Remote Australia Online

Coastal northern Australia is largely owned and occupied by Aboriginal people who are strongly connected to their traditional country. We assess the views of Aboriginal people in Arnhem Land on the impacts of climate change and their possible precautionary responses to both sea level rise and a potential increase in the intensity of tropical cyclones in coastal communities. All respondents had heard about climate change, and 48 % had already seen environmental changes, particularly sea level rise, which they attributed to climate change. Fifty-eight percent of respondents would consider relocating in the future for safety reasons, although most respondents perceived living close to the sea as highly important for their future well-being, emphasising their strong connection to their traditional sea country. Many of those willing to relocate would consider moving inland, either temporarily or permanently, provided that community facilities could also be moved. Other respondents who said they would be unlikely to relocate in the future because of climate change impacts, and would prefer to adapt in situ with government support (e.g. building more shelters for severe cyclones, building sea walls and better roads for quick evacuation if necessary). We recommend that the diversity of adaptation preferences among Aboriginal people should be accommodated in policy to minimise social impacts of climate change and to take advantage of potential opportunities that could arise from moving.

Educational and socioeconomic disadvantage in remote communities, and the inadequacies of government action to bring about significant change needs to be addressed. This article presents a descriptive study examining the complexities of staffing remote and very remote schools in Australia with appropriately-qualified teachers. The findings of analysis of data from the Australian Bureau of Statistics (ABS) on behalf of the Australian Government through the National Schools Statistics Collection (NSSC) indicate that the majority of students in remote schools in Australia live, and are educated in, Indigenous communities in three jurisdictions. This raises concerns of unacknowledged and unacceptable discrimination. Complexity within the current approach to resourcing of remote and very remote schools in Australia, especially in relation to economies of scale are explored. The analysis of existing data was discussed, and how this may be used to address the perennial failure to develop quality decisions, particularly in areas of resourcing in remote and very remote schools.

Background First Nations Australians have an internationally-recognised right to self-determination – a key social determinant of health. The recognition and application of this right varies within different regions and policy contexts but is currently unknown for First Nations Australians’ engagement in alcohol policy development. This study seeks to: explore First Nations Australians’ experiences of alcohol policy in Central Australia (Northern Territory); and identify how First Nations Australians’ right to self-determination can be recognised and applied in the development of alcohol policy in Mbantua/Alice Springs. Methods Using a blended yarning and appreciative inquiry approach, 24 interviews were conducted. Interviews were thematically coded in multiple stages, using diagrammatic methods. Results Four key themes emerged: (i) experiences of purchasing alcohol; (ii)communication of the current alcohol policy; (iii) experiences of policy described by participants (and their community); and (iv) self-determination in alcohol policy. Conclusions Current pathways for contributing to alcohol policy have been ineffective in achieving meaningful engagement with Australia's First Nations community members. This study provides some guidance as to how self-determination can more effectively be incorporated in the development of alcohol policy in the NT.

The population of Halls Creek, a small towi in the remote Kimberley region of Western Australia, is predominantly Aboriginal. After many years of high alcohol consumption, a number of measures were taken in an effor to redress its negative influence on the community. Key among these was a restriction on the trading hours when 'takeaway' alcohol was available. The effects of this intervention were monitored by examining longitudinal patterns of alcohol consumption, incidence of crime and outpatient data at the local hospital. The data were compared with equivalent period prior to the restricted trading hours. A decrease in alcohol consumption was observed for each of the two years followini the intervention. Overall, incidence of crime declined. Alcohol-related presentations to the hospital and presentations resulting from domestic violence decreased relative to the equivalent quarterly period prior to the intervention. There were short-term fluctuations observed, particularly with domestic violence, where presentations (of lesser severity) became more frequent during several quarters. Emergency evacuations as a result of injury showed a marked decrease. The consistency of trends across a variety of health and social data show a positive effect after the implementation of restricted trading hours. While a direct effect is likely, a multitude of concurrent programs which promote health in the community place limitations on this conclusion. The process in achieving change, supported by statutory measures, has, however, been successful in curbing the morbidity and mortality experienced by the community.

