Sujata Allan grew up in rural NSW near Armidale. After studying medicine at the University of NSW and the rural clinical school at Port Macquarie, she worked in hospitals in Western Sydney and the Blue Mountains, and is currently completing her GP training working in Blacktown. She has been an advocate for a healthy environment and for climate change action for many years, and is currently on the national management committee of Doctors for the Environment Australia (DEA). She has spoken at community events and conferences around NSW and interstate about the impact of air pollution, fossil fuels and climate change on health, and has organised several educational events for health professionals on climate change and health. She was involved in environmental sustainability initiatives at the Children’s Hospital at Westmead in 2015 and 2016. She completed the Australian Community Organising Fellowship in 2016. In her spare time she plays banjo and fiddle in an old-time band.
The health effects of climate change are evident today, with rural Australia particularly vulnerable owing to increasing extreme heat and bushfires, changed rainfall patterns and challenges to livelihoods. Future climate projections represent a major threat to public health in Australia and worldwide. However, tackling climate change offers significant opportunities for improvements in health (Watts et al, 2015). Rural health professionals are optimally placed to be at the forefront of this change.
Recognition of the social and environmental determinants of health is an essential foundation of healthcare. It is crucial that Australian health professionals are aware and empowered to integrate climate and health considerations into their professional practice. Health professionals’ respected position in the community empowers the profession to offer leadership in climate change mitigation by reducing carbon emissions, and to advocate for policies which safeguard and promote a healthy, sustainable Australia.
This workshop will offer health professionals an evidence-based overview of the health impacts of climate change with a focus on those relevant to rural communities in Australia and vulnerable populations including the elderly, children and those with chronic diseases. It will then lead into a discussion around the unique role of the health professional in advocacy, awareness and community engagement, and provide some tools and direction to further develop these skills. The workshop will cater for a range of knowledge bases, and is essential for those wishing to further their expertise and agency in tackling this public health issue.
Dr Jane Anderson-Wurf (B App Science, Grad Dip Ed TESOL, B. Primary Education Studies, PhD) has 30 years' experience teaching English to speakers of ther languages (TESOL) and extensive experience working with refugees in the Murrumbidgee region as more than 10 years ESOL teacher and 3.5 years as Manager of Australian Migrant English Program (AMEP). Jane has proven experience in developing health education resources for training on cultural competency and resources for GP supervisors 'Communication Skills Toolbox: for clinicians engaged with International Medical Graduates', dDeveloped with funding received from CoastCityCountry General Practice training (CCCTGP) with a $100,000 grant over two years. Her previous work with Murrumbidgee LHD included a series of cultural competence training workshops with nursing staff at MLHD targeting issues for staff working with culturally diverse patients and working successfully with colleagues from differing cultural backgrounds (2013-2014). Jane has evaluation experience from program evaluations and reports for MMLL, including: Preventative Health Initiative Evaluation (2013); Report on Care Co-ordination and Supplementary Services, part of Closing the Gap (2013); Report on Primary Health Care Initiatives (2014); Murrumbidgee District Aboriginal Health Consortium Plan (2016).Jane is a research fellow with a PhD in rural health, with extensive research in cultural competency, international medical graduate workforce, aged care and osteoporosis management.
It is predicted that osteoporosis or osteopenia will affect 6.2 million Australians aged over 50 years by 2022. However, osteoporosis often remains under-diagnosed even after a minimal trauma fracture (MTF). There is a ‘disconnect’ between the recognition of MTFs and their subsequent investigation resulting in a gap in osteoporosis care which continues to widen. This mixed method study looked at the attitudes and beliefs of general practitioners (GPs) and orthopaedic surgeons about the management of osteoporosis following MTF and the roles and responsibilities of health personnel.
Two questionnaires were developed and sent to 69 orthopaedic surgeons practising in rural and regional south-eastern Australia from the Royal Australian College of Surgeons website and 203 GPs working in a regional Local Health District. Three female and three male GPs, one female and five male orthopaedic surgeons were purposively selected for interviews. SPSS was used for descriptive statistics and NVivo10 was used for qualitative analysis. Interviews were analysed by two researchers independently and key themes were identified.
