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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: 
The University of Sydney
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): 
The research priority is to increase physical activity (PA) among Aboriginal and Torres Strait Islander populations as a means of reducing the incidence of avoidable non-communicative disease. Shilton and Brown’s review of PA among Aboriginal and Torres Strait Islander people and communities describes what the authors call the epidemiological rationale for a focus on PA. They stressed that despite the powerful evidence relating to the efficacy of PA in reducing chronic disease risk, improving physical and mental health, and improving social factors, there has been a lack of research with respect to optimising the strategic approach to increasing and sustaining PA in specific communities, in particular, Indigenous and Torres Strait Island communities. Shilton and Brown identified an urgent need for: 1) research into the effectiveness of innovative strategies for increasing PA among Indigenous people; 2) implementation of effective strategies into interventions; and 3) prioritising research in this area and to incorporate it into the scientific literature (Shilton & Brown, 2004). TCR funds in this area will greatly advance our understanding of how ‘Exercise as Medicine’ can benefit the Indigenous community. The research will focus on interaction with the Indigenous communities to establish strategic approaches leading to increased and sustainable PA.
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 TCR addresses the Australian Government Strategic Priority of ‘Promoting Population Health and Wellbeing’. Within that general priority this project directly addresses the National Health Priority Areas of cardiovascular health, diabetes mellitus, and obesity. Because of the known links to activity and circulatory health, the TCR also influences the incidence of dementia and mental health. Given the known benefits of PA for maintaining musculoskeletal function and balance a secondary influence on injury prevention and control is expected. The additional health risks of Indigenous populations impose high social and financial costs on Australian society. Consequently, the House of Representatives Standing Committee on Aboriginal and Torres Strait Islander Affairs Contribution of Sport to Indigenous Wellbeing and Mentoring Report focussed on two issues –increasing Indigenous participation in sport; and utilising sport to improve Indigenous wellbeing and ‘close the gap’. The report states that sport can be the ‘hook’ or ‘vehicle’ to encourage Indigenous participation in education and employment and to demonstrate positive behaviours through sporting role models. In this TCR we employ the recommendations of this report and other literature to endure any intervention will have a strong beneficial effect on the health status of Indigenous populations.
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): 
TCR funds will be used to develop and test Exercise as Medicine strategies from an Indigenous standpoint. Incorporating an Indigenous view of PA in program design will ensure it provides a culturally safe environment by addressing cultural sensitivity, cultural awareness and cultural safety. Fu, Cobley, and Sanders have suggested that activities should be conducted within a task-based psycho-social climate. This climate fosters enjoyment, self-efficacy and self-motivation and therefore may lead to increased levels of PA and participation in peer group games and sports. This general approach can be applied in the context of PA among Indigenous and Torres Strait Islander populations with consideration of the specific needs of the community and the specific cultural context. This involves recognition of power balances and historical, political, social and economic structures to ensure that the PA framework is culturally appropriate. Future implementation of the strategies will then be successful in improving the quality of life while reducing the incidence and prevalence of avoidable non-communicable diseases and mortality within the Indigenous community. Reference: Fu, A., Cobley, S., Sanders, R. Motor coordination training and pedagogical approach for combating childhood obesity. Journal of Physical Activity and Health. Under review.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
Colonisation has had a profoundly negative impact on well-being of Indigenous communities. The transition from a hunter-gatherer society, in which excellent cardiorespiratory fitness meant survival, to a society in which daily PA requirements are low, has led to an obesity pandemic and high incidence of non-communicable metabolic diseases. Australia has one of the best health care services in the world, yet the Australian Indigenous communities experience a level of physical health similar to third world nations. There is an urgent need to ensure that PA intervention programs are tailored to each individual community to ‘close the gap’ in health and well-being of non-Indigenous Australians. Chronic disease accounts for around three quarters of the gap in mortality rates between Indigenous and non-Indigenous Australians and increased PA levels serves to reduce this difference. To recognise the need for PA intervention programs the members of these communities need to understand the relationship between body composition, vascular function, muscular strength, aerobic fitness and metabolic syndrome. Thus, interaction with Indigenous Australian communities and their partnership in designing the intervention programs are crucial to achieving the attitudinal and behavioural changes necessary for sustained success of the PA program to derive the intended long-term benefits.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
There are a number of reports that support the need for increased PA among Indigenous populations to reduce the incidence and prevalence of non-communicable diseases. These include: Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS) 2012-13: It comprises two survey samples, one in the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), and the other in the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (NATSINPAS). Health and Welfare of Australia’s Aboriginal and Torres Strait Islander People Sport – More Than Just A Game: Contribution of Sport to Indigenous Wellbeing and Mentoring. House of Representatives Standing Committee on Aboriginal and Torres Strait Islander Affairs. Journal articles include: Hunt, J., Marshall, A. L., & Jenkins, D. (2008). Exploring the meaning of, the barriers to and potential strategies for promoting physical activity among urban Indigenous Australians. Health Promotion Journal of Australia, 19(2), 102-108. Rowley, K. G., Daniel, M., Skinner, K., Skinner, M., White, G. A., & O'Dea, K. (2000). Effectiveness of a community-directed 'healthy lifestyle' program in a remote Australian aboriginal community. Australian and New Zealand Journal of Public Health, 24(2), 136-144. Shilton, T. R., & Brown, W. J. (2004). Physical activity among Aboriginal and Torres Strait Islander people and communities. Journal of Science and Medicine in Sport, 7(1 Suppl), 39-42.

Page reviewed: 30 August, 2018