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

2. Poche Centres for Indigenous Health Welcome to country

3. Poche Centres for Indigenous Health Overview of the Key Thinkers’ Forum: format, topic and issues

4. Poche Centres for Indigenous Health Filming Briefing paper “Q and A” meets “Insight” Everyone participates Cameo speakers Poche Opinion

5. Poche Centres for Indigenous Health Steve Gutheridge The data

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

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18.2% current smokers NT Non-Indigenous population, 23.6% NT Indigenous population, 50.3% current smokers AHS 2011/12 (unpublished data) and AATSIHS 2012/13 (customised report).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

8. Poche Centres for Indigenous Health Alcohol consumption in pregnancy, 2003 to 2011 NT Midwives Collection, 2003 to 2011

9. Poche Centres for Indigenous Health Deirdre Logie Policy and legislation

10. Poche Centres for Indigenous Health National Drug Strategy 2010 – 2015 To minimise the harms of drug use using the 3 pillars approach – Intergovernmental Committee on Drugs – Collaboration of health, law enforcement with non-government – Supported by sub-strategies eg National Tobacco Strategy Demand ReductionSupply ReductionHarm Reduction Prevent / delay uptake Reduce illegal supply Community safety Reduce use Control legal supply Reduce harm to family Support recovery Reduce harm to individual Promote resilience

11. Poche Centres for Indigenous Health Legislation operates at national and jurisdictional level IssueCommonwealthJurisdiction AlcoholStronger Futures Liquor Act Police Administration Alcohol Court TobaccoAdvertising Plain Packaging Taxation Tobacco Control Act Drugs (Illicit)Narcotic Drugs Customs Sports Anti-Doping Misuse of Drugs Police Administration Diversions MedicinesTherapeutic Goods Pharmaceutical Benefits Medicines, Poisons Consumer Affairs Volatile SubstancesLow Aromatic Fuel VSA Prevention AOD Treatment Health Services Public Health Mandatory Treatment

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

13. Poche Centres for Indigenous Health Christine Connors Population strategies

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

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

16. Poche Centres for Indigenous Health Ganja major concern – Suicidal behaviour – Frequent smoking Aerosol inhalants constant vigilance – VSA plans with community Prescription abuse: codeine, pseudoephidrine Other drugs Drugs

17. Poche Centres for Indigenous Health Pat Dudgeon Social and emotional well being

18. Poche Centres for Indigenous Health THE NATIONAL EMPOWERMENT PROJECT PHASES 18

19. Poche Centres for Indigenous Health Table 1: What people say are issues confronting individuals ThemesRanking Health/Mental Health1 Employment2 Drug and Alcohol3 Family4 Children/Young People5 Violence6 Personal Issues7 Housing8 Racism/Discrimination9

20. Poche Centres for Indigenous Health

21. Tamara Mackean Workforce

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

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

25. Poche Centres for Indigenous Health Elizabeth Elliott Community led programs

26. Poche Centres for Indigenous Health 26 Fitzroy Valley: “A community in crisis.” 2007 Alcohol restrictions. 2008

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

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

29. Poche Centres for Indigenous Health Thank you Next steps Poche Opinion Paper Close

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