Kerry Arabena

Exploring Ecosystems and Health by Shifting to a Regional Focus: Perspectives from the Oceania EcoHealth Chapter.

This article highlights contributions that can be made to the public health field by incorporating “ecosystem approaches to health” to tackle future environmental and health challenges at a regional level. This qualitative research reviews attitudes and understandings of the relationship between public health and the environment and the priorities, aspirations and challenges of a newly established group (the Oceania EcoHealth Chapter) who are attempting to promote these principles. Ten semi-structured interviews with Oceania EcoHealth Chapter members highlighted the important role such groups can play in informing organisations working in the Oceania region to improve both public health and environmental outcomes simultaneously. Participants of this study emphasise the need to elevate Indigenous knowledge in Oceania and the role regional groups play in this regard. They also emphasis that regional advocacy and ecosystem approaches to health could bypass silos in knowledge and disciplinary divides, with groups like the Oceania EcoHealth Chapter acting as a mechanism for knowledge exchange, engagement, and action at a regional level with its ability to bridge the gap between environmental stewardship and public health.

Building evidence about effective health promotion in Aboriginal and Torres Strait Islander communities

The genesis of this issue of the Australian Journal of Primary Health occurred in October 2013, at the inaugural Onemda VicHealth Koori Health Unit’s writers retreat at the Mount Eliza Business School (Victoria, Australia). At this gathering, Aboriginal andTorres Strait Islander academics fromuniversities acrossAustraliametwithnon-Indigenous researchers, editors and writers, all invested in the process of writing together. Over the courseof the retreat, communitypeoplehadachance to reflect and write up theirwork, and students and academics hadopportunities to build capacity together by participating in workshops, joint exercises and walks along the beach. Over dinner, we discussed the multiple ways in which we promoted health and well-being and what is possible through the active engagement of culturally sensitive researchers with people invested in community, innovations, capacity building and shared experience. What we quickly identifiedwas that there is no simple term to expresswhat we mean by ‘health promotion’. We know health is a universal human aspiration and a basic human right. We know there are people acrossAustralia, includingmembersofourAboriginal and Torres Strait Islander communities, who may never achieve good health. We also know that there are many of us working to address the inequitable distribution of social determinants.Health promotion, we determined, is a complex interactive function of the ideas one has absorbed from others; others, in turn, whose ‘own’ ideas are a complex interactive function of the ideas they have absorbed, and so on. For some of us, such complexity is hard to tie down on a page through the act of writing. However, through the creative process of writing together, we identified some papers that we thought were worthy of publication so others could learn about the successes being discussed at this gathering. We are grateful to Ms Kate Silburn from La Trobe University (Melbourne, Vic., Australia) for putting us in touch with the editorial team at the Australian Journal of Primary Health. We also want to acknowledge the farsightedness of this team in dedicating a journal issue to health promotion with and by Aboriginal and Torres Strait Islander people. In the pages of this special issue youwill see health promotion represented as a synthesis of people with their families and communities, people with the natural world, people transforming their service delivery systems, building capacity within their organisations and changing the way mainstream communities interact with Aboriginal and Torres Strait Islander people. Others have developed key educational, practice-orientated and clinical tools and resources to engage people with their own and their community’s health and well-being. Other papers articulate the capacity of developments inAboriginal andTorres Strait Islander people’s health promotion work to inform and strengthen health promotion efforts targeted at other population groups. All work represented in this special issue of the Journal has been undertaken by people who are committed to the work of health promotion, to its social purpose and to concepts of social justice andequity for all. Importantly,manypapers start fromastrengthsbased position. A clear message from authors contributing to this special issue is that for too long Aboriginal and Torres Strait Islander people have been described as having problems that are toobig and complex to be solvedwithin communities themselves. Aboriginal and Torres Strait Islander people are starting to write back against these descriptions, changing the collective story of Aboriginal and Torres Strait Islander communities from one of deficit to one of strength and resilience. This ‘writing back against the deficit position’ is in itself a health promoting exercise, a call to which culturally sensitive researchers are starting to respond. If there is one behavioural change that wewouldwant as a result of this compilation it would be that researchers do not in the first sentence focus on our disadvantage; rather, we want them to focus on what is possible through a process of self-determination and of co-creating health and well-being. We took the responsibility of co-creating health andwell-being seriously. First, participants at thewriters retreat in Mount Eliza developed a call for papers and sent the invitation to participate through our networks. The editorial team, made up of Indigenous and non-Indigenous academics, maintained a strong commitment to ‘two ways together’. Second, we invested in a peer-review process that saw each paper reviewed by at least one Aboriginal and/or Torres Strait Islander reviewer and at least one non-Indigenous reviewer. This meant the review process supported the authors of the articles with both academic and cultural rigour. Finally, we are delighted that there are first-time authors in this issue of the Journal. Although health promotion work is innovative and inspiring, many Aboriginal and Torres Strait Islander people are employed in chronically underresourced contexts, are time poor and are not actively encouraged and supported to showcase their work in academic journals. We are proud that there are a high proportion of practice and innovation papers in this special issue of the Journal. We remained true to the principles in Indigenous scholarship to

