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

ID: 
24
This submission reflects the views of
Organisation Name: 
Uni's: CQU, Sydney, Southern Cross, CDU, ANU; Yarrabah Counc
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): 
This submission nominates Prevention of Gambling-Related Harm Amongst Aboriginal and Torres Strait Islander People as a research priority in Indigenous health. Problem and at-risk gambling amongst Indigenous Australian adults is 10-20 times higher than the general population. Surveys have found that up to 50% of Indigenous Australians are harmed by their gambling, including 8.7%-19.5% experiencing severe harms as problem gamblers, 5.4%-16.6% at moderate risk and 12.5%-15.9% at low risk but still experiencing some harms.[1] This compares to Australian adult figures of 0.6% problem gamblers, 3.7% moderate risk gamblers and 7.7% low risk gamblers.[2] Accordingly, problematic gambling contributes to the disproportionately high level of harm experienced by Indigenous communities, at a magnitude similar to the harms from alcohol misuse. However, no rigorous research exists into effective and culturally appropriate strategies to prevent or reduce the widespread harmful impacts of gambling on the health, and the social and emotional wellbeing of Indigenous gamblers, their families and communities. This is despite calls from Indigenous Australian leaders for resources – and the importance of measures appropriate to Indigenous socio-economic disadvantage, diverse geographic settings and a holistic view of health as ‘not just the physical well-being of an individual but … the social, emotional and cultural well-being of the whole Community’. [3] A TCR would catalyse high quality research conducted with Indigenous Australian peoples that: informs and develops efficacious community education on safer gambling; identifies risk and protective factors to reduce gambling problems; trials financial literacy and other programs as gambling harm reduction measures; identifies policies and resources to mitigate gambling harm; encourages leadership and advocacy on the issue; builds community capacity through sustainable practices; and promotes social norms aligned with safe gambling. Research to inform culturally sensitive gambling help is urgently needed, including treatment programs and self-help tools.[4] A deeper understanding of the broader social, cultural and environmental contexts intrinsically associated with gambling harm is needed to inform appropriate preventative measures.
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): 
This nominated research area aligns with the Australian Government’s National Research Priority (NRP) in Health to ‘Build healthy and resilient communities throughout Australia by developing treatments, solutions and preventative strategies to improve physical and mental well-being and improve the efficiency and effectiveness of Australia’s health care system’.[5] A TCR in the nominated area aligns with all four Practical Challenges (PC) in this NRP. Research into reducing gambling-related harm through improved models of health care and services, health promotion strategies and preventative measures will help to address PC1 by reducing health disparities for Indigenous Australian populations. PC2 for the ‘prevention and management of emerging local and regional health threats’ will be advanced through preventative strategies for gambling harm developed collaboratively with Indigenous peoples appropriate to their urban, regional and remote locations. The nominated research area directly addresses PC3 for ‘better health outcomes for Indigenous peoples’. It will assist PC4 where ‘effective technologies for individuals to manage their own health care’ can be advanced, e.g. through online gambling therapies and support. COAG’s 2008 National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes demonstrates prioritisation of Indigenous health by the States and Territories. This commits all Australian governments to improve the lives of Indigenous Australians and provide a better future for Indigenous children. One objective is preventive health, including for mental health. Research informing preventive strategies for gambling addiction amongst Indigenous people will reduce the incidence and prevalence of gambling disorder, facilitate a healthier transition to adulthood amongst Indigenous children, improve social and emotional wellbeing, reduce negative and anti-social behaviour, and improve social determinants of health – consistent with the Partnership’s objectives.
