Australian Indigenous

Aboriginal and Torres Strait Islander Health Bulletin
An electronic publication from the Australian Indigenous HealthInfoNet
Issue 4, October 1998 : ISSN 1329-3362

Adams, L., & Mak, D. (1998).
A diagnosis in decline: Hib meningitis.
Kimberley Public Health Bulletin, 2-6.

This article outlines the case study of an Aboriginal baby with Haemophilus influenzae type b (Hib), causing meningitis. Adams and Mak state that 'up until the availability of an effective vaccine for Hib in the late 1980's Hib was the most common cause of meningitis children<7 years, and the definitive cause of epiglottis. Now after the implementation of widespread vaccination programs this infection is a rarity, being mostly confined to children less than one year of age.' The complications of Hib meningitis include seizures, Syndrome of Inappropriate ADH secretion and sensory-neural hearing loss. Disease control measures are outlined and include a working guide to the treatment of household or family contacts. National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Adams, M. (1998).
Men's health - a cultural perspective.
Aboriginal and Islander Health Worker Journal, 22(3), 7.

This article examines the changed roles of Aboriginal men from traditional leaders, decision makers, educators, father figures and land owners to men now uncertain of their place within their families and communities, due to the establishment of settlements and missions. This issue has been addressed at Indigenous men's health workshops through-out Australia, and a more culturally appropriate perspective of Aboriginal men's health is presented. According to Adams ' Indigenous men have looked at men's health as part of the holistic view of health from an Indigenous perspective. The nature of health takes in the whole aspects of life-death-life which include cultural, spiritual, emotional, social, mental and physical well-being of the community.'
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Alimankinni, G., Kelantumama, E., Puautjimi, E., & Wommatakimi, M. (1998).
The Nguiu Community, Bathurst Island, alcohol awareness and family recovery program.
Health Promotion Journal of Australia, 8 (1), 66-68.

Issue addressed: The program aims to reduce the harm to individuals and families caused by alcohol and other drug misuse.

Methods: The issue of alcohol abuse is addressed by the community with the involvement of those who have been affected by alcohol abuse and have made use of the treatment program and/or the 'sober village'.

Results: The community is responding positively to the program and the number of non-drinkers is increasing. Knowledge of the effects of alcohol is improving and the program has given new life to our people.

So what? The use of local community ideas and strategies submitted by the people do not cause the difficulties associated with trying to cope with unfamiliar situations. When the people work out things for themselves and use familiar strategies, the results seem to be more successful.
Health Promotion Journal of Australia abstract

Andrews, S., Austin, N., Clarke, A., Goodman, H., & Miller, J. (1998).
Promoting Koori children's health - An affirmative approach.
Health Promotion Journal of Australia, 8 (1), 29-33.

Issue Addressed: A Koori Hospital Liaison Officer was first appointed to the Royal Children's Hospital (RCH) (Melbourne) in 1984. Nine years later the liaison officer was still working in isolation within the hospital. While the work of the liaison officer was greatly appreciated by the Aboriginal community, there had been no apparent change in the hospital's responsiveness to the needs of Aboriginal people.

Methods: Changes in personnel and organisational structure at the hospital combined with the fortuitous appointment of a group of staff who were committed to doing better for Aboriginal families created an environment where change could occur. Unpredictable external events, such as the launch of the report of the Stolen Children Inquiry, 'Bringing Them Home', provided additional impetus to the work.

The work of the Aboriginal Liaison Unit and their Advisory Committee has focused on organisational change and promotion of the work externally as well as improving and expanding the support offered to families and communities. The overriding approach has been of partnership, particularly Aboriginal/non-Aboriginal, Hospital/Aboriginal community.

A major achievement was obtaining funding from the Victorian Health Promotion Foundation for a further two years of implementation of a new model of enhanced service which was in the process of development. This funding also covered evaluation of this expanded service approach and development of a best practice manual. This work is still in progress.

So what? There is not a cheap or easy answer to improving access of Aboriginal children to a mainstream hospital. We believe that given the history of Aboriginal people in our society very intensive support is needed if they are to get maximum benefit from the health system. A sole Aboriginal Liaison Officer cannot possibly fulfill the requirements. Aboriginal community organisations need to be invited into hospitals at a senior advisory level; liaison officers need to be auspiced by senior management if they are to be effective; and, in order to avoid 'band-aiding', organisational change is as important as individual service provision.
Health Promotion Journal of Australia abstract

Badenoch, R. (1998).
Primary health cares response to the treatment of chronic diarrhoea in Aboriginal children.
Australian Journal of Primary Health Interchange, 4(1), 58-65.

This paper explores the issue of chronic diarrhoea in Australian Aboriginal children from a primary health care perspective. It discusses the nature of the problem and factors that influence its perpetuation as a documented health issue for this population. A variety of primary health care solutions are suggested, including those in relation to basic sanitation, improvements to local environmental conditions, education, collaborative health care planning, resourcing implications and the empowerment of local communities.
Australian Journal of Primary Health abstract

Bartlett, B. (1998).
Aboriginal health.
New Doctor, 68 (Summer), 23-26.

This article explores the historical issues that have led to the current poor state of Aboriginal health. Bartlett examines the impact on Aboriginal society of white invasion, assimilation, dispossession of land, infectious diseases and the taking away of the children. Bartlett describes the phenomenon of dysfunctional individuals, families and communities as the 'grief-anger-despair cycle' that has developed since colonialism. The destructive cycle continues with lack of family and community cohesiveness leading to poor nutrition, child neglect, substance abuse, violence, and suicide.

An outline is provided of the development of a health care system for the Indigenous population over successive years. Bartlett has developed a 10-point plan to improve Aboriginal health status based on:

• Reconciliation based on acknowledgement of the grief and distress experienced;
• Cessation of all acts of dispossession;
• Allocation of resources at a level needed to make a difference;
• Development of comprehensive primary health care systems incorporating community-based clinical services management and education support, and special preventive programs driven by the community;
• Provision of appropriate community infrastructure including health hardware (shelter, water, waste disposal systems);
• Assurance of access to adequate nutritious food;
• Development of viable community economies;
• Implementation of an appropriate education strategy for children and adults;
• Support for community access to 'country' and cultural and sporting activities;
• Changes in the practices of incarceration of Aboriginal people.

National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Barton, M. (1998).
Quality of data on Aboriginal hospitalisation.
Aboriginal and Islander Health Worker Journal, 22(2), 10-11.

This article details a 1992 study undertaken at a major teaching hospital in South Australia looking at Aboriginal utilisation of and perceptions of health services. In the study, the data on Aboriginal hospitalisation were identified as being inaccurate and some of the main factors for this were detailed. These included reluctance of admitting staff to ask whether the patient was 'Caucasian', 'Aboriginal', 'Asian' or 'Other'. Barton concludes that, 'if all groups are reminded periodically of the need for an accurate picture of Aboriginal hospital usage, this has the potential to reduce the current levels of inaccuracies'.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Bowden, F., & Savage, J. (1998).
Is the eradication of donovanosis possible in Australia?
Australian and New Zealand Journal of Public Health, 22(1), 7-8.

