tag:blogger.com,1999:blog-120403142024-03-14T21:51:33.400+09:30Remote living Aboriginals in AustraliaThis website is dedicated to the thousands of Aboriginal people across the north of Australia who are trying to live in two worlds – their world and our world.
Our life is moulded through centuries of revolutions – industrial, economic and now social revolution.
Theirs is but a short journey from hunting and gathering to fast food and television advertising.
The Aboriginal will make it – but not too fast.Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.comBlogger42125tag:blogger.com,1999:blog-12040314.post-73195296867253420762009-03-08T09:23:00.002+09:302013-12-18T20:06:37.614+09:30The Trachoma issue – what does it take?There are times when people involved in trying to close the gap in Aboriginal health hold up their hands in despair and scream “what does it take?”
<br />Following the statement of achievements during February 2009 by Prime Minister Kevin Rudd to “Closing the Gap” the Aboriginal Medical Services Alliance of the Northern Territory has called for a way to get the dollars promised to the ground as directly as possible.
<br />Congratulations to AMSANT for the suggestion that a single authority accountable to the Parliament be established to deal with all matters pertaining to Aboriginal health and the funds that are promised for this use.
<br />It is so often the public forgets the announcements, makes a judgment at the time and then wait for the next one assuming the previous have been actioned. It does not work that way.
<br />So in reality there has to be an agency that is holding governments and politicians accountable for the promises that are made. This is where the AMSANT proposal makes so much sense and without it the wheels of the bureaucracy through three levels of government still have to turn - and oh so slowly.
<br />As an example of just how hard it is to make things happen take a look at the problem of trachoma – a debilitating eye disease that can send people blind if not treated properly (and simply) with improved personal hygiene and Azithromycin.
<br />Mr. Rudd also announced during the week that $58.3 million would be made available for eye and ear health with a focus on eradicating trachoma, a disease that leads to blindness. It has been eliminated in all other developed countries.
<br />The PMs Media Release said (interalia)
<br />“Our objective must be clear: to eliminate trachoma among Indigenous Australians within a finite timeframe”.
<br />
<br />Now wind the clock back to 1997 when in The Age 27th June it is stated:
<br />“Dr Wooldridge said the Government would spend whatever was necessary to fix what was preventable blindness striking 100,000 Australians. The minister said he was angry that after so long little had improved in relation to the eye health of Aborigines in remote communities”
<br />And then in the SMH on 18th November:
<br />“Aboriginal eye health …has worsened, with the rates of the blinding disease trachoma found to be 80 per cent among some children, and indigenous people 10 times more likely to be blind than other Australians.”
<br />This followed a study, by the head of Melbourne University's Department of Opthalmology, Professor Hugh Taylor - the first such review in two decades – which found the eye health of Aborigines in remote communities had barely improved in that time.
<br />To which Minister Woolridge’s office responded that:
<br />"These things take time," he said.
<br />
<br />The amount of money the government committed in March 1998 was $4.8 million but who remembers what happened, whether it worked and ask why this is still going on. The price has now increased to $58 million although that does include ear health.
<br />
<br />Professor Hugh Taylor, the long time advocate for action on eye health must be really wondering how much time it needs for what should be a simple undertaking.
<br />
<br />Pharmacists involved in Aboriginal health will know that it was the desire to have Azithromycin made free to remote living Aboriginal people that lead to the Section 100 supply arrangements for the entire PBS Schedule Yellow Pages. It was during the PMs visit to Maningrida (NT) in 1998 that prompted the action that lead to the implementation of this change in April 1999 and now follows to all remote Aboriginal Health Services.
<br />
<br />This column supports the AMSANT call for a National Aboriginal Health Authority and calls on pharmacy organisations to give their support to the proposal by agreeing to work with it in ensuring the quality use of medicine is exemplary in whatever programs it administers.
<br />Close the Gap is not just about life expectancy – it is about reducing the distance between the politicians announcements of money being available and that money then being used on the purpose for which it is intended with the minimum of administration in between.
<br />With two levels of health bureaucracies (Australian and State/Territory governments) dealing with programs and even then it not being delivered the total sum quickly diminishes.
<br />The Aboriginal community controlled sector needs support in responding to such calls.
<br />In the Northern Territory there are 47 government controlled health clinics as against 26 community controlled. This gap needs to be narrowed also until they are all community controlled and using the money directly that is voted through the Parliament for spending on improving Aboriginal health.
<br />Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-37210546881484667292009-07-26T05:17:00.008+09:302013-12-18T20:06:37.578+09:30Spending towards an early death<meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CRollom%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="State"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Verdana; panose-1:2 11 6 4 3 5 4 4 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:536871559 0 0 0 415 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Verdana; mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";} a:link, span.MsoHyperlink {color:blue; text-decoration:underline; text-underline:single;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline; text-underline:single;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 90.0pt 72.0pt 90.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="line-height: 14pt;">The Australian public is exposed to some outrageous headlines attempting to<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSCPv6JDZ6u4uD7x0vOlKJn6W12u1Zj0cPOwrKegvA-kewD-a3yAf107eVaYR1wVzIRSROVXF1FLexhuIdKYRGM4IXRJz5xi9vSrqMcXZoMAxMQ7vrKSd2FsDTZw-Mk0PdI-Eh/s1600-h/Jetsetting_PM.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 200px; height: 55px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSCPv6JDZ6u4uD7x0vOlKJn6W12u1Zj0cPOwrKegvA-kewD-a3yAf107eVaYR1wVzIRSROVXF1FLexhuIdKYRGM4IXRJz5xi9vSrqMcXZoMAxMQ7vrKSd2FsDTZw-Mk0PdI-Eh/s200/Jetsetting_PM.jpg" alt="" id="BLOGGER_PHOTO_ID_5362501780604823602" border="0"></a> excite them about spending rorts by people in high places. Rarely though is it exposed to the enormous spending on death defying recklessness by people on tobacco products.</p> <p class="MsoNormal" style="line-height: 14pt;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 14pt;">The headline (on right) is supposed to create anger that the Nation’s Prime Minister travels too much.</p> <p class="MsoNormal" style="line-height: 14pt;">What abou<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiB0Dcz5BDc4pS3srDWpKZ9gUhMiclirljAa8AZesLsSdIrzzv6wM5ffN68N5Arqz0Nvt8_-R3Fq5O1sZC0JOB_GED87YbOkvhmXu5C0V1i4iQAzF3GaFSrxxsBOJzZC56gb8Tl/s1600-h/Tobacco_feature4.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 200px; height: 185px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiB0Dcz5BDc4pS3srDWpKZ9gUhMiclirljAa8AZesLsSdIrzzv6wM5ffN68N5Arqz0Nvt8_-R3Fq5O1sZC0JOB_GED87YbOkvhmXu5C0V1i4iQAzF3GaFSrxxsBOJzZC56gb8Tl/s200/Tobacco_feature4.jpg" alt="" id="BLOGGER_PHOTO_ID_5362491453312081922" border="0"></a>t the other? (on left) – Would it raise an eyebrow or simply be put aside with a sigh and an exclamation of – <b style=""><i style="">“oh well – you have to die of som</i></b><b style=""><i style="">ething”. </i></b>And after the death<b style=""><i style=""> – “oh yes but he was a smoker” </i></b>as if that makes it all right to smoke to death.</p> <p class="MsoNormal" style="line-height: 14pt;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 14pt;">No - it should not be like this.</p> <p class="MsoNormal" style="line-height: 14pt;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 14pt;">The hackneyed old excuse that people have to take responsibility for their own health must be banned from use in a situation where people are legally allowed to buy products that are promoting a low life expectancy. By the time people “learn” to take personal responsibility for their actions thousands will have died from the effects of tobacco products and only the government of the day will be to blame for allowing this carnage to continue. Who will then say “sorry” in 50 years time?</p> <p class="MsoNormal" style="line-height: 14pt;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 14pt;">A remote community of 2,500 population spends $80,000 a fortnight of a $500,000 welfare cheque on tobacco products. It is estimated that a further $80,00<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsTYBfilLMInvhjT2swGB3DzEU56YYEpcb2E0E1GfS5p6qZTwrivQopVv8RAZ3OR2QZhWfWzOKXyV3NO0GMEi_M6AYwDn_fnDFL7YvhT-Qq7pTuOdjSnM7uroA-UzTKv33Emnz/s1600-h/kfc1.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 200px; height: 144px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsTYBfilLMInvhjT2swGB3DzEU56YYEpcb2E0E1GfS5p6qZTwrivQopVv8RAZ3OR2QZhWfWzOKXyV3NO0GMEi_M6AYwDn_fnDFL7YvhT-Qq7pTuOdjSnM7uroA-UzTKv33Emnz/s200/kfc1.jpg" alt="" id="BLOGGER_PHOTO_ID_5362497194838804114" border="0"></a>0 is spent on Ganja. (References available).<font style=""> </font>12 years ago the community store, takeaway and licensed club at Nguiu (<st1:place st="on">Bathurst Island</st1:place>) was taking over 50% of its total revenue from beer and tobacco products. What of the others and where are the stats now? If anyone has them please speak up or is this vital market intelligence silenced by the same people that are profiting <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEphM_ZIV3glu8NTK3kTegF56eOotNMFa27_3pkn9wd7rd3Ieb8GBAmz_lG0LfRuCN18H4jO4gTLAXipKh5gCnFERew226ChraoMZxvsJvvXWoaQV58B3iSTGGr3We5iUrf6Qi/s1600-h/Grog_Nguiu.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 82px; height: 163px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEphM_ZIV3glu8NTK3kTegF56eOotNMFa27_3pkn9wd7rd3Ieb8GBAmz_lG0LfRuCN18H4jO4gTLAXipKh5gCnFERew226ChraoMZxvsJvvXWoaQV58B3iSTGGr3We5iUrf6Qi/s200/Grog_Nguiu.jpg" alt="" id="BLOGGER_PHOTO_ID_5362495905137919698" border="0"></a>from the marketing of ill health?</p> <p class="MsoNormal" style="line-height: 14pt;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 14pt;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 14pt;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 14pt;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 14pt;">And how good would it be if that same amount was being spent on community development activities or to facilitate the development of enterprises that would create employment opportunities. Yes that is right – something to do. Anyone who has (or does) smoke will know how much less is smoked when in a working environment that does either not allow smoking or is such that it is not possible to smoke. Imagine if of that 2,500 population there were suddenly 200 with a job – no time to smoke. If the money was put into a community fund a lot could happen.</p> <p class="MsoNormal" style="line-height: 14pt;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 14pt;">As for the price of cigarettes – who cares?</p> <p class="MsoNormal" style="line-height: 14pt;">A smoker will spend up to $15 a packet if they feel they need it. For all the debate about what difference the price makes, and how “price sensitive” is the marketplace – forget it. Not many smokers would know how much they paid for t<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFLj5YLMGlb8YqclWXgZHyMl6NVfiZ3FUw0JxD4lobABZ9dzFuEYGC6wV3Rd0N1EtnNLJLZYFBEHreqvanDRHtKx1PBZZfqdQgGD-NZ3JgNe9Khy1WhoX79BY-xRYcVriYQKV2/s1600-h/Tobacco_feature2.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 275px; height: 206px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFLj5YLMGlb8YqclWXgZHyMl6NVfiZ3FUw0JxD4lobABZ9dzFuEYGC6wV3Rd0N1EtnNLJLZYFBEHreqvanDRHtKx1PBZZfqdQgGD-NZ3JgNe9Khy1WhoX79BY-xRYcVriYQKV2/s200/Tobacco_feature2.jpg" alt="" id="BLOGGER_PHOTO_ID_5362504851876096802" border="0"></a>heir last packet of cigarettes.</p> <p class="MsoNormal" style="line-height: 14pt;">Just put the price up to $25 a packet and put the $10 a packet into a community fund.</p> <p class="MsoNormal" style="line-height: 14pt;">If $80,000 a fortnight is being spent on cigarettes and people halved the amount they smoked – there would be (potentially) $40,000 a fortnight to go into a community fund for extra community development activities or an educational fund for school excursions. That is $ One million a year for a community fund from a self imposed tobacco tax. The cost benefit to the community is huge – what a headline that would make!</p> <p class="MsoNormal" style="line-height: 14pt;">Only drastic measures will bring about behavioural change and it is about time the authorities “bit the bullet” and did something drastic. Tinkering around the edges has produced no change and the situation still exists where people in these communities do not know what good health is.</p> <p class="MsoNormal" style="line-height: 14pt;">Spend the money from the tobacco tax on promoting good health – but in the same vigorous way that McDonalds, Coke and <st1:place st="on"><st1:state st="on">Kentucky</st1:state></st1:place> promote ill health and oh yes VB, Four Ex, Tooheys and Fosters too.</p> <p class="MsoNormal" style="line-height: 14pt;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 14pt;">As for the remote community takeaway stores – some of them are just selling sickness. Bulldoze them all and create a “good health” store where at least the choices will be healthy ones.</p> <p class="MsoNormal" style="line-height: 14pt;"><b style=""><o:p> </o:p></b></p> <p class="MsoNormal" style="line-height: 14pt;"><b style="">NB</b> Illustrations in this article are from a presentation – “When bad health is normal – what is good health- a plan to market Good Health to remote living Aboriginal people across the North of Australia”. Copies available on request to the author.</p> <p class="MsoNormal" style="line-height: 14pt;">Rollo Manning PO Box 98 Parap NT 0804 or <a href="mailto:rollom@iinet.net.au">rollom@iinet.net.au</a></p> Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-11326788542275291002009-07-26T04:44:00.005+09:302013-12-18T20:06:37.528+09:30Promoting an early death<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-HE19D48XcnLgk2uPzVDjciakecQEbnwS0R0awl2cgAXQrVUgmma4_S3g3Q4u1N6tsX36450HAWcLTtySfDn7GQCtd6gzjGR-yZJsb4qbINVEW7MKtm4GKFoR5KwPt64vWslj/s1600-h/Tobacco_feature2.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 320px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-HE19D48XcnLgk2uPzVDjciakecQEbnwS0R0awl2cgAXQrVUgmma4_S3g3Q4u1N6tsX36450HAWcLTtySfDn7GQCtd6gzjGR-yZJsb4qbINVEW7MKtm4GKFoR5KwPt64vWslj/s320/Tobacco_feature2.jpg" alt="" id="BLOGGER_PHOTO_ID_5362485846608274482" border="0"></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRQ3bTiCy5wvI3SqjPn4qOPJBTw6Gao16kjaTIv5xUnqEQc-ikQB2r6FAOYKJRu6IQYanCyjoY2-kafkvVJ13-kSEGfbUqOXdX2wpfNGHfqoyPqnEux3PeV8N6TaswwS15cp0P/s1600-h/Tobacco_feature4.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 201px; height: 186px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRQ3bTiCy5wvI3SqjPn4qOPJBTw6Gao16kjaTIv5xUnqEQc-ikQB2r6FAOYKJRu6IQYanCyjoY2-kafkvVJ13-kSEGfbUqOXdX2wpfNGHfqoyPqnEux3PeV8N6TaswwS15cp0P/s320/Tobacco_feature4.jpg" alt="" id="BLOGGER_PHOTO_ID_5362482715197276690" border="0"></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz8jyTeLC6gL03-v6516VsiC6pW-PiRwPG5g6P02o7Hrwepb9rIWTQEcG-Fv1yr93dpZwdHzL5DoFoST-YzVxpI9yxT8nCPe0rFlVODsPvl4HffMam1vDLzjBsA4fftIBdmSzh/s1600-h/Tobacco_Feature.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 320px; height: 91px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz8jyTeLC6gL03-v6516VsiC6pW-PiRwPG5g6P02o7Hrwepb9rIWTQEcG-Fv1yr93dpZwdHzL5DoFoST-YzVxpI9yxT8nCPe0rFlVODsPvl4HffMam1vDLzjBsA4fftIBdmSzh/s320/Tobacco_Feature.jpg" alt="" id="BLOGGER_PHOTO_ID_5362482424103091810" border="0"></a><br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CRollom%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><link rel="Edit-Time-Data" href="file:///C:%5CDOCUME%7E1%5CRollom%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_editdata.mso"><!--[if !mso]> <style> v\:* {behavior:url(#default#VML);} o\:* {behavior:url(#default#VML);} w\:* {behavior:url(#default#VML);} .shape {behavior:url(#default#VML);} </style> <![endif]--><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="State"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Verdana; panose-1:2 11 6 4 3 5 4 4 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:536871559 0 0 0 415 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:Verdana; mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";} @page Section1 {size:612.0pt 792.0pt; margin:53.95pt 54.0pt 44.95pt 63.0pt; mso-header-margin:35.4pt; mso-footer-margin:35.4pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults ext="edit" spidmax="1029"> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout ext="edit"> <o:idmap ext="edit" data="1"> </o:shapelayout></xml><![endif]--> <p class="MsoNormal"><!--[if gte vml 1]><v:shapetype id="_x0000_t202" coordsize="21600,21600" spt="202" path="m,l,21600r21600,l21600,xe"> <v:stroke joinstyle="miter"> <v:path gradientshapeok="t" connecttype="rect"> </v:shapetype><v:shape id="_x0000_s1026" type="#_x0000_t202" style="'position:absolute;" stroked="f"> <v:textbox style="'mso-fit-shape-to-text:t'"> <![if !mso]> <table cellpadding="0" cellspacing="0" width="100%"> <tr> <td><![endif]> <div> <p class="MsoNormal" align="right" style="'text-align:right'"><v:shapetype id="_x0000_t75" coordsize="21600,21600" spt="75" preferrelative="t" path="m@4@5l@4@11@9@11@9@5xe" filled="f" stroked="f"> <v:stroke joinstyle="miter"> <v:formulas> <v:f eqn="if lineDrawn pixelLineWidth 0"> <v:f eqn="sum @0 1 0"> <v:f eqn="sum 0 0 @1"> <v:f eqn="prod @2 1 2"> <v:f eqn="prod @3 21600 pixelWidth"> <v:f eqn="prod @3 21600 pixelHeight"> <v:f eqn="sum @0 0 1"> <v:f eqn="prod @6 1 2"> <v:f eqn="prod @7 21600 pixelWidth"> <v:f eqn="sum @8 21600 0"> <v:f eqn="prod @7 21600 pixelHeight"> <v:f eqn="sum @10 21600 0"> </v:formulas> <v:path extrusionok="f" gradientshapeok="t" connecttype="rect"> <o:lock ext="edit" aspectratio="t"> </v:shapetype><v:shape id="_x0000_i1025" type="#_x0000_t75" style="'width:221.25pt;"> <v:imagedata src="file:///C:\DOCUME~1\Rollom\LOCALS~1\Temp\msohtml1\01\clip_image001.jpg" title="Tobacco_Feature"> </v:shape></p> </div> <![if !mso]></td> </tr> </table> <![endif]></v:textbox> <w:wrap type="square"> </v:shape><![endif]--><!--[if !vml]--><!--[endif]-->The Australian public is exposed to some outrageous headlines attempting to excite them about spending rorts by people in high places. Rarely though is it exposed to the enormous spending on death defying recklessness by people on tobacco products.</p> <p class="MsoNormal"><!--[if gte vml 1]><v:shape id="_x0000_s1027" type="#_x0000_t202" style="'position:absolute;margin-left:0;margin-top:0;width:195.9pt;height:175.95pt;" stroked="f"> <v:textbox style="'mso-fit-shape-to-text:t'"> <![if !mso]> <table cellpadding="0" cellspacing="0" width="100%"> <tr> <td><![endif]> <div> <p class="MsoNormal" align="right" style="'text-align:right'"><v:shape id="_x0000_i1026" type="#_x0000_t75" style="'width:181.5pt;height:168.75pt'"> <v:imagedata src="file:///C:\DOCUME~1\Rollom\LOCALS~1\Temp\msohtml1\01\clip_image003.jpg" title="Tobacco_feature4"> </v:shape></p> </div> <![if !mso]></td> </tr> </table> <![endif]></v:textbox> <w:wrap type="square"> </v:shape><![endif]--><!--[if !vml]--><!--[endif]-->The headline (on right) is supposed to create anger that the</p> <p class="MsoNormal" style=""><font style=""> </font>Nation’s Prime Minister travels too much.</p> <p class="MsoNormal">What about the other? (on left) – Would it raise an eyebrow or simply be put aside with a sigh and an exclamation of – <b style=""><i style="">“oh well – you have to die of something”. </i></b>And after the death<b style=""><i style=""> – “oh yes but he was a smoker” </i></b>as if that makes it all right to smoke to death.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">No - it should not be like this.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">The hackneyed old excuse that people have to take responsibility for their own health must be banned from use in a situation where people are legally allowed to buy products that are promoting a low life expectancy. By the time people “learn” to take personal responsibility for their actions thousands will have died from the effects of tobacco products and only the government of the day will be to blame for allowing this carnage to continue. Who will then say “sorry” in 50 years time?</p> <p class="MsoNormal"><!--[if gte vml 1]><v:shape id="_x0000_s1028" type="#_x0000_t202" style="'position:absolute;margin-left:297pt;margin-top:9.25pt;width:220.65pt;"> <v:textbox style="'mso-fit-shape-to-text:t'"> <![if !mso]> <table cellpadding="0" cellspacing="0" width="100%"> <tr> <td><![endif]> <div> <p class="MsoNormal"><v:shape id="_x0000_i1027" type="#_x0000_t75" style="'width:205.5pt;"> <v:imagedata src="file:///C:\DOCUME~1\Rollom\LOCALS~1\Temp\msohtml1\01\clip_image005.jpg" title="Tobacco_feature2"> </v:shape></p> </div> <![if !mso]></td> </tr> </table> <![endif]></v:textbox> <w:wrap type="square"> </v:shape><![endif]--><!--[if !vml]--><br /><!--[endif]--></p> <p class="MsoNormal">A remote community of 2,500 population spends $80,000 a fortnight of a $500,000 welfare cheque on tobacco products. It is estimated that a further $80,000 is spent on Ganja. (References available). <font style=""> </font>12 years ago the community store, takeaway and licensed club at Nguiu (<st1:place st="on">Bathurst Island</st1:place>) was taking over 50% of its total revenue from beer and tobacco products. What of the others and where are the stats now? If anyone has them please speak up or is this vital market intelligence silenced by the same people that are profiting from the marketing of ill health?</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">And how good would it be if that same amount was being spent on community development activities or to facilitate the development of enterprises that would create employment opportunities. Yes that is right – something to do. Anyone who has (or does) smoke will know how much less is smoked when in a working environment that does either not allow smoking or is such that it is not possible to smoke. Imagine if of that 2,500 population there were suddenly 200 with a job – no time to smoke. If the money was put into a community fund a lot could happen.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">As for the price of cigarettes – who cares?</p> <p class="MsoNormal">A smoker will spend up to $15 a packet if they feel they need it. For all the debate about what difference the price makes, and how “price sensitive” is the marketplace – forget it. Not many smokers would know how much they paid for their last packet of cigarettes.</p> <p class="MsoNormal">Just put the price up to $25 a packet and put the $10 a packet into a community fund.</p> <p class="MsoNormal">If $80,000 a fortnight is being spent on cigarettes and people halved the amount they smoked – there would be (potentially) $40,000 a fortnight to go into a community fund for extra community development activities or an educational fund for school excursions. That is $ One million a year for a community fund from a self imposed tobacco tax. The cost benefit to the community is huge – what a headline that would make!</p> <p class="MsoNormal">Only drastic measures will bring about behavioral change and it is about time the authorities “bit the bullet” and did something drastic. Tinkering around the edges has produced no change and the situation still exists where people in these communities do not know what good health is.</p> <p class="MsoNormal">Spend the money from the tobacco tax on promoting good health – but in the same vigorous way that McDonalds, Coke and <st1:state st="on"><st1:place st="on">Kentucky</st1:place></st1:state> promote ill health and oh yes VB, Four Ex, Tooheys and Fosters too.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">As for the remote community takeaway stores – some of them are just selling sickness. Bulldoze them all and create a “good health” store where at least the choices will be healthy ones.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Ends</p> Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-30892877708530731512013-12-18T14:04:00.001+09:302013-12-18T20:06:07.516+09:30The inequity of pharmacy distribution<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
