Remote Australia Online

Restraints imposed by various cultural practices on formal employment and economic self management at Fitzroy Crossing and surrounding communities; overview of policies of self management and self determination; Aboriginal labour relations; service sector; arts, crafts and tourism; pastoral industry; construction and mining.

This study has explored the impact of the community integration of ATDs (Australian Trained Doctors) and OTDs (Overseas Trained Doctors) in rural and remote communities on their quality of life (QOL) and its resultant effect on their retention by developing a model of research linking QOL as the intervening variable between community integration (the independent variable) and retention (the dependent variable). A national survey of 279 rural and remote GPs was conducted between September and December 2010. Satisfaction levels of both types of GPs (ATDs and OTDs) in rural and remote Australia were observed regarding their community integration and QOL. The survey proper explored the objective experiences of GPs for community integration and QOL. Their satisfaction levels with community integration was measured using the ‘Experiential Place Integration’ framework first used by Cutchin in his paper, ‘Physician retention in rural communities: the perspective of experiential place integration’ (Cutchin, 1997). The ‘Comprehensive Quality of Life scale (ComQol A-5)’ developed by Cummins (1997) was adapted and modified for measuring satisfaction with QOL of these GP respondents. &​lt;br /​&​gt;&​lt;br /​&​gt;The study observed higher satisfaction levels for GP respondents (both ATDs and OTDs) with most of the dimensions of ‘Experiential Place Integration’ domains, and as well as with the domains of QOL in rural and remote Australia. The major finding was that ATD respondents were more satisfied than OTD respondents. The results from the study further indicated that there was a significant difference between the ATD respondents and OTD respondents regarding security dimension of community integration. OTD respondents felt less secure than ATD respondents in rural and remote settings. Further, the result from the univariate analysis of GP respondents indicated that there was a significant difference between the ATD and OTD respondents in rural and remote communities regarding satisfaction with QOL domains. The major differences were observed in the domain of “material possessions’ followed by ‘acceptance by community’ and ‘sense of security’ domain respectively.

Cardiovascular disease (CVD) continues to impose a heavy burden in terms of cost, disability and death in Australia. In 2011 cardiovascular disease was the largest single cause of mortality in Australia. CVD also contributes significantly to morbidity and impaired quality of life, as more than one million Australians live with long-term illness and disability, from conditions associated with CVD. With increases in life expectancy and an ageing population the future impact of the disease in Australia is alarming with one quarter of Australians predicted to have CVD by 2051. Structured Phase 2 Cardiac Rehabilitation provides an opportunity for the development of a lifelong approach to prevention and management of coronary heart disease for patients. Benefits include reduced mortality and reduced risk of further cardiac events; improvements in physical and social functioning, risk factor profiles and quality of life; and reduced prevalence of depression. The impact of CVD in Australia is not uniform as there is clear evidence to suggest that inequities in health outcomes, access and delivery of healthcare services exist between socio-economically advantaged and disadvantaged groups. Many rural populations in Australia do not have access to structured cardiac rehabilitation (CR) programs, and the level of support available to them in the form of unstructured CR through local general practioners (GP’s) is unclear. Despite the evidence to support cardiac rehabilitation, existing services remain underutilised (National Heart Foundation 2004, p. 11). Accessibility is a major factor in the underutilisation of Phase 2 Cardiac Rehabilitation Programs. Previous studies on accessibility to cardiac services have been based on travel time, cost or distance only, and provide only a partial view of access to services. In reality, people trade off geographical and non-geographical factors in making decisions about health service use. This study defines what aspects of accessibility should be studied to determine the accessibility of Phase 2 Cardiac Rehabilitation Programs in Australia. Through applying Penchansky and Thomas’ (1981) dimensions of accessibility: availability, accommodation, affordability, and acceptability and creating a spatial model of the accessibility, of Phase 2 Cardiac Rehabilitation Programs it was possible to define how accessible the programs are to rural and remote population centres. Therefore identifying areas where accessibility to these programs could be improved and where new programs or models of delivery should be established to enhance accessibility in areas that are currently poorly served.

