Report of the 6th National Conference

Official Conference Opening

Page last updated: 07 July 2008

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Tuesday 22 May 2007

Shane Nichols, Deputy Chair, enHealth Working Group on Aboriginal and Torres Strait Islander Environmental Health (WGATSIEH)

Shane Nichols welcomed conference delegates to the Sixth National Aboriginal and Torres Strait Islander Environmental Health Conference and acknowledged the traditional owners, the Irukandjii People. He then paid respect to their Elders and to any other Aboriginal and Torres Strait Elders who were present. Shane then invited Xavier Schobben, Chair of the Working Group on Aboriginal and Torres Strait Islander Environmental Health and Director of Environmental Health in the Northern Territory, to the stage.

Xavier Schobben, Chair, enHealth Working group on Aboriginal and Torres Strait Islander Environmental Health (WGATSIEH)

Xavier Schobben welcomed everyone to the Sixth National Aboriginal and Torres Strait Islander Environmental Health Conference. He stated that the location of the conference had come back full-circle to Cairns, which had hosted the very first conference in 1998, and that ironically he felt even more at home,as he and other Northern Territory colleagues were staying at that original venue. Xavier then invited Warren Singleton, an Irukandjii traditional owner, to the stage to give a welcome to country.

Traditional Welcome to Country

Warren Singleton and the Irukandjii Traditional Owners & Dancers

Warren Singleton, an Elder of the Irukandjii People gave a welcome to country on behalf of the Irukandjii People. He thanked Xavier Schobben and Clayton Abreu from the Tropical Population Health Unit and his department, for inviting he and the Irukandjii dancers to appear at the conference in recognition of the old people who roamed the land which they claimed as their own from Cairns and Port Douglas. He then introduced the Irukandjii Dancers.

Conference Official Opening

Sophie Dwyer, Senior Director of Environmental Health Unit Queensland Health and Queensland representative of enHealth

Ms Dwyer thanked Mr Nichols and noted on behalf of Queensland Health that she was very pleased to be able to assist in organising the conference with the support of all our colleagues, adding that she would say more about this later. She said that it was with great pleasure she would like to introduce Dr Jeannette Young, Queensland’s Chief Health Officer and currently Acting Director- General, Queensland Health. Ms Dwyer thanked Dr Young for bringing a message from the Minister, and for taking time out from her busy schedule to officially open the conference.

Dr Jeannette Young, Queensland’s Chief Health Officer and currently Acting Director-General Queensland Health

“Thank you very much, Sophie. This is one of the best parts of doing my job. I love coming and doing these things and talking to people and hearing what’s going on, and often I learn so much from doing these things as people give me ‘dot points’ to put a speech together and I learn things. I think wow, people have done that, so this is a really great opportunity, and thank you so much for the invitation Sophie, and to the organising committee.
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I’d like to start with some acknowledgements. First, of course, to the traditional owners, whose land we meet on for the next couple of days, the Irukandjii People. I think that was a great start and a great opening to the next couple of days. Also to Xavier Schobben, the Chair, and to Shane Nichols, Deputy Chair, WGATSIEH on Aboriginal and Torres Strait Islander Environmental Health, Dr Roscoe Taylor, a colleague of mine on the Australian Health Protection Committee and Chair of the enHealth Sub-committee, other conference speakers, guests, including if there are any Elders of the people who lived here, ladies and gentlemen.

As I said, I am delighted to be here today. I am here to represent Queensland’s Minister for Health, The Honourable Stephen Robertson, and to open this very important conference. It is unfortunate Mr Robertson is unable to join us because Queensland parliament is sitting this week, and of course he has to be there for that responsibility. He is also participating in a number of econciliation events that are being held in Brisbane. I do know he is disappointed about not being here because Indigenous health issues are of particular interest to him, and he regards events such as these over the next few days as crucial for collaboration and relationship-building. As Queensland’s Chief Health Officer, I very much share that view, and being here today as I alluded to before is extra special, as I shall be talking about several initiatives that my own staff have been involved in, and those that I believe embody the spirit of reconciliation.

For those of you not from Cairns, I would like to welcome you to tropical North Queensland. Wherever you have travelled from I hope you have a thoroughly enjoyable stay, and maybe those of you from the south-east corner could have an extra minute in the shower. I would like to begin my address today by describing the larger health picture for Indigenous Queenslanders. This year Queensland Health has embarked on an exciting new direction in Aboriginal and Torres Strait Islander health. We endeavour to look at Indigenous health issues in a new way, and change how we do business to get better outcomes.

We want to inject more vitality into the way we do business, and focus more on results. In order to ensure that our organisation addresses Indigenous health from a clinical as well as a policy and program perspective, the Director-General engaged a consultant,Robert Griew. I think that Northern Territory’s loss is very much our gain, as Robert was of course the former CEO of the Northern Territory’s Department of Health, and has a wealth of experience. Fortunately for us, he has agreed to join Queensland Health in a part-time capacity for the next two years to work with our Aboriginal and Torres Strait Islander Health Strategy Unit to help implement some recommendations he has made during his review. Robert and the unit will implement strategies to ensure that Aboriginal and Torres Strait Islander health is enmeshed in all areas of the Department’s business. They will identify and seek to ensure better Indigenous outcomes from other government departments including the Commonwealth, and also work closely with communitycontrolled health services. Robert, I know, will be a leader, champion, scrutineer and mentor, helping to keep Queensland Health forward-focused so that Indigenous health issues don’t get bogged down or lost in bureaucracy.

So what are some of the areas of concern? Late last year some of you may be aware that I released the first in a series of two-yearly reports on the state of Queenslanders’ health. I am sure it won't come as a surprise to any of you that the report identified a number of inequities in comparing the health status of Indigenous and non-Indigenous Queenslanders. Currently the expected average life span for an Indigenous Queenslander is about 20 years less than for a non-Indigenous person, equating to about 60 years for an Aboriginal and Torres Strait Islander man, and 64 years for women. However, we have also to remember that the Indigenous population is a much younger one. It’s estimated that about 50% of our Indigenous population is under the age of 20, and it seems that socio-economic disadvantage rather than location plays a role in the overall state of Indigenous Queenslanders’ health. Sadly, it’s again a fact that death rates in Indigenous populations are estimated to be much greater for conditions such as heart disease, diabetes, chronic respiratory disease, pneumonia and injury. For example, Aboriginal and Torres Strait Islander adults are three times more likely to be admitted to hospital for chronic disease than their non- Indigenous peers.

So all of this highlights the need for action and careful consideration when developing strategies for the future. Much needs to be done – significantly more than we think, and the processes need to be ongoing. I believe the foundation has already been laid and there is some very, very, good work going on, which brings me to the focus of this conference, Environmental Health. Environmental Health is a strongly emerging area, and one in which we are seeing how community engagement and capacity building can reap great rewards. In a way I believe Environmental Health is the precursor to ensuring overall better health outcomes, so it plays a critical role in laying the foundations to improving Aboriginal and Torres Strait Islanders’ quality of life.

