and senior health professionals assists individuals to build their careers and helps the workforce as a whole to grow. The value that Aboriginal and Torres Strait Islander Health Workers bring to their positions is not reflected in some industrial awards. Lack of structured career pathways means that they are often restricted to low-paid roles in the health and community sectors, despite having multiple Vocational Education and Training (VET) and/or university qualifications. On the basis of these findings, the research team identified five contributing factors – or pillars of action – for successful careers. The pillars are: Leadership and self-determination, Cultural safety, Valuing cultural strengths, Investment in the workforce and workplace, and Education and training. General and specific strategies are suggested within each pillar. Many strategies are multifaceted and multilayered, require the engagement of one or more capacity-building pillars, and involve one or more key groups. These groups include workers, communities (such as families or health service organisations), peak community and professional organisations, training and education providers, and health systems (including funding bodies). Collaboration and partnership between jurisdictions, sectors, professional groups and communities is essential to retain, support and develop Aboriginal and Torres Strait Islander careers in the health workforce