Remote Australia Online

What is the relationship between the first two trials of the Cashless Debit Card (CDC) and Indigenous mobility? In Ceduna, Vincent conducted ethnographic research into lived experiences of the first CDC trial. In the East Kimberley, Klein conducted 51 structured interviews with people on the card and 37 semi-structured interviews with key informants. Markham used regression analysis of net migration rates at the Statistical Area 2 level to determine whether the CDC trial sites were associated with greater net population loss in 2016 census data than comparable locations. Our exploratory study finds significant local talk of displacement arising from the introduction of the CDC, as well as discussion of short-term trips away from the trial sites being made more difficult. The regression analysis found that the net migration rate was 9.3 per cent points (95% CI: 2.0, 16.5) lower in Ceduna, Wyndham and Kununurra when compared with a group of comparable towns, and 5.2 per cent points (95% CI: 0.9, 9.5) lower when compared with Australia as a whole, meaning that the populations of these towns declined faster than those of comparable towns. Policy effects on mobility should be taken seriously by researchers and policymakers when considering place-based welfare policy.

In 1903 Broken Hill temperance worker Maria Braithwaite penned a short story full of pathos about a local drunkard named Gandy. Gandy lived with his orphaned niece Sue and nephew Pinch in a humpy at Dumpers Camp, was frequently unemployed, and squandered his spasmodic wages from the mines on drink, leading to his regular arrest for drunkenness. Gandy could not control his drinking for no matter how often he vowed 'never to touch another drop' he remained 'besotted' and his failure led his charges towards a life of poverty and wretchedness. With no money for medical treatment Sue became ill and died tragically, a furnace-like heat overcoming her body. Gandy knew it was his fault because of the demon drink and after hearing the hymn 'Are you coming home tonight?' took the abstinence pledge and became a great temperance man, an action which ensured his redemption, leaving him 'uplifted - purified - cleansed'.1 Temperance here was a personal moral struggle, fought for the individual soul, and drunkenness intrinsically connected to social problems more broadly. In contrast, a public speech given by Reverend C. E. Schafer, to a local meeting of the Women's Christian Temperance Union (WCTU) in 1909, embodied a starkly different view of temperance. He depicted the cause as a political struggle between 'the temperance party' and 'the liquor party' to 'carry no-license' at the polls 'so as to render it impossible for the liquor party to open houses again'.2 This was temperance as a political contest, fought at regular elections and aiming at prohibition of the legal sale of liquor.

Aboriginal and Torres Strait Islander people (hereafter respectfully referred to as Aboriginal people) living in remote communities often face the brunt of public scrutiny because of careless reporting on sensitive issues. The consequence of such reporting can be stigmatising for individuals and communities, creating shame and potentially forcing the issues further underground, rendering them harder to manage. One such issue is the occurrence of sexually transmissible infections (STIs) in young people that is often depicted as demonstrating child sexual abuse.1-3 While every case of child sexual abuse is a criminal act that demands the full force of the law, the context in which STIs occur in young people and minors is far more complex. Notifications of STIs among young people and minors may be the outcome of child sexual abuse, but others may be occurring in the context of sexual activity between consenting similar age peers no different from that found in non‐Indigenous Australians in the same age group. While such activity is both unlawful and known to present health hazards, jurisdictions around Australia have recognised circumstances in which criminal proceedings are not in the best interest of those involved. In this article, we provide an overview of the epidemiology of STIs in remote communities, describe reported ages of sexual debut, outline mandatory reporting requirements and describe what has recently been reported about child sexual abuse. Our aim in bringing this information together is to set the record straight and form the basis for a healthier public discourse.

This article reports on the findings of a research project that investigated the use of mobile phones and the internet in remote Aboriginal and Torres Strait Islander communities in Australia. Indigenous Australians living in remote areas have previously had little access to and use of the internet (Rennie et al 2013) and are far less likely to access the internet within the home than non-Indigenous Australians (Rennie et al 2010). The proliferation of mobile phone ownership in Indigenous communities in Australian and internationally (Brady et al 2008) is resulting in increased access to the internet via mobile devices, as well as new communication, social and economic implications for phone owners. Using qualitative methodologies, including focus groups and semi-structured interviews in four remote communities, this article explores the ways that remote community members are using mobile phones; their access to online information and social media; and the problems they experience with service provision, bills and connectivity. It reinforces the need for more research into barriers to phone and internet usage by Aboriginal and Torres Strait people in remote areas, as well as the importance of informing remote community members of their telecommunications rights.

