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

ID: 
47
Personal Details
First Name: 
Michelle
Last Name: 
DiGiacomo
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 gap in life expectancy between Aboriginal and Torres Strait Islander peoples and other Australians is approximately 9.5 years for females and 10.6 years for males (Productivity Commission 2014). Cardiovascular disease (CVD) is the leading cause of death accounting for approximately 24% of deaths (AIHW 2015) with Aboriginal and Torres Strait Islander peoples 1.5 times more likely to die of CVD than other Australians (AIHW 2015). Aboriginal and Torres Strait Islander people die from CVD younger, with reports that over a third of deaths (39%) are among adults aged 45 to 64 years old (AIHW 2015). These adverse outcomes arise from a complex interplay of a range of biomedical, social and psychological factors. Comprehensive approaches are required to address this inequality. Modification of cardiovascular risk factors is critical. As reported in Better Cardiac Care measures for Aboriginal and Torres Strait Islander people (AIHW 2015), Aboriginal and Torres Strait Islander people have lower rates of access to proven therapies and services for CVD. Reasons for this are multifactorial. To facilitate access of Aboriginal people to such services and treatments, any prevention intervention should adhere to Indigenous people’s concept of holistic health which encompasses social, emotional, and cultural well-being of the entire community rather than just the physical well-being of an individual (Swan and Raphael, 1995).
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): 
A priority identified by the Australian Government in the 2009 Close the Gap report is to close the gap in life expectancy for Aboriginal and Torres Strait Islander peoples within a generation (COAG 2009). Addressing the high prevalence of CVD should be a primary goal in meeting this target. The Australian Government’s National Aboriginal and Torres Strait Islander Health Plan 2013-2023 also calls for closing the gap in life expectancy as a priority and highlights the need for a strong focus on chronic diseases to achieve this priority. A key strategy in the plan to achieve closing the gap is for “targeted activity to address key risk factors” (ADHA 2013). Principle 1 in the Australian Government’s National Chronic Disease Strategy calls for the adoption of a population health approach and reduction of health inequalities, acknowledging the unique challenges confronted by Aboriginal and Torres Strait Islander peoples as a population who are disproportionally affected by chronic diseases such as CVD. A key direction included in the strategy is to develop and implement appropriate prevention interventions that are responsive to the needs of population groups with the greatest need such as Aboriginal and Torres Strait Islander peoples (NHPAC 2006).
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): 
A TCR in primary and secondary prevention of CVD will stimulate design and delivery of sustainable, culturally appropriate programs to facilitate access to needed services, supports, and treatments, and reduce and manage risk factors in CVD. Although the problems and discrepancies have been documented, solutions have been less prominent. There remains an urgent need to address the problem of CVD in Australian Aboriginal and Torres Strait Islander peoples.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
Aboriginal and Torres Strait Islander people have lower rates of access to proven therapies and services for CVD (Gausia et al. 2014). Early detection and management of CVD risk factors have potential to reduce the incidence of cardiac disease and to lessen its severity. Active follow-up and management comprising regular monitoring, support with behavior change, and facilitating access to essential medicines are essential to reducing the burden of disease. Aboriginal and Torres Strait Islander people’s access to diagnostic services is currently variable across Australia. There are differences in procedures rates not explained by mere geographic disparity (Randall et al. 2013). Improvements in access to treatments will result in reduced mortality and expenditure in the short and long-term. Secondary prevention is important in reducing the recurrence of events or complications in people with CVD. These interventions have been shown to reduce hospital readmission and mortality rates (NHF 2006; WHO 1995).
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
Among others listed previously, the 2015 first national report into Better Cardiac Care Measures for Aboriginal and Torres Strait Islander People highlights priority areas which include: early cardiovascular risk assessment and management; timely diagnosis of heart disease and heart failure; guideline-based therapy for acute coronary syndrome; optimisation of health status and ongoing preventive care; strengthen the diagnosis, notification and follow-up of rheumatic heart disease.

Page reviewed: 30 August, 2018