Objectives: To quantify Indigenous mortality, compare it with non-Indigenous mortality, and identify causes of excess Indigenous mortality by remoteness in Queensland, 1997–2000. Design: Cross-sectional survey of all deaths of Queensland residents registered in Australia during the study period. Main outcome measures: Mortality rates were standardised to the concurrent non-Indigenous population and categorised by age and sex. Results: Death rates in Indigenous people were higher in remote areas. The difference between Indigenous and non-Indigenous mortality was also highest in remote areas. The leading causes of deaths were ischaemic heart disease, diabetes mellitus, respiratory diseases, malignant neoplasms, and injury, which accounted for more than 60% of excess deaths. Conclusions: Despite limitations with Indigenous identification, particularly in urban areas, Indigenous people, compared with the non-Indigenous population, have elevated mortality rates that increase by remoteness. This is in agreement with past work. To the extent that some of the causes of excess mortality can be attributed to lifestyle conditions, the health of Indigenous Australians can be substantially improved.

Background: Early onset and high prevalence of chronic disease among Indigenous Australians call for action on prevention. However, there is deficiency of information on the extent to which preventive services are delivered in Indigenous communities. This study examined the variation in quality of preventive care for well adults attending Indigenous community health centres in Australia. Methods: During 2005-2009, clinical audits were conducted on a random sample (stratified by age and sex) of records of adults with no known chronic disease in 62 Indigenous community health centres in four Australian States/Territories (sample size 1839). Main outcome measures: i) adherence to delivery of guideline-scheduled services within the previous 24 months, including basic measurements, laboratory investigations, oral health checks, and brief intervention on lifestyle modification; and ii) follow-up of abnormal findings. Results: Overall delivery of guideline-scheduled preventive services varied widely between health centres (range 5-74%). Documentation of abnormal blood pressure reading ([greater than or equal to]140/90 mmHg), proteinuria and abnormal blood glucose ([greater than or equal to]5.5 mmol/L) was found to range between 0 and > 90% at the health centre level. A similarly wide range was found between health centres for documented follow up check/test or management plan for people documented to have an abnormal clinical finding. Health centre level characteristics explained 13-47% of variation in documented preventive care, and the remaining variation was explained by client level characteristics. Conclusions: There is substantial room to improve preventive care for well adults in Indigenous primary care settings. Understanding of health centre and client level factors affecting variation in the care should assist clinicians, managers and policy makers to develop strategies to improve quality of preventive care in Indigenous communities

A program to control sexually transmitted diseases (STDs) was undertaken during a Men's Health Week in a remote Aboriginal community in Western Arnhem Land, Northern Territory. A total of 151 men aged 13 years and over who attended over a five–day period underwent a full physical examination, and first–void urine specimens were tested for the presence of leukocytes, chlamydia (by enzyme immunoassay antigen detection) and gonorrhoea (by culture and antigen detection). Blood was taken for syphilis serology from all patients and for human immunodeficiency virus (HIV) from patients with a proven STD or at the patient's request. Consent for testing was obtained from all participants. Patients with a positive urinary leukocyte test or symptoms were offered urethral swab investigations and treated empirically according to a set protocol. Patients with STDs detected by subsequent laboratory investigations were followed up and treated. The overall prevalence of one or more of syphilis, gonorrhoea or chlamydia was 17.4 per cent. No men presented with genitourinary symptoms and none was HIV–infected. In this population, STDs were an important cause of morbidity, and a community–based approach was adopted to identify infected persons. The use of urine for the detection of gonorrhoea and chlamydia was highly acceptable. Although not used in this study, polymerase chain reaction and ligase chain reaction technology will facilitate similar activities in the future. (Aust N Z J Public Health 1997; 21: 519–23)

Objective: To examine reported outcomes of health services delivered by telehealth to Indigenous Australians. Methods: Systematic review of the literature. Searches were conducted to identify articles that reported a telehealth service used to provide clinical services to Indigenous Australians. Articles were screened for inclusion using pre-defined criteria. Findings were synthesised narratively and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Results: 14 articles, describing 11 distinct telehealth services, were selected based on the inclusion criteria. Authors of included studies report that telehealth has improved social and emotional wellbeing, clinical outcomes and access to health services for Indigenous Australians. Further, it has reduced travel and improved screening rates. Indigenous people report positive perceptions of their telehealth interaction. Conclusion: Telehealth is used to address poor accessibility to health services and for targeted screening programs for at risk populations. Reported outcomes from existing services demonstrate the potential of telehealth for health service delivery for Indigenous Australians. Confidence in the findings of this review is reduced by the predominance of descriptive studies and small sample sizes in many of the included articles. Implications: Telehealth models of care facilitated through partnerships between Aboriginal community-controlled health services and public hospitals may improve both patient outcomes and access to specialist services for Indigenous people.

