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Draft Road Map 3: A Strategic Framework for Improving Aboriginal and Torres Strait Islander Health through Research submission

ID: 
15
This submission reflects the views of
Organisation Name: 
Public Health Association of Australia
Personal Details
Specific Questions
Question 1A: Is the proposed objective of Road Map 3 relevant?: 
Agree
Question 1B: Why/why not? Please provide further comments to support your response to Question 1A.: 
PHAA welcomes the opportunity to provide input to the National Health and Medical Research Council (NHMRC) Draft Road Map 3: A Strategic Framework for Improving Aboriginal and Torres Strait Islander Health through Research. The reduction of social and health inequities should be an over-arching goal of national policy and recognised as a key measure of our progress as a society. Aboriginal and Torres Strait Islander people have a 10-year lower life expectancy than non-Indigenous Australians1 and therefore should be a priority target group for culturally appropriate research to improve health and social outcomes. PHAA agrees with the strong community-driven focus outlined in the overall objective, and supports the undertaking of research driven by community rather than external priorities. The objective currently is to “guide NHMRC to improve Aboriginal and Torres Strait Islander health, social and wellbeing outcomes…”. PHAA suggests that cultural outcomes be added to this list rather than being encompassed within the social determinants. Separating out cultural outcomes would better reflect the meaning and importance of culture, which is different to recognised social determinants of health which are the conditions in which people are born, grow, live, work and age.2 The component of ‘research excellence and integrity’ under the overall objective notes the importance of adhering to key NHMRC ethical protocols and guidelines. PHAA suggests that in addition to this, the component should also specifically note the importance of strong representation of and genuine partnership with Aboriginal and Torres Strait Islander researchers, rather than just ‘involvement’.
Question 2A: Are the three priority areas of Road Map 3 accurate?: 
Neutral
Question 2B: Why/why not? Please provide further comments to support your response to Question 2A: 
The 3 priority areas that have been identified in the draft Road Map 3 are supported by PHAA, as being important and complimentary to each other. The 3-year Action Plan timelines will provide a mechanism for developing strategies to achieve these targets. We are pleased to note the increased focus on research into the social and cultural determinants of health, and public health research as compared with more biomedical research, which has dominated NHMRC research programs in the past. Community focused research initiatives are likely to be better supported by this new focus. Crucial to the success of this new approach will be the systems for categories, criteria, applications, assessment and allocations to ensure that the new focus is operationalised. For example, community-led research does not always fit within a framework which measures against academic success. In both research areas 1 and 2, public policy intervention research should be specifically included. In research area 1, PHAA suggests the second last example of specific research topics listed be amended to “public health, public policy and preventative disease programs”. In research area 2, PHAA suggests the second dot point of attributes for the research be amended to “…including health system improvement research, public policy research, implementation research and program evaluation research”. In priority area 3, PHAA suggests in order for the Road Map 3 to really progress these important issues, the focus should be on knowledge translation research and solutions-based research rather than disease description or prevalence studies. PHAA would also like to see issues around workforce and capacity building included in the priority areas, in line with the Lowitija Institute research programs.3 This would include both a workforce of Aboriginal and Torres Strait Islander people in health, and a culturally safe workforce for Aboriginal and Torres Strait Islander people.
Question 3A: Are there any further priority areas to add? Please provide further details: 
The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 has a vision where “the Australian health system is free of racism and inequality and all Aboriginal and Torres Strait Islander people have access to health services that are effective, high quality, appropriate and affordable. Together with strategies to address social inequality and determinants of health, this provides the necessary platform to realise health equity by 2031”.4 To better align the Road Map 3 with this vision, the PHAA recommends the addition of systemic racism in the health system as a priority area, as previously recommended by the Lowitje Institute for targeted research.5
Question 4: Is there anything missing from Road Map 3? Please provide further details: 
The Road Map 3 currently lacks a specific definition of Indigenous-led research. It is recommended that there be a clear definition of Indigenous-led research and examples. This definition would then need to be included in the assessment for NHMRC funded projects. As both the Road Map 3 and the revision of the Values and Ethics – Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research are completed, there should be close alignment between these documents. For example, the principles of respect, responsibility and cultural continuity should be demonstrated by researchers when applying for funding for Aboriginal and Torres Strait Islander health research as part of the assessment criteria.
