Glenelg Shire
Aboriginal and Torres Strait Islander
Social, Emotional and Well Being Profile
May 2014
ff0 | Page Final Version – 13 June 2014
TABLE OF CONTENT
EXECUTIVE SUMMARY ...... 1
PART A - INTRODUCTION ...... 3 Key features about this profile ...... 4
PART B - THE CONTEXT FOR ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH AND WELL BEING ...... 6
PART C - THE SOCIAL DETERMINANTS OF ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH AND WELL BEING ...... 9 Addressing the social determinants of health ...... 11 Aboriginal and Torres Strait Islander Healing ...... 13
PART D - THE SOCIAL DETERMINANTS, HEALTH AND WELLBEING PROFILE ...... 15 Population ...... 15 Age Structure...... 16 The important early years ...... 18 Low birth weight babies ...... 18 Access to Ante Natal Care ...... 18 Breast Feeding ...... 19 Parenting the early years ...... 20 Teenage Pregnancies ...... 22 Families with young children ...... 22 Australian Early Years Developmental Index ...... 23 Body Weight 0 – 9 year olds ...... 25 Immunisation and Asthma ...... 26 Literacy and Numeracy ...... 27 Trends over time...... 28 EDUCATION ...... 30 Aboriginal and Torres Strait Islander attendance at an educational institution in the Glenelg Shire ...... 30 Kindergarten and School Participation ...... 32 Technical or Further Education Participation ...... 32 Highest year of school completed by Aboriginal and Torres Strait Islander status for Glenelg 2011 ...... 33 EMPLOYMENT ...... 36 INCOME ...... 42
PART E - SOCIAL AND EMOTIONAL WELL BEING ...... 44 Aboriginal and Torres Strait Islander Life Expectancy ...... 44 Hospital Admissions ...... 44 Need for Assistance ...... 46
SELECTED HEALTH RISK AND PROTECTIVE FACTORS ...... 48 Self-Assessed Health ...... 48 Psychological Distress ...... 49 Long Term Health Conditions ...... 50 Selected current long term health problems ...... 51 Diabetes ...... 52 Key findings for Aboriginal and Torres Strait Islander people living in Victoria ...... 53
PART F - LIFE STYLE RISK FACTORS ...... 54 Overweight and Obesity ...... 54 Smoking ...... 54 Environmental Tobacco Smoke ...... 55 Fruit and Vegetable Intake ...... 58 Health Related Actions ...... 59
PART G - LOCAL ACCHO HEALTH SERVICES DATA ...... 60 Prevalence of common conditions ...... 60
This report has been commissioned by the Glenelg Shire Council and the Dhauwurd-Wurrung Elderly & Community Health Services Inc., on behalf of the Glenelg Shire Aboriginal Partnership to assist in the development of the next interaction of the Glenelg Aboriginal Partnership Plan.
The terminology ‘Aboriginal and Torres Strait Islander peoples’ has been the preferred in this document. Organisations and sources quoted use various terms including ‘Indigenous’ and “Aboriginal people’. To ensure consistency, these usages are preserved in quotations, extracts and in the names of the documents / organisations.
The information in this report has been obtained from the Australian Bureau of Statistics 2011 Census, Victorian Department of Health and other sources. It has been prepared in good faith and in conjunction with the Glenelg Aboriginal Partnership organisations. Neither the Glenelg Shire Council, partner organisations, nor staff or agents shall be responsible in any way whatsoever to any person or organization in respect to the report, including errors, omissions, therein, however caused.
May 2014
Compiled by Judy Nichols Dunkeld, Victoria Ph: 0429 121 258
EXECUTIVE SUMMARY
The Glenelg Aboriginal Partnership aspires to justice, inclusion, and equity for the Aboriginal and Torres Strait Islander community including the Gunditjmara, Bunganditj and Jardwadjali people living across the municipality. The Partnership Agreement seeks to facilitate and nurture the healing processes necessary to address and alleviate the hurt and to rectify the economic, legal, social and cultural disadvantages placed on Aboriginal and Torres Strait Islander peoples over the last 181 years. In this context, the key drivers for healing and improving the social, emotional and wellbeing of the Aboriginal and Torres Strait Islander people will be empowerment, strengthening community and identity, cultural recognition, respect and opportunity in all areas of social, civic, economic and environmental endeavour across the Shire.
Effective change is often built on reliable evidence and this Social, Emotional and Well Being profile describes not only the health status of Aboriginal and Torres Strait Islander people but delivers an analysis of the social determinants of health that underpin the healing experience and outcomes for individuals and community.
One challenge for the Glenelg Aboriginal Partnership is that justice, inclusion, and equity does not belong to the partners alone, but rather the entire community. Success will only come when Aboriginal and Torres Strait Islander people are central to all initiatives for change – not just subject to it. All approaches need to empower from the grass roots rather than be directed from the Partnership or any of its partners.
This profile introduces the concept of the Aboriginal and Torres Strait Islander World View, an important context for Aboriginal and Torres Strait Islander health. Local history, its impact on trans-generational wellbeing not only on the individual but also land and community is discussed.
The data presented includes: the early years, school retention and attainment and participation in further study. These indicators provide the precursors to employment and income data presented. Critical determinants of health and wellbeing are also described including health status and risk factors for chronic disease.
Opportunities for collaborative action are peppered throughout the profile and there are many more to describe. Those detailed focus on the social determinants of health including: • access to early childhood education and services including ante-natal care; • parenting support for some children and families that are vulnerable; 1 | Page • engagement with Elders and the community; • strengthening cultural recognition and respect across the Shire; • supporting students to complete Year 12 and from this will come employment and prosperity, health and well-being; and • achieving respect in the workplace and opportunity that allow everyone to provide for their family and fulfil their potential.
Local health services have made a difference with several initiatives including the re- instatement of Aboriginal Liaison Officer at Portland District Health in partnership with Dhauwurd Wurrung Elderly & Community Health Service for example. Winda Mara have established strong and enduring relationships with Heywood Rural Health, providing cultural safety for the Heywood community. Strengthening the cultural safety of all health, mental health, community, drug and alcohol services remains a priority and needs to extend across the community to early years centres and services, schools and workplaces.
Measurement and collecting local data remains central to understanding the social, emotional and wellbeing of Aboriginal and Torres Strait Islander people living in the Glenelg Shire. Available data at the local level is a deficit of this profile however every year more reliable information is becoming available from National and Victorian sources. This profile presents for the first time new information on psychological distress from both national and Victorian sources.
The local Aboriginal Community Controlled Health Services (ACCHO), Winda Mara Aboriginal Corporation and Dhauwurd Wurrung Elderly & Community Health Services (DWECH) have also provided for the first time de-identified population health data extracted from their medical services. From this data, there are differences in the health status of the Aboriginal and Torres Strait Islander community attending both health services. The prevalence of common conditions (asthma, depression, anxiety, hypertension, high blood fats (hyperlipidaemia and Type II diabetes) presented by Winda Mara is more than double that reported by DWECH for all conditions except Type II Diabetes.
Both ACCHO’s acknowledge the importance of sharing this data for the purpose of understanding the population health of their community. The next step is that these differences need to be understood and collaborative capacity developed to achieve health equity for Aboriginal and Torres Strait Islander people attending ACCHO medical services.
2 | Page PART A - INTRODUCTION 1
This plan, commissioned by the Glenelg Aboriginal Partnership, presents a profile of the health and social determinants of health for Aboriginal and Torres Strait Islander2 people living in the Glenelg Shire, Victoria.
This plan reflects the vision of the National Aboriginal and Torres Strait Islander Health Plan 2013-20233 an evidence-based policy framework designed to guide policies and programs to improve Aboriginal and Torres Strait Islander health over the next decade until 2023.
SNAP SHOT - National Aboriginal and Torres Strait Islander Health Plan 2013–20234
Vision The Australian health system is free of racism and inequality and all Aboriginal and Torres Strait Islander people have access to health services that are effective, high quality, appropriate and affordable. Together with strategies to address social inequalities and determinants of health, this provides the necessary platform to realise health equality by 2031.
Principles Four principles of the Health Plan: 1. Health Equality and a Human Rights Approach 2. Aboriginal and Torres Strait Islander Community Control and Engagement 3. Partnership 4. Accountability
1 Release of the Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13 2 For the purposes of this report Aboriginal and Torres Strait Islander people are referred to as Aboriginal. The term Indigenous is however used where specific reference data have used this term 3 National Aboriginal and Torres Strait Islander Health Plan 2013–2023 http://www.health.gov.au/internet/publications/publishing.nsf/Content/oatsih-healthplan-toc~overview 4 ibid 3 | Page Figure 1: NATISHP 2013 – 2023 Priorities
Key features about this profile
This profile reflects the strategic directions and purpose of the Partnership (http://www.glenelg.vic.gov.au/Files/Final_Glenelg_Aboriginal_Partnership_Agreement_Adopte d_by_Council_on_24_May_2011.pdf) and presents for the first time a National and Victorian picture of the social, emotional and well-being determinants of health for Aboriginal and Torres Strait Islander people.
New information and an expanded perspective regarding how the historical, social and economic factors affect the health experience for Aboriginal people are also included. This approach is intended to be practical and leads to the identification of “Opportunities that Affect Change” across partners to improve the healing journey and outcomes across all life stages.
As far as possible, data has been provided to align with the Local Government Area of the Glenelg Shire. Data at this Local Government Area (LGA) level has however not always been available resulting in the need to source data from the Barwon South West, Victoria and the outer regional areas of Australia of which the Glenelg Shire is included.
4 | Page Data availability at the LGA level therefore underpins an important recommendation of this profile, that is to ensure all priorities and actions leading to an improvement in the health experience and outcomes are underpinned by local evidence. This report commences this approach as data from local Aboriginal and Torres Strait Islander Community Controlled Health Services and other health services has been accessed.
Despite this data limitation, this profile does provide for the first time detailed results of the National Aboriginal and Torres Strait Islander Health Survey conducted by the Australian Bureau of Statistics as well as new data released to describe the health and well being of Aboriginal and Torres Strait Islanders across rural and urban areas of Victoria5.
To understand the impact of the social determinants of health on Aboriginal and Torres Strait Islander people, we must first understand how Aboriginal and Torres Strait Islander people conceptualise their experiences of health and its determinants. Discovering how Aboriginal and Torres Strait Islander communities and individuals think about, respond to and understand health can be the basis for developing strategies for communities and individuals to improve health.
SNAP SHOT - Reflection on cultural identity
O'Shane offered an account of the psychological impact of these experiences that included dispossession, racism, exclusion, extermination, denigration and degradation. She described them as striking at the:
'...very core of our sense of being and identity. Many of our people assume any other identity than that of Aboriginal: the denial of self. Many say, as I have done for years, I shouldn't be here in this world, I don't belong. Yet we are the most ancient people in the most ancient land on Earth. We question who we are, what we are doing, where we belong. All around us we see our families and friends adopt the dejected, rejected demeanour...Many assume aggressive, off-hand resentful mannerisms of speech and behaviour, even amongst
6 their own cohorts.'
5 The health and wellbeing of Aboriginal Victorians: Victorian Population Health Survey 2008 Supplementary report, Victorian Department of Health 2012 6 Review of the social and emotional wellbeing of Indigenous Australian peoples http://www.healthinfonet.ecu.edu.au/other-health-conditions/mental-health/reviews/our-review#fnl-34
5 | Page PART B - THE CONTEXT FOR ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH AND WELL BEING7
Before presenting the key indicators of Aboriginal health status, it is important to provide a brief summary of the context for Aboriginal Health and Well Being. To understand the contemporary life of Aboriginal people living in the Glenelg Shire, a historical and cultural understanding of the Gunditjmara Nation is provided. This is an important foundation because concepts of Aboriginal and Torres Strait Islander wellbeing are different to those of non-Aboriginal and Torres Strait Islander people.
The Aboriginal World View is important to understand as it is also different to the view within mainstream services. The traditional Aboriginal World View of health is holistic and encompasses everything important in a person's life, including, physical body, community, relationships, and law. Health is the social, emotional, and cultural wellbeing of the whole community and the concept is therefore linked to the sense of being Aboriginal. Essential, too, is the bond between person and land - a connection that constitutes one's sense of individual and social identity and responsibility. The integrity of relationships between people and spiritual entities and the clarity of connections between people and land contribute greatly to health and healing journeys for Aboriginal people across all life stages.