</w:Compatibility>
<w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel>
</w:WordDocument>
</xml><![endif]--><br />
<!--[if !mso]><img src="//img2.blogblog.com/img/video_object.png" style="background-color: #b2b2b2; " class="BLOGGER-object-element tr_noresize tr_placeholder" id="ieooui" data-original-id="ieooui" />
<style>
st1\:*{behavior:url(#ieooui) }
</style>
<![endif]--><!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:10.0pt;
font-family:"Times New Roman";}
</style>
<![endif]-->
<br />
<div class="MsoNormal">
<span style="font-size: small;"><b><span style="font-family: Verdana;">THE INEQUITY OF THE DISTRIBUTION OF PHARMACY BUSINESSES
IN </span></b><b><span style="font-family: Verdana;">AUSTRALIA</span></b></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Verdana; font-size: small;">Quote from Letter to
Editor of the Australian Financial Review (14 November 2013) from Greg Turnbull of The Pharmacy
Guild of </span><span style="font-family: Verdana; font-size: small;">Australia</span><span style="font-family: Verdana; font-size: small;">:</span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal" style="background: none repeat scroll 0% 0% rgb(230, 230, 230);">
<span style="font-size: small;"><b><i><span style="color: blue; font-family: Verdana;">The provision of <u>quality dispensing of PBS
medicines</u> at around 5300 pharmacies <u>evenly distributed across </u></span></i></b><b><i><u><span style="color: blue; font-family: Verdana;">Australia</span></u></i></b><b><i><span style="color: blue; font-family: Verdana;"> is <u>an essential
health service</u> for Australian consumers, <u>appropriately subsidised by
government since 1948.</u></span></i></b></span></div>
<div class="MsoNormal">
<span style="font-family: Verdana; font-size: small;">Source: <a href="http://www.afr.com/p/opinion/fact_is_the_best_cure_for_howes_A0ttA6GrLqkaGxR0gDmb0H">http://www.afr.com/p/opinion/fact_is_the_best_cure_for_howes_A0ttA6GrLqkaGxR0gDmb0H</a>
</span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Verdana; font-size: small;">This was posted in a
rebuttal of the article by Paul Howes in the Financial Review on </span><span style="font-family: Verdana; font-size: small;">13<sup>th</sup>
November 2013</span><span style="font-family: Verdana; font-size: small;"> </span></div>
<div class="MsoNormal">
<span style="font-family: Verdana; font-size: small;">See it at <a href="http://www.afr.com/p/opinion/no_room_left_for_pharmacy_guild_RHF7RyCxkhd0I65945sCkL">http://www.afr.com/p/opinion/no_room_left_for_pharmacy_guild_RHF7RyCxkhd0I65945sCkL</a></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Verdana; font-size: small;">So what? – Just another
bun fight between the Pharmacy Guild and a critic of the current Australian
retail pharmacy industry. “Nothing new about that” one could say.</span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Verdana; font-size: small;">Yes BUT there are aspects
of the quote that need comment when looking at the provision of pharmacy
services to ALL Australians.</span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Verdana; font-size: small;">There is one group that is
left out of the assumption that the pharmacies in </span><span style="font-family: Verdana; font-size: small;">Australia</span><span style="font-family: Verdana; font-size: small;"> are </span><span style="font-size: small;"><b><span style="font-family: Verdana;">evenly distributed</span></b><span style="font-family: Verdana;"> throughout the Nation.</span></span></div>
<div class="MsoNormal">
<span style="font-family: Verdana; font-size: small;">There are 53,000
Aboriginal people living in remote communities in the </span><span style="font-family: Verdana; font-size: small;">Northern Territory</span><span style="font-family: Verdana; font-size: small;"> who would not know what a “pharmacist” is let
alone what a pharmacy business looked like.</span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Verdana; font-size: small;">The reference to </span><span style="font-size: small;"><b><span style="font-family: Verdana;">quality dispensing of PBS medicines</span></b><span style="font-family: Verdana;"> is a joke with no pharmacist in sight at the point of dispensing and
supply to the patient – unlike every other Australian who, thanks to the PBS
money, has a pharmacist available at the point of supply everywhere a PBS
medicines is supplied.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Verdana; font-size: small;">And as for this being </span><span style="font-size: small;"><b><span style="font-family: Verdana;">an essential health service for Australian consumers </span></b><span style="font-family: Verdana;">well “yes” maybe but NOT if you are an Aboriginal
person living in one of the 100 remote communities in the Northern Territory.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Verdana; font-size: small;">It is time the Pharmacy Guild
took its head out of the sand and started to look around for ways its beloved
“service” can be improved for these Australians with the worst health status in
the land and who would not know why their prescribed medicines will work let
alone why they should take them.</span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Verdana; font-size: small;">Adherence is a problem and
none more so than amongst remote living Aboriginal Australians.</span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal" style="background: none repeat scroll 0% 0% rgb(230, 230, 230);">
<span style="font-family: Verdana; font-size: small;">One
more thing – the statement that the PBS has been </span><span style="font-size: small;"><b><i><span style="font-family: Verdana;">appropriately subsidized by government since </span></i></b><span style="font-family: Verdana;">1948 is wrong for remote living Aboriginal people –
it was not until the year 2000 that this occurred for these people through the
special arrangements made possible using Section 100 of the National Health
Act.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal" style="background: none repeat scroll 0% 0% rgb(255, 153, 0);">
<span style="font-size: small;"><b><span style="font-family: Verdana;">Any pharmacist
interested in investing in a pharmacy business and any one of the 20 remote
“growth towns” in the NT should contact the writer at <a href="mailto:rollom@oonet.net.au">rollom@iinet.net.au</a> or on 08 8991 8457 or
0411 049 872.</span></b></span></div>
<div class="MsoNormal" style="background: none repeat scroll 0% 0% rgb(255, 153, 0);">
<span style="font-size: small;"><b><span style="font-family: Verdana;">A Prospectus is to
be produced to assist future investors with their decisions.</span></b></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal">
<br /></div>
Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com1tag:blogger.com,1999:blog-12040314.post-60257507760833412112012-09-09T07:49:00.001+09:302012-09-11T11:15:24.911+09:30Chief Minister supports pharmacies in the bush<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><br />
<!--[if !mso]><img src="//img2.blogblog.com/img/video_object.png" style="background-color: #b2b2b2; " class="BLOGGER-object-element tr_noresize tr_placeholder" id="ieooui" data-original-id="ieooui" /> <style>
st1\:*{behavior:url(#ieooui) }
</style> <![endif]--><!--[if gte mso 10]> <style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:10.0pt;
font-family:"Times New Roman";}
</style> <![endif]--> <br />
<div align="center" class="MsoNormal" style="text-align: center;"><span style="font-size: small;"><b><span style="font-family: Verdana;">TRANSCRIPT</span></b></span></div><div align="center" class="MsoNormal" style="text-align: center;"><span style="font-size: small;"><b><span style="font-family: Verdana;">ABC RADIO </span></b><b><span style="font-family: Verdana;">ALICE SPRINGS</span></b><b><span style="font-family: Verdana;"></span></b></span></div><div align="center" class="MsoNormal" style="text-align: center;"><span style="font-size: small;"><b><span style="font-family: Verdana;">Thursday 6<sup>th</sup> September 2012</span></b></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: Verdana;"></span></b></div><div class="MsoNormal" style="line-height: 16pt;"><span style="font-size: xx-small;"><b><span style="font-family: Verdana;"><a href="https://dl-web.dropbox.com/get/Sound%20files/Mills%20on%20Rollo_070912.mp3?w=8a25aaac">Listen to sound file</a> </span></b></span></div><div class="MsoNormal" style="line-height: 16pt;"><span style="font-size: xx-small;"><b><span style="font-family: Verdana;">CALLER:</span></b></span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">An interview today with Rollo Manning encouraged the Government to provide pharmacies in remote communities …. what is your notion on that to get pharmacies in communities ….so there is the provision of quality use of medicines….</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><br />
</div><div class="MsoNormal" style="line-height: 16pt;"><span style="font-size: xx-small;"><b><span style="font-family: Verdana;">COMPERE:</span></b></span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">This is a story that has been around today …. about establishing pharmacies in remote communities that could lead to some employment by taking services out bush…is that something you would consider encouraging?</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgx_GUUTpPiwdZYoRlfyWtGZggXmeN8FHfRafL896Mrjg_yq3Iu0v7UdwkH-21CF3yZ8lzmaDdU1HTx2-JuioIaTvxZrYrK2xT_IuD3sHsa4wyaeA3bhK0NXAm0q9xwbuIeM9-2/s1600/Terry+Mills.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgx_GUUTpPiwdZYoRlfyWtGZggXmeN8FHfRafL896Mrjg_yq3Iu0v7UdwkH-21CF3yZ8lzmaDdU1HTx2-JuioIaTvxZrYrK2xT_IuD3sHsa4wyaeA3bhK0NXAm0q9xwbuIeM9-2/s200/Terry+Mills.JPG" width="154" /></a></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-size: xx-small;"><b><span style="font-family: Verdana;">TERRY MILLS MLA, Chief Minister</span></b></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: Verdana; font-size: 10.0pt;"> of the NT<br />
</span></b><span style="font-family: Verdana; font-size: 10.0pt;">Yes certainly – I have been at Ampilatwatja today <b style="mso-bidi-font-weight: normal;">…</b>and had a very sobering briefing on the health issues …I heard this report from Rollo Manning and <b style="mso-bidi-font-weight: normal;">it does make a lot of sense. I will be talking to my new Health Minister to pursue this. </b>Our core philosophy is to make sure wherever possible we put the decision making closer to the people that are affected by that decision. It does fit with my philosophy of allowing local people to be involved in solutions to their own problems in this case administering health and medicines to local people.</span></div>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-21001091309860033782012-09-07T08:13:00.002+09:302012-09-09T07:56:09.698+09:30Pharmacies should be built in communities says consultant - Northern Territory Country Hour - ABC Rural Australian Broadcasting Corporation)<b><span style="font-size: large;"><a href="http://www.abc.net.au/rural/nt/content/201209/s3584627.htm#.UEklfYaUB-k.blogger">Go to ABC Rural website for story and sound file</a></span></b><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSm6-NgXhEgApsFZOXqIVEMt-cWAQ-5VYIxGgxkdR6OrLpPWp-vUYMUwLg6RIHDtePORDSLbMZ4URJT_wVdy1XlXhJ-rc4iz6t9i6nTjrGeiFsl5SNZ08G7zcY33srWDEv08xD/s1600/Good+Health+Store.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="201" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSm6-NgXhEgApsFZOXqIVEMt-cWAQ-5VYIxGgxkdR6OrLpPWp-vUYMUwLg6RIHDtePORDSLbMZ4URJT_wVdy1XlXhJ-rc4iz6t9i6nTjrGeiFsl5SNZ08G7zcY33srWDEv08xD/s640/Good+Health+Store.JPG" width="640" /></a></div><div class="MsoNormal"><b><span style="font-family: Calibri; font-size: 12.0pt;">Pharmacy businesses in remote Aboriginal communities are a “natural” and must be supported to provide income to the local economy, real jobs, and career prospects for local people, a Consultant in pharmacy services to Aboriginal health facilities is telling the new CLP<span style="mso-spacerun: yes;"> </span>Government in the </span></b><b><span style="font-family: Calibri; font-size: 12.0pt;">Northern Territory</span></b><b><span style="font-family: Calibri; font-size: 12.0pt;">.</span></b></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Calibri;">Rollo Manning, a pharmacist, and the architect of the Tiwi Health Board pharmacy business in 2001, has been trying for ten years to repeat the effort in other towns but says he has received no support from the Government.</span></div><div class="MsoNormal"><span style="mso-arabic-font-family: Calibri; mso-armenian-font-family: Calibri; mso-currency-font-family: Calibri; mso-cyrillic-font-family: Calibri; mso-default-font-family: Calibri; mso-greek-font-family: Calibri; mso-hebrew-font-family: Calibri; mso-latin-font-family: Calibri; mso-latinext-font-family: Calibri; mso-thai-font-family: Calibri;"><span style="font-family: Calibri;"></span>“To read the publicity blurb behind the ‘</span><span style="font-family: Calibri;">Growth</span><span style="font-family: Calibri;"> </span><span style="font-family: Calibri;">Town</span><span style="font-family: Calibri;">’ future program of the Henderson Government it appeared that here was the answer. At last something would be done to create real jobs in communities through local entrepreneur opportunities” he said. “But alas nothing happened except an army of bureaucrats hide behind the glossy websites and colourful brochures”.</span></div><div class="MsoNormal"><span style="mso-arabic-font-family: Calibri; mso-armenian-font-family: Calibri; mso-currency-font-family: Calibri; mso-cyrillic-font-family: Calibri; mso-default-font-family: Calibri; mso-greek-font-family: Calibri; mso-hebrew-font-family: Calibri; mso-latin-font-family: Calibri; mso-latinext-font-family: Calibri; mso-thai-font-family: Calibri;"><span style="font-family: Calibri;"></span>The NT has one pharmacy to every 7.900 persons compared to the National figure of one pharmacy to every 4,200 people. The reason for this according to Rollo<span style="mso-spacerun: yes;"> </span>Manning is that the 53,000 persons living in remote<span style="mso-spacerun: yes;"> </span>communities are not serviced by a “local” pharmacy.</span></div><div class="MsoNormal"><span style="mso-arabic-font-family: Calibri; mso-armenian-font-family: Calibri; mso-currency-font-family: Calibri; mso-cyrillic-font-family: Calibri; mso-default-font-family: Calibri; mso-greek-font-family: Calibri; mso-hebrew-font-family: Calibri; mso-latin-font-family: Calibri; mso-latinext-font-family: Calibri; mso-thai-font-family: Calibri;"><span style="font-family: Calibri;"></span>“There is the is business out there due to the people having a health status recognised as four time worse than non Indigenous Australians. A population of 1000 remote living Aboriginals need the same amount of medicines under the Pharmaceutical Benefits Scheme as 4,000<span style="mso-spacerun: yes;"> </span>people in mainstream.” according to Rollo Manning.</span></div><div class="MsoNormal"><span style="mso-arabic-font-family: Calibri; mso-armenian-font-family: Calibri; mso-currency-font-family: Calibri; mso-cyrillic-font-family: Calibri; mso-default-font-family: Calibri; mso-greek-font-family: Calibri; mso-hebrew-font-family: Calibri; mso-latin-font-family: Calibri; mso-latinext-font-family: Calibri; mso-thai-font-family: Calibri;"><span style="font-family: Calibri;"></span>“Towns like Maningrida, Wadeye, Galiwin’ku and Jabiru should be able to support their own pharmacy business and I can assure anyone that there are the pharmacists ready and<span style="mso-spacerun: yes;"> </span>willing to be a part of such a movement.” he added.</span></div><div class="MsoNormal"><span style="mso-arabic-font-family: Calibri; mso-armenian-font-family: Calibri; mso-currency-font-family: Calibri; mso-cyrillic-font-family: Calibri; mso-default-font-family: Calibri; mso-greek-font-family: Calibri; mso-hebrew-font-family: Calibri; mso-latin-font-family: Calibri; mso-latinext-font-family: Calibri; mso-thai-font-family: Calibri;"><span style="font-family: Calibri;"></span>The inclusion of a pharmacist to the primary health effort is likely to be welcomed by all practitioners and a “point of sale” for all things towards </span><i><span style="mso-arabic-font-family: Calibri; mso-armenian-font-family: Calibri; mso-currency-font-family: Calibri; mso-cyrillic-font-family: Calibri; mso-default-font-family: Calibri; mso-greek-font-family: Calibri; mso-hebrew-font-family: Calibri; mso-latin-font-family: Calibri; mso-latinext-font-family: Calibri; mso-thai-font-family: Calibri;">“good health” </span></i><span style="mso-arabic-font-family: Calibri; mso-armenian-font-family: Calibri; mso-currency-font-family: Calibri; mso-cyrillic-font-family: Calibri; mso-default-font-family: Calibri; mso-greek-font-family: Calibri; mso-hebrew-font-family: Calibri; mso-latin-font-family: Calibri; mso-latinext-font-family: Calibri; mso-thai-font-family: Calibri;">would be the location of the pharmacy business.</span></div><div class="MsoNormal"><span style="mso-arabic-font-family: Calibri; mso-armenian-font-family: Calibri; mso-currency-font-family: Calibri; mso-cyrillic-font-family: Calibri; mso-default-font-family: Calibri; mso-greek-font-family: Calibri; mso-hebrew-font-family: Calibri; mso-latin-font-family: Calibri; mso-latinext-font-family: Calibri; mso-thai-font-family: Calibri;"><span style="font-family: Calibri;">“A whole of Government approach is needed and this<span style="mso-spacerun: yes;"> </span>includes the Department of Health”, he added.</span></span></div><div class="MsoNormal"><br />
</div><br />
Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com1tag:blogger.com,1999:blog-12040314.post-64074226381215253572012-09-02T12:22:00.002+09:302012-09-03T06:15:35.139+09:30NT election outcome signals new era<b><a class="twitter-follow-button" data-show-count="false" data-size="large" href="https://twitter.com/rollom38">Follow @rollom38</a> </b><br />
<b>A new approach is likely to economic development in remote Aboriginal communities as a result of the resounding victory of the Country Liberal Party (CLP) election held last weekend.</b><br />
It now looks as though the CLP have won 16 seats in the 25 seat Parliament with one seat held by the Independent Gerry Wood and the balance by the outgoing Labor Party with eights seats – down from the previous 12 seats.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRpelHBdkLZtSAy_lKcCxFcUB8WS92Jf4N2S4oLhjiHoT_55K5p2jFrW28Vd543KY0qchEU6CkQ0yrk-qxF9XF2d5mI1XHvaUC-ZMOmILASrn1ZylUn2iNwezi597wn8uIF9nL/s1600/CLP+heroes.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="329" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRpelHBdkLZtSAy_lKcCxFcUB8WS92Jf4N2S4oLhjiHoT_55K5p2jFrW28Vd543KY0qchEU6CkQ0yrk-qxF9XF2d5mI1XHvaUC-ZMOmILASrn1ZylUn2iNwezi597wn8uIF9nL/s640/CLP+heroes.JPG" width="640" /></a></div><div style="text-align: right;"><span style="font-size: xx-small;">Picture courtesy NT News </span></div>The significant element to the result was the success “in the bush” – all those seats outside of Darwin and Alice Springs – now held by CLP members of Parliament and which were previously Labor held seats.<br />
The gains have seen the following significance Aboriginal people being elected to the Parliament:<br />
<b>Alison Anderson</b> – Seat of Namatjiraa - previous Labour Minister under leader and Chief Minister Paul Henderson who defected to the cross benches in 2009 and then joined the CLP. Ms Anderson has been outspoken in her views on the Federal Intervention, that 12 maxi Shires replaced some 80 Community Government Councils and the new Stronger Futures legislation for the next ten years from Canberra.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmOLOzJidjTLnNVPVH17OgALHQ2r42ymkEe20WVBOOR6h-3nB6Aq81tVptADEHgRAIdjRKy3unuffIbP81yOOyFjrHIa8-thj0YuX5iFoTgLXh4thU2wbE8YU3kpTAQ4j5tUPd/s1600/Arafura+CLP.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="164" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmOLOzJidjTLnNVPVH17OgALHQ2r42ymkEe20WVBOOR6h-3nB6Aq81tVptADEHgRAIdjRKy3unuffIbP81yOOyFjrHIa8-thj0YuX5iFoTgLXh4thU2wbE8YU3kpTAQ4j5tUPd/s200/Arafura+CLP.JPG" width="200" /></a></div><b>Francis Xavier Maralampuwi</b> – Seat of Arafura – a local Traditional Aboriginal man from Nguiu, Bathurst Island where he has lived all his life with distinction as a leader in the Community Government Council, Land Council and more recently the Shires. Maralampuwi has a good record in sport as a footballer and in charity work helping people with alcohol and drug problems for the past 30 years. He has won the Seat of Arafura by a 58 seat margin – a seat formerly held for 11 years by popular ALP member Marion Scrymgour who also had a strong local following. It was the people of Nguiu that have put Maralampuwi into Parliament with an 80% support from that polling booth.<br />
<b>Bess Price </b>– Seat of Stuart- has ousted former Henderson Government Minister Karl Hampton. Ms Price has developed her own strong personal profile as a person who will say it as it is and not resort to politically correct verbage when describing how she sees the major issues confronting Aboriginal people in the “bush”. Her views are well known in the National sphere through appearances in shows such as ABC Q & A and SBS Insight. Her margin was a mere 187 votes in an electorate that is larger that most countries in Europe and spans from the centre around Alice Springs through the Tanami Desert to places like Timber Creek on the main highway to WA.<br />
<b>Larissa Lee</b> – Seat of Arnhem – has won from popular Government Minister for Indigenous Affairs Malandari McCarthy – a former ABC journalist in Darwin and well known traditional Aboriginal person from Borroloola. The seat had been uncontested in 2008 and the selection of Larissa as the candidate was a stroke of brilliance by the CLP given her powerful family background being the daughter of the late Jawoyn Aboriginal Elder Robert Lee. An Aboriginal Health Worker from Barunga, Larissa won the seat with a 10.6% margin.<br />
<br />
The above four persons have brought about the change in Government and the strength of the effort means that a 100% commitment has been made for doing things better for the “bush”.<br />
One of the key elements of any improvement program will be more jobs and developing real economies in places (towns) that have up until now relied on no competition, welfare handouts and a static work environment with unemployment being the main occupation.<br />
<br />
And this is where pharmacy comes in on two fronts. <br />
The first is bringing into the community money that is currently going to the main centres of Alice Springs and Darwin by way of surpluses made on trading with Medicare for the supply of Pharmaceutical Benefits Scheme medicines. This could all be going to these towns with the strategic placement of local pharmacy businesses in the Growth Towns. There are many young pharmacists keen to establish there own businesses and what better or more challenging place to do it than a remote Aboriginal community classified as a “Growth Town” and with the support of a Government committed to creating economies.<br />
The second contribution pharmacy (or pharmacists) can make is the provision of a “point of sale” for all things that will lead to a healthy lifestyle – food, activities, exercise programs, books, DVDs, motivational programs and the many many things that are taken for granted in “mainstream” culture way but denied of these people by a governance that has seen no reason for competition or no more that one store.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJBKl-wVowhxc_gx_6P9oWfd_2k2aibjef2AEslxmyIb_c9h9V73xeDv3vsScfF0UmYy5e1w81t-VMAsSsoRjia-yrnhNpcL0CDLCVqRfwTTfzoCRpq4j4M_HZkWyOicdj6uDE/s1600/Good+Health+Store.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="202" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJBKl-wVowhxc_gx_6P9oWfd_2k2aibjef2AEslxmyIb_c9h9V73xeDv3vsScfF0UmYy5e1w81t-VMAsSsoRjia-yrnhNpcL0CDLCVqRfwTTfzoCRpq4j4M_HZkWyOicdj6uDE/s640/Good+Health+Store.JPG" width="640" /></a></div><a href="http://remoteaboriginals.blogspot.com.au/2009/02/aboriginal-towns-stark-contrast-to.html">A comparison between an Aboriginal Growth Town and a mainstream country town</a> shows that there are 15 retail outlets in the mainstream town compared with five in Aboriginal land and yet a disposable income far higher with the Aboriginals than in mainstream. This is because they pay very little rent for fewer houses and are not likely to own a car. If the cost of these is taken out of a family budget it is not hard to find and extra $500 a fortnight and yet have nothing useful to spend it on. In one store there is 35% of purchases spent on tobacco products and this has increased over the past 20 years by 2%. Quite unlike the downward spiral in mainstream where tobacco products have gone down from around 60 % of the population smoking to 15% in the same period (20 years). Problem – no point of sale for health promotion – just messages through print and media.<br />
