Aboriginal Health in 21st century Research Australia in remote Bridging Australia: the gap doing work that really matters Professor Alan Cass Director, Menzies School of Health Research alan.cass@menzies.edu.au Professor Alan Cass Director, Menzies School of Health Research alan.cass@menzies.edu.au
What drives the burden of disease? Standardised incidence ratio 32 16 8 4 2 1 (circle size proportional to regional population) Rank from 1 = least to 36 = most disadvantaged region SIR = 1 for total Australian resident population 1 9 18 27 36 Rank of socioeconomic disadvantage Ethnicity & Disease 2002; 12 (3): 373-8
Early life determinants (White et al AJKD 2009)
Infectious episodes per child <15 yr Environmental effects on health number 0 10 20 30 40 Skin Chest Gastro Ear
Sharing the True Stories
Engagement of Indigenous ESKD patients Reported feeling excluded from information: There s a whole lot of us who just don t understand what s going on. They know though, the doctors and the nurses know, but they don t tell us. I don t know how to talk to the nurse or doctor. He comes down here and just checks out how we re looking after our body. It s not enough time. You don t go knocking on their door, [that s the] danger one. The door is locked. They sit behind closed doors. MJA 2008; 189: 499 503
Dislocation from community I was born and bred on these lands. How on earth could I go all the way to the city, away from my family and country, knowing there was no possibility for them to come down and stay with me, no accommodation, no facilities... There's no way I could think about being so far away... I'd just be in total despair all the time. (Senior community member, September 2010)
Kanyini Vascular Collaboration Kanyini: to have, to hold and to care Kanyini describes the principle and primacy of caring for others an obligation to nurture, protect and care for other people, family, country and the law KVC brings together Indigenous and non Indigenous researchers, health services and community to undertake research to improve health outcomes
Addressing CKD burden
Menzies vision Find solutions to problems that matter Make a meaningful difference to quality of life in Australia and across our region Sustainable health improvements through excellence and leadership in research, education and capacity development
How do we work to achieve this? Undertake highest quality research targeted at priority health issues Focus on research translation into change in policy and practice Worked with Aboriginal communities across Top End and Central Australia for 30 years Partner with communities to build capacity Attract, retain and develop the best researchers Develop pathways into higher education, science and research for Indigenous Australians
Research Excellence NHMRC 40% 35% 30% 25% Menzies 20% 15% 10% 5% 0%
ABC Study Darwin Birth Cohort 1987 to 1989 686 babies 2013 Wave 4 24 to 26 year olds
NT Diabetes in Pregnancy Study Recognising that chronic disease risk begins in utero, this study aims to improve models of care & health outcomes by reducing risk as early as possible in life course Components of partnership program: 1. NT Diabetes in Pregnancy Clinical Register 2. Models of care 3. PANDORA: Pregnancy And Neonatal Diabetes Outcomes in Remote Australia
Shop@RIC A stepped wedge design project to test the impact and cost effectiveness of a store based price reduction intervention in promoting the purchase of fruit, vegetables and low joule soft drinks/water among residents in remote Aboriginal communities in the NT Partnership with remote community store boards, ALPA and Outback Stores Intervention in 20 communities across NT Provide evidence on the effectiveness and cost effectiveness of price discounts on food and drink purchasing Intervention in a socio economically disadvantaged population in a real life setting
Global and tropical health
Improving Health Service Delivery
Acknowledgements Funding NHMRC, APHCRI, NT and Commonwealth governments, CRCAH/Lowitja, industry Research team Joan Cunningham, Jeannie Devitt, Cilla Preece, Gill Gorham, Paul Lawton, Jaqui Hughes, Sam Togni, Georgia Robinson Menzies Anushka Patel, David Peiris, Maria Tchan, Hueiming Liu, Maree Hackett George Institute Alex Brown and team SAHMRI Wendy Hoy, Paul Snelling Indigenous Research Fellows Barry Fewquandie, John Brady, Jo Devries, Ricky Mentha, Pam Simon, Suzanne Ingram, Chris Lawrence, Anne Eades Patients, health services and communities