It was noted from 2002 that the government called upon Aboriginal and Torres Strait Islander communities to take up the challenge to manage environmental health issues in their own communities, with communities as pilot tests for environmental health challenges such as mosquito control, food handling practices and animal management. Such pilot tests are employing and educating local people to advise on local issues, while bridging cultural gaps and communicating local issues and needs.
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Back in 2002 Queensland Health was recognised as the main advisory body for environmental health in Cape York. The same year the Queensland Government’s Meeting Challenges, Making Choices Strategy was launched to implement the recommendations of the Cape York Justice Study. It called for the active participation of Aboriginal and Torres Strait Islander people to take up the challenge of building the capabilities to manage the environmental health needs within their own communities. As a result, Cape York became a testing ground for a pilot Environmental Health Work Program to address matters such as mosquito control, waste management and food handling practices. It proved an enormous success by increasing the level of Indigenous employment within the community, and providing local people to advise on local issues. The qualified Environmental Health Workers were able to bridge cultural gaps by communicating their local issues and needs, which also resulted in the community valuing the positions and the people in them.

Then in 2005 the Queensland Government agreed to expand the program to include all Aboriginal and Torres Strait Islander Councils. I am proud to say - and we had a bit of a debate, so if I am wrong here please correct me - I believe that Queensland’s program is now the biggest Indigenous Environmental Health Program of any State.So I leave you to work that one out over the next few days. There are now approximately 30 Environmental Health Workers employed in 34 communities across the State. While Queensland Health provides the funds, the training and the support, it is important to note that these workers are employed by their own community councils to manage their own community health needs at the local level. This has become a remarkably successful program, and I firmly believe that there are two words that sum up why that is so - community engagement. These workers are now at the centre of their community’s life. Some of these workers are taking up further study, seeing their present positions as a springboard to new career opportunities. I congratulate all the Queensland health staff, some of whom are sitting here today, who have been involved in the development of that program.

Building on from this success is news of a second exciting program now being implemented. In December last year 34 Aboriginal Local Governments and Island Councils were invited to apply for funding to develop and implement animal management programs for their communities. The program is the first of its kind in Australia, and integrates normal animal management with animal welfare, pest and weed control. The program is funded by Queensland Health, the Department of Primary Industries and Fisheries, and the Department of Local Government, Planning, Sport and Recreation. This united effort is indicative of the Queensland Government’s commitment towards working collaboratively to improve the lives of Aboriginal and Torres Strait Islander communities.

A number of Aboriginal Local Govenrments and Island Councils applied for funding, with some making joint submissions. I am delighted to announce that just this month Queensland Health has approved the applications of 21 councils, and they will receive total funding of $1.16M to participate in the program. This funding will enable councils to employ an animal management worker, purchase equipment and develop programs which may include engaging veterinary services. You might wonder why - although I am sure you don’t - Queensland Health is involved in animal management, but we only have to look to the situation overseas and indeed in our own country to see how sick animals can lead to the spread of disease and infection. Education enforcement is the key to managing the problem.

Of course another important aspect of these plans relates to the problem of feral animals. Whilst these may not impact directly on human health, it is important to recognise that across Queensland the economic costs attributed to feral pigs and wild dogs are estimated to be $45M. Upon completing the course, the workers will have obtained skills in both feral and domestic animal management, as well as animal health and welfare. The program will also provide opportunities for those involved to develop career paths like those who have gone on to hold positions in their communities as chairmen, councillors and community leaders after being EHWs.

Queensland Health’s Indigenous Environmental Health Coordinators will also provide support in partnership with Environment Health Officers. Because this program involves other government departments, the new workers will also be provided with advice and support by specialists from those agencies. As I have said, this is a very exciting program which meshes well with the successful Indigenous Environmental Health Worker program.

Finally, I would like to leave you with one thought. The breadths and complexity of Indigenous health issues can at times seem overwhelming. There’s no doubt that there’s much to be done. However, I suggest you walk away today and try looking at some of these issues in a different light. Maybe try something new and see where you can individually add energy, expertise and commitment, to really make a difference. So thank you, and I now declare the 2007 National Aboriginal and Torres Strait Islander Environmental Health Conference officially open”.
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Sophie Dwyer, Senior Director of the Environmental Health Unit,Queensland Health, and Queensland representative on the enHealth Council

“Thank you very much, Jeannette, for your support – it will give Zac and I something to debate till the end of the conference. Firstly, I would like to say a few words, but before I do I would like to acknowledge the traditional owners, the Irukandjii People, and the Elders who are present. It is very exciting for us to be involved in this conference and it wouldn’t have happened without a lot of support. Clearly there’s the support of the organisational group, and particularly the forum, the Aboriginal and Torres Strait Islander Environmental Health forum as part of enHealth. But the support is more widespread, and if you look at your programs you will see there are a lot of logos on the back of the program, and actual recognition of the amount of support that has come from a lot of places to make this conference possible. Queensland Health would not have been able to put it on without all that support.

Firstly, enHealth itself. You will be hearing from Roscoe soon and Zac, with their support. You’ll also hear from the Forum and the Australian Government representatives, who have also been a great support. My colleagues across all jurisdictions Australia-wide have also contributed to making the conference possible - so that’s an indication of how important this conference is to enHealth. In Queensland we have also had a lot of support. You will also see quite a few of the Queensland Government logos. We call them ‘Beattie burgers’ but in fact if you look at it you will see there is support from quite a few agencies - we have a steering committee in Queensland,a cross-government agency group that looks at environmental health,and we have had Housing and Primary Industries, Environmental Protection, Treasury and other agencies involved.

Three of those agencies have also contributed to this conference, and that I think is very special for us - the Department of Local Government, Planning, Sport and Recreation, which is providing administrative support in both programs, the Environmental Protection Agency and the Department of Primary Industries which are really close partners on the animal management program. So my thanks to them. It is really good to see that cross-agency support which is probably what environmental health is all about- it is not just a health agency business. The conference has also received support from the Australian Institute of Environmental Health, Trovan Microchips and the Batchelor Institute of Indigenous Tertiary Education. So thank you to all the supporters because I think it is through that energy and commitment and financial commitment (where people put their money where their mouth is), that the conference was made possible. It made it easier for us and my staff - in particular I would like to acknowledge Sonja Carmichael, who has been particularly active. Sonja has been the ‘glue’ to hold this project together, and made sure we got to this point. We also received support from within Queensland Health from the Aboriginal and Torres Strait Islander Health Unit, and Sheryl Sandy, the Senior Director, is here today.I am sure you will meet her during the course of the conference.

So you can see that many players have come together. My task now is to introduce Dr Roscoe Taylor, an old colleague of mine, friend, and also the Chair of enHealth. Roscoe has been a member of enHealth Council (now known as the Environmental Health Committee, to give its formal name) in various capacities since 1997. He is currently the Chair, and does a wonderful job. Roscoe has been Director of Public Health in Tasmania since 2002 after spending nine years working as a public health physician in central Queensland. He has over 17 years’ experience in environmental health at both a state and federal level, and is also active in a range of other public health areas such as chronic disease and prevention. So I would like to hand over to Roscoe”.
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enHealth Report on Previous Conference Recommendations

Dr Roscoe Taylor, Member of Australian Health Protection Committee and Chair Environmental Health Committee (enHealth)

“Thanks everyone, it’s tremendous to be here and as Chair of enHealth I would like to acknowledge the traditional owners of this land and thank the Irukandjii People for that really great welcome. It’s a tremendous thing for me to be here.

