Remote Australia Online

Aboriginal and Torres Strait Islander people have notably embraced vocational education and training (VET) in places classified as very remote by the Australian Bureau of Statistics (ABS). Participation rates are high and qualification holders are increasing as a result of strong participation (Crawford & Biddle 2017; Windley 2017). Despite this strong participation, the employment outcomes for Aboriginal and Torres Strait Islander graduates in very remote parts of Australia remain low. It would seem that training is not translating into employability or employment for many (if not most) learners. One reason for this is completion rates of less than 20% for many courses, meaning there is high attrition. Completion rates are particularly low at Australian Qualifications Framework (AQF) certificates I and II. In 2015, completion rates for Aboriginal and Torres Strait Islanders in very remote areas across Australia were 10.6% for certificate I courses and 16.6% for all AQF courses. For participants then, the expectations of training may not be realised, and, for training providers and trainers, the inefficiencies created by non-completion mean that too much attention is placed on attending to the needs of administration rather than on the learners. Recognising this problem, a team of researchers representing five different institutions from around Australia set out to uncover how training retention and employability could be improved. Drawing on their experience, they identified five programs in their institutions that are considered successful in achieving above-average retention. By studying these case examples, the factors contributing to successful retention could be identified, as well as the approaches that worked. The team also examined quantitative data, available through the National Centre for Vocational Education Research’s (NCVER) VOCSTATS database, to understand the dynamics of participation, retention and completion in very remote parts of Australia.

While there is a well-developed body of literature in the health field that describes processes to implement research, there is a dearth of similar literature in the disability field of research involving complex conditions. Moreover, the development of meaningful and sustainable knowledge translation is now a standard component of the research process. Knowledge users, including community members, service providers, and policy makers now call for evidence-led meaningful activities to occur rapidly. In response, this article presents a case study that explores the needs and priorities of Aboriginal and Torres Strait Islander women in Australia who have experienced a traumatic brain injury due to family violence. Drawing on the work of Indigenous disability scholars such as Gilroy, Avery and others, this article describes the practical and conceptual methods used to transform research to respond to the realities of community concerns and priorities, cultural considerations and complex safety factors. This article offers a unique perspective on how to increase research relevance to knowledge users and enhance the quality of data collection while also overcoming prolonged delays of knowledge translation that can result from the research-production process.

Introduction: Dementia is responsible for the most significant burden of any chronic disease in older Australians. Two in five of those with dementia live in rural and remote areas. This research describes education barriers and enablers for the health and aged care workforce who care for those living with dementia in rural and remote Australia. Methods: As part of a more extensive study, this research aimed to better understand barriers and enablers of dementia education with input from sixty-seven participants in roundtable focus groups across six diverse rural and remote locations across Australia. Results: Many commonalities emerged, confirming those identified in prior literature—the most significant challenges related to staffing levels, time constraints, and competing priorities. Enablers of the uptake of training included support from employers, local collaboration, and accessibility. Participants emphasised the need for strong organisational support, content relevant to both local challenges and workers’ scope of practice, the value of local training that brought providers across different organisations together, and flexible, interactive delivery methods by experienced trainers. Participants at all sites highlighted the need for culturally safe aged care practices tailored to local cultures. Discussion: The results of the roundtables, as well as a national survey completed as part of the research, informed key principles of an education and training framework for designing, delivering and evaluating dementia education and training for rural and remote workforce in the critical area of caring for people living with dementia. Three overarching principles were identified: community and stakeholder engagement, culturally responsive training, and research and evaluation. Central to these overarching principles were seven underpinning values: local knowledge and expertise, training in a rural context, inclusivity, equitable access, flexible training design, knowledge translation, and multidisciplinary collaboration. These findings enhance our understanding of how to better meet the educational needs of this workforce.

This chapter outlines findings from a 2020 review of the impact of telecommunications infrastructure programs on internet access in Australia’s remote Indigenous communities (RICs) and outstanding needs. This review was undertaken for the Australian Communications Consumer Action Network (ACCAN) about 6 months after the arrival of the COVID-19 pandemic in Australia. The review outlined over $155 million of investment in telecommunications infrastructure in RICS by governments and industry over the last 5 years. However, it found that significant gaps in access and usage of communications technologies remained due to issues of affordability, lack of last mile delivery or community access facilities, service quality and congestion, and barriers to using online services. Some communities have chosen to not accept infrastructure due to concerns around cyber-safety, potential impacts on cultural and social cohesion, and ongoing costs of services and maintenance. Without a coordinated digital inclusion strategy in place to address these barriers, there is currently a patchwork of solutions. The chapter concludes by outlining the report’s recommendations and noting subsequent policy efforts to address the growing digital divide for First Nations people in Australia, including establishing a target to close the digital inclusion gap.