Globally, Indigenous peoples have fire management practices which are not necessarily supported by the centralised land management and natural hazard institutions of nation states. This is changing in Australia with the proliferation of engagements between government authorities and Aboriginal fire management leaders. These engagements raise a series of justice issues that critique the separation of environmental and socio-political matters, and the discriminatory positioning of Indigenous peoples and their interests as local. In this chapter, we share the experiences of Aboriginal people that have been shared with us in three places: Central Arnhem Land, the Western Desert and the Australian Capital Territory. The theory/practice of Disaster Justice offers new opportunities to ensure these socio-natural engagements are ‘just’, which requires careful attention to whose values matter, whose knowledge is important and whose political-legal rights and entities are recognised and resourced.

In 2014, the government of Western Australia proposed a plan to defund, and in effect close, about half of the nearly three hundred remote Aboriginal communities in the state. During this time, the author collaborated on a hand sign video project with five women Elders at the Kapululangu Women’s Law and Culture Centre in Balgo, an Aboriginal community in the Great Sandy Desert. The author articulates why Marumpu Wangka! Kukatja Hand Talk—an unassuming and largely improvised video—struck a chord at this precarious moment for Aboriginal communities. The author argues that hand sign videos provide a rare mode of intercultural engagement that is simultaneously culturally specific and broadly relatable. In a mediascape in which most Australian viewers are inundated with visual tropes of Aboriginal communities as either suffering or mystical, representations of jovial gesture encourage understanding beyond these stereotypes by intimately engaging everyday community interaction. Referencing the supplemental eight-minute video throughout, the author (1) overviews the significance of hand sign systems in Aboriginal Australian communities, (2) describes the collaborative and improvised hand sign video production process, and (3) argues for the importance of visual representations that can transcend—even if modestly—settler/Indigenous divides during the current dangerous times for Aboriginal communities.

BACKGROUND: Hyperglycaemia in pregnancy contributes to adverse outcomes for women and their children. The postpartum period is an opportune time to support women to reduce cardiometabolic and diabetes risk in subsequent pregnancies. AIMS: To identify strengths and gaps in current care for Aboriginal women after a pregnancy complicated by hyperglycaemia. METHODS: A retrospective review of the 12 month postpartum care provided by primary health centres in remote Australia in 2013-2014 identified 195 women who experienced hyperglycaemia in pregnancy (gestational diabetes (GDM) (n = 147), type 2 diabetes (T2D) (n = 39), and unclear diabetes status (n = 9)). RESULTS: Only 80 women (54%) with GDM had postpartum glycaemic checks. Of these, 32 women were diagnosed with prediabetes (n = 24) or diabetes (n = 8). Compared to women with GDM, women with T2D were more likely to have their weight measured (75% vs. 52%, p <0.01), and smoking status documented as "discussed" (65% vs. 34%, p < 0.01). Most women (97%) accessed the health centre at least once in the 12 month postpartum period but, during these visits, only 52% of women had service provision, either structured or opportunistic, related to diabetes. CONCLUSION: High rates of dysglycaemia among women screened for T2D after GDM in the 12 month postpartum period highlight the need for increased screening and early intervention to prevent the development of T2D and its complications. Whilst a clear strength was high postpartum attendance, many women did not attend health services for diabetes screening or management.

This chapter addresses the reflexive dimensions of research with young Indigenous men in northern Australia. Adgemis charts his own realizations regarding Indigenous Australian stereotypes, violent realities of colonization and the recent legacy of racialized attitudes, discourse, and policy that demonizes Aboriginal men. He reflects on intersubjective dimensions of working with young Yanyuwa men who experience cross-generational blame for perceived failings of cultural expectations. Adgemis draws upon his own experiences of cross-generational condemnation emanating from social change toward empathic engagement with younger Yanyuwa. Discussion is dedicated to the perceived failure of cultural expectations as the seat of shame and improvisations to avoid such shame as an ongoing factor of social change.