Suicidal behaviour in Indigenous compared to non-Indigenous males in urban and regional Australia: Prevalence data suggest disparities increase across age groups

Objectives: We compare the prevalence of suicidal thoughts and attempts between Indigenous and non-Indigenous males in urban and regional Australia, and examine the extent to which any disparity between Indigenous and non-Indigenous males varies across age groups. Methods: We used data from the baseline wave of The Australian Longitudinal Study on Male Health (Ten to Men), a large-scale cohort study of Australian males aged 10–55 years residing in urban and regional areas. Indigenous identification was determined through participants self-reporting as Aboriginal, Torres Strait Islander or both. The survey collected data on suicidal thoughts in the preceding 2 weeks and lifetime suicide attempts. Results: A total of 432 participants (2.7%) identified as Indigenous and 15,425 as non-Indigenous (97.3%). Indigenous males were twice as likely as non-Indigenous males to report recent suicidal thoughts (17.6% vs 9.4%; odds ratio = 2.1, p < 0.001) and more than three times as likely to report a suicide attempt in their lifetime (17.0% vs 5.1%; odds ratio = 3.6; p < 0.001). The prevalence of recent suicidal thoughts did not differ between Indigenous and non-Indigenous males in younger age groups, but a significant gap emerged among men aged 30–39 years and was largest among men aged 40–55 years. Similarly, the prevalence of lifetime suicide attempts did not differ between Indigenous and non-Indigenous males in the 14- to 17-years age group, but a disparity emerged in the 18- to 24-years age group and was even larger among males aged 25 years and older. Conclusion: Our paper presents unique data on suicidal thoughts and attempts among a broad age range of Indigenous and non-Indigenous males. The disparity in the prevalence of suicidal thoughts increased across age groups, which is in contrast to the large disparity between the Indigenous and non-Indigenous suicide rates in younger age groups.

Re-development of mental health first aid guidelines for supporting Aboriginal and Torres Strait Islanders who are engaging in non-suicidal self-injury

BackgroundNon-suicidal self-injury (NSSI) disproportionally affects Indigenous Australians. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is engaging in NSSI. Culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islanders who are engaging in NSSI were developed in 2009. This study describes the re-development of these guidelines to ensure they contain the most current recommended helping actions.MethodsThe Delphi consensus method was used to elicit consensus on potential helping statements to be included in the guidelines. These statements describe helping actions that Indigenous community members and non-Indigenous frontline workers can take, and information they should have, to help someone who is engaging in NSSI. The statements were sourced from systematic searches of peer-reviewed literature, grey literature, books, websites and online materials, and existing NSSI courses. A panel was formed, comprising 26 Aboriginal and Torres Strait Islanders with expertise in NSSI. The panellists were presented with the helping statements via online questionnaires and were encouraged to suggest re-wording of statements and any additional helping statements that were not included in the original questionnaire. Statements were only accepted for inclusion in the guidelines if they were endorsed by ≥90% of panellists as essential or important.ResultsFrom a total of 185 statements shown to the expert panel, 115 were endorsed as helping statements to be included in the re-developed guidelines.ConclusionsA panel of Aboriginal and Torres Strait Islander people with expertise in NSSI were able to reach consensus on appropriate strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander engaging in NSSI. The re-development of the guidelines has resulted in more comprehensive guidance than the earlier version. The re-developed guidelines will form the basis of an Aboriginal mental health first aid short course on NSSI for Indigenous community members and non-Indigenous frontline workers that will be evaluated in an upcoming trial.