<br />
The CLP Government comes into office with the following policy commitments:<br />
o The creation of a commercial environment so that businesses can earn decent profits and grow. <br />
o The creation of a strong and growing economy by allowing and encouraging private industry to thrive. <br />
o Expanding the Small Business Advisory Service across the whole Territory will help more Indigenous people in remote communities get into real jobs and off welfare. <br />
o Shires and Regional councils will be assisted to pursue new business opportunities to expand their service and revenue base.<br />
o Regional Councils will give a greater say to local people on where money is spent and how services are delivered in their region.<br />
o The Country Liberals are committed to delivering a stronger local voice, better services and a safer, more prosperous future for our regions.<br />
No better climate could have been created for emerging pharmacy businesses but it is now for the industry to get behind and back such a progression. The present profile in the NT shows that for a population of 220,000 there are 28 pharmacies – one per 7.900 persons compared with a National figure of one per 4,200.<br />
The difference is in the persons in remote communities NOT being served by a pharmacy meaning that the profits from their communities is going to the big stakeholders in Alice Springs and Darwin.<br />
Now is the time to jump and a consortium started that will seize the opportunity and allow many young pharmacists to make a contribution which although not being the most rewarding financially will certainly be rewarding in health outcomes through professional satisfaction.<br />
Ends<br />
Comments welcome to Rollo Manning, PO Box 98 Parap NT or rollom@iinet.net.au or 0411 049 872<br />
<br />
Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0Darwin NT 0800, Australia-12.4628198 130.84176939999998-12.4735238 130.83265539999996 -12.4521158 130.8508834tag:blogger.com,1999:blog-12040314.post-40777289996647327062012-06-21T06:39:00.000+09:302012-06-21T06:39:00.049+09:30<a href="https://twitter.com/rollom38" class="twitter-follow-button" data-show-count="false" data-size="large">Follow @rollom38</a><br />
<script>!function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0];if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src="//platform.twitter.com/widgets.js";fjs.parentNode.insertBefore(js,fjs);}}(document,"script","twitter-wjs");</script>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com1tag:blogger.com,1999:blog-12040314.post-14214329455990965752012-04-02T17:46:00.000+09:302012-04-02T17:46:56.099+09:30Who is an “Aboriginal”? The need to distinguish between “remote” and “urban”<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if !mso]><img src="http://img2.blogblog.com/img/video_object.png" style="background-color: #b2b2b2; " class="BLOGGER-object-element tr_noresize tr_placeholder" id="ieooui" data-original-id="ieooui" /> <style>
st1\:*{behavior:url(#ieooui) }
</style> <![endif]--><!--[if gte mso 10]> <style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:10.0pt;
font-family:"Times New Roman";}
</style> <![endif]--> <br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrqCfwkKMt5Djkeu_Rz-o5bnTnQhLalOKF9LuW940f3GgxfVL3joIyQ6DWMXMtLN-mSj5XfyCd0sx-gtzYmwDHWORIP6YxzasDdnHiMSwh1O0g-DKHG1bWDg5nHCSOUE50JgiE/s1600/Dulcie_Hayley.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="164" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrqCfwkKMt5Djkeu_Rz-o5bnTnQhLalOKF9LuW940f3GgxfVL3joIyQ6DWMXMtLN-mSj5XfyCd0sx-gtzYmwDHWORIP6YxzasDdnHiMSwh1O0g-DKHG1bWDg5nHCSOUE50JgiE/s200/Dulcie_Hayley.jpg" width="200" /></a></div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDQou2uXJ9SriOh04TaX-8KyPoOVhYn25dSznCkUh53jcFGWKvqOROz8VKvljqOSkJcaR1X1rlDhEAnc6Hlp9BFulaA-OWZpC63j4Yb8sGOIYVN7L_Hrh5VDWum3fGGsGTih0a/s1600/Oxfam.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDQou2uXJ9SriOh04TaX-8KyPoOVhYn25dSznCkUh53jcFGWKvqOROz8VKvljqOSkJcaR1X1rlDhEAnc6Hlp9BFulaA-OWZpC63j4Yb8sGOIYVN7L_Hrh5VDWum3fGGsGTih0a/s200/Oxfam.jpg" width="140" /></a><br />
<div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">The averaging of indicators of disadvantage does nothing to help understand the plight of remote living Aboriginal people in </span><span style="font-family: Verdana; font-size: 10.0pt;">Australia</span><span style="font-family: Verdana; font-size: 10.0pt;">.</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">There are some 140,000 persons living “in remote” out of a total population of 520,000 claiming Aboriginal heritage – that is 26%.</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">The majority of </span><span style="font-family: Verdana; font-size: 10.0pt;">Australia</span><span style="font-family: Verdana; font-size: 10.0pt;">’s “Aboriginal people” live in urban areas of the cities and towns with access to education, health services, employment opportunities and the lifestyle of mainstream Australians. They have been born and raised in those developed environments and so have access to facilities to improve their life. The majority have succeeded.</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">By contrast, the remote living Aboriginal people who make up the 140,000 that live in communities may have never seen a train or tram, caught a bus or attended a movie cinema for entertainment. Their view of the world is entirely different from their cousins in the towns and cities. To them the world is little or no education, over crowded houses, one store with a limited range of fresh food and people who come and go delivering health services. It is a “world view” that the average Australian cannot imagine.</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">Nearly all of the remote living Aboriginals are full blooded Aboriginal people with no mixed blood and thus with the full gene compliment of the original race of people. Western culture has added its genes to the pool that make up the remainder of the Aboriginal population thus making comparisons difficult on the basis of genotypes.</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">So why is it that when analysing the “gap” - disadvantage, life expectancy or disease incidence the all Aboriginal statistic is given?</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">Surely the Australian Bureau of Statistics knows by now who is who – it is after all since 1967 that Aboriginal Australians have been included in Census data. So long as statistics are averaged across all Aboriginal persons a skewed picture will be obtained and the contrast between the two population cohorts not appreciated by the policy makers.</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">A good example of this was the PBS QuMAX/s100 Forum recently held in </span><span style="font-family: Verdana; font-size: 10.0pt;">Melbourne</span><span style="font-family: Verdana; font-size: 10.0pt;"> with pharmacists from all over </span><span style="font-family: Verdana; font-size: 10.0pt;">Australia</span><span style="font-family: Verdana; font-size: 10.0pt;"> gathered to learn about and discuss quality use of medicine programs to Aboriginal (and Torres Strait Islander) people in </span><span style="font-family: Verdana; font-size: 10.0pt;">Australia</span><span style="font-family: Verdana; font-size: 10.0pt;">. Thus pharmacists dealing with these two world views were thrust together and expected to understand each others target audiences as if they were the same. It has to be recognised by the policy makers and program planners that this is not the case and it is only when it is taken into account that realistic programs can be put in place.</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">The statistic is given that in 2006 deaths and hospitalisations caused by cardiovascular disease for indigenous Australians were double the rates of non-indigenous Australians<a href="http://www.blogger.com/post-create.g?blogID=12040314#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Verdana; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">[1]</span></span></span></span></a>; or that Aboriginal and Torres Strait Islander people are much more likely to develop complications (e.g. pneumonia and ear damage) from respiratory tract infections<a href="http://www.blogger.com/post-create.g?blogID=12040314#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Verdana; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">[2]</span></span></span></span></a>. </span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">Such sweeping statements do nothing to help understand the degree of Aboriginality that makes up the cohort from which such conclusions have been drawn. It must be possible to draw a distinction between the remote living Aboriginal people and urban living persons. The Pharmaceutical Benefits Scheme for one thing is done differently and the medicine use for remote Aboriginal people is through special arrangements using Section 100 of the National Health Act to supply medicines directly to the Aboriginal Health Services. This would allow an analysis to be done on the supplies that are paid for by Medicare to the supplying Approved Pharmacies in either hospitals or the community. But alas, after three years of trying the Centre for Chronic Disease at the </span><span style="font-family: Verdana; font-size: 10.0pt;">University</span><span style="font-family: Verdana; font-size: 10.0pt;"> of </span><span style="font-family: Verdana; font-size: 10.0pt;">Queensland</span><span style="font-family: Verdana; font-size: 10.0pt;"> has been denied access to the Medicare data.</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">At the above mentioned Forum in </span><span style="font-family: Verdana; font-size: 10.0pt;">Melbourne</span><span style="font-family: Verdana; font-size: 10.0pt;"> it was stated that the three most prescribed medicines for “Aboriginal people” were Metformin, Atorvastin and Salbutamol. This was from CTG prescriptions and should have been possible to correlate with the usage through the s100 arrangements - but no – there is no such data available even though the scheme has been operating for 12 years. </span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">This writer knows that from the data of one Aboriginal Health Service<a href="http://www.blogger.com/post-create.g?blogID=12040314#_ftn3" name="_ftnref3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Verdana; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">[3]</span></span></span></span></a> in a remote location the usage shows the top three supplied medicines are Ramipril, Atorvastin and Amoxycillin. Such a figure should be available from supplies to all AHSs.</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">The final piece of information that demonstrates the point of this article is life expectancy.</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">When averaged out across the total population of Aboriginal Australians the 17 year gap is identified. This means the Aboriginal person has a life expectancy of 62 years for males and 67 for females.</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">However if the age at death is looked at for Aboriginal people in the Northern Territory<a href="http://www.blogger.com/post-create.g?blogID=12040314#_ftn4" name="_ftnref4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Verdana; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">[4]</span></span></span></span></a> the median age at death for males is 51 years (15 years less than non Indigenous) and females is 55 years (20 years less than non Indigenous). A stark contrast to the “average” over the total population. When remote locations are taken into account the difference is even greater.</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="font-family: Verdana; font-size: 10.0pt;">In the words of Professor Wendy Hoy, Director of the Centre for Chronic Disease in </span><span style="font-family: Verdana; font-size: 10.0pt;">Brisbane</span><span style="font-family: Verdana; font-size: 10.0pt;">:</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><i style="mso-bidi-font-style: normal;"><span style="color: black; font-family: Verdana; font-size: 10.0pt;">“The quickest way to “narrow the gap” is to reduce disease burden and deaths in remote areas, where rates are much higher than in Indigenous people living closer to population centres”. </span></i></div><div class="MsoNormal" style="line-height: 16.0pt;"><br />
</div><div class="MsoNormal" style="line-height: 16.0pt;"><span style="color: black; font-family: Verdana; font-size: 10.0pt;">Ends</span></div><div class="MsoNormal" style="line-height: 16.0pt;"><br />
</div><div style="mso-element: footnote-list;"><br clear="all" /> <hr align="left" size="1" width="33%" /> <div id="ftn1" style="mso-element: footnote;"> <div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=12040314#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="font-family: Verdana; font-size: 8.0pt;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Verdana; font-size: 8.0pt; mso-ansi-language: EN-AU; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">[1]</span></span></span></span></span></a><span style="font-family: Verdana; font-size: 8.0pt;"> NPS at <a href="http://www.nps.org.au/news_and_media/media_releases/repository/Experiencing_the_outback_side_of_pharmacy">http://www.nps.org.au/news_and_media/media_releases/repository/Experiencing_the_outback_side_of_pharmacy</a> </span></div></div><div id="ftn2" style="mso-element: footnote;"> <div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=12040314#_ftnref2" name="_ftn2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="font-family: Verdana; font-size: 8.0pt;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Verdana; font-size: 8.0pt; mso-ansi-language: EN-AU; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">[2]</span></span></span></span></span></a><span style="font-family: Verdana; font-size: 8.0pt;"> NPS at <a href="http://www.nps.org.au/bemedicinewise/common_colds/antibiotics_dont_kill_viruses">http://www.nps.org.au/bemedicinewise/common_colds/antibiotics_dont_kill_viruses</a> </span></div></div><div id="ftn3" style="mso-element: footnote;"> <div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=12040314#_ftnref3" name="_ftn3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="font-family: Verdana; font-size: 8.0pt;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Verdana; font-size: 8.0pt; mso-ansi-language: EN-AU; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">[3]</span></span></span></span></span></a><span style="font-family: Verdana; font-size: 8.0pt;"> Personal communication to author</span></div></div><div id="ftn4" style="mso-element: footnote;"> <div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=12040314#_ftnref4" name="_ftn4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span style="font-family: Verdana; font-size: 8.0pt;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Verdana; font-size: 8.0pt; mso-ansi-language: EN-AU; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">[4]</span></span></span></span></span></a><span style="font-family: Verdana; font-size: 8.0pt;"> ABS<u> - <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Products/3302.0%7E2010%7EChapter%7EDeaths+of+Aboriginal+and+Torres+Strait+Islander+Australians?OpenDocument"><span style="color: windowtext; mso-bidi-font-weight: bold;">Deaths of Aboriginal and Torres Strait Islander Australians</span></a></u>. 2010</span></div></div></div>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-78311789837766715792012-01-03T06:31:00.000+09:302012-01-03T06:31:18.756+09:30May 2012 be the year that SOCIAL INCLUSION is the commitment to inspiring a reinvigorated relief for Aboriginal disadvantage<div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-RmuydWecsBA/TwDsbDl6u0I/AAAAAAAAAjs/lEuOrwfuLqo/s1600/Photo+Butler+Mark+100495+-+010+%25284%2529.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="141" src="http://3.bp.blogspot.com/-RmuydWecsBA/TwDsbDl6u0I/AAAAAAAAAjs/lEuOrwfuLqo/s200/Photo+Butler+Mark+100495+-+010+%25284%2529.JPG" width="200" /></a><!--[if !mso]> <style>
v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
b\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</style> <![endif]--><!--[if pub]><xml> <b:Publication type="OplPub" oty="68" oh="256"> <b:OhPrintBlock priv="30e">280</b:OhPrintBlock> <b:NuDefaultUnits priv="1004">1</b:NuDefaultUnits> <b:DptlPageDimensions type="OplPt" priv="1211"> <b:Xl priv="104">7560000</b:Xl> <b:Yl priv="204">10692000</b:Yl> </b:DptlPageDimensions> <b:DxlDefaultTab priv="1504">359410</b:DxlDefaultTab> <b:OhGallery priv="180e">259</b:OhGallery> <b:OhFancyBorders priv="190e">261</b:OhFancyBorders> <b:OhCaptions priv="1a0e">257</b:OhCaptions> <b:OhQuillDoc priv="200e">275</b:OhQuillDoc> <b:OhMailMergeData priv="210e">262</b:OhMailMergeData> <b:OhColorScheme priv="220e">278</b:OhColorScheme> <b:DwNextUniqueOid priv="2304">1</b:DwNextUniqueOid> <b:IdentGUID priv="2a07">0``````````````````````</b:IdentGUID> <b:DpgSpecial priv="2c03">5</b:DpgSpecial> </b:Publication> <b:PrinterInfo type="OplPrb" oty="75" oh="280"> <b:OhColorSepBlock priv="30e">281</b:OhColorSepBlock> <b:FInitComplete priv="1400">False</b:FInitComplete> <b:DpiX priv="2203">0</b:DpiX> <b:DpiY priv="2303">0</b:DpiY> </b:PrinterInfo> <b:ColorSeperationInfo type="OplCsb" oty="79" oh="281"> <b:Plates type="OplCsp" priv="214"> <b:OplCsp type="OplCsp" priv="11"> <b:EcpPlate type="OplEcp" priv="213"> <b:Color priv="104">-1</b:Color> </b:EcpPlate> </b:OplCsp> </b:Plates> <b:DzlOverprintMost priv="304">304800</b:DzlOverprintMost> <b:CprOverprintMin priv="404">243</b:CprOverprintMin> <b:FKeepawayTrap priv="700">True</b:FKeepawayTrap> <b:CprTrapMin1 priv="904">128</b:CprTrapMin1> <b:CprTrapMin2 priv="a04">77</b:CprTrapMin2> <b:CprKeepawayMin priv="b04">255</b:CprKeepawayMin> <b:DzlTrap priv="c04">3175</b:DzlTrap> <b:DzlIndTrap priv="d04">3175</b:DzlIndTrap> <b:PctCenterline priv="e04">70</b:PctCenterline> <b:FMarksRegistration priv="f00">True</b:FMarksRegistration> <b:FMarksJob priv="1000">True</b:FMarksJob> <b:FMarksDensity priv="1100">True</b:FMarksDensity> <b:FMarksColor priv="1200">True</b:FMarksColor> <b:FLineScreenDefault priv="1300">True</b:FLineScreenDefault> </b:ColorSeperationInfo> <b:TextDocProperties type="OplDocq" oty="91" oh="275"> <b:OhPlcqsb priv="20e">277</b:OhPlcqsb> <b:EcpSplitMenu type="OplEcp" priv="a13"> <b:Color>134217728</b:Color> </b:EcpSplitMenu> </b:TextDocProperties> <b:StoryBlock type="OplPlcQsb" oty="101" oh="277"> <b:IqsbMax priv="104">1</b:IqsbMax> <b:Rgqsb type="OplQsb" priv="214"> <b:OplQsb type="OplQsb" priv="11"> <b:Qsid priv="104">60</b:Qsid> <b:TomfCopyfitBase priv="80b">-9999996.000000</b:TomfCopyfitBase> <b:TomfCopyfitBase2 priv="90b">-9999996.000000</b:TomfCopyfitBase2> </b:OplQsb> </b:Rgqsb> </b:StoryBlock> <b:ColorScheme type="OplSccm" oty="92" oh="278"> <b:Cecp priv="104">8</b:Cecp> <b:Rgecp type="OplEcp" priv="214"> <b:OplEcp priv="f">Empty</b:OplEcp> <b:OplEcp type="OplEcp" priv="111"> <b:Color>16711680</b:Color> </b:OplEcp> <b:OplEcp type="OplEcp" priv="211"> <b:Color>52479</b:Color> </b:OplEcp> <b:OplEcp type="OplEcp" priv="311"> <b:Color>26367</b:Color> </b:OplEcp> <b:OplEcp type="OplEcp" priv="411"> <b:Color>13421772</b:Color> </b:OplEcp> <b:OplEcp type="OplEcp" priv="511"> <b:Color>16737792</b:Color> </b:OplEcp> <b:OplEcp type="OplEcp" priv="611"> <b:Color>13382502</b:Color> </b:OplEcp> <b:OplEcp type="OplEcp" priv="711"> <b:Color>16777215</b:Color> </b:OplEcp> </b:Rgecp> <b:SzSchemeName priv="618">Bluebird</b:SzSchemeName> </b:ColorScheme> </xml><![endif]--><!--[if pub]><xml> <b:Page type="OplPd" oty="67" oh="265"> <b:PtlvOrigin type="OplPt" priv="511"> <b:Xl>22858095</b:Xl> <b:Yl>22852380</b:Yl> </b:PtlvOrigin> <b:Oid priv="605">(`@`````````</b:Oid> <b:OhoplWebPageProps priv="90e">266</b:OhoplWebPageProps> <b:OhpdMaster priv="d0d">263</b:OhpdMaster> <b:PgtType priv="1004">5</b:PgtType> </b:Page> <b:WebPageInfo type="OplWebPageProps" oty="96" oh="266"> </b:WebPageInfo> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="3073" fill="f" fillcolor="white [7]"
strokecolor="black [0]"> <v:fill color="white [7]" color2="black [0]" on="f"/> <v:stroke color="black [0]" color2="white [7]"> <o:left v:ext="view" color="black [0]" color2="white [7]"/> <o:top v:ext="view" color="black [0]" color2="white [7]"/> <o:right v:ext="view" color="black [0]" color2="white [7]"/> <o:bottom v:ext="view" color="black [0]" color2="white [7]"/> <o:column v:ext="view" color="black [0]" color2="white [7]"/> </v:stroke> <v:shadow color="#ccc [4]"/> <v:textbox inset="2.88pt,2.88pt,2.88pt,2.88pt"/> <o:colormenu v:ext="edit" fillcolor="blue [1]" strokecolor="black [0]"
shadowcolor="#ccc [4]"/> </o:shapedefaults><o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> </div><div class="MsoNormal"><span style="font-size: large;"><span style="color: #993300; font-family: "Arial Rounded MT Bold"; font-weight: bold; line-height: 100%;">Minister for Social Inclusion, Mark Butler MP needs to be<span> r</span>eminded that remote living<span> </span>Aboriginals are in need of<span> </span>recognition before being<span> </span>excluded even more—write and tell him c/o Parliament House, Canberra, ACT, 2600</span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: x-small;"><span style="color: #993300; font-family: "Arial Rounded MT Bold"; font-weight: bold; line-height: 100%;"><span style="color: black; font-size: large;">Extract from<i> The Australian</i>, Monday 26th December 2011</span> </span></span><span style="language: EN-AU;"></span></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-i5ebs03Ep14/TwDvDzD-TQI/AAAAAAAAAkE/Odmi0UKv8PA/s1600/Social+Inclusion4.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="420" src="http://2.bp.blogspot.com/-i5ebs03Ep14/TwDvDzD-TQI/AAAAAAAAAkE/Odmi0UKv8PA/s640/Social+Inclusion4.JPG" width="640" /><span><span style="background-color: yellow;"></span></span></a></div><div class="separator" style="clear: both; text-align: center;"></div><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif; font-size: large;"><b>I never stop wondering what I could do to help bring about social inclusion. There are so many examples of where it has gone wrong over the few years I have been involved, such as the following...</b></span><br />
<br />
<!--[if !mso]> <style>
v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