Budj Bim ( Mount Eccles) Dean Maar ( Lady Julia Percy Island
Here our spirit is born Here is the last stepping stone for the spirit before it departs this world
7 In this report the term Aboriginal is used to include Aboriginal and Torres Strait Islander peoples 6 | Page The historical events of colonisation across the Gunditjmara Nation are outside the scope of this profile and can be read elsewhere8. The direct linkages between the current health status of Aboriginal people and the various practices that followed invasion and colonisation; the removal of people from land and culture, failed attempts at assimilation, racism, and denial of citizenship rights and recognition in the Australian Constitution as the “first Australians are well established (Figure 2).
Figure 2: Impact of colonisation on social, emotional health and well being9
COLONISATION
PROTECTION & CONTROL, 1890 - 1938 Massacres, disease, control, mixing together of groups; welfare dependency; loss of culture including: land; language; lore; dance; bush food and gathering practices; practice of spirituality, imposition of Christianity.
ASSIMILATION 1938 -1968 Changed lifestyle Mission settlements
Children taken away from Poor nutrition, reduced Poor housing, over families – based on skin daily activity crowding
colour
Families not allowed to have contact with children THE IMPACT on SOCIAL, EMOTIONAL HEALTH & WELL
BEING Children institutionalized & trained for menial work Confusion, fear, anger
Warrior self- determination, courage, resilience Further breakdown of family and clan Loss of identity Loss of opportunities to engage with family and child rearing Loss of connection with land, family, culture
Welfare dependency, unemployment, poverty Marginalisation within white society, racism, discrimination Disengagement from education, unemployment Lateral Violence
Personal distress, anxiety & depression Poor nutrition, alcohol and other drugs abuse Domestic violence, accidents, deaths in custody Low birth weight babies, parenting challenges Chronic disease
Reluctance to access to health services in particular services for early intervention and prevention
8 NGOOTYOONG GUNDITJ NGOOTYOONG MARA SOUTH WEST MANAGEMENT PLAN Cultural Heritage and Social Values Assessment Volume 2: Gunditjmara Thematic History August 2012 Prepared for Gunditj Mirring Traditional Owners Aboriginal Corporation & Parks Victoria 9 Adapted from Mathews JD. Historical, social and biological understanding is needed to improve Aboriginal health. Recent Advances Microbiology 1997;5: 257-334. 7 | Page SNAP SHOT - Aboriginal leaders world view
Patrick Dodson
“Governments tend to see issues in a piece-meal fashion –for example; Native title legislation is one thing, in a separate compartment from Heritage legislation from customary law, from developmental proposals, from environmental issues, from cultural and language maintenance –this convenient compartmentalisation and rigid demarcation of the modern bureaucracy is not possible to for us to view.
Neither are solutions that are imposed with a single focus We need holistic solutions for complex inter-related programs, and leaders that can juggle the issues.
All of these issues are about our survival as a people. We have been taught to expect failure in this country –in our country”.
Four hundred people witnessed the signing of a
historic agreement between Glenelg Shire Council and the Aboriginal and Torres Strait Islander community at the Portland Civic Hall. More than half the audience was made up of schoolchildren.
The Glenelg Aboriginal Partnership Agreement 2011-2020, took nearly two years to prepare.
The agreement aimed to promote recognition, healing and reconciliation between Aboriginal residents —including Gunditjmara, Bunganditj and Jardwadjali people — and non-Aboriginal residents.
“This document acknowledges the hurt and suffering endured by local Aboriginal communities
COUNCILLOR Ken Saunders as since European settlement” leading to “the Glenelg Mayor Bruce Cross watches dispossession of Aboriginal peoples in terms of at the Portland Civic Hall 10 culture, belief systems, history, language, land and its abundant wealth, and a complete ‘way of being’ that served Aboriginal peoples in this area for many thousands of years.”
10 Portland Observer June 2011 8 | Page PART C - THE SOCIAL DETERMINANTS OF ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH AND WELL BEING
Present‐day health status and experiences are underpinned by social indicators including income, rates of unemployment and educational attainment11.
Between one third and one half of the life expectancy gap may be explained by differences in the social determinants of health12 . They affect the health of people and can also influence how a person interacts with health and other services. For example, Aboriginal and Torres Strait Islander adults are less likely to smoke if they have completed Year 12, are employed and if they have higher incomes13. Additionally, higher levels of education are associated with healthier lifestyle choices and improved health literacy. Alternatively, rheumatic heart disease is associated with environmental factors such as poverty and poor living conditions, and Aboriginal and Torres Strait Islander people will remain at risk while socioeconomic disadvantage and barriers to accessing health care persist.
Table 1: Social determinants of health through a mainstream lens14
Socio economic determinants Psycho-social risk factors Community and societal characteristics Age Poor social networks Social networks and support Gender Self Esteem structures Ethnicity Self efficacy Social and community participation Education Depression Civic and political involvement Occupation Anxiety Trust in People Income Insecurity Trust in social institutions Employment Loss of control Tolerance of diversity Religion High physical/psychological Altruism, philanthropy, volunteering Housing ( security, tenure, structure, demand Poverty crowding) Isolation Residence Anger/hostility Income equality Coping Crime rate Perceptions Domestic violence Expectations Unemployment
11 Carson B, Dunbar T, Chenhall RD, Bailie R, eds. (2007) Social determinants of Indigenous health. Crows Nest, NSW: Allen and Unwin 12 Booth, A & Carroll, N (2005) The health status of Indigenous and non- Indigenous Australians. Centre for Economic Policy Research, Australian National University Canberra 13 Australian Health Ministers Advisory Council 2012, Aboriginal and Torres strait Islander Health Performance Framework 2012 Canberra 14 The health and wellbeing of Aboriginal Victorians: Victorian Population Health Survey 2008 Supplementary report Victorian Population Health Survey
9 | Page For Aboriginal and Torres Strait Islander people it is important to address the social and cultural determinants of health as there are many drivers of ill health that lie outside the direct responsibility of the health sector. Action across key social determinants such as health, housing, education, employment, the alignment of strategies across organisations will strengthen partnerships and the impact of collaborative actions.
Table 2: Additional Determinants for Aboriginal and Torres Strait Islander Health and Well Being
Socio economic determinants Psycho-social risk factors Community and societal characteristics Cultural impact on Early Years Capacity to engage in Opportunities to engage in participation strengthening identity mainstream decision making • Playgroup, • Maternal and Child Connection to land, Community control Health, • Kindergarten Knowledge and practice of Opportunism for self determination language, spirituality and Year 12 retention culture Culturally respectful services and Transport access Identity agencies
Social Inequality Removal from family, Organisational racism
Welfare dependency Cultural dislocation, Social exclusion
Racism and discrimination, Lateral violence
Chaos
Shame
More recent data indicates that in 2008 Aboriginal and Torres Strait Islander Victorians suffered greater ill-health than their non-Aboriginal and Torres Strait Islander counterparts15. The data suggests that the health impact of the differences in the social determinants of health may be far greater than their indirect impact via disease-inducing behaviours. This has important implications for determining priorities and actions that will make a difference in reducing the health inequities experienced.
For example, rates of smoking are high amongst Aboriginal and Torres Strait Islander Victorians and the health impacts of smoking are well known. There is a predominance of programs to QUIT smoking and to manage its effects e.g. asthma management plans for children raised in smoke filled homes. It is however critical to take action on the determinants of smoking i.e. contributors to psychological distress and to understand how healing from an Aboriginal World View context can make a difference to distress and the influence it may have on smoking behaviour.
15 Ibid 10 | Page While these findings from the Victorian Population Health Survey are important to help us to identify priorities, they do not consider or make measurements about the context of social determinants of health from the Aboriginal World View. Data on many important Aboriginal and Torres Strait Islander social determinants are not investigated. For example the impact of history on health: racism and marginalisation, poverty, social class, control over our own health, powerlessness, place, incarceration and the justice system, family separation, land and reconciliation16. For many Gunditjmara Nation people, the ongoing effects of 'protection' and the forced separation of children from their families compound their poor health and their journey to recovery.
Addressing the social determinants of health Taking action to address the social determinants of health for Aboriginal and Torres Strait Islander people remains a challenge. There are good examples of promising health partnerships between ACCHOs and mainstream agencies. These partnerships aim for all to respect and appreciate their role in improving the health experience. For Aboriginal and Torres Strait Islander and non- Aboriginal and Torres Strait Islander people, improving health outcomes is not only the responsibility of health services.
In 2003, Hunter developed an approach to demonstrate how the social determinants of health can be co-ordinated across a community17, from the perspective of the Aboriginal and Torres Strait Islander community living in the Glenelg Shire, his approach has been adapted to consider local priorities and themes and may be a starting point for continuing collaboration within the Glenelg Partnership and beyond.
16 Beyond Band-aids: Papers from the Social Determinants of Aboriginal Health Workshop, Adelaide, July 2004 Edited by Ian Anderson, Fran Baum and Michael Bentley Exploring the Underlying Social Determinants of Aboriginal Health 17 Hunter E (2003) Mental health. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press: 127-157 11 | Page Table 3: A framework to consider the social determinants of health for the Glenelg Shire including local themes
Level Activity Society Social justice, reconciliation, recognition, valuing culture, acknowledging history Community Community development empowerment ( early years, education participation and retention ( early years, school, tertiary), employment ( getting a job and keeping it , housing, cultural safety for all) Aboriginal workforce Accessing systems that have been denied Land Management and preservation Social Enterprise Entrepreneurship Philanthropy Family/Kin Respecting and engaging Elders Family wellbeing and parenting programs Addressing Lateral Violence Reclaiming cultural strength and practices Individual Indigenous therapies Western therapies Adapted/appropriated therapies (e.g. narrative therapy) Culturally appropriate conventional therapies Healing Pathways
Healing is about returning and preserving country, learning language and dance
Original stone hut remains Gunditjmara Men eel fishing
12 | Page Aboriginal and Torres Strait Islander Healing
A profile of the health status of Aboriginal and Torres Strait Islander people living the Glenelg Shire is not complete without consideration to how “healing” is supported from an Aboriginal World View.
The Aboriginal and Torres Strait Islander community living in the Shire has expressed the need to health “thyself”, the community as well as the land.
SNAP SHOT - Aboriginal and Torres Strait Islander Healing
The Glenelg Aboriginal Partnership Agreement 2011-2020 acknowledges that Gunditjmara, Bunganditj and Jardwadjali members of Glenelg Shire’s Aboriginal and Torres Strait Islander Community have a unique and deeply spiritual relationship with those lands and waters.
Healing for Aboriginal and Torres Strait Islander people takes time & each individual journey needs to be seen as unique. No two healing journeys will ever be the same. This philosophy highlights the need to have a variety of programs & services to support a variety of Aboriginal and Torres Strait Islander people.
Healing happens in many ways & must be seen as a holistic process taking into account all aspects of a person’s life.
With the sharing of knowledge, wisdom & information, people become more aware of themselves & to past, present & future situations & or experiences. People only know what they know. Ensuring people are well informed about all topics that matter can empower them enough to make informed choices about what to do next.
With more insight into ourselves, our culture and our history and the world around us, we are able to navigate through life with more clarity, peace & freedom”1.
“As a Board, our commitment to a healing journey is not new as we have all have been on our own journey for our entire lifetime. We bring with us the suffering of our ancestors and our healing journey is also for them. We know our services are not enough for our community and we need to better meet the needs of our community1”
13 | Page Opportunities That Affect Change BACKGROUND In 2013, DWECH was successful in an application to the Healing Foundation18 to design and develop an Aboriginal and Torres Strait Islander Healing Centre commencing in February 2014. The application highlights the needs for an open, transparent and accountable partnership approach.
ACTION That the Glenelg Partnership provides a representative to the committee overseeing the DWECH Design and Development of the Healing Centre.
18 The Healing Foundation www.healingfoundation.org.au/ 14 | Page PART D - THE SOCIAL DETERMINANTS, HEALTH AND WELLBEING PROFILE
Population
The Glenelg Shire has more than three times the average proportion of Aboriginal and Torres Strait Islander residents compared with the Victorian average. In the 2011, Australian Bureau of Statistics (ABS) figures there were 406 people identifying as Aboriginal or Torres Strait Islanders in the Glenelg Shire19.
The proportion of Aboriginal and Torres Strait Islander people in the Shire has continued to increase from 1.2% of population in 2003 to 1.9% in 2006 and 2.1% in 2011.