Basically I became Chair of enHealth by accident really. I’d only been there for a couple of years and I acknowledge the work of my predecessor, Michael Jackson, from Western Australia. I really want to congratulate the organisers, particularly the National Organising Committee, the local organising group and to Queensland Health for organising all this. Thanks to all of you. I understand the turnout today is about twice what it was for the first national conference back in 1998, here in Cairns. So that’s just indicative of the growth that is going on, and to hear Jeannette and Sophie talk about the way Queensland is starting to get the intersectoral collaboration going around environmental health, really, I think is a tremendous step forward. One of the issues I think in the past has been that environmental health has been a bit of a ‘Cinderella’ and tends to fall between some of the cracks between the different departments. However, now you start to see this integrated ownership of it as an issue, and I think that really augers very well. So congratulations to those initiatives that have been announced here.

Communication is an extremely important concern to environmental health at all levels of the system. This event we are having this week is a great opportunity to come together and hear the presentations, give each other food for thought, and see how many of the issues we are all facing are the same in different ways. However, we are all working together on different aspects of what are often the same types of issues. This gives people an opportunity to talk with others from across all levels of the system - from grass roots people, to those advocating for increased funding, and those seeking strategic directions.

I encourage you to use this opportunity over the next few days to meet new people and swap contact details, so you can keep in touch with each other and also to renew old friendships. Networking and the sharing of ideas are a big theme. We will hear lots of stories and there will be a common theme, I think, about partnership being a major focus of how we actually reach good environmental health outcomes. I also want to acknowledge the work and thank the members of the Working Group for Aboriginal and Torres Strait Islander Environmental Health (whose precursor was the National Indigenous Environmental Health Form, but this is
the new name), and Xavier will come back to that in his presentation and talk about how that has evolved, and the new structure in which we find ourselves, together with implications for Indigenous environmental health in Australia.

The partnership you would be very familiar with is the one between government, non-government and the community. Environmental health is something not any one party can do on its own, and it really does behove us all to be players. So we are all responsible. I should stop and dwell a moment on the restructure that has occurred under the Australian Health Minister's Advisory Council. After 2005 there was a review of the AHMAC structures including the National Public Health Partnership, and enHealth. A new entity called the Australian Health Protection Committee was formed as a principal subcommittee of AHMAC, and there was also a range of other committees. One of them was a Population Health Development Committee. Under the Australian Health Protection Committee were brought several existing subcommittees, including enHealth. Under enHealth in turn is the Working Group on Aboriginal and Torres Strait Islander Environmental Health (WGATSIEH). In addition, under enHealth is the Water Working Group, the Air Working Group and the Toxicology Working Group at this point in time, totalling four key foundation working groups that do a lot of the actual work for enHealth.

The members of enHealth include the Directors of Environmental Health from each State and Territory, Australian Government Department of Health and Ageing, Environment and Water Resources, Australian Institute of Environmental Health, Australian Local Government Association, the Public Health Association of Australia, the Australian Consumers’ Association or ‘Choice’ as it is called now, the National Health and Medical Research Council, and we also have Shane Nichols as Deputy Chair of WGATSIEH. Thanks Shane.
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The Terms of Reference - I won’t dwell on these in great detail - but they were reframed in the context of the AHMAC restructure to:
  • Provide nationally-agreed environmental health policy advice.
  • Coordinate implementation of nationally-agreed environmental health policies and approaches.
  • Provide environmental health expertise and support for AHPC’s emergency management role, which was one of the drivers of the establishment of the Health Protection Committee in response to issues such as SARS, pandemic influenza and bioterrorism concerns - all of those things which have caused a national look at how we manage those from a health policy perspective. Mass casualties issue is another one. We, too, need to feed into that work.
  • Provide expert, and where nationally-agreed, health advice in environmental policy forums.
  • Consult with stakeholders as appropriate in developing and implementing environmental health policy.
  • Contribute to international collaboration on environmental health issues.
  • Coordinate research, share information and develop practical environmental health resources.
enHealth these days reports through that structure right up to Health Ministers. The domain of our work is very much driven by what Health Ministers can influence as well. We still work using the same principles that we have always had and the membership is much the same as it was before, and that includes the principles of collaboration and consultation. If you need to know more go to the website http://www.nphp.gov.au/enhealth/.

Our strengths include expertise, and commitment – and that’s true of a number of members on enHealth who are a tremendous group to work with. With the new structure we now have a centrally located Secretariat in the Australian Government Department of Health and Ageing, which gives us a more robust secretariat arrangement.

enHealth’s work includes identifying where national approaches are needed, and where indicated go on to develop national policies, guidelines and models - things that we believe will be useful to people in their specific field, or in conducting specific projects. We now form part of a communication system to Health CEOs and Health Ministers, and we can help share the information, skills, experience and expertise of others, and people like you. We can also advocate to a degree.

What we can’t do, unfortunately, is guarantee funding. There isn’t a particular bucket of funding that enHealth itself controls. Like others, we have to stand in the queue and advocate for the purposes of a particular funded project. We can’t take action without consultation and collaboration. We must work with AHPC and our colleagues. We can’t undertake projects outside our terms of reference. This becomes important when you come to look at the conference recommendations over the years.

I see a key role of the Working Group on Aboriginal and Torres Strait Islander Environmental Health is to inform and to help drive these things through enHealth and with enHealth. The challenges we face (and I am sure you know these so well):
  • Isolation – both geographically and professionally.
  • Being on your own – limited support, status and poor infrastructure.
  • Competing demands – where do you start when you are confronted with so much to do?
  • An inadequate pay structure – the wheels are turning in the right direction here now.
  • Not enough ‘hands on deck’.
  • Inadequate funding for resources and equipment.
To governments and communities the value of investing in enHealth is pretty clear once they start to understand the linkages to people’s wellbeing and health. To quote a government report from Western Australia in 1998
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‘Improvement of environmental health conditions, particularly in remote communities, (must) be treated as the single highest priority for the government’s program’.

