Initiatives targeting health risks

National Indigenous Australians Agency. (2020). Policies and strategies - Initiatives targeting health risks, Aboriginal and Torres Strait Islander Health Performance Framework website. Retrieved from https://www.indigenoushpf.gov.au/report-overview/policies-and-strategies/initiatives-targeting-health-risks

Policies and strategies - Initiatives targeting health risks, Aboriginal and Torres Strait Islander Health Performance Framework website. National Indigenous Australians Agency, 08 December 2020, https://www.indigenoushpf.gov.au/report-overview/policies-and-strategies/initiatives-targeting-health-risks

National Indigenous Australians Agency. Policies and strategies - Initiatives targeting health risks, Aboriginal and Torres Strait Islander Health Performance Framework website [Internet]. Canberra: National Indigenous Australians Agency, 2020 [cited 6 September 2024]. Available from: https://www.indigenoushpf.gov.au/report-overview/policies-and-strategies/initiatives-targeting-health-risks

National Indigenous Australians Agency (AIHW) 2020, Policies and strategies - Initiatives targeting health risks, Aboriginal and Torres Strait Islander Health Performance Framework website, viewed 6 September 2024, https://www.indigenoushpf.gov.au/report-overview/policies-and-strategies/initiatives-targeting-health-risks

%0 Report %T Policies and strategies - Initiatives targeting health risks, Aboriginal and Torres Strait Islander Health Performance Framework website %A National Indigenous Australians Agency, %D 2020 %C Canberra %I AIHW & NIAA %U https://www.indigenoushpf.gov.au/report-overview/policies-and-strategies/initiatives-targeting-health-risks

Initiatives targeting health risks

• National and regional
• Health System
• Cultural and social determinants of health

This page was last updated on 8 December 2020. The next update to the Policies and Strategies section will occur in 2024.

Child and maternal health

Enhanced primary care services and continued improvement in care have the capacity to support improvements in the health of babies, children and mothers. Australian governments are investing in a range of initiatives aimed at improving child and maternal health. Some of these are outlined below.

The Australian Government also funds the development of nationally consistent maternal and perinatal data collections. Improving data collections is critical to informing actions to improve outcomes for mothers and babies, including reducing perinatal mortality.

Overarching initiatives

The National Framework for Health Services for Aboriginal and Torres Strait Islander Children and Families articulates a vision and principles for the delivery of child and family health services to Aboriginal and Torres Strait Islander children and families across Australia. It aims to provide guidance for policy and program design and the development and implementation of services to meet the needs of Aboriginal and Torres Strait Islander children and families.

The Indigenous Australians’ Health Programme (IAHP) has allocated $23.5 million over six years (from July 2016) to the Connected Beginnings program to support the integration of early childhood health and education services in a number of Indigenous communities. The Connected Beginnings program aims to provide Indigenous children and families with greater access to cohesive and coordinated service provision, tailored to their individual needs, so more children are healthy, safe and ready to thrive at school. The Department of Education, Skills and Employment also allocates around $12 million annually for the education component of the program.

Pregnancy and antenatal care

Enhanced primary care services and continued improvement in antenatal care have the capacity to support improvements in the health of the mother and baby.

The Australian Government developed the Clinical Practice Guidelines - Pregnancy Care (the Guidelines) in 2019 to help ensure that health professionals provide women with consistent, high quality, evidence-based maternity care. The Guidelines recognise that Indigenous Australian women experience worse perinatal outcomes than non-Indigenous women. They also recognise the importance of cultural safety training for health professionals and discuss issues specific to providing antenatal care for Indigenous Australian women.

The Australian Nurse-Family Partnership Program (ANFPP) is an evidence based, nurse-led home visiting program. The program supports women pregnant with an Aboriginal and/or Torres Strait Islander baby who may benefit from a more intensive level of support to improve their own health and the health of their baby. The program aims to improve pregnancy outcomes by helping women engage in good preventative health practices; support parents to improve their child’s health and development; and help parents develop a vision for their own future, including continuing education and finding work. The program is implemented in 13 sites across Australia.

The New Directions: Mothers and Babies Services provides access to and information on immunisation status and infections, in addition to a series of other child and maternal health services and information. The program is now implemented in 136 locations across Australia. The Program was consolidated into comprehensive primary health care funding on 1 July 2019.

State examples

The Maternal Early Childhood Sustained Home Visiting Program (MECSH) is an evidence-based structured program of sustained nurse home visiting for families needing extra support and engages with families until their child is three years old. While the program starts with a pregnancy or new baby, it focuses on the whole family. The Northern Territory MECSH model was co-designed with four ACCHS, which deliver the program in three Northern Territory regions—the Barkly Region, the Big Rivers Region and the East Arnhem Region, supporting a whole of government commitment to incorporating local decision-making principles into program design and delivery, and the commitment to ensure every child has the best possible start in life.

The Healthy Under 5 Kids Partnering with Families Program (HU5K-PF program) is a universal standardised child and family health program for all Northern Territory families with children 0-5 years of age. The HU5K-PF program provides a platform that builds on partnerships between the family and the health professional, and provides the care and support needed to empower families to become confident parents and caregivers. The program aims to support optimal child health and development and offer the best opportunity to succeed in life.

The program consists of 14 key age contacts throughout the first five years of life. This improves the likelihood of embedding a therapeutic relationship between the health professional and the parents/carers and at the same time provides the opportunity to regularly identify and intervene early when issues present. At the core of these key contacts are surveillance of the child’s growth and development, parenting education and support and health promotion.

Smoking during pregnancy

The National Tobacco Campaign, Quit for You, Quit for Two is aimed at reducing smoking prevalence among pregnant women, their partners and women who are contemplating pregnancy.

Under the Tackling Indigenous Smoking (TIS) program, regional tobacco control grants allow for focused work on priority groups such as pregnant women and relationships with other programs for mothers and babies. The TIS program also supports training in smoking cessation for health professionals who provide services to Indigenous women during pregnancy.

An iSIStAQuit (implement Supporting Indigenous Smokers To Assist Quitting) program will be delivered under TIS from 2019-20 to 2021-22, and is being trialled nationally. It is based on the iCAN QUIT in Pregnancy (in New South Wales) and the SISTAQUIT (by University of Newcastle) programs that were co-developed and piloted with Aboriginal communities. iSISTAQUIT provides self-paced online training to health professionals via webinars, a treatment manual and patient resources to aid smoking cessation care. This will be accompanied by a social marketing campaign to support Indigenous Australian pregnant women to quit smoking.

Alcohol consumption during pregnancy

In 2018, the Australian Government Department of Health released the National Fetal Alcohol Spectrum Disorder (FASD) Strategic Action Plan 2018-2028 which focuses on prevention, screening and diagnosis, support and management with a particular focus on priority groups including Indigenous Australians and remote locations. Alongside the release of the Strategic Action Plan, the Department of Health announced a $7.2 million funding commitment to support providers to deliver activities under the Strategic Action Plan. Various activities are being undertaken across jurisdictions. For example, the Northern Territory Government released the Addressing Fetal Alcohol Spectrum Disorder (FASD) in the Northern Territory 2018–2024, which complements the National Strategic Action Plan and focuses on ways to support individuals, families, communities and the workforce to address FASD.

