Top 3 questions – Closing the Gap day

Hear from Doctor Lucas De Toca, COVID-19 Primary Care Response First Assistant Secretary, talking about Closing the Gap day.


I'm Dr Lucas de Toca, and I lead the Pandemic Response in Primary Care for the Australian Government. Also lead the vaccine rollout through general practices, community pharmacies, Aboriginal Health Services. Prior to working in the Department, I worked in indigenous health for an Aboriginal Health Service in the Northern Territory. So I'm actually really excited to be doing top three today on Close The Gap day. Close The Gap acknowledges the difference in social and health outcomes between Aboriginal and Torres Strait Islander Australians and other Australians, but also celebrates how through true partnership and community-led initiatives, those gaps are closing, and outcomes for First Nations people in our country are improving. Here, today, I'm on their land of the Ngunnawal people, so I want to acknowledge their ownership.   And I also acknowledge the traditional owners of the lands where you may be watching from. And a strong shout out to everyone who works in Aboriginal and Torres Strait Islander Health, particularly in Aboriginal Community Controlled Health Services across the country that have shown immense leadership, resilience and just skill and professionalism while dealing with the COVID pandemic over the last two years and with improving Aboriginal and Torres Strait Islander Health more broadly.

The first question today is about, you know, if you've been worried about your health, if you're an Aboriginal Torres Strait Islander person, haven't been to the GP or their Aboriginal health practitioner or registered nurse in a while, what can you do or should you do? As part of the overarching program in partnership with the sector to improve Aboriginal and Torres Strait Islander Health, in Australia we have annual health checks that any First Nations person can access for free at an Aboriginal medical service or a bulk-billing clinic. Those health checks are really important to make sure that you're up-to-date with your care and that you're not missing out on something that is going on with your body or your wellbeing that you're not aware and might impact on your future health. If you go to an AMS, or an ACCHO, or a bulk-billing GP clinic and ask for an annual health check, you might have seen in some of their promotional materials what's also called a 715 check, which is just a number that is used in Medicare for billing a particular service, you will have a longish conversation with your health provider about your overall wellbeing, about how you're feeling, about your family history, you're own history with health issues. They will take some measurements, take some checks, do some tests on your blood, your urine and just get an overarching picture of what your health is so that you can be empowered to take action on anything that is worrying you. It's really important to remember that it is your health and it is your check. So you can drive the conversation, and you can bring up anything that worries you. It doesn't have to be what the doctor or the nurse or the health practitioner are thinking the priorities are. It is your health. So you're in charge. While more and more people every year are getting these checks, it's still less than one in three Aboriginal and Torres Strait Islander people who get these annual health checks, so it's a good opportunity to remind everyone to go out and get one if you haven't had one in a while. And you might help address things that have been worrying you for a while and you haven't actioned on. So, yeah, consider getting your Annual Health Check. It's also important to talk about tobacco, which is a big contributor to the gap in life expectancy, and it feels like, especially in the last two years, preventative health and talk about other things that impact our health and wellbeing, is being ignored, because all we talk about is COVID. So it's actually really important that we remember there are many other aspects of health that we can act on, to keep us healthy. Tobacco use has been declining quite significantly over the last 15 years among First Nations people in Australia, which is great, because many lives have been saved out of that reduction, but it's still a very large contributor to the gap in life expectancy and other health outcomes between Aboriginal and Torres Strait Islander and other Australians. However, as I was saying, things are getting better, and now there's more Aboriginal and Torres Strait Islander people who don't smoke, than Aboriginal and Torres Strait Islander people who smoke, which is a very big change over the last 20 years.

Merv from Redfern has written to us, worried about vaping or e-cigarettes, noting that he's seen more and more people, especially young people in the community, vaping. And whether that's an issue or a solution, as many people are portraying it to be. The reality is that vaping is growing amongst young people quite significantly. Nearly 15% of young people in secondary school in Australia are now vaping, and the majority of those, about half, weren't smoking before. So, some of the potentially misleading communications that we are seeing through industry groups and lobby groups, in social media are particularly targeting youth, sort of, portraying e-cigarettes or vaping as a harmless alternative to smoking, or a tool to quit smoking, it's not telling the full story. Because what we are seeing is often vaping or e-cigarettes becoming a gateway into smoking for people who otherwise would not be smoking. So I think we need to be very aware of that. And like any of these products, they are absolutely not harmless, and while some of the direct impacts may be less harmful than traditional combustion cigarettes, they still have a number of substances that get inhaled, and many of them have high levels of nicotine and other toxins that are an issue. Especially if people are perceiving them as less harmful or increasing uptake in younger people. Whether we worry about vaping, e-cigarettes, or traditional smoking, which is still a very significant issue, you can go to your Aboriginal medical service and talk to the Tackling Indigenous Smoking team, the TIS teams, or Tackling Indigenous Smoking teams, and you’ve probably seen them in community with very distinctive polo shirts and lots of health promotion activities, can help connect you with a number of services whether it’s clinical support or therapy support to address smoking. They can give you resources.  They can give you strategies. They can also help you tell that story if you want to quit smoking, and are finding it hard among your peer group to maintain that impetus. You can also go to and see information about both TIS, or Tacking Indigenous Smoking teams all around the country, and where’s the nearest AMS, where you can check out on the team, get an appointment, and start your ‘quit smoking’ journey.

