Putting Indigenous Cultures and Indigenous Knowledges Front and Centre to Clinical Practice: Katherine Hospital Case Example.

The inclusion of Indigenous cultures, known as the cultural determinants of health, in healthcare policy and health professional education accreditation and registration requirements, is increasingly being recognised as imperative for improving the appalling health and well-being of Indigenous Australians. These inclusions are a strengths-based response to tackling the inequities in Indigenous Australians' health relative to the general population. However, conceptualising the cultural determinants of health in healthcare practice has its contextual challenges, and gaps in implementation evidence are apparent. In this paper, we provide a case example, namely the Katherine Hospital, of how healthcare services can implement the cultural determinants of health into clinical practice. However, to be effective, health professionals must concede that Australia's Indigenous peoples' knowledges involving cultural ways of being, knowing and doing must co-exist with western and biomedical knowledges of health practice. We use the Katherine Hospital ABC Radio National Background Briefing interview, which was mentioned by two research participants in a 2020 study, as an example of good practice that we can learn from. Additionally, the six Aboriginal and Torres Strait Islander Health actions contained in the 2nd Edition of the Australian National Safety and Quality Health Service Standards provide governance and accountability examples of how to enable Indigenous people's cultures and their knowledges in the provision of services. The role of non-Indigenous clinical allies and accomplices is imperative when embedding and enacting Indigenous Australians' cultures in service systems of health. When Indigenous Peoples access mainstream hospitals, deep self-reflection by allies and accomplices is necessary to enable safe, quality care, and treatment that is culturally safe and free from racism. Doing so can increase cultural responsiveness free of racism, thereby reducing the inherent power imbalances embedded within mainstream health services.

Applying collective impact in Aboriginal health services and research: three case studies tell an important story.

BACKGROUND: Co-design is the latest buzzword in healthcare services and research and is ubiquitous in Australian funding grants and policy documents. There are no standards for what constitutes co-design and it is often confused with less collaborative processes such as consultation. Collective impact is a co-design tool used for complex and entrenched problems. It uses a systematic approach and requires power and resource sharing. We applied collective impact to three research projects with Aboriginal communities. This paper explores how collective impact can enhance participation and outcomes in healthcare services and research. METHODS: We evaluated the collective impact process and outcomes in three translational health research projects with Aboriginal people and communities using a case study approach. We adapted the model using an iterative co-design approach. RESULTS: We adapted the collective impact model in three ways: 1) replaced the precondition of 'problems that are urgent' with 'problems that are complex and entrenched'; 2) added to the 'common agenda' the requirement to establish a planned exit and long-term sustainability strategy from the outset; and 3) added the delivery of a public policy outcome as a result of the collective impact process. CONCLUSIONS: Aboriginal and Torres Strait Islander health is an important public policy priority that requires new and different approaches to service delivery and research. This study adapted the collective impact approach and developed the Rambaldini model through three translational health research case studies and found that a modified collective impact approach is an effective tool for engagement and outcomes.

Equitable Expanded Carrier Screening Needs Indigenous Clinical and Population Genomic Data.

Expanded carrier screening (ECS) for recessive monogenic diseases requires prior knowledge of genomic variation, including DNA variants that cause disease. The composition of pathogenic variants differs greatly among human populations, but historically, research about monogenic diseases has focused mainly on people with European ancestry. By comparison, less is known about pathogenic DNA variants in people from other parts of the world. Consequently, inclusion of currently underrepresented Indigenous and other minority population groups in genomic research is essential to enable equitable outcomes in ECS and other areas of genomic medicine. Here, we discuss this issue in relation to the implementation of ECS in Australia, which is currently being evaluated as part of the national Government's Genomics Health Futures Mission. We argue that significant effort is required to build an evidence base and genomic reference data so that ECS can bring significant clinical benefit for many Aboriginal and/or Torres Strait Islander Australians. These efforts are essential steps to achieving the Australian Government's objectives and its commitment "to leveraging the benefits of genomics in the health system for all Australians." They require culturally safe, community-led research and community involvement embedded within national health and medical genomics programs to ensure that new knowledge is integrated into medicine and health services in ways that address the specific and articulated cultural and health needs of Indigenous people. Until this occurs, people who do not have European ancestry are at risk of being, in relative terms, further disadvantaged.

Models of smoking cessation brief interventions in oral health.

The links between tobacco smoking, and periodontal disease and oral cancer make the inclusion of smoking cessation interventions at dental visits an important prevention strategy in oral health services. The 5As (Ask, Advise, Assess, Assist, Arrange), which utilises a stages of change model, is the most commonly recognised framework for the provision of smoking cessation brief interventions and is advocated widely. While the popularity of the 5As continues, increasingly evidence suggests that staged-based interventions in smoking cessation may not be the best approach. Lack of time and expertise are also cited by health professionals as barriers to undertaking brief interventions and thus abbreviated forms of the 5As have been advocated. In 2009, NSW Health introduced a mandatory policy for public dental services in NSW to conduct smoking cessation brief interventions at the chairside based on a three-step approach, which is currently being evaluated. Given the debate and the pending evaluation results, this paper reviews models of smoking cessation brief interventions, to contribute to achieving a best practice model for public oral health in NSW.

Utilisation of the Medicare Teen Dental Plan in NSW, 2008-2010.

AIM: To examine the use of the Medicare Teen Dental Plan in NSW, its uptake in the private and public dental sectors and to map the geographical pattern of program use. METHODS: Data describing the use of the Medicare Teen Dental Plan were assembled from a variety of sources including Medicare, the NSW Oral Health Data Collection and the NSW Teen Dental Survey 2010. RESULTS: In 2010, use of the Medicare Teen Dental Plan across the entire NSW eligible aged population ranged from 20 to 25.5%, with the average usage across all ages being 20.2%. For the period 2002 to 2010, the average utilisation rate for teenagers accessing public dental care was approximately 6.8%. CONCLUSION: As a single Dental Benefits Schedule item is used for service provided under the Plan, it is difficult to evaluate the mix of dental treatment items and the comparative value of the service provided unless these services are provided in a public dental service with a data collection that can flag care provided under a Medicare Teen Dental Plan voucher.

Child Dental Health Survey 2007: a snapshot of the oral health status of primary school-aged children in NSW.

OBJECTIVES: The Child Dental Health Survey 2007 was commissioned to establish the oral health status of school children in NSW aged 5-12 years, to provide reliable regional oral health statistics and contribute to national population-based data collections. METHODS: A total of 7975 children were clinically examined at 107 public, catholic and independent schools across NSW. RESULTS: Key findings from the survey include: mean dmft for 5-6-year-olds of 1.53; mean DMFT for 11-12-year-olds of 0.74; 61.2% of 5-6-year-olds and 65.4% of 11-12-year-olds have never experienced decay in their primary and permanent teeth, respectively. These figures compare favourably to national benchmarks set in 2001. CONCLUSIONS: Data from the survey will be used as a baseline to measure the success of early intervention and prevention programs, for international comparisons, to provide solid evidence to support population oral health planning and for ongoing surveillance of populations of interest.

Rural oral health workforce issues in NSW and the Charles Sturt University Dentistry Program.

Adequate numbers of dental, medical and allied health professionals in rural and regional areas of NSW are vital for the health of these populations and supporting local community structures and economies. Well-documented shortages of health professionals are a major social and political issue in rural and regional communities and this workforce shortfall is recognised by both the NSW Government State Plan and the State Health Plan. This paper outlines rural and regional dental workforce shortages in NSW and describes current rural oral health workforce initiatives, including the new Charles Sturt University Dentistry Program.