Birthing, midwifery and postnatal care

The Pregnancy, Birth and Baby helpline and website, provides a range of support to women, partners and families in relation to pregnancy and parenting.

The Guiding Principles for Developing a Birthing on Country Service Model and Evaluation Framework Phase 1 was developed and endorsed by the Australian Health Ministers’ Advisory Council in September 2016. It was developed to guide the establishment of birthing on country models of care.

State and territory examples

The Queensland Government’s Growing deadly families: Aboriginal and Torres Strait Islander Maternity Services Strategy 2019-2025, identifies characteristics of effective, culturally focussed and safe maternal health services for mothers of Aboriginal and/or Torres Strait Islander babies. The Strategy aims to embed cultural traditions, values and beliefs of Aboriginal and Torres Strait Islander people and their communities into maternal health services.

Queensland Health supports the Birthing in our Communities (BiOC) program, which establishes a continuity of care model for women and their families birthing an Indigenous baby in Brisbane. The program is built on a partnership model between the Mater Mothers’ Hospital, the Institute for Urban Indigenous Health and the Aboriginal and Torres Strait Islander Community Health Service Brisbane. The program provides 24/7 continuity of care through pregnancy, birth and up to six weeks postnatally for women birthing an Indigenous baby.

The premise of BiOC is to ensure every woman participating in the program has their own midwife on call, as well as a support team that includes Indigenous Health Workers, student midwives, doctors and other health professionals. The service provides antenatal care, smoking cessation advice, intrapartum care, birthing support, perinatal mental health, breastfeeding support and family support services.

Winnunga Nimmityjah Aboriginal Health and Community Services (Winnunga) provides a wide range of primary health and wellbeing services including an Aboriginal Midwifery Access program in the Australian Capital Territory. The Aboriginal Midwifery Access Program provides culturally safe midwifery care to Indigenous Australian families. The midwifery team pride themselves on offering flexible care for all women who enter the program. The midwives have successfully linked clients in with Karinya House for additional support and accommodation and referred younger clients to Canberra College’s ‘CC Cares’ to promote education and completion of primary, secondary and/or tertiary education. The midwives also cater for all pregnancies including high risk pregnancies.

Koori Maternity Services (KMS) deliver culturally appropriate care for Indigenous Australian mothers and their families, across 14 sites in Victoria, including three in public hospitals. KMS are an integral component of Victoria’s maternity service system working in partnership with women, families and the local community to ensure that service delivery is culturally safe, responsive and meets the unique needs of individuals and community. The role of KMS is critical to improving outcomes and increasing participation in maternity care for Indigenous Australian women, babies and families.

The Aboriginal Maternal and Child Health Initiative (AMCHI) was established to improve access to and participation in the Universal Maternal Child Health (MCH) program and provide culturally responsive and high-quality services to all Aboriginal families in Victoria. The Victorian Government worked with Koori communities to co-design an MCH service delivery model that provides more culturally responsive and high quality MCH services through both Aboriginal Community Controlled Organisations (ACCOs) and current MCH service providers.

Breastfeeding

The Australian National Breastfeeding Strategy: 2019 and Beyond was endorsed by Health Ministers in 2019. The Australian National Breastfeeding strategy aims to provide an enabling and empowering environment that protects, promotes, supports and values breastfeeding, and recognises the importance of breastfeeding support especially for priority groups.

The Australian Government provides funding for the Australian Breastfeeding Association to support the National Breastfeeding Helpline which offers a free call 24-hour service across all of Australia. It provides evidence-based education, information and support to mothers, their partners and families.

State example

The Tasmanian Breastfeeding Coalition protects, promotes and supports breastfeeding through actions based on the Australian National Breastfeeding Strategy. The Tasmanian Food and Nutrition Policy remains a relevant framework to guide action and investment for breastfeeding promotion and support.

Stillbirth

On 5 December 2018, the Australian Government announced $7.2 million to reduce stillbirths. This includes $3 million for stillbirth education and awareness programs, $1.2 million to the University of Melbourne for research to minimise preventable stillbirth through the use of biomarkers and ultrasound in late pregnancy; and $3 million for stillbirth research through the Medical Research Future Fund.

In addition to this funding, the Australian Government also announced that a National Stillbirth Action and Implementation Plan will be developed (consultations occurred mid-2020), in collaboration with a range of stakeholders including health professionals, researchers, bereaved parents and non-government organisations.

Oral, ear, and eye health

Oral health

Under the Agreement on Adult Public Dental Services (2017), states and territories were provided additional funding for adult public dental services for concession card holders.

The Healthy Mouths, Healthy Lives: Australia’s National Oral Health Plan 2015–2024 is to improve health and wellbeing across the Australian population by improving oral health status and reducing the burden of poor oral health. The Plan identifies Aboriginal and Torres Strait Islander people as a priority population and provides strategies to improve oral health outcomes and key performance indicators.

Territory example

Under the Northern Territory Remote Aboriginal Investment: Oral Health Program the Australian Government provides funding to reduce the prevalence and impact of oral health issues, with services targeted to Indigenous children aged under 16. Services include clinical services, preventative services, dental health education and health promotion.

Funding is provided through the Indigenous Australians’ Health Programme to support oral health services in six Northern Territory Aboriginal Community Controlled Health Organisations.

Ear health

A number of initiatives are in place to help reduce the incidence of hearing loss amongst Indigenous Australians. $104.58 million will be provided over the period 2018-19 to 2022–23 for ear health initiatives to assist in reducing the number of Indigenous Australians suffering avoidable hearing loss, and give Indigenous children a better start to education. This includes $30 million announced in the 2018 Federal Budget for diagnostic hearing assessments and follow-up treatment for Indigenous Australian children in the years before commencing school.

The Hearing Assessment Program—Early Ears has been co-designed with Aboriginal Community Controlled Health Services and other stakeholders and is delivered by Hearing Australia. It aims to reduce the long-term effects of ear disease in Indigenous children. More than 2,100 diagnostic hearing assessments have been conducted in 76 communities since it began in 2019.

Additional funding has been announced in the 2020 Federal Budget to further embed use of the Parent evaluated Listening and Understanding Measure (PLUM) and Hear and Talk Scale (HATS). These questionnaires enable carers, early childhood educators and health professionals to screen hearing and communication difficulties in young Indigenous children. The tools were co-designed with Indigenous communities. Funding is also being provided for Aboriginal Community Controlled Health Services to provide quiet spaces that can be used for audiology assessments.

Ongoing initiatives include the Healthy Ears—Better Hearing, Better Listening Program which increases access to clinical ear health services for Indigenous children and youth, with a focus on rural and remote areas. Funding also remains available to streamline care pathways, train health professionals, supply equipment and provide the Care for Kids’ Ears health promotion resources.

In 2019-20, the Australian Government’s Hearing Services Program (HSP) funded Hearing Australia to deliver hearing services to Indigenous Australians, this included $4.2 million for outreach sites including remote communities, and $6.7 million for the delivery of hearing services to eligible Indigenous Australians over 50 years of age.