Rural and remote communities’ health and wellbeing needs are often more complex than those of urban communities (AIHW, 2022). Inadequate healthcare resources and infrastructure compounds poorer health outcomes and poorer access to, and use of, healthcare services (AIHW, 2022; Edelman, et al., 2020). As a result, rural and remote Registered Nurses (RNs) practice with greater autonomy. This autonomy still requires RNs to closely engage with their colleagues and communities, to deliver effective healthcare in diverse cultural and geographical contexts. This unique context of practice offers highly rewarding professional and leadership opportunities for RNs’ career development. The intent of the National Rural and Remote Nursing Generalist Framework 2023–2027 (the Framework) is to describe this unique context of practice and core capabilities for rural and remote RN practice. It is underpinned by the Nursing and Midwifery Board of Australia’s (NMBA) Registered Nurse Standards for Practice (2016).

Objectives: To determine local values for environmental attributable fractions and explore their applicability and potential for public health advocacy. Methods: Using World Health Organization (WHO) values for environmental attributable fractions, responses from a practitioner survey (73% response rate) were considered by a smaller skills-based panel to determine consensus values for Kimberley environmental attributable fractions (KEAFs). Applied to de-identified data from 17 remote primary healthcare facilities over two years, numbers and proportions of reasons for attendance directly attributable to the environment were calculated for all ages and children aged 0–4 years, including those for Aboriginal patients. Results: Of 150,357 reasons for attendance for patients of all ages, 31,775 (21.1%) were directly attributable to the environment. The proportion of these directly due to the environment was significantly higher for Aboriginal patients than others (23.1% v 14.6%; p<0.001). Of 29,706 reasons for attendance by Aboriginal children aged 0–4 years, 7,599 (25.6%) were directly attributable to the environment, significantly higher than for non-Aboriginal children aged 0–4 years (25.6% v 18.6%; p<0.001). Conclusions: By addressing environmental factors, 20% of total primary healthcare demand could be prevented and, importantly, some 25% of presentations by Aboriginal children. Implications: KEAFs have potential to monitor impact of local environmental investments.

Background and methods: Despite a concentration of risk factors for HIV transmission, many remote Aboriginal communities in central Australia have a low uptake of HIV testing. We studied, the uptake of HIV testing in six clinics in remote Aboriginal communities following the introduction of voluntary confidential testing to assess the impact of the intervention and to determine if the program was reaching people most at risk of HIV infection and transmission. Setting: The study was conducted by Nganampa Health Council, an Aboriginal-controlled health service on the Anangu Pitjantjatjara Lands in the far north-west of South Australia. Results: Since the introduction of confidential coded testing in August 1994 the number of HIV tests provided through the remote clinics has increased from 83 tests/year to 592 tests/year. In the 12-month audit period (August 1, 1995, to July 31, 1996) 62.7% of women aged 20–24 years, 44.6% of people aged 12–40 years and 24% of the total population had an HIV test. Fifty per cent of tests were accounted for by the 15–25 year age groups and 60% of tests related to an STD consult. Discussion: This study shows that a high uptake of HIV testing in high-risk groups can be achieved in remote Aboriginal communities where a high level of confidentiality is maintained.

In October 2016, Warren Mundine addressed the Minerals Council of Australia Workforce of the Future Forum in Canberra on the topic of Indigenous people and the future minerals industry workforce. In that address he said: "The questions and answers on the future workforce and economic development are the same for Indigenous and non-Indigenous people. It’s not corporate social responsibility. It’s business. If you find the right solutions to the challenges, the outlook for Indigenous Australians and the future minerals industry workforce is bright."Following that address, the Minerals Council of Australia commissioned this paper to expand on the key themes and explore how the minerals industry can meet the challenges put to it in that address.

