Research Strength: Indigenous Health

See also:

Introduction Staff involved Research and evaluation Translational research and capacity building Teaching Service and committees Advocacy Key events in 2008 Selected Indigenous Health Publications 2007-2009 Indigenous Health Research Brochure

Indigenous Health in Australia For post-graduate students of medicine, forensic mental health and the health sciences, Muru Marri Indigenous Health Unit delivers a 6UOC course PHCM9630 "Indigenous Health in Australia". This course focuses on four broad themes related to Indigenous health: 1. Past and contemporary contexts 2. Primary health care and health promotion 3. Research and ethics 4. Advocacy and activism. Online Handbook Link

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Introduction

Improving the health and well-being of Aboriginal and Torres Strait Islander peoples across the lifespan ...

Muru Marri Indigenous Health Unit is a dedicated Indigenous health research Unit, which resides within the School of Public Health and Community Medicine. Indigenous health is identified as a research strength of the School.

Launched in 2004, Muru Marri is a visible, active contributor to the health and well-being of Aboriginal and Torres Strait Islander peoples through research and intervention projects – particularly for urban-dwelling populations – as well as in the area of teaching, community service, publication, representation on peak bodies, and advocacy.

Alongside Muru Marri are a range of UNSW partners, including colleagues in Nura Gili Indigenous Programs, Centre for Health Equity Training Research and Evaluation, Centre for Primary Health Care and Equity, National Drug and Alcohol Research Centre, the Rural Clinical School, the Indigenous Law Centre, the Indigenous Policy and Dialogue Research Unit , the Prince of Wales Medical Research Institute, and Shalom College. Significant growth has also occurred in our collaborations with critical friends beyond UNSW and partners within the community.

To Aboriginal people, health is defined as a positive concept, much more than just the absence of disease. Ill-health can be a manifestation of many things, including spiritual and emotional alienation from Land and Country, family and culture. Land and Country are central to Aboriginal people’s identity and spiritual beliefs, as is connection to family and community. Much of what we see today in the health and social inequalities now widely referred to as "the Gap" can be attributed to a lack of healing from the profound alienation experienced by Australia's First Peoples through and since colonisation.

This concept of health and well-being forms the core of Muru Marri’s work.

Well-being was also significantly highlighted by the inaugural Parliamentary Welcome to Country that took place on February 12, 2008, which took place the day before the National Apology to Aboriginal and Torres Strait Islander peoples – particularly the Stolen Generations – the first order of business for the 42nd Parliament of Australia. Both events heralded far-reaching changes in national Indigenous policy towards achieving equality in health and well-being, and in the approach towards achieving this we will take as a nation. They also make way for a transformation in belonging for all Australians, and of the many way obligations and responsibilities that draw from this.

Muru Marri contributes to the healing and the health and well-being of Aboriginal and Torres Strait Islander peoples through:

1. Research and evaluation
2. Translational research and capacity building
3. Teaching
4. Service and committees
5. Advocacy

Research and evaluation

Projects that are currently underway in the MMIHU are highlighted below. For more information go to Muru Marri's Current Projects.

What is the burden of dementia in urban dwelling Indigenous Australians?

Research team: Broe GA, Jackson Pulver LR, Chalkey S, Flicker L, Grayson D and KGOWS Team.
Working in partnership and collaboration with a number of Aboriginal communities and organisations, this project, also known at the Koori Growing Old Well Study (KGOWS), is asking a number of questions of Aboriginal people living in NSW who are aged 45 years and over: What proportion of Aboriginal people has a dementia? What types of dementia occur amongst Aboriginal people? How is cognitive impairment, leading to dementia, best measured in Aboriginal communities? What is the meaning of ‘dementia’ for Aboriginal people themselves? How is dementia best measured in Aboriginal communities? What are the causes of dementia in Aboriginal communities? What problems does dementia cause? How are people with dementia cared for in the communities? What is the burden of dementia for the carers? This research aims to establish a longitudinal study of Aboriginal health and ageing covering urban and regional/rural contexts. A number of other projects are developing from this and it is hoped that we will (1) establish basic care needs and support systems for ageing and disability and (2) determine longitudinal factors for successful and less successful cognitive ageing with an emphasis on educational and social factors.