Table 4: Aboriginal and Torres Strait Islander population in Glenelg 1996 – 201120
1996 2001 2006 2011 Male Female Total Male Female Total Male Female Total Male Female Total Aboriginal 77 102 179 96 110 206 154 180 334 185 199 384 Torres 5 17 22 4 7 11 5 9 14 3 7 10 Strait Islander Both 0 3 3 4 5 9 8 15 23 4 7 11 Total 82 122 204 104 122 226 166 204 370 192 213 405
The Glenelg Shire has the highest proportion of Aboriginal and Torres Strait Islander people of any local government area in Victoria.
There has been a five-fold increase in Aboriginal and Torres Strait Islander population in the Glenelg Shire over the 15 years from 1996 to 2011.
Figure 3: Population Change 1996 - 2011 across the Glenelg Shire
450 400 350 300 250 Male 200 Female 150 Total 100 50 0 1996 2001 2006 2011
19 Estimated Resident Population, Australian Bureau of Statistics Census 2011 20 Source GSGLLEN Environmental Scan 2013 15 | Page Age Structure
The Age Structure of the Glenelg Shire community provides key insights into the level of demand for age based services and facilities such as child care. It is also an indicator of Glenelg Shire's role and function and how it is likely to change in the future. Five year age groups present a classic age profile of the population and enables direct comparison between each group.
Table 5: Aboriginal and Torres Strait Islander and Non Aboriginal and Torres Strait Islander Population –Glenelg Shire 201121
Males Females Total Total Total Non Total Aboriginal Aboriginal Aboriginal Aboriginal &Torres Strait &Torres Strait &Torres &Torres Islander Islander Strait Strait Persons Percent Islander Islander Persons Percent 0-4 years 18 18 36 8.9% 973 5.3% 5-14 years 53 61 114 28.2% 2367 12.9% 15-24 years 27 29 56 13.86% 1985 10.8% 25-44 years 49 58 107 26.4% 4068 22.2% 45-64 years 37 38 75 18.56% 5648 30.8% 65 years and over 6 10 16 3.9% 3281 17.9% Total 191 213 404 18322
There is more than double the proportion of Aboriginal and Torres Strait Islander children aged 5-4 years compared with non-Aboriginal and Torres Strait Islander children 28.2% cw 12.9 %, however the percentage of adults over 45 years of age is smaller than the non-Aboriginal and Torres Strait Islander adults, 22.5% cw 48.7 %.
Figure 4: Aboriginal and Torres Strait Islander and Non Aboriginal and Torres Strait Islander Population –Glenelg Shire 2011
35.00% 30.00% 25.00% 20.00% Total Indigenous Percent 15.00% 10.00% Total Non Indigenous 5.00% Percent 0.00% 0-4 5-14 15- 25- 45- 65 Total yrs yrs 24 44 64 yrs+ yrs yrs yrs
21 Source ABS 2011 Census 16 | Page In 2011, across the Shire, the percentage of Aboriginal and Torres Strait Islander families with dependents was more than double that of the Barwon South West Region (3.6 cw 1.6 %) and more than triple that of Victoria (1.2 %).
Of the 2,451 families counted across the Shire with dependent children, 52.3 % had at least one child aged 0 to 8 Year and 4.4 % of these families were Aboriginal and Torres Strait Islander. This was greater than the proportion of Aboriginal and Torres Strait Islander families with at least one child aged 0 to 8 years in Victoria (1.4 %).
When 76 of the 79 LGAs in Victoria were ranked in terms of the proportion of Aboriginal and Torres Strait Islander population aged 0 to 8 years, Glenelg Shire was ranked 9th where a rank of 1 was assigned to the LGA with the highest proportion of its Aboriginal and Torres Strait Islander population aged 0 to 822.
In 2008, there were 7 Aboriginal and Torres Strait Islander children enrolled in four year old kindergarten in Glenelg Shire. In 2014 there are 9 enrolments in Shire managed kindergartens 23 and an additional one enrolment when all kindergartens are included 24.
Opportunities That Affect Change Build the capacity and connection between early childhood services, and families to improve kindergarten and playgroup participation and transition for all Aboriginal and Torres Strait Islander children.
That the Council and “stand alone” kindergartens work in consultation with ACCHO’s and families to better understand the barriers and enablers for early years program participation.
That the Council resource training for all early years professionals to understand cultural safety for more inclusive service delivery and program planning.
That ACCHO’s target and facilitate access to playgroups as a prelude to children attending 3 year old and 4 year old kindergarten.
That the Traditional Owners groups contribute to opportunities for cultural practices to be integrated within the kindergarten and ACCHO playgroup activities.
22 Early Childhood Community Profile. Glenelg Shire 2010 DEECD 23 Personal Communication Children’s Services Co-ordinator Glenelg Shire, January 2014 24 Personal Communication Elsa McLeod Kindergarten, Jaycee Kindergarten and Good Start Early Learning Centre 17 | Page The important early years
Low birth weight babies
Maternal under-nutrition is one factor linked to low birth weight, which is about twice as common among babies born to Aboriginal and Torres Strait Islander mothers as it is among babies born to non-Aboriginal and Torres Strait Islander mothers25.
Babies with low birth weights (LBW – under 2500 grams) have a higher risk of poor health and development later in life. Low birth weight has been associated with a range of factors, including the mother’s physical characteristics (including size, age and ethnicity), illness during pregnancy, the number of babies previously born to the mother, multiple births and the duration of pregnancy, use of alcohol, tobacco or drugs during pregnancy and her diet and overall health.
In 2010, 6.3% of Victorian babies were of LBW compared with 10.3% for Aboriginal and Torres Strait Islander mothers. Across Victoria, the greatest proportions of babies with LBW in Victoria were from outer regional and low socio-economic areas26 and born to Aboriginal and Torres Strait Islander mothers 27. For the Barwon South Western region, 16% of Aboriginal and Torres Strait Islander babies were low birth weight, compared with 6% of babies born to non-Aboriginal and Torres Strait Islander mothers in 2007. The relatively small size of the number of self-identified Aboriginal and Torres Strait Islander mothers does not allow for more local data to be extracted however highlights the need for ante natal care access for all Aboriginal and Torres Strait Islander mothers.
Access to Ante Natal Care
Antenatal care plays an important role in the reduction of LBW babies, and the social, emotional wellbeing of mothers and their families. The Glenelg Shire is serviced by the Regional Koori Maternity Service (KMS) located at the Gunditjmara Health Service based in Warrnambool. This service visits Portland and Heywood twice a month. According to the KMS Nurse, low birth weight babies have not been recorded for Aboriginal and Torres Strait Islander babies across the municipality in 2012- 201328. Data was sourced29 to confirm this evidence and it was noted that the rate of LBW per 1000 live births in Glenelg, pooled over 4 calendar years, 2000 to 2003 and 2004 to 2007 was 130.7 and 157.9 compared with 62.9 and 47.5 per 1000 for Aboriginal and Torres Strait Islander mothers. Clearly mothers “at risk” of delivering LBW are “hard to reach” and do not necessarily attend the specialist regional services of the KMS.
25 National Aboriginal and Torres Strait Islander Health Study 2004-05 26 Glenelg Shire is the 14th most disadvantaged municipality in Victoria 27 State of Victoria’s Children 2012 http://www.education.vic.gov.au/Documents/about/research/FINAL%20The%20State%20of%20Victoria%27s%20Children_2012% 20v2.pdf 28 Regional Koori Maternity Service Warrnambool. Personal Communication December 2013. 29 Aboriginal Early Years Community Profile –Glenelg Shire 2009 DEECD 18 | Page Opportunities That Affect Change That the Council advocate to the Department of Health for funding or a change in the model of care to increase access to the Regional Koorie Maternity Services especially for ante natal care in Portland and Heywood.
Breast Feeding
Breast milk is the optimum food for babies and contains anti-infective properties providing for some immunity against early childhood diseases. The NHMRC recommends that as many infants as possible are exclusively breastfed until 6 months-of-age and that mothers then continue breastfeeding until 12 months-of-age30.
In 2012-2013 and 2011-2012 there were 19 and 18 children identified as Aboriginal and/or Torres Strait Islander born in the Glenelg Shire.
The Shire’s Maternal and Child Health Service records the number of fully breastfed babies and the number of partially breastfed babies at several stages including: On discharge from hospital; At 2 weeks of age; At 3 months of age and at 6 months of age.
The proportion of all babies breast fed is provided in the following table and there were no observable differences between Aboriginal and Torres Strait Islander and non -Aboriginal and Torres Strait Islander babies31.
Table 6: Proportion of all babies born in the Glenelg Shire and duration of being exclusively breast fed
YEAR DISCHARGE 2 WEEKS 3 MONTHS 6 MONTHS 2011-2012 75.9% 71.4% 53.6% 39.1% 2012-2013 86.2% 76% 62.8% 45%
30 Victorian Government Better Health Channel 31 Personal Communication Maternal and Child Health Service Glenelg Shire 19 | Page Parenting the early years
Aboriginal and Torres Strait Islander families play a critical role in their children’s development and learning32. The body of research examining the effectiveness of parenting programs since the 1960s demonstrates a consensus that parenting programs focusing on early parenting to improve parent- child interaction in particular, and parenting practices more generally, are the key to promoting the wellbeing of children and preventing the development of later problems33.
For Aboriginal and Torres Strait Islander communities, support for parents in their parenting role has a different context from within non-Aboriginal and Torres Strait Islander communities. Child rearing and teaching children has traditionally been achieved through an extended family, kin and community relationship and responsibility and today this remains a cultural practice.
The education of Aboriginal and Torres Strait Islander mothers is particularly important as international evidence shows that educational, health and social outcomes are better for children when mothers (carers) are better educated and healthy, when mothers and children receive educational and social support in the pre‐school years, and when families actively support their children’s education34.
Programs for Aboriginal and Torres Strait Islander families need to consider: cultural practices associated with raising children; the need for community involvement and consultation; that mainstream parenting education and home visiting programs may not be appropriate for Aboriginal and Torres Strait Islander communities; the use of Aboriginal and Torres Strait Islander workers and cultural consultants to work alongside non-Aboriginal and Torres Strait Islander workers; and a strong focus on relationship building and communication.
32 Mildon, R & M Polimeni 2012 Parenting in the early years: effectiveness of parenting support programs for Indigenous families. Australian Institute of Health and Welfare. Closing the Gap Clearing House. 33 Barlow J, Smailagic N, Ferriter M, Bennett C & Jones H 2010. Group based parent-training programmes for improving emotional and behavioural adjustment in children from birth to three years old. Cochrane Database of Systematic Reviews, Issue 3. Art. no.: CD003680. DOI: 10.1002/14651858.CD003680.pub2. 34 Review of the social and emotional well being of Aboriginal people’s http://caepr.anu.edu.au/Definitions-wellbeing-and-their- applicability-Indigenous-policy-Australia.php 20 | Page Opportunities That Affect Change • That the Council strengthen its collaboration with DEECD and ACCHO’s for the introduction of Aboriginal and Torres Strait Islander specific early years programs in particular resourcing early parenting programs;
• That the Council confirm the number of kindergarten enrolments, monitor absenteeism and work with ACCHO’s to achieve 100% enrolment and participation;
• That the Council ensure the needs of the Aboriginal and Torres Strait Islander community are presented and represented in its Early Years Plan and the Great South Coast priority “Year 12 or Equivalent Project”;
• The ACCHO Early Years initiatives are supported for example “WASP” at DWECH and the Winda Mara parenting and playgroup initiatives; and
• That DWECH and Winda Mara develop co-operative strategies and share scarce resources and capacity for the benefit of the community.
SNAP SHOT - Concern expressed by Elder regarding parenting
In 2013, a group of eight women gathered at DWECH, Portland to discuss their concerns, define the problem and draft their purpose for taking action.
The concerns expressed by Elders include:
• “Concern for young children in the community , their safety and health;
• Concern for the health of young women having babies at risk of being born with drug dependencies, foetal alcohol syndrome and low birth weight from smoking;
• Prevalence of alcohol, drugs ( ice ) misuse in the community and the impact on women and children;
• Need to develop a health promotion approach incorporating cultural activities to build cultural identity; increase knowledge of culture including language and “ on country” assets; and
• Need to build community leadership to address community issues.
21 | Page Teenage Pregnancies
Over the three year period from 2004-05 to 2006-07, the teenage birth rate in Aboriginal and Torres Strait Islander women in Glenelg was near to 5 times higher than that of non-Aboriginal and Torres Strait Islander women. The Koori Maternity Services nurse did not report any teenage pregnancies in the 2012-2013 year across the Glenelg Shire.
