O c t o b e r 2 0 0 6 V o l u m e 9 , I s s u e 5
The 10th Annual CDN conference emphasised the need to broaden our engagement with other sectors in order to meet the challenges that chronic disease prevention and management present to us throughout the Northern Territory and Australia.
The conference attracted 240 delegates and included numerous workshops where ideas were stimulated and engagement enhanced.
Important aims of the conference include providing practical tools for delegates to take back to their workplaces and to create networking opportunities.
A balmy Darwin evening accompanied this year’s CDN Conference Opening Ceremony at Parliament House hosted by the Minister for Health, Hon Dr Chris Burns. The Minister spoke of the incremental wins we are having with chronic diseases in Aboriginal communities and of the challenges ahead.
Dr Tarun Weeramanthri as MC spoke of the role of the network, Nicole Brown welcomed us to Larrakia Country and Helen Smith (CDN Steering Committee Member) gave a comprehensive overview of the life and times of the CDN.
The first day of the conference began with a warm welcome by our conference MC:
Geoffrey (Jacko) Angeles who enhanced the entire two days of the conference with his fabulous humour and skill. Jacko shared his background and language in his opening, and provided much stimulus for delegates’
engagement and enjoyment.
“Great ambience. Liked June Mills’
entertainment at lunchtime. MC great humour and set the scene.”
Project Officer
T HE C HRONICLE
From left: Minister for Health Hon Dr Chris Burns, CEO Cancer Council NT Helen Smith, DHCS Chief Health Officer Dr Tarun Weeramanthri
Below from left : Dr Tarun Weeramanthri, Geoffrey Angeles, Inge Baumann-May, Christine Nakarnarra Long, Malcolm Jampajimpa Fry, Julie Robinson, Trevor Shilton, Renate Millonig, Dr Leonie Katekar, Dr Fran Boyle, Melissa Roberts
10th Annual Chronic Diseases Network Conference:
Health is everyone’s business - everybody’s choice?
“This was my first CDN conference and I found it incredibly informative, educational and friendly-feeling.” Social Worker
2
Continued from Page 1
The first Keynote speaker was Mick Gooda from the Cooperative Research Centre for Aboriginal Health who stressed the need for Aboriginal participation throughout the research process, and for research results to have practical application. Given the health issues that confront Aboriginal people, he also advised those in health not to be overwhelmed in trying to do everything, but to do what we do well.
“Mick Gooda’s talk was good. What he had to say made a lot of sense. Encouraging to see CRC grounded in community needs. Good to bring people together from a range of disciplines.” CEO non health NGO Trevor Shilton (National Heart Foundation WA) asked us to consider the big issues and urged us to take on the significant inequities and disparities in disease burden that include the social determinants: social gradient, poverty, social exclusion and early childhood experiences. He noted that optimal chronic disease prevention demanded strategic investment and advocacy to create policies to include: education, employment, poverty reduction, food and transport beyond the health silo. (More from Trevor on P. 10)
Dr Fran Boyle, who has a firm grounding in capacity building, spoke about the vital role of non-government organisations in providing psychosocial support, information and education for people managing their chronic conditions.
“The holistic concept of health was promoted very well and the fact that the agencies outside health have an indirect and direct input into health outcomes e.g. housing, power, water, sports and recreation, education etc.” RN Numerous concurrent sessions followed into the afternoon, and included practical workshops to enhance the keynote sessions.
Our healthy lunch (taking note of the Northern Territory Department of Health and Community Services’ Catering Policy) was enhanced by the voice of June Mills. June sang and played guitar while we ate and chatted. June is one of many traditional artists on the ‘Skinnyfish music’ label whose music we promoted at the conference.
“Very good conference just for the networking alone. But the talkers and subjects were very good.” Delegate
THE CHRONICLE
EDITOR: Renate Millonig, Chronic Diseases Network Coordinator DEPARTMENT OF HEALTH & COMMUNITY SERVICES
PO BOX 40596 CASUARINA NT 0811 PHONE: (08) 89228280 FAX: (08) 89227714 E-MAIL: [email protected]
Contributions appearing in The Chronicle do not necessarily reflect the views of the editor or DHCS.