There is increasing recognition that the arts and creative sector has a crucial role to play in supporting and sustaining communities in Australia’s remotest regions where the demographics and circumstances are vastly different from other urban, peri-urban, and regional locations. The Creative Barkly project worked closely with partners Barkly Regional Arts (BRA) and Regional Development Australia, Northern Territory (RDANT) to address a pressing need for evidence-based research that examines how this sector is currently functioning in very remote Australia and where its growth potential lies. In order to contextualise these findings, and inform their interpretation, the report features a significant review of literature from Australia and overseas that relates to regional and remote development broadly. In this literature review we discuss the predominant deficit construction of regional and remote areas as well as the major role of the arts in development. This covers 6 areas such as inclusive social and economic development, human rights, community development and renewal, regional and remote health and wellbeing, and cultural transmission. This review also discusses the diverse roles of regional arts organisations in development. We conclude by highlighting key concepts from existing literature, such as creative placemaking, livelihoods, strength-based development, and mobility, that speak to the diverse lived experiences of arts and development evidenced in our research in the Barkly Region. Key Findings: The Barkly arts and cultural sector can be conceived as a value creating ecology. At the time of research, that ecology included multiple sectors, organisations, individuals and forms of value inclusive of cultural, political, ecological, human, spiritual, and natural value. With ongoing investment, evaluation, and support, major annual events such as the Desert Harmony Festival can emerge as internationally recognised best practice in arts led holistic and inclusive regional development. There is a strong opportunity to develop major annual regional arts events such as the Desert Harmony Festival as emerging models for holistic and inclusive regional development in remote arts ecologies. Art centres, arts organisations, and events create vibrant and enthusiastic audiences for regional arts and cultural activities that facilitate tourism. Arts related volunteering is strong in the Barkly and can support individual, community, and regional development. When asked to report on things that impacted on their arts practice, a majority of respondents (20.5%) stated that health was the principal factor affecting their arts and creative practice followed by cultural factors (15.2%) and lack of funding (14.3%). First Nations’ respondents were most impacted by health, family and cultural factors while non-Indigenous respondents were equally impacted across health, work, costs and finances, and lack of time factors. This report therefore recommends that arts development plans and strategies developed by government, arts and non-arts organisations, must respond to challenges and limitations that impact on artistic practice in the Barkly Region. Participants in the Barkly arts ecology should be supported by the Australian and Territory Governments to challenge and make redundant unethical practices such as “carpetbagging”. Carpetbagging has been reported in the Barkly Region and neighbouring centres such as Alice Springs. It involves external parties entering the region to exploit local artists for commercial gain, often without adherence to ethical and legal industry practices, artist development, or local development aspirations. There is an opportunity to strengthen regional art centres’ relationships with artists to create “ethical spaces” for arts industry and artist career development and sales. This research found that the arts and creative sector in the Barkly Region was vibrant and diverse. As the findings have demonstrated, the sector was being supported and enabled by a number of key strengths among people, organisations, and communities; and advantages of Country, landscape and culture. The researchers found that each organisation and community involved in the study had its own unique interpretation and approach to arts delivery according to their situation, needs, and skills. The ability to collaborate and to use a community’s strengths and resources, positive attitudes among artists and creative workers, and high levels of informal education, training and skills development, meant that the Barkly was home to a number of successful and sustainable arts and creative programs and initiatives.