Improvements have been made in the provision of access to eye and ear surgeries under the Australian Government’s Eye and Ear Surgical Support program. From 2015 – 2019 approximately 3,500 Indigenous Australians living in rural and remote communities within Australia received expedited eye and/or ear surgery. The program provides a culturally safe surgical pathway that includes support for the patient and their carer throughout the surgical process.

The Commonwealth, State and Territory Health Ministers have agreed to work jointly to consider the recommendations of the Roadmap for Hearing Health, which provides a framework for collaborative policies and programs

State examples

State and territory governments have implemented a variety of programs for Indigenous ear or hearing health.

In New South Wales, the Healthy Ears, Happy Kids Aboriginal Ear Health Program works to reduce the number of young Indigenous Australian children affected by otitis media by working with families to reduce the risk factors among parents, carers and their extended families. The program aims to increase awareness of ear health in the Indigenous community and among health and education professionals to support a preventative approach and early detection, and deliver services to Indigenous families to lessen the impact of otitis media on health and learning.

In Queensland, the Deadly Ears Program works in 11 rural and remote areas across the state, delivering ear and hearing health services and building local capacity. In addition, the program coordinates policy and practice changes across the health, early childhood and education sectors, provides training and development for health care professionals and educators, and undertakes research to improve prevention, treatment and management of middle ear disease and its impacts on early childhood development.

In Western Australia, the Earbus Foundation outreach program visits up to 65 locations across the state. The program offers mobile ear health clinics to Aboriginal children in schools, kindergartens and playgroups, and works with local primary health care services to connect the community with General Practitioners, audiologists and ear, nose and throat specialists without duplication. Each location is visited multiple times a year to ensure continuous surveillance and follow-up.

Across the Northern Territory, the Top End Health Service and Central Australia Health Services deliver the Australian Government funded Hearing Health Services Program to children and adolescents. This program is part of the Partnership Agreement on Northern Territory Remote Aboriginal Investment. Northern Territory Health has an urban diagnostic hearing service provided by Northern Territory based Audiologists and nurse Audiometrists in the five urban centres (Darwin, Nhulunbuy, Katherine, Tennant Creek and Alice Springs) to both Indigenous and non-Indigenous children. The urban audiology services targets children under the age of five years, which is a critical phase for learning, speech and language development. Hearing services are available to older children and adolescents on referral.

The Northern Territory’s Families as First Teacher Program is an early learning and family support program for remote Indigenous families, and where, among other services, the Hearing Health Partnerships are delivered. This program focuses on reducing the prevalence and incidence of ear disease among Aboriginal children under 16 years. Additionally, newborn hearing screening is available and undertaken at Northern Territory birthing hospitals.

Eye health

The Australian Government is providing around $43 million over the period 2019–20 to 2022–23 to improve the eye health of Indigenous Australians. Around $10.5 million is allocated in 2019–20 to 2020–21 to continue national efforts to eliminate trachoma as a public health problem. The remaining funding is for a range of activities including improved access to clinical services, streamlining of care pathways, provision of training for health professionals, supply of equipment and trachoma health promotion activities.

Approximately $36 million is provided from 2020–21 to 2023–24 to support the Visiting Optometrists Scheme (VOS), which improves access to optometry services for people living in rural and remote locations. $14.4 million is specifically for VOS services for Indigenous Australians.

In November 2016, MBS rebates were made available for retinal photography screening for patients with diabetes. Indigenous Australians are eligible for screening annually. To complement this initiative, funding has been provided to purchase retinal cameras and train staff to use the equipment.

The Australian Government also commissioned Vision 2020 Australia to develop an eye health roadmap for Indigenous Australians. Strong Eyes, Strong Communities: A Five-Year Plan for Aboriginal and Torres Strait Islander Eye Health and Vision 2019-2024 was released in March 2019, and seeks to improve eye health and vision outcomes for Indigenous Australians.

State and territory examples

There has been a range of Indigenous eye health programs delivered by state and territory governments. The Outback Vision van in Western Australia is a mobile eye health clinic, and the Squeaky Clean Kids Program is a health promotion initiative to reduce incidence of trachoma in Aboriginal communities in Western Australia. The Anyinginyi Health Aboriginal Corporation in the Northern Territory coordinates eye specialist visits and runs regional clinics. The Victorian Aboriginal Spectacle Subsidy Scheme provides subsidised glasses for Indigenous Australians.

Communicable disease

Immunisation

The Australian Government recognises that immunisation is highly effective in reducing morbidity and mortality caused by communicable diseases—diseases that can spread from person to person. The following initiatives aim to reduce the transmission of diseases.

The National Immunisation Program (NIP) provides free childhood vaccines to eligible Australians. In addition to the standard childhood schedule, the NIP provides free supplementary vaccines to Indigenous Australians, such as:

• pneumococcal vaccine and hepatitis A vaccine for children in high-risk areas
• pneumococcal vaccine for persons aged 15–49 years who are medically at risk, and adults aged 50 years and over
• seasonal influenza vaccines for all Indigenous Australians aged 6 months and over.

The Australian Government is providing an additional $12 million over three years from 2019 to boost a national immunisation education campaign.

Through the National Immunisation Strategy 2019-24, Commonwealth and state governments have committed to achieving 95% immunisation coverage amongst children. This target is supported by performance benchmarks in, the National Partnership Agreement on Essential Vaccines (NPEV) including for improving coverage among Indigenous children.

The National Human Papillomavirus (HPV) Vaccination Program commenced in 2007 for females and was extended to males in February 2013. It is delivered through an ongoing, school-based program to students aged 12–13 years.

Communication activities to support the NIP and HPV include specific components for Indigenous Australians, including tailored resources and social media about the vaccines and eligibility.

The Australian Nurse-Family Partnership Program also includes a focus on achieving immunisation benchmarks up to a child’s second birthday.

State example

In Western Australia, to support Aboriginal children in the metropolitan area who are overdue for their 12-month vaccinations, a dedicated Aboriginal Health Officer is available to families to assist in organising appointments and transport to enable them to access vaccination services.

Sexually transmissible infections

To combat sexually transmissible infections, the Fifth National Aboriginal and Torres Strait Islander Blood Borne Viruses (BBV) and Sexually Transmissible Infections Strategy (STI) 2018-22 is one of a set of five national strategies that together outline a framework for a high-quality and coordinated national response to BBV and STI in Australia.

The Fifth National Aboriginal and Torres Strait Islander BBV and STI Strategy has the overarching goals of:

• significantly reducing the transmission of BBV and STI among Aboriginal and Torres Strait Islander people
• closing the gap in BBV and STI incidence, prevalence, testing and treatment rates between Aboriginal and Torres Strait Islander and non-Indigenous Australians
• reducing the morbidity and mortality related to BBV and STI
• minimising the personal and social impact of BBV and STI
• minimising the negative impact of stigma, racism, discrimination, and legal and human rights issues upon Aboriginal and Torres Strait Islander people’s health.