Indigenous children living in the more remote areas of Australia where Indigenous languages continue to be spoken often come to school with only minimal knowledge of English, but they may speak two or more local languages. Others come to school speaking either a creole, or Aboriginal English, non-standard varieties which may sound similar to English, which gives them their vocabulary, while differing in terms of structure, phonology and semantics and pragmatics. This paper begins with a discussion of the linguistic contexts the children come from and the school contexts the children enter into before moving on to discuss a potential role for some use of translanguaging techniques in the classroom and discussing the potential benefits and advantages these may have.

Background: Mortality from trauma in rural areas is increased compared with the urban environment. We aimed to describe the relationship between trauma deaths and various categories of remoteness in rural areas, in Western Australia (WA). Methods: We used Death Registry data from July 1, 1997 to June 30, 2006. Deaths were allocated to one of the five Remoteness Areas classified by the Accessibility/ Remoteness Index of Australia: Major Cities, Inner Regional, Outer Regional, Remote, and Very Remote. Population data were obtained from the Australian Bureau of Statistics 2001 census. Results: There were 4,937 deaths (3,543, 71.8% men; mean age 43.4 years ± 24.3 years). The least number of deaths occurred in Remote WA, and the age at which death occurred decreased as remoteness increased. Falls occur predominantly in the elderly in the major city. Transport injuries are the leading cause of death (43.3%) outside the major city, where self harm is the leading cause of death (31.2%). The relative risk for death in very remote WA compared with the major city is 4.28 (95% CI 3.93–4.68). The standardized age-specific death rates ranged from 24.09 per 100,000 person-years in the major city, to 103.30 per 100,000 person-years in very remote WA. Conclusions: We have quantified the direct relationship between remoteness and trauma deaths. In particular, the death rate in very remote areas is over four times the rate in major cities. Such data should be useful for the planning of trauma systems in these areas.

Aims: To report on the prevalence of falls, urinary incontinence, pain and associated factors in remote living Indigenous Australians over the age of 45?years. Methods: A cross-sectional, semi-purposeful sample of 363 indigenous men and women aged over 45 years living in six remote communities and one town in Kimberley, Australia. Participants were assessed for self- or informant-reported rates of falls, urinary incontinence and pain. Results: The prevalence of self- or informant-reported falls was 31% (95% CI 25.3, 36.7), pain 55% (95% CI 47.4, 62.6) and urinary incontinence 9% (95% CI 5.9, 12.1%). Associations with falls after adjustment for age, sex and education included alcohol use (OR 2.4, 95% CI 1.4, 4.2), stroke (OR 2.4, 95% CI 1.1, 5.0), epilepsy (OR 3.5, 95% CI 1.1, 11.6), head injury (OR 2.1, 95% CI 1.3, 3.3) and poor hearing (OR 2.5, 95% CI 1.4, 4.1); for urinary incontinence epilepsy (OR 6.0, 95% CI 1.7, 21.2) and stroke (OR 16.7, 95% CI 6.0, 46.3); and for pain, poor hearing (OR 1.9, 95% CI 1.0, 3.3) and female sex (OR 1.8, 95% CI 1.2, 2.7). Conclusions: Falls, urinary incontinence and pain are common and reported for the first time in older indigenous people living in remote regions. The presence of these syndromes in ages over 45 may be due to accumulation of health insults during the life course.