The overall aim of this project is to develop an empirically-based and community-driven framework to facilitate the efficient use, and secure long-term supply of water and water-related energy in remote and isolated Aboriginal and/or Torres Strait Islander communities. STAGE ONE: The research objective was to gather baseline qualitative and quantitative data to characterise water consumption activities, attitudes and challenges as well as water-related energy use in remote Aboriginal and Torres Strait Islander communities. The following are key insights from this stage:• Not all remote Australian communities have access to a continuous (“24/7/365”) supply of adequately treated drinking water.• There are good opportunities to substantially reduce water-related energy through community water demand management strategies.• Household health hardware is variable across remote communities and needs to be pragmatically considered when developing community water demand management strategies. For example, around one quarter of all homes surveyed reported having toilet, shower and outdoor tap leaks.• Rainwater is generally more valued than ‘town’ water (e.g. the treated mains supply) as a drinking water source. This is due to the perception of chemicals in the treated water being detrimental to people’s health and also the frequency of “boil water” alerts in some communities.• The distrust of ‘town’ water and preference for rainwater by some residents may present barriers to changing water conservation behaviours e.g. continued use of ‘town’ water (less valued) for high water use activities (e.g. outdoor use).• There is a trend for households that use more outdoor water to be less concerned about water security in their community.• Outdoor water use is inextricably linked to health and wellbeing, yet it is a key contributor of unsustainably high water demand in remote communities. STAGE TWO: The research objective was to trial and evaluate co-developed community-based water demand management (CWDM) strategies in four remote Aboriginal and Torres Strait Islander communities (including mainland and islands). The following are key insights from this stage: • To help address the range of high water use drivers, behaviours and attitudes, a suite of both community and council/service provider-led water conservation actions is needed within a broader water demand management program.• Water reductions up to 40% of pre-CWDM trial consumption were achieved — though long-term reductions will require sustained and positive efforts from councils/service providers e.g. they need to include the “why” and “how” of water conservation in their on-going messaging to community.• Water-related energy reductions between 25% and 65% of pre-CWDM trial were estimated.• Community responses to the CWDM trial clearly illustrated that councils/water service providers need to more fully engage in a positive and informative way with individual householders. • Individualised water use feedback, including comparisons with the water use of other households was a popular CWDM strategy from the trials in all four communities—from both the community and council/service provider perspective. STAGE THREE: The research objective was to identify suitable and pragmatic community water demand management strategies to promote long-term, efficient use of water in remote communities. The following are key insights from this stage: • There is a need to co-design any CWDM program with Indigenous representation from the start and for collaboration to be truly effective, government must budget sufficient community engagement costs into any water demand management program.• Successful and long term water demand management strategies require a suite of tools to be implemented over time. This is especially true for CWDM in remote Indigenous communities. Each community also has different limitations and opportunities for achieving water efficient outcomes and these must be understood and respected.• WDM strategies can be grouped into five main approaches: Education, Encouragement, Engineering, Economics and Enforcement• Transitioning to a more community focussed WDM approach may initially require a mix of Education/Encouragement strategies and Engineering/Enforcement strategies; with a reduction in these latter two strategies over time.• In the early-mid stages of implementation, communities need a “Safe to Fail” approach to allow some long-term behaviour change patterns to occur and to promote greater trust between local community members, councils/service providers and external parties.• Indoor and outdoor water conservation messaging needs to avoid discouraging the use of water for key Healthy Living Practices essential for human health (washing bodies, washing clothes, washing bedding etc.).

Background Women face challenges when accessing abortion, including varied legislation and reduced access to services in rural and remote settings. There are limited clinical guidelines in Australia and little information regarding the patient journey, particularly the timeframe between referral to abortion procedure. Legislation reform in the Northern Territory (NT) legalised early medical abortion (EMA) in primary health care, providing an opportunity to review service provision of elective surgical abortion prior to and after these changes. Aims To review the waiting time to access abortion, percentage eligible for EMA based on ultrasound gestation alone, percentage of Indigenous women accessing abortion in the NT and the effects of the legislation change. Materials and Methods Retrospective audit-analysed surgical abortion data from 354 patient files who underwent suction curettage of uterus between 2012?2017 in one NT public hospital. Results Mean wait-time ranged from 20 to 22 days in 2012?2016 and dropped to 15 days in 2017 following the law reform. Sixty-two percent of women waited longer than that in the recommended clinical guidelines. Indigenous women represented approximately 25% of patients accessing surgical abortion services. Average gestation at surgical abortion procedure increased following reform. Prior to reform up to 95% of patients accessing surgical abortion would have been eligible for EMA at time of referral. Conclusions Results demonstrate potential for changes in service provision of abortion in the NT with increased choice, patient-centred care and reduced waiting times. This audit demonstrated the possibility to move the majority of abortion services into primary health care leading to cost savings.