Objective: To examine clinical service activity amongst patients of the Royal Flying Doctor Service South Eastern Section in Far West New South Wales and to evaluate the management of chronic disease among frequent users of evacuation services. Design: A retrospective audit of the Royal Flying Doctor Service South Eastern Section patient database inclusive of patients within the geographical study area who accessed a clinical or remote consultation, or evacuation service at least once between 1 July 2008 and 30 June 2013. Frequent users of evacuation services (≥3 evacuations per year) were investigated through RFDS patient files for determinants of chronic disease management. Main outcome measures: Category of service accessed, clinical consultation amongst frequent evacuees, determinants of chronic disease management. Results: Total number of evacuees increased by 5.4%; number of remote and clinical consultation patients increased by 5.4%. Of the 47 frequent users of evacuation services, 19 (40%) were infrequent or non-users of clinics (≤3 attendances per year) and 32 (70%) did not have a general practice management plan. Frequent evacuees averaged 2.7 chronic conditions per patient and had seen an average of 16.8 primary care physicians over the 5-year evaluation. Conclusion: Most frequent evacuees had several chronic conditions, multiple primary care providers, did not have a general practice management plan and had infrequent clinic reviews. This evidence highlights the challenge of remote primary care and the need to improve systems of chronic disease management. It underlines the importance of current local efforts to improve electronic records, follow-up and team care and to explore further telehealth implementation.

Without major policy initiatives, and rural medical student schemes not withstanding, there will be a serious shortfall in rural medical and dental resources. Currently, the shortfall estimate for rural GPs is over 1,000. In Queensland and New South Wales only eight of 643 recent graduates were working in rural/remote settings. This shortfall extends to many urban areas. Patients are waiting up to six hours in emergency departments, and hundreds are being told they can not get an appointment with their GP for over a week. The quality of care is not likely to increase with the growth in mega-practices. To graduate more doctors to move into the rural workforce will take over a decade. A number of overseas trained doctors are unsuited for rural Australian careers for a variety of social, cultural and professional reasons. Despite the rise in practice nurses who undertake some of the procedural tasks of practice, their use as clinicians is minimal. Categories of clinicians, though less trained than a doctor or dentist, have been successfully employed for decades in both industrial countries such as the US, and the less resourced world. They have worked both independently and in association with general practitioners/family physicians, and emergency physicians. Such practitioners are able to‘recognise andmanage’ common conditions competently. Midwives of course have been doing this in the field of obstetrics for centuries. While many rural practitioners work 24/7, schemes such as the state and federally funded South Australian Rural Doctors Workforce Agency (RDWFA) initiatives, provide significant relief. In South Australia, at least, training programs for hospital-based rural nurses has provided some primary clinical care skills which have enabled some nurses to assess and carry out basic primary medical care e.g. for an acute asthmatic attack. These nurses relieve the need to summon a doctor for every attendance after hours, but there are few of them, and the system needs to provide regular refresher programs. Within 10 years, one quarter of the rural towns in rural Australia supplied with, or presently without, medical or dental practitioners could/will be serviced by nurse practitioners and dental therapists. A few nurse practitioners have been trained during the past decade but remain few in number, e.g. there is only one working in rural South Australia, and she is in the private sector. Rural Australia cannot find adequate numbers of doctors who are prepared to live and work in rural and remote areas. Recently in rural New South Wales even a $500,000 start-up carrot proved insufficient to attract a doctor. There is no reason why such communities should be denied basic clinical care because a doctor or dentist cannot be found to provide it. Nurses on remote communities, with minimal additional training, and dental therapists in South Australian primary schools have been undertaking such care for decades. The fundamental axiom in care provision should be that ‘nobody is prevented from doing anything they can readily be taught to do competently with appropriate supervision’. Such supervision may be in the same room, next door, in the next town, or at the end of telephone. In evaluating patients seen in general and emergency departments for over three decades, I estimate that a nurse trained for a further 12 months in clinical diagnosis and management can undertake in excess of 50% of the medical workload. The use of such a cadre enables the general practitioners to spend more time with those patients whose problems are more complex. Such a clinically trained nurse could provide competent, and much quicker care, to those in nursing homes and hostels, and relieve pressure in emergency departments. I have trained and used nurses‘to recognise and manage competently the common and significant conditions’ in primary medical care in several countries. This includes the ability to ‘recognise’ serious conditions and‘initiate appropriate primary care and arrange referral’. If further consultation for the GP is only as far away as a telephone or an email (with or without photographs), then certainly it is no less so for a nurse or dental assistant.