BACKGROUND: Australian Aborigines in remote areas have very high rates of kidney disease, which is marked by albuminuria. We describe a "multihit" model of albuminuria in young adults in one remote Aboriginal community. METHODS: Urinary albumin/creatinine ratios (ACR) were measured in all subjects who volunteered to participate in a community-wide health screen. Subjects for this study were young adults who had birth weights recorded and whose medical records were inspected for a history of post-streptococcal glomerulonephritis (PSGN). Urine ACR levels were evaluated in the context of birth weights, PSGN history and current BMI. RESULTS: 580 subjects (335 males and 245 females) who were aged 18 - 39 years at time of screening and qualified for inclusion. 26% of subjects had birth weights of < 2.5 kg, and the median birth weight was 2.8 kg. 23% of subjects had a remote history of PSGN, all 3 or more years earlier. Median BMI for the group was 21 kg/m2. Urine ACR levels exceeded the microalbuminuria threshold of 3.4 g/mol in 35.5% of subjects. Birth weight (inversely), remote PSGN, and current BMI were all independent predictors of ACR levels. Median levels of ACR were lowest in those with birth weights ≥ 2.5 kg, and no history of PSGN, intermediate in those with either birth weights < 2.5 kg or a history of PSGN, and highest in those with both low birth weights and a PSGN history. ACR levels were higher in those with BMIs above the median values, most notably in those with lower birth weights or a PSGN history or both. INTERPRETATION: Much of the great excess of disease in this population is explained by high rates of the early life risk factors, low birth weight and PSGN. Their effects are expressed through amplification of ACR in the context of increasing age, and are further moderated by levels of current body size. Both early life risk factors are potentially modifiable.

Indigenous land owners of the Tiwi Islands, Northern Territory Australia have begun the first formal freshwater allocation planning process in Australia entirely within Indigenous lands and waterways. The process is managed by the Northern Territory government agency responsible for water planning, the Department of Natural Resources, Environment, The Arts and Sport, in partnership with the Tiwi Land Council, the principal representative body for Tiwi Islanders on matters of land and water management and governance. Participatory planning methods (‘tools’) were developed to facilitate community participation in Tiwi water planning. The tools, selected for their potential to generate involvement in the planning process needed both to incorporate Indigenous knowledge of water use and management and raise awareness in the Indigenous community of Western science and water resources management. In consultation with the water planner and Tiwi Land Council officers, the researchers selected four main tools to develop, trial and evaluate. Results demonstrate that the tools provided mechanisms which acknowledge traditional management systems, improve community engagement, and build confidence in the water planning process. The researchers found that participatory planning approaches supported Tiwi natural resource management institutions both in determining appropriate institutional arrangements and clarifying roles and responsibilities in the Islands’ Water Management Strategy.

Drinking water quality remains a persistent challenge across regional and remote Australia. We reviewed public reporting by 177 utilities and conducted a national assessment of reported exceedances against the health-based and aesthetic guideline values of the Australian Drinking Water Guidelines (ADWG). Four definitions of a basic level of drinking water quality were tested to quantify service gaps across regional and remote areas of each subnational jurisdiction in 2018–2019. At least 25,245 people across 99 locations with populations <1000 reportedly accessed water services that did not comply with health-based guideline values. Including larger towns and water systems, the estimated service gap rises to at least 194,572 people across more than 115 locations. Considering health parameters and the ADWG definition of ‘good’ aesthetic characteristics, the reported service gap rises further to at least 627,736 people across 408 locations. Forty percent of all locations with recorded health exceedances were remote Indigenous communities. Monitoring and reporting gaps indicate that the actual incidence of non-compliance with the guideline values of the ADWG could be much higher than our estimates. Our results quantified the divergence in the assessment of water quality outcomes between Sustainable Development Goal Target 6.1 and the ADWG, demonstrated disparities between service levels in capital cities and the rest of Australia, and highlighted the need for place-based solutions. The methods and dataset provide a ‘proof-of-concept’ for an Australian national drinking water quality database to guide government investments in water services.