b\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</style> <![endif]--><!--[if pub]><xml> <b:Publication type="OplPub" oty="68" oh="256"> <b:OhPrintBlock priv="30e">280</b:OhPrintBlock> <b:NuDefaultUnits priv="1004">1</b:NuDefaultUnits> <b:DptlPageDimensions type="OplPt" priv="1211"> <b:Xl priv="104">7560000</b:Xl> <b:Yl priv="204">10692000</b:Yl> </b:DptlPageDimensions> <b:DxlDefaultTab priv="1504">359410</b:DxlDefaultTab> <b:OhGallery priv="180e">259</b:OhGallery> <b:OhFancyBorders priv="190e">261</b:OhFancyBorders> <b:OhCaptions priv="1a0e">257</b:OhCaptions> <b:OhQuillDoc priv="200e">275</b:OhQuillDoc> <b:OhMailMergeData priv="210e">262</b:OhMailMergeData> <b:OhColorScheme priv="220e">278</b:OhColorScheme> <b:DwNextUniqueOid priv="2304">1</b:DwNextUniqueOid> <b:IdentGUID priv="2a07">0``````````````````````</b:IdentGUID> <b:DpgSpecial priv="2c03">5</b:DpgSpecial> </b:Publication> <b:PrinterInfo type="OplPrb" oty="75" oh="280"> <b:OhColorSepBlock priv="30e">281</b:OhColorSepBlock> <b:FInitComplete priv="1400">False</b:FInitComplete> <b:DpiX priv="2203">0</b:DpiX> <b:DpiY priv="2303">0</b:DpiY> </b:PrinterInfo> <b:ColorSeperationInfo type="OplCsb" oty="79" oh="281"> <b:Plates type="OplCsp" priv="214"> <b:OplCsp type="OplCsp" priv="11"> <b:EcpPlate type="OplEcp" priv="213"> <b:Color priv="104">-1</b:Color> </b:EcpPlate> </b:OplCsp> </b:Plates> <b:DzlOverprintMost priv="304">304800</b:DzlOverprintMost> <b:CprOverprintMin priv="404">243</b:CprOverprintMin> <b:FKeepawayTrap priv="700">True</b:FKeepawayTrap> <b:CprTrapMin1 priv="904">128</b:CprTrapMin1> <b:CprTrapMin2 priv="a04">77</b:CprTrapMin2> <b:CprKeepawayMin priv="b04">255</b:CprKeepawayMin> <b:DzlTrap priv="c04">3175</b:DzlTrap> <b:DzlIndTrap priv="d04">3175</b:DzlIndTrap> <b:PctCenterline priv="e04">70</b:PctCenterline> <b:FMarksRegistration priv="f00">True</b:FMarksRegistration> <b:FMarksJob priv="1000">True</b:FMarksJob> <b:FMarksDensity priv="1100">True</b:FMarksDensity> <b:FMarksColor priv="1200">True</b:FMarksColor> <b:FLineScreenDefault priv="1300">True</b:FLineScreenDefault> </b:ColorSeperationInfo> <b:TextDocProperties type="OplDocq" oty="91" oh="275"> <b:OhPlcqsb priv="20e">277</b:OhPlcqsb> <b:EcpSplitMenu type="OplEcp" priv="a13"> <b:Color>134217728</b:Color> </b:EcpSplitMenu> </b:TextDocProperties> <b:StoryBlock type="OplPlcQsb" oty="101" oh="277"> <b:IqsbMax priv="104">1</b:IqsbMax> <b:Rgqsb type="OplQsb" priv="214"> <b:OplQsb type="OplQsb" priv="11"> <b:Qsid priv="104">61</b:Qsid> <b:TomfCopyfitBase priv="80b">-9999996.000000</b:TomfCopyfitBase> <b:TomfCopyfitBase2 priv="90b">-9999996.000000</b:TomfCopyfitBase2> </b:OplQsb> </b:Rgqsb> </b:StoryBlock> <b:ColorScheme type="OplSccm" oty="92" oh="278"> <b:Cecp priv="104">8</b:Cecp> <b:Rgecp type="OplEcp" priv="214"> <b:OplEcp priv="f">Empty</b:OplEcp> <b:OplEcp type="OplEcp" priv="111"> <b:Color>16711680</b:Color> </b:OplEcp> <b:OplEcp type="OplEcp" priv="211"> <b:Color>52479</b:Color> </b:OplEcp> <b:OplEcp type="OplEcp" priv="311"> <b:Color>26367</b:Color> </b:OplEcp> <b:OplEcp type="OplEcp" priv="411"> <b:Color>13421772</b:Color> </b:OplEcp> <b:OplEcp type="OplEcp" priv="511"> <b:Color>16737792</b:Color> </b:OplEcp> <b:OplEcp type="OplEcp" priv="611"> <b:Color>13382502</b:Color> </b:OplEcp> <b:OplEcp type="OplEcp" priv="711"> <b:Color>16777215</b:Color> </b:OplEcp> </b:Rgecp> <b:SzSchemeName priv="618">Bluebird</b:SzSchemeName> </b:ColorScheme> </xml><![endif]--><!--[if pub]><xml> <b:Page type="OplPd" oty="67" oh="265"> <b:PtlvOrigin type="OplPt" priv="511"> <b:Xl>22858095</b:Xl> <b:Yl>22852380</b:Yl> </b:PtlvOrigin> <b:Oid priv="605">(`@`````````</b:Oid> <b:OhoplWebPageProps priv="90e">266</b:OhoplWebPageProps> <b:OhpdMaster priv="d0d">263</b:OhpdMaster> <b:PgtType priv="1004">5</b:PgtType> </b:Page> <b:WebPageInfo type="OplWebPageProps" oty="96" oh="266"> </b:WebPageInfo> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="3073" fill="f" fillcolor="white [7]"
strokecolor="black [0]"> <v:fill color="white [7]" color2="black [0]" on="f"/> <v:stroke color="black [0]" color2="white [7]"> <o:left v:ext="view" color="black [0]" color2="white [7]"/> <o:top v:ext="view" color="black [0]" color2="white [7]"/> <o:right v:ext="view" color="black [0]" color2="white [7]"/> <o:bottom v:ext="view" color="black [0]" color2="white [7]"/> <o:column v:ext="view" color="black [0]" color2="white [7]"/> </v:stroke> <v:shadow color="#ccc [4]"/> <v:textbox inset="2.88pt,2.88pt,2.88pt,2.88pt"/> <o:colormenu v:ext="edit" fillcolor="blue [1]" strokecolor="black [0]"
shadowcolor="#ccc [4]"/> </o:shapedefaults><o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> <br />
<div class="separator" style="clear: both; text-align: center;"></div><div class="MsoNormal" style="margin-bottom: 14pt;"><a href="http://3.bp.blogspot.com/-DeSM3Sp6pRM/TwE-l5KdGlI/AAAAAAAAAlM/xIhQcmc46dc/s1600/Deleece1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="http://3.bp.blogspot.com/-DeSM3Sp6pRM/TwE-l5KdGlI/AAAAAAAAAlM/xIhQcmc46dc/s200/Deleece1.jpg" width="161" /></a><span style="font-size: large;"><span style="color: black; font-family: "Arial Rounded MT Bold"; font-weight: bold; line-height: 100%;">Deleece </span><span style="color: black; font-family: Calibri; line-height: 100%;">was let down by a system that thrives on mediocrity.<br />
Centrelink, Job Services Australia and the entire “job ready” effort is organised by an army of bureaucrats gobbling up endless amounts of money and losing sight of what they are really there for – the people, and yes... there are people at the end of the line that need help.<br />
<b>SOCIAL INCLUSION</b> should mean the provision of the tools for everyone, regardless of location, to education and training to join in their share of the Nation’s wealth.</span></span></div><div class="MsoNormal" style="margin-bottom: 14pt;"><span style="font-size: large;"><span style="color: black; font-family: Calibri; line-height: 100%;"> </span></span></div><span style="font-size: small;"> </span><div class="MsoNormal"><a href="http://4.bp.blogspot.com/-2WDoPvIZRqI/TwEvOqPhavI/AAAAAAAAAk0/K9qQzWyMVe8/s1600/Zoe_Lucinda1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="http://4.bp.blogspot.com/-2WDoPvIZRqI/TwEvOqPhavI/AAAAAAAAAk0/K9qQzWyMVe8/s200/Zoe_Lucinda1.jpg" width="185" /></a><span style="font-size: large;"><span style="font-family: "Arial Rounded MT Bold"; font-weight: bold; line-height: 100%;"> Zoe and Lucinda </span><span style="font-family: Calibri; line-height: 100%;">are from a remote community with a population of 1200 people 500 Kms north east of<span> </span>Darwin. There are few<span> </span>employment opportunities apart from services and little attention is given to starting entrepreneurial businesses. Without this to observe, the growing child has little opportunity to view scope, dreams or vision for the future. Their future is in our hands.</span></span></div><div class="MsoNormal" style="line-height: 12.0pt; mso-line-height-rule: exactly;"><span style="font-size: large;"><span style="font-family: Calibri; line-height: 100%;"><b>SOCIAL INCLUSION</b> should give all children the chance to dream and aspire to future successes - at present they complete their schooling and have no idea what they want to do with the rest of their life. Hundreds of young Aboriginal children who finish their schooling are lost every year to another generation of welfare recipients simply because they know of nothing better to do.</span></span><span style="font-family: "Arial Rounded MT Bold"; font-size: 12.0pt; font-weight: bold; language: EN-AU; mso-ansi-language: EN-AU; mso-arabic-font-family: Calibri; mso-armenian-font-family: Calibri; mso-ascii-font-family: "Arial Rounded MT Bold"; mso-currency-font-family: Calibri; mso-cyrillic-font-family: Calibri; mso-default-font-family: "Arial Rounded MT Bold"; mso-greek-font-family: Calibri; mso-hebrew-font-family: Calibri; mso-latin-font-family: "Arial Rounded MT Bold"; mso-latinext-font-family: Calibri; mso-thai-font-family: Calibri;"> </span></div><div class="MsoNormal" style="line-height: 12pt;"><span style="font-family: "Arial Rounded MT Bold"; font-size: 12pt; font-weight: bold;"><br />
</span></div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-CfBIXSQjVjk/TwE6t_nx-aI/AAAAAAAAAlA/SCpq7ZqgQZA/s1600/Bob+Beadman.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="177" src="http://1.bp.blogspot.com/-CfBIXSQjVjk/TwE6t_nx-aI/AAAAAAAAAlA/SCpq7ZqgQZA/s200/Bob+Beadman.JPG" width="200" /></a></div><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 10]> <style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:10.0pt;
font-family:"Times New Roman";}
</style> <![endif]--> <div class="MsoNormal"><span style="font-size: large;"><b><span style="font-family: "Arial Rounded MT Bold";">Bob Beadman asked...<br />
"WHAT HAPPENED TO THE DREAMS?"<br />
</span></b></span><span style="font-size: large;"><b><span style="font-family: Calibri;">(</span></b><i><span style="font-family: Calibri;">Do Indigenous youth have a dream</span></i><span style="font-family: Calibri;">– Menzies Research Centre 2004)</span></span></div><div class="MsoNormal" style="line-height: 12pt;"><br />
</div><div class="MsoNormal"><span style="font-size: large;"><span style="font-family: Calibri; line-height: 100%;">“</span><span style="font-family: Calibri; line-height: 100%;">I am looking at human detritus right</span><span style="font-family: Calibri; line-height: 100%;"> </span><span style="font-family: Calibri; line-height: 100%;">here in Darwin, and wonder what dreams they might have once had for themselves</span><span style="font-family: Calibri; line-height: 100%;">? <span> </span></span><span style="font-family: Calibri; font-weight: bold; line-height: 100%;"></span></span></div><div class="MsoNormal"><span style="font-size: large;"><span style="font-family: Calibri; line-height: 100%;">What dreams they might have had for their children</span><span style="font-family: Calibri; line-height: 100%;">?</span><span style="font-family: Calibri; line-height: 100%;"> What dreams their children might have had for themselves</span><span style="font-family: Calibri; line-height: 100%;">?</span><span style="font-family: Calibri; line-height: 100%;"> </span><span style="font-family: Calibri; line-height: 100%;"></span></span></div><div class="MsoNormal"><span style="font-size: large;"><span style="font-family: Calibri; line-height: 100%;">I wonder if people have abandoned those dreams, what caused</span><span style="font-family: Calibri; line-height: 100%;"> </span><span style="font-family: Calibri; line-height: 100%;">them to give up, what is it about the world that surrounds us all that makes them think</span><span style="font-family: Calibri; line-height: 100%;"> </span><span style="font-family: Calibri; line-height: 100%;">that their dreams </span><span style="font-family: Calibri; line-height: 100%;">are<span> </span>unachi</span><span style="font-family: Calibri; line-height: 100%;">evable</span><span style="font-family: Calibri; line-height: 100%;">.</span><span style="font-family: Calibri; line-height: 100%;">”</span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><u><i><span style="font-size: large;"><span style="font-family: Calibri; line-height: 100%;">We must strive to assist the young ones to develop those dreams they once had but now seem forgotten. </span></span><span style="language: EN-AU;"></span></i></u></div><u><i> </i></u><div class="MsoNormal" style="margin-bottom: 14.0pt;"><span style="color: black; font-family: Calibri; font-size: 12.0pt; language: EN-AU; line-height: 100%; mso-ansi-language: EN-AU; mso-arabic-font-family: Calibri; mso-armenian-font-family: Calibri; mso-ascii-font-family: Calibri; mso-currency-font-family: Calibri; mso-cyrillic-font-family: Calibri; mso-default-font-family: Calibri; mso-greek-font-family: Calibri; mso-hebrew-font-family: Calibri; mso-latin-font-family: Calibri; mso-latinext-font-family: Calibri; mso-thai-font-family: Calibri;"><br />
</span><span style="font-family: Calibri; font-size: 4.0pt; language: EN-AU; line-height: 100%; mso-arabic-font-family: Calibri; mso-armenian-font-family: Calibri; mso-ascii-font-family: Calibri; mso-currency-font-family: Calibri; mso-cyrillic-font-family: Calibri; mso-default-font-family: Calibri; mso-greek-font-family: Calibri; mso-hebrew-font-family: Calibri; mso-latin-font-family: Calibri; mso-latinext-font-family: Calibri; mso-thai-font-family: Calibri;"></span></div><div class="MsoNormal" style="margin-bottom: 14pt;"><span style="font-size: large;"><span style="color: black; font-family: Calibri; line-height: 100%;"><b>SOCIAL INCLUSION </b>should not be hard to grasp - it does what it says - includes people in a social context as well as economic and environmental settings in communities. Where social capital is the glue that holds a community together - social inclusion is the philosophy under which all else happens.</span></span></div><div class="MsoNormal" style="margin-bottom: 14pt;"><span style="font-size: large;"><span style="color: black; font-family: Calibri; line-height: 100%;"><b>SOCIAL INCLUSION</b> must be the focus of a renewe<span style="background-color: yellow;"></span>d reconciliation for all young Aboriginal children and youth no matter where they are from BUT particularly those from remote commuinities where an understanding of the dominant culture's world view is somewhat lacking. The youth of Australia must be made to know they are wanted and loved and be inspired to enjoy the Nation's opportunities just like their urban counterparts attending the plush private schools in the capital cities.</span></span></div><div class="MsoNormal" style="margin-bottom: 14pt;"><span style="color: black; font-family: Calibri; font-size: 12pt; line-height: 100%;"><span style="font-size: large;">Ends</span></span><span style="font-family: Calibri; font-size: 4pt; line-height: 100%;"></span></div><div class="MsoNormal"><br />
</div>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-26579725556143786192011-11-30T06:31:00.000+09:302011-11-30T06:31:04.642+09:30INTEREST HIGH WITH STUDENTS IN ABORIGINAL HEALTH<!--[if !mso]> <style>
v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</style> <![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 10]> <style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:10.0pt;
font-family:"Times New Roman";}
</style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="1027"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> <br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimXpfIlfbO_ekR_NWA8IlfsR6TzyIKU2Bi__gESMwQkoLhYO78PCCDtQQnad9O96O792U9RMKB0OmqUrqi72AOsD9_lVmvOnwn4r0mCbH7L-VFDLv_dwGQX0Clo-pqkhLJ5jrQ/s1600/Janine1096.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimXpfIlfbO_ekR_NWA8IlfsR6TzyIKU2Bi__gESMwQkoLhYO78PCCDtQQnad9O96O792U9RMKB0OmqUrqi72AOsD9_lVmvOnwn4r0mCbH7L-VFDLv_dwGQX0Clo-pqkhLJ5jrQ/s320/Janine1096.jpg" width="320" /></a></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri; font-size: 14.0pt;"></span></b></div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: Calibri;">The future supply of pharmacists to work in Aboriginal health is healthy if the outcome of a National Australian Pharmacy Students’ Association survey is anything to go by.</span></div><div class="MsoNormal" style="line-height: 150%; mso-layout-grid-align: none; text-autospace: none;"><span style="font-family: Calibri; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: TrebuchetMS;">While 83% of respondents felt it is important to be taught about Aboriginal and Torres Strait Islander health issues as part of their pharmacy course curriculum, only 60% have access to such education. Furthermore, only half of those respondents feel they are taught enough about this topic.</span><span style="font-family: Calibri;"></span></div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: Calibri;">Students believed that the present level of awareness was good with 60% saying they had exposure to Aboriginal health learning during their course. </span></div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: Calibri;">Only 9% of respondents had Aboriginal health as an integral part of the core curriculum while 50% had the information delivered in just one or two lectures.</span></div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: Calibri;">A minority of respondents (25%) felt they were trained to competently practice in a culturally acceptable manner while 35% felt they could not.</span></div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: Calibri;">The favoured method of learning about cultural awareness in Aboriginal health was a half day or one day training course (45%) while practical experience was mentioned as the best way of learning the subject.</span></div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: Calibri;">The recommendations of the survey outcomes should see an increase in the component of Aboriginal health training in pharmacy curriculum with an emphasis on cultural awareness.</span></div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: Calibri;">With a workforce planning study being commenced on the supply and demand for pharmacists in rural and remote areas it is to be hoped that staff establishments for primary health care in communities will include the position of a pharmacist.</span></div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: Calibri;">It is only by participating that pharmacists will be able to show how they can contribute beyond the “pick and lick” image that is currently held on their role.</span></div><div class="MsoNormal" style="line-height: 150%;"><br />
</div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: Calibri;">Ends</span></div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: Calibri;">Comment to Rollo Manning at <a href="mailto:rollom@iinet.net.au">rollom@iinet.net.au</a> or call on 0411 049 872</span></div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: Calibri;"><span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="line-height: 150%;"><br />
</div>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0Parap NT 0820, Australia-12.4311499 130.84331369999995-12.4383539 130.83446019999997 -12.4239459 130.85216719999994tag:blogger.com,1999:blog-12040314.post-33119542701605871332011-03-29T16:17:00.001+09:302011-03-30T06:06:29.331+09:30Senate inquiry agreed to in Parliament— PBS to remote living Aboriginals to be examined<span style="color: black; font-family: Symbol; font-size: 12pt;"></span><span style="font: 7pt "Times New Roman";"> </span><span style="font-family: "Century Schoolbook"; font-size: 9pt; line-height: 89%;"></span> <br />
<div class="MsoNormal" style="line-height: 15pt;"><b><span style="font-family: "Century Schoolbook"; font-size: 9pt;">On </span></b><b><span style="font-family: "Century Schoolbook"; font-size: 9pt;">24th March 2011</span></b><b><span style="font-family: "Century Schoolbook"; font-size: 9pt;"> the Senate agreed to a motion from Senator Rachel Siewert (Greens, WA) that the supply of Pharmaceutical Benefits Scheme medicines to remote area Aboriginal Health Services be referred to the Senate Community Affairs Reference Committee. The special arrangements under Section 100 of the National Health Act have provided a bulk supply scheme with no value added component from a pharmacist.</span></b></div><div class="MsoNormal" style="line-height: 15pt;"><span style="font-family: "Century Schoolbook"; font-size: 9pt;">Three reviews of the scheme in 2004 (Kelaher) 2006 (Urbis) and 2010 (Nova Policy) have failed to produce any significant improvement in the quality use of medicines by Aboriginal clients of health services. </span></div><div class="MsoNormal"><span style="color: #006600; font-family: "Century Schoolbook"; font-size: 16pt;">A matter of equity </span></div><div class="MsoNormal" style="line-height: 15pt;"><b><span style="font-family: "Century Schoolbook"; font-size: 9pt;">The matter to be reviewed by the Senate Committee is a matter of justice, fairness and equity particularly relevant at a time when <i>Closing the Gap</i> is so much in the headlines and remote living Aboriginal people are dying at such a young age.</span></b></div><div class="MsoNormal" style="line-height: 15pt;"><span style="font-family: "Century Schoolbook"; font-size: 9pt;">After three reviews of the Section 100 supply arrangements little change has occurred. The Senate Inquiry should be able to identify what needs to be improved and which agency should be responsible for making it happen. The involvement of pharmacists in this process should be a leading principle.</span></div><div class="MsoNormal" style="line-height: 15pt;"><span style="font-family: "Century Schoolbook"; font-size: 9pt;">Inequities for remote Aboriginal Health Services (AHS) and the Pharmaceutical Benefits Scheme (PBS) include:</span></div><ul><li><span style="font-family: "Century Schoolbook"; font-size: 9pt; line-height: 89%;">Over the ten years the scheme has been in place there has been no money made available to the Aboriginal Health Services to develop their own pharmaceutical care program.</span><span style="font-family: "Century Schoolbook"; font-size: 9pt; line-height: 89%;"></span></li>
<li><span style="color: black; font-family: Symbol; font-size: 12pt;"></span><span style="font: 7pt "Times New Roman";"> </span><span style="font-family: "Century Schoolbook"; font-size: 9pt; line-height: 89%;">Recording of outgoing supplies (dispensing) by any electronic process incorporating scanning is absent and hand written labels are the norm.</span><span style="font-family: "Century Schoolbook"; font-size: 9pt; line-height: 89%;"></span></li>
<li><span style="color: black; font-family: Symbol; font-size: 12pt;"></span><span style="font: 7pt "Times New Roman";"></span><span style="font-family: "Century Schoolbook"; font-size: 9pt; line-height: 89%;"> While the PBS pays a dispensing fee ($6.42) to pharmacies in all situations under Section 85 (mainstream) there is no fee paid for the dispensing carried out at Aboriginal Health Services.</span><span style="font-family: "Century Schoolbook"; font-size: 9pt; line-height: 89%;"></span></li>
<li><span style="color: black; font-family: Symbol; font-size: 12pt;"></span><span style="font: 7pt "Times New Roman";"> </span><span style="font-family: "Century Schoolbook"; font-size: 9pt; line-height: 89%;">The PBS saves $3.68 every time a PBS medicine is dispensed to a remote living Aboriginal person. A handling fee of $2.74 is paid to the supplying Approved Pharmacy for the bulk supply but no dispensing fee is paid to the AHS.</span><span style="font-family: "Century Schoolbook"; font-size: 9pt; line-height: 89%;"></span></li>
<li><span style="color: black; font-family: Symbol; font-size: 12pt;"></span><span style="font: 7pt "Times New Roman";"> </span><span style="font-family: "Century Schoolbook"; font-size: 9pt; line-height: 89%;">Mainstream Australians have access to a pharmacist (by law) in every pharmacy in Australia when a PBS prescription is dispensed. No such facility is available to an Aboriginal patient of an AHS or to a </span><span style="font-family: "Century Schoolbook"; font-size: 9pt; line-height: 89%;"></span><div class="MsoNormal"></div><span style="font-family: "Century Schoolbook"; font-size: 9pt; line-height: 89%;">person trained by a pharmacist to inform them of the nature of the medicine prescribed.</span><span style="font-family: "Century Schoolbook"; font-size: 9pt; line-height: 89%;"></span></li>
<li><span style="color: black; font-family: Symbol; font-size: 12pt;"></span><span style="font: 7pt "Times New Roman";"> </span><span style="font-family: "Century Schoolbook"; font-size: 9pt; line-height: 89%;">No data is analysed to assist in decision making towards improved medicine utilisation across States and regional boundaries.</span><span style="font-family: "Century Schoolbook"; font-size: 10.5pt; font-weight: bold; line-height: 100%;"> </span></li>
</ul>Go to the following link for details on the Inquiry and the making of a submission: <br />
<a href="http://www.aph.gov.au/Senate/committee/clac_ctte/pbs_medicines/index.htm">http://www.aph.gov.au/Senate/committee/clac_ctte/pbs_medicines/index.htm</a><br />
<br />
<div style="background-color: #cfe2f3; color: #073763;"><span style="font-size: large;"><b>Closing date for Submissions is 30th June 2011. </b></span></div><br />
<div class="MsoNormal" style="line-height: 15pt;"><b><span style="font-family: "Century Schoolbook"; font-size: 10pt;">The </span></b><b><span style="font-family: "Century Schoolbook";">Terms of Reference </span></b><b><span style="font-family: "Century Schoolbook"; font-size: 10pt;">seek comment on a range of issues. The full text of the Motion agreed to by the Senate follows:</span></b></div><div class="MsoNormal" style="line-height: 15pt;"><span style="font-family: "Century Schoolbook"; font-size: 9.5pt;">The effectiveness of the special arrangements established in 1999 under section 100 of the National Health Act 1953, for the supply of Pharmaceutical Benefits Scheme (PBS) medicines to remote area Aboriginal Health Services, with particular reference to:</span></div><div class="MsoNormal" style="line-height: 15pt;"><span style="font-family: "Century Schoolbook"; font-size: 9.5pt;">(a) whether these arrangements adequately address barriers experienced by Aboriginal and Torres Strait Islander people living in remote areas of Australia in accessing essential medicines through the PBS;</span></div><div class="MsoNormal" style="line-height: 15pt;"><span style="font-family: "Century Schoolbook"; font-size: 9.5pt;">(b) the clinical outcomes achieved from the measure, in particular to improvements in patient understanding of, and adherence to, prescribed treatment as a result of the improved access to PBS medicines;</span></div><div class="MsoNormal" style="line-height: 15pt;"><span style="font-family: "Century Schoolbook"; font-size: 9.5pt;">(c) the degree to which the ‘quality use of medicines’ has been achieved including the amount of contact with a pharmacist available to these patients compared to urban Australians;</span></div><div class="MsoNormal" style="line-height: 15pt;"><span style="font-family: "Century Schoolbook"; font-size: 9.5pt;">(d) the degree to which state/territory legislation has been complied with in respect to the recording, labelling and monitoring of PBS medicines;</span></div><div class="MsoNormal" style="line-height: 15pt;"><span style="font-family: "Century Schoolbook"; font-size: 9.5pt;">(e) the distribution of funding made available to the program across the Approved Pharmacy network compared to the Aboriginal Health Services obtaining the PBS medicines and dispensing them on to its patients;</span></div><div class="MsoNormal" style="line-height: 15pt;"><span style="font-family: "Century Schoolbook"; font-size: 9.5pt;">(f) the extent to which Aboriginal Health Workers in remote communities have sufficient educational opportunities to take on the prescribing and dispensing responsibilities given to them by the PBS bulk supply arrangements;</span></div><div class="MsoNormal" style="line-height: 15pt;"><span style="font-family: "Century Schoolbook"; font-size: 9.5pt;">(g) the degree to which recommendations from previous reviews have been implemented and any consultation which has occurred with the community controlled Aboriginal health sector about any changes to the program;</span></div><div class="MsoNormal" style="line-height: 15pt;"><span style="font-family: "Century Schoolbook"; font-size: 9.5pt;">(h) access to PBS generally in remote communities; and</span></div><div class="MsoNormal" style="line-height: 15pt;"><span style="font-family: "Century Schoolbook"; font-size: 9.5pt;">(i) any other related matters.</span></div><div class="MsoNormal" style="line-height: 15pt;"><b><span style="font-family: "Century Schoolbook"; font-size: 10.5pt;">Question agreed to.</span></b></div><div class="MsoNormal"><br />
