Report of the 6th National Conference

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Hygiene Interventions: What Evidence is Available About Their Effectiveness?

Liz Mc Donald, Ross Bailie, Peter Morris & David Brewster, Menzies School of Health Research - Charles Darwin University

Theme: Environmental Health Services in Communities
The slow progress to achieve healthy living environments in many remote Indigenous communities calls for a more considered evidence based approach to developing policy and program address the current problems. The World Health Organisati recommends that all public health interventions should be based far as possible on a mix of scientific evidence, expert opinion practical experience. In choosing what interventions to intro into communities, environmental health workers need to hav capacity to assess the likely effectiveness of interventions a to the population group to be targeted, the context and vehi for delivery, and quality of the evidence available. To contrib to meeting the needs of policy makers and others working to achieve improved hygiene and healthy living environments in remote Indigenous communities, a systematic literature revi concerning a wide range of hygiene interventions has been completed.

This review looks beyond examining the strength of epidemiological evidence. Only studies that involved Indigenous populations, and populations from developing countries who live in tropical climates, were considered eligible for inclusion. More than one intervention type or one primary outcome measure was eligible. Outcomes measured included the suite of infections that Indigenous Australian children frequently experience, that is upper respi tract infections (including Otitis Media), skin infections (inclu infected scabies), and chronic gastrointestinal disorders cau pathogenic viral and bacterial agents, and helminths.

National Indigenous Housing Guide 3rd Edition

Anne Rhodes, Colleen Gibbs & Paul Pholeros, FaCSIA & Healthabitat Pty Ltd

Theme: Housing Issues and Planning

Aims/Objectives
  • The National Indigenous Housing Guide provides practical about housing design, construction and maintenance to i the living environment for Indigenous people, with a focus o safety and health
  • The guide complements the Building Code of Australia a State/Territory government building standards
  • It is distributed across Australia to designers, architects, builders, maintenance workers and environmental health
Project/Program
  • The third edition has been expanded to include communi planning information and specific instructions for mainten of health hardware
  • Data from housing for health projects has been updated a differences since 2003 have been analysed and discussed
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Results/Evaluation
  • The third edition has been compiled following a review of second edition by technical experts
  • Submissions were invited from over 300 stakeholders
  • The contents were decided in a two-day workshop with selected contributors
Sustainability
  • The third edition of the National Indigenous Housing Guide will be published in hard copy and available on the Internet
  • A web-based forum will be established to encourage use to exchange information, designs, ideas and debate abo Indigenous housing design, construction and maintenance issues
Lessons Learnt
  • The guide has been endorsed by the Standing Committee on Indigenous Housing, which comprises the Australian and all state and territory governments
  • The data indicates that there have been some improvements in the condition of houses since the second edition was published in 2003.
Budget / Funding
  • The National Indigenous Housing Guide third edition is published by the Australian Government Department of Families, Community Services and indigenous Affairs contacts / links / resources
Contacts / Links / Resourses
  • Healthabitat Pty Ltd
  • Reference and resources are listed in the third edition of the guide
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Aboriginal Environmental Health Officer

Jeff Standen, Manager Aboriginal Environmental Health Unit, NSW Health Andrew Reefman, AEHU, NSW Dept. of Health.

Theme: Local Regional and National Initiatives

The program aims to train Aboriginal people in the field of environmental health in an effort to develop an Aboriginal workforce with the leadership and technical skills to progress environmental health issues into the future.

In April 1997, NSW Health (with some initial funding support from the Commonwealth government) launched a five-year pilot program to train and provide study support for six Aboriginal people to become Environmental Health Officers.

The initiative has now grown into a continuing training program. It is fully funded by NSW Health with eight trainees employed full-time by an Area Health Service based in urban and regional Public Health Units within NSW.

With supervision by senior staff in the Public Health Unit, the trainee progressively, takes on more responsibilities. The trainee also participates in University studies via distance education to complete a Batchelor of Applied Science (Environmental Health) with the University of Western Sydney.