Aim: To (i) describe the prevalence of malnutrition among a cohort of central Australian, predominantly Indigenous, haemodialysis patients and (ii) determine the sensitivity and specificity of the Patient Generated Subjective Global Assessment total score for identification of malnutrition in these patients. Methods: Cross-sectional observational study of all patients attending haemodialysis units within the Central Australia Health Service. Patients were assessed using the Patient-Generated Subjective Global Assessment. Chi-Square tests were used to determine the association between nutritional status and location, age and gender. Receiver Operator Characteristic curves were used to ascertain the predictive validity for malnutrition of the total score. Results: Indigenous patients comprised 98% of study haemodialysis patients (n = 249/253). One third were male, and 72% were aged between 30 and 59 years. Approximately 29% (74/253) were malnourished, and 93% (69/74) had a total score ≥ 4. The most frequently reported problems that kept malnourished patients from eating were early satiety (32%), no appetite (31%), diarrhoea (26%) and dental problems (24%). Money problems were reported by 32%, as were transport (20%) and depression (19%). The traditional tool cut off score of ≥ 9 had low sensitivity (50%) for detecting malnutrition. Instead, a score ≥ 3 is suggested due to a higher sensitivity (96%) and specificity (45%). Conclusion: Malnutrition was found to be common, and we suggest using a Patient-Generated Subjective Global Assessment total score of ≥ 3 to improve the identification of malnourished individuals in this cohort of predominantly Indigenous haemodialysis patients. This will significantly increase referrals for dietetic intervention.

The 'Living Waters, Law First' water governance framework centres Living Waters, First Law and the health/well-being of people and Country. The framework is based on a groundwater policy position developed by the Walalakoo Aboriginal Corporation (WAC), the Nyikina and Mangala peoples' native title corporation, in the West Kimberley, Western Australia in 2018. This article celebrates Traditional Owner's pragmatic decolonising strategies. It explores the emerging conceptual challenges to the status quo by comparing the Living Waters, First Law framework to Australia's settler state water governance framework, represented by the National Water Initiative. Bacchi's 'what is the problem represented to be' approach is used to interrogate the underlying assumptions and logics (2009). We find that there are incommensurable differences with First Law and the Australian water reform agenda. Yet, our analysis also suggests 'bridges' in relation to sustainability, benefits and responsibilities could promote dialogues towards decolonial water futures.

Language naming systems are local ways of organising diversity, yet the language names used by linguists are sometimes incommensurable with the lived social reality of speakers. The process of assigning language names is not neutral, trivial or objective: it is a highly political process driven and shaped by understandings of group identity, similarity and difference. Closer attention to local perspectives on language naming offers important insights into ideologies around social and linguistic differentiation. This paper draws together accounts of diverse language naming practices from across Indigenous Australia and applies a close lens to the region of western Arnhem Land. Through an examination of three groups (speakers of Bininj Kunwok, Mawng, and Burarra), we describe the range of strategies speakers use to divide up their local language ecologies, practices for naming lects, and the role of variation in the processes of differentiation. Naming practices between these groups show interesting similarities but also striking differences. We further highlight the interplay between two key processes which characterise local language naming strategies in the region: the ‘erasure’ of difference, typically from the perspective of a politically more powerful group, and the intentional creation of linguistic differentiation, or ausbau.

There is a significant gap between the life outcomes of Aboriginal and non-Aboriginal people in Western Australia. The gap is worse in regional and remote areas and, for most outcomes, is not closing. Problems are complex, entrenched and multi-dimensional. There is no one-size-fits-all solutions. In recognition of lack of progress, the Regional Services Reform Unit was established in 2015 to drive major reforms in the way services and infrastructure are delivered in regional and remote Aboriginal communities. In mid-2016, the State Government published Resilient Families, Strong Communities: A roadmap for regional and remote Aboriginal communities. Since the launch of the roadmap in 2016, the Reform Unit has embarked on an unprecedented journey of on-the-ground consultation with residents of remote Aboriginal communities across Western Australia. The roadmap was used as the guiding document for consultation.

Purpose In 2020, mining activity by Rio Tinto destroyed rock caves in Western Australia's Juukan Gorge that are considered sacred sites by the First Nation Peoples of that area, the Puutu Kunti Kurrama and Pinikura (PKKP) Peoples. This paper examines the public response to the damage caused at this culturally sensitive site and identifies cultural heritage protection strategies that emerged in the aftermath of this catastrophic event. Design/methodology/approach This research applies a qualitative case study method and analysis of open-sourced official policy documents, media reports and published institutional statements. Findings The research identified specific cultural heritage protection strategies, including stakeholder-driven advocacy and shared values approach to business practices to help foster a greater appreciation of the connections between people, objects and lands. Whilst the mining activities were considered lawful, significant gaps in the legislation to protect heritage sites were also exposed. Originality/value Using a recent case that occurred in 2020, this paper unpacks how the motivations for accessing minerals can override cultural sensibilities and legal/ethical frameworks established to protect cultural heritage. This paper brings to light the liabilities associated with the mining industry when operating in a culturally significant environment where appropriate due diligence to manage cultural heritage is not thoroughly applied. The paper highlights the role the community can play in demanding improved corporate social responsibility which can, in turn, act as a strategy for cultural heritage protection.