<b><span style="background-color: #d9ead3; color: #274e13; font-size: small;">Any person or organisation requiring further background to the Inquiry or assistance with the writing of a submission can contact Rollo Manning at rollom@iinet.net.au or 0411 049 872.</span></b></div><div class="MsoNormal"><br />
</div>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-87955010887843044692011-03-16T06:41:00.002+09:302011-03-16T06:47:34.373+09:30Take medicines - seriously, and help Close the Gap<div class="MsoNormal" style="line-height: 14pt;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiHPBarkfMvMqEcYcJRb4eR5wVokChpEMGrT5sGVS0V5yQNAKM8c5-e96TQdjxSlsdeyic8xFvo9_zpZCZGTMEHNU5Zrc6ckd57bm-fqYMZ9xNet7_YzSusN4SsmeaMsQMzQag/s1600/Oxfam.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiHPBarkfMvMqEcYcJRb4eR5wVokChpEMGrT5sGVS0V5yQNAKM8c5-e96TQdjxSlsdeyic8xFvo9_zpZCZGTMEHNU5Zrc6ckd57bm-fqYMZ9xNet7_YzSusN4SsmeaMsQMzQag/s200/Oxfam.jpg" width="140" /></a></div><span style="font-size: 10pt;">The life expectancy gap for Indigenous Australians could be significantly closed if the same level of pharmaceutical care was applied to those living in remote communities as it is for the rest of the Australian population. The management of chronic diseases requires urgent attention in the provision of prescription medicines - in both monitoring adherence and follow up adjustment of dosing. </span></div><div class="MsoNormal" style="line-height: 14pt;"><span style="font-size: 10pt;">Patients attending Aboriginal health services in remote communities are being dispensed medicines with little recording, probably no label and scant advice on what to expect of it. This is the outcome of ten years of bulk supply of Pharmaceutical Benefits Scheme (PBS) medicines from an Approved Pharmacy with no involvement of a pharmacist in the dispensing process. The scheme is costing the Australian taxpayer $40 million a year yet even the Department of Health and Ageing admit there is wastage and an analysis of the Medicare records of payment would not be an accurate evaluation of what is being supplied to patients.</span></div><div class="MsoNormal" style="line-height: 14pt;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhquBlh8134xGX7PKG3NBQU-8TvBBH4RJ8sXH1vv0aO9tUvj8RPgFsJDWJGQTyOhWB_l1BZqB1xn2kiF52y-AFvFgdvgYaPie1BnOe1gqgt5VP7QVs-fl_Am6r_jZEeZc4EYAcN/s1600/Timeline_s100_spend.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="154" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhquBlh8134xGX7PKG3NBQU-8TvBBH4RJ8sXH1vv0aO9tUvj8RPgFsJDWJGQTyOhWB_l1BZqB1xn2kiF52y-AFvFgdvgYaPie1BnOe1gqgt5VP7QVs-fl_Am6r_jZEeZc4EYAcN/s200/Timeline_s100_spend.JPG" width="200" /></a><span style="font-size: 10pt;">Whilst it will take years for medicine taking to impact on the life expectancy gap between Indigenous and non-Indigenous Australians this discreet group of patients with only one supply route should be an ideal target for some primary practice research. </span></div><div class="MsoNormal" style="line-height: 14pt;"><span style="font-size: 10pt;">But no! </span></div><div class="MsoNormal" style="line-height: 14pt;"><span style="font-size: 10pt;">Researchers admit that the missing element in data with respect to chronic disease management is knowing whether the patient is taking their medicine. Whilst this might apply to the bulk of Australians with chronic diseases, the clinical signs should be there to illustrate the benefits of medicine taking. Otherwise why is the taxpayer paying $8.4 billion a year on the PBS?</span></div><div class="MsoNormal" style="line-height: 14pt;"><span style="font-size: 10pt;">With no record of supply and the labelling an unknown quantity – the quality of pharmaceutical care is suspect.</span></div><div class="MsoNormal" style="line-height: 14pt;"><span style="font-size: 10pt;">Approved Pharmacies (agents for the supply of PBS medicines) are under no obligation to provide support in the supply on to the patient. That is the job of the Aboriginal health service and done by doctors, nurses and Aboriginal Health Workers with no payment from the PBS to meet the cost of dispensing.</span></div><div class="MsoNormal" style="line-height: 14pt;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEim3P-OnRYYFLddc3NqJ_RLbZDDhTWGeluFKX-dhdPLsZAKMXw3DQlAxgIyfRJT_ylWsIvRRu70J81l6KMFgu5B7YLmooOmWPauUNfpZM8h5UJPiJ_QTV90jxrWsM5qvyDm7r4K/s1600/New+man.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="220" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEim3P-OnRYYFLddc3NqJ_RLbZDDhTWGeluFKX-dhdPLsZAKMXw3DQlAxgIyfRJT_ylWsIvRRu70J81l6KMFgu5B7YLmooOmWPauUNfpZM8h5UJPiJ_QTV90jxrWsM5qvyDm7r4K/s320/New+man.jpg" width="320" /></a></div><span style="font-size: 10pt;">In mainstream PBS supply the Approved Pharmacy is paid $6.42 every time a prescription is dispensed. It is recorded on an IT system that has been paid for and upgraded by the PBS. In remote “drug rooms” there is no such luxury – not even a typewriter for labelling. </span></div><div class="MsoNormal" style="line-height: 14pt;"><span style="font-size: 10pt;">Of the $40 million dollar cost to the PBS in this financial year, $10 million will go to the Approved Pharmacy through a combination of a $2.74 handling fee per item and a 15% mark up on the cost of goods. The PBS actually saves $3.68 every time a packet of pills is given to a remote living Aboriginal person. Extended across a year this amounts to $5.52 million and that would employ a lot of pharmacists at Aboriginal health services to add some quality to the supply and give the patients an understanding of what western medicine is all about.</span></div><div class="MsoNormal" style="line-height: 14pt;"><span style="font-size: 10pt;">All Australians, when given a prescription by a doctor, take it to a pharmacy for dispensing. They can then ask the pharmacist (always present by law) whatever question they want about that medicine. The salary of that pharmacist is largely contributed to by the PBS through the dispensing fee. For the remote living Aboriginal there is no such practice. There are no pharmacists employed by Aboriginal health services in the NT and only three in the whole of </span><span style="font-size: 10pt;">Australia</span><span style="font-size: 10pt;">.</span></div><div class="MsoNormal" style="line-height: 14pt;"><span style="font-size: 10pt;">This is a shameful situation and one that shows a high degree of discrimination and unacceptable level of unequal opportunity. The National Indigenous Health Equality Council is not interested in this matter claiming that it does not fall within its terms of reference. The Pharmacy Guild is interested in its members being viable entities while NACCHO (the Aboriginal health peak body) is overwhelmed by the Pharmacy Guild into thinking that “this is as good as it gets”. </span></div><div class="MsoNormal" style="line-height: 14pt;"><span style="font-size: 10pt;">The diseases killing Aboriginal people at a young age were not there 40 years ago and have been brought on by lifestyle choices. This makes it even more important that information is provided to help the patient understand what the medicine is going to do and how it will work to help them live longer. </span></div><div class="MsoNormal" style="line-height: 14pt;"><span style="font-size: 10pt;">Such is the need for a greater emphasis on the quality use of medicine for Aboriginal people in remote communities if <i>Close the Gap</i> is to be taken seriously.</span></div><div class="MsoNormal" style="line-height: 14pt;"><span style="font-size: 10pt;">Ends</span></div>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com1tag:blogger.com,1999:blog-12040314.post-17049571511616008742011-01-24T11:52:00.001+09:302011-01-24T11:55:39.769+09:30The plethora of pharmacy programs<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_u3ugQLB59ZU0VGygV9JvOImnbIMpNIaT0yDdZsPcB1MM3aaEp5LswcrlvhFw2fuTKr0Q_5mHuP12A_EHqpb6IuAGfYg0-qpC6ejK2BYUAnnKZ92-zAZRtPl5281iABQrNvf2/s1600/A+cost+of+medicne.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br />
</a><br />
<div style="background: none repeat scroll 0% 0% rgb(243, 243, 243); border: 1pt solid silver; padding: 1pt 4pt;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_u3ugQLB59ZU0VGygV9JvOImnbIMpNIaT0yDdZsPcB1MM3aaEp5LswcrlvhFw2fuTKr0Q_5mHuP12A_EHqpb6IuAGfYg0-qpC6ejK2BYUAnnKZ92-zAZRtPl5281iABQrNvf2/s1600/A+cost+of+medicne.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br />
</a></div><div><div id="ftn2"><div style="background: none repeat scroll 0% 0% rgb(243, 243, 243); border: 1pt solid silver; padding: 1pt 4pt;"><div style="background: none repeat scroll 0% 0% rgb(243, 243, 243); border: medium none; line-height: 13pt; padding: 0cm;"><b><span style="font-family: Verdana; font-size: 10pt;">The purpose of this paper is to describe the current situation for Aboriginal and Torres Strait Islander people obtaining a prescription for medicine under the Pharmaceutical Benefits Scheme and dispensed by a pharmacy – be that in a hospital, the community setting or from an Aboriginal Health Service either government owned and operated or under community control.</span></b></div></div><div style="line-height: 13pt;"><b><span style="font-family: Verdana; font-size: 10pt;">Introduction</span></b><span style="font-family: Verdana; font-size: 10pt;"><br />
The past ten years has seen some effort put into improving the compliance rate and health gains by Aboriginal and Torres Strait Islander people from the use of western medicines. Emphasis has been placed on chronic disease conditions which are having a serious impact on longevity of life and forcing a wide gap in life expectancy between Indigenous Australians and non-Indigenous Australians. The average “gap” is shown to be 17 years although by region those living in remote areas of Australia have a lower life expectancy and are thus crucial to “closing the gap” on an Australia wide count.</span></div><div style="line-height: 13pt;"><b><span style="font-family: Verdana; font-size: 10pt;">Background<br />
</span></b><span style="font-family: Verdana; font-size: 10pt;">The respective stakeholders in primary health care each has a concern for the health of Indigenous Australians. The needs of the patient must be paramount over the processes that suit a mainstream population. Too often remote living Indigenous Australians have been forced to accept a mainstream model of service delivery when their needs reflect more that of a Third World country requiring a program designed to specifically meet their needs. This applies to the Section 100 PBS to remote AHS arrangements. In urban areas where possible the needs of the patient can be made to fit the mainstream model and this should be done rather than establishing new processes. The QuMAX and <i>Close the Gap</i> programs have failed to do this effectively.</span></div><div style="line-height: 13pt;"><span style="font-family: Verdana; font-size: 10pt;">The Federal Government, as the funder, has tried to meet the requests emanating from the prime peak bodies, the Pharmacy Guild and NACCHO. In addition the following have had some part in the lobbying process:</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghyphenhyphenY88v3lTOFNWiTRhXQ98RdQ8WnOntZaJNB8WdffI6TttqVSm0J5lfiaxOiKLyCinGgOorVvvo-vEM961htOo193AC8Ei32ndCuCupB3rIO2le9hNZm9k4dy_ZxQrvNPBnNPT/s1600/A+sick+in+bed.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghyphenhyphenY88v3lTOFNWiTRhXQ98RdQ8WnOntZaJNB8WdffI6TttqVSm0J5lfiaxOiKLyCinGgOorVvvo-vEM961htOo193AC8Ei32ndCuCupB3rIO2le9hNZm9k4dy_ZxQrvNPBnNPT/s320/A+sick+in+bed.jpg" width="290" /></a></div><ul><li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Verdana; font-size: 10pt;">The Pharmaceutical Society of </span><span style="font-family: Verdana; font-size: 10pt;">Australia</span><span style="font-family: Verdana; font-size: 10pt;"></span></li>
<li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Verdana; font-size: 10pt;">The Australian Medical Association</span></li>
<li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Verdana; font-size: 10pt;">Australian Divisions of General Practice</span></li>
<li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Verdana; font-size: 10pt;">Royal</span><span style="font-family: Verdana; font-size: 10pt;"> </span><span style="font-family: Verdana; font-size: 10pt;">Australasian</span><span style="font-family: Verdana; font-size: 10pt;"> </span><span style="font-family: Verdana; font-size: 10pt;">College</span><span style="font-family: Verdana; font-size: 10pt;"> of Physicians</span></li>
<li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Verdana; font-size: 10pt;">Royal</span><span style="font-family: Verdana; font-size: 10pt;"> </span><span style="font-family: Verdana; font-size: 10pt;">Australian</span><span style="font-family: Verdana; font-size: 10pt;"> </span><span style="font-family: Verdana; font-size: 10pt;">College</span><span style="font-family: Verdana; font-size: 10pt;"> of GPs</span></li>
<li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Verdana; font-size: 10pt;">Rural Doctors Association</span></li>
<li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Verdana; font-size: 10pt;">National Rural Health </span><span style="font-family: Verdana; font-size: 10pt;">Alliance</span><span style="font-family: Verdana; font-size: 10pt;"></span></li>
<li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Verdana; font-size: 10pt;">Australian Pharmacy Council</span></li>
<li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Verdana; font-size: 10pt;">The Society of Hospital Pharmacists of </span><span style="font-family: Verdana; font-size: 10pt;">Australia</span><span style="font-family: Verdana; font-size: 10pt;"></span></li>
</ul><div style="line-height: 13pt;"><br />
</div><div style="line-height: 13pt;"><span style="font-family: Verdana; font-size: 10pt;">The following programs have been put in place over the past ten years:</span></div><ol><li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Verdana; font-size: 10pt;">Special PBS listing of medicines specifically for Indigenous Australians</span></li>
<li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Verdana; font-size: 10pt;">Section 100 arrangements for supply to remote living Indigenous Australians</span></li>
<li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Verdana; font-size: 10pt;">Special allowance for pharmacists supplying remote health services under s100 to implement quality use of medicine measures</span></li>
<li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Verdana; font-size: 10pt;">National Prescribing Service program for “outreach pharmacists” to remote Aboriginal health services (OPRAH)</span></li>
<li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Verdana; font-size: 10pt;">QuMAX program for cost of DAAs to Indigenous patients attending eligible community controlled health services.</span></li>
<li><span style="font-family: Symbol; font-size: 10pt;">·<span style="font: 7pt "Times New Roman";"> </span></span><i><span style="font-family: Verdana; font-size: 10pt;">Close the Gap</span></i><span style="font-family: Verdana; font-size: 10pt;"> co-payment relief for Indigenous people attending eligible general practice centres and registered for chronic disease management.</span></li>
</ol><div style="line-height: 13pt;"><span style="font-family: Verdana; font-size: 10pt;">The above programs have solved some problems but in doing so have created problems of their own. There needs to be a “global” look at the whole scene to evaluate where this has occurred and what can be learnt from the past ten years involving operators at the coalface. </span></div><div style="line-height: 13pt;"><span style="font-family: Verdana; font-size: 10pt;">In evaluating the cost benefits of these programs it is important to keep in mind the four basic principles of the National Medicines Policy which should be the underlying guide to development of quality pharmaceutical care. These are:</span></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><span style="font-family: Verdana; font-size: 10pt;">1.<span style="font: 7pt "Times New Roman";"> </span></span><b><span style="font-family: Verdana; font-size: 10pt;">Timely access</span></b><span style="font-family: Verdana; font-size: 10pt;"> to the medicines that Australians need at a cost individuals and the community can afford – this has been assured across the Nation</span></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><span style="font-family: Verdana; font-size: 10pt;">2.<span style="font: 7pt "Times New Roman";"> </span></span><b><span style="font-family: Verdana; font-size: 10pt;">Medicines meeting appropriate standards </span></b><span style="font-family: Verdana; font-size: 10pt;">of quality, safety and efficacy – including the correct recording and labelling of prescribed medicines in accordance wit the law – this has been assured across the Nation.</span></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><b><span style="font-family: Verdana; font-size: 10pt;">3.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: Verdana; font-size: 10pt;">Quality use of medicines</span></b><span style="font-family: Verdana; font-size: 10pt;"> with information to allow the patient to understand the medicines they are getting including effects, side effects, interactions and expectations of outcome. This is available to ALL Australians through a local retail pharmacy – but not remote living Aboriginal people.</span></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><b><span style="font-family: Verdana; font-size: 10pt;">4.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: Verdana; font-size: 10pt;">Maintaining a responsible and viable medicines industry</span></b><span style="font-family: Verdana; font-size: 10pt;"> including sustainable research, manufacturing and supply chain to the patient. The s100 to remote arrangements offer a sizeable income to retail pharmacies thus ensuring their viability. The urban programs ensure the “bill” is paid at the local pharmacy by health services and their patients.</span></div><div style="line-height: 13pt;"><b><span style="font-family: Verdana;">Situation analysis<br />
</span></b><span style="font-family: Verdana; font-size: 10pt;">The following comments are now made on each of the above:</span></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><b><span style="font-family: Verdana; font-size: 10pt;">1.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: Verdana; font-size: 10pt;">Special PBS listing of medicines specifically for Indigenous Australians</span></b><span style="font-family: Verdana; font-size: 10pt;"><br />
The list is essentially medicines which can be bought over the counter at a pharmacy. The cost of such an item when added to the PBS list and supplied in accordance with a legal PBS order immediately increases the cost to taxpayer by the dispensing fee, safety net recording fee and in the instance of urban dwellers the “additional extra charge”. This result means either the PBS or the consumer is paying more because of PBS listing unless the consumer has a Health Care Card.</span></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsY4BePN304dXlgW7qu_ebFN6modDBFpfAi3kX1sEoZR8SbCCsyeKrxAm4_nM6z0TVt5gYguBiHvSVdZMtKJLIZyvxgF7Ihlb9PY4l1GTQrR8SCfD7c9rlthbtKxIz_G5yGVhq/s1600/A+goods+arrive.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsY4BePN304dXlgW7qu_ebFN6modDBFpfAi3kX1sEoZR8SbCCsyeKrxAm4_nM6z0TVt5gYguBiHvSVdZMtKJLIZyvxgF7Ihlb9PY4l1GTQrR8SCfD7c9rlthbtKxIz_G5yGVhq/s320/A+goods+arrive.jpg" width="320" /></a><b><span style="font-family: Verdana; font-size: 10pt;">2.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: Verdana; font-size: 10pt;">Section 100 arrangements for supply to remote living Indigenous Australians<br />
</span></b><span style="font-family: Verdana; font-size: 10pt;">This has increased the availability of the full range of PBS general list of medicines to remote Aboriginal health service. However in devising the reimbursement formula to supplying pharmacies no consideration has been given to meeting the cost of dispensing at the AHS as the PBS does for every other Australian attending an Approved Pharmacy. The result has been poor quality in the standard of pharmaceutical care and no apparent indication of which party is responsible for improvements. The State/Territory governments are responsible for ensuring the legal requirements for supply are being met whilst the Commonwealth should be responsible for ensuring the remuneration is adequate to meet the principles of the National Medicines Policy.<br />
<br />
</span></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><b><span style="font-family: Verdana; font-size: 10pt;">3.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: Verdana; font-size: 10pt;">Special allowance for pharmacists supplying remote health services under s100 to implement quality use of medicine measures<br />
</span></b><span style="font-family: Verdana; font-size: 10pt;">This allowance has provision for two visits a year by a pharmacist to an Aboriginal Health Service to which the pharmacy is supplying medicines. This is inadequate to meet the needs of the patients attending that centre to understand and comply with the expectations of the medicine. Trust and confidence as a member of the central team is simply not possible with such infrequent visits. Reports of the major mission being to check for out dated stock do not indicate a high level of </span><span style="font-family: Verdana; font-size: 10pt;">QUM</span><span style="font-family: Verdana; font-size: 10pt;"> activity.<br />
<br />
</span></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><b><span style="font-family: Verdana; font-size: 10pt;">4.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: Verdana; font-size: 10pt;">National Prescribing Service program for “outreach pharmacists” to remote Aboriginal health services (OPRAH)<br />
</span></b><span style="font-family: Verdana; font-size: 10pt;">This program has the distinct advantage of bringing together pharmacists who are involved in the supply function to remote AHSs. This could provide a forum for a wide ranging discussion on improving quality and the avenues that work but unfortunately due to the policy of the NPS it is an educational session on a topic identified though “focus groups” in mainstream Australia and does not always bear relevance to a vital subject in remote Aboriginal health. If it was more directed to the target audience it could be more relevant.<br />
Participants should be assisted to understand the social determinants for health and where the management of medication use fits in to the overall patient care and prevention of illness process.<br />
<br />
</span></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><b><span style="font-family: Verdana; font-size: 10pt;">5.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: Verdana; font-size: 10pt;">QuMAX program for co-payment relief and cost of DAAs to Indigenous patients attending eligible community controlled health services.<br />
</span></b><span style="font-family: Verdana; font-size: 10pt;">This program has failed to meet a wide audience of need due to its restriction to the community controlled sector. Funding for this program will cease on </span><span style="font-family: Verdana; font-size: 10pt;">30 June 2011</span><span style="font-family: Verdana; font-size: 10pt;">. Even then the bureaucratic processes that have been established have not assisted a rapid uptake of co-payment relief or provision of more DAAs. An examination of the 13 page “Business Rules and Guidelines”<a href="http://www.blogger.com/post-create.g?blogID=12040314#_ftn1" name="_ftnref1" title=""><span class="MsoFootnoteReference"><span class="MsoFootnoteReference"><span style="font-family: Verdana; font-size: 10pt;">[1]</span></span></span></a> is testament to this. The money spent on preparing, implementing and evaluating these could have been well spent in providing a pharmacist to many ACCHOs to do what they wanted in the spirit of community control.<br />