The overall response rate was 60.8% for orthopaedic surgeons and 35.5% for GPs. Almost all GPs and two-thirds of orthopaedic surgeons thought the most appropriate healthcare professional to initiate discussion about osteoporosis was the GP. Common reasons orthopaedic surgeons gave for not initiating osteoporosis treatment following MTF were that they did not have time and it was not their responsibility. The main barrier for GPs not initiating treatment was that they were not informed that the patient had sustained a MTF. The majority (70%) of both groups rated the quality of coordination of osteoporosis patient care between hospital and general practice as unsatisfactory or poor.
There was general agreement among the interviewees that the role of the orthopaedic surgeon was to fix the fracture and the role of the general practitioner was to manage osteoporosis as a disease. orthopaedic surgeons perceived their role was to ‘fix the fracture and send them home’ and ‘my role in the whole medical community is to operate and that takes up 100% of my time’. The difference in opinions centred on whether the orthopaedic surgeons had a responsibility to raise the issue of osteoporosis with a patient when they were in the acute stage of an MTF. GPs felt strongly that orthopaedic surgeons have a significant role in mentioning osteoporosis to the patient at the time of fracture and it should be a key element in the discharge summary.
Mitchell Anjou is an optometrist and public health practitioner who works as an Academic Specialist and Senior Research Fellow in Indigenous Eye Health at The University of Melbourne. He leads advocacy and implementation initiatives to Close the Gap for Vision for Aboriginal and Torres Strait Islander Australians. Mitchell directed public eye care services in Victoria for over two decades as Clinic Director at the Australian College of Optometry and a Senior Fellow in the Optometry Department of the University of Melbourne. In 2013 he was awarded a Member of the Order of Australia for significant service to optometry and public health and currently contributes through boards and committees of the Australian College of Optometry, the Optometry Council of Australia and New Zealand, Vision 2020 Australia, Optometry Australia and jurisdictional and regional eye care groups across Australia.
The eye health of Aboriginal and Torres Strait Islander people is improving compared to other Australians—the gap for vision is demonstrably closing. The recent National Eye Health Survey (2016) reports Indigenous Australians having three times the rate of blindness and three times more vision loss compared to non-Indigenous Australians and in 2008 the blindness rate was six times greater. Over 90% of Indigenous vision loss—caused by refractive error, cataract, diabetic retinopathy and trachoma—is considered preventable or treatable, and the interventions required are affordable, effective and doable.
The Roadmap to Close the Gap for Vision (2012), proposes 42 sector-endorsed, evidence-based recommendations to address Indigenous eye health inequity through health systems reform, and require implementation at national, jurisdictional and regional levels and across the whole of Australia. The Roadmap describes the patient pathway of eye care as a ‘leaky pipe’ in which each ‘leak’ needs to be fixed, to ensure Indigenous people receive adequate eye care outcomes. Fixing one or two or even three leaks will not improve overall outcomes and it is only together, by eye care stakeholders working collaboratively, that the eye care pathway can flow successfully.
Regional implementation of the Roadmap requires a whole-of-system collaborative approach. Regional stakeholders groups are established, bringing together those involved along the patient eye care pathway, to discuss opportunities to reduce current gaps and barriers to access. To facilitate these discussions, patient pathways are mapped to identify ‘leaks’ or gaps existing within the eye care system. Priority areas are then self-determined by the region, who work together toward solutions to close the gap for vision. Currently, 48 regions across the country are operating in this way, covering over 75% of Australia’s Indigenous population.
In Tasmania, three Indigenous eye health regional groups (north, north-west and south) were formed in 2017. From these regional gatherings, stakeholders together identified barriers to access for eye care services and outcomes, which included, the identification of Aboriginal patients, costs of consultations and treatment and awareness of eye health pathways. Each regional group is now working together on solutions that address these barriers and improve Aboriginal eye health outcomes.
This presentation will discuss how collaborative approaches are being used to successfully tackle the ‘leaks’ of the eye care patient pathway for Aboriginal and Torres Strait Islander people in Tasmania and more broadly across Australia. These successes to close the gap for vision illustrate initiatives that are better together.