This paper documents the growth of Aboriginal children in remote communities and gazetted towns of the Kimberley region in the far north of Western Australia over the past 20 years. The study's specific aim was to compare the height and weight growth of children in different environments from birth to five years of age. From 1979 to 1983, children living in towns were significantly taller and heavier than their counterparts in remote communities. From 1984 to 1988 and thereafter, there were no significant differences in the growth patterns of children in towns and remote communities. Overall, weight-for-age and height-for-age of children in remote communities has improved since the 1970s relative to their town-dwelling counterparts. These changes in growth shed light on the quality of the social and physical environment over the past 20 years and may assist with the development of future programs for child health.

Background: Australia’s Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities. Methods: We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4) were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems. Results: The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician. Conclusion: Participating services had both strengths and weaknesses in the delivery of maternal health care. Increasing access to evidence-based screening and health information (most notably around smoking cessation) were consistently identified as opportunities for improvement across services.

Objective: To examine the accuracy of birth counts for two remote Aboriginal communities in the Top End of the Northern Territory. Methods: We compared livebirth counts from community birth records with birth registration numbers and perinatal counts. Results: For 2004–06, for Community 1, there were 204 recorded local livebirths, 190 birth registrations and 172 livebirths in perinatal data. In Community 2, the counts were 244, 222 and 208, respectively. The mean annual number of babies, indicating service requirements for babies and their mothers, ranged from 57 to 68 (depending on source) in Community 1, and from 69 to 81 in Community 2. Most differences were for births to Aboriginal mothers. Births to ‘visitors’ accounted for 16 births in Community 1 and 30 cases in Community 2. Conclusion: Birth registration and perinatal data apparently underestimate community birth counts at a local level. Mobility of Aboriginal women seems to partly explain this. Implications: The differences in birth counts have important implications for local planning in relation to demand on housing, health and education services. The number of births is also a critical data requirement for measuring infant health status, including mortality rates, with measures of disadvantage strongly influenced by the number of births. Aboriginal mobility is not a ‘data problem’, but an integral part of Aboriginal life that needs to be catered for in administrative data collections in the Northern Territory.

Objectives: To address a shortfall in evidence with which to justify gambling-specific interventions for the Indigenous population, we analysed two surveys (2002 National Aboriginal and Torres Strait Islander Social Survey and General Social Survey) that contain information on reported gambling problems for the NT. Methods: Estimates of reported gambling problems are presented for each state and territory by remoteness for the Indigenous and total population for 2002. Factor analysis was used to identify the relationship between gambling problems and other negative life events for the NT Indigenous and total population. Results: High levels of reported gambling problems were apparent for the Indigenous population particularly in the remote parts of the NT and Queensland. Gambling problems were associated with other stressors relating to social transgressions. Among the NT Indigenous population, gambling problems were correlated with levels of crowding, community involvement, personal and community violence and self-assessed health status. Conclusions: The high levels of reported gambling problems suggest that gambling is causing significant problems for Indigenous people. The multivariable adjusted associations indicate that gambling-related problems are intimately connected to a range of community contexts. Implications: Policies of intervention need to address broader social and environmental contexts that are intrinsically associated with gambling (and associated problems), in addition to public education in harm associated with gambling and provision of counselling services to assist problem gamblers.

The burden of chronic disease in Indigenous Australia is more than double that of non-Indigenous populations and even higher in remote Northern Territory (NT) communities. Sufficient levels of physical activity are known to reduce the risk of chronic disease and improve the health of those already suffering from chronic disease. It has been identified that effective promotion of physical activity in Indigenous settings requires the diverse cultural perspectives and participation of Indigenous people. However, Indigenous concepts of physical activity are not represented in the public health literature and examples of Indigenous involvement in physical activity promotion are scarce. This study aimed to explore and describe local perspectives, experiences and meanings of physical activity in two remote NT Indigenous communities.

Introduction: Many of the health problems faced by rural and remote Aboriginal people have been attributed to a poor living environment. In the mid 1980s we began a process of defining problems with the immediate living environment that would affect health. These related particularly to safety, washing and hygiene practice. Methods: Between January 1999 and November 2006 we undertook a standardised and detailed assessment of housing in Aboriginal communities. This involved an initial assessment of 250 items in each house and living area, focusing on performance and their impact on these healthy living practices. At the first survey-fix we implemented a limited cost repair of non-functioning health hardware and then six months later returned to the communities for a repeat assessment to examine improvement in performance. Results: Between January 1999 and November 2006 we assessed 4,343 houses in 132 communities in four States and the Northern Territory during survey-fix 1 (SF1) and have repeated that survey-fix assessment (SF2) in 3,448 houses in 112 of those communities. This survey demonstrates extraordinarily poor performance of Aboriginal houses. In the survey period, 71,869 items referred for repair by survey teams were inspected by licensed electricians or plumbers and 49,499 of these have so far been fixed. Only 10% of these house items requiring repair were due to vandalism or misuse. Conclusion: Improvements in the living environment for Aboriginal people will require a sustained commitment to the planning, funding and implementation of maintenance programs in addition to adherence to the design, construction and supervision detail outlined in the National Indigenous Housing Guide.