Contributions are consistent with the aims of the Chronic Diseases Network and are intended to :
• Inform and stimulate thought and action;
• encourage discussion and comment;
• promote communication, coordination and collaboration.
CDN Conference 2006 1-4
CRANA awards 4
Outstation research 5, 7
Team Effort 6
Bill Raby Fellowship 7, 11 Nutritionist’s story 8-9
Tiwi Poster 9
Advocacy as asset 10, 11 Smoking and Pregnancy 11 Palmlesstonnes award 12
I N S I D E T H I S I S S U E :
Delegates at a healthy morning tea Mick Gooda, CRCAH Dr Fran Boyle
“Excellent conference – pitched at an appropriate level.” Podiatrist Being healthy spiritually, socially, culturally, emotionally, mentally and physically is often expressed by Aboriginal people as their way of keeping well. Jean Turner and Caroline Harris from ‘Aunty Jean’s Good Health Team’ gave us a taste of looking beyond the disease and beyond the clinic to focus on life, destination and fun. They didn’t need much encouragement to have the entire plenary group on their feet doing the Macarena in honour of one of their elders who came to them in a wheelchair, progressed to a walking frame, stick and is now a carer!
These stories like a healing like a medicine presented by Djapirri Mununggirritj and Shona Russell from the Dulwich Centre brought yet another way of working with the health of Aboriginal communities. Two communities from across Australia shared stories about how they were coping with many suicides, and ended up strengthened and transformed by each other.
Jacko wrapped up the first day and invited us to take a walk to the next conference social event.
Our informal dinner amongst the sounds, smells and sights at Mindil Beach enabled delegates to enjoy the sunset, browse, shop, eat, chat, grab a massage or souvenir at their leisure after a stimulating day at the conference.
Dr Tim Williams commenced the second day of keynotes outlining the latest initiatives from the Commonwealth Department of Health and Ageing expressing their commitment to the National Chronic Disease Strategy and to prevention and management of chronic diseases.
Professor Gary Egger explored the need for a paradigm shift in health care. He compared
‘lifestye medicine’ (the application of behavioural, medical and motivational principles to the management of lifestyle based health problems) with conventional medicine and explained how it is aimed at modifying the behavioural and lifestyle bases of disease, rather than treating the disease clinically. He saw this style of medicine as a form of health promotion concerned with individuals and small groups.
Dr Iain Butterworth gave us an overview of the links between urban planning and health – taking us on a journey through time to witness how hygiene and the building of towns and cities were closely worked together. He used visuals to allow us to experience how we are affected by places and buildings, and what elements encourage us to participate in community life.
The World Health Organisation’s ‘Healthy Cities’
initiative promotes comprehensive and systematic policy and planning with a special emphasis on health inequities and urban poverty, the needs of vulnerable groups, participatory governance and the social economic and environmental determinants of health. Iain then shared his work with the Victorian Government in an initiative called
‘Environments for Health’ that draws on the
‘Healthy Cities’ approach.
Using a story of the ‘fish people’, where whatever happened to the fish - happened to the people, Michael La Flamme illustrated how the health of people and country are linked.
Michael’s work in Central Australia is aimed at bringing together traditional and modern science to help identify the benefits of investing in indigenous livelihoods caring for country that integrate health, wellbeing, education, income and governance.
“Complimented many ideas/thoughts that I have been struggling to showcase with non- indigenous health professionals.”
Aboriginal Health Worker
Continued on Page 4 From left: Shona Russell, Djapirri Mununggirritj. Lynette
O’Dounoghue, Bernadette Shields
From left: Jean Turner, Caroline Harris, Delegates on their feet doing the Macarena
From left: Dr Tim Willaims, Prof Gary Egger
4
CRANA AWARD FOR NORTHERN TERRITORY NURSE 2006
Sandy McElligott was awarded the Council of Remote Area Nurses Award at the CRANA conference this year in Hobart for her outstanding contribution for Remote Area Nursing.