Opportunities That Affect Change That the Council’s Maternal and Child Health Services identify families of low birth weight babies when notification of births are received.
That these families including teenagers are offered culturally appropriate home based consultation in partnership between the Maternal & Child Health Nurse, domiciliary midwife and ACCHO.
That the Council advocate to the Department of Health for funding or a change in the model of care to increase access to the Regional Koorie Maternity Services especially for ante and post natal care in Portland and Heywood.
Families with young children35
Of the 2,451 families in Glenelg Shire with children under 15 and/or dependent students aged 15-24 years, 52.3% had at least one child aged 0 to 8 years. 56 (4.4%) of these families were Aboriginal and Torres Strait Islander.
The family composition of Aboriginal and Torres Strait Islander families in Victoria with young children was almost equally divided between couple families and one parent families. Children in one parent families are more likely than children in couple families to experience factors that put their developmental outcomes at risk, including stressful life events, financial hardship and housing instability.
The percentage of Aboriginal and Torres Strait Islander one parent families with children aged 0 to 8 years in Glenelg Shire (53.6%) was greater than the percentage of Aboriginal and Torres Strait Islander one parent families with children in this age group in Victoria (49.0%) and greater than the percentage of all one parent families with children aged 0 to 8 years in Glenelg Shire (18.6%).
35.ibid 22 | Page The median weekly income for Aboriginal and Torres Strait Islander couple families in Victoria with young children ($1,073) was more than double that of Aboriginal and Torres Strait Islander one parent families ($510). The median weekly family income for Aboriginal and Torres Strait Islander families with young children in Glenelg Shire was $1,016 for couple families and $375 for one parent families.
Seventy three of the 79 LGA’s in Victoria were ranked on the weekly family income for Aboriginal and Torres Strait Islander one parent families with children aged 0 to 8. The Glenelg Shire was ranked 46 out of all LGA’s on the median income for Aboriginal and Torres Strait Islander one parent families with children aged 0 to 8. A rank of 1 was assigned to the LGA with the highest median income.
Opportunities That Affect Change
That the Portland Community Landcare Group is promoted as a culturally safe place for families with young children to learn the skills of community garden and role of Indigenous plants for household economy and good nutrition.
Australian Early Years Developmental Index
The Australian Early Years Developmental Index (AEDI) provides a population measure of young children's development in communities across Australia. The first AEDI assessment was conducted in 2009 and again in 2012.
The AEDI measures five areas, or domains, of early childhood development including: social competence; emotional maturity; language and cognitive skills; communication skills and general knowledge, and physical health and wellbeing.
23 | Page Table 6.1: Australian Early Years Developmental Index 2012 Results Australia, Victoria and the Glenelg Shire
LOCATION No. of Proportion of children developmentally vulnerable % children Physical Social Emotional Language Communication Vulnerable Vulnerable health competence maturity and skills and on one or on two or & well cognitive general more more being skills knowledge domains domains of of the the AEDI AEDI Australia 289,973 9.3 9.3 7.6 6.8 9.0 22.0 10.8 Victoria 67,931 7.8 8.1 7.2 6.1 8.0 19.5 9.5 Glenelg 244 8.1 8.2 6.4 5.7 9.8 25.1 9.5 Glenelg 20 10.5 15.0 10.0 20.0 20.0 47.4 15.0 Central Heywood & 31 10.0 20.0 6.7 6.7 20.0 36.7 16.7 Surrounds Portland 128 6.9 5.6 11 4.2 6.8 21.3 7.3 Portland & 44 4.9 2.9 2.6 0.0 0.0 8.3 2.8 Surrounds
The data from the previous AEDI survey collected in 2009, showed the majority of Aboriginal and Torres Strait Islander children were developmentally on track on each of the five AEDI domains, however they were more than twice as likely to be developmentally vulnerable than non- Aboriginal and Torres Strait Islander children. The proportion of Aboriginal and Torres Strait Islander children from the Glenelg Shire was also twice as likely to be vulnerable on two or more domains of the AEDI36.
In 2008, there were 7 Aboriginal and Torres Strait Islander children enrolled in four year old kindergarten in Glenelg Shire and in 2014, 10 recorded enrolments.
The Maternal and Child Health (MCH) Service is a universal primary care service for families with children from birth to school age. The service offers support, information and advice regarding parenting, child health and development, child behaviour, maternal health and well-being, child safety, immunisation, breastfeeding, nutrition and family planning.
The percentage of Aboriginal and Torres Strait Islander children seen at the 3.5 year key ages and stages visit in the Barwon South West region was 20.6 per cent, compared to 40.3 per cent across Victoria.
36 AEDI Local Government Summary Sheet 2009 DEECD 24 | Page Body Weight 0 – 9 year olds
Despite the widespread and well-documented alarm about the rising obesity epidemic for all children, being underweight is serious and possibly under-recognised problem. Being underweight for age and height also carries health risks. Low weight often indicates poor nutritional intake, which can have effect such as growth retardation, impaired mental development, and increased susceptibility to infectious diseases.
Data provided by Winda Mara Aboriginal Co-operative 37 shows the majority of children below 9 years of age who were measured at the health service were underweight ( Fig 5).
Figure 5: Body Mass Index of clients attending Winda Mara Aboriginal Co-operative Health Service38
BMI count
10
9
8
7
6 Morbid Obese 5 Overweight 4 Healthy Underweight 3
2
1
0 0 4 5 9 10 15 20 25 30 35 40 45 50 55 60 65 70 75 14 14 24 29 34 39 44 49 54 59 64 69 74 79
BMI stands for “Body Mass Index”. BMI is one measure of overweight and obesity and calculated from your weight (kg) / Height (m2). The higher you’re BMI, the higher your risk for certain diseases such as heart disease, high blood pressure, type 2 diabetes and certain cancers.
37 The figures are collected from Pencat and are from 231 active (3 x visits in 2 years) clients. These clients have identified as being Aboriginal and or Torres Strait Islander. Specific thanks to Jason Saunders for providing data from the Community Forum in 2012 38 Ibid 25 | Page Opportunities That Affect Change That the assessment and referral partnerships to identify vulnerable children in both Portland and Heywood are resourced ad supported to identify children who are underweight.
That the families of these children are connected to community, schools and services to ensure breakfast, lunch, dinner and snacks are available and provided to these children whose weight is monitored each month.
Immunisation and Asthma
In 2007-08, 100.0% of Aboriginal and Torres Strait Islander children in Glenelg were fully immunised at age group 3. This was greater than the percentage of non-Aboriginal and Torres Strait Islander children in this area who were fully immunised at age group 3 (90.2%) and greater than the percentage of Aboriginal and Torres Strait Islander children fully immunised at age group 3 in Victoria (82.3%).
Asthma is the most common long-term condition among Australian children aged under 14 years. It is also the most common cause of hospitalisation in this age group9. Asthma hospitalisations are included as part of the ambulatory care sensitive conditions for which hospitalisation are considered avoidable with the application of preventative care and early disease management.
Over the three year period from 2005-06 to 2007-08, the rate of asthma separations for Aboriginal and Torres Strait Islander children aged 0 to 8 years in the Barwon South West region was 4.6 per 1000 Aboriginal and Torres Strait Islander children aged 0 to 8 years. The rate of hospital separations for asthma across Victoria during this period was 7.7 per 1000 Aboriginal and Torres Strait Islander young children.
During 2005-08, the rate of asthma separations for Aboriginal and Torres Strait Islander children aged 0 to 8 years in Glenelg could not be derived due to small numbers. The rate of asthma separations in 2005-08 for Aboriginal and Torres Strait Islander children in the broader region of Barwon South West in which Glenelg is contained was 4.6 per 1000 Aboriginal and Torres Strait Islander children aged 0 to 8 years. This was lower than the asthma separation rate of Aboriginal and Torres Strait Islander children aged 0 to 8 years in Victoria (7.7 per 1000 Aboriginal and Torres Strait Islander children aged 0 to 8 years) and lower than the rate of asthma separations for the total population during this period (7.4 per 1000 children aged 0 to 8 years).
26 | Page Literacy and Numeracy
Poor literacy and numeracy skills can severely compromise children’s ability to engage in school learning, to undertake future learning, to be successfully employed and to positively participate in society. Students who do not attain minimum standards for literacy and numeracy in the early years of schooling may have difficulty progressing further, and are less likely to enter higher education.
Data is presented on the proportion of Year 3, 5, 7 and 9 Aboriginal and Torres Strait Islander students achieving national benchmarks for literacy and numeracy using data from the National Assessment Program —Literacy and Numeracy (NAPLAN) across Victoria39.
SNAP SHOT - NAPLAN Key findings for Aboriginal and Torres Strait Islander students in Victoria 2012
% students achieved the reading benchmark Reading Aboriginal Non Aboriginal Year 3 88 96 Year 5 83 95 Year 7 88 96 Year 9 83 94
% students achieved the reading benchmark Writing Aboriginal Non Aboriginal Year 3 91 97 Year 5 83 95 Year 7 74 92 Year 9 67 88
% students achieved the reading benchmark Spelling Aboriginal Non Aboriginal Year 3 87 95 Year 5 80 94 Year 7 84 94 Year 9 78 92
% students achieved the reading benchmark Grammar & punctuation Aboriginal Non Aboriginal Year 3 87 96 Year 5 82 95 Year 7 81 95 Year 9 72 92
39 Aboriginal and Torres Strait Islander Health Performance Framework Report, Victoria 2012 Australian Institute of Health and Welfare Jan 2014 update 27 | Page % students achieved the reading benchmark Numeracy Aboriginal Non Aboriginal Year 3 90 97 Year 5 86 96 Year 7 86 964 Year 9 80 95
Trends over time
Between 2008 and 2011 in Victoria, there was little change in the proportion of Aboriginal and Torres Strait Islander students achieving the Year 3 and 5 literacy and numeracy benchmarks.
There was however a notable increase in the proportion of Aboriginal and Torres Strait Islander Year 7 students achieving the grammar and punctuation benchmark (from 76% in 2008 to 81% in 2011), and the proportion of Year 9 students achieving the spelling benchmark (from 71.6% to 77.9%).
SNAP SHOT - Significant achievements of the Glenelg Southern Grampians Indigenous Consultative Group40
In 2010, the Glenelg Southern Grampians Indigenous Consultative Group was formed. This establishment of this Group was facilitated by the Glenelg Southern Grampians Local Learning and Employment Network (LLEN).
The LLEN partnered with the local Koori Engagement Support Officer team, Koori Transition Officer, Wurreker Broker and Koori Engagement Support Officers from across the Shire.
In 2011, the Advancing Country Towns initiative Project for Heywood, Lake Condah and surrounding towns and the Heywood District Secondary College to establish a 41 Standing Tall School Based Mentoring program in Heywood. The Standing Tall program works towards achieving an increase in the retention of students including Aboriginal and Torres Strait Islander students in school, improve careers planning for the younger cohort and build education pathways and support for the community.
In 2009, year 7 -10 retention rates were 42.9%, in 2011 50% and in 2012, 64%42.
40 Glenelg Southern Grampians Local Learning and Employment Network Report 2013 41 Funded by DPCD in nine communities across Victoria, the Advancing Country Towns Project aims to revitalise communities in rural and regional Victoria through improved coordination of investment in order to enhance prosperity and quality of life. Key priorities for the Heywood, Lake Condah program are economic development and employment, skills and training with a focus on Indigenous outcomes. 42 DEECD ATSI enrolment data LLEN Data Disk 28 | Page
Career Action Plans have now been developed for 100% of Aboriginal and Torres Strait Islander students43
The Group has delivered a three day career and aspiration program for all Aboriginal and Torres Strait Islander secondary students in the region. This three day program delivered local Aboriginal and Torres Strait Islander history, visits to culturally significant sites, career planning sessions and presentations from job services. Community members from across the region and staff from Winda Mara, DWECH, Gunditj Mirring and Glenelg Shire Aboriginal Development officer support and participate in the program.
“I believe this program assists many students at Heywood to be more committed to their education and to see the significance of making career decision. They have also appreciated making connections with Koorie adults from across age groups who are contributing to making a difference in their communities.
I believe that this role modelling is making a real difference to how our students value their education (by seeing it in a more positive light; as a means to an end). They have benefited from hearing diverse community members reflect on the importance of education in enabling them to have meaningful roles in life as contributors to society… I can see that this sort of program, early in their schooling, is having an impact on students generally making more positive choices and seeing the purpose of their attendance and participation in learning”44.