Question 5: Are there any other comments you would like to make regarding Road Map 3? Please provide details: 
Indigenous-led research The Road Map states that in 2010-16 there were 546 Indigenous health research grants, and 50 NHMRC grants led by Indigenous researchers. This indicates about 9% of grants for Aboriginal and Torres Strait Islander health research were led by Aboriginal and Torres Strait Islander health researchers. With dedicated funding opportunities for Indigenous health researchers through PhD scholarships and early career fellowships, and a critical mass building of Aboriginal and Torres Strait Islander health researchers, this proportion may be expected to be higher. As mentioned above, the focus on community-driven research may not easily fit within the framework measuring against academic success. PHAA recommends that researchers also be scored on their record of engaging with and working with communities, to better reflect the needs of community-driven research. A thorough review of the scoring criteria for grants may assist in highlighting reasons for the current low rates, and the proportion of Aboriginal and Torres Strait Islander led proposals that are funded or not funded, compared with non-Indigenous led research. PHAA supports calls for increased capacity building through Indigenous led research.6 Complementary medicines The holistic nature of alternative and complementary therapies means that they may be closer to traditional Aboriginal and Torres Strait Islander healing methods than more Western medicine, and there may be benefits in combining western and traditional medicine.7 PHAA recommends that NHMRC invest in research into how Aboriginal and Torres Strait Islander people respond to different types of therapies, and the value of those which honour spirit as part of a holistic view. Spirituality The specific recognition of and inclusion of Aboriginal and Torres Strait Islander spirituality and spiritual aspects to health should be highlighted in the Road Map 3. Enhancing spiritual involvement in health can benefit the whole community, learning from Aboriginal and Torres Strait Islander health. Funding allocation The PHAA notes that the allocation of funding under the Medical Research Endowment Account to Aboriginal and Torres Strait Islander health has been set at 5% for a number of years now in Road Maps 1 and 2, and that the current draft Road Map 3 does not alter that allocation. Given the continuing gap in health between Indigenous and non-Indigenous people in Australia, and the contribution that research can make to reducing that gap, PHAA suggests that the allocation be increased. The PHAA also notes that there is a difference between funding being allocated to research on Aboriginal and Torres Strait Islander health, and support for Aboriginal and Torres Strait Islander researchers and research organisations. In order for this translation to occur, appropriate structures and regulations need to be in place. Funding security for the Lowitja Institute is a good example of the translations required.8 The draft Road Map 3 notes that “to qualify as Aboriginal and/or Torres Strait Islander health research, NHMRC Funding Rules state that ‘at least 20% of the research effort and/or capacity building must relate to Aboriginal and/or Torres Strait Islander health’”. While it is helpful to have a criterion for this, the burden of disease and gaps in health mentioned above suggest that it should be set higher than 20%. Conclusion PHAA supports the broad directions of the Road Map 3. However, we are keen to ensure the framework is of greatest benefit to Aboriginal and Torres Strait Islander health, in line with this submission. We are particularly keen that the following points are highlighted:  Indigenous led research must be the priority with Aboriginal and Torres Strait Islander researchers more than just ‘involved’  The addition of systematic racism in the health system would more closely align this Framework with the Aboriginal and Torres Strait Islander Health Plan  The focus on social determinants of health is strongly supported and would be further strengthened by the inclusion of cultural determinants The PHAA appreciates the opportunity to make this submission and the opportunity to contribute to the NHMRC Strategic Framework for Improving Aboriginal and Torres Strait Islander Health Through Research. Please do not hesitate to contact me should you require additional information or have any queries in relation to this submission. References 1.Australian Health Ministers’ Advisory Council. Aboriginal and Torres Strait Islander Health Performance Framework 2017 Report. Canberra: Commonwealth of Australia; 2017. 2.World Health Organization. Social determinants of health: Key concepts http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/2017 [cited 2017 17 October]. 3.The Lowitja Institute. Research http://www.lowitja.org.au/research: The Lowitja Institute; [cited 2017 6 December]. 4.Australian Government. National Aboriginal and Torres Strait Islander Health Plan 2013-2023. Canberra: Commonwealth of Australia; 2013. 5.The Lowitja Institute. Public Call - Research Priorities in Aboriginal and Torres Strait Islander Health. https://www.lowitja.org.au/sites/default/files/docs/NHMRC-Aborignal-Health-Priorities-Sept16.pdf: The Lowitja Institute; 2016. 6.Bond C. Leading Aboriginal researcher raises some critical questions for NHMRC. Croakey https://croakeyorg/leading-aboriginal-researcher-raises-some-critical-questions-for-the-nhmrc/. 21 November 2016. 7.Poche Indigenous Health Network. Traditional Aboriginal Healing and Western Medicine. Key Thinkers Forum: Opinion Paper. file:///C:/Users/policy/Downloads/POCHE_Opinion-Paper_Close-the-Gap-Ten-Year-Anniversary.pdf: Poche Indigenous Health Network; 2016. 8.McInerney M, Finlay SM. Indigenous health leaders call for support for Uluru Statement and a secure future for premier research institute. Croakey https://croakeyorg/indigenous-health-leaders-call-for-support-for-uluru-statement-and-a-secure-future-for-premier-research-institute/. 15 November 2017.

Page reviewed: 31 July, 2018