Self-collection for under-screened women in a National Cervical Screening Program: pilot study

Background Commencing 1 December 2017, Australia introduced human papillomavirus (hpv)-based cervical screening. As part of this Australian renewed National Cervical Screening Program (ncsp) women who are either never- or under-screened and who refuse a practitioner collected sample will be able to collect their own sample for cervical screening. The aim of this study is to examine the quantitative results of a pilot study into the acceptability of the self-collection alternative pathway. Methods Eligible participants were offered the opportunity to collect their own sample. Those who agreed were given a flocked swab and an instruction sheet and took their own sample in an area of the health care clinic that afforded them adequate privacy. These samples were then given to clinic staff who returned them to Victorian Cytology Service (vcs) Pathology for hpv nucleic acid testing. Results Of 98 eligible women, seventy-nine undertook self-collection for hpv-based cervical screening. Seventy-seven produced valid results, 14 were positive for oncogenic hpv, with 10 undertaking follow-up. Three women were found to have cervical squamous abnormalities with two of those being high-grade intraepithelial squamous lesions. Conclusion The pilot study for self-collection for cervical screening produced quantitative data that were similar to that already reported in the literature, but had a much higher rate of acceptance compared with self-collection programs based in the home.

Re-development of mental health first aid guidelines for supporting Aboriginal and Torres Strait islanders who are experiencing suicidal thoughts and behaviour

BackgroundSuicide is a leading cause of death among Indigenous Australians. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is suicidal. Culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islander persons who are experiencing suicidal thoughts or behaviour were developed in 2009. This study describes the re-development of these guidelines to ensure they contain the most current recommended helping actions.MethodsThe Delphi consensus method was used to elicit consensus on potential helping statements to be included in the guidelines. These statements describe helping actions that Indigenous community members and non-Indigenous frontline workers can take, and information they should have, to help someone who is experiencing suicidal thoughts or displaying suicidal behaviour. A panel was formed, comprising 27 Aboriginal and Torres Strait Islander people who have expertise in Indigenous suicide prevention. The panellists were presented with the helping statements via online questionnaires and were encouraged to suggest re-wording of statements and any additional helping statements that were not included in the original questionnaire. Statements were only accepted for inclusion in the guidelines if they were endorsed by ≥90% of panellists as essential or important.ResultsFrom a total of 301 statements shown to the expert panel, 172 were endorsed as helping statements to be including in the re-developed guidelines.ConclusionsAboriginal and Torres Strait Islander suicide prevention experts were able to reach consensus on appropriate strategies for providing mental health first aid to an Aboriginal or Torres Strait Islander person experiencing suicidal thoughts or behaviour. The re-development of the guidelines has resulted in more comprehensive guidance than the earlier version, for which the panel had rated 166 helping statements and had endorsed 52. These re-developed guidelines can be used to inform Indigenous suicide gatekeeper training courses.

An Introduction from Kerry Arabena, the New IAEH President

I acknowledge the traditional owners, leaders and lands of Indigenous peoples around the world and acknowledge all those who have a continued connection to Country. I celebrate your resilience and contributions to our world. To all our ‘Exquisite Elders’ from different knowledge traditions who pioneered EcoHealth and created for us all a path that we may now follow; we are proud of your achievements and humbled by the opportunity to follow you. We thank you for your thought leadership and generosity in sharing your insights. These gifts set us in good stead for the civilisational transition that is our generation’s to make, and we look forward to respectfully engaging you over the coming year. On behalf of the Board of Directors for the International Association for Ecology and Health, it is my pleasure to acknowledge the tremendous effort and legacy of past Presidents and retired Directors of the Board and offer them a vote of thanks. We salute our retiring President, Professor Jakob Zinsstag, and retiring Board members Associate Professor Edouard Kouassi, Professor Nitish Debnath and Adjunct Professor Karen Morrison. These Board members made significant contributions to the progression of EcoHealth ideals through their commitments to membership, regional chapter development, student engagement and Board functioning. We also acknowledge and offer a vote of thanks to Lisa Crump, EcoHealth Journal staff and office holders for their active participation in the business of the Association, and their provision of secretariat, administrative and communication supports during the past term. We extend a warm welcome to incoming Board members including Dr. Hung Nguyen, Dr. Neville Ellis, Dr. Hume Field and Arron Jenkins. We are delighted to have conferred 2016 EcoHealth Awards to worthy winners in a ceremony at the inaugural OneHealth EcoHealth Congress held in Melbourne last December 2016. From a competitive field, Emeritus Professor Valerie Brown received the Lifetime Achievement Award in recognition of her years of contribution, achievement, student engagement and support. Professor Brown was joined by Dr. Jonathan Kingsley and Dr. Hung Nguyen as Exceptional Early Career Award Winners and Kouassi Richard M’Bra, Melanie Bannister-Tyrrell and Melanie Voevodin took out the Student Awards. The Organising Committee of the Congress committed to a process that facilitated the involvement of over one thousand delegates from over eighty-six countries and over 170 scholarship holders. Front and centre of the joint Congress was the strong student and early career delegations who together developed the Aspirational Statement from the Conference, a living document that the Board are committed to incorporating in our future work. The Aspirational Statement will form part of the re-visioning efforts by engaging with members and affiliates in a strategic planning process to consider governance and EcoHealth 14, 208–209, 2017 DOI: 10.1007/s10393-017-1222-4