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): 
Gambling causes substantial detriments to health, and the social and emotional well-being of Indigenous people and communities. About 80% of Indigenous Australian adults gamble and up to two-thirds of these gamblers experience harm from their gambling, with 10%-20% having a serious gambling disorder – which is a behavioural addiction leading to clinically significant impairment or distress.[6] Amongst Indigenous Australian people, gambling disorder has been found to lead to poor physical health, suicide, and comorbid mental disorders.[7] It diminishes social and emotional well being, elevating divorce rates, household arguments, domestic violence, estrangement from children and poor school attendance.[8] It increases poverty, bankruptcy and financial dependence; with humbugging a frequently accommodated kinship practice that spreads harm throughout communities.[9] These financial impacts are exacerbated because contemporary card games no longer retain money within communities, but money instead leaks out through externally organised high-stakes card rings and commercial gambling conducted in venues and online (e.g. poker machines, casino gambling, wagering).[10] Gambling problems in Indigenous Australian households are related to poor child health outcomes and intergenerational harms, with children participating in and organising gambling games for money, being routinely exposed to adult gambling and associated social norms, and negatively affected by adult gambling problems.[11] A TCR to prevent and reduce gambling harm would improve Indigenous health and wellbeing across all of the above domains.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
The World Health Organisation (WHO) extends the notion of health to include states of positive wellbeing. Health is 'a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity'.[12] Gambling problems have been definitively associated with poor physical health outcomes, psychological and emotional harm (e.g. stress, depression), anti-social behaviour (e.g. domestic violence), as well as financial insecurity and deprivation. It is well established that Indigenous populations suffer a disproportionately higher burden of disease (BoD) across all these dimensions. Prevalence of problem gambling (PG) is much higher among Indigenous Australians than the general population. Recent population-representative surveys indicated that rates of PG were 10 times higher amongst Indigenous Australian people, whilst a much larger, but non-representative survey suggested that their PG rates were over 20 times higher than the general Australian population.[13] Using the BoD framework, and employing orthodox elicitation methods, Browne et al. determined disability weights for each category of problematic gambling in the Australian general population.[14] Applying this methodology to Indigenous Australian gambling figures, gambling problems may contribute to between 52,210 and 104,000 years of healthy life lost (YLL) annually in Indigenous Australian populations.[15] This scale of impact is similar to the total impact of gambling problems across the entire state of Victoria (101,675 YLD), and of a similar magnitude to the harm caused by alcohol misuse.[16] Thus, due to the concentration of negative health impacts among Indigenous Australians, any reduction in the health burden borne by this group provides significant scope to improve health outcomes at the national population level, reduce the BoD on the health system and lower associated costs to the Australian economy.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
Indigenous Australian leaders and community members have called for measures to alleviate the structural disadvantage underpinning excessive gambling (e.g. poverty, boredom, powerlessness), as well as more direct measures including awareness campaigns, culturally appropriate help services and resources, diversionary programs, government support for change and greater regulation.[17] A recent review of research into Indigenous Australian gambling advanced several considerations for preventative measures.[18] Measures targeting Indigenous Australian people from all demographic groups are needed to raise awareness of the risks and likelihood of experiencing harms from gambling, and how to recognise gambling problems in self and others. Given strong kinship bonds, community education should emphasise the harmful effects of gambling on gamblers, families and communities, its life course impacts on children, and the importance of preventing early gambling exposure and underage gambling. Culturally appropriate help services and community development programs are urgently needed and self-help resources should be developed collaboratively with Indigenous groups. With reliance on informal help, guidance on how best to help significant others with gambling problems is needed. The importance of initiatives to reduce gambling-related harm amongst Indigenous Australians cannot be overstated. However, no research has rigorously examined efficacious preventative strategies. It is clear that these strategies need to be developed in consultation with Indigenous communities in urban, regional and remote locations and based on rigorous targeted research. The NHMRC could play a major role in ameliorating this serious health issue through a TCR in this area. Doing so would also improve the social determinants of health for Indigenous populations which will contribute to reducing other disease burden in the medium to long term – thus reducing overall BoD and assisting with closing the gap. SIGNATORIES: Professor Nerilee Hing, Experimental Gambling Research Laboratory, CQUniversity. E: n.hing@cqu.edu.au; Mr Ross Andrews, Mayor, Yarrabah Shire Council. E: randrews@yarrabah.qld.gov.au; Professor