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Highlights of Government Support for Diabetes 1999 - Groups with Special Needs: Indigenous people

Diabetes is a major cause of health problems and death for Aboriginal and Torres Strait Islander people, with the prevalence rate among adults at least two to four times that of non-indigenous Australians.

People from non-English Speaking Backgrounds | The Elderly | People Living in Rural and Remote Areas | Young People with Type 1 Diabetes

Indigenous People

Highlights of Government Action
Commonwealth Action
State-based Approach

Life expectancies for Aboriginal and Torres Strait Islander men and women are 15 to 20 years below those of other Australians.

Diabetes is a major cause of health problems and death for Aboriginal and Torres Strait Islander people, with the prevalence rate among adults at least two to four times that of non-indigenous Australians.

The main form of diabetes among indigenous people is type 2 diabetes that occurs at an earlier age - by several decades - compared with non-indigenous Australians. GDM is also more common.

A screening program for Torres Strait Islanders in 1997 found that about 20% of this population had diabetes. In a 1999 screening, similar proportions were found (up to 22%). However, prevalences are higher among older Torres Strait women and men with 50% and 58% of women (1997, 1999) and 25% and 36% of men with diabetes.

A major barrier to improving diabetes care is limited availability and access to necessary and culturally appropriate health care.

Related factors include socio-economic problems, social and cultural differences, poor access to quality food, location, workforce issues, housing and poor nutrition.

Governments recognise that systematic and coordinated primary health care is essential to improve the health of indigenous Australians.

A focus on primary health care risks, such as weight, is important but must include changes to issues such as access to healthy and affordable food, exercise facilities and educational opportunities.

Recommendations for clinical care guidelines, derived from an evidence-based review commissioned by OATSIH, have been disseminated nationally.

This work was undertaken to assist Aboriginal community-controlled primary health care services in the development of their own diabetes management guidelines.

Highlights of Government Action Across-jurisdictional Action

Health checks:

Periodic health examinations are part of diabetes care measures being taken at the primary health care level throughout the country, for instance in WA through ACCOs in the Kimberleys and, in Victoria, through the Koori Diabetes Service. In Queensland, elements of the Strategic Plan for Diabetes in Torres Strait Islanders are being implemented and a Well Person's Health Check, which includes screening for diabetes, is under way for indigenous people in far north Queensland. Queensland Health is also developing a Chronic Disease Strategy for indigenous people based on two Commonwealth reviews and the Torres Strait strategic plan.

Contact: OATSIH - Ph (02) 6289 5339.

Victoria - Joan Vickery, Koorie Diabetes Services. Ph   (03)   9482   9211 or e-mail diabetes@netspace.net.au

Queensland - Dr Robyn McDermott, Tropical Public Health Unit Network (Cairns), Qld Health. Ph (07) 4050 3600.

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Commonwealth Action

OATSIH Projects:

The Office for Aboriginal and Torres Strait Islander Health is implementing projects funded under an allocation from the National Diabetes Initiative. These include:

• an Aboriginal diabetes and nutrition project officer to work within the NACCHO;
• publication and distribution of two reviews of diabetes in Aboriginal and Torres Strait Islander populations;
• support for diabetes specific training for Aboriginal health workers;
• support for the regional development, by community-controlled primary health care services, of clinical care guidelines for diabetes in Indigenous populations; and,
• trialling equipment, training and quality control for community-controlled primary health services to monitor patients with diabetes.

State-based Approach

• Australian Capital Territory
• New South Wales
• Northern Territory
• Queensland
• South Australia
• Tasmania
• Victoria
• Western Australia

Australian Capital Territory

Aboriginal worker training and diabetes education:

A contract between Winnunga Nimmityjah Aboriginal Health Service, Rotary, the ACT Division of General Practice and Diabetes Australia (ACT) makes blood-glucose meters available to Aboriginal and Torres Strait Islander people. They receive the meters and diabetes education through Diabetes Australia (ACT), which facilitates the training of Winnunga Nimmityjhah's Aboriginal health workers. Funds for this project were made available through the Rotary club.

Contact: Marlene Eggert, Diabetes Australia (ACT). Ph (02) 6288 9830.

New South Wales

Diabetes Integrated Care Pilot Project:

The diabetes pilot project assisted some Aboriginal Medical Services in the training of staff in providing diabetes care and provision of early detection and complication screening for people with diabetes. General screening programs for diabetes are conducted by some Aboriginal Medical Services. Some AMS (Durri and Daruk) are providing innovative primary care, for example food cooperatives, diabetes education tools such as board games, diabetes camps and offering lunch (insensitive) for attendance at complication screening clinics.