Young Aboriginal and Torres Strait Islander people have been identified as a priority group in the Fifth National Aboriginal and Torres Strait Islander BBV and STI Strategy, which recognises that young people are disproportionately affected by BBV and STI and need special consideration in the national response.

There is an ongoing outbreak of infectious syphilis affecting young Aboriginal and Torres Strait Islander people, predominately aged between 15 and 29 years, living in the Northern Territory, Queensland, Western Australia and South Australia. The Australian Government has committed $21.2 million over four years (2017-18 to 2020-21) for an enhanced response to the syphilis outbreak. This enhanced response comprises:

• workforce supplementation for the roll out of the ‘Test and Treat’ model, including point-of-care tests (PoCT) and treatment medication
• development and roll out of a ‘train the trainer’ model to upskill the existing and supplemented workforce in the ‘Test and Treat’ model and sexual health in general
• the development and dissemination of culturally appropriate health, communication and education materials.

Territory example

The Australian Capital Territory Health Directorate’s funding agreement with the Winnunga Nimmityjah Aboriginal Health and Community Services includes a focus on harm reduction, which focuses on providing access to information about preventing blood borne viruses and sexually transmitted infections, screening and treatment for blood borne viruses (for example hepatitis B, hepatitis C and HIV) and sexually transmitted infections.

Chronic disease

The National Strategic Framework for Chronic Conditions is the overreaching policy document for chronic conditions. It sets the directions and outcomes to help Australians live healthier lives through effective prevention and management of chronic conditions. The National Strategic Framework for Chronic Conditions was agreed by Health Ministers from all state and territory governments under the Australian Health Ministers’ Advisory Council.

Chronic disease strategies are included in the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 and the Indigenous Australians’ Health Programme (IAHP).

The IAHP funds activities and programs that focus on the prevention, early detection, and management of chronic disease including through expanded access to and coordination of comprehensive primary health care.

The Australian Government provides funding for GP health assessments for Aboriginal and Torres Strait Islander people under the MBS, which includes follow-on care. Funding is also provided for incentive payments for improved chronic disease management, and for cheaper medicines through the PBS:

• The MBS Medicare Chronic Disease Management items, including GP Management plans and Team Care Arrangements, are used by doctors to plan and coordinate the care of patients who have chronic or terminal medical conditions.
• The MBS item for very remote renal dialysis assists with the management of haemodialysis to people with end-stage kidney disease.

The Practice Incentives Program—Indigenous Health Incentive (PIP–IHI) supports GP and Indigenous health services to provide better health care for Indigenous Australian patients, including best practice management of chronic disease. GPs receive payments for registering with the program, for registering Indigenous Australian patients with chronic disease and for providing best practice management of chronic disease.

The Medical Outreach Indigenous Chronic Disease Program (MOICDP) improves access to culturally competent clinical services by addressing a range of financial disincentives experienced by health professionals when providing outreach services for people in rural, remote and some urban areas of Australia. The MOICDP supports a wide range of health services including those provided by medical specialists, GP, Aboriginal Health Workers, allied health workers and other health professionals.

The Integrated Team Care program aims to improve timely access to coordinated and multidisciplinary care for eligible Indigenous Australians with chronic disease. This includes care coordination to support patients to navigate the health system so that they receive access to the care they need in clinically appropriate timeframes.

The Health Care Homes initiative provides patients ongoing coordination, management and support of their chronic conditions. A central element of the Health Care Homes model is a tailored and dynamic electronic shared care plan. A ‘Health Care Home’ is a GP or Aboriginal Community Controlled Health Services (ACCHS) that coordinates care for patients with chronic and complex conditions. The Health Care Homes program was rolled out in ten selected PHNs. Eligible patients can enrol with a participating medical practice (‘home base’) for the ongoing coordination, management and support of their conditions. Part of the enrolment process is to select a ‘lead clinician’ to coordinate the patient’s care. In December 2018 the Health Care Homes program was extended to 30 June 2021 and will allow the GP and ACCHS already participating in the program further time to implement new flexible models or care tailored to the needs of their patients. Over 10,000 patients in ten PHN regions across Australia were registered and continue to receive coordinated and innovative patient-centred care for their chronic and complex health conditions.

State examples

In Victoria, the Road to Good Health program, an element of the broader Life! program, is designed to support Aboriginal Health Workers and health professionals working with Indigenous Australian communities to promote, educate and encourage healthy lifestyles to enable healthy lifestyle choices and prevent chronic diseases.

In Western Australia, the Wirraka Maya Health Service funds primary prevention in Indigenous communities (for example child health checks, hygiene sessions, ear health education, an alcohol in pregnancy intervention and development of an outreach service to surrounding communities).

The Tasmanian Department of Health, through TAZREACH, administers Commonwealth funded outreach programs which aim to improve the health outcomes for the people living in rural, remote and some urban locations by supporting health professionals to provide outreach services across Tasmania. This includes MOICDP services such as respiratory medicine, dermatology, ophthalmology, cardiology, diabetes education, psychology and mental health, paediatrics, physiotherapy and podiatry.

Northern Territory Health, through the Australian Government Rural Health Outreach Fund, provides chronic conditions specialist outreach services to Aboriginal Territorians living in remote communities. This includes renal, cardiac, diabetes and respiratory specialists.

Specific diseases

The Australian Government is currently working with the states and territories to develop policy Roadmaps for ear and hearing health, eye health, renal health, and rheumatic heart disease (RHD). The Roadmaps will be high level frameworks to be used to guide policy, prioritisation, and planning decisions over the coming years. The impact of these conditions is acutely experienced by Indigenous Australians and presents challenges for prevention, access to health services and treatment, and requires collaboration with other sectors to address social determinants that particularly impact on these conditions such as housing and transport.

Rheumatic heart disease

The Australian Government is investing $24.6 million for rheumatic heart disease prevention through its Rheumatic Fever Strategy (RFS) announced in the 2017-18 Budget.

Under the RFS, a National Partnership Agreement was established between the Australian Government and the Northern Territory, Queensland, South Australian and Western Australian governments. This partnership agreement supports the improved detection, monitoring and management of acute rheumatic fever and rheumatic heart disease through coordinated state-based disease registers and control programs.

Under the Medical Research Future Fund, the Indigenous Health Research Fund includes a commitment to ending rheumatic heart disease. The Australian Government has provided $35 million to support the development of a vaccine to eliminate rheumatic heart disease in Australia.

The National Health and Medical Research Council (NHMRC) funds the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE). The END RHD CRE has released The RHD Endgame Strategy: The blueprint to eliminate rheumatic heart disease in Australia by 2031. The END RHD CRE is a coalition of organisations led by the ACCHS sector, and has advocated for the implementation of the Endgame Strategy, and to educate Australians about the role the coalition can play.

The Queensland Aboriginal and Torres Strait Islander Rheumatic Heart Disease Action Plan 2018–2021 continues to provide a platform for targeted action and intervention for both acute rheumatic fever and rheumatic heart disease. Examples of direct actions include community‑based screening and the establishment of transition clinics to support the point of transition for young adults moving to care under the adult cardiology system.

