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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: 
Rural Clinical School of WA, University of WA
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): 
A central priority for Aboriginal health is for Aboriginal families to be supported to maximize the chances of Aboriginal children developing to their potential. In particular children at risk of delay or with minor delay evident need to be identified and be supported very early in life. A targeted call for research to develop and test appropriate primary care/community interventions to improve Aboriginal child development/neurodevelopment is required to fast track this Aboriginal health priority. Current research into Aboriginal child development identifies ‘gaps’, painting a story of deficits, rather than focusing on strengths of Aboriginal people and identifying solutions. Research needs to focus on the strengths of Aboriginal families and find solutions to work with families to improve child development. Research in this area could: • Improve understanding of the barriers and enablers of plausible community based interventions to improve Aboriginal children’s neurodevelopment • Develop strategies to identify Aboriginal children vulnerable to developmental delay or with early developmental delay in infancy (ideally first 6 – 9 months) • Develop and test interventions to improve child development for Aboriginal infants and younger children that can be incorporated into community based services including primary care services for infants and children
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): 
National Aboriginal and Torres Strait Islander Health Plan: “Aboriginal and Torres Strait Islander Children are in good health and meet key developmental milestones, laying the foundation for strong and healthy lives” Close the Gap Strategy: Improving early child development has been identified as an important strategy to end the intergenerational cycle of disadvantage. CTG targets: • 95 per cent of all Indigenous four-year-olds enrolled in early childhood education (by 2025) • Halve the gap for Indigenous children in reading, writing and numeracy achievements within a decade (by 2018) • 2016 CTG Prime Minister’s Report recognises that to achieve these targets, we need to address early childhood (0-5) education and use initiatives that empower parents to be first teachers Better Start to Life Approach • Response to government’s commitment to overcoming Indigenous disadvantage, especially in the first 5 years of life • Recognises focus on early years (including child development) is necessary to provide children with a positive foundation to life • Up to 85% of children in some areas are developmentally vulnerable (<10th centile) in one or more developmental domains with a high need for effective child development services
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): 
The value of early childhood interventions is evidenced based however significant early childhood developmental disparities between Aboriginal and non-Aboriginal children remain. Early childhood is the critical period in which policies and interventions can shape lifelong health and wellbeing trajectories for Aboriginal and Torres Strait Islander people. Early intervention programs can mitigate the effects of social disadvantage with data from early enrichment programs demonstrating positive effects on school achievement, job performance, social behaviours and cognitive and non-cognitive skills which persist well beyond the duration of the intervention. It is not sufficient to apply interventions that work in very different cultural, social and geographic settings to address this issue. Aboriginal families will play an important role in the design of interventions, acknowledging the emerging evidence that growing up in a community with strong attachment to local culture correlates positively with wellbeing. Research is needed to ensure such interventions are culturally appropriate, acceptable, feasible, efficient, effective and build upon local strengths and resources. Research from this TCR should: adapt existing evidence, develop new evidence and translate this evidence into practice in the diverse circumstances of Aboriginal and Torres Strait Islander peoples across the country.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
Substantial evidence, including that seen in James Heckman’s Nobel Prize winning research, has led economists to assert that investment in early childhood is ‘the most powerful investment a country can make’ through increasing productivity, preventing chronic disease (thus decreasing health expenditure) and reducing need for remedial interventions (police/ custody for crime, adult literacy and public job training etc). According to Heckman: Rate of return for investments in early childhood development for disadvantaged children is 7-10% per annum, through better outcomes in education, health, sociability, economic productivity and reduced crime. Developmental discrepancies increase with age (children learn by building upon existing skills) and the later the intervention, the more costly to close the gap. Despite the current evidence limited progress is being made for Aboriginal and Torres Strait Isalnder people, particularly in very early childhood where the greatest benefit is likely. To make these investments as efficient and effective as possible it is important that more practical implementation and translational research is undertaken across diverse settings.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
There have been extensive reports on the value and necessity of early childhood interventions to make major changes across generations, yet these have not happened consistently and interventions applied from elsewhere have, where implemented for Aboriginal children, not been upscaled or translated sufficiently. This is a central issue in comprehensively ‘Closing the Gap’. A sample of reports include: • Bowes J, Grace R. Review of early childhood parenting, education and health intervention programs for Indigenous children and families in Australia. Canberra: Australian Institute of Health and Welfare, 2014 • Commonwealth of Australia. A Better Start to Life for Indigenous Children. 19 June 2014. • Heckman JJ. The Case for Investing in Disadvantaged Young Children. Big Ideas for Children: Investing in Our Nation's Future. Washington First Focus; 2008. • Silburn SR, Nutton G, Arney F, Moss B. The first 5 years: Starting early. Darwin: Northern Territory Government, 2011. • Australian Research Alliance for Children and Youth. A healthy start in life: Evidence based programs for Aboriginal and Torres Strait Islander children and their families. Canberra: Lowitja Institute, 2014. • Grantham-McGregor S, Cheung YB, Cueto S, et al. Developmental potential in the first 5 years for children in developing countries. Lancet 2007; 369(9555): 60-70.

Page reviewed: 30 August, 2018