Matthew Rockloff, Experimental Gambling Research Laboratory, CQUniversity. E: m.rockloff@cqu.edu.au; Dr Alex Russell, Experimental Gambling Research Laboratory, CQUniversity. E: a.m.russell@cqu.edu.au; Dr Matthew Browne, Experimental Gambling Research Laboratory, CQUniversity. E: m.browne@cqu.edu.au; Erika Langham, School of Human, Health and Social Sciences, CQUniversity. E: e.langham@cqu.edu.au; Dr Helen Breen, Adjunct Senior Lecturer, Centre for Gambling Education and Research, Southern Cross University. E: helen.breen@scu.edu.au; Associate Professor Martin Young, Centre for Gambling Education and Research, Southern Cross University. E: martin.young@scu.edu.au; Dr Matthew Stevens, Menzies School of Health Research, Charles Darwin University. E: matthew.stevens@menzies.edu.au; Dr Marisa Fogarty, Centre for Aboriginal Economic Policy Research, Australian National University. E: marisa.fogarty@anu.edu.au; Professor Alex Blaszczynski, School of Psychology (M02), The University of Sydney. E: alex.blaszczynski@sydney.edu.au; Dr. Sally Gainsbury, Senior Lecturer, Centre for Gambling Education & Research, Southern Cross University. Email: sally.gainsbury@scu.edu.au; Dr Anna Thomas, Manager, Australian Gambling Research Centre, Australian Institute of Family Studies. E: anna.thomas@aifs.gov.au. REFERENCES: [1] Hing, N., Breen, H., Gordon, A., & Russell, A. (2014). Risk factors for problem gambling among Indigenous Australians: An empirical study Journal of Gambling Studies, 30(2), 387-402; Hare, S. (2015) A study of gambling and health in Victoria, Australia. Melbourne: Victorian Responsible Gambling Foundation and Victorian Department of Justice and Regulation. [2] Gainsbury, S. M., Russell, A., Hing, N., Wood, R., Lubman, D. I., & Blaszczynski, A. (2014). The prevalence and determinants of problem gambling in Australia: Assessing the impact of interactive gambling and new technologies. Psychology of Addictive Behaviors. 28(3):769-79. [3] Aboriginal Health & Medical Research Council of NSW (AH&MRC). (2007). Pressing problems: Gambling issues and responses for NSW Aboriginal communities. Sydney: Author; Christie, M., & Greatorex, J. (2009). Workshop report, regulated gambling and problem gambling among Aborigines from remote Northern Territory communities: A Yolgnu Case Study. Retrieved from: https://business.nt.gov.au/publications/gambling-research/workshop-report-regulated-gambling-and-problem-gambling-among-aborigines; National Aboriginal Community Controlled Health Organisation (NACCHO). Definition of Aboriginal Health. Retrieved from: http://www.naccho.org.au/about/aboriginal-health/definitions/ [4] Aboriginal Health & Medical Research Council of NSW (AH&MRC). (2007). Pressing problems: Gambling issues and responses for NSW Aboriginal communities. Sydney: Author. [5] Australian Government (2016). Health – Capability statement. Retrieved from: http://www.science.gov.au/scienceGov/ScienceAndResearchPriorities/Pages/Health.aspx [6] Hing, N., Breen, H., Gordon, A. & Russell, A. (2014). The gambling behavior of Indigenous Australians. Journal of Gambling Studies, 30(2), 389-396; American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders 5th edition. APA. [7] Aboriginal Health & Medical Research Council of NSW (AH&MRC). (2007). Pressing problems: Gambling issues and responses for NSW Aboriginal communities. Sydney: Author. [8] Hing, N., Breen, H., Gordon, A., & Russell, A. (2014). Gambling harms and gambling help-seeking amongst Indigenous Australians. Journal of Gambling Studies, 30(3), 737-755. [9] Ibid. [10] Marum, J., & Stevens, M. (2006). Indigenous Gambling Scoping Study–A Summary. Retrieved from: http://trove.nla.gov.au/work/38804866?q&versionId=51528500 [11] Stevens, M., & Bailie, R. (2012). Gambling, housing conditions, community contexts and child health in remote indigenous communities in the Northern Territory, Australia. BMC Public Health, 12(1), 1; Hing, N., Breen, H., Gordon, A., & Russell, A. (2014). Risk factors for problem gambling among Indigenous Australians: An empirical study Journal of Gambling Studies, 30(2), 387-402. [12] World Health Organization (1948). WHO definition of health. Retrieved from: http://www.who.int/about/definition/en/print.html [13] Hare, S. (2015) A study of gambling and health in Victoria, Australia. Melbourne: Victorian Responsible Gambling Foundation and Victorian Department of Justice and Regulation; Hing, N., Breen, H., Gordon, A., & Russell, A. (2014). Risk factors for problem gambling among Indigenous Australians: An empirical study Journal of Gambling Studies, 30(2), 387-402. [14] Browne, M., Langham, E., Rawat, V., Greer, N., Li, E., Rose, J., ... & Bryden, G. (2016). Assessing gambling-related harm in Victoria: A public health perspective. Melbourne: Victorian Responsible Gambling Foundation. [15] Ibid. [16] Ibid. [17] Christie, M., & Greatorex, J. (2009). Workshop report, regulated gambling and problem gambling among Aborigines from remote Northern Territory communities: A Yolgnu Case Study; Nagel, T., Hinton, R., Thompson, V., & Spencer, N. (2011). Yarning about gambling in indigenous communities: An Aboriginal and Islander mental health initiative. Australian Journal of Social Issues, 46(4), 371; Hing, N., Breen, H., Gordon, A., & Russell, A. (2014). Gambling harms and gambling help-seeking amongst Indigenous Australians. Journal of Gambling Studies, 30(3), 737-755. Breen, H., Hing, N., Gordon, A., & Buultjens, J. (2012). Meanings of Aboriginal gambling across New South Wales. International Gambling Studies, 12(2), pp. 243-256. [18] Hing, N., & Breen, H. (2015). Indigenous Australians and gambling. Invited Discussion Paper for the Australian Institute for Family Studies. https://aifs.gov.au/agrc/sites/default/files/publication-documents/agrc-dp2-indigenous-gambling.pdf

Page reviewed: 30 August, 2018