The Northern Territory is developing the Northern Territory Rheumatic Heart Disease Strategic Plan, which is due to be released in 2021. Implementation of the strategic plan will ensure a whole of government and cross-sectoral approach focussed on eliminating RHD. The Strategic plan has a focus on addressing the social determinants of RHD while also strengthening primary and secondary prevention activities and tertiary care services.

Circulatory diseases

IAHP activities aimed at helping patients who experience circulatory disease include the Tackling Indigenous Smoking program and a care coordination and outreach workforce based in Aboriginal medical services and mainstream services.

A new National Strategic Action Plan for Heart Disease and Stroke is being developed which will give consideration to Indigenous Australians. The Action Plan will contain guidance and direction around key goals and priorities for heart disease and stroke. It will identify specific actions and activities that could be introduced to realise improvements for each goal/priority.

The National Strategic Action Plan for Childhood Heart Disease provides a guide to improve the care of patients, assist to coordinate policy action for tackling childhood heart disease, and drive collaboration in management, care, support, research and community awareness. The Action Plan targets priority populations that are disproportionally affected by childhood heart disease, including Indigenous Australians.

A new MBS item was introduced on 1 April 2019 for heart health assessments, lasting at least 20 minutes, by a GP. The new item will provide patients with a comprehensive assessment of their cardiovascular health, identification of any physical or lifestyle-related risks to their cardiovascular health, and a comprehensive preventative health care plan to improve their cardiovascular health.

Respiratory disease

IAHP activities aimed at helping patients who experience respiratory disease include the Tackling Indigenous Smoking program, and a care coordination and outreach workforce based in both Aboriginal medical services and mainstream services.

The National Strategic Action Plan for Lung Conditions has been developed to help people living with chronic lung conditions, including Indigenous Australians as a priority group.

The National Asthma Strategy was launched in 2018. The National Asthma Strategy draws from best practice understandings of optimal asthma care, and management and advice from clinical and academic experts. The National Asthma Strategy includes a strong emphasis on improving asthma control in high risk and vulnerable populations, including Indigenous Australians.

Queensland Health provides the Indigenous Outreach Program to deliver primary, secondary and tertiary health care services to support and improve the prevention, screening, diagnosis, treatment and management of respiratory and cardiac conditions in Indigenous Australians in locations with limited access to specialist services. For respiratory conditions this involves the delivery of both paediatric and adult outreach clinics as well as the training and support of local health staff to improve disease management.

High blood pressure

IAHP activities aimed at high blood pressure include Tackling Indigenous Smoking; a care coordination and outreach workforce based in Aboriginal medical services and mainstream services; and GP, specialist and allied health outreach services serving urban, rural and remote communities.

The Australian Government provides funding for GP health assessments for Indigenous Australians under the MBS, which includes blood pressure measurement and follow-on care.

Cancer

The National Aboriginal and Torres Strait Islander Cancer Framework 2015 provides a shared agenda for improving Indigenous cancer outcomes in Australia. The National Aboriginal and Torres Strait Islander Cancer Framework is supported by the National Aboriginal and Torres Strait Islander Cancer Monitoring and Reporting Framework which provides a strategic approach to monitoring and reporting data in the seven priority areas identified in the National Aboriginal and Torres Strait Islander Cancer Framework.

Cancer prevention under the IAHP includes the Tackling Indigenous Smoking Program, which aims to reduce smoking rates.

Cancer Australia aims to minimise the impact of cancer, address disparities and improve outcomes for people affected by cancer. Cancer Australia's work is underpinned by a model for engaging Indigenous communities including: community engagement, information exchange, evidence generation and translation, and sustainability.

The National Human Papillomavirus (HPV) Vaccination Program includes specific communication strategies for Indigenous communities such as distribution of tailored resources to schools, as well as targeted public relations activities and social media engagement.

BreastScreen Australia and the National Bowel Cancer Screening Program (NBCSP) include culturally specific advertising and stakeholder engagement. State and Territory governments provide a range of programs. For example, in Victoria, the Strengthening Clinical Care and Pathways project aims to increase cancer treatment in public hospitals.

The IAHP also funds the National Bowel Cancer Screening pilot project, which aims to increase bowel cancer screening rates for Indigenous Australians. Six years of funding from 2014–15 was allocated to pilot and evaluate a range of strategies to increase NBCSP participation in up to 50 Indigenous primary health care services to determine the most effective model/strategies for potential national implementation.

Cancer Council Victoria’s Under Screened Recruitment Program targets Indigenous Australian participation in breast, cervical and bowel screening.

In Victoria, Korin Korin Balit-Djak is driving action to reduce the incidence, mortality and morbidity associated with cancer experienced by Aboriginal people in Victoria, including the Optimal Cancer Care Pathway for Indigenous Australians, cultural competency training in cancer services and the Aboriginal Women’s Breast Screening Shawl project, which aims to improve Indigenous women’s experience with breast screening and increase the cultural competency of BreastScreen Victoria staff.

BreastScreen Northern Territory runs mobile services to 20 remote Aboriginal communities.

Diabetes

The Australian National Diabetes Strategy 2016–2020 seeks to prioritise Australia’s response to diabetes and its complications and comorbidities. Goal 5 of the Australian National Diabetes Strategy aims to reduce the impact of diabetes among Indigenous Australians. The IAHP includes activities aimed at diabetes.

The Quality Assurance for Aboriginal and Torres Strait Islander Medical Services (QAAMS) provides support to better manage diabetes amongst Indigenous communities. The program supports culturally appropriate and clinically effective management of diabetes patients in Indigenous communities. This occurs through training, technical support and quality assurance for ‘point of care’ pathology testing.

Diabetes in Australia: Focus on the Future implementation plan identifies priority diabetes-related actions that include addressing gaps in the current direction of diabetes work and investment, minimising duplication of effort across all sectors and to ensure the current focus of activity across sectors remains strong and relevant into the future. The actions outlined have been agreed by all jurisdictions as activities that can be developed, expanded or modified to produce targeted, tangible improvements in the prevention, early detection, management and care of all forms of diabetes.

In Victoria, the Life! program is helping prevent type 2 diabetes, heart disease and stroke. The Life! program includes a component specifically targeting Aboriginal Victorians.

The Northern Territory Diabetes Network focuses on type 2 diabetes in Aboriginal young people aged between 10 and 24 years. The Network is implementing new screening and referral pathways as well as a new care plan for diabetes among young people.

The Top End Health Service provides diabetes services through telehealth. These sessions are led by an endocrinologist, a credentialed diabetes educator and a nurse. In addition, Top End and Central Australia health services through MOICDP provide diabetes outreach services to remote communities.

The Northern Territory Department of Health in partnership with the Menzies School of Health Research and the Aboriginal Medical Service Alliance Northern Territory are addressing inter‑generational diabetes and aim to prevent early onset of diabetes in children of mothers who had diabetes during pregnancy. This includes improved models of care for pregnant women with diabetes, which provides education for clinicians and primary care health workers about the prevalence of diabetes during pregnancy and its effects. Another aim is to bring diverse service providers together to overcome silos and improve care through a Continuous Quality Improvement approach across acute and primary health care.