Sandy works as the Remote Women’s Health Educator for the Central Australian Department of Health and Community Services and works tirelessly for the health of women and kids in Central Aus- tralia. Sandy travels out to Remote Health Centres and provides training to Aboriginal Health Workers and Remote Area Nurses and anyone else who happens to be around!
Sandy came to Alice Springs in 1992 and was the Clinical Nurse Consultant in the Ma- ternity Unit of the Alice Spring’s Hospital and created a client/family focussed Unit. This was not an easy task given some entrenched prejudices.
Sandy has produced Shout it Loud a short DVD regarding child abuse which can be seen by anyone. Powerful...as is Sandy.
By Jenny Hains
“One of the best, most relevant conferences I’ve attended. Thank you and well done!”
Remote GP Following this stimulating succession of talks, concurrent presentations and workshops followed until our panel session in the afternoon. Dr Ngiare Brown (Menzies School of Health Research), John Robinson (Aboriginal Medical Services, NT) and Jenny Cleary (DHCS) spoke briefly about downstream, midstream and upstream health factors and Nikki Clelland as chair called for comments, questions and advice.
It is clear from the conference content and delegates’ comments that the health sector needs to engage and partner with many sectors in order to meet the challenges of chronic disease prevalence in the Northern Territory. A holistic approach is culturally appropriate for the Aboriginal community and required for the community at large – given the lifestyle basis of many chronic diseases.
“Have the Treasurer open the next CDN conference.” Presenter
The Chronic Diseases Network aims to
encourage intersectoral activity and will continue to promote communication and engage members to work collaboratively.
Bernadette Shields (Senior Aboriginal Health Worker) who has worked in the field for decades had the final say on the day: “Health is about life and living anyway you find it.”
“Great program, stimulating, well rounded.
Jacko excellent!” Remote GP As CDN Conference Coordinator and on behalf of the CDN Steering Committee, I thank our sponsors: Australian Government Department of Health and Ageing, Northern Territory Government Department of Health and Community Services, Cooperative Research Centre for Aboriginal Health, General Practice and Primary Health Care NT, Top End Division of General Practice, HealthConnect NT, Pfizer and the Good Health Alliance.
Special thanks to the CDN Steering Committee, Conference sub-committee, Dr Christine Connors, the Preventable Chronic Diseases Team and to Gaye Messer and ‘The Best Conference & Events Company’ for their excellent work. by Renate Millonig
From left: Dr Iain Butterworth, Dr Michael La Flamme, Sue Stewart, Final Panel Members, Geoffrey (Jacko) Angeles
‘Outstation’ is not a dirty word: Lower than expected morbidity and mortality rates for an Aboriginal population*
Rowley K,a Brown ADH,c Saraswati K,d Tilmouth R,d Roberts I,c Fitz J,c Wang Z,b McDermott R,e Anderson IP,a Thomas D,c O’Dea K.b
aOnemda VicHealth Koori Health Unit, Centre for Health and Society, School of Population Health, and bDepartment of Medicine (St Vincent’s Hospital), The University of Melbourne VIC;
cMenzies School of Health Research NT;
dUrapuntja Health Service, Utopia NT;
eDivision of Health Sciences, University of South Australia SA.
Aboriginal communities achieving good health outcomes provide models on which to base effec- tive intervention and service delivery design. We have followed trends in chronic conditions in an Aboriginal population in central Australia, using serial cross-sectional survey sampling and cohort studies. From 1988 to 1995, there was no change in the prevalence of diabetes among adults, the prevalence of impaired glucose tolerance fell by over 50% and, on Homeland (outstation) communities remote from a store, there was no change in mean BMI.1
Smoking prevalence fell significantly among men and remained close to zero among women.