To curb high rates of alcohol-related violence and injury in Indigenous communities, alcohol management plans (AMPs) were implemented in 2002–2003 and tightened in 2008. This project compares injury presentations and alcohol involvement from two Indigenous Cape York communities, one that entered full prohibition and one that did not. Aclinical file audit was performed for the period 2006–2011, capturing changes in alcohol availability. Medical files were searched for injury presentation documenting type of injury, cause of injury (including alcohol), date of injury and outcomes of all presenting injuries for the time period 1 January 2006 to 31 December 2011, capturing the major changes of the 2008 AMP restrictions. Findings indicated injury presentation rates were higher in both communities before prohibition than afterwards andreduction was more pronounced in community 2 (prohibition). Ongoing research is imperative, as this area is characterised by a near-absence of evidence.

Early childhood is one of the most influential developmental life stages. Attainments at this stage will have implications for the quality of life children experience as they transition to adulthood (COAG 2009; COSDH 2007; Maggi et al. 2005). Children residing in remote Australia are exposed to disadvantages that can contribute to developmental delays and resultant poorer education and health outcomes. Remoteness is defined in the Australian context by geographical location through the Australian Standard Geographical Classification - Remoteness Areas (ASGC-RA). Communities in far west NSW are identified as RA3 - outer regional, RA4 - remote, and RA5 - very remote (ABS 2013). In addition, remote locations have been identified as sharing common characteristics that include higher levels of health risk and disease burdens, limited access to health services, health workforce shortages and socio-economic disadvantage (McGrail and Humphreys 2009).

The link between one’s postcode and probable school ‘success’ is well recognised. For those in remote Australian schools, it is an indicator that the further one lives from the metropolis, the less likely they are to be successful. Improved educational outcomes are desirable for students in remote communities to broaden their future life choices. This paper considers what neo-conservative policies around ‘improvement’ and ‘success’—largely formed and mandated in metropolitan centres of education governance—mean for students living in remote locations. Using an example of leading a remote Australian school, we consider if educational success for students in remote schools can be readily evidenced through standardised testing alone. We also consider what this means for teachers, teaching in a remote site. This article draws primarily on the experiences of a school leader conducting an autoethnography, following their three-year tenure as a leader in a remote school. Through applied qualitative inquiry, drawing in particular on reflexive self-study, the paper explores one remote school’s response to calls from governments for ‘improvement’.

Introduction Centre-based cardiac rehabilitation (CR) programs were disrupted and urged to adopt telehealth modes of delivery during the COVID-19 public health emergency. Previously established telehealth services may have faced increased demand. This study aimed to investigate a) the impact of the COVID-19 pandemic on CR attendance/completion, b) clinical outcomes of patients with cardiovascular (CV) diseases referred to CR and, c) how regional and rural centre-based services converted to a telehealth delivery during this time. Methods A cohort of patients living in regional and rural Australia, referred to an established telehealth-based or centre-based CR services during COVID-19 first wave, were prospectively followed-up, for ≥90 days (February to June 2020). Cardiac rehabilitation attendance/completion and a composite of CV re-admissions and deaths were compared to a historical control group referred in the same period in 2019. The impact of mode of delivery (established telehealth service versus centre-based CR) was analysed through a competitive risk model. The adaption of centre-based CR services to telehealth was assessed via a cross-sectional survey. Results 1,954 patients (1,032 referred during COVID-19 and 922 pre-COVID-19) were followed-up for 161 (interquartile range 123–202) days. Mean age was 68 (standard deviation 13) years and 68% were male. Referrals to the established telehealth program did not differ during (24%) and pre-COVID-19 (23%). Although all 10 centre-based services surveyed adopted telehealth, attendance (46.6% vs 59.9%; p<0.001) and completion (42.4% vs 75.4%; p<0.001) was significantly lower during COVID-19. Referral during vs pre-COVID-19 (sub hazard ratio [SHR] 0.77; 95% CI 0.68–0.87), and to a centre-based program compared to the established telehealth service (SHR 0.66; 95% CI 0.58–0.76) decreased the likelihood of CR uptake. Discussion An established telehealth service and rapid adoption of telehealth by centre-based programs enabled access to CR in regional and rural Australia during COVID-19. However, further development of the newly implemented telehealth models is needed to promote CR attendance and completion.