Kidney disease

A National Strategic Action Plan for Kidney Disease is being developed which will give consideration to key goals and priorities specifically targeting the disproportionate burden of kidney disease on Indigenous Australians.

In South Australia, the Mobile Dialysis Unit for Aboriginal people is a specially designed truck that has been fitted with three dialysis chairs and visits remote Aboriginal communities across South Australia. The Unit allows Aboriginal dialysis patients living in regional or metropolitan centres (for the purposes of dialysis treatment) to visit their home communities for short-term respite while continuing treatment.

The Unit commenced operating in 2014 and has visited many communities allowing people to return home for significant community events and to spend time on country with family and friends.

Western Desert Nganampa Waltja Palyantjaku Aboriginal Corporation, known as Purple House, is an Indigenous-owned and run health service based in Alice Springs in the Northern Territory. It operates 18 remote renal dialysis clinics and a mobile dialysis unit supporting dialysis patients to return home for respite, family and cultural obligations.

Top End Health Service and Central Australian Health Service provide comprehensive renal care through multidisciplinary teams. The service provides Indigenous Australians from rural and remote communities with an option to undertake self-managed home-based peritoneal dialysis or haemodialysis.

Health promotion

Healthy behaviour can lower the risks of developing chronic diseases. As such, all levels of Australian governments are promoting good health among Indigenous Australians. Below is a list of some initiatives targeting smoking, alcohol and drugs, and physical activity and diet.

Smoking

Australian Governments have worked with Indigenous Australians and health organisations over many years to deliver a range of approaches to address the high rate of tobacco smoking in the Indigenous Australian population. These policies and programs complement state and territory activities to reduce the harms from smoking:

• The National Tobacco Strategy 2012–18 aims to build on existing programs and partnerships to reduce smoking rates among Aboriginal and Torres Strait Islander people. The National Tobacco Strategy includes demand and supply reduction, and harm reduction approaches. A new National Tobacco Strategy is in development.
• Don’t Make Smokes Your Story is the latest phase of the National Tobacco Campaign using an empowering and positive approach to encourage quit attempts among Indigenous smokers. Break the Chain and Quit for You, Quit for Two (a TV advertisement), is part of an integrated strategy utilising mainstream mass media, local and targeted channels, digital and social media.
• Under the Indigenous Australians' Health Programme (IAHP), the Australian Government’s Tackling Indigenous Smoking (TIS) program funds regional projects to deliver a range of evidence-based activities that suit the local context and the needs of the community to prevent the uptake of smoking and support smoking cessation.
• The Aboriginal and Torres Strait Islander Smoking Cessation Program in the Australian Capital Territory supports a number of smoking cessation activities in the region, with an emphasis on pregnant smokers and their cohabitants.
• In Western Australia, Tackling Smoking - a development of the Midwest Region Wide Tobacco Strategy and Campaign is a project that integrates different intervention approaches (such as regulatory, structural, participative and enhancement). The multi-faceted promotional campaign uses radio, newspaper, community events and the distribution of promotional materials. Results from a short-term evaluation indicated early success and an increase in calls to the Aboriginal Quitline following the campaign.
• The Tasmanian Tobacco Control Plan 2017–2021 is designed to support Aboriginal Tasmanians to stop smoking. The Tasmanian Department of Health is implementing the No One Left Behind: An action plan to achieve a smoke free Tasmania 2018–2021 which lists actions to support people from priority populations to quit smoking. The Tasmanian Aboriginal Centre, with a Healthy Tasmania grant for their makara patapa/Stop Smoking program, aims to reduce smoking rates in the Tasmanian Aboriginal community by providing intensive smoking cessation support to people who use the Aboriginal Health Service across Tasmania. The Tasmanian Department of Health has developed the Smoke Free Young People strategy to discourage young people from starting smoking.
• Queensland Health continues to support the Yarn to Quit program available through the statewide Quitline telephone service. This funding supports the employment of Indigenous Australian phone counsellors, allowing the option for Indigenous Australians accessing Quitline to engage with these counsellors to discuss steps to quitting tobacco, develop a quit plan and receive information about products to assist with quitting tobacco.
• The Northern Territory Tobacco Action Plan 2019–2023 has a strong focus on increasing awareness on the harmful effects of tobacco smoking, supporting people to quit, and promotes smoke-free workplaces across the Northern Territory. This includes working with Aboriginal groups and communities to denormalise smoking and promote positive role models.

Physical activity and diet

The Implementation Plan to the National Aboriginal and Torres Strait Islander Health Plan (2013–2023) seeks to draw on the evidence base to identify new strategies to support nutrition and physical activity choices. The plan recognises the importance of addressing the social and cultural determinants of health that contribute to poor dietary choices and poorer health outcomes, through coordinated whole-of-government action.

The Australian Government revised physical activity and sedentary behaviour guidelines for children, young people and adults in February 2014 following a review of the best available evidence concerning the relationship between physical activity, sedentary behaviour and a range of health outcome indicators, including the risk and prevention of chronic disease and obesity.

In 2019, the Australian Government released 24-Hour Movement Guidelines for the Early Years (0–5 years) and Children and Young People (5- 17 years). These guidelines are in addition to Australia’s Physical Activity and Sedentary Behaviour Guidelines for Adults and Older Australians.

The Girls Make Your Move campaign encourages and supports young women and girls aged 12–19 years to be more active and reinforces the benefits of an active life. Indigenous girls feature in the campaign advertising which was placed in Indigenous specific media channels.

The Health Star Rating social marketing campaign is intended to support all grocery buyers of packaged goods to make more informed nutritional choices at the point of purchase by providing easy-to-understand front-of-pack labelling. The campaign includes a specific focus on out-of-home and social media aimed at Indigenous audiences.

The Healthy Bodies Need Healthy Drinks program encourages Aboriginal and Torres Strait Islander school-aged children, their families and communities to choose water instead of high-sugar drinks in an effort to prevent obesity, chronic disease and dental caries.

The Australian Government is investing around $10 million in a number of initiatives which focus on improving nutrition for Indigenous Australians by helping to increase access, affordability and consumption of fresh foods, particularly in rural and remote communities. These include:

• The Edge of Nowhere Thriving Communities Program being funded over 2018–19 to 2021–22 to:
  • establish edible gardens within schools and communities
  • run healthy eating workshops
  • provide in-home nutrition awareness services
  • offer and deliver training in horticulture.
  • provide training to Aboriginal Health Workers and other health professionals to assist people living with chronic disease to achieve better health outcomes
  • deliver a Nutrition Support Program, which focuses on the importance of nutrition in preventing chronic disease and provides practical tools and resources for participants to use with individuals and communities.
  • provide a whole-of-community approach to educate Indigenous children about making healthy living choices. Tucka-Time is delivered through six Queensland schools, providing practical food preparation and cooking skills focussing on the prevention of obesity and increasing overall health and wellbeing.
  • to build networks to increase access to fresh fruit and vegetables in communities. The program is a pilot to help expand delivery of fresh food in specific communities in Queensland and New South Wales.