Let’s take a look at progress over the past 10 years:
  • Establishment of more Environmental Health Worker positions. (WA: 50+, Qld: 30+, NT: 10+, NSW-HHWs).
  • Better sharing of successes and failings.
  • Greater awareness of issues among all levels of government.
  • Improved training for EHWs.
  • More opportunities to become EHOs.
  • Improved promotion of EHWs as a valued profession.
We have seen since 1998 a number of recommendations made at each national conference like this one - very valuable bits of work – a consensus of opinions coming forward. It was decided at the last conference to get a group together to look at the themes arising from those, and to do a stocktake on progress. The themes that have emerged from all of the conference recommendations fell into the following groups:
  • Firstly, the value and merit of having conferences such as this – these were seen as worthy of continuation.
  • Secondly, a whole range of things that fall under the headings of
  • Policy and process.
  • Management and support.
  • Training.
  • Models of working.
  • Advocacy.
  • Food.
  • Housing and infrastructure.
I am not going to go back into the previous four national conferences, because I understand that the previous chair, Chair Michael Jackson, at Terrigal, provided a recap of how we have been implementing those recommendations. Today I will just have a look at the recommendations from the Fifth National Conference:
  • EH input, third edition National Indigenous Housing Guide – actioned and completed.
  • Advocate for Indigenous communities to be listed as special areas under Building Codes of Australia – being progressed.
  • Develop an industrial award for EHWs – found not to be feasible to have a specific award with current numbers of EHWs. Local Government awards are being utilised by some communities. This is one that is more of a jurisdictional issue rather than one that can be progressed nationally.
  • Provide scholarships or cadetships for Indigenous EH practitioners – being progressed by jurisdictions to variable degree. This is something very valuable to continue working on.
  • Update the enHealth website – this is included in WGATSIEH Work plan.
  • Conduct a national review of the status of Indigenous EH every four years – currently being explored.
  • Development of a National Indigenous Environmental Health Strategy – in the WGATSIEH Work plan. An interesting issue here is about the integration into a national EH strategy and how that best be pursued.
  • Subject all Indigenous community water supplies to appraisal under the Framework for Management of Drinking Water Quality – Community Water Planner: A Tool for Small Communities to Develop Drinking Water Management Plans.
So what’s the future? So much has been done when you look back on it, which is encouraging, but there’s so much more work to be done. We must still work together, with Environmental Health being a cornerstone to health improvement. I think one of the key things for the future is the rollout of the Population Health Training Package for Indigenous Environmental Health. Fundamentally though, Indigenous Environmental Health must remain a major priority for enHealth. Thank you everyone for your time, and I hope you have a good conference”.
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For Further information
Dr Rosco Taylor
Chair, Environmental Health Committee (enHealth)
Department of Health and Ageing, GPO Box 9848, Canberra, ACT
Phone: 03 6222 7729 Email: enhealth@health.gov.au

Working Group on Aboriginal and Torres Strait Islander enHealth

Xavier Schobben, Chair, enHealth Working group on Aboriginal and Torres Strait Islander Environmental Health (WGATSIEH)

“On behalf of the WGATSIEH, we’d like to acknowledge the Irukandjii People on whose land in Cairns we are meeting. It is indeed a beautiful part of Australia. We have certainly come fullcircle in hosting these national conferences. We had 112 delegates at our very first 1998 national Aboriginal and Torres Strait Islander Environmental Health Conference in Cairns, and now we have close to 300. While that very first conference was organised very quickly, it achieved what we had planned. That was quite simply to get those people who worked in Indigenous environmental health together to share information, and identify and discuss the issues
that had national significance.

At that time, the conference was organised and funded by the National Environmental Health Forum, which was a committee made up of the Commonwealth and State/Territory Directors of Environmental Health. The Forum later became enHealth Council in 1999 and the national conferences were organised by the Conference organising committee and from 2000 onwards by the National Indigenous Environmental Health Forum, which has now become the Working Group on Aboriginal and Torres Strait Islander Environmental Health, known as WGATSIEH.

I would like to touch very briefly on the background to AHMAC sub-committee review. In 2005 AHMAC directed that the committees reporting to it be reviewed, as it intended to tighten its reporting mechanisms. The guiding principle for the sub-committee review was that a national committee should only exist if its major focus was on national policy development with a view to trying to achieve national consistency. EnHealth Council, which at the time reported to the National Health Partnership, was considered in the Population Health committee component of the AHMAC review.

The review’s recommendations and its endorsement by AHMAC resulted in the establishment of the Australian Health Protection Committee and the Population Health Development Principal Committee. The review also recommended that the enHealth Council be replaced by the Environmental Health Committee (enHealth). AHMAC also directed that all of its sub-committees review their sub-structures, including the National Indigenous Environmental Health Forum, and place a higher priority on national policy development. enHealth endorsed a working group structure to concentrate on air, water, toxicology and Aboriginal and Torres Strait Islander environmental health. AHMAC’s re-emphasis on national policy development required that people with jurisdictional responsibility for Indigenous environmental health policy were now also invited to become members of the new WGATSIEH.
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WGATSIEH is comprised of the following members:
  • New South Wales : Adam McEwen, Jeff Standen.
  • Northern Territory : Zane Hughes, Nicola Slavin, Xavier Schobben (Chair).
  • Queensland : Clayton Abreu, Sonja Carmichael.
  • South Australia : Craig Steele.
  • Victoria : Shane Nichols (Deputy Chair).
  • Tasmania : Stuart Heggie.
  • Western Australia : Owen Ashby.
  • Commonwealth : Jenni Paradowski.
  • Secretariat : Commonwealth.
WGATSIEH first met by teleconference on 19 December 2006, and later got together in this beautiful city on 2 February 2007 to finalise preparations for this Conference.

The role of WGATSIEH is to provide coordinated advice to enHealth and other key stakeholders on national environmental health policies and associated environmental enHealth issues.

The Working Group’s terms of reference are to:
  • Advise enHealth on Aboriginal and Torres Strait Islander environmental health issues.
  • Support the review and development of national Aboriginal and Torres Strait Islander environmental health policy.
  • Act as focal group for enHealth in promoting Aboriginal and Torres Strait Islander environmental health with relevant stakeholders.
  • Also provide input and direction into enHealth Aboriginal and Torres Strait Islander environmental health conferences and other mainstream conferences relating to environmental health. The National Indigenous Environmental Health Forum was the predecessor to WGATSIEH, and worked very hard since its inception in May 2000 through to mid-2006. Fortunately there area number of members from the Forum still present on WGATSIEH, and I would also like to pay tribute to the Forum members and thank them for their achievements.
WGATSIEH has developed a major work plan to be progressed over the next five years that we hope will achieve some good outputs and outcomes for Aboriginal and Torres Strait Islander communities and environmental health practitioners.

After this conference, WGATSIEH members will also meet to evaluate this Conference and identify any areas for improvement for the benefit of the next Conference to be held in Western Australia.

This Conference provided the opportunity for environmental health practitioners at all levels to network, share ideas and adapt solutions to their local context. The keynote addresses and the 18 presentations should also help you in continuing to take on the important challenge of improving Aboriginal and Torres Strait Islander environmental health.

For more information
Xavier Schobben
Chair, enHealth Working Group on Aboriginal and Torres Strait Islander Environmental Health (WGATSIEH) and Director Environmental Health
NT Department of Health and Community Services
PO Box 40596, Casuarina, NT, 0811
Ph: 08 8999 2575 Email: xavier.schobben@nt.gov.au
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Guest Speaker

Cleveland Fagan, CEO Apunipima Cape York Health Council

“Good afternoon, and thank you for the invitation to come and talk to you guys at the Environmental Health Conference. Before we start I would like to acknowledge the traditional owners, the Irukandjii People and also the Elders from Cairns, Cape York, Torres Strait and other parts of Australia. I am here today not to talk specifically about environmental health, but more so around the wider health reforms happening in Cape York.

What I want to cover today is just a bit of background behind Cape York, and then I want to talk a bit about the concept behind what we use at Apunipima. I’d like to talk about the Cape York health reforms, a bit about my organisation, and then talk about the continuum of care which is something we have developed within Apunipima to try and get our thinking right about how we are going to address Indigenous health in Cape York. Last is a very brief talk around what I see are the linkages in health reforms in Cape York, the other reforms that are happening and also the linkages to environmental health.