As the incidence of suicide contagion proliferates within traditional Indigenous communities in Northern Territory, Australia, it has dramatically impacted on youth and young adults, with clusters of attempted and completed suicide in these age groups. There are six different aspects of suicide contagion identified in Indigenous settings including the social, behavioural, emotional, cultural, familial, and intergenerational which are explored. The experience of suicide contagion is different in Indigenous communities as it halts dramatically around the age of fifty which points to a protective factor within Indigenous Elders that is not available to Indigenous youth and young adults. It also suggests a possible intergenerational segregation at that age, where the older and younger generations rarely intersect. Indigenous suicide is almost exclusively by hanging, especially in the very young, and the social issues that determine suicide in Indigenous settings, are indicative of a troubled youth and young adult Indigenous population, with resultant political ramifications. Combined with the specific vulnerabilities within Indigenous settings, suicide contagion is difficult to contain and has led to an echo cluster phenomenon in certain high risk settings. The “Echo Cluster Model” represents this process and pattern of echo clusters. There is now emerging evidence of suicide containment in some high risk communities where Indigenous communities are able to harness the strengths of the Indigenous Elders who are protected from suicide contagion (> 50 years). Promote Life NT Models 3 and 4 and descriptive examples, demonstrate the ability of Elders through cross generational re-engagement, to support and protect youth and young adults by intergenerational integration, to contain and reduce suicide and support broad postvention initiatives in Indigenous settings.

Background: In a remote region of Western Australia, Kimberley, residents have nearly twice the State average per capita consumption of alcohol, four and a half times the level of alcohol-related hospitalizations and nearly three times the level of alcohol-related deaths. This study aimed to evaluate the long term effects of alcohol sale restrictions on health service utilization in two remote towns in Kimberley.Methods: Sale of high strength packaged alcohol was restricted in Fitzroy Crossing and Halls Creek since October 2007 and May 2009, respectively. Alcohol-related Emergency Department (ED) attendances and hospitalizations utilized by local residents before and after the intervention between 2003 and 2013 was compared by using yearly rates (/1,000 person-years) and interrupted time series analysis with Autoregressive Integrated Moving Average (ARIMA) modeling. The Western Australia specific aetiological fractions (AAFs) were applied to hospital inpatient data for estimation of the proportion of hospital separations attributable to alcohol.Results: In Fitzroy Crossing, there was a significant reduction of over 40% on rates (/1,000 person-years) of alcohol-related acute hospitalizations (54.2 [95% CI: 53.8–54.7] vs. 31.7 [31.4–32.1]) and ED attendances (534.1[532.8–535.5] vs. 294.5 [293.5–295.4]). In Halls Creek, there was a significant reduction of over 50% on rates (/1,000 person-years) of alcohol- related acute hospitalizations (17.7 [17.6–17.8] vs. 8.0 [7.9–8.1]) and ED attendance (248.4 [247.9–248.9] vs. 111.1[110.8–111.5]). Domestic violence and injury related hospitalization rates were also reduced by over 20% in both towns.Conclusions: The total restriction of selling high strength alcohol through a community driven process has shown to be effective in reducing alcohol-related health service utilization in post-intervention period. Continue monitoring is required to address new emerging issues. Future research on health service utilization related to alcohol by using interrupted time series analysis incorporating ARIMA modeling and applying AAFs are recommended for evaluating alcohol-related interventions.