43 Local school data 44 Heywood and District School, Koori Education Support Officer 29 | Page EDUCATION
Education is an important social determinant of health. Those with higher levels of education tend to have better health, higher incomes and stronger social relationships. Education has a dual role, first the aspect of learning and also the social benefits of participation and finally the economic benefits.
Poor education has exacerbated the social disadvantage of people and limited the life opportunities for their children. Improvements in education helps all Australians to increase access to employment, transport, secure housing, health promoting lifestyles, improved levels of health literacy and choices regarding how and when to access to medical care.
Aboriginal and Torres Strait Islander attendance at an educational institution in the Glenelg Shire45
Numbers of Aboriginal and Torres Strait Islander students in Glenelg Shire are well above state and national averages. Numbers drop off in later years with relatively few young Aboriginal and Torres Strait Islander people completing Year 12 in school. Retention of Aboriginal and Torres Strait Islander students requires continued effort from the community and its partners in education. In comparison to the overall retention rate of students in Glenelg and Southern Grampians in 2010 the Year 7-Year 12 retention rate of students self-identifying as Aboriginal and Torres Strait Islander was only 30%46.
Table 7: 2005-2012 Aboriginal and Torres Strait Islander (ATSI) full time equivalent enrolments in Glenelg Secondary Schools47
Year 7 Year 8 Year 9 Year 10 Year 11 Year 12 Ungraded Special Totals 2005 8 11 6 4 5 3 0 0 37 2006 7 7 10 5 3 2 0 0 34 2006 12 7 6 11 1 2 0 0 39 2008 10 8 5 7 9 1 0 0 40 2009 8 5 11 2 4 6 0 0 36 2010 7 8 6 7 2 2 0 0 32 2011 11 9 8 5 7 0 0 0 40 2012 8 11 10 7 4 5 0 2 47
45 GSGLLEN Environmental Scan 2013 - ABS Indigenous Profile, Census 2011, Type of Educational Institution Attending by Indigenous Status by Sex 46 GSGLLEN Environmental Scan 2014 Draft Material 47 Ibid adapted 30 | Page In 2011 there were no Aboriginal and Torres Strait Islander students enrolled in Year 12 in the Glenelg Shire even though the number of Aboriginal and Torres Strait Islander students enrolled in secondary school overall was at its highest level in this year. • Comparing total number of Aboriginal and Torres Strait Islander students enrolled in secondary school in 2005 with 2011 shows an increase of 51%; • The pattern of change in Aboriginal and Torres Strait Islander secondary enrolments has been fluctuation with a trend resulting in an increase in numbers in 2011 compared with 2005; and • It should be noted that it is not known whether the increase is due to a real growth in the Aboriginal and Torres Strait Islander population or a change in the number of people identifying themselves as Aboriginal and/ or Torres Strait Islander.
Table 8: Aboriginal and Torres Strait Islander attendance at an educational institution48
Glenelg Males Females Persons Pre-school 5 8 13 Infants/Primary 38 36 74 Secondary 22 19 41 Technical or Further Educational Full-time student: Aged 15-24 years 0 0 0 Aged 25 years and over 0 3 3 Part-time student: Aged 15-24 years 3 0 3 Aged 25 years and over 3 8 11 Full/Part-time student status not stated 0 0 0 Total 6 11 17 University or other Tertiary Institution: Full-time student: Aged 15-24 years 0 0 0 Aged 25 years and over 0 3 3 Part-time student: Aged 15-24 years 0 0 0 Aged 25 years and over 0 0 0 Full/Part-time student status not stated 0 0 0 Total 0 3 3 Other type of educational institution 0 7 7 Type of educational institution 15 20 35 not stated Total 86 104 190
48 ABS Indigenous Profile, Census 2011, Type of Educational Institution Attending by Indigenous Status by Sex (Table I 05) for Glenelg
31 | Page Kindergarten and School Participation
Figure 6: Pre-school to Secondary School Participation across the Glenelg Shire
Pre school - School Participation 40 35 30 25 20 Males 15 Females 10 5 0 Pre-school Infants/Primary Secondary
Technical or Further Education Participation
Figure 7: Technical or Further Education Participation across the Glenelg Shire
Technical and Further Education Participation 9 8 7 6 5 Aged 15-24 years 4 Aged 25 years and over 3 2 1 0 Males Females
Longitudinal studies show that people who go on to higher education (universities, colleges of advanced education, and other tertiary institutions) and graduate with a degree or diploma are more likely to obtain full-time work and earn higher incomes compared with those who do not. Likewise people who complete a course at a Technical and Further Education (TAFE) institution are more likely to be employed after the completion of their course than they were before.
32 | Page Those undertaking TAFE education who are already employed are more likely to receive a promotion and/or an increase in income after completion of their TAFE course49.
Highest year of school completed by Aboriginal and Torres Strait Islander status for Glenelg 201150
Glenelg Shire's school completion data is a useful indicator of socio-economic status. With other indicators, such as Proficiency in English, the data informs planners and decision-makers about people's ability to access services.
Combined with Educational Qualifications it also allows assessment of the skill base of the population. Table 9: Highest years of school completed
Aboriginal and Non Aboriginal and Torres Torres Strait Strait Islander Islander Year 12 or equivalent 52 22% 4,425 31.3% Year 11 or equivalent 46 19.7% 2,754 19.5% Year 10 or equivalent 62 26.5% 3,266 23% Year 9 or equivalent 33 14% 1,522 10.8% Year 8 or below 22 9.4% 1,493 10.5% Did not go to school 0 38 2.7% Highest year of school not 19 8.2% 659 4.7% stated TOTAL 234 14,157
Figure 8: Highest level of school education across the Glenelg Shire
Highest school education completed (%) 40 35 30 25 20 15 10 5 Indigenous 0 Non Indigenous
49 Overcoming Indigenous Disadvantage Steering Committee for the Review of Government Service ProvisionSCRGSP 2007 50 GSGLLEN Environmental Scan 2013 Source: ABS Indigenous Profile, Census 2011, Type of Educational Institution Attending by Indigenous Status by Sex 33 | Page 2011 census data (Table 9) shows that of the population of stated Aboriginal and/ or Torres Strait Islander status who were aged 15 years and over and who were no longer attending primary or secondary school in Glenelg: 50% had completed year 10 or below; 19.7% had completed year 11; 22% had completed year 12 ; 8% were not stated.
The percentage of those who completed year 12 is lower than the non-Aboriginal population of whom 31.3% had completed year 12.
SNAP SHOT - The work of the Great South Coast Local Learning Employment Partnership
Between the period 2006- 2011 Glenelg Shire went from being the second highest to the 47th highest level of youth disengagement in the state (per 78 LGA’s).
During these five years, the number of disengaged young people dropped from 132 in 2006 to 72 in 20111. This is testament to the significant impact the Portland re-engagement and other collaborative initiatives are having at a local level.
The Glenelg Shire’s Municipal Health and Wellbeing Plan outlines its commitment to education and lifelong learning. “Lifelong learning is a way of life in the Glenelg Shire.”
This Plan has listed its actions as follows : providing support for vulnerable families in the early years; developing a Learning Community Strategy; increasing opportunities for lifelong learning; building capacity of early years workforce; providing flexible community based education opportunities and improving educational attainment of young people.
34 | Page Opportunities That Affect Change Ensure the interests of year 12 attainment for Aboriginal and Torres Strait Islanders are included in the Great South Coast Yr 12 attainment project.
Develop an “Education Attainment” working group of the Glenelg Partnership, include Kindergarten, P-12 schools to develop a collaborate, cultural and learning partnership approach to: • Help community to understand the importance of education, new opportunities and pathways and to have higher expectations of their children; • Support parents and children to transition well into kindergarten, primary and secondary school; • Know about and support the Portland Secondary re-Engagement Program; • Help teachers to understand and respond to community aspirations and cultural priorities.
That the Council consider developing a Vulnerable Children and Families Strategy with consideration to the recommendations of the Protecting Victoria’s Vulnerable Children Inquiry tabled in Parliament 2012 including policy, program design and delivery for addressing vulnerability and protecting children and young people51.
LLEN Koori career aspirations day 2013 Left to Right Tim Church, Greg Kennedy, Laura Lovett-Murray, John Bell, Thomas Day
51 Protecting Victoria’s Vulnerable Children Inquiry Victorian Government 2012 35 | Page EMPLOYMENT
Ensuring there is a place in the workforce for Aboriginal and Torres Strait Islander people across the Glenelg Shire would improve health outcomes for those employed and their families as well as the economic and workforce sustainability for the Shire. The Aboriginal and Torres Strait Islander population is growing faster than non –Aboriginal and Torres Strait Islander. With over 50% of the population is between 25 and 65 years, the potential for the Aboriginal and Torres Strait Islander community to contribute to the workforce sustainability across the Glenelg Shire cannot be overlooked.
In 2006, the Australian Council for Educational Research (ACER) analysed the major barriers to employment with SED Consulting following up with consultation to gain community perspectives on the findings52.
Key barriers outlined in the literature review were summarised as: • low levels of formal education and training; • discrimination and racism; • a high concentration in the younger age groups; and • especially in remote locations, a lack of conventional employment opportunities.
Additionally the report highlighted a number of key drivers for improved employment outcomes, these included: • consultation and partnerships with Aboriginal and Torres Strait Islander communities – this is the most important issue to be understood if Aboriginal and Torres Strait Islander employment strategies are to be successful • developing a clear framework for monitoring and evaluation based on key performance indicators including: capacity building and pathways; recruitment; induction and retention; career development; workplace culture; and Aboriginal and Torres Strait Islander community organisations • education and training – including the provision of scholarships, cadetships, traineeships, apprenticeships, in-service professional development and training, time allowance for further study • workplace practices –that give appropriate attention to recruitment processes; mechanisms for career development; flexibility; cultural awareness training • leadership– that is meaningful, purposeful, and visionary and which operates at all levels.
52 Enhancing employment opportunities for Indigenous Victorians : a review of the literature.Australian Council for Educational Research (ACER) 2006 36 | Page The community consultation process highlighted that the large majority of barriers faced by Aboriginal and Torres Strait Islander Australians are not dissimilar to that of the mainstream community although the complexity of each Aboriginal and Torres Strait Islander individual’s case is a result of the multitude of barriers faced, further effected by the entrenched stigma and experiences faced by Aboriginal and Torres Strait Islander people both in employment and broader social justice context.
Specifically the barriers discussed included:
• Multiple disadvantage experienced by Aboriginal people was a key theme that emerged. This included poor education and training outcomes (including literacy and numeracy skills as well as lack of requisite vocational skills – i.e. work readiness), lack of affordable access to childcare, transport (including lack of appropriate public transport to get to jobs, access to private vehicles and no license) and impact of poor health and housing
• Racism and discrimination which in part was related to a perception that Aboriginal and Torres Strait Islander people could only work in Aboriginal organisations/areas
• Lack of employment opportunities
• Lack of engagement with Aboriginal and Torres Strait Islander communities particularly in both funded service provision positions as well as support for self-employment (enterprise development)
• Isolation experienced when being the only Aboriginal and Torres Strait Islander (or one of few) people working in a non-Aboriginal and Torres Strait Islander workplace. As such there appeared to be a preference for working in the Aboriginal and Torres Strait Islander community sector which was seen to have a better level of cultural understanding and support. This perception needed to be considered against tradeoffs such as low job security, lack of career advancement and high staff turnover
• The need for intensive employment assistance for people engaged in the justice system.
37 | Page SNAP SHOT - Race Based Discrimination53
Race-based discrimination can be defined as ‘those behaviours and practices that result in avoidable and unfair inequalities across groups in society based on race, ethnicity, culture or religion’. Individuals can experience multiple forms of discrimination such as: racist taunts and insults, physical violence, being refused service in shops and poor expectation of academic ability at school, differential treatment in hospital care.
The experience of discrimination has a negative impact on health and wellbeing and is known to be associated with poor mental health, physical health and self-rated health. It is particularly associated with an increased risk of anxiety and depression and has possible associations with diabetes, obesity and cardiovascular disease. For example, Aboriginal and Torres Strait Islander Australians are three times less likely to receive kidney transplants than other Australians with the same level of need.
There are four main pathways through which racism can affect ill health: • reduced access to the societal resources required for health (e.g. employment, education, housing, health care); • negative self-esteem and self-worth leading to mental ill health; stress and negative emotion reactions which lead to mental ill health as well as affecting the immune, endocrine and cardiovascular systems; and maladaptive responses to racism such as smoking, alcohol and other drug use54.