These trends were associated with health promotion activities and support for outstation commu- nities by the community-controlled primary health care service. In contrast, during approximately the same period of time, prevalence of diabetes and obesity increased almost 2-fold in another Aboriginal community in central Australia,2 while for Australia generally diabetes and obesity con- tinued to increase.3
Mortality from this period was lower than the average reported for Aboriginal people in the NT.4 Cohort data (unpublished) for the period 1995 to 2004 show that mortality from all-causes and cardiovascular disease remain approximately 40% lower than that reported for Indigenous peo- ples in the NT as a whole.5 The rate of hospitalisation for cardiovascular diseases was also sig- nificantly lower than expected.
Conventional clinical and epidemiological indicators are unlikely to explain the reasons for this success in chronic disease prevention: the associated social, psychosocial, environmental and cultural factors require investigation in order to understand the beneficial effects of outstation liv- ing and to inform interventions for chronic disease prevention and management for Indigenous peoples in other settings. Explaining these phenomena necessitates an understanding of local Indigenous society and worldviews.
Primary Health Care and other services require an appropriate level of resources to continue their support of outstations in order to maintain these health benefits. We also note the importance of recognising trends in Indigenous health (both nationally and locally) in addition to more commonly reported disease prevalence statistics, in order to identify and support positive models of health.
Acknowledgements
This work was largely funded by grants from the NH&MRC. We acknowledge the Elders and members of the Utopia community, and in particular the late Mr Kumantjayi Kunoth. We are grateful for the assistance of Stacey Swenson, Paul Rickards, Hugh Heggie and Sabina Knight, and statistical advice from Allison Hodge, Dallas English and Margaret Kellaher.
References—Page 7
*This research was presented at the CDN Conference as a ‘Good News Story’ on Friday 22 September along with the research of Dr David Thomas and Steve Guthridge.
6
As health professionals we are taught that good interpersonal relationships are fundamental when providing medical care. We are also told that effective communication correlates to im- proved health outcomes. What isn’t taught is how language and cultural barriers can impede communications.
We are not taught what ‘ba bang’, ‘Nga bard babang’, ‘barle’, ‘merlemdulmuk’ or ‘Ka- ngolekwokdi’ means or what they relate to. These words are a part of the Kunwinjku dialects in Western Arnhem Land and relate to health issues that health staff confront every day. To bridge the communication gap, Dr Glynis Johns (Senior GP) encouraged the Aboriginal Benefits Foundation Ltd. to provide funds for a joint project between the Gunbalanya (Oenpelli) Health Clinic and the Injalak Arts Centre.
The Aboriginal Benefits Foundation Ltd. is an organisation that supports projects to enhance the health of aboriginal people. The Foundation became interested in a project that involved the technique of Xray painting (unique to Western Arnhem Land) to characterise the various human systems. Indigenous artists traditionally portray creatures such as fish, kangaroo and turtle using this technique, but rarely the human form.
The first stage of the project started with Dr Glynis Johns and Tony Curran (Chronic Disease Coordinator) meeting with the Aboriginal Health Workers (AHW’s) to discuss the various sys- tems in the body using conventional anatomical diagrams. This was an important aspect of the project, as we needed our AHW’s to assist us in translation of the concept of this program and to act as cultural brokers with the artist. The second stage was the meeting with the art- ist. Books in hand (many books at that) the team waded into a large group of men of all ages and the usual formalities and negotiations started. Six body systems were chosen from the gastro-intestinal, skeletal and circulatory systems.
Because this art form needed to show humans in detail, the artist had to develop a new tech- nique, and that meant the program had to be extended from six to twelve months. The artist rose to the challenge, and produced six fantastic paintings that have now become the prop- erty of the Health Clinic.
From these paintings, posters and flip charts can be produced. These will be labelled in Kun- winjku to help staff assist patients to understand how their body works. The Gunbalanya Clinic is very proud to possess these unique works of art, and the people of Gunbalanya can be very proud of this collaborative working between the Clinic and the Injalak Art Centre.
Our thanks to Gabrial Maralngurra, Wilfred Nawirridj, Gershom Garlngarr, Dr Glynis Johns, Anthony Murphy and the Aboriginal Benefits Foundation Ltd.