Contact: Laurie Clay, Durri Aboriginal Medical Service. Ph (02) 6562 4919 or Dea Thiele, Daruk Aboriginal Medical. Ph (02) 9832 1356.

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Northern Territory

The NT Stores Project:

A number of specific strategies identified in the NT Food and Nutrition Policy relate to the community store. For this reason the major focus during the past 12 months has been The Stores Project. Resources and projects developed to support this initiative include The Store Book, Store Video and Good Store - Healthy People poster. A short training program on food and nutrition has been developed for people working in the store. A booklet, Food for Thought, has been written for store managers to increase their awareness of nutritional issues related to the community store. The aim of these resources is to encourage Aboriginal people to become more involved in their community store and to develop and put into place food and nutrition policies for their local store.

Contact: Vivienne Hobson. Ph  (08) 8999 2953 or e-mail vivienne.hobson@nt.gov.au

Queensland

The Queensland Health Tropical Public Health Unit:

The North Queensland unit is involved in a number of projects addressing diabetes prevention and management, some of which focus on the indigenous community. These projects are conducted in partnership with other health agencies and with community bodies. The range includes:

Well Person's Health Check:

The Well Person's Health Check was initiated by Apunipima Cape York Health Council and Queensland Health primarily to address sexual health issues but it also addresses nutrition-related diseases such as diabetes. The operational phase of the project is conducted by the Tropical Public Health Unit and district health staff. The project involves extensive community consultation, a screening phase with subsequent reporting to community bodies and to individual participants. Follow-up interventions include treatment and referral, support for improved clinical services, and support for community planning and implementation of programs to improve nutrition and health. Target Group: Indigenous people in Torres District, Mt Isa District and Cape York District. Reach: Torres District, Mt Isa District and Cape York District.

Contact: Dr Robyn McDermott, Tropical Public Health Unit Network (Cairns), Public Health Services, Qld Health. Ph (07) 4050 3600.

Meriba Zageth for Diabetes - Our Work for Diabetes:

Meriba Zageth for Diabetes - Our Work for Diabetes is an action plan for the prevention and management of diabetes in the Torres District, which was compiled in 1996. Tropical Public Health Unit Network staff members are supporting Torres District Health Services in the implementation of Meriba Zageth for Diabetes - Our Work for Diabetes. Components of Meriba Zageth which have been conducted and supported by TPHU staff include a trial of the Gut Buster program, a study of the incidence of gestational diabetes and preliminary investigations for an intervention to address smoking. Target Group: Indigenous people in the Torres District. Reach: Torres District.

Contact: Dr Robyn McDermott, Dympna Leonard or Donald Whaleboat, Tropical Public Health Unit Network (Cairns). Ph (07) 4050 3600.

Healthy Weight Program:

This program addresses healthy eating and exercise and focuses on the indigenous community. Facilitators are trained to conduct the program, consisting of six workshops plus individual consultation with participants. The program focuses on sustained lifestyle changes and gives priority to loss of "belly fat". Tropical Public Health Unit staff worked on the program's development and have trained and supported district health staff to run the program. Evaluation of the first phase of the program is under way. Discussions are ongoing with diabetes service providers to incorporate the Healthy Weight Program into routine diabetes care.

Contact: Dympna Leonard, Tropical Public Health Unit Network (Cairns), Qld Health. Ph (07) 4050 3600.

Food supply issues in North Queensland:

Difficulties in accessing healthy food in remote Aboriginal and Torres Strait Islander communities contributes to the high prevalence of diet-related disease. The Tropical Public Health Unit Network has developed the Healthy Food Access Basket (HFAB) to monitor access to basic healthy food in urban, remote and rural areas. HFAB studies were conducted in North Queensland in 1997 and across the State in 1998. Queensland Health is also working with government-controlled stores to implement a store food and nutrition policy. Target Group: HFAB Queensland, store policies - remote indigenous DOGIT communities. Reach: Tropical North Queensland.

Contact: Dympna Leonard, Tropical Public Health Unit Network (Cairns). Ph (07) 4050 3600.

Improved nutrition:

Three Indigenous nutrition coordinators have been employed across Queensland and local collaborative planning teams are being developed involving district decision makers and local service providers, including Aboriginal providers. The impressive 50% reduction in inpatient episodes associated with the employment of one diabetes/nutrition worker in a rural district health service in Queensland (South Burnett) suggests that access to preventive care can significantly reduce acute complications. A further three whole-of-community nutritionists and a Statewide coordinator position are also being employed.