  The Australian Government also provides funding of around $9 million per annum to support School Nutrition Projects, which provide meal services during the school term for school-aged children from Transition to Year 12 in a number of communities in the Northern Territory.

  Additionally, the wholly owned and independent Commonwealth company, Outback Stores, has a mandate to improve access to affordable healthy food for remote Indigenous communities through the provision of quality retail management services for community stores. Outback Stores encourages management practices that promote healthy food choices and improve nutrition in remote communities as outlined in the

  Outback Stores Healthy Food Strategy 2017–2020. As part of this work, Outback Stores is developing a sugar reduction strategy to reduce the sales of high sugar products in selected remote community stores.

  State examples

  Korin Korin Balit-Djak focuses on improving Aboriginal Victorians’ health and longevity, including through: increasing sport and recreation opportunities for Aboriginal children and young people in out-of-home care, including Aboriginal sporting carnivals.

  Move Well Eat Well (primary schools and early childhood settings) in Tasmania aims to improve the policies and practices in these settings to support nutrition and physical activity.

  Cancer

  Targeted communication activities have been delivered to promote the BreastScreen Australia program and the National Bowel Cancer Screening Program to Indigenous audiences, with the aim of increasing participation and subsequently delivering better health outcomes. Culturally specific advertising and public relations activities have been delivered.

  Mental health and social and emotional wellbeing

  Policy responses to social and emotional wellbeing need to be multi-dimensional and involve a range of stakeholders. Strategies should build on the strengths, resilience and endurance within the Indigenous community. Some mental health and social and emotional wellbeing initiatives are listed below.

  The National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017–2023 sets out a comprehensive and culturally appropriate stepped care model that is applicable to both Indigenous specific and mainstream health services. It helps guide and support Indigenous mental health policy and practice and is an important resource for policy makers, advocates, service providers, clients, consumers and researchers.

  Through the Department of Health, funding for Indigenous specific suicide prevention is now an ongoing component of Australian Government suicide prevention investment under the new National Suicide Prevention Strategy. This funding is in addition to funding specifically earmarked for Indigenous mental health through Primary Health Networks (PHNs). From 2019–20 the PHNs will be funded for $1.45 billion over 3 years to deliver community mental health services, including $121 million for Indigenous mental health and $77 million for suicide prevention. Approximately $5.6 million per annum is allocated to PHNs for the delivery of culturally appropriate suicide prevention services for Indigenous Australians. The National Suicide Prevention Trial was launched in 2016 for 12 sites, with funding of $36 million, and a further $13 million allocated in 2018 to run until 30 June 2020. The program is administered by PHNs based in Darwin, the Kimberley, Western New South Wales, Mid-West Western Australia, Brisbane North, North Coast New South Wales, North Western Melbourne, Perth South, Northern Queensland, Wide Bay, Sunshine Coast and Central Queensland, Tasmania and Country South Australia. Two of the trial sites are focused on implementing integrated approaches specifically and exclusively in Indigenous communities (Darwin and the Kimberley). At least five other sites involve suicide prevention in Indigenous communities.

  The Fifth National Mental Health and Suicide Prevention Plan outlines actions to address social and emotional wellbeing, mental illness and suicide amongst Indigenous Australians as a priority. In addition, other priority areas in the Plan include regional integration, coordination of treatment and support, suicide prevention, the physical health of people with mental illness, stigma and discrimination, safety and quality, and systems improvement.

  Under the National Suicide Prevention Leadership and Support Program (the Program), the Australian Government is providing funding to the University of Western Australia establish and operate the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention. The Centre aims to reduce the causes, prevalence and impact of suicide by identifying, translating and promoting the adoption of best practice in Indigenous suicide prevention activity. Additional funding will be available from 2019–20 to 2020–21 under a two year extension of the Program. The Program will be evaluated to determine what works in suicide prevention, including for Indigenous Australians.

  The Healing Foundation (2019–22) allocates $19.6 million for healing programs. This includes community healing activities, men’s healing projects, and healing projects for members of the Stolen Generations and their families.

  Under the IAHP, the Department of Health has provided $3.4 million since 2016–17 for the implementation of the Trauma Assessment Referral and Recovery Outreach Teams Project (TARROT). The TARROT project applies a child-centric approach to identifying and addressing the developmental, emotional and behavioural impacts of trauma and is designed to break intergenerational cycles of trauma impacting Indigenous families in a number of underserviced communities in Australia.

  The Indigenous Advancement Strategy’s (IAS) Safety and Wellbeing program provides funding to enhance community safety and support Indigenous wellbeing, by funding activities on five key outcome areas: safe and functional communities; improved individual and community health, wellbeing and resilience; violence reduction and victim support; reduced substance misuse and harm; and crime prevention, diversion and rehabilitation.

  In relation to IAS Safety and Wellbeing program activities specifically supporting improved wellbeing, there are a range of social and emotional wellbeing services funded across Australia. Funded activities aim to support members of the Stolen Generations and their families in particular and include individual counselling, case management, group therapy, referrals, outreach, family support, family tracing and reunions as well as Social and Emotional Wellbeing workforce development and training.

  The IAS provides funding for Aboriginal and Torres Strait Islander Mental Health First Aid (MHFA) training, which teaches people how to recognise the signs of mental ill-health and support people to get the help they need. The IAS also funds the National Indigenous Postvention Service to provide timely and culturally safe postvention support to Indigenous Australians impacted by suicide.

  The Australian Government is investing $3.6 million in mental health initiatives for small business, including $3.1 million through EveryMind’s Ahead for Business project targeted at supporting small and family businesses, particularly sole proprietors, and $500,000 for an online platform.

  State and territory examples

  Alive and Kicking Goals is a multi-award winning youth suicide prevention project based in the Kimberley region of Western Australia. The project aims to reduce the high suicide rate among Indigenous youth through peer education workshops, one-on-one mentoring and counselling. The project is wholly owned and led by young Aboriginal women and men.

  Through South Australian Department of Health funding, access to Traditional Healers is available at no cost to Aboriginal patients through referrals from clinicians and health practitioners. Traditional Healers play an important role in the healing process for Indigenous Australians and influence and support the positive management of Indigenous Australian’s emotional, spiritual and physical wellbeing.

  The Family Wellbeing program is a social and emotional wellbeing program originally developed in 1993 in South Australia and in over 20 years has spread to 56 sites across most states and territories. Its objective is to develop people’s skills and capacity to move from a position of disempowerment to empowerment.

  The Western Australia State-wide Specialist Aboriginal Mental Health Program continues to provide culturally secure services to Aboriginal people.

  In Victoria, under Balit Murrup: Social and Emotional wellbeing Framework, four demonstration projects are currently delivering integrated, culturally safe mental health services that are designed to meet the mental health, and social and emotional wellbeing needs of their local Aboriginal communities across three focus areas: adult mental health, child protection and corrections. The four projects are delivered by Aboriginal Community Controlled Organisations in partnership with a local public health service:

  • The Ballarat and District Aboriginal Co-operative (BADAC), in partnership with Ballarat Health, is supporting parents who have mental illness with children in, or at risk of entering, the child protection system.
  • Mallee District Aboriginal Service (MDAS), in partnership with Mildura Base Hospital and Mallee Family Care, is providing treatment for clients with mental health needs who are in contact with the justice system. The innovative model of care involves collaboration from mental health clinicians, support workers, the client and their family.
  • Wathaurong Aboriginal Co-operative (Wathaurong), in partnership with Barwon Health, is supporting Aboriginal adults with moderate to severe mental illness and are experiencing social disadvantage (regional site).
  • Victorian Aboriginal Health Service (VAHS); in partnership with St Vincent Health, Austin Health, and North Western Mental Health; is supporting Aboriginal adults with moderate to severe mental illness.