Research on a range of agreements between Indigenous people and extractive industries suggests that equitable benefits from such activity on Indigenous land are rare. In Central Australia, the Central Land Council has piloted a new approach to generating benefits from land use agreements by establishing a community development unit and encouraging Indigenous traditional owners to apply some of the income from land use agreements with mining companies and similar parties to community development activities. This paper discusses the variety of community development projects this unit is undertaking with traditional owners and Aboriginal community members, and the challenges it is facing as it tries to utilize community development principles in its projects. It indicates some of the issues that may need to be considered in government policy which seeks to assist Indigenous landholders gain optimum benefit from land-related payments. In particular, the paper demonstrates that the priorities of Indigenous people to support and promote social and cultural activities, including maintaining micro-communities (outstations) on homelands, may conflict with government views as to how to ‘optimize benefits’ from land use agreements.

BACKGROUND: There are significant health status inequalities in Australia between those people living in rural and remote locations and people living in metropolitan centres. Since almost ninety percent of the population use some form of primary health care service annually, a logical initial step in reducing the disparity in health status is to improve access to health care by specifying those primary health care services that should be considered as "core" and therefore readily available to all Australians regardless of where they live. A systematic review was undertaken to define these "core" services.Using the question "What primary health care services should residents of rural and remote Australia be able to access?", the objective of this paper is to delineate those primary health care core services that should be readily available to all regardless of geography. METHOD: A systematic review of peer-reviewed literature from established databases was undertaken. Relevant websites were also searched for grey literature. Key informants were accessed to identify other relevant reference material. All papers were assessed by at least two assessors according to agreed inclusion criteria. RESULTS: Data were extracted from 19 papers (7 papers from the peer-reviewed database search and 12 from other grey sources) which met the inclusion criteria. The 19 papers demonstrated substantial variability in both the number and nature of core services. Given this variation, the specification or synthesis of a universal set of core services proved to be a complex and arguably contentious task. Nonetheless, the different primary health care dimensions that should be met through the provision of core services were developed. In addition, the process of identifying core services provided important insights about the need to deliver these services in ways that are "fit-for-purpose" in widely differing geographic contexts. CONCLUSIONS: Defining a suite of core primary health care services is a difficult process. Such a suite should be fit-for-purpose, relevant to the context, and its development should be methodologically clear, appropriate, and evidence-based. The value of identifying core PHC services to both consumers and providers for service planning and monitoring and consequent health outcomes is paramount.

Objective: To identify areas of relative need and inform future planning of health workforce and health services in discrete Indigenous communities. Method: Descriptive analysis of relevant variables from the 1999 Community Housing and Infrastructure Needs Survey (CHINS), including all discrete Indigenous communities in Australia. Results: Almost 90% of the Indigenous population of the Northern Territory live in discrete communities. The corresponding figure for Queensland, South Australia and Western Australia is around 25%, for New South Wales 8% and Victoria 1%. Just over 4,000 people (5% of the population surveyed) live 100 kilometres or more from the nearest community health centre and almost 60,000 (54%) live 100 kilometres or more from the nearest hospital. Approximately 4,000 Indigenous people (6% of population surveyed) have little or no access to a registered nurse or a doctor in their community. Access to Indigenous health workers is also limited, with more than 26,000 people (40%) having almost no access to a male Indigenous health worker and about 10,400 (16%) having almost no access to a female Indigenous health worker. More than 13,000 people (20%) have no access to a dentist and many thousands (30–50%) have no access to allied health or mental health care workers. An obstetrician or ENT/respiratory physician never visited the communities of almost 40,000 people (55% and 59%, respectively) and about 24,000 people (36%) have no access to an ophthalmologist. Conclusion: CHINS data provide a unique source of information to monitor the status of health services and the workforce in discrete Indigenous communities.

