Poche Centres for Indigenous Health Key Thinkers’ Forum Darwin 11 July 2014

1. Poche Centres for Indigenous Health Key Thinkers’ Forum Darwin 11 July 2014

2. Welcome to country

3. Overview of the Key Thinkers’ Forum: format, topic and issues

4. Filming • Briefing paper • “Q and A” meets “Insight” • Everyone participates • Cameo speakers • Poche Opinion

5. Steve Gutheridge The data

6. How much? • Average annual per capita alcohol consumption 13.4 litres compared with national 10.3 litres (15 years & over) NT wholesale alcohol supply & ABS apparent consumption of alcohol, Australia 2012-13 ABS population estimates, 15 years and over Who? • NT adults aged 18 years and over • Non-Indigenous population, 90.2% consumed in previous year • Indigenous population, 50.3% consumed alcohol AIHW NDSHS 2010 & ABS AATSIHS 2012-13 The cost and harms, in 2004/05? • Total social cost, $642 million or $4197 per adult c/w $943 for Australia • 93% of costs are from consuming risk or high risk levels Whetton S et al. (2009) Harms from and costs of alcohol consumption in the Northern Territory; South Australian Centre for Economic Studies (SACER), Adelaide Some NT numbers for alcohol

7. and some NT numbers for tobacco • Who? • NT adults aged 18 years and over • Australia 18.2% current smokers • NT Non-Indigenous population, 23.6% • NT Indigenous population, 50.3% current smokers • AHS 2011/12 (unpublished data) and AATSIHS 2012/13 (customised report). • The cost, (2005/06) • $764 million, or $5,150 per person aged over 14 years. • Whetton S et al (2013) Harms from and costs of tobacco consumption in the Northern Territory. • South Australian Centre for Economic Studies (SACER), Adelaide

8. Alcohol consumption in pregnancy, 2003 to 2011 NT Midwives Collection, 2003 to 2011

9. Deirdre Logie Policy and legislation

10. National Drug Strategy 2010 – 2015 To minimise the harms of drug use using the 3 pillars approach • Intergovernmental Committee on Drugs • Collaboration of health, law enforcement with non-government • Supported by sub-strategies eg National Tobacco Strategy

11. Legislation operates at national and jurisdictional level

12. Demand Reduction • Promote healthy lifestyles, treatment services, diversion programs • Social marketing, change AOD culture • Limit exposure to AOD advertising, sponsorship • Clinical standards for treatment service Supply Reduction • Strengthen regulatory framework about promotion, sale and supply • Place based approaches eg permit system, point of sale, Accords • Licensing conditions • National principles on liquor licensing Harm Reduction • Safer communities with effective partnerships – health, police, licensing, local govt, transport • Child and family sensitive practise, education, culture • Preventative approaches – outlet density, warning labels

13. Christine Connors Population strategies

14. Alcohol • The total cost of grog related harm in the Northern Territory, is about $642 million per year. • Territorians drink grog at ONE AND HALF times the national average. • Two in three of all domestic violence incidents in the Northern Territory are alcohol-related. • 60% of all assaults that happen in the NT are grog-related • NT per capita consumption decreasing • Address supply and demand • Limited access to treatment services in PHC • Mandatory alcohol treatment • Individual treatment • Can reduce pressure on families • 99% clients are Aboriginal people

15. Tobacco • Taxation and social marketing most effective strategies • Smoke free policies and brief interventions change the “smoking culture” • Monitoring wholesale data will allow NT to monitor consumption which may be more sensitive to price changes ATSI smoking prevalence ABS surveys

16. Drugs • Ganja major concern • Suicidal behaviour • Frequent smoking • Aerosol inhalants constant vigilance • VSA plans with community • Prescription abuse: codeine, pseudoephidrine • Other drugs

17. Pat Dudgeon Social and emotional well being

18. THE NATIONAL EMPOWERMENT PROJECT PHASES

21. Tamara Mackean Workforce

23. Indigenous Health Indigenous Cultures • Multidimensional • Spiritual • Cultural • Social • Psychological • Physical • Ceremonies • Sorry Business • Languages • Kinships • Responsibilities • Obligations CULTURAL SAFETY Cultural Competence • Professionalism • Quality clinical interactions • Appropriate diagnostic reasoning • Responsive health services • Culturally appropriate research processes

24. Sources of work related stress Workload Expectations Boundaries Recognition, respect and support Working conditions Racism and stigma Complex personal circumstances Loss, grief and Sorry Business Culturally safe ways to work Funding , job security and salaries.

25. Elizabeth Elliott Community led programs

26. Fitzroy Valley: “A community in crisis.” 2007 Alcohol restrictions. 2008

27. “FASD is a tragedy that somehow transcends other aspects of grief and trauma. “ June Oscar AO. 2008

28. Marulu: A Community-led Strategy to address FASD Three themes: DIAGNOSE, PREVENT, SUPPORT (2008-9) The Lililwan Project: FASD prevalence (2009-14)

29. Thank you • Next steps • Poche Opinion Paper • Close

30. Poche Centres for Indigenous Health Key Thinkers’ Forum Darwin 11 July 2014