Contact: Michael Tilse, Manager Health Promotion Services, Qld Health. Ph (07) 3234 0622.

Maternal and Child Nutrition:

It is now recognised that under-nutrition in early life is associated with increased risk of obesity and diabetes in later life. The Tropical Public Health Unit nutrition team is involved in research into infant feeding practices among North Queensland indigenous families and the provision of in-service training to health staff for improved nutrition of mothers and babies. Training is being conducted in collaboration with the University of Queensland. Target Group: Indigenous people in NQ. Reach: NQ.

Contact: Ros Gabriel, Tropical Public Health Unit (Townsville). Ph (07) 4750 4040.

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South Australia

Aboriginal health workers becoming diabetes educators (South Australian Aboriginal Health Partnership):

Recent consultation with Aboriginal communities by the SA Aboriginal Health Partnership identified diabetes as a priority by every Aboriginal community in South Australia. The need for more Aboriginal health workers (particularly Aboriginal men) to undertake the Diabetes Educators Course through Flinders University was specifically identified. There is also a need for more designated Aboriginal health workers in community-controlled and mainstream settings working in the area of diabetes, more recognition for Aboriginal health workers as part of the medical team, and development of more State-based diabetes health promotion materials. Within two years, 26 Aboriginal health workers will be trained as diabetes educators and working in their communities for the prevention, treatment and management of diabetes.

Contact: Meri King, Flinders University. Ph (08) 8201 3481.

Tasmania

Diabetes Policy and Program Manager:

In 1998, the first Diabetes Policy and Program Manager was appointed to develop a Statewide strategy for a coordinated and consistent approach to policy planning and service development in diabetes and to provide input into national diabetes policy. A multidisciplinary group of key health professionals involved in diabetes service delivery provides professional advice and strategic direction on diabetes policy and planning.

Contact: Liz Bingham, Diabetes Policy and Program Manager, Health Advancement, Department of Health and Human Services. Ph (03) 6233 6117 or e-mail liz.bingham@dchs.tas.gov.au

Menzies Centre for Population Health Research:

The Menzies Centre maintains its basic operations through the support of the University of Tasmania, the State and Federal Governments and the Menzies Foundation. Some funding is also provided by other government bodies, research grants and commercial contractual agreements. Since its inception in 1988, the Menzies Centre has developed a strong reputation as one of the world's leading research institutes specialising in epidemiology and public health. The Menzies Centre works in collaboration with the International Diabetes Institute in Melbourne. As a World Health Organisation research body for the primary prevention of cardiovascular disease, the centre has entered a partnership with the Commonwealth Department of Health and Aged Care to establish and develop the Burnie Take Heart Project in North-West Tasmania.

Tasmanian Insulin Treated Diabetes Register:

The Tasmanian registry was established in 1984 to look into the cause, treatment and prevention of diabetes and its complications. The registry seeks information on all cases of insulin-treated diabetes in Tasmania and is unique in Australia. Most registries worldwide collect information on people developing diabetes in childhood only. The Tasmanian registry seeks to collect information from people who begin insulin at any age and is one of only two registries in the southern hemisphere to do so. This may help determine why some people develop diabetes requiring insulin in childhood while others do not develop it until adult life.

GADA Study:

This study aims to obtain population-based data on the blood level of glutamic acid decarboxylase antibodies (GADA) in people with insulin-treated diabetes mellitus. Several hundred volunteers from the registry and their relatives are helping to develop this test by donating a blood sample. The data collected is being used to confirm how well the GADA test distinguishes between type 1 and type 2 diabetes. The GADA test can also be used to predict type 1 diabetes before clinical onset.

Genetic studies of diabetes:

Tasmania offers a well-characterised, self-contained and stable population over six to seven generations, providing a unique opportunity to investigate the role of genetic factors in chronic disease states such as diabetes. This study, which began in late 1998, will collect information from Tasmanian families with non-insulin dependent diabetes. Family history, demographics and other relevant information will be obtained by interview and blood samples will be collected for genetic analysis.

Contact: Professor Terry Dwyer. Ph (03) 6226 7700 or e-mail T.Dwyer@utas.edu.au

Tasmanian Divisions of General Practice:

The three Divisions of General Practice in Tasmania - North, North-west and South - have diabetes programs which comprise screening components, recall registers, GP education and multidisciplinary shared-care diabetes management programs in collaboration with the State Government and Diabetes Australia. Although each Division is conducting diabetes programs designed to meet local needs, there are plans to collate data towards improving and coordinating case finding and diabetes management Statewide.