This editorial outlines the need for on going vigilance in the fight against infectious diseases such as donavanosis in remote and isolated communities. The Commonwealth Government has undertaken a six-year program to eradicate donavanosis. Recent improvements in treatment has meant that patients are now able to have a seven day course of azithromycin 500mg daily or a 1.0g dose once a week for four weeks. This treatment, which is more convenient and flexible, has led to a rapid improvement in a patient's condition. In order to eradicate donavanosis a campaign will need to include:

• Support from affected communities through local Aboriginal Medical Services;
• Central coordination of a national program, endorsed by appropriate bodies;
• Local coordination run by suitably qualified health staff;
• Good educational programs and materials for health practitioners and the community;
• Standardised diagnosis, treatment and follow-up program;
• Freely available medication and diagnostics;
• Better epidemiological data to ensure the goals of the campaign are achieved;
• Ongoing research.

National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Brideson, T. (1998).
Mental health information - goes bush.
Aboriginal and Islander Health Worker Journal, 22(3), 8-10.

The 'Djirruwang' Aboriginal and Torres Strait Islander Mental Health Education and Training Program is involved in the setting up of the Mental Health Information for Rural and Remote Australia (MHIRRA) Project. The project aims to provide an Internet-based information resource and central data base on Indigenous mental health services. In addition, a service will be provided whereby rural and remote clinicians or professionals can immediately access information and mental health referral services. Brideson states that, 'by having an easily accessible data base, the opportunity exists for mental health services to more readily meet the specific needs of Aboriginal and Torres Strait Islander people seeking assistance and care'.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Burns, C., Clough, A., Currie, B., Thomsen, P., & Wuridjal, R. (1998).
Resource requirements to develop a large, remote Aboriginal health service.
Australian and New Zealand Journal of Public Health, 22(1), 133-38.

In 1994 the Commonwealth funded studies to establish and develop Aboriginal health services. One such study was undertaken in 1995 at Maningrida, Northern Territory: to identify the health-service needs of the population and consider community management structures; to identify Northern Territory expenditure for primary health care; and to provide a three- to five-year development budget. Approximately 2,100 Aboriginal residents in the region used the service, including 750 living on 24 outstations within 75 km. Nearly 40 per cent were aged under 15 years. Childhood morbidity was high, with children under two averaging 1.4 hospital admissions per year. The age pyramid reflected premature adult mortality from the third decade of life. Service providers identified inadequate staffing and infrastructure as barriers to service development. Community consultations emphasised the need for resident doctors, improved outstation services and aged and respite care, local training for Aboriginal health workers and housing for staff. These developments would require per capita primary health care expenditure ($872) to be doubled. Aboriginal people in remote areas are disadvantaged through Commonwealth Grants Commission funding formulae and lack of Medicare access. As the sole funding source, the Northern Territory spends over $1.83 million per year providing health services at Maningrida. Additionally, the study proposed that the Commonwealth spend $1.96 million a year over five years on staffing and infrastructure. Local Aboriginal organisations also agreed to allocate resources for health service development. Ineffective implementation, lack of clarification of government responsibilities and funding shortfalls remain barriers to developing remote Aboriginal health services.
Australian and New Zealand Journal of Public Health abstract

Busch, J. (1998).
Working together for better nutrition for Aboriginal people in Western NSW.
Aboriginal and Islander Health Worker Journal, 22(3), 15-18.

The poor nutritional health of the Indigenous population of New South Wales was discussed at an Aboriginal Nutritional Forum in 1996. The recommendations from this forum were to:

• Form an Aboriginal Nutrition Advisory Group;
• Train Aboriginal people as nutritional workers;
• Send representatives to the Northern Territory to observe the ' Strong Women, Strong Babies, Strong Culture' program;
• Develop and establish a general protocol for cultural awareness that can be implemented through health promotion and education;
• Extend the length and position of the Aboriginal Nutrition Project;

These recommendations were undertaken and a range of successful nutritional projects has been developed. Nutrition courses for Aboriginal Health Education Workers were conducted by the public health nutritionist with the Macquarie Area Health Service. Busch concludes that 'key ingredients to the success of the nutrition training have been the increased cultural awareness between Aboriginal and non-Aboriginal people, sharing of knowledge, stories and resources and direction by all involved.' National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Cahill-Miller, L., O'Donoghue, L., & Parfitt, D. (1998).
The Jabiru immunisation project.
Health Promotion Journal of Australia, 8 (1), 71-74.

Issue addressed: The Jabiru Immunisation Project aimed to ensure that the children were immunised against serious but preventable diseases by: informing mothers when their children were due for immunisation; increasing mothers' knowledge of the benefits of immunisation; and developing appropriate resources to further promote and educate people about the reasons for immunisation. The paper describes the process undertaken to plan, implement and evaluate the project.

Methods: The Aboriginal health worker worked with members of the community and local community organisations to design and implement a process to alert mothers to when their children were due to be immunised and educate people about the reasons for immunisation. Project planning was undertaken during a Health Promotion Workshop for Senior Aboriginal Health Workers and funding was obtained to expand the project and further develop resources.

Results: Mothers are now taking their children to the clinic to be immunised. People within the Jabiru community are now better informed about the importance of immunisation and the rate of immunisation in the community has increased.

So what? Immunisation is national issue currently and an issue high on the Northern Territory public health agenda and it should remain a focus for the community of Jabiru and outstations.
Health Promotion Journal of Australia abstract

Carnie, J., Randall, M., & Ng, M. (1998).
Tuberculosis. The old and the new
Australian Family Physician 27(7)615-8.

Background: The overall incidence of tuberculosis (TB) in the general Australian population is low and has been stable over the past 10 years. The incidence is, however, much higher in certain subgroups of the population and these include overseas-born people (especially from countries in Asia) and Aboriginal and Torres Strait Islander populations. Other groups regarded as at increased risk of TB are nursing home residents, the homeless, prison populations and immunosuppressed patients, especially those who are HIV positive.

Objective: Patients regarded as high risk should be investigated promptly if they present with signs or symptoms suggestive of TB.

Discussion: The best method of preventing the transmission of TB and preventing the emergence of drug resistant strains of the organism are by ensuring that sputum smear positive patients are isolated until non-infectious; that any patient with TB receives prompt and adequate treatment; that all patients with TB comply with a full course of treatment until cured: and that contact tracing is undertaken to detect newly infected patients so as to offer chemoprophylaxis and to detect previously unrecognised cases.
Australian Family Physician abstract

Coory, M. (1998).
Gestational-age-specific stillbirth risk among Australian Aborigines.
International Journal of Epidemiology, 27, 83-86.

This is the first study to compare the stillbirth risk of Australian Aboriginals and non-Aboriginals using the number of babies in utero rather than births at each gestational age. The author studied data from the Queensland Perinatal Data Collection covering six years from 1987-1992. The results showed that at full term there was little statistical difference between the risk of stillbirth for Indigenous and non-Indigenous women. 'When the number of babies in utero was used as the denominator, preterm Aborigines had a statistically significant three- to four-fold increase in the risk of stillbirth compared with non-Indigenous.' The author concluded that as there is a high risk of stillbirth for preterm Aboriginals, there should be further research to determine the reasons why.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

D'Antoine, H. (1998).
Health care and homelessness: the view from the Perth Aboriginal Medical Service.
Health Issues, 54 (March), 35-36.