The Gudaga Project: Understanding the health, development and service use of Aboriginal children in an urban environment

Research team: Comino E, Harris E, Jackson Pulver L, Harris M, Smith P, Kong K, Kemp L.

The Gudaga Project - a five year NHMRC funded project - follows a birth cohort of Aboriginal children from birth to 5 years in order to describe their health, development and service (health and children's) use. It is the first study of its kind in Eastern Australia, and is based at the Centre for Primary Health Care and Equity. The research team are working closely with stakeholders in Aboriginal health care including the local Aboriginal community to implement the research. The outcomes of the study will contribute to understanding of the health and other needs of Aboriginal children in an urban Aboriginal community. A paper discussing the project's themes and values with regard to cultural and ethical appropriateness is forthcoming.

Empowerment of consumers, carers and communities support people with mental illness in Indigenous communities

Research team: Haswell M, Hunter E, Tsey K, Cadet-James Y, and Kavanagh D. Funded through a 5-Year Priority Driven Research Grant of the Australian Health Ministers Advisory Council (2005-2010).

This project involves a mental health research partnership that is underpinned by empowerment principles and seeks to foster strength among community organisations to support better outcomes for consumers, families and communities. It uses a four pronged approach that was developed in a pilot study and is now being addressed in a research-based implementation phase:

• Gaining two-way understanding of perspectives on mental health and promoting universal awareness;
• Supporting the empowerment of carers, families, consumers and at-risk groups through existing community organizations to gain greater understanding and control of their situation;
• Developing pathways of care at the primary health centre level to enable support of social and emotional well being as well as more integrated mental health care.
• Accessing data to enable an ongoing process of analysis/sharing/planning and monitoring to inform future activity.

One of the key learnings to emerge in this project so far is that empowerment through partnership becomes possible when there is a concerted effort to strengthen grassroots community organisations, such as social health teams and Men’s and Women’s groups, that can engage local people in an action orientation.

Enhancing the capacity of Primary Health Care Services to implement and evaluate pathways and tools to support social and emotional well-being and mental health services

Project 1: Review of social and emotional well-being and mental health services for the Many Rivers Aboriginal Medical Service Alliance (MRAMSA)

Research team: Jackson Pulver L, Blignault I, Scott M in collaboration with MRMSA.
The aim of this review is to better equip MRAMSA members to meet the social emotional well being and mental health needs of their service communities located in northern NSW. This work builds on previous work that Muru Marri has done with Aboriginal Community-Controlled Health Services and Stolen Generations Groups, including evaluation of the Graniators Support Group at Pius X Aboriginal Corporation in Moree and academic support to the Bringing Them Home Forum.

Project 2: Implementation of the “Protocols for the Delivery of Social and Emotional Wellbeing and Mental Health Services in Indigenous Communities”

Working together with government, community-controlled and non-government service providers, we have developed a document that aims to facilitate nine improvements in service delivery and capacity in the area of wellbeing and mental health support. This includes guidelines for assessment, evidence-based clinical protocols for clinicians, health workers, carers and consumers that were adapted from the Royal Australia and New Zealand College of Psychiatrists It has attracted attention across the country and is being taken into training and delivery processes in many settings and services. Research is being conducted alongside the implementation of the Protocols in selected sites to enable monitoring, evaluation and continual improvement.

Evaluation of the 'Filling the Gap' Indigenous Dental Program

Research Team: Jackson Pulver LR, Fitzpatrick S, Ritchie J, Norrie M with Kennedy G & Windt U

'Filling the Gap' enables the provision of services by qualified dental practitioners who volunteer to provide oral health and dental services to clients of Wuchopperen Health Service in Cairns, Queensland. This evaluation sought to ascertain the worth or value of the program, which has been running for two years, to all parties involved, and to examine barriers and enablers to the program's provision as well as its sustainability. A recent PowerPoint of the evaluation delivered at the 2009 ADA Conference in Perth can be downloaded here. Large file warning.