For those who don’t know Cape York or aren’t from Cairns or Queensland, Cape York is the northern tip of Queensland and runs from Mossman Gorge, which is about an hour north of Cairns. It runs right up to the NPA which takes in Horn Island and then down the western side of Cape York back to Kowanyama. Cape York itself is roughly the size of Victoria, so it is a big area we cover. There are roughly 13 Aboriginal communities, four townships of Weipa, Laura, Coen and Cooktown. It has a population of 14,628 of which approximately 50% are Indigenous. Cape York comprises mostly remote communities that are difficult to access for approximately five months of the year, when it is wet and difficult to access by vehicle. Primary health care is provided by the Royal Flying Doctors and Queensland Health, with further specialist care needs requiring people to fly to Cairns, Townsville or Brisbane.

This diagram (life expectancy diagram) is something we always provide when we talk about Indigenous health. I suppose it is one of the reasons why I work in Apunipima, why people work in Queensland Health, the Royal Flying Doctor Service or any of the other health service employers across Australia. There’s been a lot of talk about Indigenous health and about the life expectancies of Indigenous people over the couple of years. But
we know as Aboriginal people that the health of our people is very bad. In Queensland, for example, state-wide the average life expectancies for Indigenous males is 56, and for females is 63, whereas non-Indigenous people as you can see from that graph is up to 76 and 82. So really Aboriginal and Torres Strait Islander people are expected to live 20 years less than our non-Indigenous counterparts.

One of the things I did when I first came into Apunipima was to look at trying to provide a simple diagram where people in my organisation and community could look at and understand what we are doing to improve Indigenous health. This is something that we came up with, which tries to link what is happening in the social environment to what we are doing in the health environment, and to work towards the overall aim of reducing the differences in life expectancies. We know up in the north here that our main aim is to improve Indigenous health, so we need to look at and address the reasons why our people are hospitalised, or die. We know these range from things like diabetes, to cancer, to cardio-vascular, to mental health or injury, and the way that we will address these are by dealing with two issues. One is dealing with the health environment, and that’s the area that health service providers plan. Organisations like Apunipima, Queensland Health, Royal Flying Doctor Service, Divisions of GP – these are the areas that we are responsible for. What we look to do in the health environment is to make sure that services we deliver are actually aligned with whatever the health issues are at the community level. At the same time we need to understand that there are a lot of social issues that
impact on what we do. Housing, employment, education, land, culture - all of these social issues impact on our ability of what we do in the health arena. The only way we can really get health gains is to deal and address both of those environments together.

When we talk about Indigenous health, we look at what happens overseas. We have looked extensively at what happens in Canada, and you can see in both Canada and New Zealand that life expectancies are considerably higher than what we have in Australia. The figures are anywhere between 13-15 years higher. Indigenous people in those countries live a lot longer. Imagine what we could do as Indigenous people if we had an extra 13-15 years of living, and what we could do with our families and our communities? The interesting thing is that 30 years ago the health status of these communities had the same health status as our communities do now. So they did things back then 30 years ago that actually led to improvements of overall health. Basically what they did is they transferred responsibility from government over to community people. So what we are looking at here is moving from what we currently have, which are poor services. These poor services are directly aligned with community health issues - poor responsibilities in the sense that these are individual, family and community responsibilities around health - to a service where we have the programs that align with community issues that are delivered in an appropriate way for our communities. There is also an individual responsibility to look after yourself.
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One of the questions that we asked ourselves was how were these improvements made? We looked at a lot of the literature out there and it came down to three basic things:
  • Government-provided resources to Aboriginal health at a level that matches the level of need. It should not be that departments fund according to how much they have allocated to Indigenous health, or how much they have allocated according to a population level - we need funding based on the level of need.
  • The other thing they did overseas is that they enabled a lot more Indigenous control over the health services. This ranges from health service planning and management through to the delivery of appropriate health programs and services, monitoring and evaluation.
  • Government supported and enabled a holistic approach to health, recognising the impact that broader social and economic factors have on health.
So if this can happen overseas, and if they can improve the health of their Indigenous people over a 30-year period, then the question is, ‘What are the key things we can take out of those learnings and apply to Cape York so that hopefully in 30 years’ time we can look at the same levels of success”? Around 2005 the Commonwealth and the State funded the Cape York Institute for Policy and Leadership to undertake a report into Cape York - the Health Reform Report - which identified the following key reforms (which mirrored overseas experiences) The recommendations that came out of the Report were:
  • Development of the Cape York Health Board.
  • Appropriate levels of funding based on need.
  • Community control of primary health care services
This is what we are talking about when we refer to health reforms in Cape York. Apunipima has been given the responsibility to undertake this type of planning, and to identify how we as an organisation in a regional area can move to greater control of health services in Cape York.

A bit about my organisation – we were established in 1994 by Cape York people, and it came out of a meeting at Pajinka (which is right up on tip of the Cape of the NPA). Cape York people came together and asked what they could do to improve the health of their people. One of the key messages coming out is that we need to control what we do, and what happens in our community concerning health. The name that they gave our organisation is a name from that area up there - Apunipima means United all in one. They recognised as a group that if we want to improve our health, then we need to start pulling together in addressing these issues in a way that’s appropriate for our communities. We are a community-controlled health organisation, but not in the same sense of some of the Aboriginal medical services around Australia. Our main role is to advocate on behalf of the health needs of Cape York people. This means we don’t deliver straight medical services, but we identify what are the problems with existing services to people of Cape York. We then advocate to the relevant agencies to improve these services, and also to take the higher level policies and funding issues to a national and state level. At the moment we employ about 16 staff but we know with movement over to
community control that this number will increase significantly into other professions of the health services. Our staff at the moment focus more around project management and administration, but we know that as we move to a true community organisation we will have to employ doctors and nurses, allied health, environmental health officers and truly become a community-controlled health organisation that’s delivering services.

The vision for our organisation reflects what we hope to achieve under the Health Reforms. Our vision is around Cape York communities owning solutions to live long, healthy, lives through strengthening our culture and regaining our spirits. The way we aim to achieve this is through eliminating health inequalities, strengthening community control of health outcomes, increasing access to culturally-appropriate services, educating better,
advocating for communities and influencing social issues that impact on health. This is the vision and these are the aims of the organisation that I’ve been given responsibility to actually achieve.

When we looked at how our health would be improved – I spoke before around the 20-year difference in life expectancy, around how our people die a lot sooner - we have the concept diagram there that spoke around how we will address these issues dealing with health and social issues. It’s good to have those concept diagrams there, but the question that we need to ask ourselves is how do we take that diagram and turn it into services on the ground. What we have started to do is to talk with all our stakeholders, Queensland Health, the Commonwealth, and communities about trying to put in place a continuum of care. This continuum of care is around making sure that when we deal with specific issues across Cape York, we deal with everyone on the same page - that we don’t have certain stakeholders going off and doing different things in each community.