Tony Curran Chronic Disease Coordinator
Oenpelli
Team Effort, Breaking the Barriers:
The Ganbalanya Healthy Bodies Project
References—from Page 5
1. Rowley KG, Gault A, McDermott R, Knight S, McLeay T, O’Dea K. Reduced prevalence of im- paired glucose tolerance and no change in prevalence of diabetes despite increasing BMI among Aboriginal people from a group of remote homeland communities. Diabetes Care 2000; 23: 898-904.
2. McDermott R, Rowley KG, Lee AJ, Knight S, O’Dea K. Increase in prevalence of obesity and dia- betes and decrease in plasma cholesterol in a central Australian Aboriginal community. Medical Journal of Australia 2000; 172: 480-484.
3. Dunstan D, Zimmet P, Welborn T, Sicree R, Armstrong T, Atkins R, Cameron A, Shaw J, Chad- ban S on behalf of the AusDiab Steering Committee. Diabesity and associated disorders in Australia 2000. International Diabetes Institute, Melbourne 2001.
4. Burgess CP. A follow-up study of diabetes in a central Australian Aboriginal community. The Uni- versity of Melbourne 1996 (B Med Sci thesis).
5. Li SQ, Guthridge SL. Mortality in the Northern Territory 1981-2000, Part 1: Key indicators and overview. Department of Health and Community Services, 2004.
Bill Raby Diabetes Fellowship
Winners of Bill Raby Diabetes Fellowships for 2005/06 were announced at a Healthy Living NT function in Alice Springs in August.
Fellowship Board of Governors member and Centralian businessman, Des Rogers awarded Fellowships totaling $10,000 to five successful applicants to assist them with their continuing professional development in the field of diabetes. :
• Ms Sharon Johnson, a Public Health Nurse at Anyinginyi Congress in Tennant Creek. Awarded $4,100 to pursue a Graduate Certificate in Diabetes Education at Curtin University
• Ms Inge Baumann-May, Public Health Nurse employed by Central Australian Aboriginal Congress at Yuendemu – awarded $2,700 to pursue a Graduate Certificate in Health: Chronic Disease Self Management at Flinders University
• Ms Trisha Anne Cormack, a Registered Nurse in Alice Springs – awarded $1,700 to pursue a Graduate Certificate in Health: Diabetes Management & Education - Flinders University
• Ms Glynis Dent, a Diabetes Nurse Educator at Alice Springs Hospital – awarded $750 to attend the 2006 Australian Diabetes Educators Annual Conference
• Ms Irma Raven, Public Health Nutritionist with DHCS in Alice Springs – awarded $750 to attend Diabetes Australia -QLD's annual health professional symposium
On behalf of the Board of Governors, Des Rogers said that merit was the primary test in the selection of the Fellows, including the benefit of the CPD activity to the applicant and how the CPD activity will be applied to the benefit of people with diabetes in the NT.
Under the terms of the agreement, each Fellow is required to submit a report on completion of their activity. A summarised report of Irma Raven’s findings is in this edition.
The Bill Raby Diabetes Fellowship was established by the Diabetes Association of the NT Inc. (trading as Healthy Living NT) in 2005 as a means of recognising the significant contribution of Bill Raby OBE to the Association and the well-being of people with diabetes in the NT. Healthy Living NT has undertaken to provide
$10,000 funding per annum to the Fellowship.
The aim of the Fellowship is to provide opportunity, by the provision of financial support, to enable health professionals to further their knowledge and understanding in the field of diabetes and, by doing so, improve the quality and delivery of services to Territorians with diabetes.
Applications for 2006/07 Fellowships have been called and applications close 31 March 2007.
See advertisement on Page 11
8
With the media coverage of remote aboriginal communities of late, it is easy for the Australian public to 'write off' aboriginal communities by attributing blame. I was asked to report on what it is like to work as a public health nutritionist in a remote aboriginal community that has received a lot of negative attention recently.