Objective : To examine the trends of all-cause natural mortality for people aged 15 years and over in a remote Australian Aboriginal community between 1996 and 2010. Methods : The annual population in the community by gender and age group was obtained from the Australian Bureau of Statistics (ABS). All known deaths and all records of start of renal replacement therapy (RRT) for renal failure were recorded between 1996 and 2010. Five-year aggregated death rates were calculated and the changes in natural mortality over the interval were evaluated. Mortality was compared with those of the Northern Territory (NT) Indigenous and non-Indigenous people as a whole from 1998 to 2006. Results : Rates of natural deaths were lower in the third interval 2006–2010 relative to the first interval 1996–2000, with higher, but more rapidly falling rates for females than males. Reductions were prominent for both sexes in the 65 and over age groups, but death rates in females of earlier middle age also trended lower. The trends applied whether or not the starting of RRT was considered as a natural death. There was a similar trend in rates of natural death in the aggregate Indigenous population of NT. Conclusions: The downward trends probably reflect improvements in risk factor status since the 1960s, all-of-life health interventions, as well as better chronic disease management in the last two decades. The higher death rates in females than males in this community remain unexplained, but the rapid rate of decline of female death rates predicts that this gap will soon be minimised.

OBJECTIVE: To determine trends in health status over a 10-year interval in a high-risk remote Australian Aboriginal community. METHODS: Two health surveys were performed, one between 1992 and 1997 and the other between 2004 and 2006, on people aged five years or older. Outcomes were compared across age-matched and sex-matched pairs. RESULTS: There were 1,209 matched pairs. In the second survey, birthweights tended to be higher, and there were significant increases in heights of adolescents and young adults, and high density lipoprotein cholesterol (HDL-C) levels generally. Young adult males were lighter, had lower measurements for waist circumference and blood pressure and less frequently had overt-albuminuria, while elevated blood pressure was less common in older males. However, females≥15 years had higher measurements for waist circumference, waist to hip ratio (WHR), body mass index (BMI) and diastolic blood pressure and a higher proportion of diabetes, notably in those aged older than 45 years. Males aged 15-24 years were less likely to be smokers while women aged less than 45 years were more often current drinkers. CONCLUSIONS: Results indicative of better nutrition among youth, better health of young adult males, stable or lower levels of albuminuria and improved HDL levels are all encouraging. The waist circumference increase in females might reflect better food access. An increase in diabetes in older subjects probably reflects recent enhanced survival of middle-aged and older people with--and at risk for--diabetes.

Objectives: Trachoma remains a major health concern in many remote Indigenous Australian communities, despite behaviour-modifying and biomedical strategies. This review aims to examine the social epidemiology of trachoma in remote Indigenous communities and identify practical, sustainable strategies to alter the social determinants of the disease. Methods: A systematic search and critical review explored the proximal, intermediate and distal determinants of trachoma. The impact of swimming pools in remote Indigenous communities on trachoma and other infectious diseases was further examined. Results: Having a clean face was found to be protective for trachoma, but face-washing education programs have produced no significant benefits. Sanitation infrastructure in a community was the key determinant of facial cleanliness. Installation of swimming pools in remote Indigenous communities has been demonstrated to reduce the prevalence of several common childhood infections. However, minimal research has explored the impact of pools on trachoma rates. Conclusions: The locally supported construction of pools in remote Indigenous communities may contribute to a decline in trachoma. A prospective, controlled trial is needed to test this hypothesis in endemic communities. Implications: If validated by a well-designed study, pool construction may provide a much sought-after practical government strategy to combat trachoma in remote Indigenous communities.

This report attempts to identify a way forward on some of the challenging self-governance and service delivery issues facing governments and Aboriginal peoples, by identifying strategic opportunities for change and the development of more collaborative relationships. It has been commissioned by the Central Australian regional office of the Aboriginal and Torres Strait Islander Commission (ATSIC). However the report has not been restricted, in its commissioning, to either an ATSIC or a Central Australian perspective. The issues here are of relevance to all stakeholders dealing with the related issues of governance and service delivery for remote Aboriginal communities across the Northern Territory. Underlying the report is the basic premise that self-governance, local government and service delivery are inextricably intertwined both conceptually, and in practice.