This continuum of care has three levels - community, family and the individual, because there are things that you do differently at different levels. The other key parts of this continuum of care are the upstream issues including for example housing, education, food supply, domestic violence, economic development and behavioural changes. The challenge is how do we deal with these issues in a coordinated way. Unless we start dealing with the ‘upstream’ issues, people will come into the health system, get fixed up and go straight back into the same social environment - the same health problem will reoccur. One of the other key things we need
to do is how we get people into the health system. There are many communities up in Cape York (as in other parts of Australia), that have a very, very, low access rate to the health system.
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One community, for example, has a population of 1400 yet has only 400 on the primary health care centre books. So what happens to the other 1000 people in that community? There needs to be ways of getting people to access the health system. We can’t get an effective health system working until we actually know what the health system issues are that are being faced in a particular community. In the health services this is the key part of the whole continuum of care, because this is where your health care gains are going to be made. Health gains aren’t going to be made by what I do or what my board of directors do - health gains are going to be
achieved through what the nurses, the health workers, the doctors, the environmental health workers, and the allied health professionals do within the community. In the health services we have broken it down into four key areas that are based on a Chronic Disease Strategy for North Queensland that came out of the work that was done in a diabetes trial in the Torres Strait. The work that was done in the Torres Strait was through simple education, detection and management of diabetes. They were actually able to reduce the diabetes rates up there, so if it worked up there then there’s no reason why it can’t work in other parts of Cape York.

Therefore, the key areas are health promotion and education, early detection, management, and then links into specialist care. What we do in these areas is to look at who delivers what services around health promotion and education. Now we know with one application that was done over a year ago for Healthy for Life, that out of 17 communities across Cape York, only one community delivered health promotion and education programs around child and maternal health. So how will mothers know how to look after their kids or how to access antenatal care if you don’t have programs being delivered out into the communities in an appropriate way? Then you look at health promotion and education across the other major health issues of chronic disease, social and emotional wellbeing, mental health, across Cape York - if we are not doing it right in one area, how do we know that we are doing it right in the others?

The second part of the health services is around early detection. How do we know when someone comes into one of the primary health care services in Cape York that their health issues have actually been picked up? How do we know that when it is picked up that they are actually being managed properly, or if they need linkages into specialist care? How do we know if this is actually happening? So the main aim of this is making sure that services that are delivered into Cape York are delivered in a coordinated, collaborative way. We don’t want, for example, current cases of where in one community 20 service providers and mental health people go in to provide services to the same part of the community - the community has a population of only about 1000. It is important to identify which of the current service providers will be better placed to deliver health promotion education programs, which are those that are better placed to do the detection andmanagement, and then determine how we link into specialist care, bearing in mind these aren’t currently available in Cape York.

One of the last parts of this continuum is around the integration back into community. When someone has a baby in Cairns or when they come down here and need an operation on their heart and are told to lose weight or stop smoking, they go back into the community for a two-month period. How do we know that the support is there to help them to do those things? So we are looking at what the support services are for those major health issues those people face, and making sure that they are put in place.

I have spoken about the concept and the continuum of care, and this is the actual model we are going to put in place. It came out of the Cape York Institute Report, and has five levels. The first level is around funding, so it is based on getting the funding mix right. At the moment $30-40M goes into Cape York, but it goes in via four or five different organisations. Therefore, what we are looking at here is to develop a funds pool where the money goes in, and we have contracts and agreements with the State and Commonwealth about the outcomes that we will achieve for that amount of money. That’s ongoing and that’s not going to be achieved in the next 18 months. The second level is around board and governance. Our organisation has a two-tier governance system. The first one is around our Governing Committee which is two representatives, a male and a female, from each community. The Governing Committee is made up of 34 members, and out of the 34 members we select 10 members to sit on our Executive. When we move to a greater organisation with more responsibility we recognise that we need expert advice being provided to our Executive Committee in order to make informed decisions. We are now in the process of establishing a group of experts that are pooled with a certain
skill. These experts will sit down with our Executive Committee, and provide the advice that our Board needs.

The third level is then around identifying and determining the services that we can provide, and what services that we will purchase from the existing service providers. As I said, that part of it won’t happen over night – it will be a long, drawn out process. However, at the end of the day there are things that we can do to enhance current services out to the communities. The fourth level is around the community clusters. We have identified that we need more staff in certain areas around Cape York that will go in and assist and provide extra services to staff on the ground. At the moment that’s happening through the Commonwealth initiatives of improving primary health care, which is about getting more allied health professionals out there. They operate on a cluster level, so when they go in to Kowanyama, for example, they provide extra advice around dieticians and physiotherapy. Once we have identified what the community issues are, we will determine which programs are needed and if we can’t get the services on the ground, then we will put those services in at the cluster level. This means looking after about three communities, where teams will go in once or twice every month to assist local staff.
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The last is around the Health Action Teams. This is the most important part of community control in the health reforms, because it’s about community people taking greater responsibility for health in their community, making decisions about what programs they want addressed, and how those programs should be delivered in accordance with the needs of their community. In terms of how this will work at a community level, we spent the last eight months developing Health Action Groups. Health Action Groups are a collection of community people that come together, that start to take control of health and decision-making at a community level. These Health Action Groups can be made up of anyone interested in that community. For example, clan and family groups, individuals, justice group members, men’s group, women’s group, youth groups, health workers. In Coen, for example, we also have another group involved which we call ‘they’re the white people that live in that town’. So for the Health Action Groups it doesn’t matter who you are - if you are interested in health in that community then you can be part of the Health Action Group. The link then between the Health Action Group and the Council is there. With changes to the shire councils, a lot of councils are starting to focus on local
government responsibilities. This means that where previously Council focused on roads, rates, rubbish, housing, etc, they are not going to be able to continue to do that. What we are now looking at is saying to Council is that the Health Action Groups will assume the health responsibility in the community, that the Council will help and will sit on our Health Action Group, and they’ll be the body responsible for health in that community.

I have spoken very broadly about some of the health reforms in Cape York, though I am not an expert in environmental health. A lot of the things here I see are linkages between the reforms and environmental health, but I say that a lot of the clarification of the linkages between environmental health and what we are doing with the wider health reforms, will start to be clarified when we start to do the more detailed planning. However, the impacts that I can see are a transition of Aboriginal councils under the Local Government Act which is happening in Queensland, and possible amalgamation of boundaries in Queensland at the moment where we have a directive from State government that councils need to look at how they can amalgamate and create bigger shires. That’s a problem for our communities in Cape York, because each of our communities has separate shire councils. So it is going to happen - and how it is going to look - we don’t really know at this stage. The reason I raised this is that a lot of the EHWs in Cape York are employed by Council, so it is an issue of where do they sit, who employs them and if the health responsibility is being taken away from Shire Councils, then who has the responsibility to employ the EHWs? There’s also the issue of what are the health reforms of the greater community into environmental health issues by community Health Action Groups, which is likely to raise the profile of environmental health and the recognition of the impacts between environmental health and a lot of the ‘upstream’ issues services in the health services. Like I said, it’s hard to answer a lot of those questions. I know that at the moment it is an issue, but as we go down the planning process and we start to develop the
blueprint for health reforms in Cape York, a lot of those linkages and questions will be answered.

In conclusion, health reforms will occur in Cape York. There will be a staged process to transition of decision-making of services and funding allocation from the current State and Commonwealth government over to community control. There’s an increased capacity of Apunipima to be able to provide or purchase services, management of funds (both State and Commonwealth) and the ability to demonstrate provision of health outcomes.