It is difficult to encapsulate all of the barriers to health facing people who live in communities where access to education, food security and opportunities to change, are limited or inadequate. Nutrition can be difficult to introduce or prioritise where there are large numbers of people experiencing worse poverty than that of a developing country.
Access to healthy foods at affordable prices are limited, with prices for basic grocery items being up to three times that of an urban supermarket. While we have managed to get store managers to subsidise the cost of fruit and vegetables, the price of a pan or pot to cook them in, or foods to cook them with, the price remains enormous.
Additionally, some communities are so isolated that fruit and vegetables can only be delivered weekly or fortnightly. By the time a delivery comes, often fruit and vegetables are sold out, poor in quality or rotten.
Education is a contentious issue for both the education department and the people living in the community. Children from many different cultural backgrounds and speaking any of as many as 56 different dialects are taught in a single school.
Teachers work hard but are faced with massive communication problems and cultural barriers that must be daunting for both them and the children.
Health and nutrition education is hard to get across with school attendance being so low.
In some places overcrowding of housing is the standard, with cases of 20-30 people living in one house. Living standards promote poor hygiene, and many kitchen facilities which are in a state of disrepair, where basic utensils such as cutlery, cutting boards and knives have been long lost due to so many people sharing and using them.
On one occasion recently I drove around for 20 minutes with some local women while we door knocked to find some cups to borrow so that we could go out into the bush for a trip. We ended up using empty tins to drink tea from. It is a constant reminder to me that the things we take for granted in order to prepare healthy foods are inaccessible to so many people.
Unfortunately all these factors lead to a reliance on food from the takeaway shop, which is excruciatingly high in salt, fat or sugar.
The aim of the nutritionist in this part of Australia is to advocate for food security, educate people around health, provide support and advice to people both working and living in the community, and to provoke motivation with reasons to change.
The work is very non-conventional; with 90 per cent about relationship building and forming trust. I was very wrong in thinking that I could arrive in a community and inspire change by simply providing education the way I was taught at university.
People in communities are sick of health workers arriving in droves with flipcharts and telling people about the way they must do things. Western medical and health concepts are foreign and therefore of little significance to them, making them less likely to be taken on board.
It took me a while to let go of my desire to use clinical terms and prescriptive dietary advice, switching simple terms like 'tucker' for food and 'big mobs' for large amounts. As English is a second or third language in the communities I visit I resort to pictures and games to teach basic healthy eating concepts. Times of the day are not separated into breakfast, lunch and dinner as they are for us, and people usually eat as a response to hunger as opposed to a social norm.
The most important component of our work is to support traditional values and learn 'old ways' instead of forcing 'new ways'. I have just returned from a trip that is a perfect example of this, as I take local women out hunting for traditional foods.
We went in 4wd to some very remote locations, over 400km away from Darwin. At times I was getting concerned that we were lost and felt very disoriented, as the directions from the women in the back included "turn left and that big grey tree, turn right at the burned bush". I may not have had any idea where we were, but they always did, their sense of direction being remarkable. We stayed hidden in beautiful vine trees by the Moil River, where we made damper and healthy stew on a campfire.
We collected seeds and looked for sugar ants. After 12 months of working with them, the women gave me a local name: Gihmpy - named after their favorite billabong. As a treat they drew me a map of how to get to a private waterfall and permission from the traditional land owners to go there.
Tales from the Community: a Nutritionist’s Story
As a part of the program I run with the women we do cooking lessons, store tours, store food labeling in local language, as well as education groups with the young mothers, where I show them pictures and the women translate in language. This is often done sitting under a tree on a picnic blanket, and I usually have to pick everyone up myself in order to get them to come along!
Evaluating the usefulness of sessions is difficult when language skill and literacy is so low.
However I value its importance so I have resorted to giving everyone textas and food pictures to make posters of what the session meant to them.
Often the council or store will let us display the posters for everyone to see and for the people
who attended to feel proud that they did so.
The one thing I find fascinating about their way of life is that time passes easily. They are not concerned about the future, from one hour, one day, one week to the next. They live for moment and as such have a relatively stress free existence. It means that people will find it hard to get motivation to change when they cannot see, and that their actions now will impact on their health in the future.