Contact: Dr Geoff Chapman. Ph (03) 6278 9772 or e-mail southtas@gpnetwork.net.au

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Victoria

Diabetes - It's in your hands:

Koorie Diabetes Services has developed the health worker manual, the community information booklet and video which form the package, Diabetes - It's in your hands. The health worker manual, a resource for health workers working with Koori people with diabetes, will be provided to health workers who complete the "train the trainer" program conducted by the International Diabetes Institute and Koorie Diabetes Services. The community information book is provided to individuals with diabetes and contains information about diabetes to empower them to manage their condition. Culturally acceptable and appropriate, these products have been designed to enhance management of diabetes within Aboriginal communities. This initiative was funded by the Department of Human Services.

Western Australia

Improved nutrition:

The Health Department of WA's Office of Aboriginal Health has developed and implemented the Aboriginal Food and Nutrition Policy for Western Australia. The policy aims to raise Aboriginal people's awareness of the importance of nutrition, identify specific concerns in this area and provide a focal point for a multidisciplinary approach to improving Aboriginal nutritional health. Examples of activities include increasing the range and affordability of nutritious foods in community food stores and encouraging the use of traditional bush foods. A steering committee has been formed to direct the development of the Aboriginal Food and Nutrition Program Plan and its implementation.

Contact: Shane Houston, Office of Aboriginal Health, Health Department of WA. Ph (08) 9222 2455 or e-mail Shane.Houston@health.wa.gov.au.
OR Dr Michael Gracey. Ph (08) 9222 2453 or e-mail Michael.Gracey@health.wa.gov.au

Aboriginal Family Futures Program:

This project was developed by the Health Department of Western Australia's Office of Aboriginal Health to develop culturally appropriate and holistic health programs that focus on the importance of Aboriginal families and communities. A key feature of the program is the assignment of Aboriginal health workers to extended Aboriginal families to support significant health events such as pregnancy and adolescence.

Contact: Sheryl Baldwin, Office of Aboriginal Health, Health Department of WA. Ph (08) 9222 4473   or e-mail Sheryl.Baldwin@health.gov.au

Heart Health:

More than 1,000 Aboriginal people throughout Western Australia have been screened as part of a major health initiative to raise community awareness of heart-related illness throughout Aboriginal Medical Services in Perth, Kalgoorlie, Geraldton and Roebourne.

Contact: Jean Thornton, Office of Aboriginal Health, Health Department of WA. Ph (08) 9222 4365 or e-mail Jean.Thornton@health.wa.gov.au

Aboriginal health worker training in diabetes prevention and control:

An Aboriginal health worker curriculum in diabetes prevention and control has been developed by the Southern Public Health Unit. The competency-based curriculum and teaching package have been supported by the Commonwealth Rural Health Support Education and Training Program. This program is accredited by the WA Department of Training and the WA Training Accreditation Council. The program, managed by Diabetes Australia WA, has five modules and nominal time allocation of 35 hours.

Contact: Emma Ellis or Francesca Webb, Diabetes Australia WA. Ph (08) 9325 7699 or e-mail emmae@dawa.asn.au

Schools education:

The Pilbara Public Health Unit has developed and successfully implemented a health promotion and education package for use by teachers. The package, entitled You Don?t Have to Get Diabetes, is based on walking the wells along the historical Canning Stock Route.

Contact: Sandra Radich, Pilbara Public Health Unit. Ph (08) 9140 2377 or e-mail Sandra.Radich@health.wa.gov.au

Looma healthy lifestyle:

The key objectives of this program are to help overweight people find ways to lose weight and to prevent younger people from becoming overweight as they grow older. Strategies include community education, screening, exercise programs and provision of health food in the community store and school. A supplementary program involves providing healthy breakfasts and lunches at the Looma School canteen.

Contact: Kate Edwards, Michelle Skinner or Karen Skinner, Looma Remote Health Centre. Ph (08) 9191 4767.

Pilot Diabetes Clinic at Derbarl Yerrigan Health Service:

This pilot program aims to provide a culturally appropriate clinical service for Aboriginal people attending Derbarl Yerrigan Health Service (formerly Perth Aboriginal Medical Service). Strategies include the provision of allied health care specialising in diabetes, training of the health services staff, development of a resource manual for local GPs and helping patients better manage their self-care.

Contact: Christine Nichols, Derbarl Yerrigan Health Service. Ph (08) 9421 3888. or e-mail nicholsc@derbarlyerrigan.com.au