Objective: To describe a 2013 outbreak of pandemic influenza A (H1N1) virus in a remote Western Australian Aboriginal community; inform outbreak prevention and control measures and discuss the community susceptibility to H1N1, three years after the A(H1N1)pdm09 pandemic. Methods: Records at the local clinic were used to classify cases as ‘confirmed’ (laboratory test positive for H1N1 or temperature >38°C with cough and/or sore throat) or ‘probable’ (self-reported fever with cough and/or sore throat). Additional data were collected from medical records and public health databases. Results: A total of 108 individuals met case definitions. Clinical attack rate was 23%. Children under five years of age had the highest age-specific attack rate (545 per 1,000 population). Thirty cases (28%) experienced complications with six (5.6%) requiring aero-evacuation. Only 7% of the community had received H1N1-containing vaccine during the previous year. No H1N1 cases from the community were previously reported. Conclusions: This is the first description of the effects of a novel influenza strain on a remote Australian Aboriginal community. Isolation and low vaccination are likely explanations for the apparent naivety to H1N1. Implications: There may be other remote communities at risk of H1N1. High attack and complication rates confirm that Aboriginal Australians should be prioritised in pandemic planning.

Objective:To provide the first report of long-term mortality trends over recent decades for an Indigenous Australian population. Very little information is available about improvements over time, or lack thereof, in the health status of Indigenous Australians. Methods:Internally consistent time series of deaths and population data were produced for the Indigenous population of the Northern Territory (NT) for 1966–2001. Time trends for Indigenous mortality rates and differentials between NT Indigenous and total Australian rates were examined for 1967–2000. Results:NT Indigenous mortality declined in all age groups and both sexes. The decline was greatest in age group 0–4 (85%). In those aged five years and over, NT Indigenous mortality declined by 30% in females and 19% in males However, these declines did not keep pace with the relative decline for the total Australian population, so that mortality rate ratios (NT Indigenous to total Australian) increased for all age groups except 0–4 years. NT Indigenous mortality declined for communicable, maternal, perinatal and nutritional conditions by 62%, and for injury by 33%, but did not decline for non-communicable diseases. Conclusions:Indigenous mortality has improved in the NT in recent decades, but the relative gap between Indigenous and other Australians has increased. Implications:Reductions in NT Indigenous mortality reported here may provide some reassurance that improvement in Indigenous health is possible and has occurred, but even greater effort will be required to accelerate the pace of improvement.

Objective:To assess the extent to which Indigenous status confounds the association between remoteness and neonatal mortality in Queensland. Methods:We used routine data from the Queensland Perinatal Data Collection. Poisson regression modelling was used to assess confounding. Results:Babies born to Indigenous mothers have mortality rates 2.42 times those of the rest of the population, regardless of whether they live in urban, rural or remote areas (95% CI 2.09–2.80). The babies of non-Indigenous women who live in remote areas have a low risk of neonatal death, similar to their rural and urban counterparts. Conclusion:In Queensland, the key demographic variable that determines neonatal mortality is Indigenous status, not remoteness. Implications:Policymakers should not assume that an excess of a particular health problem in remote areas necessarily reflects equal disadvantage for all the Australians who live there.

In July 2009, COAG requested the development of a National Strategy for Food Security in Remote Indigenous Communities (the Strategy). This document sets out the Strategy, which is a schedule to the National Indigenous Reform Agreement (NIRA). Improving the food security of Indigenous people living in remote Indigenous communities will require sustained action across all sectors and governments to address the structural and systemic problems that have resulted in poor food security for many remote Indigenous communities. Specifically, the response will require a coordinated and targeted approach aimed at both providing a secure, sustainable and healthy food supply to remote Indigenous communities; and actions aimed at increasing the purchase and consumption of this healthy food. This Strategy builds on the experience of all relevant jurisdictions in working with Indigenous people in remote areas, and recognises that approaches to implementation will reflect the different circumstances of Indigenous people and communities in each State or Territory.