This article explores the correlation between homelessness and poor Aboriginal health in the Aboriginal population attending the Perth Aboriginal Medical Service. D'Antoine states that, 'if families are given assistance with their social needs such as housing, then they are much more successful when dealing with their medical needs'. The AMS has been involved in assisting many Aboriginal families to find suitable long-term housing.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Daniels, A., & Castro, D. (1998).
Milikapiti Rubbish Removal Service and Beautification of the Health Centre.
Health Promotion Journal of Australia, 8 (1), 75-76.

Issue addressed: Milikapiti had a problem with the amount of rubbish lying around the community. The health centre was also experiencing overcrowding. An area where people could sit and wait for family in comfort was needed.
Methods: Two community projects were undertaken. Several meetings were organised with council members and the Community Development Education Program (CDEP) manager to discuss the removal of rubbish. Fliers were developed for community meetings to discuss rubbish collection and to promote it. The second project was implemented by the council using Health Promotion Incentive Funds to develop an outdoor area at the health centre.

Results: Outcomes achieved by the two projects are a cleaner, more attractive community and the provision of an area within the grounds of the health centre where people can wait for family.

So what? It may take one or two people to get things started, but after that everybody in the community gets involved. Community people are reluctant to become involved until they actually see something happening.
Health Promotion Journal of Australia abstract

Doctors Reform Society. (1998).
The DRS policies.
New Doctor, 68, 11-22.

This article provides a full-text copy of the Doctors Reform Society Policies, one of which includes an Aboriginal and Torres Strait Islander health policy. This policy covers support of community-controlled health organisations, and Indigenous involvement in all areas of health planning and health services.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Dunn, M. (1998).
Tampon testing - improving access to STD screening for women
Northern Territory Disease Control Bulletin, 5(2), 5-7.

The AIDS/STD Unit in Darwin, in collaboration with Menzies School of Health Research and Royal Women's Hospital in Melbourne, conducted a study in order to determine the accuracy and acceptability of using tampons as a method of specimen collection to test for STDs. The 'Tampon Study' involved both Indigenous and non-Indigenous women attending community health centres, STD clinics and family planning clinics.

Of the 480 women participating in the study, 84% preferred the self-administered tampon test to regular swab testing. Significantly the study showed that 76% of the Aboriginal women studied were already users of tampons. The results showed that tampon testing was more sensitive than conventional swab or urine tests.

The author concluded, 'we believe that the self-administered tampon technique represents a major advance in the diagnosis of STDs for women and provides us with a great tool for greatly improved management and hence control of STDs in our population'.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Ellis, R., & Campbell, D. (1997).
The Public Health Association 29th annual conference.
Aboriginal and Islander Health Worker Journal, 21(6), 6 - 11.

This article provides a summary of the presentations and workshops relevant to Indigenous health presented at the Public Health Association 29th annual conference in October 1997. Aboriginal health workers presented papers on effective projects and programs run in their communities.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Field, P. (1998).
Heart Foundation goes bush!!
The Chronicle: Bulletin of the chronic diseases network of the Northern Territory, 1(11), 8-9.

The National Heart Foundation has developed priorities and strategies aiming to decrease the rate of cardiovascular disease in rural and remote areas. This is particularly important as the number of deaths in these areas has not decreased as it has in urban centres. Field states that, 'to develop these strategies, the NHF is building networks with a range of community, educational, and government organisations, health professionals and research institutions.' The NHF has developed a model network of health professionals in South-Eastern New South Wales and aims to use this community-based approach in the rural and remote areas.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Gracey, M.(1998).
Substance misuse in Aboriginal Australians.
Addiction Biology, 3, 29-46.

Australia's Aborigines lived in isolation from the rest of humanity as successful hunter-gatherers for tens of thousands of years. That isolation ended abruptly with British colonisation in the late l8th century and was followed by a traumatic 200 years for Aborigines who are now seriously disadvantaged, socio-economically and in terms of their health standards. It has often been assumed that the Aborigines had no access to psychotropic substances before permanent European contact but several pieces of evidence dispute this view. The history of Aboriginal contact with and usage of intoxicating substances, including alcohol, is extremely complex and affected by a maze of restrictive government policies. These interact with a wide range of other Federal and State policies which have changed rapidly since the late 1960s when Aborigines were first granted the franchise; access to unrestricted drinking followed soon afterwards. Today Aborigines suffer disproportionately to other Australians from the physical and social consequences of excess alcohol consumption, tobacco usage, petrol and other solvent sniffing, usage of marijuana, amphetamines, cocaine and heroin, as well as other drugs. The Aboriginal population is dispersed in cities, towns, fringe settlements, rural and remote areas over this vast continent and there are different patterns of drug usage from place to place. This review attempts to synthesise some of this information in order to give an overview to the history, background, current status of substance misuse by Aborigines as well as some strategies being used to try to overcome this serious problem.
Addiction Biology abstract

Gray, D., Sputore, B., & Walker, J. (1998).
Evaluation of an Aboriginal health promotion program: A case study from Karalundi.
Health Promotion Journal of Australia, 8 (1), 24-28.

Issue addressed: This paper describes the evaluation of an Indigenous health promotion program in Western Australia aimed at enhancing self-esteem and reducing drug use among Aboriginal students.

Methods: The processes and outcomes were evaluated using qualitative data and a quantitative questionnaire developed for a similar project conducted among non-Indigenous students in New South Wales.

Results: The results were compromised by problems with the evaluation design, with the inappropriateness of the questionnaire, and because of the unsystematic nature of qualitative data collection. While the qualitative data suggest some positive outcomes of the program, on the basis of the data at hand it was not possible to formally demonstrate these.

Conclusions: While the results of the evaluation were inconclusive, this should not be interpreted as a failure of the program, but as a consequence of the design and implementation of the evaluation strategy. Through no fault of the community organisation which conducted the program, the evaluation methods employed were technically, culturally, and financially inappropriate.

So what? The problems raised are not unique to this particular program. They lay with the inadequate assessment of project and program proposals by funding agencies, and the lack of support provided to Aboriginal community-based organisations. We propose a number of steps that can be taken to address these problems and, in so doing, help to better identify strategies for promoting the health and well-being of Aboriginal people.
Health Promotion Journal of Australia abstract

Grant, M., Laird, S., & Cox, M. (1998).
Fifteen years of health promotion in Kimberley Aboriginal community-controlled health services.
Health Promotion Journal of Australia, 8 (1), 46-50.

Issue addressed: This paper describes the development of health promotion conducted by Kimberley Aboriginal community-controlled health services over a 15-year period.

Methods: A description of the environment out of which health promotion grew is provided and examination is made of innovative strategies used and why innovation has been sustained over a long period.

