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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: 
UQ Poche Centre for Indigenous Health
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 we nominate is understanding the Indigenous health gap and how to close it in Australian major urban and inner regional settings. Currently our understanding of the gap assumes that it is distributed evenly and homogenously across the Indigenous population, yet much of our data and evidence is drawn from rural and remote settings. More than half of Indigenous Australians now live in major urban or inner-regional centres, and 60% of the Indigenous health gap is attributed to the non-remote population. The Indigenous populations of major urban and inner regional areas are the fastest growing in the country, partly because of natural population growth and partly because of internal migration. There are major gaps in our understanding of the health needs and health status of these rapidly growing populations, and the interactions between health, education, employment and housing as determinants of urban Indigenous health. Research in areas including basic epidemiology, health services and evaluation research, health promotion and education research, and clinical prevention and treatment research are urgently needed with a specifically urban focus. A TCR would meet our urgent need to better understand the nature, social determinants, and dynamics of the health gap in urban Indigenous populations
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): 
Closing the gap in life expectancy between Indigenous and non-Indigenous Australians within a generation (by 2031) remains a core driving target of Australian health policy (http://closingthegap.dpmc.gov.au/chapter-05/index.html), and this TCR addresses this target directly. The proposed TCR will also speak to three of the four practical challenges in health research laid out in the current Health - Capability Statement (http://www.science.gov.au/scienceGov/ScienceAndResearchPriorities/Pages/Health.aspx). 1. The TCR will allow us to develop better models of health care and services in relation to more than half the Indigenous population that improve outcomes, reduce disparities for disadvantaged and vulnerable groups, increase efficiency and provide greater value for a given expenditure. 2. It will allow us, in the context of a rapidly growing and changing urban Indigenous population to improve prediction, identification, tracking, prevention and management of emerging local and regional health threats. Our current lack of basic data and evidence puts us at a great disadvantage in terms of agile planning for current, let alone future health threats in the urban Indigenous population. 3. Particularly, the proposed TCR will allow us to research to provide for better health outcomes for Indigenous people, with strategies for both urban and regional communities.
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): 
It is well-established that Aboriginal and Torres Strait Islander people living remote areas experience the greatest health disadvantage. Yet non-remote dwelling Indigenous Australians contribute to 60% of the Indigenous health, due simply to their larger numbers. Compared to Indigenous Australians living in remote areas, urban Indigenous people are alarmingly overrepresented in mental health disorders, and constitute the majority of the gap in injuries, chronic respiratory disease, cardiovascular disease, diabetes and cancer, among others. There is also some limited evidence that Aboriginal and Torres Strait Islander people in urban areas experience different health problems from those in remote areas. For instance, Indigenous children in urban areas experience higher rates of asthma, dental decay and mental health issues, while children in remote areas have higher rates of infectious disease. In major cities and other urban areas, Indigenous health is not on the radar of many mainstream services, and these often lack cultural sensitivity and competency. This is compounded by a disproportionately low Indigenous health workforce. A TCR would allow us to begin to understand and address specific health gaps that exist for Aboriginal and Torres Strait Islander people living in major urban and inner regional areas is a systematic and evidence-based way.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
One of the core issues with not knowing how the gap works in urban Indigenous populations is that health policies and health expenditure based on rural and remote models and data cannot ensure that health expenditure by Australian governments is being used most effectively to target the greatest need of the largest and growing groups of Indigenous Australians. There is evidence that despite the investment of successive state, territory and commonwealth governments, the gap is widening in some key areas. For example, cancer mortality rates are rising and the gap between Indigenous and non-Indigenous Australians dying from cancer is widening. Between 2006 and 2013, there was a 10 per cent increase in cancer death rates for Indigenous patients and a 6 per cent decline for non-Indigenous Australians (http://closingthegap.dpmc.gov.au/chapter-05/index.html). Urban-dwelling Aboriginal and Torres Strait Islander people have greater rates of chronic disease and injury, and urbanisation is not lessening the disadvantage they experience relative to the rest of the population. A TCR in the area of the urban gap would give us much better data and models for interventions that work for these populations, and policies that function to most efficiently reduce the health gap across the country.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
Australian Bureau of Statistics. (2011). Demographic, social and economic characteristics overview: Aboriginal and Torres Strait Islander people and where they live. The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, October 2010. (Cat. No. 4704.0). Canberra: ABS. Brand E, Bond C, Shannon C. 2016. Indigenous in the City: Urban Indigenous populations in local and global contexts. UQ Poche Centre for Indigenous Health Monograph 1, Brisbane. https://issuu.com/uqpochecentre/docs/poche-paper1/1 Eades, S. J., Taylor, B., Bailey, S., Williamson, A. B., Craig, J. C., & Redman, R. (2010). The health of urban Aboriginal people: insufficient data to close the gap. MJA, 193(9), 521-524. Scrimgeour, M., & Scrimgeour, D. (2007). Health Care Access for Aboriginal and Torres Strait Islander People Living in Urban Areas, and Related Research Issues: A Review of the Literature. Darwin, Australia: CRCAH. Vos, T., Barker, B., Stanley, L., & Lopez, A.D. (2003). The burden of disease and injury in disease and injury in Aboriginal and Torres Strait Islander peoples: summary report. Brisbane, Australia: School of Population, UQ. Ware, V. (2013). Improving the accessibility of health services in urban and regional settings for Indigenous people. (Closing the Gap Clearinghouse Resource Sheet No. 27). Melbourne, Australia: Australian Institute of Family Studies.

Page reviewed: 30 August, 2018