This chapter considers Indigenous community patrols (Night Patrols) as a form of community-owned and designed safety initiative. Their service represents a reaction to the “bare life” policing of Indigenous people, which is overwhelmingly concerned with protecting white property and white order. Instead, Night Patrols are a form of place-based sovereignty enactment that focuses on maintaining the wellbeing of local Indigenous people and strengthening community bonds. They facilitate Indigenous mobilities that have long been confined by the colonial project. They extend inter-cultural struggle in two respects: through their mediation of police power and through their negotiation of government regulation. The increasing incursions of Indigenous mobility since the Northern Territory Intervention (2007), we demonstrate, has threatened the Night Patrol as well as other freedoms of Indigenous people to travel on roads and in vehicles. These settler state interventions have rendered the road or the bush track another camp in the settler colonial archipelago. Alongside these interventions has been Indigenous peoples’ appropriation of the vehicle for refusal, resistance and resurgence.

Emerging research on linguistic diversity and critical language awareness has highlighted the importance of understanding and affirming the complex and dynamic language ecologies (see Simpson et al., and Angelo et al., this volume) of the community in classrooms (Fairclough, 1992; Garcia, 2015; Carter, Angelo and Hudson, 2018; Ollerhead, 2018). This orientation demands novel ways of including children's perspectives on their own linguistic practices, identities and learning needs in research, policy and practice. This paper describes two arts-informed, multimodal language awareness activities: language portraits (Wolf, 2014; Busch, 2016) and interactional language network maps (Dagenais and Berron, 2001; Prasad, 2014; Smythe and Toohey, 2009). These were used in a larger study of the way in which Warlpiri students in a remote bilingual school in Australia's Northern Territory understand and represent their diverse communicative practices. Students made strong connections between language and identity and expressed sophisticated awareness of their own language use. The tools revealed the depth and variety of linguistic resources and cultural funds of knowledge that students in a remote community bring to their classrooms and raised questions about how this knowledge might be harnessed to enrich learning in multilingual classrooms.

Background: Rural and remote residents are more likely to smoke than those who live in major cities; however, recruitment of research participants from rural and remote areas can be challenging. The cost per participant recruited from rural and remote areas via online (eg, social media) and traditional strategies (eg, print) has implications for researchers on how to allocate resources to maximize the number of participants recruited. Participant characteristics such as demographics, financial stress, mental health, and smoking-related factors may be associated with recruitment method (ie, online vs traditional), and so it is important to understand whether certain subgroups are more likely to be recruited via a particular strategy. Objective: This study aimed to determine the cost per participant recruited and examine whether characteristics such as demographics, financial stress, mental health, and smoking-related factors may be associated with the recruitment method (ie, online vs traditional). Methods: Participants were recruited into a randomized trial that provided smoking cessation support. Eligible participants were aged 18 years or older; used tobacco daily; had access to video communication software, internet, and telephone; had an email address; and lived in a rural or remote area of New South Wales, Australia. This study describes the natural (observed) experience of recruiting participants via online and traditional methods into a smoking cessation trial. Results: Over 17 months, 655 participants were recruited into the smoking cessation trial. A total of 88.7% (581/655) of the participants were recruited via online methods. Moreover, 1.8% (12/655) of the participants were recruited from remote locations and none from very remote areas. The cost per participant recruited by the various online strategies ranged from Aus $7.29 (US $4.96, £4.09, and €4.43) for Gumtree, a local online classified website, to Aus $128.67 (US $87.63, £72.20, and €78.28) for email. The cost per participant recruited using traditional strategies ranged from Aus $0 (US $0, £0, and €0) for word of mouth to Aus $3990.84 (US $2757.67, £2227.85, and €2477.11) for telephone. Women had greater odds of being recruited via online methods than men (odds ratio 2.50, 95% CI 1.42-4.40). No other characteristics were associated with the recruitment method. Conclusions: The cost per participant recruited via online and traditional strategies varied, with the range being smaller for online than traditional recruitment strategies. Women have greater odds of being recruited via online strategies into rural smoking cessation trials. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000514303; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372584&isReview=true

KindiLink is a program of supported playgroups offered through selected public schools in Western Australia for Aboriginal children who are not old enough to enrol in kindergarten. It forms a link between raising children at home and teaching them at school.