Staphylococcus aureus and Streptococcus pyogenes are important contributors to disease in northern Australia. Both are opportunistic pathogens, frequently carried on the skin or in the respiratory tract in the absence of disease. A large proportion of the S. aureus strains causing infection in northern Australia possess the Panton Valentine (PVL) toxin, with ST93, ST5, and ST121 being significant. PVL+ strains are associated with both community- and healthcare-associated infections, and a large proportion are methicillin-resistant S. aureus (MRSA). MRSA strains known to be healthcare associated (ST239 and ST22) are not prevalent. CC1 PVL− MRSA continue to cause infections. The diversity of S. pyogenes emm types in northern Australia is high with skin tropic and non-tropic emm types predominating. This contrasts with other parts of Australia where emm diversity is lower and rates of pharyngitis higher. The high diversity raises concerns for the likely efficacy of vaccines based on the variable region of the M protein, the nucleotide sequence of which underpins emm typing. It is likely that complex interactions occur between these two important bacterial pathogens, and other important skin pathogens in the region such as the scabies mite.

Several Torres Strait communities have significant infrastructure and sacred sites located only a few metres above sea level. As a consequence, these areas are vulnerable to erosion due to the projected increase in storm surge intensity caused by climate change. Common sense suggests that Islanders would welcome new scientific research about how climate change might affect them, in order to understand the significance of these impacts and the timeframes involved. However, one leader has taken a seemingly counterintuitive stance, and has refused to let new climate research occur. We explore why this position was taken, and the implications of this decision for ongoing scientific research. In order to carry out this analysis, we provide a contextual background by assessing Islanders' recent experience with scientific researchers, and the response of policy-makers to it. We find that despite a clearly documented problem with ?top-down? decision-making, this process remains. In this instance, we find that there is a systemic lack of collaboration with Islanders to allow them to prioritise their concerns, and a lack of adequate resources to allow them to build their resilience to climate impacts. We conclude that only through a genuine collaborative approach to climate adaptation can activities be properly developed, prioritised and undertaken.

Background: Fly-In Fly-Out (FIFO), which entails travelling mostly from the urban areas to stay and work in remote areas for designated periods and travel back home to spend designated days of leave, has become a common work arrangement in the mining sector globally. This study examined the mental and physical health of FIFO workers and described their health-related behaviours during on-and off-shift periods. Methods: A cross-sectional study was conducted with FIFO workers (N = 216) in the mining industry in Australia who completed an online survey. Paired t-test and McNemer’s analysis examined the differences in health-related behaviours during workers’ on-and off-shift days. Logistic regression examined the predictors of physical health and psychological distress status of FIFO workers. Results: Workers reported longer sleep duration (7.5 ± 1.5 h vs 6.3 ± 1.2 h, p < 0.001) and better sleep quality (78.2% vs 46.3%, p < 0.001) during off-shift nights than on on-shift nights. Smoking prevalence was 26.4%, and workers reported smoking a similar number of cigarettes per day during on-and off-shift days. Most workers reported drinking alcohol (86.1%) and more often at risky levels during off-shift than on-shift days (57.9% vs 34.3%, p < 0.001). Fruits and vegetable consumption was low but with higher vegetable intake during off-shift days (2.8 ± 1.4 vs 2.3 ± 1.3 serves, p < 0.001). Workers had good physical health status (91.2%), but 71.4% were overweight/obese and 33.4% indicated high levels of psychological distress. Working on long shifts (OR 6.63, 95% CI 1.84–23.91) and smoking (OR 7.17, 95% CI 2.67–19.26) were linked to high psychological distress. Conclusions: The prevalence of psychological distress and risky health behaviours was high. Interventions should aim to reduce psychological distress and support multiple behaviour changes, considering FIFO work-related characteristics including long shift hours.

This report represents an overview of the health of Goldfields residents, to inform evidence-based health service planning and delivery. Additional information about the region and districts within the region may be found in service plan documents located on the WA Country Health Service (WACHS) Publications page. The 2017 WACHS Child Health Profile and WACHS Health Profile Summary 2017 are also available.