Health and wellbeing outcomes of programs for Indigenous Australians that include strategies to enable the expression of cultural identities: a systematic review

Indigenous people have long maintained that strong cultural identities are critical to health and wellbeing. The purpose of this systematic review is to examine whether interventions that entail strategies to enable expression of cultural identities for Australian Indigenous peoples are associated with measurable improvements in health and wellbeing. Peer-reviewed articles that reported quantitatively expressed health and wellbeing outcomes involving Indigenous Australian participants only were included. The cultural intervention component was defined and assessed by Indigenous researchers on the team. A narrative analysis was conducted. The protocol was registered on PROSPERO (CRD42015027387). Thirteen articles describing eleven studies were identified, including one randomised control trial (RCT), one cluster RCT and two studies with non-randomised controls. Other studies reported on case series or cross-sectional studies. All except two studies described multiple intervention strategies. Eight studies showed significant improvement in at least one psychosocial, behavioural or clinical measure, with two showing a positive direction of effect and one showing no improvement. Publication bias may discourage researchers to report negative findings of these interventions. Although studies vary in quality, this review provides evidence that interventions that include opportunities for expression of cultural identities can have beneficial effects for Australian Indigenous peoples.

Addressing structural challenges for the sexual health and well-being of Indigenous women in Australia

According to the most recent national data in Australia, chlamydia and gonorrhoea were 3 and 18 times more likely to be diagnosed in Aboriginal populations, respectively, compared with the non-Indigenous population, with 16–19 years old Indigenous Australians carrying the greatest burden of these infections.1 Reports confirm that almost half this age group living in remote communities has one or more of gonorrhoea, chlamydia and trichomonas infections.2 In addition, significant increases in the prevalence of chronic hepatitis B and higher rates of hepatitis C acquired through burgeoning injecting drug use, combined with high rates of chronic disease, means there is a significant burden of disease among Aboriginal and Torres Strait Islander people that costs individuals, communities and health systems dearly.3 Current Australian efforts in this area focus on prevention, early detection and treatment, monitoring and provision of care for people living with disease. These efforts, however, are not collectively addressing the complex array of needs of those many Indigenous women and children experiencing vulnerability. An increasing number of Indigenous women in Australia and globally are now demanding that politicians, policy makers, practitioners, researchers and educators coordinate their efforts to identify and address barriers to effective sexual and reproductive health services, and also to change the marginalised position of Indigenous peoples in their respective countries. Indigenous women and their children need health equity and societal equality. This can be achieved by redressing structural and systemic barriers to quality services, and working together to realise human rights for all Australians. This year my friend, whose 17-year-old sister went missing 22 years ago, attended a Canadian conference on the over-representation …

An Australian model of the First 1000 Days: an Indigenous-led process to turn an international initiative into an early-life strategy benefiting indigenous families

Internationally, the 1000 days movement calls for action and investment in improving nutrition for the period from a childs conception to their second birthday, thereby providing an organising framework for early-life interventions. To ensure Australian Indigenous families benefit from this 1000 days framework, an Indigenous-led year-long engagement process was undertaken linking early-life researchers, research institutions, policy-makers, professional associations and human rights activists with Australian Indigenous organisations and families. The resultant model, First 1000 Days Australia, broadened the international concept beyond improving nutrition. The First 1000 Days Australia model was built by adhering to Indigenous methodologies, a recognition of the centrality of culture that reinforces and strengthens families, and uses a holistic view of health and wellbeing. The First 1000 Days Australia was developed under the auspice of Indigenous peoples leadership using a collective impact framework. As such, the model emphasises Indigenous leadership, mutual trust and solidarity to achieve early-life equity.