Background Child abuse and Youth Sexual Violence and Abuse (YSVA) are persistent social issues across the globe. The development and implementation of effective prevention strategies are a common focus for those working at the coalface. The Cairns Child Protection Investigation Unit of the Queensland Police Service (QPS) developed and implemented the “Speak Up. Be Strong. Be Heard.” (SUBSBH) initiative. This police-led multi-component child abuse prevention initiative has been implemented in 26 Aboriginal and Torres Strait Islander communities across the Far North Queensland Police District since June 2016. Objective The aim of this research was to evaluate the success of the SUBSBH initiative. Participants and setting Existing data held by QPS were examined. These data include statistics on reporting of YSVA offences, internal program documents and reports, and evaluation feedback forms completed prior to this evaluation study. Information collected via these sources pertained to 26 Indigenous communities within the Far North Queensland Police District. The above-mentioned feedback forms were completed by 307 participants, of whom approximately 90% are Indigenous. Methods This study adopted desktop analysis and triangulation through a range of qualitative and quantitative data to ensure robust and rigorous evaluation of the SUBSBH initiative. Results The study found that the initiative was successful in meeting basic accepted practice for child abuse and YSVA prevention programs, receiving positive participant feedback on the educational program, achieving the initiative’s objective to increase reporting of YSVA, and achieving cost-efficiency in meeting outcomes. Importantly, the increase in reporting of YSVA was statistically significant. Conclusion This study contributes to current understanding regarding the implementation of multi-component child abuse prevention initiatives and provides an example of a cost-efficient police-led community response to child abuse and YSVA in Indigenous communities. The findings may guide responses in other communities which grapple with this critical social issue.

The last four decades have witnessed profound social, demographic and economic change in Denham, the main town (a ‘village’ in European terms) in the Shark Bay region of Western Australia. Formerly highly isolated and dependent upon fishing and pastoralism, Denham today is a hub for nature-based tourism and nature conservation activities, and the site of residential developments catering largely to the distant urban population in the Western Australian capital, Perth. Shark Bay's World Heritage Area (WHA) status, proposed by the Australian government in the late 1980s and declared in 1991, became a popular symbol of these processes of socio-economic development and a focal point for conflict over the nature, scale and pace of local change. This paper examines WHA designation at Shark Bay, placing it within a broader context of Denham's transformation through the overlapping and interrelated processes of declining primary industries, improving transport networks, the growth of tourism and the expansion of nature conservation reserves and activities, and demographic change. It focusses on the reasons for the strength and persistence of negative perceptions towards WHA listing, and links a recent shift in community attitudes to demographic change and corresponding developments in the regional economy and local council membership. Denham, we suggest, presents a characteristically Australian case study of regional polarization against a backdrop of the shift from extractive primary industries towards tourism and nature conservation now characteristic of an increasingly large part of the nation's ‘outback’ communities.

Background There are ongoing health workforce shortages in rural Australia with nurses a major component of the provision of health care. Training for nursing students in rural areas is one strategy to overcome this. Aim To explore possibilities for nursing student rural clinical placements, with a view to increase the length of placements and strengthen the future rural nursing workforce. Methods A Nursing Roundtable was held in regional Western Australia (WA) with representatives from five Western Australian universities, tertiary providers and service clinical stakeholders. Participants attended site visits to local facilities which included primary, community and hospital-based facilities. Findings Major issues identified included short length of nursing placements; inflexibility of bookings via centralised placement databases; financial and family responsibilities inhibiting students taking up placements; quality of on-site supervision; and the availability of graduate programs after qualifying. Participants agreed longer student clinical placements reduced workload for academic and clinical staff allowing students to settle and be industry ready. Discussion There was a strengthening of goodwill and willingness of university and clinical stakeholders to work collaboratively to lengthen student placements and consider placements in non-traditional settings to expand student understanding of career possibilities, rural and Indigenous communities, and the underpinning determinants of health. Conclusion Back-to-back practicums or potential to share placements between different organisations were recognised as opportunities for further development. Efforts to increase placement length, broaden experiences and overcome financial barriers need to be addressed. Production of a marketing video to include job potential post-graduating was suggested to attract students.