So what? Currently, a great challenge to health promotion is the balancing of ongoing appropriateness with sustainability.
Health Promotion Journal of Australia abstract

Hampton, C. (1998).
Evaluation of the 'Wise use of medicine' training promotions program by Tangentyere Council, Central Australian Aboriginal Congress and the Council on the Aging
Menzies School of Health Research Newsletter, 20 (April 1998), 9.

The 'Wise use of Medicine' training and promotion project is a joint initiative of the Tangentyere Council, Central Australian Aboriginal Congress and the Council on the Aging. The project aimed to work with Aboriginal health workers to address the difficulties many older people have with medicine use. These include safe storage, remembering to take multiple medicines, preparing daily doses of medicines and using dosette boxes. The evaluation of the project will monitor the process, dissemination and accessibility of the program within an Indigenous context.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Hanna, J., Brookes, D., Ritchie, S., & van den Hurk, A. (1998).
Malaria and its implications for public health in far North Queensland: a prospective study.
Australian and New Zealand Journal of Public Health, 22(2), 196-199.

This prospective study's objectives were to describe the features of all episodes of malaria diagnosed in Far North Queensland (excluding the Torres Strait) and to assess how much a threat they posed to the area's public health.

Over a three-year period, 216 episodes of malaria were diagnosed (158 Plasmodium vivax and 68 P. falciparum infections). Most (82%) of the infections were acquired in Papua New Guinea (PNG). Approximately 70% of the episodes occurred in Australian citizens, about half of whom were in malaria-endemic countries for work; the remainder traveled abroad for recreation. Three-quarters of the Australian citizens with malaria had taken either no or inadequate prophylaxis. Australian citizens who had taken adequate prophylaxis were much less likely to develop P. falciparum than other types of malaria compared with those who took either no or inadequate prophylaxis (p=0.01). Gametocytes were present in 121 (56%) of the episodes of malaria. Mosquito surveillance was carried out in response to 38 (31%) of these gametocytaemic episodes. Significant numbers of Anopheles farauti sensu lato mosquitoes were found close to the residence of a patient in 4 (11%) of these episodes. Only two occasions when local transmission could have possibly occurred were recognised. We do not believe malaria poses an important threat to the health of the public in Far North Queensland. Nevertheless, it remains an important problem for those who travel abroad to malarious areas.
Australian and New Zealand Journal of Public Health abstract

Hunter, E., Fagan, P., & Wilkes, T. (1998).
Bama Wadu Wadu Mara Mara - Young Aboriginal Men and Women.
Aboriginal and Islander Health Worker Journal, 22(2), 12-18.

This paper summarises the presentations made at the Pacific Rim Indigenous Adolescent Health Conference in Cooktown on November 8-10 1997. Papers presented covered topics such as sexual health, traditional Aboriginal sexuality, adolescent juvenile justice issues, leadership, family ways and mental health.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Hunter, E., & Garvey, D. (1998).
Indigenous mental health promotion: Mind over matter.
Health Promotion Journal of Australia, 8 (1), 4-11.

Issue addressed: The promotion of 'mental health' in Aboriginal and Torres Strait Islander populations.

Methods: The authors describe the development of 'mental health' as a field of inquiry and practice in Aboriginal and Torres Strait Islander populations. They proceed to explore the possibility of 'promoting' mental health within Indigenous populations which do not necessarily share mainstream understandings of mental health, and where persistent and pervasive social disadvantage is the major factor compromising emotional well-being.

Results: Ethical and practical considerations are raised and examples provided of ongoing projects that seek to enhance Indigenous social and emotional well-being.

Conclusions: Eliminating social injustice will surely promote Indigenous social and emotional well-being. However, measures that are more modest but attainable in the short term should not be deferred for want of such major social change.
Health Promotion Journal of Australia abstract

Jacobs, A., & Fowler, B. (1998).
Work shouldn't be this hard.
Aboriginal and Islander Health Worker Journal, 22(2), 26-27.

Indigenous workers employed by Aboriginal health corporations are suffering from an increasing rate of work-related stress and injury. The factors identified by Jacobs and Fowler for this are:

• The structure of Aboriginal corporations and its impact on workers' health;
• The need for better occupational safety and health management systems;
• Socio-cultural difficulties and their impact on workers' health.

In order to improve this situation corporations should be developing policies that address the occupational safety and health management rights and responsibilities of the employers and employees. It is also important for Aboriginal health workers to be identifying problems, planning interventions and evaluating occupational safety and health issues in the workplace.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

James, R., Routh, R., & Prowse, N. (1998).
Getting your stories published.
Health Promotion Journal of Australia, 8 (1), 79-80.

Aboriginal people and Torres Strait Islanders would like to share the results of their projects, stories of their lives, and biographies of notable leaders with the rest of the world by publishing in relevant journals. Many, however, do not feel confident about submitting material for publication because they have not been trained as writers. Traditionally, Aboriginal stories have been told orally.

The Editorial Board of the 'Health Promotion Journal of Australia' has an ongoing commitment to assisting Aboriginal people publish their stories in their own words. To help progress this goal, the authors of this article developed a three-hour workshop to discuss what makes a good story, topics worth writing about, the difference between talking a story and getting it published, and guidelines for getting published.

The initial workshop was conducted in Fremantle, Western Australia for a group of Aboriginal people with health, education and social welfare experience. We hope the workshop and this article will inspire Aboriginal health workers to write and submit their stories for publication.
Health Promotion Journal of Australia abstract

Johnston, F., Beecham, R., Dalgleish, P., Malpraburr, T., & Gamarania, G. (1998).
The Maningrida 'Be Smoke Free' Project.
Health Promotion Journal of Australia, 8 (1), 12-17.

Issue addressed: Aboriginal people in the Top End of the Northern Territory (NT) have among the highest rates of smoking in Australia and as a consequence suffer an enormous burden of ill-health. In spite of this, there is very little information about how many Aboriginal school children smoke, when and why they start, and what interventions help reduce the uptake of smoking. This project aimed to describe the current knowledge, attitudes and practices regarding tobacco use in school-aged children, and to develop and evaluate a culturally sensitive intervention that is readily adaptable to other remote Aboriginal communities of the Top End.

Methods: A two-week educational intervention was conducted in one of three participating remote Aboriginal communities in the Top End. Pre-and post-intervention questionnaires about current practices, knowledge and attitudes to smoking were administered by local staff in all three communities. The intervention included the launch and use by all students of a locally produced CD-ROM, classroom teaching of the NT tobacco curriculum, declaration of smoke-free education and health centres, prizes for Be Smoke Free songs and posters created by students, a Be Smoke Free concert featuring local rock bands, visits from well-known NT sporting personalities, and community educational displays. The CD-ROM was aimed at primary school students but designed to be adaptable to different languages, and to be accessible to all age groups, regardless of their level of literacy.

Results: The intervention met with considerable enthusiasm and community-wide support. Initially, a little more than 31 per cent of enrolled children were surveyed in the intervention community (A) and around 56 per cent in one control community (B). In the third community (C), only 24 children (9 per cent) were surveyed. There was a high uptake of smoking among schoolchildren in both communities A and B. The most common reasons given for smoking were 'liking it' and 'other kids'. The major reasons given for not smoking were either health-related or being 'too young'. Almost all the children lived with adult smokers and many were asked to light cigarettes for them. Most had a reasonable knowledge about the health effects of smoking and a greater proportion in both communities gave correct answers in the knowledge quiz in the second questionnaire. Our ability to interpret the changes in the results of the pre- and post-intervention questionnaires was limited by variable school attendance. The children enjoyed participating in the project. Using the CD-ROM was the most popular activity and has been subsequently well received in smoking education projects in the two non-intervention communities.