I have started to study my Masters in Public Health Care in an effort to understand how to help people with this. I am still searching for the answers, so stay posted....
By Erica Reeve Public Health Nutritionist, Darwin
This ‘mental health’ poster has been created with the people of the Tiwi.
It is reproduced with permission through Anthea Orloff.
10
Advocacy: an asset not an enemy
Trevor Shilton (National Manager, Physical Activity, National Heart Foundation) pre- sented a keynote address and 90 minute workshop at the CDN conference recently.
Due to many requests for his material, I have gathered information from his work at the conference and information from his article
‘Advocacy for physical activity – from evi- dence to influence’ published in the Interna- tional Journal of Health Promotion and Edu- cation Vol XIII Number 2 2006.
Advocacy is an evolving and underdeveloped ele- ment of public health practice. Since the Ottawa Charter (WHO, 1986), the health promotion movement has embraced a broad view of the role of advocacy. The public health community now see advocacy as social action primarily aimed at effecting changes in legislation, policy and envi- ronments that support healthy living.
Advocacy is defined by the World Health Organi- sation as a combination of individual and social actions designed to gain political commitment, policy support, social acceptance and systems support for a particular health goal or program.
(WHO 1995).
Public health advocacy often involves campaign- ers pitting their skills and arguments against an opponent. But if we take physical activity as an example, we find that there is not an evident en- emy (aside from ‘couch potato’ mentalities, apa- thy or ignorance) there are many assets.
Principal among these is the mounting evidence of the public health benefits. Other assets are the many opportunities for cross-community benefits and partnerships. Physical activity advo- cates can find allies among those that are con- cerned about the environment, fuel consumption and traffic congestion. Therefore, there can be major physical activity gains in advocacy that is directed at sectors outside health (WHO, 1997).
A model for understanding and mobilizing through advocacy can be described in a three step process:
1. Gathering and translating the most pertinent evidence – the ‘why?’
Evidence that is systematically collected, pub- lished and disseminated is crucial for the sound
development of policy and effective interventions and practice. Evidence serves to justify deci- sions, and provides a basis for justifying an advo- cacy platform.
Evidence has different meanings across sectors.
Even within health, evidence has important spe- cific meanings that differ across disciplines. Politi- cians and key decision-makers may want health evidence complimented by information demon- strating the proposed actions are acceptable with their electorate, popular with the media, or will do no harm to their political standing. A community- wide approach may open many doors for the ad- vocate.
2. Developing from the evidence an advo- cacy agenda and articulating a plan of key actions – the ‘what?’
To successfully advocate, we need to move from the evidence to formulate:
a. Consensus about agreed mes- sages that detail the amount and type of activity and the benefits it will deliver
b. An agreed, well-justified and priori- tized set of actions - an agenda for success
Such an agenda should articulate a mix of initia- tives, policy, environmental and educational inter- ventions to be implemented across community settings targeted to reach those at greatest need and consider differences across gender, culture and age-span. (Trevor suggests a ten point plan in his article).
3. Implementing a mix of advocacy strate- gies to influence and mobilize support for the particular agenda – the ‘how/
who?’
Once the evidence has been distilled and a clear agenda articulated, a combination of strategies is required to shift public and professional opinion and mobilise support and resources for a greater focus on the actions of the plan. While political and media advocacy tend to dominate the advo- cacy discourse, a more comprehensive approach is recommended:
• Political advocacy
• Media advocacy
• Professional mobilisation
• Community mobilisation
• Advocacy from within organisations
Continued next page
Smoking and pregnancy
Smoking during pregnancy is associated with poorer birth outcomes. This report is one of a series of initiatives commissioned by the National Advisory Group on Smoking and Pregnancy as part of an overall strategy to re- duce smoking in pregnancy in Australia. It presents data on pregnancy and births according to the mother's smoking status during pregnancy for the period 2001 to 2003, using the National Perinatal Data Collection (NPDC). Data from the NPDC were available for this report from five states and territories: New South Wales, Western Australia, South Australia, the Australian Capital Territory and the Northern Territory, representing 53.5% of women who gave birth in Australia in 2003. Tasmania and Queensland began collecting smoking data in 2005, so data from these jurisdictions will be available for reporting in the future.