National archives house a rich legacy of materials that document many intangible aspects of Indigenous cultural heritage. It is the moral right of Indigenous people to have access to these materials, but their reintroduction back into present-day worlds is not without impact. Here, I analyse contemporary spaces in which Warlpiri women have engaged with archival cultural heritage materials and incorporated them into present-day contexts for the performance of yawulyu. These include the production of song books, dance camps at bush locations, and broader community arts performances. These cases illustrate that for proper engagement with these legacy materials knowledgeable Indigenous people must lead activities which are supported as part of the repatriation process.

The high prevalence and health effect of tobacco smoking and secondhand smoke exposure among Aboriginal and Torres Strait Islander people is well known. Due to its significance, the responsibility of tackling smoking among Aboriginal and Torres Strait Islander people should not remain solely with health service providers. The creation of supportive environments and collaboration beyond the health sector are critical elements of comprehensive primary health care practised by Aboriginal Community Controlled Health Services. This paper discusses how Apunipima Cape York Health Council worked with three Aboriginal Shire Councils to create more smoke-free places, using local working groups, information sessions and community-based health promotion. The flexibility and the time allocated to the engagement process with councils, community leaders, organisations and community members were important. All three communities acknowledged the benefits of role modelling and working together to improve health, with addressing tobacco smoking seen as 'everyone's business' and 'not just service providers'. Aboriginal Shire Councils can play a critical role, in partnership with Aboriginal Community Controlled Health Services, in creating healthy places that enable healthy choices.

Introduction and Aims Liquor permits were once used throughout Scandinavia and North America for managing alcohol, but largely disappeared in the late 20th century. Today, they are used in some Indigenous communities in Nunavut, Canada and the Northern Territory, Australia. This paper examines the extent to which liquor permits: (i) contribute to reducing alcohol-related harms in Indigenous communities; and (ii) offer a viable mechanism for managing alcohol in Indigenous communities. Design and Methods The study draws on published and unpublished international literature on liquor permit systems in Indigenous communities, and on field visits to northern territory (NT) communities. Results Apart from one anecdotal report, the study found no evidence that liquor permit systems in Nunavut communities have reduced alcohol-related problems. In the NT, they have reduced alcohol-related harms in some communities. However, management of liquor permit systems generates significant administrative demands in communities. Discussion and Conclusions Effectiveness of liquor permit systems is a product of five factors: permits themselves; agencies and procedures for issuing and managing permits; agencies and procedures for supplying liquor; enforcement of permit conditions, and the presence of other agencies—legal and illegal—affecting supply and consumption of liquor. Liquor permits continue to be valued by some Indigenous communities for managing alcohol. This study suggests that they can do so provided: (i) agencies administering permits have adequate support; (ii) controls over non-legal purchasing and consumption of liquor are effective, and (iii) the permit system is viewed in the community as legitimate, equitable and transparent.

Background: Warfarin remains a widely used anticoagulant but application in the remote context is not well documented. This study aimed to assess in more detail whether warfarin is being utilised effectively in Australia’s most isolated and remote areas. Methods: Retrospective cohort analysis of 2013 captured international normalised ratio (INR) results from people engaged in long term warfarin usage within a number of remote Northern Australian communities. Assessment of monitoring, effectiveness of dosing and complication rates was undertaken. Results: A cohort of 167 patients was established. On average, warfarin was utilised within therapeutic range 52% of the time. Monitoring frequency averaged 16 days. Major bleeding and thrombo-embolism occurred at rates of 5.8 and 4.1 per 100 patient years respectively. Conclusions: Therapeutic utilisation of warfarin in this setting is close to accepted rates but has room for improvement. Monitoring was acceptable and complication rates were not disproportionately high. This study indicates that warfarin is being used with reasonable safety and efficacy in remote regions, but further research is needed.

Worldwide health and social outcomes of Indigenous people are poorer than those of non-Indigenous. In Australia, the Indigenous population experience disability at more than twice the rate of the non-Indigenous population, and a quarter live in geographically remote areas. The challenges associated with accessing services and supports in remote communities can impact on a good life for Aboriginal people with disability. Interviews were conducted with Aboriginal people (Anangu) with disability and family carers from remote Central Australian communities and service workers. Thematic data analysis determined factors Anangu viewed as essential to living a good life: connection to their Lands, being with family and engaging in cultural activities. Workers' support for a good life involves ?Proper Way? help and an understanding of Anangu culture. Three culturally relevant strengths-based concepts are important in supporting Anangu with disability to live a good life: being connected to the Lands and family, sharing together and working together.