Conclusions: In spite of reasonable knowledge of adverse health effects, smoking cigarettes appeared to be perceived as an acceptable and expected part of being an adult. The use of school-based surveys alone to evaluate educational interventions is of limited value in remote communities where school attendance is variable.

So what? In spite of the high prevalence of smoking in Indigenous communities of the Top End there is interest, enthusiasm and potential for successful smoking prevention programs. This is important because smoking is a major but preventable cause of illness and death.
Health Promotion Journal of Australia abstract

King, R., & Smith, G. (1998).
The Northern Territory Aboriginal health promotion training program and incentive fund: Linking training and funding.
Health Promotion Journal of Australia, 8 (1), 40-42.

Issue addressed: The Aboriginal Health Promotion Principles and Practices Training Program aims to increase the knowledge of health promotion among Territory Health employees, while the Aboriginal Health Promotion Incentive Fund enables employees to use their knowledge. This translates to health promotion activity at community level.

Methods: The program offers quality training and professional support to participants. It also offers small grants to support the initiatives developed during the training.

Results: The Health Promotion Principles and Practices Training Program and the Aboriginal Health Promotion Principles and Practices Training Program have trained more than 200 employees of Territory Health Services. Of these, 46 participants were Indigenous people from a health-related field. The Incentive Fund has supported more than 40 projects, with many being sustained after the funding period.

So what? The training of Aboriginal health workers can be enhanced by making training programs culturally appropriate. Support from the incentive fund has enabled Aboriginal health workers to implement strategies learned at training programs.
Health Promotion Journal of Australia abstract

Kong, G. (1998).
Breast cancer and Aboriginal and Torres Strait Islander women - a national report.
Aboriginal and Islander Health Worker Journal, 22 (3), 3-5.

This article provides a summary of the Breast Cancer and Aboriginal and Torres Strait Islander Women - A National Report. The report produced by the National Breast Cancer Centre provides an overview of breast cancer and Indigenous women. Topics covered in the report are incidence and mortality, early detection, perceptions of Indigenous women about breast cancer, risk factors and recommendations for improving future care. Kong states that, 'it appears that Indigenous women are less likely than non-Indigenous women to participate in early detection programs. If this is the case, then Indigenous women may be less likely to have breast cancer found at an early stage, when treatment can be most successful and more options are available'.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Laws, R. A., & Fitzgerald, H. (1997).
Intercultural interactions in dietetic practice.
Australian Journal of Nutrition and Dietetics, 54(1), 34-39.

Culture, an important factor in interactions between dietitians and their clients, can affect the outcome of nutrition interventions. This paper provides an introductory examination of intercultural interactions in dietetic practice by reviewing some of the relevant literature and incorporating information obtained in interviews with practising dietitians. While various approaches to intercultural counseling have been discussed in the literature, there is an absence of widely available published research on the actual approaches and strategies currently being utilised by dietitians in practice. Furthermore, few studies have explored the actual cultural issues which frequently arise in dietetic counseling in multicultural settings. Finally, the level of understanding of dietitians in regard to cultural issues has only been superficially researched using quantitative questionnaires and not in-depth qualitative research methodology. Hence, there is considerable need and scope for research on intercultural interactions in dietetic practice.
Australian Journal of Nutrition and Dietetics abstract

Lehman, T., & Frances, R. (1998).
Victorian Aboriginal Health Service Co-operative Ltd injecting drug use project.
Health Promotion Journal of Australia, 8(1), 51-54.

Issue addressed: A study of injecting drug use in the Melbourne Aboriginal community was carried out by the Victorian Aboriginal Health Service Co-operative Ltd to document problems associated with the practice and to tap community views on appropriate strategies for prevention.

Methods: An action-research strategy was adopted with 32 injecting drug users and other community members, community workers and Aboriginal and non-Aboriginal service providers participating in unstructured interviews and small group discussions.

Results: Almost every family in the community had been touched in some way by injecting drug use. Most people who injected drugs were also dealing. The findings contradicted the commonly held belief that injecting drug use is a young person's pastime. In many cases, Aboriginal people were injecting drugs as a way of dealing with unhappiness in their lives. Community members' recommendations for dealing with the problems were compiled in a Community Report.

So what? The Victorian Aboriginal Health Service has convened a Working Party to determine priorities and seek appropriate sources of funding to implement the recommendations. The Melbourne Aboriginal community has suffered enormously because of the use of drugs of addiction and projects such as this are a critical part of the process of healing.
Health Promotion Journal of Australia abstract

Main, D., Talbot, L., Eltchelebi, W., & Pattison, S. (1998).
Using primary health-care philosophy to promote cross-cultural awareness for tertiary students studying Aboriginal health.
Health Promotion Journal of Australia, 8 (1), 34-39.

Issue addressed: The study program addressed improvements in cross-cultural awareness for tertiary students in regional Victoria to promote the health of Aboriginal Australians.

Methods: Implementation occurred by successful participation, collaboration and new partnerships formed with Koori people in northern Victoria and through a successful pilot program. The pilot was trialed in four Koori communities in Victoria, including Dja Dja Wurrung (Bendigo), Njernda Corporation (Echuca), Yorta Yorta (Barmah), and Latje Latje (Robinvale). The study program was then implemented using two-day intensive study blocks and a residential component with students staying in Yorta Yorta country and being taught by Elders and Aboriginal health workers.

Results: Process evaluation determined that while the overall response from the students, Elders, Aboriginal health workers, community representatives and staff who participated in the pilot and implemented the study program was positive, it also identified aspects of the program for further attention. Importantly, the strengths of the process and model were also identified.

Conclusions: By addressing historical and cultural awareness regarding Aboriginal health in a health education context, the study program has the potential to effect a range of responses by students/graduates/practitioners to promote the health of Aboriginal Australians. The process and model design formed the basis of a Primary Health Care Study Program conducted in a South Pacific nation, also with positive results for students, participation and partnerships.

So what? Health promotion practitioners and academics require information or study programs to improve cross-cultural awareness and best practice methods to address the overall tragic Aboriginal health status. Process evaluation of the Primary Health Care Study Program in Aboriginal Health provided insights into the barriers and enablers which could advance further implementation and/or modifications of this study program.
Health Promotion Journal of Australia abstract

Markey, P. (1998).
The effect of conjugate Hib vaccines on the incidence of invasive Hib disease in the NT.
Northern Territory Communicable Diseases Bulletin. 5 (1), 3.