Paradies et al (2008) demonstrated strong evidence that systemic racism leads to reduced opportunities to access societal resources required for health. While there is little research that quantifies the health effects of systemic racism, Paradies et al. (2008) identified several studies in Australia which suggest that racism impacts on health care delivery56.
53 Ethnic and race-based discrimination as a determinant of mental health and wellbeing (VicHealth 2007) and Building on our strengths: a framework to reduce race-based discrimination and support diversity in Victoria (VicHealth 2009) at www.vichealth.vic.gov.au/publications.
54Paradies, V, Harris, R and Anderson ,I ( 2008) The Impact of Racism on Indigenous Health in Australia and Aotearoa: Towards a Research Agenda Yin Paradies • Ricci Harris • Ian Anderson Discussion Paper Series: No. 4 Co-operative Research Centre for Aboriginal Health 38 | Page In addition to the identified barriers, a number of drivers were identified. Many of these were consistent with the findings of the literature review. In summary these were:
• Education and training initiatives (scholarships, cadetships, traineeships, apprenticeships, pre- employment programs and professional development for existing staff) including establishing relationships with schools and tertiary institutions to promote employment opportunities and provide advice
• Establishment of Aboriginal and Torres Strait Islander Employment Officers to address the need for job preparation/readiness skills as well as providing practical group training, individual mentoring, organisation cross cultural programs and support a culturally appropriate workplaces
• Mentoring: "It’s no point in setting someone up to fail". This included the provision of explicit support to employees and employers and use of Aboriginal and Torres Strait Islander role models to share their experiences
• Work place initiatives such as a buddy system -placement of more than one Aboriginal and Torres Strait Islander person in a workplace and creation of an Aboriginal and Torres Strait Islander Employment Network to assist in addressing the issue of isolation
The following tables present employment data for Aboriginal and Torres Strait Islander men and women across the Shire.
Table 10: Labour Force Status by Age and sex for Aboriginal and Torres Strait Islander Persons – Male55 Age 15-24 25-34 35-44 45-54 55-64 65 years years years years years years and over Total Employed: Worked full-time 6 12 12 18 3 0 51 Worked part-time 0 4 6 3 0 0 13 Away from work 0 0 0 0 0 0 0 Total 6 16 18 21 3 0 64 Unemployed 11 0 0 0 0 0 11 Total labour force 17 16 18 21 3 0 75
Not in the labour force 8 3 9 8 7 4 39 Labour force status not 0 0 3 0 0 0 3 stated
Total 25 19 30 29 10 4 117
55 ABS Indigenous Profile, Census 2011 39 | Page
Figure 9: Employment Status Aboriginal and Torres Strait Islander men across the Glenelg Shire56
Employment Status - Male 60 50 40 30 20 10 Employment Status - 0 Male
Table 11: Labour Force Status by Age and sex for Aboriginal and Torres Strait Islander Persons – Female57
Age 15-24 25-34 35-44 45-54 55-64 65 years years years years years years and over Total Employed: Worked full-time(a) 7 7 7 10 0 0 31 Worked part-time 3 9 5 3 3 3 26 Away from work(b) 3 0 0 0 0 0 3 Total 13 16 12 13 3 3 60 Unemployed 0 3 0 3 0 0 6 Total labour force 13 19 12 16 3 3 66
Not in the labour force 14 14 5 13 6 7 59 Labour force status not 3 3 3 0 0 0 9 stated
Total 30 36 20 29 9 10 134
56 ABS Indigenous Profile, Census 2011 57 ABS Indigenous Profile, Census 2011 40 | Page
Figure 10: Employment Status Aboriginal and Torres Strait Islander women across the Glenelg Shire58
Employment Status - Female 70 60 50 40 30 20 10 Employment Status - 0 Female
Opportunities That Affect Change • That the Glenelg Council establish a "whole-of-community" strategic framework for coordinating and sustaining efforts to achieve a greater representation of Aboriginal people across all areas of Council
• That the Glenelg partnership develop an “Employment” working group of the Glenelg Partnership, including Service Clubs and Business representatives groups and the LLEN to:
o Showcase careers to year 8 and above students and their families; o Showcase career pathways increasing awareness in VCAL and VET pathways into health; children’s services and Logistics for example;
o Create scholarship and trainee ship opportunities within Council; o Provide leadership across the Glenelg Shire to create Aboriginal employment opportunities;
o Assist business across the Shire to provide workplaces free of racism and discrimination.
58 ABS Indigenous Profile, Census 2011 41 | Page INCOME
Low income is associated with a wide range of disadvantages including poor health, shorter life expectancy, poor education, substance abuse, reduced social participation, crime and violence. Most careful studies show a positive (though non-linear) relationship between income and most measures of wellbeing. Furthermore, stable, well-paid employment remains one of the key protective factors against poverty and social exclusion59.
There are several competing explanations as to how income affects socioeconomic status and the reason why low income contributes to poor health. Disparity in income is one aspect of socioeconomic status through which some Aboriginal people face disadvantage. Income is closely linked to other measures but most particularly employment status, single-parent families and educational attainment.
Households form the common 'economic unit' in our society. Glenelg Shire's Household Income is one of the most important indicators of socio-economic status. With other data sources, such as Educational Qualifications and Occupation, it helps to reveal the economic opportunities and socio-economic status of Glenelg Shire.
Figure 11: Weekly Household Income for home with Aboriginal and Torres Strait Islander people across Victoria60
Weekly Household Income for homes with indigenous persons 30 20 10 Weekly Household 0 Income for homes with indigenous persons $3,000… $1,000-… $1,250-… $1,500-… $2,000-… $2,500-… $1-$199 Negative… $200-$299 $300-$399 $400-$599 $600-$799 $800-$999
The large disparity in Aboriginal and Torres Strait Islander peoples’ income compared with the non- Aboriginal and Torres Strait Islander population has important implications for health. These include the capacity to access goods and services required for a healthy lifestyle, including adequate nutritious food, housing, transport and health care. Other factors that may exacerbate the situation faced by low income households include resource commitments to extended families and visitors 61.
59 Aboriginal and Torres Strait Islander Health Performance Framework 2010. DoHA Canberra 60 ABS Indigenous Profile, Census 2011 61 Aboriginal and Torres Strait Islander Health Performance Framework 2010. DoHA Canberra 42 | Page
Table 12: Weekly household incomes for home with Aboriginal and Torres Strait Islander persons62
Households with Other Total Aboriginal and Torres households households Strait Islander person(s)(b)
Negative/Nil income 5 93 98 $1-$199 9 125 134 $200-$299 10 282 292 $300-$399 9 735 744 $400-$599 24 990 1,014 $600-$799 27 805 832 $800-$999 22 668 690 $1,000-$1,249 20 600 620 $1,250-$1,499 13 531 544 $1,500-$1,999 16 781 797 $2,000-$2,499 9 469 478 $2,500-$2,999 3 325 328 $3,000 or more 6 340 346 Partial income stated(c) 13 528 541 All incomes not stated(d) 9 247 256
Total 195 7,519 7,714 (a) Excludes 'Visitors only' and 'Other non-classifiable' households. (b) A household with Aboriginal and Torres Strait Islander person(s) is any household that had at least one person of any age as a resident at the time of the Census who identified as being of Aboriginal and/or Torres Strait Islander origin (c) Comprises households where at least one, but not all, members aged 15 years and over did not state an income, and/or was temporarily absent on Census Night. (d) Comprises households where no members present stated an income.
62 ABS Indigenous Profile, Census 2011 43 | Page PART E - SOCIAL AND EMOTIONAL WELL BEING
Aboriginal and Torres Strait Islander Life Expectancy 63 Aboriginal and Torres Strait Islander people experience significant levels of disadvantage and hardship with the most telling indicator of this disadvantage that on average, life expectancy of Aboriginal and Torres Strait Islander people nationally is 10.5 years less than non-Aboriginal and Torres Strait Islander people. On average, Aboriginal and Torres Strait Islander males live 67.2 years, 11.5 years less than their non-Aboriginal and Torres Strait Islander peers, women live 72.9 years, 9.7 years less 64.
Across Australia, causes for lower life expectancy include: poverty, poor health, nutrition and housing, dispossession of their traditional lands, low education level, high unemployment, hidden racism and inability of politicians to address Aboriginal problems65.
Eighty percent of the life expectancy gap can be attributed to chronic diseases such as heart disease (22%), diabetes (12%) and liver disease (11%) 66.
It is estimated that more than six years of the life expectancy gap could be removed if Aboriginal and Torres Strait Islander people experienced the same level of cardiovascular health as non- Aboriginal and Torres Strait Islander people. Aboriginal and Torres Strait Islander people are more likely to die from a heart attack without being admitted to hospital. They are also more than twice as likely to die even if admitted to hospital 67, have a significantly lower chance of receiving key investigations and treatments for heart disease such as angiography, angioplasty or bypass surgery. There is also evidence for low compliance to medication making a contribution to cardiovascular events due to numeracy and literacy levels and poor health literacy68.
Hospital Admissions All Victorian public hospitals submit admission data to the central Victorian Admitted Episodes Dataset (VAED). Admission data reflects the total number of admission episodes to hospital over time, not the number of individuals admitted. One person may have multiple admissions over time.
63 http://www.creativespirits.info/aboriginalculture/health/aboriginal-life-expectancy#toc1#ixzz2mvwo8800 64 Aboriginal and Torres Strait Islander Health Performance Framework 2010. DoHA Canberra 65 http://www.creativespirits.info/aboriginalculture/health/aboriginal-life-expectancy#toc1#ixzz2mvwo8800 66 Aboriginal and Torres Strait Islander Health Performance Framework 2010. DoHA Canberra 67 AIHW 2006, Aboriginal and Torres Strait Islander people with coronary heart disease: further perspectives on health status and treatment, Australian Institute of Health and Welfare, Canberra 68 Aboriginal and Torres Strait Islander Health Performance Framework 2010. DoHA Canberra 44 | Page VICTORIAN HOSPITAL ADMISSIONS Between 2010–11 and 2011–12 Aboriginal and Torres Strait Islander recorded admissions to hospital increased state-wide by 2,433 representing a 14.6% increase and in emergency presentations by 1,038, or 5.4%. Admissions for renal dialysis continue to grow and make up a high proportion of all admissions with 34.4% of all Aboriginal and Torres Strait Islander admissions and 17.9% of all non- Aboriginal and Torres Strait Islander admissions. Diabetes continues to be a significant health problem for Aboriginal and Torres Strait Islander people, occurring at three times the rate that it does for non-Aboriginal and Torres Strait Islander people with diabetes related Aboriginal and Torres Strait Islander admissions increasing by 22% between 2008–09 and 2011–12.
Aboriginal and Torres Strait Islander rates of presentation to hospital emergency departments are almost double those for non-Aboriginal and Torres Strait Islander people. They are higher in all age groups, especially in the 35–54 age range which is almost three times that of non-Aboriginal and Torres Strait Islander people.
Mental health related admissions have increased from 764 in 2010–11 to 868 in 2011–12. Aboriginal and Torres Strait Islander rates of admission are higher than non-Aboriginal and Torres Strait Islander rates for all age groups except those aged over 65 years. Children (0–14 years) are commonly admitted for injury/poisoning and respiratory diseases, younger adults (15–34 years) for injury/poisoning and general symptoms; older adults (35–54 years) for injury/ poisoning and digestive diseases; and the elderly (55+) for general symptoms and injury/poisoning.
Table 13: Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander admissions 2009-1- to 2011 to 201269
Hospital 2009-2010 2010-2011 2011-2012 Aboriginal Non Aboriginal Non Aboriginal Non & Torres Aboriginal & & Torres Aboriginal & & Torres Aboriginal Strait Torres Strait Strait Torres Strait Strait & Torres Islander Islander Islander Islander Islander Strait Islander Portland 238 4,204 179 4,090 254 4,672 Heywood Casterton Data numbers are too small to be released70
Hamilton 51 6,569 102 7415 180 7201 Warrnambool 250 17,457 305 19,119 332 20,519
69 Koori Health Counts Victorian Hospital Data 2011-2012 70 Personal Communication Ann Margeson Barwon South West Department of Health January 2014 45 | Page Across Victoria, chronic diseases (for example, circulatory disease, cancer, diabetes, respiratory disease, kidney disease) were the cause of a large proportion of Aboriginal and Torres Strait Islander hospitalisations in Victoria between 2008–09 and 2009–10. Aboriginal and Torres Strait Islander people were hospitalised at twice the rate of non- Aboriginal from diabetes and almost twice the rate from respiratory diseases.