Objective: To review the effectiveness of community-based initiatives involving restrictions on alcohol availability in remote and regional locations in Australia, and to assess their implications for other communities or towns contemplating similar measures. Methods: Findings from evaluations of community initiatives in Tennant Creek (NT), Derby (WA), Halls Creek (WA), Elliott (NT) and Curtin Springs (NT) are compared with respect to impact on alcohol consumption, and on indicators of alcohol-related harm relating to public order, health and well-being, and economic activities. The extent of community support for these initiatives is also examined. Results: Restrictions were found to have a modest but real impact on alcohol consumption, and a significant impact on indicators of alcohol-related harm, especially violence. Restrictions were also found to have widespread community support, often qualified by a belief that other measures were also required. Conclusions: Restrictions on availability are an effective means of reducing alcohol-related harm at a local level and, depending upon the processes involved in their introduction, are likely to have strong community support, provided that other measures are also pursued. Implications: Five issues are identified that are likely to arise in other settings where restrictions are contemplated. These are: the issue of representativeness (‘who speaks for the community?’); selection of particular kinds of restrictions on availability; selection of most appropriate additional measures; universal vs. selective restrictions; and the role of liquor licensing authorities in imposing or facilitating restrictions.

Based on our experience in developing and evaluating community–based health promotion programs in Aboriginal and Torres Strait Islander communities, we offer guidelines to assist nonindigenous health and public policy professionals whose information gathering in these communities includes the use of unstructured interviewing or survey questionnaires. The guidelines primarily apply to research among mainland remote Aboriginal communities, but are placed in a cultural context such that those dealing with Torres Strait Islanders and rural or urban community Aborigines also may benefit from the guidelines. The major aims of these guidelines are to facilitate communication between interviewers and indigenous interviewees and to ensure that interviewing is done with maximum sensitivity to cultural differences and with minimum discomfort to the respondents.

Objective: Hypertension and other chronic disease risks are common among Aboriginal and Torres Strait Islander adults but there is little evidence regarding the epidemiology of these risk factors during adolescence. This study examines the prevalence of pre-hypertension, hypertension and other cardiovascular risk factors in Aboriginal and Torres Strait Islander people aged 15–24 years living in remote Indigenous communities in north Queensland. In so doing, it aims to better inform the approach to cardiovascular disease in this population. Methods: This is a descriptive study that retrospectively examines health service data from a program of community screening, the Young Persons Check (YPC). Participants were 1,883 Aboriginal and Torres Strait Islander people aged 15–24 years who attended for a YPC in 11 remote communities in north Queensland between March 2009 and April 2011. Results: Overall, the prevalence of pre-hypertension was 34.0%; stage I hypertension was 17.7% and stage II hypertension was 3.3%. The prevalence of elevated waist circumference was 47.6%, overweight or obesity 45.9%, elevated triglycerides 18.3%, decreased HDL 54.8% and proteinuria 24.3%. The prevalence of hypertension (stage I or II) among Torres Strait Islander males was 34.1%, Aboriginal males 26.9%, Torres Strait Islander females 12.6% and Aboriginal females 13.0%. Hypertension was associated with sex (males) (OR= 4.37, p<0.000), overweight (OR=2.46, p<0.000), obesity (OR=4.59, p<0.000) and elevated triglycerides (OR=2.38, p<0.000). Conclusion: Pre-hypertension, hypertension and other cardiovascular risk in this population is highly prevalent. Hypertension was particularly prevalent among male participants. The results reiterate the importance of early life experience in cardiovascular disease prevention.