I have given you the big picture of the view around what we see happening in Cape York, and it all comes back to this slide here, which is around improving the differences in life expectancies for Indigenous people. I hope that with the health reforms and the visions that we have for Cape York, we can look back in five to ten years’ time and see that the work we have done has really started to reduce the gap in life expectancies between Indigenous and non- Indigenous people. Thank you”.

For further information
Cleveland Fagan
CEO
Apunipima Cape York Health Council
Ph: 07 40815600 Email: Cleveland.Fagan@apunipima.org.au
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Guest Speaker

Walter Mackie, TSRA Portfolio Member for Environment and Health and Chairman of Iama (Yam) Island Community Council

“It’s good to be here this afternoon. Welcome, everyone, to this conference. I would like to begin by firstly acknowledging the traditional owners of the land, the Irukandjii People, Elders who are present, ladies and gentlemen. I represent the Torres Strait Regional Authority (the TSRA) and I am the Portfolio Member for Environment and Health. Today I would like to inform you of the work that has been progressed by the TSRA, to improve environmental health outcomes in the Torres Strait. My presentation will cover three areas. Firstly, I will provide you with a brief overview of the Torres Strait, then inform you of the TSRA, followed by the environmental health initiatives currently being progressed and delivered by the TSRA.

The Torres Strait

The Torres Strait is a diverse and unique part of Australia situated on the tip of the Cape York Peninsula, extending some 150 klms north to the border of Papua New Guinea’s Western Province, and north-west toward Indonesia’s West Irian Jaya Province. The region includes 18 inhabited island communities, and two mainland communities of Seisia Bamaga located on the Northern Peninsula Area. The Torres Strait population is approximately 8,306 of whom 6,168 are Torres Strait and Aboriginal People (2001 ABS Census).

The Torres Strait Regional Authority (TSRA)

The TSRA was established on 1 July 1994 under the Aboriginal and Torres Strait Islander Commission Act 1989, which today is known as the Aboriginal and Torres Strait Islander Act 2005. It is an Australian Government Statutory Authority and is the peak representative body for the Indigenous people of the Torres Strait. It has an annual budget of approximately $56.8M from the Australian Department of Finance and the TSRA formulates and implements programs and services to strengthen the economic, social and cultural development of our region. They aim to do this by working toward our six goals of:
  • Gaining recognition of their rights, customs and identity as Indigenous peoples.
  • Achieving a better quality of life for all people living in the Torres Strait region.
  • Developing a sustainable economic base.
  • Achieving better health and community services.
  • Ensuring protection of the environment.
  • Asserting Torres Strait native title over the lands and waters of the Torres Strait region.
By striving for these goals they aim to improve the lifestyle and wellbeing of Torres Strait Islander and Aboriginal people living in the Torres Strait.
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Health in the Torres Strait

Despite being part of a developed country and living an often envied life on beautiful tropical islands, no-one can deny that the Torres Strait people still experience hardships and diseases that are regularly found in third world surroundings. It is well-documented that Indigenous people experience more illness and die at a younger age, compared with non-Indigenous Australians. A Report on health indicators for the Torres Strait and Northern Peninsula Area Health Service District (2001 a publication of the Tropical Public Health Unit Network of Queensland Health) has identified that:
  • Rates for all causes of death were higher in the Torres Strait and Northern Peninsula Area Health Service District than the rest of Queensland, with most of these occurring in 40-70 years age group.
  • Deaths due to Diabetes Mellitus were more than 10 times higher in the District than in Queensland. (Information on deaths due to Diabetes Mellitus was sourced from Improving Diabetes Self-Care in the Torres Strait: a one-year randomised cluster trial 2002-2003). Hospital admission rates for Diabetes Mellitus were 10 times higher in the Torres Strait than the rest of the State over the period 1994-1998.
  • Mosquito-borne diseases are 164 times higher than rates for Queensland for the period 1999-2003. Recent Dengue Fever outbreaks resulted in 277 cases and the death of one person in 2003-2004.
With figures such as these the TSRA has played a leading role in discussions, establishing partnerships and is taking part in key initiatives that are aimed at improving Indigenous health outcomes. TSRA believes a whole-of-government approach is needed to address the health concerns of the Torres Strait. For example, in 1999 TSRA signed the Torres Strait Health Partnership Agreement with the Australian Department of Health and Ageing, and the Queensland Department of Health, the Island Coordinating Council (ICC) and the District Health Council. As a partner the TSRA provides policy advice, secretariat support and information on a
range of health issues to the Partnership, and also ensures that environmental health and community infrastructure programs, including mainstream health programs, are linked and appropriate for regional communities.

On 25 July 2006 the Partnership entered a new five-year Health Framework Agreement. The Australian Government Minister for Health and Ageing, Minister Tony Abbott, Queensland Minister for Health, Minister Stephen Robertson, with the Chairperson of the TSRA, ICC and District Health Council, made a commitment together to work towards:
  • Advancing Torres Strait people’s access to relevant health and health-related programs, as well as improving the reporting and sharing of services and programs.
  • Increasing health service resources to address the higher level of health needs by Indigenous people.
  • Support joint planning processes and include Indigenous participation on decision-making and priority determination, to improve the coordination and delivery of service. The TSRA hopes that through this Agreement the region will begin to see positive health outcomes being delivered to and experienced by, community members.
Dengue Prevention

As mentioned in the previous list of statistics, mosquito-borne diseases reported in the period of 1999 to 2003, were 164 times higher in the Torres Strait and NPA Health District than the rest of Queensland. In addition, Dengue Fever outbreaks resulted in 277 reported cases, and the death of one person. To further complicate the fight against dengue fever, a second mosquito that is also capable of causing Dengue Fever was found in the Torres Strait in 2005.

The TSRA and the Department of Family, Community Services, and Indigenous Affairs have begun to address Dengue Fever by entering a Memorandum of Understanding to fund the ‘Asian Tiger Mosquito Control Project’. This Project is aimed at controlling the Asian Tiger Mosquito population, thereby decreasing the incidence of Dengue fever. This $1.1M program will be managed by the Island Coordinating Council, which will work together with all Island Councils and Queensland Health to take necessary measures in controlling the region’s Asian Tiger Mosquito population. The TSRA is involved in a number of key initiatives that aim to
improve the overall health of the region. However, TSRA recognises the fundamental key to creating good health outcomes is not only for the people to lead an active and healthy lifestyle, but to also live in a healthy and safe environment.
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Housing

A report to the Housing Ministers Advisory Council Multi Measure Modelling of Indigenous Housing Needs in August 2003, reveals that in the Torres Strait:
  • 20.7% of those households studied for the Report were overcrowded. This was above the total regional average for all ATSIC regions (18.92%).
  • The Torres Strait region was the third highest region, with the highest number of dwellings requiring major repair or replacement. The number of dwellings needing major repair or replacement was 369. This is 19% of the total Queensland figure of 1,916. (Major repairs were defined as repairs of $20,000 to less than $60,000 in low-cost areas, $27,000 to less than $80,000 in medium-cost areas and $33,000 to less than $100,000 in highcost areas. Replacement was defined as repairs of $60,000 or more in low-costs areas, $80,000 or more in medium-cost areas and $100,000 or more in high-cost areas).
  • This figure represented 36.8% of the total number of dwellings surveyed in the Torres Strait, and is above the total regional average for all ATSIC regions of 26.1%.
Housing is a critical issue in the region, and when combined with severe overcrowding and poor conditions, the standard of housing no doubt can have an adverse affect on health in the Torres Strait. TSRA is working with partner agencies and organisations to investigate and attempt to improve home ownership opportunities, as well as address housing shortages, a dysfunctional housing market, and the abnormally high cost of housing in the region. Associated with housing problems there are the issues of land tenure, community viability and sustainability, waste management, adequate data collection, and the need to adequately plan for population trends. In the case of Thursday and Horn Islands particularly, there is a need to balance the needs of housing with the needs of Government, with the housing needs of the general population.

