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Targeted Call for Research - public call for research priorities in Aboriginal and Torres Strait Islander health

This submission reflects the views of
Organisation Name: 
Telethon Kids Institute
Personal Details
Specific Questions
1. What is the research priority (a significant research knowledge gap or unmet need) you are nominating? How would a TCR in this area greatly advance our understanding of this issue? (200 word maximum): 
Intergenerational trauma. Atkinson (2002) defines trauma as "an event or process which overwhelms the individual, family or community and the ability to cope in mind, body, soul and spirit". Intergenerational trauma is "passed down directly from one generation to the next" while transgenerational trauma "is transmitted across a number of generations". Transgenerational trauma is a destructive, persistent legacy of colonisation, dispossession, massacres and the Stolen Generation. While there has been academic interest in post traumatic stress, the issue of complex trauma, and its impacts on health and social and emotional wellbeing, is under-studied. There is a correlation between unresolved childhood trauma and chronic diseases which are endemic in the Indigenous population (Van der Kolk 2006). Its effects include poor mental health, suicide, family and domestic violence, over-representation in the justice and child protection systems, poor school completion rates and high rates of unemployment and welfare dependency. It has been linked to chronic diseases including heart disease, cancer, stroke, diabetes, and liver disease (Van der Kolk 2006). A TCR would provide funding to understand how trauma is transmitted inter-generationally, how it manifests at the individual and community levels, treatments (‘healing’) that are effective and how to forestall its transmission.
2. What are the relevant Australian Government Priorities, and/or Ministerially-agreed State and Territory health research priorities linked to your nominated priority? (200 word maximum): 
Achieving the Commonwealth Government’s Closing the Gap In Indigenous Health Outcomes policy agenda requires researching the epigenetic effects of intergenerational trauma, an area which is under-acknowledged as a research priority and is conspicuously absent from the Australian research agenda. The national Science and Research Priority of Health identifies a need to focus on health services rather than biomedical and clinical sciences in particular the need for: Better models of health care and services that improve outcomes, reduce disparities for disadvantaged and vulnerable groups, increase efficiency and provide greater value for a given expenditure; and Better health outcomes for Indigenous people, with strategies for both urban and regional communities. While mental health was identified as a Strategic Investment Priority by the Federal Government in 2011, the investment did not include any work on intergenerational trauma specifically. The DHS’ Family and Domestic Violence Strategy 2016-19 recognises that Aboriginal and Torres Strait Islander people are more vulnerable to family and domestic violence and that this can “be complicated by other factors such as historical trauma”.
3. How would a TCR in this area contribute to Aboriginal and Torres Strait Islander health and improve health outcomes for the individual and/or community? (200 word maximum): 
Van der Kolk (2006) argues that childhood trauma is probably today’s single most important public health challenge which could be overcome by appropriate prevention and intervention. Child victims of trauma have been shown to have a high risk of parental difficulties and abuse of their own children (Atkinson et al in Dudgeon et al 2014). The transmission occurs through a number of means including poor attachment relationships between children and their primary care-givers, poor parenting, family dysfunctional, parental mental illness, parental physical ill-health, and separation from family, community and culture (Milroy in Zubrick et al 2005). Policy makers, practitioners and communities need to know how to intervene effectively in these areas to prevent the transmission of trauma to the next generation and reduce the secondary effects of trauma currently experienced by children and their parents. Developing an evidence base of interventions that work will have a major impact on the downstream effects of unresolved trauma (Milroy, Dudgeon & Walker in Dudgeon et al 2014).
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
Mental health and substance use disorders are the third most burdensome group of diseases behind cancer and cardiovascular diseases and the leading cause of non-fatal burden, accounting for 24% of all YLD in 2011 (AHIW 2016). The effects of transgenerational trauma on mental health and wellbeing and substance use are not included as risk factors in the report. Chronic diseases linked to unresolved trauma include heart disease, cancer, stroke, diabetes, and liver disease (Van der Kolk 2006). “Two-thirds of the gap in death rates between Aboriginal and Torres Strait Islander and non-Indigenous people is contributed by chronic disease (AHMAC 2012)” (AIHW 2014). The cost of hospitalisations for Indigenous Australians in 2010-11 for cardiovascular disease, neoplasms and Type 2 diabetes was $219.8m. Expenditure on mental and behavioural disorders accounted for a further $191m (AIHW 2013). In the Kimberley there is a clear link between trauma, the development of PTSD and suicidal ideation (Ralph et al 2006). The suicide rates in the Kimberley are among the highest in the world (McHugh et al 2016). Community healing programs result in healing at the individual level (Silove 2005) reducing the need for clinicians who are in chronic short supply in rural and remote Australia.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
Unresolved grief is a major contributing factor to the range of social and health issues experienced by Indigenous Australians (Calma 2007; Atkinson et al in Dudgeon, Milroy & Walker 2014). The WA Aboriginal Child Health Survey (2005) found those forcibly removed had higher rates of substance abuse and mental health problems while their children were twice as likely to have emotional and behavioural problems. Research on holocaust survivors has shown the involvement of epigenetic mechanisms in intergenerational transmission of stress effects in humans with effects on FKBP5 methylation (Yehuda et al 2016). The Adverse Childhood Experiences Study of 17,421 participants found the higher the number of stressors during childhood, the higher the likelihood of poor health in later life (Felitti 2002). A study of 125,000 patients has shown that when doctors acknowledged the trauma openly, their patients’ reduced by 38% the number of doctors’ visits they required (Chadwick et al. 2014). Research is required to understand the mechanisms by which unresolved trauma results in chronic disease and poor mental health and social and emotional wellbeing. There is a need to understand the specific factors that protect against the effects of trauma at the community, family and individual level.

Page reviewed: 30 August, 2018