Trainees study at home (study leave is also part of the conditions of employment) and in the workplace and attend the university campus at least once a semester for on-campus residential workshops (for up to one week at a time) and again for tutorials and exams at the end of the semester (usually a few days).

The program covers the cost of travel and expenses associated with the trainee’s employment or study. Course fees (including HECS) for up to 24 subjects (being the full degree course load), and any other associated costs (including text books, technical equipment and graduation costs) are met by NSW Health.

At the completion of their study, trainees are offered two years employment with the Public Health Unit as a graduate EHO to consolidate their skills.

Trainees and graduates are playing an increasing role in ensuring the success of public health projects in communities and also in developing links between the communities and the public health units.

Trainees are also entitled to student membership of the Australian Institute of Environmental Health, the professional body for Environmental Health.

Evaluating the NSW Housing for Health Program

Darren Mayne, Epidemiologist Aboriginal Environmental Health Unit, NSW Health (now with South Eastern Sydney/Illawarra Area Health Service). Jeff Standen, Manager Aboriginal Environmental Health Unit, NSW Health

Theme: Housing Issues and Planning Local, Regional and National Initiatives Community Engagement/Partnership Environmental Health Services in Communities

Housing for Health is a repair and maintenance program that focuses on surveying and fixing Aboriginal housing, with all works prioritised to maximise health benefit, particularly for children 0-5 years old.

The Housing for Health process aims to assess, repair or replace health hardware so that houses are safe and the occupants have the ability to carry out healthy living practices (HLPs). All works carried out are prioritised in terms of health benefit. The priorities are:
  • Safety - Immediate life threatening dangers are addressed as the highest priority.
  • Healthy Living Practices -
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  1. Washing people
  2. Washing clothes and bedding
  3. Removing waste safely
  4. Improving nutrition
  5. Reducing the impact of animals, vermin or insects
  6. Reducing dust
  7. Controlling temperature
  8. Reducing trauma
  9. Reducing overcrowding
The program has a philosophy of no survey without service and involves training community members in this area. It is as much a community development project as an asset management project.

In partnership with Department of Aboriginal Affairs, NSW Health has undertaken Housing for Health projects in over 50 communities across NSW since 1997.

NSW Health’s involvement in this program is for a number of reasons:
  • The anticipated health benefit particularly in children, by ensuring community housing is equipped to enable residents to undertake healthy living practices. Research has shown that improving essential health hardware (fixing a leaking toilet, electrical repairs, having sufficient hot water, having somewhere to wash a baby or child etc.) can lead to improvements in health status;
  • Reduce health expenditure through reduction in infectious diseases;
  • Reduce social stress by ensuring basic health hardware (toilets, hot water etc) are working in the houses;
  • Building a bridge between communities and Public Health Units, across which other health related projects can follow.
NSW Health has been evaluating projects throughout the program in a number of ways including:
  • Post- project evaluation. This involved revisiting communities to evaluate the effectiveness and sustainability of the gains initially made in the project. This was done by carrying out the survey and fix process in a community 2-3 years after the completion of the initial project.
  • Evaluating the health impacts of the program. This involved an analysis of hospital separations data in an attempt to determine whether an association between the Housing for Health program and a health status could be identified.
  • Documenting qualitative benefits that have arisen out of the program including the development of follow on programs with communities (such as asthma reduction, injury prevention, pest control), and employment and training opportunities provided for community members, such as apprenticeships and Healthy Housing Workers.
The presentation will outline some of the results of the program to date as well as results of the health evaluation.

References: Pholeros, Paul; Rianow, Stephan; Torzillo, Paul. (1993).
Housing for Health: Towards a Health Living Environment for Aboriginal Australia. Healthabitat: Newport Beach, NSW. Department of Family and Community Services (2003).
National Indigenous Housing Guide (2nd edition) Commonwealth of Australia: Canberra.
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