Translational research and capacity building

Teaching

"Indigenous Health in Australia" (PHCM9630) is offered as an elective course in the School of Public Health and Community Medicine's Master of Public Health Program. This course aims has four areas of focus: (1) investigating successive government policy and its instrumental role in exacerbating and maintaining the ongoing and inequitable burden of illhealth experienced by Indigenous Australians; (2) health promotion and primary health care—exploring Indigenous perceptions of wellbeing and health approaches that call for more comprehensive and holistic views of healthcare; (3) investigating research into Indigenous health issues in a range of contexts; and (4) examining advocacy and activism and their critical contribution to the development of better living environments and more appropriate health services for Indigenous families and communities.

Since 2009, Muru Marri has delivered the Indigenous component of the NSW Health's Public Health Officer Training Program (PHOTP) , as part of the academic partnership with NSW Health and the School of Public Health and Community Medicine.

A robust body of research is supported by the Unit through the supervision of post-graduate students undertaking PhD and Masters programs at both UNSW and a number of other institutions. Muru Marri's Director delivers regular guest lectures to UNSW Faculty of Medicine students and to students of the School's Master of Public Health "Introduction to Public Health", She also contributes to numerous other courses both on and off the campus, including at the University of Sydney, Macquarie University and Randwick TAFE.

Students

Rachelle Arkles
Rachelle Arkles is a researcher with Muru Marri and the Prince of Wales Medical Research Unit. Formerly with the School of Public Health and Community Medicine, Rachelle has conducted research into global health workforce flows; international medical graduates, including their deployment in Aboriginal Community Controlled Health Services; and the areas of rural medical students; particularly the recruitment and retention of Indigenous students for careers in medicine and health. Rachelle is currently working on a three year NHMRC funded project grant addressing the burden of dementia in urban dwelling Indigenous Australians (see above) and she enrolled in the UNSW PhD program in Semester 1, 2009.

Service and committees

– Professor Lisa Jackson Pulver
Muru Marris’ director, Professor Jackson Pulver, is a member of several national fora, including the Aboriginal and Torres Strait Islander Health and Research Advisory Committee of the NHMRC, the National Advisory Group Aboriginal & Torres Strait Islander Health Information & Data (NAGATSIHID) and Leaders in Indigenous Medical Education (LIME) amongst others. She also participates in a number of key international committees including the International Group for Indigenous Health Measurement, and the International Network of Indigenous Health Knowledge and Development. Professor Jackson Pulver is also a Board Member of the 'Filling the Gap' Indigenous Dental Program.

– Associate Professor Melissa Haswell
Associate Professor Melissa Haswell is a member of the Australian Public Health Association and Special Interest Groups in Indigenous, Environmental and Mental Health. She is a Co-Leader of the Empowerment Research Program (ERP) and a member of the Family Wellbeing Network. She participates in a number of advisory and working groups for research projects addressing areas such as prison health, social and emotional wellbeing, Remote Area adult and youth Mental Health services, and in the Assessing Cost Effectiveness Prevention Project.

– Associate Professor Jan Ritchie
Professor Ritchie serves as Regional Director, South Western Pacific Region, of the International Union for Health Promotion and Education (IUHPE). She was a recent President of the Austrlaian Health promotion Association recently awarded a Life Membership of this Association in recognition of her contribution to the profession.

– Sally Fitzpatrick
Sally Fitzpatrick is currently Secretary of the national rights advocacy organisation, Australians for Native Title and Reconciliation (ANTaR). She has also played leadership roles on various NSW reconciliation organisations. Sally is also a member of the Bringing Them Home Working Group, working with the Minister for Families, Housing, Community Services and Indigenous Affairs to achieve justice for the Stolen Generations. Sally is also a Board Member of the 'Filling the Gap' Indigenous Dental Program and a number of other NSW-based NGOs.

Advocacy

Scholarships

Muru Marri has played a key role in the establishment of number of UNSW scholarships, including the Shalom Gamarada Residential Scholarship for Indigenous medical students.