Finally, another virus that we’re hearing a lot of these days, that it’s not SARS-CoV2, the one that causes COVID, is the Japanese encephalitis virus or JEV. Japanese encephalitis is a disease that’s mosquito borne. It’s a virus that is transmitted by mosquito bites that unfortunately has now been detected in NSW, Victoria, and more recently, South Australia, whereas normally it’s confined to tropical regions of the very far north of the country and of course, other countries where it is endemic. Japanese encephalitis is a virus. It’s transmitted by animal host. It’s what called a zoonosis or a disease that’s transmitted from animals to humans. And humans are only, so to speak, incidental hosts. We are not part of the reproductive cycle of the virus, and that’s why human-to-human transmission even if it’s a mosquito biting a person who’s been infected by it and then biting another person after cannot occur. The transmission has to be from an animal to a human by a mosquito bite. It’s generally spread broadly by water birds, waterfowl, but then it suffers what we call an amplification cycle in pigs. The general way an outbreak of Japanese encephalitis virus happens, and also what we have been seeing in Australia, is it’s introduced into an area, normally through birds. A mosquito bites the bird, and then bites a pig. Inside the pig, we see a significant amplification. The virus reproduces a lot and generates a high viral load, with often very mild or no disease to the pig themselves, and then a mosquito bites a pig, and then bites a human, and that’s where it can cause disease in humans. But as I said, subsequent biting from a mosquito to an infected human to other humans cannot spread the disease, which is what helps in some ways contain when we have outbreaks often associated with piggeries or areas with high concentration of pigs. The flooding situation that we have been experiencing over the last few weeks and months, and the generally wet conditions that we have had this summer, are very likely contributing to that progression of the Japanese encephalitis disease to more southern latitudes than what we normally see. The majority of people who get infected by Japanese encephalitis virus have no symptoms and a small proportion of people might have some mild disease. But unfortunately, roughly about 1%, so one in 100 who get infected with this virus, develop what's called encephalitis, which is an inflammation, a swelling, of parts of the brain and the linings of the brain. That is a very serious condition and often requires hospitalisation. And unfortunately, of the 18 people for whom Japanese encephalitis has been confirmed in Australia as part of these outbreaks, two have passed away. So, it is a serious disease and there are many ways that we can help prevent it. The Australian Government, in partnership with states and territories, is rolling out JEV, or Japanese encephalitis national plan. That includes vaccination of people in high-risk areas, and there's effective vaccines for these as well. So, people who work in piggeries or around piggeries and healthcare workers, including pathologists, who deal with JEV samples or mosquitos, are being prioritised for vaccination. But yourself, you can do things to prevent or minimise the risk of being infected by this virus, remembering that the way you get it is from mosquito bites. So, wearing loose-fitting clothes, particularly light clothes, which can also help with continuing to be sun smart, as we all know in Australia. Making sure that you have appropriate mosquito netting or screens or even if you're camping, that you keep the space where you sleep as protected from mosquitos as possible. And if you're outside, or in a mosquito prone area, wearing mosquito repellent on any exposed skin, and there's many products in Australia, but just look for the ones that have picaridin or DEET or eucalyptus based compounds. And just try to minimise that risk of being bitten by a mosquito. It cannot be transmitted from other humans, it cannot be transmitted by eating pork or just being in contact with pigs, it's the mosquito from the pig or the water bird into the human that transmits it. We'll see how those outbreaks go, and whether this is just a flare up or actually the disease becoming more common in southern parts of the country, but there's a lot of activity at the moment to contain it and most people are not at risk from exposure to this disease.

That's all we have for today. Thank you for continuing to engage and submitting your questions, and we'll see you next time.

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This annual awareness day aims to close the health and life expectancy gap between the Indigenous and the non-Indigenous communities in Australia.

Top 3 questions:

  1. Closing the gap
  2. Tobacco use
  3. Japanese encephalitis virus.
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