The positive side for NMP purposes is that it assists in paying the bill at the pharmacy providing the services and thus add to its likely sustainability.<br />
The provision of DAAs through this program will cease on </span><span style="font-family: Verdana; font-size: 10pt;">30 June 2011</span><span style="font-family: Verdana; font-size: 10pt;"> while this has been seen by pharmacists as a positive aid to adherence. A scheme such as exists for Department of Veterans Affairs beneficiaries is advocated to replace the QuMAX initiative.<br />
<br />
</span></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><b><span style="font-family: Verdana; font-size: 10pt;">6.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><i><span style="font-family: Verdana; font-size: 10pt;">Close the Gap</span></i></b><b><span style="font-family: Verdana; font-size: 10pt;"> co-payment relief for Indigenous people attending eligible general practice centres and registered for chronic disease management support <br />
</span></b><span style="font-family: Verdana; font-size: 10pt;">While the QuMAX program assisted patients of community controlled health services, the <i>Close the Gap</i> program assists patients attending a GP centre or an ACCHO thus replacing the QuMAX scheme. Patients eligible to register must be considered at risk of developing a chronic disease. The notion that cheaper PBS medicine will improve adherence is suspect as at some ACCHOs patients have had “free” medicine for years. This program is simply helping to “pay the bill” at the local pharmacy and not assisting the patient to obtain the quality needed to meet principle three of the National Medicines Policy shown above.</span></div><div style="line-height: 13pt;"><b><span style="font-family: Verdana; font-size: 10pt;">To summarise – </span></b><span style="font-family: Verdana; font-size: 10pt;">for the <b>remote living Indigenous Australians</b> there is a second class PBS that provides no help in understanding medicines and their effect on the body but provides a good income to the supplying pharmacies. The cost of dispensing is not being met by the PBS as it does for every other Australian with the Commonwealth saying that this is a State/Territory government responsibility.</span></div><div style="line-height: 13pt;"><span style="font-family: Verdana; font-size: 10pt;">For <b>urban living Indigenous Australians</b> there are two systems both of which provide financial advantages to the dispensing pharmacy by ensuring the cost is met by the PBS as opposed to the health service or patient. Where this is advantaging the Aboriginal health service by saving it money on patient co-payments there is no requirement for these savings to be spent on “Quality use of Medicine” improvements.<br />
The complicated bureaucratic process to obtain the benefits is believed by some to be “not worth the effort” while the Indigenous patient has no idea of what the programs are or how best they can access them. Even pharmacists are confused as to what applies to whom.</span></div><div style="line-height: 13pt;"><b><span style="font-family: Verdana;">Recommendations</span></b></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><b><span style="font-family: Verdana; font-size: 10pt;">1.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: Verdana; font-size: 10pt;">PBS listing</span></b><span style="font-family: Verdana; font-size: 10pt;"> – disband the current Indigenous Expert Advisory Panel due to its listings being inconsequential to improving Indigenous health in a cost effective way. Replace it with a panel including people involved in delivering pharmaceutical care services and have a scope beyond just PBS listings and include quality use of medicine measures. The most relevant factor is making product available to Indigenous Australians at the best price through a functioning pharmacy in every Aboriginal Health Service under the supervision of a registered pharmacist.<br />
<br />
</span></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><b><span style="font-family: Verdana; font-size: 10pt;">2.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: Verdana; font-size: 10pt;">Section 100 Remote </span></b><span style="font-family: Verdana; font-size: 10pt;">– make funds available to AHSs to meet the cost of dispensing on to patients after having received product from a supplying pharmacy. This can be done by initially meeting the cost of dispensing as it applies in mainstream ($6.42 at </span><span style="font-family: Verdana; font-size: 10pt;">1 January 2011</span><span style="font-family: Verdana; font-size: 10pt;">). At present 25% of government outlays (estimate $40 million in 2010-11) goes to the supplying pharmacy and nil to the dispensing AHS.<br />
No data is available to analyse drug utilisation as happens with the mainstream PBS. Although this has been called in a review of the program<a href="http://www.blogger.com/post-create.g?blogID=12040314#_ftn2" name="_ftnref2" title=""><span class="MsoFootnoteReference"><span class="MsoFootnoteReference"><span style="font-family: Verdana; font-size: 10pt;">[2]</span></span></span></a> – Medicare </span><span style="font-family: Verdana; font-size: 10pt;">Australia</span><span style="font-family: Verdana; font-size: 10pt;"> is still unable to make publicly available detailed statistics.</span></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><b><span style="font-family: Verdana; font-size: 10pt;">3.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: Verdana; font-size: 10pt;">Special allowance under s100 </span></b><span style="font-family: Verdana; font-size: 10pt;">– disband this allowance and put funds into 2) above. The current arrangement provides no value add to the individual patient which is where the focus should be. Pharmacists checking stock for out of date and smoothing administrative arrangements are a waste of professional time.</span></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><b><span style="font-family: Verdana; font-size: 10pt;">4.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: Verdana; font-size: 10pt;">NPS OPRAH program – </span></b><span style="font-family: Verdana; font-size: 10pt;">this should be directed to pharmacists working “at the coalface” and be relevant to the needs of the patients. Past programs such as pain management, stroke prevention, COPD and diabetes are well covered by primary health care specialists in patient education. An evaluation from the AHS level would be of interest.</span></div><div style="line-height: 13pt; margin-left: 36pt; text-indent: -18pt;"><b><span style="font-family: Verdana; font-size: 10pt;">5.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: Verdana; font-size: 10pt;">and 6.</span></b><span style="font-family: Verdana; font-size: 10pt;"> <b>QuMAX and Close the Gap - </b>should be disbanded and incorporated into the PBS General Scheme with Aboriginal people entitled to whatever concessions Governments of the day believe provides equity and justice. This should NOT be based on where a person attends a doctor as it is now. If all persons identifying as Indigenous and at risk of chronic disease they should be issued with a Health Care Card. If there is a need for an income/asset test then leave that to Centrelink in issuing the card as for every other Australian. There must be a universal Indigenous Pharmaceutical Care program and not one based on the governance structure of a health service. Hospital pharmacies must be included in having access to these measures. At present patients are discharged from hospital with a varying array of quantities and charges. The training provided for Medicare officers and retail pharmacy operators has also failed to meet the need with respect to the detail and cross cultural sensitivities.</span></div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_u3ugQLB59ZU0VGygV9JvOImnbIMpNIaT0yDdZsPcB1MM3aaEp5LswcrlvhFw2fuTKr0Q_5mHuP12A_EHqpb6IuAGfYg0-qpC6ejK2BYUAnnKZ92-zAZRtPl5281iABQrNvf2/s1600/A+cost+of+medicne.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br />
</a> <br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_u3ugQLB59ZU0VGygV9JvOImnbIMpNIaT0yDdZsPcB1MM3aaEp5LswcrlvhFw2fuTKr0Q_5mHuP12A_EHqpb6IuAGfYg0-qpC6ejK2BYUAnnKZ92-zAZRtPl5281iABQrNvf2/s1600/A+cost+of+medicne.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="219" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_u3ugQLB59ZU0VGygV9JvOImnbIMpNIaT0yDdZsPcB1MM3aaEp5LswcrlvhFw2fuTKr0Q_5mHuP12A_EHqpb6IuAGfYg0-qpC6ejK2BYUAnnKZ92-zAZRtPl5281iABQrNvf2/s320/A+cost+of+medicne.jpg" width="320" /></a></div><div style="line-height: 13pt; margin-left: 0.15pt;"><b><span style="font-family: Verdana; font-size: 10pt;">Conclusion<br />
</span></b><span style="font-family: Verdana; font-size: 10pt;">As a general principle all benefits should be made to fit a program developed with the Indigenous patient as the beneficiary. The PBS contains various elements that can be utilised to suit the need. There is no reason why NGOs such as the Pharmacy Guild, NACCHO or Divisions of General Practice, should be involved in delivering a program that falls within the scope of PBS capability with the elements to obtain special benefits for special groups of patient needs.<br />
The reality is that for some patients money would have to be paid to them for them to take their medicine. Making it available at little or no cost does in no way help them to understand why they should take it.<br />
Rollo Manning</span></div></div></div>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-1683840683918121142010-12-02T12:11:00.000+09:302010-12-02T12:11:33.888+09:30GET A JOB AND A LOT OF SOCIAL PROBLEMS WILL DISAPPEAR<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if !mso]><img src="http://img2.blogblog.com/img/video_object.png" style="background-color: #b2b2b2; " class="BLOGGER-object-element tr_noresize tr_placeholder" id="ieooui" data-original-id="ieooui" /> <style>
st1\:*{behavior:url(#ieooui) }
</style> <![endif]--><!--[if gte mso 10]> <style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:10.0pt;
font-family:"Times New Roman";}
</style> <![endif]--> <br />
<div class="MsoNormal" style="line-height: 16pt;"><b><span style="font-family: Calibri;">This may be a simplistic few words but let’s think it through – how relevant is this in today’s remote communities?</span></b></div><div class="MsoNormal" style="line-height: 16pt;"><span style="font-family: Calibri; font-size: 11pt;">One indication to the drastic social problems confronting young Indigenous Australians living in remote communities is the fact that there are two references before Parliamentary Committees in Canberra that have a direct bearing on two major social problems. They are:<br />
1. Indigenous youth and the criminal justice system</span></div><div class="MsoNormal" style="line-height: 16pt;"><span style="font-family: Calibri; font-size: 11pt;">2. Early intervention programs to prevent youth suicide</span></div><div class="MsoNormal" style="line-height: 16pt;"><span style="font-family: Calibri; font-size: 11pt;">The population in jails in the </span><span style="font-family: Calibri; font-size: 11pt;">Northern Territory</span><span style="font-family: Calibri; font-size: 11pt;"> for Aboriginal people is 82% of all inmates and over 50% of them are under the age of 30 years. There are around 900 Aboriginal people in gaol with 95% being males.</span></div><div class="MsoNormal" style="line-height: 16pt;"><span style="font-family: Calibri; font-size: 11pt;">In the NT there has been a concerning increase in suicides in recent months. The NT news typifies the situation in the following Editorial on </span><span style="font-family: Calibri; font-size: 11pt;">29<sup>th</sup> September 2010</span><span style="font-family: Calibri; font-size: 11pt;">:<strong><span style="font-family: Calibri;"></span></strong></span></div><div style="background: none repeat scroll 0% 0% rgb(224, 224, 224); border: 1pt solid windowtext; padding: 1pt 4pt;"> <div style="background: none repeat scroll 0% 0% rgb(224, 224, 224); border: medium none; padding: 0cm;"><strong>AT least seven Territory children have killed themselves in the past month. </strong></div><div style="background: none repeat scroll 0% 0% rgb(224, 224, 224); border: medium none; padding: 0cm;">That bald statistic masks unfathomable pain - the hopelessness that leads young people to give up on life, the never-ending anguish of the loved ones left behind.<br />
As revealed in the NT News yesterday, the problem is not confined to remote Aboriginal communities, although the suicide rate among indigenous youth is far higher than among non-indigenous children.<br />
Most young Territorians are drunk or stoned - or both - when they kill themselves, proving that alcohol and ganja (Marijuana) can turn someone who is depressed suicidal.</div></div><h3><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">The unemployment rate where these young men come from is around 30%, although an exact figure is hard to know due to the various reporting processes and Centrelink definitions that include people on disability pensions as not being employable. A person may be classed as disabled for Centrelink because they are illiterate.</span></h3><h3><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">The social scene and degree of cohesion and strength of social capital is weak on all counts and the greatest thing missing for young people is hopes, dreams and ambitions for the future.</span></h3><h3><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">When life in a community is a struggle to exist from day to day due to the indicators of poverty there is no time to think about or plan for the future. The future around them is bleak, the facilities are non existent and there is no encouragement for developing personal micro economic enterprises that might create a job.</span></h3><h3><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">The manner in which these social problems have been dealt with in other </span><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">Third World</span><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;"> situations revolves around enterprise facilitation and that means self help and initiative.</span></h3><h3><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">Why can’t Aboriginal people be encouraged to do this? </span></h3><h3><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">There is one simple barrier–money – money from heaven for doing nothing. A tempting gift to resist.</span></h3><h3><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">In the meantime employment opportunities must be considered as a solution to social malaise. </span></h3><h3><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">A reason to get up in the morning. </span></h3><h3><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">A reason to be pleased to come home at the end of the day and eat a good meal satisfied that life is good. </span></h3><h3><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">And then a good nights sleep.</span></h3><h3><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">Should that be too hard? – well it is – so lets work through the barriers together with the Aboriginal people and stop blaming them, the Government or other external factors.</span></h3><h3><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">Get a job – give a job – make a job – it is good for your health and then you live longer.</span></h3><h3><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">IE CLOSE THE GAP!</span></h3>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-71964963438872250992010-08-30T09:12:00.000+09:302010-08-30T09:12:56.727+09:30Remote Aboriginals left out of inclusion agenda<meta content="text/html; charset=utf-8" http-equiv="Content-Type"></meta><meta content="Word.Document" name="ProgId"></meta><meta content="Microsoft Word 10" name="Generator"></meta><meta content="Microsoft Word 10" name="Originator"></meta><link href="file:///C:%5CUsers%5CRollom%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml" rel="File-List"></link><o:smarttagtype name="date" namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:smarttagtype><o:smarttagtype name="country-region" namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:smarttagtype><o:smarttagtype name="place" namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:smarttagtype><o:smarttagtype name="City" namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:smarttagtype><style>
<!--
/* Font Definitions */
@font-face
{font-family:Wingdings;
panose-1:5 0 0 0 0 0 0 0 0 0;
mso-font-charset:2;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:0 268435456 0 0 -2147483648 0;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;
mso-font-charset:0;
mso-generic-font-family:swiss;
mso-font-pitch:variable;
mso-font-signature:-520092929 1073786111 9 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-parent:"";
margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";}
h3
{mso-margin-top-alt:auto;
margin-right:0cm;
mso-margin-bottom-alt:auto;
margin-left:0cm;
mso-pagination:widow-orphan;
mso-outline-level:3;
font-size:13.5pt;
font-family:"Times New Roman";}
@page Section1
{size:595.3pt 841.9pt;
margin:44.95pt 55.3pt 44.95pt 63.0pt;
mso-header-margin:35.4pt;
mso-footer-margin:35.4pt;
mso-paper-source:0;}
div.Section1
{page:Section1;}
/* List Definitions */
@list l0
{mso-list-id:1387219712;
mso-list-template-ids:399272754;}
@list l0:level1
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:36.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:"Courier New";}
@list l1
{mso-list-id:1949585476;
mso-list-type:hybrid;
mso-list-template-ids:340821274 201916431 201916441 201916443 201916431 201916441 201916443 201916431 201916441 201916443;}
@list l1:level1
{mso-level-tab-stop:36.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;}
ol
{margin-bottom:0cm;}
ul
{margin-bottom:0cm;}
-->
</style> <br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1ZBnc_AtV3rXtRkGRJv5j1hiluAlmguN6J7hZTJlhY41L85UQjWTp3y0VKCGSC5yBJTQwZ7TL7LLhbO4K3SiJEWghjLlEmrz5YwhzIkTTV7wDX7xCY2_qLqMOpjrMQycTvurV/s1600/Fix_aint_broke.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1ZBnc_AtV3rXtRkGRJv5j1hiluAlmguN6J7hZTJlhY41L85UQjWTp3y0VKCGSC5yBJTQwZ7TL7LLhbO4K3SiJEWghjLlEmrz5YwhzIkTTV7wDX7xCY2_qLqMOpjrMQycTvurV/s1600/Fix_aint_broke.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1ZBnc_AtV3rXtRkGRJv5j1hiluAlmguN6J7hZTJlhY41L85UQjWTp3y0VKCGSC5yBJTQwZ7TL7LLhbO4K3SiJEWghjLlEmrz5YwhzIkTTV7wDX7xCY2_qLqMOpjrMQycTvurV/s200/Fix_aint_broke.jpg" width="200" /></a></div><meta content="text/html; charset=utf-8" http-equiv="Content-Type"></meta><meta content="Word.Document" name="ProgId"></meta><meta content="Microsoft Word 10" name="Generator"></meta><meta content="Microsoft Word 10" name="Originator"></meta><link href="file:///C:%5CUsers%5CRollom%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml" rel="File-List"></link><o:smarttagtype name="date" namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:smarttagtype><o:smarttagtype name="country-region" namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:smarttagtype><o:smarttagtype name="place" namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:smarttagtype><o:smarttagtype name="City" namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:smarttagtype><style>
<!--
/* Font Definitions */
@font-face
{font-family:Wingdings;
panose-1:5 0 0 0 0 0 0 0 0 0;
mso-font-charset:2;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:0 268435456 0 0 -2147483648 0;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;
mso-font-charset:0;
mso-generic-font-family:swiss;
mso-font-pitch:variable;
mso-font-signature:-520092929 1073786111 9 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-parent:"";
margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";}
h3
{mso-margin-top-alt:auto;
margin-right:0cm;
mso-margin-bottom-alt:auto;
margin-left:0cm;
mso-pagination:widow-orphan;
mso-outline-level:3;
font-size:13.5pt;
font-family:"Times New Roman";}
@page Section1
{size:595.3pt 841.9pt;
margin:44.95pt 55.3pt 44.95pt 63.0pt;
mso-header-margin:35.4pt;
mso-footer-margin:35.4pt;
mso-paper-source:0;}
div.Section1
{page:Section1;}
/* List Definitions */
@list l0
{mso-list-id:1387219712;
mso-list-template-ids:399272754;}
@list l0:level1
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:36.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:"Courier New";}
@list l1
{mso-list-id:1949585476;
mso-list-type:hybrid;
mso-list-template-ids:340821274 201916431 201916441 201916443 201916431 201916441 201916443 201916431 201916441 201916443;}
@list l1:level1
{mso-level-tab-stop:36.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;}
ol
{margin-bottom:0cm;}
ul
{margin-bottom:0cm;}
-->
</style> <br />
<meta content="text/html; charset=utf-8" http-equiv="Content-Type"></meta><meta content="Word.Document" name="ProgId"></meta><meta content="Microsoft Word 10" name="Generator"></meta><meta content="Microsoft Word 10" name="Originator"></meta><link href="file:///C:%5CUsers%5CRollom%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml" rel="File-List"></link><o:smarttagtype name="date" namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:smarttagtype><o:smarttagtype name="country-region" namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:smarttagtype><o:smarttagtype name="place" namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:smarttagtype><o:smarttagtype name="City" namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:smarttagtype><style>
<!--
/* Font Definitions */
@font-face
{font-family:Wingdings;
panose-1:5 0 0 0 0 0 0 0 0 0;
mso-font-charset:2;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:0 268435456 0 0 -2147483648 0;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;
mso-font-charset:0;
mso-generic-font-family:swiss;
mso-font-pitch:variable;
mso-font-signature:-520092929 1073786111 9 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-parent:"";
margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";}
h3
{mso-margin-top-alt:auto;
margin-right:0cm;
mso-margin-bottom-alt:auto;
margin-left:0cm;
mso-pagination:widow-orphan;
mso-outline-level:3;
font-size:13.5pt;
font-family:"Times New Roman";}
@page Section1
{size:595.3pt 841.9pt;
margin:44.95pt 55.3pt 44.95pt 63.0pt;
mso-header-margin:35.4pt;
mso-footer-margin:35.4pt;
mso-paper-source:0;}
div.Section1
{page:Section1;}
/* List Definitions */
@list l0
{mso-list-id:1387219712;
mso-list-template-ids:399272754;}
@list l0:level1
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:36.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;
mso-ansi-font-size:10.0pt;
font-family:"Courier New";}
@list l1
{mso-list-id:1949585476;
mso-list-type:hybrid;
mso-list-template-ids:340821274 201916431 201916441 201916443 201916431 201916441 201916443 201916431 201916441 201916443;}
@list l1:level1
{mso-level-tab-stop:36.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;}
ol
{margin-bottom:0cm;}
ul
{margin-bottom:0cm;}
-->
</style> <br />
<h3 style="line-height: 14pt;"><u><span style="font-family: Calibri; font-size: 14pt;"><o:p></o:p></span></u></h3><h3 style="line-height: 13pt; margin-left: 0.3pt;"><i><span style="font-size: 14pt;">“Hey – don’t forget us – we were here first!”<br />
</span></i><span style="font-family: Calibri; font-size: 10pt; font-weight: normal;">Remote living Aboriginals and the cycles of disadvantage which place them at the bottom of the socio economic ladder in </span><st1:country-region><st1:place><span style="font-family: Calibri; font-size: 10pt; font-weight: normal;">Australia</span></st1:place></st1:country-region><span style="font-family: Calibri; font-size: 10pt; font-weight: normal;"> must get special treatment from a new Government in </span><st1:city><st1:place><span style="font-family: Calibri; font-size: 10pt; font-weight: normal;">Canberra</span></st1:place></st1:city><span style="font-family: Calibri; font-size: 10pt; font-weight: normal;">. The fact that </span><st1:country-region><st1:place><span style="font-family: Calibri; font-size: 10pt; font-weight: normal;">Australia</span></st1:place></st1:country-region><span style="font-family: Calibri; font-size: 10pt; font-weight: normal;">’s first people are still living in “</span><st1:place><span style="font-family: Calibri; font-size: 10pt; font-weight: normal;">Third World</span></st1:place><span style="font-family: Calibri; font-size: 10pt; font-weight: normal;">” conditions in one of the wealthiest countries of the World is a shameful situation and only special treatment will raise their standards to a point where they can be considered “included” in Australian society. <o:p></o:p></span></h3><h3 style="line-height: 13pt; margin-left: 0.3pt;"><span style="font-family: Calibri; font-size: 10pt; font-weight: normal;">The “social inclusion agenda” of the Rudd Labor Government said that it was a means of <i>“building a nation in which all Australians have the opportunity and support they need to participate fully in the nation’s economic and community life, develop their own potential and be treated with dignity and respect.” <br />