Diabetes was 3 times more prevalent among the Aboriginal and Torres Strait Islander population than the non-Aboriginal and Torres Strait Islander population in Victoria based on data from the 2004–05 NATSIHS71.
Hospitalisations for assault were nearly 5 times the rate for non-Aboriginal and Torres Strait Islanders during 2008–10. Aboriginal and Torres Strait Islanders were nearly 3 times as likely to be hospitalised for intentional self-harm as non-Aboriginal and Torres Strait Islanders in Victoria72.
Need for Assistance In 2008 and across Australia, an estimated 8% of Aboriginal and Torres Strait Islander adults had a profound or severe core activity limitation. The level of need for assistance among Aboriginal and Torres Strait Islander Australians was more than twice as high as that among non-Aboriginal and Torres Strait Islander Australians with physical disability the most common disability type experienced by Aboriginal and Torres Strait Islander Australians.
Glenelg Shire's disability statistics relate directly to need for assistance due to a severe or profound disability i.e. those who need help with at least one core activity (self-care, mobility or communication) some or all of the time. The need for assistance with core activities increases with age for all people however Aboriginal and Torres Strait Islander people experience increasing rates of disability at younger ages. In 2008, and across Australia the proportion of people with disability or long-term health condition was similar for males (48%) and females (51%). The corresponding data for the Glenelg Shire do not reflect the national data with only 7 males over 45 years (41%) and no females of the same age requiring assistance73.
71 Aboriginal and Torres Strait Islander Health Performance Framework Report, Victoria 2012 Australian Institute of Health and Welfare 72 Ibid page 13 73 ABS Indigenous Profile, Census 2011 46 | Page
Table 14: Core Activity Need for Assistance by Age and sex for Aboriginal and Torres Strait Islander Persons –Male74
Has need Does not Need for Total for have assistance assistance need for not stated assistance 0-4 years 0 15 3 18 5-14 years 3 53 0 56 15-19 years 0 13 0 13 20-24 years 0 10 0 10 25-34 years 0 20 0 20 35-44 years 0 26 5 31 45-54 years 4 26 0 30 55-64 years 3 8 0 11 65 years and over 3 3 0 6 Total 13 174 8 195
Table 15: Core Activity Need for Assistance by Age and sex for Aboriginal and Torres Strait Islander Persons –Female75
Has need Does not Need for Total for have assistance assistance need for not stated assistance 0-4 years 3 18 0 21 5-14 years 0 54 4 58 15-19 years 0 16 3 19 20-24 years 0 10 3 13 25-34 years 6 30 0 36 35-44 years 0 19 0 19 45-54 years 0 29 0 29 55-64 years 0 9 0 9 65 years and over 0 8 0 8
Total 9 193 10 212
74 ABS Indigenous Profile, Census 2011 75 ABS Indigenous Profile, Census 2011 47 | Page SELECTED HEALTH RISK AND PROTECTIVE FACTORS
Self-Assessed Health Self-assessed health status has been shown to be a reliable predictor of ill-health, future healthcare use and premature mortality, independent of other medical, behavioural or psychosocial risk factors.
When adjusted for age differences, self-assessed health reveals that across Australia, Aboriginal and Torres Strait Islander people are twice as likely as non-Aboriginal and Torres Strait Islander people (30 per cent compared with 15 per cent) to perceive that their health is only fair or poor. In 2012, the first release of data from the National Aboriginal and Torres Strait Islander Health Study compared self-assessed health status within Australia. Glenelg Shire forms part of the analysis co- hort “outer regional”.
In 2012–13, around two in five (39%) Aboriginal people aged 15 years and over assessed their health as excellent or very good (13% and 26% respectively). A further 36% reported good health and 25% rated their health as fair or poor (18% and 7% respectively). Males were more likely than females to have reported excellent or very good health (43% compared with 36%). Similar proportions of males and females rated their health as fair or poor (24% compared with 26%).
Differences between the Australian and outer regional cohort of Aboriginal people were not significant.
Figure 12: Self Assessed Health Status76
Self-assessed health status (%)
Fair/poor
Poor
Fair
Good Australia Outer regional Excellent/very good
Very good
Excellent
0.0 10.0 20.0 30.0 40.0 50.0
76 Profile of Health Australia 2011-2013 (4338.0) 48 | Page How these rates compare with rates for non-Aboriginal and Torres Strait Islander people?
After adjusting for differences in age structure between the two populations, Aboriginal and Torres Strait Islander people aged 15 years and over were around half as likely as non-Aboriginal people to have reported excellent or very good health Conversely, the proportions of Aboriginal and Torres Strait Islander people with fair or poor health were at least twice as high as the comparable rates for non-Aboriginal people.
Psychological Distress The 2012-2013 release of results from the National Aboriginal and Torres Strait Islander Health Survey provide for the first time in Australia the data on psychological distress, based on the Kessler 10 (K10) psychological distress scale77.
Across Australia, nearly one in every three Aboriginal and Torres Strait Islander adults experienced high levels of psychological distress; more than twice the rate for non-Aboriginal and Torres Strait Islander Australians. 78 Rates were particularly high among victims of violence (46%), people with a disability or long-term health condition (43%), and those who had experienced discrimination (44%) or removal from their natural family (39%). Despite high rates of psychological distress, the majority (72%) of adults reported being happy all or most of the time. Rates were higher among those living in remote areas (78%) than non-remote areas (71%).
Almost one in four Aboriginal Victorians (22%) had high or very high psychological distress levels, almost twice that of non‑Aboriginal Victorians (11.3%). High or very high levels of psychological distress are a significant risk factor for depression and anxiety. Almost 35% of Aboriginal and Torres Strait Islander Victorians, compared with 20%t of non-Aboriginal and Torres Strait Islander Victorians, had ever been diagnosed by a doctor with depression or anxiety. In turn, depression and anxiety puts individuals at greater risk of various chronic diseases such as cardiovascular disease and possibly certain cancers, albeit that causality is notoriously difficult to prove79. There is a significantly higher prevalence of cancer and heart disease among Aboriginal and Torres Strait Islander Victorians compared with non-Aboriginal and Torres Strait Islander Victorians.
77 The Kessler Psychological Distress Scale (K10) is a set of 10 questions designed to measure the level of psychological distress 78 Prevalence of Psychological Distress in Aboriginal and Torres Strait Islanders http://www.abs.gov.au/ausstats/[email protected]/mediareleasesbytitle/3C18155D35250456CA2574390029C0E5?OpenDocument 79 National Cancer Institute 2011). 49 | Page
Figure 13: Factors that contribute to psychological distress80
ADVERSE SYSTEMIC Prevention is key, however when addressed many correlates may LIFE DISCRIMINATION reduce or cease. EVENTS Spiritual, Disproportionate land, grief numbers of Child and loss notifications, removal, Trauma, investigations, injury, poverty, ill substantiations of child problem health abuse, neglect gambling, Violence, racism Disproportionate suicide numbers of juvenile Distress, justice supervision aggression, orders Health alcohol, Behaviours drugs INCREASING violence PSYCHOLOGICAL Serious DISTRESS Psychological Distress High rates of morbidity and mortality due to Poor SEWB poor quality health High prevalence services mental health, Chronic disease
depressions early morbidity & Disproportionate and anxiety mortality numbers in jail disorders
Lack of Social & Emotional Well Being Services
Long Term Health Conditions A long-term condition is defined as a condition that is current and has lasted, or is expected to last, for 6 months or more.
80 Adapted from Kelly, K., Dudgeon, P., Gee, G. & Glaskin, B. (2010) Living on the Edge: Social and Emotional Wellbeing and Risk and Protective Factors for Serious Psychological Distress Among Aboriginal and Torres Strait Islander People, Discussion Paper No. 10, Cooperative Research Centre for Aboriginal Health, Darwin
50 | Page Figure 14: Number of long term health conditions –Australia wide81
Number of long term health conditions (%)
Three or more
Two Australia One Outer regional
No current long-term health condition
0.0 10.0 20.0 30.0 40.0
Selected current long term health problems
Figure 15: Type of long term health conditions –Australia wide82
Selected Long Term Health Problems (%)
Osteoporosis Malignant neoplasm (cancer) Kidney disease Heart and circulatory… Eye/sight problems Australia Ear/hearing problems Outer regional Diabetes/high sugar levels Back pain/problem, disc disorder Asthma Arthritis
0.0 10.0 20.0 30.0 40.0
81 Profile of Health Australia 2011-2013 (4338.0) 82 Profile of Health Australia 2011-2013 (4338.0) 51 | Page Diabetes
Diabetes is a long-term (chronic) condition that can damage various parts of the body due to high glucose levels. In 2012–13, across Australia the prevalence of diabetes/high sugar levels in the Aboriginal and Torres Strait Islander population ranged from about 7% in major cities and inner regional areas to 12% in very remote areas83. Aboriginal and Torres Strait Islander people are also more than three times as likely as non-Aboriginal and Torres Strait Islander people to have diabetes/high sugar levels.84 Rates for diabetes/high sugar levels among Aboriginal and Torres Strait Islander people were between three and five times as high as the comparable rates for non- Aboriginal and Torres Strait Islander people in all age groups from 25 years and over.
Diabetes can lead to life-threatening health complications, some of which may develop within months of diagnosis, while others may take years to develop. Complications of diabetes include disease of the large blood vessels, which can cause heart disease and stroke, and disease of the small blood vessels, which can cause eye disease and nerve disease to the kidney and lower limbs and feet. Diabetes is also known to have adverse effects on pregnant women and their babies.
Prevention, early detection and better management of diabetes will be important in closing the gap in life expectancy. For many Aboriginal and Torres Strait Islander people, diabetes is not diagnosed until after complications have developed; when diagnosis occurs in the presence of end-stage disease it results in higher death rates, a greater dependency on tertiary level care, and higher health care costs.
Data is presented on the self-reported prevalence of diabetes for Aboriginal and Torres Strait Islander Australians using data from the 2004–05 NATSIHS85, as well as hospitalisation rates for persons diagnosed with diabetes. This data source is considered more reliable than data collected by the Victorian Population Health Survey due to the insufficient sample size of Aboriginal and Torres Strait Islander people in the Victorian data.
83 ABS National Aboriginal and Torres Strait Islander Population Health Survey 2012-13 84 ibid 85 ABS National Aboriginal and Torres Strait Islander Population Health Survey 2004-05 52 | Page Key findings for Aboriginal and Torres Strait Islander people living in Victoria 3.5% of males and 5.5% of females reported diabetes or high sugar levels. After adjusting for differences in age structure, Aboriginal and Torres Strait Islander people were 3 times as likely to report diabetes or high sugar levels as non-Aboriginal and Torres Strait Islander people in Victoria. Prevalence of diabetes was highest among Aboriginal and Torres Strait Islander and non- Aboriginal and Torres Strait Islander people aged 55 and over (35% and 11% respectively)86
86 Aboriginal and Torres Strait Islander Health Performance Framework Report, Victoria 2012 Australian Institute of Health and Welfare Jan 2014 update 53 | Page PART F - LIFE STYLE RISK FACTORS Overweight and Obesity Being overweight or obese is an important risk factor for developing type 2 diabetes, cardiovascular disease, hypertension, certain cancers, sleep apnoea and osteoarthritis.
In 2008, 45.6% of males and 26.0% of females in the Glenelg Shire (Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander) were overweight, similar to Victorian males and females (39.9% and 24.2% respectively). Approximately one in four males (25.4%) and 22.9% of females in the Shire were obese, higher than Victorian males and females (17.3% and 16.1% respectively). Males in the Shire were also more likely to be overweight compared with females in the Shire.
While cultural differences on overweight and obesity are not available at the LGA level, for Victoria there were no statistically significant differences between Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander people in body weight status. There was a substantially higher prevalence in obesity for Aboriginal and Torres Strait Islander men and women compared with their non‑Aboriginal and Torres Strait Islander counterparts.
Smoking Tobacco use increases the risk of chronic disease, including cardiovascular disease, certain cancers, and lung diseases. Tobacco use is also a risk factor for complications during pregnancy and is associated with preterm birth, low birth weight babies, and perinatal death.
In 2003, tobacco use was the leading cause of burden of disease and injury among Aboriginal and Torres Strait Islander people, responsible for 12% of the total burden of disease across Australia. Tobacco use accounted for one-in-five deaths in the Aboriginal and Torres Strait Islander population87.