In 2017, Australia celebrates 50 years since the 1967 referendum, when more than 90% of Australians voted to amend the constitution to allow the national government to create laws for Indigenous people and include them in the census. We spoke with the Honourable Ken Wyatt, the Minister for Indigenous Health and the Minister for Aged Care, about what has occurred over the past 50 years in Indigenous health from a political perspective, and what we have learnt to improve health outcomes in the future.

This project is positioned in the context of reforms to remote Indigenous housing that aim to improve housing conditions and expand housing options. The study is especially concerned with reforms to property and tenancy management and asks what forms tenancy management arrangements are taking in different jurisdictions and what factors have influenced these decisions. The policy framework for housing reforms in remote Indigenous communities is the National Partnership Agreement on Remote Indigenous Housing (NPARIH) and the National Partnership Agreement on Remote Service Delivery (NPARSD). The NPARIH establishes a 10-year (2008–2018) housing strategy in which the Australian Government has provided funding to the states and the Northern Territory for the construction of new housing, refurbishment of existing homes and management of housing on remote Indigenous communities. The NPARIH building and refurbishment program is scheduled to deliver up to 4200 new houses and rebuild or refurbish around 4876 existing houses by the end of 2018 .

AIM: Aboriginal leaders concerned about high rates of alcohol use in pregnancy invited researchers to determine the prevalence of fetal alcohol syndrome (FAS) and partial fetal alcohol syndrome (pFAS) in their communities. METHODS: Population-based prevalence study using active case ascertainment in children born in 2002/2003 and living in the Fitzroy Valley, in Western Australia (April 2010-November 2011) (n = 134). Socio-demographic and antenatal data, including alcohol use in pregnancy, were collected by interview with 127/134 (95%) consenting parents/care givers. Maternal/child medical records were reviewed. Interdisciplinary assessments were conducted for 108/134 (81%) children. FAS/pFAS prevalence was determined using modified Canadian diagnostic guidelines. RESULTS: In 127 pregnancies, alcohol was used in 55%. FAS or pFAS was diagnosed in 13/108 children, a prevalence of 120 per 1000 (95% confidence interval 70-196). Prenatal alcohol exposure was confirmed for all children with FAS/pFAS, 80% in the first trimester and 50% throughout pregnancy. Ten of 13 mothers had Alcohol Use Disorders Identification Test scores and all drank at a high-risk level. Of children with FAS/pFAS, 69% had microcephaly, 85% had weight deficiency and all had facial dysmorphology and central nervous system abnormality/impairment in three to eight domains. CONCLUSIONS: The population prevalence of FAS/pFAS in remote Aboriginal communities of the Fitzroy Valley is the highest reported in Australia and similar to that reported in high-risk populations internationally. Results are likely to be generalisable to other age groups in the Fitzroy Valley and other remote Australian communities with high-risk alcohol use during pregnancy. Prevention of FAS/pFAS is an urgent public health challenge.

This paper describes the participatory video (PV) method as a means of engaging children in remote Aboriginal communities as participants in health research. The PV method was piloted in two remote communities in the Goldfields region of Western Australia. There was widespread community acceptance of this approach and preliminary findings are discussed with reference to the key themes of perspectives on health, benefits to participants and benefits to communities. The PV method has a number of strengths, including flexibility to respond to community priorities, a lack of dependence on verbal or written data collection and the capacity to generate immediate benefits for participants. While not without methodological problems, these pilot projects suggest that the PV method is well suited to the remote Aboriginal communities who participated. The ethical implications of the PV method are discussed with specific reference to published ethical guidelines.

The government’s welfare reforms for Indigenous Australians look like slavery: On 19 September 2017 in New York, where I happened to be residing temporarily, the International Labour Organization (ILO) released new research developed jointly with the Walk Free Foundation and published in Global Estimates of Modern Slavery. The research reveals that there are an estimated 40 million victims of modern slavery in 2016, with about 25 million entrapped in situations of forced labour. There are also an estimated 152 million in child labour around the world. The ILO tells us that without dramatically increased efforts the UN’s Sustainable Development Goals, particularly Goal Target 8.7, which looks to eradicate forced labour, human trafficking and child labour (including the recruitment and use of child soldiers), will not be achieved.