Objective: To evaluate the Indigenous sexual health promotion program in the Torres Strait 2006–2012 that culminated in an education-entertainment radio drama, Kasa Por Yarn (KPY). Methods: A mixed methods approach applied to unpublished program documents and program-derived peer-reviewed publications was utilised. Results: Early initiatives established a strong partnership with Torres Strait Islander stakeholders. Significant community engagement throughout ensured a positive process. Telephone survey data (n=100, TSI, 15–24 years) found: 95% had heard of KPY and 80% listened to 2 or more episodes (reach); 86% recalled storylines/characters (recall); and 54% talked about KPY to family/friends (resonance). There was improvement in sexual health knowledge scores (p<0.00) in the 15–19-year-old Torres Strait Islander population between 2007 and 2012. The 2012 15–24-year-old population exposed to KPY had higher sexual health knowledge scores compared with those unexposed (p=0.02). Conclusions: This is an uncommon comprehensive evaluation of population-based sexual health communications strategies delivered over years in a remote Australian setting. The findings are encouraging but demonstrate that positive shifts take time and are incremental. Implications: In addition to clinical strategies, strategic and sustained investment in sexual health promotion expertise that leads community partnership and program development is required to reduce youth risk and prevent HIV/AIDS in remote populations.

This is a report of a participatory action research project, Indigenous Families and Early Childhood Practitioners Working Together, undertaken by local Indigenous community members and two researchers from Batchelor Institute of Indigenous Tertiary Education (BIITE) over a 3 month period (April to June, 2010). The project investigated effective community engagement and partnership practices occurring amongst an Indigenous community school, children’s service and the community, in the small remote Indigenous community of Jilkminggan, located 450 km from Darwin. Much attention in recent years has been given to the early childhood years (0-8) and young Indigenous children’s transition to school as pivotal experiences impacting on their future educational trajectory (Shepherd & Walker, 2008; McTurk et al, 2008). However, the majority of the period defined as early childhood (0-8 years) occurs well before the compulsory school age (6 years old) and a child’s entry to formal schooling. Therefore, school-community engagement processes should commence with families of children engaged in children’s services and preschool, as well as the early years of school. This project targets the community school engagement practices occurring across the early childhood age range in order to learn from the experience of one remote Indigenous community. The building of strong relationships between Indigenous families, communities and the educational institutions that serve them is critical to children’s successful transition into mainstream learning environments. Indigenous children are often on their own in negotiating the gaps that occur between home and school practices and expectations, many of which may be at odds with each other in terms of children’s behaviour, use of language, cultural norms and background experiences.

Objective: To explore availability, variety and frequency consumption of traditional foods and their role in alleviating food insecurity in remote Aboriginal Australia. Methods: Availability was assessed through repeated semi-structured interviews and consumption via a survey. Quantitative data were described and qualitative data classified. Results: Aboriginal and non-Indigenous key informants (n=30 in 2013; n=19 in 2014) from 20 Northern Territory (NT) communities participated in interviews. Aboriginal primary household shoppers (n=73 in 2014) in five of these communities participated in a survey. Traditional foods were reported to be available year-round in all 20 communities. Most participants (89%) reported consuming a variety of traditional foods at least fortnightly and 71% at least weekly. Seventy-six per cent reported being food insecure, with 40% obtaining traditional food during these times. Conclusions: Traditional food is consumed frequently by Aboriginal people living in remote NT. Implications for public health: Quantifying dietary contribution of traditional food would complement estimated population dietary intake. It would contribute evidence of nutrition transition and differences in intakes across age groups and inform dietary, environmental and social interventions and policy. Designing and conducting assessment of traditional food intake in conjunction with Aboriginal leaders warrants consideration.

Objective: To determine the average price difference between foods and beverages in remote Indigenous community stores and capital city supermarkets and explore differences across products. Methods: A cross-sectional survey compared prices derived from point-of-sale data in 20 remote Northern Territory stores with supermarkets in capital cities of the Northern Territory and South Australia for groceries commonly purchased in remote stores. Average price differences for products, supply categories and food groups were examined. Results: The 443 products examined represented 63% of food and beverage expenditure in remote stores. Remote products were, on average, 60% and 68% more expensive than advertised prices for Darwin and Adelaide supermarkets, respectively. The average price difference for fresh products was half that of packaged groceries for Darwin supermarkets and more than 50% for food groups that contributed most to purchasing. Conclusions: Strategies employed by manufacturers and supermarkets, such as promotional pricing, and supermarkets’ generic products lead to lower prices. These opportunities are not equally available to remote customers and are a major driver of price disparity. Implications: Food affordability for already disadvantaged residents of remote communities could be improved by policies targeted at manufacturers, wholesalers and/or major supermarket chains.