AIHW catalogue number PER 33. This publication is available from CanPrint (1300 889 873) for $25.00.
http://www.aihw.gov.au/publications/index.cfm/title/10254 or http://www.npsu.unsw.edu.au/
smoking2006.htm
Applications Invited
The Fellowship recognises the significant contribution of Bill Raby OBE to the Diabetes Association of the NT Inc. and the well-being of people with diabetes in the NT.
The aim of the Fellowship is to provide financial support to enable health professionals to further their knowledge and understanding in the field of diabetes and, in turn, improve services to people with diabetes in the NT.
The Fellowship is administered by an independent Board of Governors.
Fellowship applications are invited from practising health professionals for Continuing Professional Development activities in the field of diabetes.
Applications close 31 March 2007
For further information:
www.healthylivingnt.org.au or contact the CEO,
Healthy Living NT on 89 278 488 or by email at [email protected]
Empowerment through knowledge Empowerment through knowledge Empowerment through knowledge Empowerment through knowledge
Trevor Shilton Continued from P 10
Trevor Shilton as Keynote speaker at CDN conference
Trevor discusses each of the strategies for advo- cacy comprehensively in his article. Each of the ad- vocacy strategies can em- ploy a range of partici- pants. Just as the strat- egy is broad, so too can many players in different roles.
In addition to the above, there is a special place for talented, passionate and articulate individuals who have been characterised as ‘spark plugs’ that play a key role in igniting the passion in others, spark- ing change.
By Renate Millonig
12
Palmerston City Council Named NT Highly Commended Winner
Recognised for best practice in heart health by Heart Foundation and Kellogg
Palmerston City Council scores $500 to further promote, develop and sustain the highly successful Palmlesstonnes healthy lifestyle program. The council has been recognised for its important role in improving the general fitness of the Palmerston Community in a fun and educational manner and in fighting cardiovascular disease. Palmerston Council has been awarded a High Commendation along with $500 as part of the Heart Foundation Kellogg Local Government Awards.
For over 10 years the Heart Foundation Kellogg Local Government Awards program has recognised and raised awareness of local government’s work to encourage healthier life- styles in their communities, and thereby reducing the risk of heart attack and stroke.
Local governments play a pivotal role in introducing structural change, implementing poli- cies and creating supportive environments which allow people to be physically active, re- duce smoking and improve their nutrition.
By Lisa Fox National Heart Foundation NT
From left: Dallas Frakking, Lisa Fox
and Mayor Annette Burke Mid to far right: Justine Glover and Annie Villeseche amongst participants
Goodbye to all Chronic Diseases Network members and Chronicle readers! I want to let you know that I will be moving from the Coordinator position and Darwin, and to wish you all the best in your work in creating health within the chronic diseases context. I hope that you have enjoyed the last 6 editions of The Chronicle and this year’s CDN Conference. It has been a most enjoyable and stimulating job and I have many fabulous people and memories to recall—especially the Prevent- able Chronic Diseases Team with Dr Christine Connors.
Many thanks and kind regards, Renate Millonig On behalf of Chronic Disease Network I would like to thank Renate for the fabulous job she has done as Coordinator over the last 12 months. This position is challenging, requires excellent net- working and communication skills. Renate has more than met the challenge and has brought new ideas and ways of working to the PCD team and CDN. She has introduced creative and artistic ideas into how we do our business. She has expanded our links with organisations outside the health sector, and this was showcased at the recent conference. I would also like to thank Renate for the excellent job she did organising this conference. As you can see from this edition, the feed- back was very positive. We are sorry she is leaving us, and wish her well in her future endeavours.
The position will be advertised soon, and we hope members of the network will be keen to apply for this exciting role. Watch this space.…
Christine Connors