In 2008, 46% of Aboriginal and Torres Strait Islander people aged 15 and over in Victoria were current daily smokers, which was almost 3 times the rate for non-Aboriginal and Torres Strait Islander people. In 2009 in Victoria, 44% of Aboriginal and Torres Strait Islander mothers smoked during pregnancy. Although this was lower than the proportion of Aboriginal and Torres Strait Islander mothers who smoked nationally (52%), Aboriginal and Torres Strait Islander mothers were more than 3 times as likely as non-Aboriginal and Torres Strait Islander mothers to smoke during pregnancy in Victoria88.
87 Factors contributing to Indigenous health http://www.healthinfonet.ecu.edu.au/health-facts/overviews/health-risk- factors#fnl-45 Accessed December 2013 88 Aboriginal and Torres Strait Islander Health Performance Framework Report, Victoria 2012 Australian Institute of Health and Welfare 54 | Page Environmental Tobacco Smoke Environmental tobacco smoke (passive smoking) is of notable concern to health, with children particularly susceptible to problems that include middle ear infections, asthma, and sudden infant death syndrome.
Environmental tobacco smoke, or passive smoking, is a significant cause of morbidity and mortality. There is strong and consistent evidence that passive smoking increases a non-smoker’s risk of lung cancer and ischaemic heart disease. Passive smoking is also associated with increased risk of respiratory conditions and otitis media in children (Thomson et al.2012; Jacoby et al. 2008) and of respiratory disease in adults (NHMRC 1997). Data is presented on the proportion of Aboriginal and Torres Strait Islander children aged 0–14 years who live in households with regular smokers using data from the 2008 NATSISS.
In 2008 in Victoria, about 65% of Aboriginal and Torres Strait Islander children aged 0–14 lived in households with a daily smoker, compared with 30% of non-Aboriginal and Torres Strait Islander children the same age. At the same time, 21% of Aboriginal and Torres Strait Islander children aged 0–14 in Victoria were living in households with a daily smoker who smoked at home indoors, compared with 5% of non-Aboriginal and Torres Strait Islander children of the same age. The proportions nationally were 22% for Aboriginal and Torres Strait Islander children and 7% for non- Aboriginal and Torres Strait Islander children of the same age89.
Excessive consumption of alcohol is a major risk factor for conditions such as liver disease, pancreatitis, diabetes and some types of cancer. Alcohol is also a frequent contributor to motor vehicle accidents, injuries and suicide. It can also lead to anti-social behaviour, domestic violence and family breakdown.
Consumption of alcohol in pregnancy can affect the unborn child leading to foetal alcohol spectrum disorder (FASD), an umbrella term that describes a range of conditions (comprising abnormalities such as growth retardation, characteristic facial features, and central nervous system anomalies (including intellectual impairment)) These disorders are incurable, but wholly preventable90.
89 Aboriginal and Torres Strait Islander Health Performance Framework Report, Victoria 2012 Australian Institute of Health and Welfare Jan 2014 update 90Factors contributing to Indigenous health http://www.healthinfonet.ecu.edu.au/health-facts/overviews/health-risk- factors#fnl-45 Accessed December 2013 55 | Page SNAP SHOT - How many Drinks is too many?
Risky/high-risk alcohol consumption The consumption of alcohol at risky and high-risk levels was defined as alcohol consumption that exceeded the National Health and Medical Research Council (NHMRC) guidelines for low risk drinking in the short or long term. These guidelines are outlined below:
Short-term risky drinking more than 6 but fewer than 11 standard drinks on any one day for males, and more than 4 but fewer than 7 standard drinks for females.
Short-term high-risk drinking 11 or more standard drinks on any one day for males, and more than 7 standard drinks for females.
Long-term risky drinking an average of more than 4 but fewer than 6 standard drinks per day for males, and more than 2 but fewer than 5 standard drinks per day for females.
Long-term high-risk drinking an average of more than 6 standard drinks per day for males, and more than 4 standard drinks per day for females.
Surveys have shown consistently that Aboriginal and Torres Strait Islander people are less likely to drink alcohol than non-Aboriginal and Torres Strait Islander people, but those who do drink are more likely to consume it at harmful levels91.
Current levels of risky alcohol consumption (both chronic and binge) are a concern for Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander people alike, and are major risk factors for morbidity and mortality in both populations92.
In 2004–05, an estimated 50% of Aboriginal and Torres Strait Islander people aged 18 and over in Victoria reported drinking alcohol at risky/high risk levels in the past 12 months. This was higher than the proportion for non-Aboriginal and Torres Strait Islander people in Victoria (38%) and for Aboriginal and Torres Strait Islander people nationally (47%)93.
91 ibid 92 Aboriginal and Torres Strait Islander Health Performance Framework Report, Victoria 2012 Australian Institute of Health and Welfare Jan 2014 update 93 Aboriginal and Torres Strait Islander Health Performance Framework Report, Victoria 2012 Australian Institute of Health and Welfare 56 | Page
SNAP SHOT - Southern Grampians and Glenelg Drug and Alcohol Action Plan 2010-2012
This Plan identifies groups which are particularly susceptible to risky drinking behaviours: young people, rural and regional populations; people with mental illnesses; and Aboriginal and Torres Strait Islander and CALD communities.
Young people in this region tick two of these boxes simply by being here. With a high proportion of Aboriginal and Torres Strait Islander people, and an average distribution of mental illnesses, there are many young people at risk of experiencing problems as a result of risky drinking.
Discussions with Senior Sergeant Michael Finnegan (Hamilton Police) and Leading Senior Constable Leo Finnegan (Portland Police) support the observation that alcohol misuse by young people is a major issue in this region, more so than drug abuse.
The Drug and Alcohol Action Plan identifies alcohol as the issue of most concern amongst those who were consulted in their process. They identify the following priority issues: • binge drinking; • underage drinking (including sale of alcohol to minors); • role of sporting clubs and alcohol (and underage members); and • dominance of alcohol at social and public events.
57 | Page Fruit and Vegetable Intake The current Australian guidelines94 recommend a minimum daily vegetable intake of four serves for people aged 12–18 years and five serves for people aged 19 years and over, where a serve is defined as half a cup of cooked vegetables or a cup of salad vegetables or one cup of diced pieces (see table 16).
Table 16: Recommended daily intake of fruit and vegetables95
Guideline Age Group Recommended Daily Intake FRUIT Persons Aged 12-18 yrs Three serves Persons Aged 19 and over Two serves VEGETABLES Persons Aged 12-18 yrs Four Serves Persons Aged 19 and over Five Serves
A higher proportion of Aboriginal and Torres Strait Islander people did not meet the guidelines for fruit and vegetable intake in both rural and urban areas of Victoria (Table 17).
Table 17: Proportion of people who did not meet guidelines for fruit and vegetable intake96
Fruit Intake Vegetable Intake RURAL URBAN RURAL URBAN Aboriginal and Torres Strait 61.1 63.2 87.7 90.7 Islander Non Aboriginal and Torres Strait 53.1 50.2 88.8 91.2 Islander
Figure 16: Fruit and Vegetable Intake
Percent not meeting fruit and vegetable guidelines in Rural Victoria 100
80
60 Aboriginal 40 Non Aborignal
20
0 FRUIT VEGETABLES
94 NHMRC Australian Dietary Guidelines 2003 95 The recommended minimum daily fruit intake is three serves for people aged 12-18 years and two serves for people age years and over, where a serve is defined as one medium piece or two small pieces of fruit 96 NHMRC Australian Dietary Guidelines 2003 58 | Page Health Related Actions Understanding when there is a need to go to a health service and taking action will improve health outcomes for all people. Aboriginal and Torres Strait Islander people have had a history of waiting to take action due to a variety of reasons including: cost; health literacy; transport and their feelings of cultural safety when attending the services. It is well known that early intervention and prevention has better outcomes for chronic disease.
Table 18: Proportion of people and preventative health actions across urban and rural Victoria97
Health Checks Aboriginal and Torres Strait Non Aboriginal and Torres Islander Strait Islander Rural Urban Rural Urban Eye Examinations 74.4 75.7 77.8 77.6 Blood Pressure 79.2 84.9 78.5 79.5 Blood cholesterol check 56.9 60.4 52.6 57.7 Blood Glucose check 57.4 56.3 50.3 52.8
Table 18 shows the proportion of Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander Victorians in 2008 who had ever undergone an eye examination and/or had their blood pressure, blood cholesterol, or blood glucose checked by a health professional in the previous two years, by sex.
There were no significant differences between Aboriginal and Torres Strait Islander and non- Aboriginal and Torres Strait Islander Victorians in the proportion who had ever had an eye examination, blood pressure check, blood cholesterol and blood glucose checks in the last two years.
Breast cancer screening rates in Victoria for Aboriginal and Torres Strait Islander women aged 50– 64 were however lower than for other women of this age (28% compared with 53% in 2008–09) and are also lower than the rates for Aboriginal and Torres Strait Islander women nationally (37%)98.
97 Aboriginal and Torres Strait Islander Health Performance Framework Report, Victoria 2012 Australian Institute of Health and Welfare Jan 2014 update 98 Aboriginal and Torres Strait Islander Health Performance Framework Report, Victoria 2012 Australian Institute of Health and Welfare Jan 2014 update 59 | Page PART G - LOCAL ACCHO HEALTH SERVICES DATA
Prevalence of common conditions Winda Mara Aboriginal Co-operative and DWECH have provided data to be used in this profile. The data for clients identified as being an Aboriginal and Torres Strait Islander has been extracted from the PenCAT99 tool and Ferret100 tool a software system able to extract information from software used by their medical services. These analyses enable the medical practice team to take a population health approach to examining their client population.
Figure 17: Prevalence of most common conditions Winda Mara and DWECH
Prevalence of most common conditions
Winda Mara DWECH 22.7 20.2 15.5 11.28 11.5 12.2 11.2 7.3 6.4 4.6 4.9 4.9
The prevalence of asthma reported for Winda Mara and DWECH clients are below the Victorian estimates by 12 and 24 % respectively where the lifetime prevalence of asthma for Aboriginal and Torres Strait Islander people is 35.9% compared with 22.9% for non-Aboriginal and Torres Strait Islander people101.
99 Pen Computer Systems’ Clinical Audit Tool, PenCAT collects and collates patient and billing data, presenting statistical information in graphs and tables, combined with the ability to produce patient lists for further review and follow up contact or actions. 100 Project Ferret is a primary health information system designed to support care delivery by multidisciplinary care teams. Underpinned by a decision support system Project Ferret is able to automatically schedule all preventative patient health care and adjust this “cradle to grave” plan Integrated with the patient database is a “data mining capability” that allows health program managers and administrators to detail the health status of the patient population or target patient groups within it. This presents information in work lists, in reports and in graphical format. 101 The Health and Well Being of Aboriginal Victorians, 2008 Supplement Department of Human Services 60 | Page In 2008, high levels of psychological distress, which includes feelings of depression and anxiety, were experienced by 31% of Aboriginal and Torres Strait Islander adults102. When the prevalence data for depression and anxiety are combined for the ACCHO’s, Winda Mara reflects the national average of 32.4% of people attending their medical services experience psychological distress compared with 16.1% for DWECH clients.
Winda Mara also reports a higher prevalence of type 2 diabetes compared with DWECH. The 2008 Victorian Population Health Survey estimate of 5.5 per cent specifically captured doctor- diagnosed type 2 diabetes and is therefore comparable to the ACCHO health service estimates.
These data present curious comparisons between the Aboriginal and Torres Strait Islander community accessing the two ACCHO’s across the Shire and this warrants engagement between the organisations to understand these differences and solutions.
SNAP SHOT - Jason Saunders talks about Mental Health Plans at Winda Mara Aboriginal Co-operative
“Mental health is a growing concern. This chart shows me that more people are speaking up and seeking support for their mental health issues. One of the other reasons for this rise in this area is that the GPs that we have visiting WMAC are very proactive in identifying the need for the Mental Health Care Plan and are working in conjunction with the AHWs to identify the needs for the plans being carried out. But not all clients who suffer from mental health have care plans developed. This is something that WMAC encourages people to have done to improve the clients overall wellbeing”. “Visits to our psychologist have increased by 70% showing our people are taking action to improve their mental health, and their social and emotional well –being”.
102 Prevalence of Psychological Distress http://www.abs.gov.au/ausstats/[email protected]/mediareleasesbytitle/3C18155D35250456CA2574390029C0E5?OpenDocument 61 | Page