Indigenous policy reform

The Unit contributes advice to the national campaign to Close the Gap in life expectancy between Indigenous and non-Indigenous Australians, particularly in the areas of Indigenous workforce development and Indigenous data issues, and more broadly through all of its reseach, teaching and service activities.

Capacity building

Through our work on the 'Filling the Gap' Indigenous Dental Program, Muru Marri has been able to contribute to the national debate on Indigeous oral health and improve access to culturally appropriate dental services.

From 2007 until April 2009, Muru Marri worked in partnership with others including OATSIH and the AH&MRC to support the capacity development of the NSW Bringing Them Home Counsellors Consultative Group.

More recently through collaborations in North Queensland, Muru Marri has become involved in the delivery of the Family Well Being Empowerment Program with Cape York and Far West community members through funding provided by Royal Flying Doctors Service (Queensland Division). The Unit is also linked into the development of a 6-month Empowerment Evaluation and Wellbeing Support Training Program for the Social Health Team in Yarrabah community. Work to offer these capacity building activities in NSW is commencing.

International

Senior Visiting Fellow, Associate Professor Jan Ritchie has continued to advocate for Aboriginal and Torres Strait Islander health in her role as Regional Director, South Western Pacific Region, of the International Union for Health Promotion and Education (IUHPE). In this role Professor Ritchie has been active in supporting a Working Group of Regional Members set up specifically to take forward resolutions concerning Indigenous health declared at the 18th IUHPE World Conference in Health Promotion that was held in Melbourne in 2004. Achievement of resolution outcomes was actively pursued at the 19th World Conference on Health Promotion held in Vancouver, Canada in 2007. The Working Group is now continuing to exert its influence to achieve a strong focus on Indigenous health issues at the forthcoming 20th World Conference on Health Promotion programmed for Geneva, Switzerland in July, 2010.

Key Events in 2008

Aboriginal Ageing Workshop, August, 2008

An inaugural national workshop on the topic of Aboriginal ageing and longevity was held at the University of New South Wales on the 15th August 2008. This was an initiative of the Australian Association of Gerontology and the event was sponsored by a range of organisations. This event was followed by a visit and seminar presentation from Professor Michael Ungar at Dalhousie University who's team work on cross-cultural resilience with Canadian Aboriginal communities and a number of communities internationally including Australia and New Zealand. For more information, go to The Resilience Research Centre, Nova Scotia, Canada.

The purpose of the Aboriginal Ageing Workshop was to convene a group of people interested in developing a progressive agenda on Aboriginal health and ageing, with a focus on ageing across the life span.

A web seminar of the proceedings has been produced by UNSW Find out more .... A final report produced by Dennis McDermott and colleagues to provide feedback on the outcomes and direction of the workshop is nearing completion.