Objective: Retrospectively evaluate food price discounts in remote Aboriginal community stores. Methods: Four price discount strategies of 10% were designed in 2010, aiming to influence grocery, fruit, vegetables and diet soft-drink sales. This natural experiment across a group of stores was evaluated using an explanatory, sequential mixed method design through analysis of store point-of-sale, document, observation and interview data. The outcome was measured by change in: 1) percentage of grocery sales to total food and beverage; 2) fruit and vegetable sales; and 3) diet soft-drink sales. Qualitative data enabled the interpretation of outcomes through understanding perceived success and benefits, and enablers and barriers to implementation. Results: Eighteen community stores and 54 informants participated. While targeted price discounts were considered important to improving health, no discernible effect was evident, due to inadequate design and communication of discount promotion, and probably inadequate magnitude of discount. Conclusions: Strategy impact on food and beverage sales was limited by promotion and magnitude of discount. Implication for Public Health: This study demonstrates key factors and commitment required to design, communicate, implement and monitor strategies to improve health in this challenging remote retail context. Evaluation of natural experiments can contribute evidence to policy-making.

Health at the margins: providing services in remote areas and for marginal populations

Objective: Aboriginal leaders concerned about high rates of Fetal Alcohol Spectrum Disorder (FASD) in the Fitzroy Valley, remote north-western Australia, introduced restrictions on access to take-away full-strength alcohol. Following this, Aboriginal leaders engaged strategic partners in a broader strategy to address FASD in the region. The aim of this study was to develop and implement a community-led, researcher-supported, FASD strategy. Methods: A review of literature focusing on community-led FASD strategies identified key components that informed the Marulu FASD strategy. These included strategy ownership, leadership, and governance by participating communities, and a research framework. Results: Community meetings and workshops led to the development of The Marulu FASD Strategy (2008). Feasibility and community consent to conduct a FASD prevalence study (the Lililwan Project) was confirmed, and implementation was progressed (2010–2013). Concurrent FASD prevention activities were conducted. In 2012, the Marulu FASD Unit was established within a local Aboriginal organisation to sustain and coordinate ongoing strategy activities. Conclusions: Community control of public health initiatives can be achieved when Aboriginal communities prioritise issues of significant concern, and engage strategic partners to overcome them. Implications for public health: The Marulu Strategy forms a template for action to address FASD and other public health issues in Aboriginal communities in Australia and internationally.

On 1 July 2013, a new labour market and community participation program—the Remote Jobs and Communities Program (RJCP)—started operating across remote Australia. It replaced several other programs, most importantly Job Services Australia (JSA) and the Community Development Employment Projects (CDEP) scheme. JSA has in recent years been Australia’s principal ‘mainstream’ labour market program in which all unemployment payment recipients in Australia who are able to work are expected to participate. CDEP is a much longer-standing program, originally designed to provide some form of paid work to Indigenous people living in remote communities. RJCP was presented by the Gillard Labor government as offering services that would be locally flexible, be delivered in partnership with communities and have a strong focus on getting people into work. Its dual focus—on community participation and on jobs—was reflected in arrangements for its administration, jointly managed by the Department of Families, Housing, Community Services and Indigenous Affairs and the Department of Education, Employment and Workplace Relations. However, a change of government in September 2013 brought RJCP into the Department of the Prime Minister and Cabinet. The new Abbott Coalition government was critical of RJCP and immediately included it in a review of Indigenous employment and training programs, led by Andrew Forrest. This working paper reports on a survey of provider organisations conducted almost one year into the implementation of RJCP. It is part of a larger research project on the implementation of RJCP during its first three years, with funding support from the Australian Research Council and Jobs Australia (Linkage Project 130100226). The project aims to understand how RJCP is developed from a general policy idea to specific grounded practice, at the community, regional and jurisdictional levels. This survey report includes findings about basic arrangements and characteristics of provider organisations; ideas about joblessness in remote areas and welfare conditionality; provider perceptions of the government officials with whom they work; operational details (staffing, money and administrative challenges including information technology (IT) systems); and broader influences on the shaping of program delivery, like Community Action Plans and community perceptions. A second survey in 2015–16 will track developments in these areas over time.