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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: 
School of Medicine, Western Sydney University
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): 
Urban Aboriginal and Torres Strait Islander community health Urban Aboriginal and Torres Strait Islander people are largely invisible in health statistics and often assumed to have similar health problems albeit at lower rates compared with rural and remote communities. Yet 75% of Aboriginal and Torres Strait Islander people live in cities and regional centres where there is evidence of disparity impacting substantially on health outcomes. Holistic research, that account for social, emotional, cultural and spiritual elements and determinants of health and wellbeing. This means research beyond individuals to family and community supports, and not simply clinical and lifestyle interventions. Strengths-based approach to understanding and overcoming health disparities Many illnesses impacting on morbidity and mortality in Aboriginal communities require social determinant and lifestyle interventions. Whilst some people are able to address risk factors and improve their health status, others struggle. Research on promoting social and emotional wellbeing is required, including collective healing. The ongoing impact of trauma, griefs and losses related to colonisation, and impacts of compounding losses are not well understood, particularly in urban communities. We further propose research that includes well-funded trials of holistic, transgenerational interventions identified by community members as priorities.
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): 
The National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) (1 ) emphasises the centrality of culture and social and emotional wellbeing as a platform for health improvements, including prevention and clinical care (p. 7-9). The NATSIHP identifies the importance of strength-based approaches, in which self-determination and capability of individuals and communities is pivotal for long term gains (p. 23-4). Our recommendation for holism, particularly in urban populations, accords with National Health Priority Areas Initiative principles, including supporting collaborative actions likely to achieve greatest benefits across large numbers of the population. To understand progress in addressing health determinants, the Implementation Plan for the NATSIHP (2) (p. 40) states that evaluation of good governance and system-level effectiveness is critical. Research about effectiveness of partnerships in “planning, service delivery and evaluation” (p. 3) are required, with “monitoring and accountability”(p. 7) to inform the Indigenous Australians Health Programme (3) , which updates the Implementation Plan. (1) Australian Government. (2013). National Aboriginal and Torres Strait Islander Health Plan 2013-2023. Canberra: Author. Accessed from http://www.health.gov.au/internet/main/publishing.nsf/content/B92E980680486C3BCA257BF0001BAF01/$File/health-plan.pdf (2) Australian Government. (2015). Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023. Canberra: Author. Accessed from http://www.health.gov.au/internet/main/publishing.nsf/Content/AC51639D3C8CD4ECCA257E8B00007AC5/$File/DOH_ImplementationPlan_v3.pdf (3) Australian Government. (2015). Indigenous Australians’ Health Programme. Canberra: Author. Accessed from http://www.health.gov.au/internet/main/publishing.nsf/Content/09AEEA5F377AEBB5CA257F1C00159135/$File/Accessible-IAHP-Programme-Guidelines.pdf
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): 
Given that health is socially determined, political, environmental, historical and socio-economic factors influence the lives of Aboriginal and Torres Strait Islander peoples and contribute to health disparities. Research to date has largely had a disease or “problem” focus. The risk in this approach is that underlying determinants are not addressed, and new “diseases” and health “problems” arise to replace those addressed in a “problem-by-problem” approach. Many chronic diseases share common causal pathways best addressed by an holistic approach, including to prevention. Yet, ongoing social inequalities, as well as compounding trauma, grief and losses impacting on individuals and communities make individual-level change in lifestyles challenging. Complex interactions between social determinants of health and their health impacts mean a single point of intervention is unlikely to be successful. There is evidence that research with a “strengths perspective” can result in positive outcomes as well as provide a better understanding of effective and culturally appropriate ways of tackling health risks and improving health and other related outcomes. This impact is likely to be greater where the research is genuinely led by Aboriginal and Torres Strait Islander people and supported by researchers with appropriate skills including in culturally-safe research approaches and capacity building experience.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
Whilst we are not advocating neglect of the 25% of Aboriginal and Torres Strait Islander peoples living in rural and remote communities, there are clearly social, health and economic benefits in additional attention on improving social determinants of the 75% of Aboriginal and Torres Strait Islander Australians who live in urban and regional centres. Their health outcomes, underscored by inequalities in social and economic status, greatly contribute to current disparities between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Our prioritisation of monitoring and evaluation research including about implementation of the NATSIHP, will be one of the single-most effective strategies to reduce economic and individual-level burdens. Current data showing the worsening of some health outcomes and determinants indicates that recent-past policies and approaches have not been effective. Concerns about barriers to policy implementation and evaluation have frequently been raised. The NATSIHP includes quality, culturally-sensitive initiatives; research to demonstrate its effective and timely implementation is critical to its success. We also propose research investigate the existing strengths in urban Aboriginal and Torres Strait Islander communities in order to design culturally-appropriate interventions to improve health and wellbeing, including addressing health risk behaviours based in social determinants and lifestyle change.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
Health of individuals is greatly influenced by underlying determinants. Without addressing these, individual-level health behaviour change interventions often fail (Marmot, M., & Wilkinson, R. G. (2006). Social determinants of health. Oxford: Oxford University Press. ‘Implementation science’ research guides greater accountability, and ‘closing the gap’ between practice and policy (http://www.ausimplementationconference.net.au/workshops.php) Contrary to popular opinion, the majority of Aboriginal and Torres Strait Islander people live in urban areas (Australian Bureau of Statistics. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. 2011. ABS cat. no. 4704.0. Canberra: ABS). Strengths-based research within a resiliency paradigm allows orientation of research to positive factors, which can become the focus of change strategies designed to enhance strengths in individuals and communities (Zimmerman MA. Resiliency Theory: A Strengths-Based Approach to Research and Practice for Adolescent Health Education & Behavior. 2013;40(4):381-3). Thinking beyond the individual to their family and community supports, such as through use of ecological models, is a useful for research in Aboriginal and Torres Strait Islander health, and reflects the Aboriginal holistic definition of health (Green et al. Cross-sector collaborations in Aboriginal and Torres Strait Islander childhood disability: a systematic integrative review and theory-based synthesis. International Journal for Equity in Health. 2014;13:126).

Page reviewed: 30 August, 2018