</i>These words are admirable except that there is a need for an Action Plan to ensure it is followed through in reality. The population cohort of 150,000 Aboriginal people living in remote communities across the north of the country and in the central and western desert regions – are at present living in a constant state of “exclusion”. <o:p></o:p></span></h3><h3 style="background: none repeat scroll 0% 0% rgb(230, 230, 230); line-height: 13pt; margin-left: 0.3pt;"><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;">The </span><span style="font-family: Calibri; font-size: 11pt;">National Social Inclusion Board</span><span style="font-family: Calibri; font-size: 11pt; font-weight: normal;"> has been asked to take immediate steps to arrest the slide that has been happening since the introduction of “self government” and welfare dependency in 1970s. These are:<o:p></o:p></span></h3><ol start="1" style="margin-top: 0cm;" type="1"><li class="MsoNormal" style="background: none repeat scroll 0% 0% rgb(230, 230, 230);"><b><span style="font-family: Calibri; font-size: 10pt;">A “</span></b><st1:place><b><span style="font-family: Calibri; font-size: 10pt;">Third World</span></b></st1:place><b><span style="font-family: Calibri; font-size: 10pt;">” classification</span></b><span style="font-family: Calibri; font-size: 10pt;"> is given by Government to remote communities that are home to Aboriginal people across the north of </span><st1:country-region><st1:place><span style="font-family: Calibri; font-size: 10pt;">Australia</span></st1:place></st1:country-region><span style="font-family: Calibri; font-size: 10pt;"> and in the central and western desert. This is said to be essential for the rebuilding of social capital and economic prosperity to a standard required by the inhabitants to contribute to the Australian Society.<o:p></o:p></span></li>
<li class="MsoNormal" style="background: none repeat scroll 0% 0% rgb(230, 230, 230);"><b><span style="font-family: Calibri; font-size: 10pt;">The <i><span style="font-family: Calibri; font-style: normal;">Aboriginal people themselves must be involved in identifying their own social priorities of need</span></i></span></b><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;"> and establishing measures to alleviate these with funding available to initiate micro economic enterprises that will provide the incentive to work and shake off welfare dependence. <o:p></o:p></span></i></li>
<li class="MsoNormal" style="background: none repeat scroll 0% 0% rgb(230, 230, 230);"><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">The payment of money to individuals should cease on a universal basis when a clan or tribe group present a solid business plan for social and economic reform. Universal welfare payments have failed and worked against social inclusion. <b>“Cashed out” Centrelink payments</b> should be possible to put the same amount of money into targeted assistance packages and economic development.<o:p></o:p></span></i></li>
<li class="MsoNormal" style="background: none repeat scroll 0% 0% rgb(230, 230, 230);"><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">The <b>life expectancy of remote living Aboriginal Australians should be expressed separately</b> in order to show the difference between urban and remote. <o:p></o:p></span></i></li>
<li class="MsoNormal" style="background: none repeat scroll 0% 0% rgb(230, 230, 230);"><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">An acceptance of the fact that to <b>educate young women between the age of 16 to 24 years</b> will assist them and enable them to pass down to their children the need for an education and work ethic. Without this another generation will be lost to welfare dependency.</span></i><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;"><o:p></o:p></span></li>
</ol><div class="MsoNormal"><span style="font-family: Calibri; font-size: 10pt;"><br />
<span style="font-size: x-small;">Remote living Aboriginals are a unique cohort whose life style and life outcomes are clearly delineated through statistical measurements. Nowhere near is enough use made of this information in planning change. This is “</span></span><span style="font-size: x-small;"><st1:place><span style="font-family: Calibri;">Third World</span></st1:place></span><span style="font-family: Calibri; font-size: 10pt;"><span style="font-size: x-small;">” country and has to be recognised as such. Some input from AusAid might be more useful for framing policy than bureaucrats used to dealing with mainstream populations living in communities with a wide range of services available in settings with already strong social capital. The remote living Aboriginal has none of these “luxuries”. </span><br />
</span><i><b><span style="font-family: Calibri; font-style: normal;"> <o:p></o:p></span></b></i></div><div class="MsoNormal"><i><b><span style="font-family: Calibri; font-style: normal;">The cycles of disadvantage<br />
</span></b></i><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">The numerous cycles of disadvantage in remote Aboriginal communities are interrelated and synergistic in their effect on the individual. More research needs to be done to identify the priorities of need (as seen by the community) in attacking each one. Too often the cry goes out that it is “too hard” and nothing is done. The people themselves must be drawn into a conversation on the social priorities and needs for their communities. In this way moves towards building social capital can be commenced through social and economic development. <br />
The main cycles are:<o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 14pt; margin-left: 18pt; text-indent: -18pt;"><i><span style="font-family: "Courier New"; font-size: 10pt; font-style: normal;">o<span style="font: 7pt "Times New Roman";"> </span></span></i><i><b><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">A denial of the human rights of the child</span></b></i><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;"> such that abuse of those rights becomes the norm and is accepted by new generations. Housing, nutrition, education and leisure opportunities are lacking and this leads to a child frustrated from inactivity, opportunities to show creativity and exercise initiative. The overcrowded house is under estimated in the minds of government policy makers as a prime influence on this fact and each of those following. The overcrowded house brings with it immense unsafety, insecurity, a lack of food security, own space to reflect, household facilities that do not work because they were never built for so many persons living in the house. This absolutely hopeless situation is still evident with no real action to make an immediate response to this devastating influence on the ability to feel included in a social setting filled with joy and harmony. It is disgraceful that the policy makers allow a town of 2,200 people (Galiwin’ku) to have 152 houses while another in the white man’s world (Boorowa NSW) to have 857 for the same population. Galiwin’ku has five retail outlets against 15 in Boorowa – how much more serious can a lack of social inclusion get when people are denied choices, job opportunities but receive money for doing nothing and have little choices of what to spend it on.<br />
<br />
<o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 14pt; margin-left: 18pt; text-indent: -18pt;"><i><span style="font-family: "Courier New"; font-size: 10pt; font-style: normal;">o<span style="font: 7pt "Times New Roman";"> </span></span></i><i><b><span style="font-family: Calibri; font-size: 10pt;">Poor literacy and numeracy </span></b></i><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">stems from an inability of children to understand why this is needed when all they see is adults sitting around doing nothing and no role models from their parents or carers who do not work. Creating work opportunities should be an essential part of the mix and is not receiving nearly enough attention at the local level. Unemployment is the norm and this becomes the key in removing welfare dependence. Much bolder mechanisms must be tried at the local level to encourage economic activities and employment opportunities such as “cashing out” Centrelink payments within a community or Clan group in a community. The writer is in the process of obtaining from Centrelink the stats on the quantum of money going into communities to ascertain how much would be available if people decided to “cash out”. The principle involved here relates to the social justice in paying money to individuals rather than to communities for economic and social development.<br />
<br />
</span></i><i><span style="font-family: Calibri; font-size: 10pt;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 14pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Courier New"; font-size: 10pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><i><b><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">Su</span></b></i><i><b><span style="font-family: Calibri; font-size: 10pt;">bstance abuse </span></b></i><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">leads to violence and both are symptoms of a community without direction. The fact that substance abuse (alcohol and Marijuana or Gunja) is so widespread means that children are exposed to it at an early age and peer pressure may result in consuming drugs (marijuana) by age 10 years. This rules against any possible development of social dreams, hopes and ambitions. Future planning is absent and few children have any idea of what they want to do in a future life apart from nothing which carries with it distinct boredom and further substance abuse. The flow on is arguments, fighting, stealing for money to sustain the habit and prosecution. It is well recognised that recidivism for Aboriginal prison inmates is high following its acceptance as being “part of life”. The cyclical nature of family violence is strong, despite the resource of domestic violence orders which seem useless in alcohol and drug charged family disputes. Men and women seem to ignore the rights of the individual to lead a peaceful life free of torment, danger, uncertainty and stress. Mental health problems surge to the front of “health” problems and the resulting stress is a dampener on many a discussion regarding future hope. It is the survival of “today” that is the prime motivator not consideration of a peaceful future and how that can be attained. The definition of poverty given by </span></i><span style="font-family: Calibri; font-size: 10pt;">Muhammad Yunus</span><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;"> in an Interview with Andrew Denton describes the situation admirably:<br />
<br />
</span></i><i><b><span style="background: none repeat scroll 0% 0% rgb(230, 230, 230); font-size: 10pt; font-style: normal;">“</span></b></i><b><i><span style="background: none repeat scroll 0% 0% rgb(230, 230, 230); font-size: 10pt;">Poverty, is almost, you can describe is a living in a box, all with the thick wall, no window, no door, no light, so you don't know what's coming next, you have no idea of new day starting in different way, you repeat the same thing over and over again. No hope, basically. So you try to survive the day in very uncertain conditions. So that's poverty, you have no control over your life, that's total, that's it.”</span></i></b><i><b><span style="background: none repeat scroll 0% 0% rgb(230, 230, 230); font-size: 10pt; font-style: normal;"> </span></b></i><i><span style="background: none repeat scroll 0% 0% rgb(230, 230, 230); font-family: Calibri; font-size: 10pt; font-style: normal;">(ABC-TV </span></i><st1:date day="7" month="12" year="2009"><i><span style="background: none repeat scroll 0% 0% rgb(230, 230, 230); font-family: Calibri; font-size: 10pt; font-style: normal;">07/12/09</span></i></st1:date><i><span style="background: none repeat scroll 0% 0% rgb(230, 230, 230); font-family: Calibri; font-size: 10pt; font-style: normal;">)<br />
<br />
</span></i><i><span style="font-family: Calibri; font-size: 10pt;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 14pt; margin-left: 18pt; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Courier New"; font-size: 10pt;">o<span style="font: 7pt "Times New Roman";"> </span></span><i><b><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">Health, nutrition and physical activity</span></b></i><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;"> – the cycle of poor nutrition and reduced physical activity leading to poor health has been gaining momentum since 1975. This has lead to a situation where all people born after 1975 have lived their entire life in a community with the health status on the decline. The child fed a breakfast of black tea with noodles thinks that is normal. The two takeaway shops in town (two of the five retail outlets at Galiwin’ku) selling death through cigarettes, high fat content foods and sugar loaded soft drinks are making huge profits by selling sickness. The businesses of the two takeaways are owned by </span></i><st1:city><st1:place><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">Darwin</span></i></st1:place></st1:city><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;"> based syndicates and staffed by Asian workers on “457” Visas. And we allow this to happen to the most under privileged Australians who were here for 40,000 years before colonial British settlement. Social justice? Hardly. Social inclusion? No attempt. Only recently has there been evidence of organised sport for young people with the major emphasis having been on adult age football and basketball. The scope for athletics, swimming sports, junior football and basketball is immense and such activities could include the entire family. <br />
The end result is the early death – and at a much earlier age than the National average depicts – let’s get real and respect the huge differences where the median age at death for men is 43 years and for women 53 years. That is a lot of adults taken out of a community at a young age and this then becomes the norm in people’s minds as if this is the way it has to be.<br />
<br />
It does not have to be this way and a concerted effort under the banner of social inclusion which has with it a “bottoms up” approach to a social revolution might help to reduce the intensity of these cycles.<br />
Better health is not about building better health clinics and employing more clinical staff – it is about the relationship the dominant culture has with the people to enhance their understanding of the risks associated with lifestyle choices and the opportunities they create to reduce stress and lead a useful life. This was well expressed by Professor Fiona Stanley who said:<br />
<br />
</span></i><b><i><span style="background: none repeat scroll 0% 0% rgb(243, 243, 243); font-size: 11pt;">“..the real gains in reducing disease and improving health will come from the social and economic circumstances operating in families, communities and the wider society. That is that the most effective preventive strategies lie OUTSIDE the traditional areas of the health professions.” </span></i></b><span style="background: none repeat scroll 0% 0% rgb(243, 243, 243); font-family: Calibri; font-size: 11pt;">(National Press Club. August 2003.)</span><span lang="EN-US" style="font-family: Calibri; font-size: 11pt;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 14pt;"><br />
</div><div class="MsoNormal" style="line-height: 14pt;"><b><span style="font-family: Calibri; font-size: 11pt;">The entrapment of cycles of disadvantage</span></b><i><b><span style="font-family: Calibri;"><br />
</span></b></i><span style="font-family: Calibri; font-size: 10pt;"> People are born into these communities and have no option when their families have lived there for generations and their ancestors respected and owned the land for thousands of years. There is an affinity to the land which is unique. It is the heritage a child takes on from its predecessors.<br />
<i><span style="font-family: Calibri; font-style: normal;">It is very important that when there are people who want to break out of the cycle of disadvantage that they are helped 100% in a quest to do so. If someone puts up there hand and says </span></i><i><span style="font-family: Calibri;">“I want to lead a better life”</span></i><i><span style="font-family: Calibri; font-style: normal;"> there must be the facility to make that happen. To follow the lead of overseas efforts in </span></i></span><st1:place><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">Third World</span></i></st1:place><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;"> countries it will be the young women who are targeted for improvement. Educate a girl and you educate a future family. We must put sexist attitudes aside and decide to concentrate on young women between the ages of (say) 16-24 years old. </span></i><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">If nothing is done to help these young women there will be no role models coming forward to show the younger ones that <i><u>good</u></i> is a better choice in life than bad. Is it any wonder there are no persons from remote communities attending university? – there is simply not enough done to make it happen. The fault is not with the person but with the system that seems intent on having these people continue a life of poverty. <br />
<br />
</span><b><span lang="EN-US" style="font-family: Calibri; font-size: 11pt;">Mutual obligation has to work both ways</span></b><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;"><br />
An example can be given of a 21 year old woman from a remote community who came to </span><st1:city><st1:place><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">Darwin</span></st1:place></st1:city><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;"> to “make good” and was s</span><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">huffled between Centrelink and Job Services Australia (JSA) agencies for three months. All she got was appointments or on three occasions cancelled appointments that did not suit the JSA agent. So much for mutual obligation! The Prime Minister during the recent election campaign claimed a get tough policy on the unemployed who did not turn up for appointments. The same should apply to JSA agents who fail to meet appointments and more importantly fail to provide a training program. Sure excuses will be made as to how hard this is but regrettably no excuses should be accepted. It is imperative we return the obligation for to leave a person in a city like </span><st1:city><st1:place><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">Darwin</span></st1:place></st1:city><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;"> with all the distractions for three months with no work, no training and no future is just asking them to continue the exclusion. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 14pt;"><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">What do the authorities planning this transition from welfare to work expect people to do with their idle time? Or are they so used to people that do not want anything to happen (like find a job) that when a person wanting to do better comes along they cannot handle the positive nature of the inquiry. It appears that the entire system is geared to mediocrity and the Centrelink and job finding agencies are so used to people that don’t want to work that they have no strategy to help those few that want to make good. There could be no bigger turn off for anyone than to be left in front of a TV all day waiting for the next appointment when what they really want is to learn and find work that suits their ambitions.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 125%;"><span lang="EN-US" style="font-family: Calibri; font-size: 10pt; line-height: 125%;">The problem of “disengaged youth” is attracting a lot of attention from Government programs and in the work of Non Government Organisations (NGOs). And yet little is being done to prevent young people from becoming “disengaged” when they really want to be more engaged. There are youths (aged 16-24yo) who want to be included in the world—not excluded like so many of their peers that end up in prison or on diversion programs. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 14pt;"><span style="font-family: Calibri; font-size: 10pt;">In </span><st1:city><st1:place><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">Darwin</span></st1:place></st1:city><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;"> there is an 800 bed prison, Berrimah Gaol, costing $80 million a year for people who have chosen to be bad. The young Aboriginal inmate – and that is 90% of the prison population – is probably in there for some anti social behavior fuelled by alcohol and Gunja – will receive tuition in literacy and numeracy and computer skills. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 14pt;"><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">Upon release they will be remanded to a formal rehabilitation program in a beautiful garden setting hostel style accommodation with all meals and training provided for a further 12 weeks. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 14pt;"><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">Oh for such a facility for those those who want to do “good” – and not just for those who choose to do “bad”. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 14pt;"><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">Government programs exist—the Job Services Australia network; Language, Literacy and Numeric Program; Step-Up; WELL; Youth Connect; the Indigenous Youth Mobility Program; Youth in Communities and the exalted Youth Attainment and Transitions program - BUT there is no co-ordination and each program is delivered by a contracted provider that once having gained the contract has little competition leaving mediocrity to reign. <br />
Glossy websites and publications mean nothing if the product is not being delivered. The so-called “<i>mutual obligation” </i>means equal commitment from all parties and yet Governments seem to think their obligation is finished with the appointment of an agency to deliver programs. If the government funded agency fails to perform there seems to be no obligation but if the client does not arrive at an appointment the welfare payment can be stopped. This begs the question of why it is so hard to co-ordinate the efforts of these similar government funded programs with the same goals so that the clients get what <b><u>they</u></b> want. An element of “discretionary funding” must be made available for use at the local level to stimulate initiatives and help to fund the work needed to build plans to a point of applying for funding. </span><span style="font-family: Calibri; font-size: 10pt;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 14pt;"><i><b><span style="font-family: Calibri; font-style: normal;">Breaking out of cycles of disadvantage<br />
</span></b></i><i><b><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">C</span></b></i><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">ontrol of ones own life is an important element in building social capital. The principles that were espoused in the </span></i><i><span style="font-family: Calibri; font-size: 10pt;">Australian Assistance Plan</span></i><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;"> of the Labor Government in 1972-75 were said to be ahead of their times but maybe the time is NOW for Aboriginal communities to receive an </span></i><i><span style="font-family: Calibri; font-size: 10pt;">Aboriginal Assistance Plan</span></i><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;"> along the same lines that could involve the people in determining their social needs and priorities. This would also make micro loans available to seed new ventures that would create training, employment, independence from welfare and a purpose for rising every morning and getting the children to school.<br />