  The Victorian Government is also funding additional clinical and therapeutic mental health positions in Aboriginal Community Controlled Health Organisations across Victoria, and 10 Aboriginal mental health trainee positions, to increase the workforce available to deliver culturally responsive, trauma-informed services that can address the social and emotional wellbeing and mental health needs of Aboriginal people in Victoria.

  Alcohol and other drug services

  The National Drug Strategy (NDS) 2017–2026 provides a national framework for building safe, healthy and resilient Australian communities through preventing and minimising alcohol, tobacco and other drug related health, social and economic harms among individuals, families and communities. The National Aboriginal and Torres Strait Islander Peoples Drug Strategy (NATSIPDS) 2014–2019 is a sub-strategy of the NDS. The goal of the two strategies is to reduce the harmful effects of alcohol and drugs on individuals, families, and their communities. A National Alcohol Strategy is currently being developed, and will complement the NDS.

  As part of the December 2015 response to the National Ice Taskforce’s Final Report, funding was allocated to Primary Health Networks (PHNs) to commission additional drug and alcohol treatment services with a component allocated specifically for treatment services for Indigenous Australians.

  PHNs are to pursue holistic approaches to Indigenous drug and alcohol treatment that are culturally safe, competent and respectful in both Indigenous specific and mainstream services. In the 2019 Budget the Australian Government announced $153 million to extend the National Ice Action Strategy funding for two years (from 2020–21).

  The Indigenous Advancement Strategy—Safety and Wellbeing Program provides funding for strategies to enhance wellbeing and community safety. This includes funding support for a range of alcohol and other drug (AOD) treatment services across Australia. Funding currently supports around 80 alcohol and other drug services to improve access to culturally appropriate treatment, prevention, rehabilitation, education and aftercare services for Indigenous Australians, particularly in regional and remote areas.

  State and territory examples

  Under the National Partnership on Northern Territory Remote Aboriginal Investment the Australian Government is providing around $91.5 million (over 7 years, to 2021–22) to tackle the harms caused by alcohol and other drugs in the Northern Territory.

  The Northern Territory Mental Health & AOD Directorate supports a range of Alcohol Action Initiatives (AAI’s) across the Territory. These community projects are centred on local solutions and practical actions to reduce alcohol related harm in remote Northern Territory Aboriginal communities. AAIs tackle the social determinants through AOD diversion and education activities such as culture camps, mental health first aid training, AOD and FASD workshops and strong women’s groups. There are currently 332 AAIs funded through the Alcohol Schedule, Community Safety Implementation Plan, of the National Partnership Agreement on Northern Territory Remote Aboriginal Investment. Coordination of AAIs is the responsibility of the Harm Minimisation Unit, Mental Health, Alcohol and Other Drugs Branch, Department of Health. Local governance and decision making structures have been implemented in over 40 communities to develop proposals and oversee AAI project implementation.

  The Northern Territory Addressing Fetal Alcohol Spectrum Disorder Strategy 2018–2024 is focused on prevention, screening and diagnosis, support and management as well as focusing on at risk populations. It seeks to maximise public awareness of the risks of consuming alcohol during pregnancy, including FASD; ensuring that treatment for alcohol misuse is available and accessible to all women (and that women who are high-risk alcohol users are being referred to treatment providers); and ensuring that wrap around services are mobilised to address the social determinants of health for women who are high-risk alcohol users.

  In Western Australia, the FASD prevention program targets alcohol consumption during pregnancy in the Kimberly region run by the Ord Valley Aboriginal Health Service. The program applies innovative strategies in providing education and support of antenatal clients and their families, as well as providing regular education sessions to students in the region.

  Strong Spirits, Strong Minds is a media campaign that aims to prevent and/or delay the early uptake of alcohol and other drugs by young Aboriginal people in the Perth metropolitan area. The multi-faceted communication strategy includes mainstream mass communication channels to deliver Aboriginal specific messages. The project was developed from a strong cultural foundation with input from an Aboriginal youth advisory panel.

  Consistent with the Korin Korin Balit Djak policy on self-determination, the Victorian Department of Health and Human Services has promoted the design and delivery of existing and future Aboriginal AOD funding. The process is led by the Victorian Aboriginal Community Controlled Health Organisation (VACCHO).

  The Low Aromatic Fuel Act 2013, prohibits the supply and sale of regular unleaded petrol in four locations (Katherine, Daly and Tennant Creek regions in the Northern Territory, and Palm Island in Qld) to prevent petrol sniffing and help reduce the potential harm to the health of people in those areas.

  In the Australian Capital Territory, the Health Directorate will collaborate with Indigenous services and other stakeholders to determine specialist AOD implementation priorities, including residential rehabilitation for Indigenous Australians.

  Disability

  The National Disability Insurance Scheme (NDIS) has been gradually implemented across Australia, since July 2013. The NDIS provides funding for long-term, individualised care and support to meet the needs of people with permanent disability, where a person’s disability significantly affects their communication, mobility, self-care or self-management.

  The NDIS also provides all people with a disability with information and connections to services in their communities such as doctors, sporting clubs, support groups, libraries and schools, as well as information about what support is provided by each state and territory government.

  The Aboriginal and Torres Strait Islander Engagement Strategy focuses on enabling quality management, service delivery and leadership to ensure the successful delivery of the NDIS in Indigenous communities in Australia. The Aboriginal and Torres Strait Islander Engagement Strategy was developed drawing on the knowledge and experience of NDIS trial sites and expertise of the Aboriginal and Torres Strait Islander Reference group.

  The National Disability Strategy 2010–2020 provides a 10 year national policy framework for all levels of government aimed at improving the lives of people with disability. The National Disability Strategy seeks to drive a more inclusive approach to the design of policies, programs and infrastructure so that people with a disability can participate in all areas of Australian life. The plan outlines actions Australian Government agencies can take to improve life outcomes for Indigenous Australians living with a disability.

  A new National Disability Strategy is being developed and is expected to be released in 2021.

  The Australian Government is providing $5.9 million over the next two years to the National Aboriginal Community Controlled Health Organisation (NACCHO) to strengthen NDIS services within Aboriginal and Torres Strait Islander communities. NACCHO is being funded to work with ACCHOs and Aboriginal Medical Services to increase registrations to deliver NDIS services. This will help build capacity for these organisations to transition to and operate as NDIS providers and, in turn, grow the Indigenous Australian NDIS market and workforce. The project will improve access to culturally appropriate support under the NDIS for Indigenous Australians with disabilities living in urban, regional and remote communities.