This paper summarises the effect of the 1993 introduction of the Hib vaccines on the incidence of invasive Hib disease in the Northern Territory. Prior to the immunisation program there had been a high incidence of infection caused by invasive Haemophilus influenzae type b. The incidence in the Aboriginal population was over five times greater than for non-Aboriginals. Following the introduction of the vaccine program there was a decline of invasive Hib disease from 141/100,000 to 19/100,000 in children under five years. The number of cases of Aboriginal children with Hib disease fell from 84 to 9, while for non-Aboriginals the number dropped from 23 to 3. The program was considered to be effective and successful in reducing the incidence of invasive Hib disease.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Meiklejohn, B., & Parker, E. (1998).
Enhancing Aboriginal and Torres Strait Islanders health workers' knowledge and skills in health promotion, submission writing and project management.
Health Promotion Journal of Australia, 8 (1), 43-45.

Issue addressed: Enhancing the skills and capacities of Aboriginal and Torres Strait Islander health workers has been cited as important in enhancing the health status of Aboriginal and Torres Strait Islander Communities. This paper presents the results of a two-year program funded by Queensland Health to enhance the submission-writing skills of Aboriginal and Torres Strait Islander health workers in Queensland. Health workers attended two-day workshops which introduced them to health promotion program planning and project management principles. This knowledge was applied in practice during the workshop to develop submissions for funding for community health promotion projects addressing specific health needs in the health workers' communities.

Methods: A survey of 50 rural and urban health workers provided feedback on the design elements of the two-day workshops. A state-wide recruitment strategy was implemented. Ten workshops were conducted in rural, remote and regional centres. An action learning design was utilised, whereby participants worked on actual funding submissions for their specific community programs while learning health promotion content. A submission form from the Aboriginal and Torres Strait Islander Health Advancement Branch at Queensland Health guided the process. At the conclusion of the workshop, applications for funding were completed. Health workers were encouraged to work at their own pace and the emphasis was on understanding health promotion planning principles as the process for writing a successful submission. The submissions were competitively judged by Queensland Health staff using government funding criteria.

Results: Twenty-one grants, ranging from $5000 to $10,000, were funded for health promotion programs in Indigenous communities in Queensland. Subsequently, an Indigenous-scripted, acted and produced 15-minute video and educational package was developed by project staff and health workers in 1997. The video outlines the program planning steps in designing a funding submission and can be used as a self-paced education vehicle.

Conclusion: Innovative action learning outcomes concerning health promotion applications occurred as a result of the project, through collaborative partnerships with health workers, a university and the community. Projects of importance to communities were funded. An educational video resource sustained the project's aims to ensure wider distribution of health promotion knowledge and skills. Funding is being sought to disseminate and evaluate the video/education resource.

So what? This project was successful in demonstrating the need for skills training resources. A rigorous evaluation of the process of development of skills training resources, and evaluation of those resources, will ensure the quality of resources and assist dissemination of health promotion skills.
Health Promotion Journal of Australia abstract

Morgan, D. L., & Slade, M. D. (1997).
Aboriginal philosophy and its impact on health care outcomes.
Australian and New Zealand Journal of Public Health, 21(6), 597-601.

Philosophical perspective is an important factor influencing the health and health care outcomes of Aboriginal Australians. To date, the nature of the Aboriginal perspective and its differences from mainstream European thinking have been poorly understood. The negative impact that this has on the health and health care of Aboriginal people has been seriously neglected. We outline some of the important features of the philosophical perspective of Aboriginal Australians. We suggest ways in which the recognition of these views can inform changes in treatment settings and methods that can contribute to improvements in the health care outcomes of Aboriginal Australians.
Australian and New Zealand Journal of Public Health abstract

Paul, D. (1998).
'It's not as easy as just walking in the door': interpretations of Indigenous people's access to health care.
Australian Journal of Primary Health Interchange, 4 (1), 66-71.

Discussion about the on-going poor health status of Aboriginal and Torres Strait Island peoples in Australia needs to be better informed about both history and the nature of health determining factors. Access is one of many factors of importance in health seeking behaviour. This paper explores how the cultural appropriateness of health care services is a determinant of whether they are accessed or not. Contemporary attitudes, and their historical roots, are key issues which need to be addressed by health care providers and services. The onus is on health care providers to be informed and to act appropriately in all their interactions with health care consumers. The Royal Commission into Aboriginal Deaths in Custody provides some useful suggestions for improving the quality of health care services.
Australian Journal of Primary Health Interchange abstract

Peach, H. G., Pearce, D. G., & Farish, S. J. (1998).
Age-standardised mortality and proportional mortality analyses of Aboriginal and non-Aboriginal deaths in metropolitan, rural and remote areas.
Australian Journal of Rural Health, 6, 36-41.

The study's aim was to assess how much of the variation in disease-specific mortality between metropolitan, rural and remote areas is specific to those diseases or reflects the all-cause mortality pattern. The ranges and variances of disease-specific standardised proportional mortality ratios between geographical areas were compared to those of the corresponding standardised mortality ratios. For most chapters in the International Classification of Diseases, the ranges and variances of the standardised proportional mortality ratios were less than 40% of those of the corresponding standardised mortality ratios. Only a small proportion of the variation in mortality can therefore be attributed to a specific disease component; the remainder must be attributed to an underlying force of mortality. Research, programs and policies addressing the socio-economic disadvantages of living in remote areas may lead to a greater improvement in mortality than those targeting specific diseases.
Australian Journal of Rural Health abstract

Pretty, G., Henneberg, M., Lambert, K., & Prokopec, M. (1998)
Trends in stature in the South Australian Aboriginal Murraylands
American Journal of Physical Anthropology. 106 (4):505-14.

Millennial and secular changes in body height of prehistoric and recent Aboriginal South Australians are investigated. Skeletal remains of 55 male and 40 female individuals who were excavated at Roonka on the River Murray were dated from 9800 to 100 years BP. Stature was reconstructed by using humerus, femur, and tibia ratios to stature derived from Abbie's (1975) data on living Aborigines and the Trotter-Gleser method for African Americans. The respective averages were 1,652 mm and 1,665 mm for males and 1,527 mm and 1,549 mm for females. In 1996-1997, statures of 27 adult males and 21 adult females were measured in Aboriginal centers of Gerard and Raukkan (Point McLeay) on the Lower River Murray. These people, as far as it can be ascertained, are the descendants of the people from Roonka. Their statures were adjusted for the stature loss with age, so that the data represent young individuals (< = 30 years of age). The average male stature was 1,712 mm, and the average female stature was 1,567 mm. Data collected by Wood Jones and Campbell in 1924 for Aboriginal South Australians show that young adult male stature was 1,668 mm (n=6), and female stature was 1,552 mm (n=4). Slopes of regressions of individual statures on radiocarbon dates and on dates of birth are not significantly different from zero. The same is true for regressions of individual long bone lengths on radiocarbon dates. It can be concluded that there was little change in stature of Aboriginal South Australians from prehistoric to recent times. Regressions of individual age-corrected heights on birth dates (1860-1980) of Aboriginal men and women measured in 1924 and in 1996 further indicate no significant increase in height in either sex.
American Journal of Physical Anthropology abstract

Reath, J. (1998).
Working in Aboriginal controlled community health services.
Australian Family Physician, 27(3), 133-134.