Selected Indigenous Health Publications 2007-2009

Peer-reviewed publications

Laliberte A, Nagel T, Haswell-Elkins M.* (in press). Low Intensity Cognitive Behavioural Therapy with Indigenous consumers: creative solutions for culturally appropriate mental health care. Oxford Guide to Low Intensity Cognitive Behavioural Therapy, Oxford, UK.
Tsey K, Whiteside M, Cadet-James Y, Haswell-Elkins M.* (in press) The contribution of empowerment to Indigenous Australian health: the case of Family Wellbeing Empowerment Program. Health and Social Care in the Community.
Santhanam R, McKewan A, Bainbridge R, Hunter E, Haswell-Elkins M*, Tsey K. Development of performance indicators for remote area child and youth services. Indigenous Health Bulletin, 2009, 9(1): January to March.
Haswell-Elkins M*, Reilly L, Fagan R, Ypinazar V, Hunter E, Tsey K, Gibson V, Connolly B, Laliberte A, Wargent R, Gibson T, Saunders V, McCalman J, Kavanagh D. Listening, sharing understanding and facilitating consumer, family and community empowerment through a priority driven partnership in Far North Queensland. Australasian Psychiatry, 2009, 17 (Suppl 1): S54-58.
Laliberte A, Haswell-Elkins M*, Reilly L. The healing journey: empowering Aboriginal communities to close the health gap. Australasian Psychiatry, 2009, 17 (Suppl 1): S64-67. Blignault I & Ritchie J. 'Revealing the wood and the trees: reporting qualitative research.' Health Promotion Journal of Australia, 2009: 20(2): 140-145.
Ritchie J*, Zwi AB, Blignault I*, Bunde-Birouste A, Silove D. 'Insider-outsider positions in health-development research: reflections for practice.' Development in Practice, 2009: 19(1): 106-112.
Matthews A, Jackson Pulver LR*, Ring IT. 'Strengthening the link between policy formulation and implementation of Indigenous health policy directions.' Australian Health Review, November 2008; 32(4): 613-625.
Durie A, Hill P, Arkles R*, Gilles M, Peterson K, Wearne S, Canuto C, Jackson Pulver L*. 'Overseas-trained doctors in Indigenous rural health services: negotiating professional relationships across cultural domains.' Australian and New Zealand Journal of Public Health, 2008: 32(6): 512-518.
Jackson Pulver LR* & Fitzpatrick S*. 'Beyond Sorry - the first steps in laying claim to a future that embraces all Australians.' MJA, 2008; 188(10): 556-558.
Jackson Pulver LR* & Immerman H OAM. 'What's new in the Shalom Gamarada Ngiyani Yana residential scholarship?' MJA, 2008; 188(10): 593.
Arkles RS*, Hill PS & Jackson Pulver LR*. 'Overseas-trained doctors in Aboriginal and Torres Strait Islander health services: many unanswered questions.' MJA, 2007; 186 (10): 528-530.
Comino E, Titmus A, Harris E, Craig P, Jackson Pulver LR*. 'Identification of Aboriginal infants at an urban hospital.' Journal of Paediatrics and Child Health, 2007; 43(9) 623.
Jackson Pulver LR*. 'We walk together as friends: the Shalom Gamarada Ngiyani Yana residential scholarship program.' MJA; 186(10): 551.
Sullivan E, Blignault I*, Duncan S and Jackson Pulver LR*. 'The Graniators support group program.' International U Health Promotion & Education Supplement 2007 (2): 24-5.
Graham S, Jackson Pulver LR*, Yueping AW, Kelly PM, Laws PJ, Grayson N, Sullivan EA. 'The urban-remote divide for Indigenous perinatal outcomes.' MJA, 2007:186(10):509-512.

Public domain reports and inquiries

Haswell-Elkins M*, Hunter E, Wargent R, Hall B, O’Higgins C, West R. Protocols for the delivery of social and emotional well being and mental health services in Indigenous communities: guidelines for health workers, clinicians, consumers and carers. Published by University of Queensland and Queensland Health, Cairns, 2009.
Broe GA and Arch M. Tjilip Pampa Nyumpu Tjutaka. Aged Care and Disability Care Program Review. A Consultation for Nganampa Health Council Final Report, 2008.
Arkles R*, Jackson Pulver L*, Broe, GA*, Robertson H*, Draper, B. Cognition, dementia and ageing in Australian Aboriginal and Torres Strait Islander Peoples: A Review of the Literature. Muru Marri Indigenous Health Unit Monograph Series, MMIHU and the Prince of Wales Medical Research Institute, (Forthcoming)
Fitzpatrick S*, Greer S, Jackson Pulver LR*. Submissions 57 & 57A. 'Overcoming Indigenous disadvantage in New South Wales.' Final report. Standing Committee on Social Issues. Sydney, NSW. 2008.
Jackson Pulver LR*, Harris E, Waldon J. Chapter 9, 'Australia and New Zealand', in An Overview of Current Knowledge of the Social Determinant of Indigenous Health commissioned by the Commission on Social Determinants of Health, World Health Organisation, 2007.
Arkles, R*, Guthrie, J, Sutherland, S, Dance, P, Dejanovic, A*, McDermott, D*, Jackson Pulver, L*. 'Barawul Yana: Better strategies for the recruitment, retention and support of Indigenous medical students in Australia.' Muru Marri Indigenous Health Unit Monograph Series, September 2007.