Recently, the Queensland Department of Housing has undertaken a research project to identify housing issues on Thursday Island. This important project commenced in April of this year, and will consider all aspects of housing provision, including impacts on Indigenous people, non-Indigenous residents and Government and private sector employees. This research will include the land and town planning situation, projected housing supply and demand, and land supply and land tenure. The capacity of surrounding islands on housing demand, supply and capacity may also be considered. TSRA is supporting this project and views it as a significant and necessary step in the process of resolving the serious housing issues that confront the Torres Strait region as a whole.

Major Infrastructure Program (MIP)

In 1996, it was identified that the Torres Strait people were living in substandard conditions. It was also estimated that a total capital cost of $318M was required to provide necessary basic infrastructure to begin lifting their living standards. Essential infrastructure such as clean drinking water supplies and water treatment augmentation, reticulated sewerage and treatment, subdivisional development and essential services extensions, roads and stormwater drainage, and solid waste disposal, were just some of the areas that need attention and enhancement.

In 1998 the Australian and Queensland Governments made a $100M commitment to begin improving and upgrading the region’s essential infrastructure. Subsequently the TSRA, representing the Australian Government, and the Department of Local Government and Planning, representing the Queensland Government, jointly created and commenced the Torres Strait MIP. The main objective was to improve the health and well-being of the Torres Strait Indigenous people by providing appropriate and sustainable environmental health infrastructure. Over the last decade close to $92.4M has been spent in progressively addressing the region’s infrastructure shortfalls. Close to 10 years on, MIP has delivered over 33 infrastructure projects, with a further 11 projects currently in construction or design phase and due for completion later this year. Some of MIP’s life-changing projects include:
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  • 19 sewerage and sanitation projects completed ($26.5M).
  • 5 reticulated sewerage schemes in progress ($32.1M).
  • 17 water supply upgrades/augmentation completed ($14.2M).
  • 3 water supply upgrades in progress ($3.4M).
  • 6 internal road and stormwater drainage upgrades completed ($3.7M).
  • 3 internal road and stormwater drainage projects in progress $1.7M).
  • 9 subdivision projects completed ($5.5M).
  • 2 regional solid waste projects in progress ($0.9M).
  • 2 solid waste projects completed ($0.3M).
  • 2 regional solid waste projects in progress ($1.2M).
The success of MIP can be attributed not only to the constant delivery of essential infrastructure, but keeping in line with the policy objectives and priorities of the Australian and Queensland Governments and local community councils. Its Whole-of- Government approach has provided an excellent example of all tiers of government working successfully together. It has also demonstrated flexibility, accountability and leadership, and has implemented the broad government policy objectives of shared responsibility and partnership. Furthermore, with its regional focus, MIP has realised a high level of Indigenous participation and ownership. MIP has laid the foundations for the economic development for the region. Through basic services, such as roads, constant water supply and flushing toilets, it has equipped communities to participate in income-generated ventures such as tourism, enhancing the local economy and increasing employment opportunities. In addition, MIP has supported Indigenous enterprise and the local workforce by engaging local councils to oversee
and construct works and at the same time up-skilling community members by the use of accredited training programs attached to, or partnered with, MIP.

Environmental Health Outcomes Delivered by MIP

Despite major difficulties inherent in delivering infrastructure to the remote and isolated islands of the Torres Strait, MIP has successfully begun changing environmental health outcomes in the region. In fact, health statistics have confirmed that improved environmental health infrastructure delivered by MIP are playing a key role in the reduction of water and hygiene-related infectious diseases in the region. For example, indications of water and hygiene associated communicable diseases like Shigellosis, Salmonella and Hepatitis A, have decreased in the 10-year period between 1996 and 2006. The Queensland Notifiable Conditions Database (NOCS) reports that incidences of such environmental health related diseases in the Torres Strait have halved, with close to 40 cases per year in 1996 down to under 20 cases reported in 2006.

Through improved environmental health infrastructure such as improved water quality and sanitation by MIP, such illnesses have receded, especially when combined with health education, immunisation interventions and awareness. It is clear that a community’s living conditions play an important role in the health and wellbeing of individuals, and clean water, good sanitation and improved hygiene practices are important in determining good health outcomes.

Last year the World health Organisation (WHO) estimated that 24% of the global disease burden and 23% of all deaths can be attributed to environmental factors. According to WHO, global environmental infectious diseases such as diarrhoea were attributable to water, sanitation and hygiene. In fact, 88% of such cases were attributed to these. WHO also revealed that 94% of all cases of diarrhoea around the world were attributable to the environment, resulting in more than 1.5 million deaths annually.
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In the Torres Strait, MIP has significantly contributed to improved environmental health outcomes:
  • In 1996, 34% of people living in the Torres Strait lived in third world sewerage conditions which were a major health hazard. MIP removed all pan toilets, ensuring that all residents had flushing toilets and hand-washing facilities. MIP has or is progressively constructing reticulated sewerage systems in 11 communities.
  • In 1996 only 39% of people in the Torres Strait had access to drinking water that met the Australian Drinking Water Guidelines – National Health and Medical Research Centre, as very few water supplies were chlorinated. The water quality of the drinking water that all residents have access to now meets the Australian Drinking Water Guidelines.
  • In 1996 there were dramatic water shortages requiring annual barging of emergency water. By 2000 every person in the Torres Strait had access to 250 litres per day (minimal requirement).
  • MIP has implemented appropriate regional planning, allowing for effective delivery of prioritised essential infrastructure to meet the most urgent environmental health needs across the Torres Strait region. Results of this planning include appropriate housing subdivisions rather than haphazard development.
  • Steadily upgrading internal roads and storm water drainage in each community, thereby reducing dust and flooding, and improving access to important services such as school and health clinics.
  • MIP has completed preliminary solid waste management improvements by providing designated disposal areas away from the immediate town area, and disposing of bulk waste from each island.
In summary in almost a decade of hard work the people of the Torres Strait now have access to clean and safe drinking water, flushing toilets, serviced housing lots, sealed roads and drainage systems. In addition, local community councils are well informed and trained to manage community waste through the provision of sewerage treatment plants and improved refuse control techniques.

It is through programs such as MIP that you can see how much environmental health infrastructure is needed to produce positive health outcomes for people. However, while living standards in the Torres Strait are still not comparable to that of mainstream Australia, it is vital that all levels of government continue to work together and support such programs to continue this life-changing work. Thank you”.

For further information
Walter Mackie
Chair
Iama Island Council
Yam Island, Qld, 4875
Ph: 07 4069 0700 Email: susan.reilly@tsra.gov.au
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