Working in a range of community-controlled Aboriginal health services has provided the author with a first hand insight to the appalling state of Aboriginal health. Reath uses these experiences to support her examination of relevant issues in health care delivery in Aboriginal communities. The issues discussed are patterns of illness, the positive 'spirit' of Aboriginal communities, and the continuing confrontation with mainstream attitudes and institutions.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Rodgers, K., Willis, D., & Thomas, R. (1998).
Environmental factors influencing Aboriginal nutrition in Western New South Wales.
Health Promotion Journal of Australia, 8 (1), 18-23.

Issue addressed: As part of a project addressing the nutritional health of Aboriginal people in western New South Wales (NSW), various environmental issues which may influence food habits were researched. Environmental issues researched included the extent and type of external advertising, food price and availability and take-away food outlets.

Methods: Four communities in western NSW participated in the study. The number, type and size dimensions were observed for all external advertising within the participating towns. The managers of take-away food outlets within the participating towns were interviewed in relation to attitudes to adopting healthier food alternatives, food preparation practices and food marketing. The price and availability of food in the participating communities were recorded and compared to Woolworths in a larger regional centre.

Results: Approximately 90 per cent of advertising focuses on unhealthy food options such as alcohol, soft drinks, take-away foods and ice-cream. The majority of take-away food shops do not wish to introduce healthier foods to their menus. The range of average prices for the selected food products was higher than those offered by a national food chain.

So what? Recommendations have been formulated for each of these areas to improve the nutritional status of Aboriginal people living in western NSW. Those recommendations complement the work of the Aboriginal Nutrition Project.
Health Promotion Journal of Australia abstract

Saek, L., & Lowe, J. (1998).
Writing to be read: Publishing the results of health promotion activities.
Health Promotion Journal of Australia, 8 (1), 77-79.

Issue addressed: Indigenous and non-Indigenous health promoters have shown an interest in being provided with guidance on how to write for publication. This article addresses the questions most asked by authors, and provides tips authors have found most useful.

Methods: The development of writing skills is outlined and information provided to assist an author's progress through the publication process. Writing requirements are presented with recommendations on how to achieve the desired writing outcomes.

So what? The process of writing for publication can be rewarding. Just as for a multitude of other tasks within our work environment, writing for publication can be assisted by developing a set of skills and knowledge.
Health Promotion Journal of Australia abstract

Savage, J. (1998).
Update on HIV and hepatitis C virus in the Northern Territory.
Northern Territory Communicable Diseases Bulletin, 5(1), 7.

This article provides an update on HIV and hepatitis C virus in the Northern Territory. Since recording began in 1985, there have been 100 notifications of HIV infection in the Territory. All 12 Aboriginal cases have been notified since1991. The overall proportion of Aboriginal cases (12%) suggests a much lower rate among Aboriginal than non-Aboriginal people, which is different to the situation elsewhere in the country (where Aboriginal and non-Aboriginal rates are similar). The author notes that the trend of notifications since 1991 raises concerns that the NT situation may be approaching the national pattern of roughly similar rates for Aboriginal and non-Aboriginal people.

Hepatitis C virus (HCV) is one of the most commonly notified viruses in the Northern Territory. Since testing began in 1991 there have been 1,493 cases of HCV. Of the 343 cases notified in 1997, Indigenous status was recorded as non-Aboriginal in 208 cases (60.6%), Aboriginal in 11 cases (3.2%) and was not recorded in 124 cases. (36.2%). The author notes that the missing data makes it difficult to comment on the risk factors for HCV in Aboriginal people.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Skull, A., Krause, V., Morris, P., Leach, A., Yonovitz, A., Selby-James, T., Anand, A., Scott, J., Reid, S., Scott, P., & Roberts, L. (1998).
The Child Care Ear Project.
The Chronicle: Bulletin of the chronic diseases network of the Northern Territory, (11), 7.

A prospective cohort study of young children was conducted in Darwin to develop information on the incidence of otitis media in child care centres. These data would then be used to ascertain the burden and costs to the community of otitis media and to approximate the costs of a vaccine against the most commonly causative organism, Streptococcus pneumoniae.

The early results of the study showed:

• There is a high prevalence of otitis media in children attending child care (47%);
• The S.pneumoniae carriage rates are high and there is a high prevalence of S.pneumoniae resistance;
• Otitis media and other infections are a considerable burden to families as 17% of families had taken time off work or study, and 25% of children had visited a doctor in the fortnight of study.

National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Smith, G., & King, R. (1998).
Well men's checkups - A program of the East Arnhem Health Promotion Unit.
Health Promotion Journal of Australia, 8 (1), 69-71.

Issue addressed: Men, especially Aboriginal men, rarely go to the health centre when they are sick, let alone when they are healthy. Providing health education to groups of young men can also be a difficult exercise.

Method: The Nhulunbuy health promotion team developed a well men's checkup strategy which was implemented in east Arnhem Land. The checkups aimed to raise awareness of health issues and encourage lifestyle changes to improve health.

So what? Making health promotion strategies relevant and taking them to where men already meet are ways of improving the health behaviour of Aboriginal men.
Health Promotion Journal of Australia abstract

Thomas, D., Heller, R., & Hunt, J. (1998).
Clinical consultations in an Aboriginal community-controlled health service: a comparison with general practice.
Australian and New Zealand Journal of Public Health, 22(1), 86-91.

Clinical consultations at Danila Dilba, an Aboriginal community-controlled health service in Darwin, were compared with consultations in Australian general practice. We described 583 consultations, using a questionnaire based on the International Classification of Primary Care. The methods were similar to those of the Australian Morbidity and Treatment Survey (AMTS) of consultations in Australian general practice undertaken by the University of Sydney Family Medicine Research Unit. Compared with Australian general practice consultations, consultations with Danila Dilba were more complex: more young patients, more new patients, more home visits, more problems managed, more new problems and more consultations leading to emergency hospital admission. Skin infections, diabetes mellitus, chronic alcohol abuse, rheumatic heart disease (or rheumatic fever) and chronic suppurative otitis media were much more commonly managed at study consultations at Danila Dilba than at consultations with general practitioners in the AMTS. Nearly all patients saw an Aboriginal health worker first, and nearly half the consultations were with Aboriginal health workers alone. The results suggest possible limitations of fee-for-item Medicare funding of Aboriginal community-controlled health services compared with existing block grant funding
Australian and New Zealand Journal of Public Health abstract

Walley, C., & Sullivan, D. (1998).
The Western Australian Aboriginal smoking project.
Health Promotion Journal of Australia, 8 (1), 55-58.

Issue addressed: Tobacco is a significant cause of disease and premature death among Aboriginal people. While it is acknowledged that major improvements are required in all aspects of Aboriginal health status in Western Australia, significant health gains can be made in terms of reduced morbidity and mortality by reducing the prevalence of smoking among Aboriginal people.