Background: Despite a national focus on closing the gap between Aboriginal and non-Aboriginal child health outcomes in Australia, there remain significant challenges, including provision of health services in very remote communities. We aimed to identify and map child health services in the very remote Fitzroy Valley, West Kimberley, and document barriers to effective service delivery. Methods: Identification and review of all regional child health services and staffing in 2013. Verification of data by interview with senior managers and staff of key providers in the Western Australian Country Health Service, Kimberley Population Health Unit, Nindilingarri Cultural Health Services and non-government providers. Results: We identified no document providing a comprehensive overview of child health services in the Fitzroy Valley. There were inadequate numbers of health professionals, facilities and accommodation; high staff turnover; and limited capacity and experience of local health professionals. Funding and administrative arrangements were complex and services poorly coordinated and sometimes duplicated. The large geographic area, distances, extreme climate and lack of public and private transport challenge service delivery. The need to attend to acute illness acts to deprioritise crucial primary and preventative health care and capacity for dealing with chronic, complex disorders. Some services lack cultural safety and there is a critical shortage of Aboriginal Health Workers (AHW). Conclusions: Services are fragmented and variable and would benefit from a coordinated approach between government, community-controlled agencies, health and education sectors. A unifying model of care with emphasis on capacity-building in Aboriginal community members and training and support for AHW and other health professionals is required but must be developed in consultation with communities. Innovative diagnostic and care models are needed to address these challenges, which are applicable to many remote Australian settings outside the Fitzroy Valley, as well as other countries globally. Our results will inform future health service planning and strategies to attract and retain health professionals to work in these demanding settings. A prospective audit of child health services is now needed to inform improved planning of child health services with a focus on identifying service gaps and training needs and better coordinating existing services to improve efficiency and potentially also efficacy.

The human T-cell leukaemia virus type 1 (HTLV-1) is associated with pulmonary inflammation. Indigenous Australians in central Australia have a very high prevalence of HTLV-1 infection and we hypothesised that this might contribute to high rates of bronchiectasis in this population.80 Indigenous adults with confirmed bronchiectasis, each matched by age, sex and language to two controls without bronchiectasis, were recruited. Case notes and chest imaging were reviewed, HTLV-1 serology and the number of peripheral blood leukocytes (PBLs) infected with HTLV-1 (pro-viral load (PVL)) were determined, and radiological abnormality scores were calculated. Participants were followed for a mean±sd of 1.14±0.86 years and causes of death were determined.Median (interquartile range) HTLV-1 PVL for cases was 8-fold higher than controls (cases 213.8 (19.7–3776.3) copies per 105 PBLs versus controls 26.6 (0.9–361) copies per 105 PBLs; p=0.002). Radiological abnormality scores were higher for cases with HTLV-1 PVL ≥1000 copies per 105 PBLs and no cause of bronchiectasis other than HTLV-1 infection. Major predictors of bronchiectasis were prior severe lower respiratory tract infection (adjusted OR (aOR) 17.83, 95% CI 4.51–70.49; p&lt;0.001) and an HTLV-1 PVL ≥1000 copies per 105 PBLs (aOR 12.41, 95% CI 3.84–40.15; p&lt;0.001). Bronchiectasis (aOR 4.27, 95% CI 2.04–8.94; p&lt;0.001) and HTLV-1 PVL ≥1000 copies per 105 PBLs (aOR 3.69, 95% CI 1.11–12.27; p=0.033) predicted death.High HTLV-1 PVLs are associated with bronchiectasis and with more extensive radiological abnormalities, which may result from HTLV-1-mediated airway inflammation.Higher numbers of HTLV-1-infected cells in peripheral blood are associated with bronchiectasis and more extensive radiological abnormalities among those with no cause for bronchiectasis other than HTLV-1 infection http://bit.ly/2V6pw98