Miranda Ashby has worked in the youth, community and mental health sectors in Tasmania for over 25 years. This has been in both non-government and government organisations, including Red Cross, Hobart City Council, Colony 47, Flourish Mental Health Action In Our Hands, Youth Justice and Children and Youth Services. Miranda has been the Centre Manager of headspace Hobart for over three years and works for The Link Youth Health Service (headspace Hobart’s Lead Agency). Miranda is passionate about youth participation and community development.
Relevance: The increase in demand for headspace services in Tasmania has identified a need to review, and potentially refine and improve demand and intake management processes. The need for a review was identified in discussions between Primary Health Tasmania and commissioned providers for headspace services in Tasmania: The Link Youth Health Services based in Hobart and Cornerstone Youth Services based in Launceston. As per the ASGC remoteness area classification, Launceston and Hobart classify as inner regional areas (RA2). Young people accessing headspace centres however also come from outer regional and remote regions. It was identified that increased service demand and comparatively small funding increases make service intake processes and waiting times difficult to manage. It was reported that staff at headspace centres are experiencing increased workloads and are frustrated with not being able to provide timely services when young people need them. Increasing demand for service and limited access to alternative mental health service providers, adds additional pressure on headspace services to continuously review their practices and develop innovative models of care that improve efficiency and client access.
Methods: In June 2018 Primary Health Tasmania commissioned Brockhurst Consulting to review intake and assessment processes, report on innovative intake and assessment models currently used in youth organisations in Australia and provide recommendations of improvements for consideration.
Results: Key findings that are going to be presented:
- summary and analysis of current intake and assessment systems and processes in youth organisations in Australia
- recommendations for improvement of intake and assessment processes taking into consideration the local context.
- recommendation of a draft implementation plan to assist service providers with the practical steps on how to implement recommendations, including the implications of any suggested changes on current policies, procedures, workforce requirements and systems.
Arts in health
Dr Jennifer Ayton is a researcher/lecturer in public health at the School of Medicine, College of Health and Medicine, University of Tasmania. Jen has a PhD in Sociology and Public Health and works with a diverse range of partners using sociology, creative arts, and public and primary health. Jen is a mixed methods and qualtitive researcher. Her research focus is family and maternal/infant health, in particular infant and young child feeding/breastfeeding behaviours and patterns. Her applied understanding of health sociology, social theory and extensive clinical background as a midwife/nurse, including working in Aboriginal and Torres Strait Islander and African communities adds to her expertise and balanced perspective.
Understanding how people engage with research and health promotion messages is important to inform the delivery of appropriate context based health care. Arts-based translational methods are effective modes for disseminating academic knowledge to non-academic audiences and creating public platforms for the discussion of health issues. The art-health lens provides a board paradigmatic framework (qualitative, visual/creative arts, social science) to explore and understand complex social phenomena that impact on both individual and communities health and wellbeing. Using these frameworks can offer an innovative multidisciplinary and collaborative approach to inform context based rural service models and create new public platforms for the discussion of sensitive public health issues.
We present an example of an innovative Arts and Health methodology used in our project ‘Broken Bodies’ that translated previously collected empirical research (127 Tasmanian mothers breastfeeding narratives) into visual art forms for a public exhibition. Based on qualitative interviews conducted with 20 gallery visitors and six artists involved in the generating of the work and exhibition, this paper provides evidence of a new approach for using art-health methods as a form of evidence translation and generation, public engagement and the impact it has on generating awareness and social discourse around sensitive health issues. We also highlight the use of artists’ skills in empirical research translation, in particular the role that empathy plays in generating awareness and social discourse around health. In keeping with the findings of the primary research and the conflicted, and often painful experiences of breastfeeding reported by mothers, this paper highlights the ethical importance of sustaining empathy throughout each stage of translation; from the artist’s response to the data and the conceptual development of their work, to the presentation of their work in a local gallery setting and gathering of the audience responses.
This methodology can be used to translate and generate data, return the research findings to the primary participants and local community, foster creative engagement across settings and disciplines whilst assessing the impact on community perception and understandings of public health promotional messages.