Methods: In 1994, the Aboriginal Smoking Project was implemented by the Smoking and Health Program, Health Department of Western Australia. Strategies and resources developed to date include Quit newsletters, a resource manual, and seminars on smoking and health issues for Aboriginal health workers; radio and television advertising, targeting adult Aboriginal smokers; posters and swap cards promoting a smoke-free lifestyle through the use of high-profile Aboriginal sporting role models; and support for state and national programs. Awareness of the harmful effects of tobacco on health among Aboriginal communities is low. As a consequence, the primary focus of the project so far has been on Aboriginal health workers. The short-term aims of the project are to raise awareness among Aboriginal health workers throughout the state of the harmful effects of smoking and to assist and support them in the development of interventions at a local level.

Results: While a range of strategies and resources have been developed and implemented in collaboration with Aboriginal health workers and health agencies, it has been difficult to evaluate their effectiveness other than by anecdotal feedback. Furthermore, the implementation of sustainable community programs in support of tobacco control has yet to be achieved. While there is growing interest in smoking and health issues among Aboriginal health workers and agencies, lack of education and training, resource support and wider community involvement continue to present barriers.

Conclusion: Sustained, collaborative effort, and the support and involvement of Aboriginal community leaders, is vital to achieving a reduction in the prevalence and harm caused by tobacco in Aboriginal communities.

So what? Tobacco use is the most preventable cause of disease in developed countries. Reductions in the prevalence and harm caused by tobacco use among Aboriginal communities is a major health promotion challenge.
Health Promotion Journal of Australia abstract

Weeramanthri, T. (1998).
The chronic diseases strategy.
The Chronicle :Bulletin of the chronic diseases network of the Northern Territory, 1(12), 2.

The chronic diseases strategy of the Northern Territory Health service aims to reduce within 10 years the prevalence and impact of diseases such as diabetes, high blood pressure, renal disease, ischaemic heart disease and chronic respiratory disease. Early risk factors for these conditions include low birth weight, malnutrition, repeated childhood infections and later, weight gain, poor diet, and lack of exercise. According to the author, 'the CCDS sees the diseases and their underlying factors as potentially preventable, but interventions are needed well before the late disease stages appear. Primary prevention, early detection and best practice management will lead to fewer adverse health outcomes'.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Weeramanthri, T. (1998).
Practice guidelines for health professionals dealing with death in the Northern Territory Aboriginal Australian population.
Mortality, 3 (2) 161-172.

This article summarises the content of recently published guidelines for health professionals dealing with the Northern Territory Aboriginal Australian population. An account is given of the stimulus for the guidelines, the applied research context (the Adult Aboriginal Mortality Project) in which guidelines were developed, and their initial reception by service providers. The guidelines deal with the time of death and afterwards, when the practical, communicative and cross-cultural challenges that health professionals face are intimately connected. It is argued that, from a mental health perspective, what happens after death is as important as what happens before. The relationship of the guidelines to the other areas of research carried out in the five-year period over which the Mortality Project was conducted is described. A case scenario is also presented to illustrate the real-life difficulties addressed by these guidelines. The potential for local guideline development to improve communicative practice around death in other settings and situations (both national and international) is highlighted.
Mortality abstract 

Wiseman, V., & Nona, P. (1998).
Setting health care priorities of Badu Island.
Aboriginal and Islander Health Worker Journal, 22(2), 21-22.

Badu Island in the Torres Strait is developing a community health strategy in collaboration with the Torres Strait District Health Service. The aim is to determine how health service resources can be utilised to improve the health of the Badu community. The project team state that it is essential to involve the local community in all stages of planning, process and on-going control of the project. This planning builds on background from the 'Primary Health Care Model' that has been developed by the Torres Strait District Health Service which encourages community participation in health services.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Woods, B., Cambell, C., Miller, M., & Lilburne, A. (1998).
Aboriginal food and nutrition policy for Western Australia.
Health Promotion Journal of Australia, 8 (1), 64-65.

Issue addressed: Diet-related diseases are the major cause of illness and death among Aboriginal adults. Under-nutrition commonly affects Aboriginal children.

Methods: This article describes how a draft policy was developed following consultations with stakeholders to address the nutrition of Aboriginal people.

So what? The draft Aboriginal Food and Nutrition Policy for Western Australia has been released for comment.
Health Promotion Journal of Australia abstract

Woods, B., Campbell, C., Miller, M., & Thompson, C. (1998).
'Eat healthy tucker' Aboriginal training workshops.
Health Promotion Journal of Australia, 8(1), 62-63.

Issue addressed: The high rate of diet-related diseases among Aboriginal people can be addressed by promoting healthy eating habits.

Methods: The Eat Healthy Tucker Project was conducted to provide a community-based nutrition program that trains health workers, health professionals and key Aboriginal community groups working in the area of Aboriginal nutrition.

So what? A training manual and workshops have been developed and further work on Aboriginal nutrition in Western Australia has been recommended.
Health Promotion Journal of Australia abstract

Woollard, K. (1998).
Support for Indigenous health must not wane.
Australian Medicine, 10 (6).

Dr Keith Woolard, President of the Australian Medical Association (AMA) describes his tour of Northern Australia with Dr Ngiare Brown, the AMA's Indigenous health advisor. According to Dr Woolard, 'the visit provided an opportunity to gain an insight into the unique problems of Territory health, for both the Indigenous and non-Indigenous populations, to gather information and experience in remote communities, and to reinforce the commitment of the AMA to its members and the health of Aboriginal and Torres Strait Islanders.' The AMA is involved also in addressing the need for more doctors to work in remote communities by its joint representation with RDAA in a report on 'Increasing Rural Medical Services'.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Young, D. (1998).
Successful strategies for an adult immunisation program.
Health Promotion Journal of Australia, 8 (1), 69-61.

Issue addressed: Respiratory disease is a leading cause of mortality and morbidity in Aboriginal and Torres Strait Islander adults. In Queensland, for example, respiratory diseases follow circulatory diseases as the second most frequent cause of excess mortality in Aboriginal and Torres Strait Islander adults aged 40 to 60 years. In far north Queensland, Indigenous adults have a four-fold greater hospitalisation rate from respiratory diseases than non-Indigenous adults.

Methods: A health promotion program was undertaken in far north Queensland to increase awareness of, and uptake of, respiratory vaccines in Aboriginal and Torres Strait Islander adults. Culturally appropriate resources were developed for the program and focus tested in rural, remote and urban communities. A staff education/in-service session was developed which clarified 'at risk' groups and provided an example of each category. This paper discusses a range of strategies utilised to promote the program.

Results: The 1996 pilot program and 1997 program resulted in approximately 5,000 Aboriginal and Torres Strait Islander adults 'at risk' of pneumococcal infection being immunised. The National Health and Medical Research Council (NHMRC) recommend yearly vaccination for influenza and five-yearly vaccination for pneumonia and the program will be ongoing to offer 'at risk' adults immunisation.

Conclusions: The program reached the target group of 'at risk' adults and used a mix of strategies to achieve it. The program needs to be a priority in health districts to attract the necessary resources and to be sustainable.

So what? Community members now have a greater awareness of pneumonia and immunisation. Personal skills were developed during the program for Aboriginal health workers and they have the knowledge and support to coordinate the program in the future. The program gave many organisations which usually work in isolation the opportunity to work together.
Health Promotion Journal of Australia abstract  

Last updated: 14 August, 2003