The time is now when it comes to building stronger social capital in remote Aboriginal communities and this is well reflected in the words of Nobel Laureate Chilean born <b>Gabriel Mistral</b> who said of the needs of children:<br />
<br />
</span></i><b><i><span style="background: none repeat scroll 0% 0% rgb(243, 243, 243); font-size: 11pt;">Many things we need can wait, the child cannot. Now is the time his bones are being formed, his blood is being made, his mind is being developed. To him we cannot say tomorrow, his name is today.<br />
</span></i></b><b><i><span style="background: none repeat scroll 0% 0% rgb(243, 243, 243); font-size: 10pt;"><br />
</span></i></b><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">There must come a time when the policy makers shed the shroud of fear about matters such as “paternalism”, “stolen generations” and “separatism”. In decrying <b>paternalism</b> self determination was brought in and it has now been recognised that has been a failure. The basic ability and understanding is simply not there for these Aboriginal people to negotiate the machinations for moving ahead in the western world. There does need to be considerable mentoring, guidance and fostering of confidence which can still be done in a facilitative way without being labelled as paternalistic. To wait until the people are ready for change could be to wait another one or two generations – a prospect that no Australian would feel comfortable in accepting. If there is tutoring and mentoring to be done we must do it in a vigorous manner and not just pay lip service to it against a backdrop of centralist policies and program development.<br />
With respect to the <b>stolen generation</b> - there is no doubt the forced removal of children from their parents in previous generations was despicable. However this was forced removal. To suggest that an Aboriginal child may be assisted by attending a boarding school in another state is not forced removal. The paranoia that surrounds suggestions of moving must be diminished by examples of well being fostered from such experiences. Research should be done to demonstrate the long term benefit in voluntary removal to allay these fears. Even the “dormitory” style living and mentoring and caring for children who are disengaged would be better than the nomadic existence so many young children have to undertake when abandoned by their natural mother or father.<br />
<b>Separatism </b>was a sensitive issue in the world in the early 1970s with vivid memories of the tour of the Springbok Rugby Team in 1971 still vivid in the minds of those of us around at the time. The apartheid movement in </span></i><st1:country-region><st1:place><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">South Africa</span></i></st1:place></st1:country-region><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;"> has finished and should never be seen again. It was the forced separation of one race of people from another with harsh penalties for anyone who crossed the line. However in decrying apartheid it should be acknowledged that there will be situations where one race of people may decide that it does not want to live in the same way as another. At no time in the history of the Aboriginal survival efforts have they been given the opportunity to decide the way they want to live. The Aboriginal men from remote communities seem unable to embrace a mainstream culture and legal constraints while for the women there are those that simply see themselves as “community girls” with no intention of even trying to live the mainstream lifestyle. If we do accept that assimilation failed and that self determination has failed then we need another word that will describe a phase whereby Aboriginal people are given the resources to develop a world of their own that takes what they want from the western world and allows them to remain in their own country.<br />
<br />
</span></i><i><b><span style="font-family: Calibri;">Personal choice should play a part<br />
</span></b></i><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">Choices are made on a basis of knowledge so that the costs and benefits of a situation can be weighed up critically to choose a path. In the situation under review the people involved do not have an education or awareness of a logical framework in thinking that allows to them to participate in an analysis of choices. The educated mainstream person does not appreciate the manner in which their upbringing in a culture that has thousands of years of development through many “revolutions” that have embraced invention to move that culture ahead in a manner that is “mind boggling” to a person from a culture that subsisted in the desert for thousands of years without even knowing what a wheel could do. It was not until the arrival of ships from foreign countries such as </span></i><st1:city><st1:place><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">Holland</span></i></st1:place></st1:city><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;"> and </span></i><st1:country-region><st1:place><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">Indonesia</span></i></st1:place></st1:country-region><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;"> (Macassans) in the 16<sup>th</sup> and 17<sup>th</sup> century that these people learned what metal was. The power of logical thinking that comes with an ability to manage a situation, prioritise things, file away messages and thoughts in the brain to a later date are all practices that come naturally to the educated dominant culture person in </span></i><st1:country-region><st1:place><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">Australia</span></i></st1:place></st1:country-region><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">. </span></i><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">This value was highlighted during a recent visit to </span><st1:country-region><st1:place><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">Australia</span></st1:place></st1:country-region><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;"> of the </span><st1:country-region><st1:place><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">Somalia</span></st1:place></st1:country-region><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;"> born women’s activist <b>Ayaan Hirsi Ali</b> who said:<o:p></o:p></span></div><div class="MsoNormal" style="background: none repeat scroll 0% 0% rgb(230, 230, 230); line-height: 14pt;"><i><b><span style="font-size: 11pt;">“We can learn from you and your centuries of critical thinking. You Westerners come to </span></b><st1:place><b><span style="font-size: 11pt;">Africa</span></b></st1:place></i><b><span style="font-size: 11pt;"><i> with your money but you can keep your money - we want to share with you your values. The most important value – the value of critical thinking – questioning authority – no matter who it is – question why things are the way they are and why they cannot be done better.”</i> </span></b><span style="font-family: Calibri; font-size: 11pt;">(Interview with Monica Attard – Slow TV – August 2010)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 14pt;"><i><span style="font-family: Calibri; font-size: 10pt; font-style: normal;">To expect Aboriginal people to think through their options for survival in a world that none of them has grown up in is a tall order and the resolution needs a lot more talk and research to find the best path ahead. In 2005 the present Co-ordinator General for Remote Service Delivery in the NT, Mr. <b>Bob Beadman</b> wrote a paper in which he lamented the fact that something had taken away the ability for Indigenous people to have dreams for their future. He wrote:<br />
<br />
</span></i><b><i><span lang="EN-US" style="background: none repeat scroll 0% 0% rgb(230, 230, 230); font-size: 11pt;">“I am looking at human detritus right here in </span></i></b><st1:city><st1:place><b><i><span lang="EN-US" style="background: none repeat scroll 0% 0% rgb(230, 230, 230); font-size: 11pt;">Darwin</span></i></b></st1:place></st1:city><b><i><span lang="EN-US" style="background: none repeat scroll 0% 0% rgb(230, 230, 230); font-size: 11pt;">, and wonder what dreams they might have once had for themselves. What dreams they might have had for their children? What dreams their children might have had for themselves? I wonder if people have abandoned those dreams, what caused them to give up, what is it about the world that surrounds us all that makes them think that their dreams are unachievable.” (</span></i></b><span lang="EN-US" style="background: none repeat scroll 0% 0% rgb(230, 230, 230); font-family: Calibri; font-size: 11pt;">Do Indigenous youth have a dream Menzies Research Centre, </span><st1:city><st1:place><span lang="EN-US" style="background: none repeat scroll 0% 0% rgb(230, 230, 230); font-family: Calibri; font-size: 11pt;">Canberra</span></st1:place></st1:city><span lang="EN-US" style="background: none repeat scroll 0% 0% rgb(230, 230, 230); font-family: Calibri; font-size: 11pt;">, 2004).</span><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;"><br />
<br />
Work is needed to ascertain how many young people would like to see a better life and this needs to be carefully structured. The target population is not English speaking, does not understand concepts of space and time and is not confident in working with the dominant culture. The young people must be encouraged to question why the situation is the way it is and not to simply accept as normal or necessary for it to stay the same.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 14pt;"><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">Somehow the minds of the young have to be engaged in wanting to see an improved life ahead for their children – the next generation and social inclusion could be the agenda through which to make this happen.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 14pt;"><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">Ends <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 14pt;"><st1:date day="30" month="8" year="2010"><b><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;">30<sup>th</sup> August 2010</span></b></st1:date><b><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;"><o:p></o:p></span></b></div><b><span lang="EN-US" style="font-family: Calibri; font-size: 10pt;"><o:p></o:p></span></b>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-17235972759461865652010-05-22T12:21:00.004+09:302010-05-22T12:43:48.677+09:30Is the PBS playing its part in “Closing the Gap” in Indigenous Health?<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2AvXbnqc_UGmp9apQ93fvYU1BLMLA3lbJz2boxsIGxsqa2UF5ao85g66aXZ9u1VrncytNBgCqqdzMbE_kxxzEVzDuwmjeSpbJGRki-KtbgcU1NhLKcAg-XzCkN7ZIYylCudbJ/s1600/A+1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2AvXbnqc_UGmp9apQ93fvYU1BLMLA3lbJz2boxsIGxsqa2UF5ao85g66aXZ9u1VrncytNBgCqqdzMbE_kxxzEVzDuwmjeSpbJGRki-KtbgcU1NhLKcAg-XzCkN7ZIYylCudbJ/s320/A+1.jpg" /></a></div><b>ADDRESS BY ROLLO MANNING to the <br />
7th Annual Future of the Pharmaceutical Benefits Scheme Forum, Sydney, organised by Informa Australia, 22-23 April 2010</b><br />
<br />
<span style="font-size: large;"><b>The Pharmaceutical Benefits Scheme and Aboriginal Australians</b></span><br />
<br />
<br />
The future sustainability of the PBS centres on whether it is achieving the objectives that were set out for it when it was introduced in 1949 – to provide a range of medicines to Australians that are essential to achieve better health. We must not lose sight in all the discussions that in the end there is a patient and so long as that consumer of the PBS is getting healthier as a result of it is achieving its objective. At times there is too much emphasis on the process rather than the patient.<br />
<br />
The PBS is a small part of a big effort to try and maintain good health so we should not get carried away with the importance of the PBS in an overall sense.<br />
<br />
This presentation will look at <br />
• The background to Aboriginal health and the overall picture of the problems that exist and how these have arisen.<br />
• The infrastructure that supplies the PBS to Australians with the retail pharmacy sector still being dominant in that supply chain. <br />
• Evaluate the PBS against the four pillars of the National Medicines Policy to comment on its effectiveness in Closing the Gap – that difference in life expectancy between an Aboriginal person and mainstream Australians.<br />
<br />
<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div>Working in this field of endeavour is a constant learning process. In my first venture into Aboriginal health I was amazed at how badly pharmacy was practiced in the remote communities in the Katherine region through the 23 remote community health centres being supplied medications from the Katherine Hospital. There was little quality in the way medicines were being used - few records were kept of outgoing supplies, no labelling was being done and the consumer had very little idea of what their medicines were all about. There was little emphasis on dispensing and indeed no payment was received for the cost of dispensing and even now – 13 years further on – there is a discrepancy of $3.73 between what the PBS pays for dispensing PBS medicines to people from retail pharmacies and what is paid to pharmacies to supply PBS to remote Aboriginal health centres. $6.42 is the price paid to dispense a PBS item from a retail pharmacy and only $2.69 when that same item is supplied to a remote living Aboriginal person. The result of this that the Aboriginal health service – be it either government owned and operated or an Aboriginal community controlled health organisation (ACCHO) has to pay for the cost of dispensing. <br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoYHafuouCrMNfNxrgbmEYRBag6Z8ZndcxqiWmnd12Tynlou5-ZI126tIH-6UM1PDxSOeSDpJddF88IGjO-HHynSFrsFAIGmgMA_5IEkjfnY0tklhwbs0QDmGlA8MhSLSqyv3k/s1600/Continuum5.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoYHafuouCrMNfNxrgbmEYRBag6Z8ZndcxqiWmnd12Tynlou5-ZI126tIH-6UM1PDxSOeSDpJddF88IGjO-HHynSFrsFAIGmgMA_5IEkjfnY0tklhwbs0QDmGlA8MhSLSqyv3k/s320/Continuum5.jpg" /></a></div>In a question to the Senate Estimates Committee in June last year Senator Rachel Siewert asked why the difference and was told by the DoHA officers that the “function is not as intensive”. One has to ask why is it not so “intensive”. Are you saying the Aboriginal people do not need the same rigour in the supply of medicines as other Australians?” Of course they do and it is a cop out to say otherwise.<br />
The Wurli pharmacy upgrade project in Katherine is asking for the $3.73 per item supplied to go towards the cost of employing a pharmacist for 12 months – that based on 12 month usage of PBS will amount to $70,000.<br />
<br />
Let’s look at the situation in a remote Aboriginal community - Galiwin’ku in north east Arnhem Land. It has a population of 2000 people – they live in 152 houses - 90% of children under one year old have been diagnosed with scabies; dosette boxes are still used as they say they cannot afford Websterpaks; 10,000 cigarettes are smoked a day; there are five retail outlets. One store, three takeaway outlets, and the place where they buy petrol. What is it about us that we think these 2,000 people only need one store as a retail outlet? <br />
A comparison between Galiwin’ku and Boorowa (NSW) shows a stark contrast. Boorowa has 15 retail outlets and the people live in 850 houses. Straight away it shows up the over crowded housing and lack of employment opportunities. This is the sort of community that I feel for with their level of health far below the average Australian.<br />
The median age of death for these people is 43 years for males and 53 years for females. This is showing that the Australian average of a life expectancy gap of 17 years is not a true picture when remote living Aboriginals are included. It means young children left without a parent (or both) and their upbringing left to the grandparents who are still around with their education from the mission days. These young children are destined for a life of alcohol and drug taking simply because they have nothing better to do and through a lack of quality education. We cannot blame children who at age 10 wonder why they need an education when they see so many adults sitting around doing nothing. Jobs are a must to stimulate the need for an education. Sadly we have young adults leaving school with a Year 12 Certificate but they cannot read and write. This is sad for them and a bad reflection on our ability to help them raise their living standards.<br />
<br />
The above shows examples of the social determinants of health that are so prevalent in Aboriginal communities - poor education and lack of employment opportunities. Along with these come overcrowded housing, high crime rate, substance abuse and poor personal and domestic hygiene. These factors have to be recognised by anyone working in primary health care as they have such a huge impact on the quality of life and therefore health. To live in a constant state of poverty is a classic precursor to poor health.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPq1g5J2tJHpYHDE1-b5Pzenwl8nRMxpkOCaBn3GTNuOvTF48VmS78-h2rlFxAmyiKD523sBv-fptx1pz5xOQwiaRDjEs-ugbrSZfQtyRb8fru4rU5jE1JTiPUQSOzpws-aiXp/s1600/Fran+Baum.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPq1g5J2tJHpYHDE1-b5Pzenwl8nRMxpkOCaBn3GTNuOvTF48VmS78-h2rlFxAmyiKD523sBv-fptx1pz5xOQwiaRDjEs-ugbrSZfQtyRb8fru4rU5jE1JTiPUQSOzpws-aiXp/s320/Fran+Baum.jpg" /></a></div>As shown by Professor Fran Baum at a Chronic Disease Network conference in Darwin last September it is no use helping people to get better and then make them go back to live in the unhealthy environment that caused them to be sick in the first place – and yet that is what we are doing. There is an urgent need for a total approach to the living environment to improve health across all sectors that have a responsibility to improve housing, environmental health, employment opportunities and education.<br />
<br />
So this is the profile of the people I concern myself with – the remote living Aboriginals across the north of Australia – and there are some 150,000 of them living in remote communities. For many of these people the developed world has only been with them for the past 50 years and that is a very short time for them to get used to our way of living.<br />
<br />
I used to think that we should find the latest advances and rocket these people into the next generation of pharmacogenetics and the like but really we are not even doing the simple things well. I will show later what I mean in outlining the Tiwi Islands Pharmacy that was owned and operated by the Tiwi Health Board itself with an Approval Number to supply and claim the cost of PBS supplied to the Health Centre.<br />
<br />
<span style="font-size: large;"><b>What is the PBS?</b></span><br />
The PBS is a huge sum amount of money (ca $10 billion) that funds a large amount of things one of which, and the most important one, is the supply of medicine to the public. In the process of doing this it helps to fund research, manufacturing, marketing, distribution, dispensing and the provision of information to the client. It is thus money that we have to be sure is being used in an efficient manner to enable the patient at the end of the line to receive the right drug with enough information for them to understand why they need the medicine to get better.<br />
<br />
The landscape for supplying the PBS to the Australian public is dominated by the retail sector which in turn means the Pharmacy Guild of Australia. One aspect that is often overlooked by parties criticising the Guild for its actions is that the Pharmacy Guild is the only organisation named in the National Health Act to negotiate with Government over the fees to be paid to pharmacists for their role in supplying PBS medicines to the Australian public. The criticism emanates from those, such as the PSA, saying that the Guild has overstepped the powers given to it by negotiating professional services that go beyond the scope of fees.<br />
The five yearly Community Pharmacy Agreements sets the scene for the next five years on how pharmacy practice is going to be conducted.<br />
The carve up of the PBS money “pie” shows that the manufacturer gets the largest share, the wholesalers a small amount and the pharmacy 26% of the total to cover the mark up on cost of goods and fees. Now there is no problem with the mark up as that is a legitimate amount to cover the cost of the inventory in a business. It is the fees component where the worry starts in terms of getting value for money. The Consumers Health Forum weighed in two weeks ago with a Discussion Paper calling for input to inform the 5th Community Pharmacy Agreement. Justifiably so in their criticisms is the lack of audit processes to see if pharmacists are delivering the services they are getting paid to provide through the dispensing fee of $6.42. If we compare the rigid audit process the wholesalers have to undertake to justify the spend of $150 million through the Community Service Obligation with its reams of paper work with the degree of audit the retail pharmacists do for their $1.2 billion the difference is stark. <br />
<br />
When we have a look at the programs that should have been delivered by retail pharmacists following the $570 million in the 4th Agreement we see from the budget papers for 2009/10 that only half the pharmacies were participating. The rest are simply taking the dispensing fee of $6.42 and doing nothing more than a supply function. The statement by the PSA in the pharmacy press some two weeks ago that the Pharmacy Guild had overstepped its responsibility to negotiate fees is wholly justified. The Guild, to give it credit, is doing the job it has to do to maintain the viability of the 5,000 pharmacies and this it does very well. It is just that we do not need 5,000 pharmacies to do the job at hand resulting in an inefficient use of public money with it being spread across too many outlets.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVXsM8zwMktVJB6AMDnvv8WgZxiBQ2LE6N7a2YU4owix0ueD0uRw4P61JojqKhuGoa2p94dsyPtfC6VCb489DCaQY9vBjDn73NJVL0NPpjR0tOGfFWJQM5PwnwKINq8o0olAnt/s1600/Darwin.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVXsM8zwMktVJB6AMDnvv8WgZxiBQ2LE6N7a2YU4owix0ueD0uRw4P61JojqKhuGoa2p94dsyPtfC6VCb489DCaQY9vBjDn73NJVL0NPpjR0tOGfFWJQM5PwnwKINq8o0olAnt/s320/Darwin.jpg" /></a></div>At the PBS Future Forum last year I made the statement that if half the pharmacies in PhARIA One closed tomorrow nobody would really miss them – the consumers would simply go to one nearby. We do not need four pharmacies in the CBD of Darwin to dispense all the PBS prescriptions and the same happens in most urban areas. It means there is a lot of money being distributed to too many pharmacies resulting in the PBS dollar being unevenly distributed and the consumer is missing out by not being provided with the service expected. The PBS dollar is being inefficiently distributed.<br />
<br />
I do not have a problem with the $1.2 billion paid out in fees, it is just that when spread across to entire population of retail pharmacies there is too much to too many that provide nothing but a supply function.<br />
<span style="font-size: large;"><br />
</span><br />
<span style="font-size: large;">Where does this having an impact on Aboriginal Health Services? </span><br />
As a result of the above inefficient supply system for PBS and the insistence on the 5,000 retail pharmacies remaining the custodians of the PBS Aboriginal Health Services are forced to fit into an inefficient mainstream model that simply does not work for their client base. The time must come when Aboriginal Health Services have their own in house pharmacy operation so they have complete control over the pharmaceutical care process in the same way as they do over every other aspect of primary health care. It is only when this happens that the wealth in the PBS can be shared and put to work in the best interests of the client (consumer). Dispensing is happening now in Aboriginal Health Service but in a way that does not meet the standards that are expected in mainstream pharmacy. Examples exist where dispensing is done from a tiny room stacked full of samples from drug reps and any other source that can be found to be able to dispense to patients who are unlikely to take their prescription to an Approved Pharmacy. <br />
<br />
Let’s look at the PBS for Aboriginal people against the principles of the National Medicines Policy. We can see that access is okay in that the facility is there to provide medicines. It is just that the client base is not comfortable in a glitzy mainstream store in a prime retailing location. The quality is there for storage however efficacy is compromised by a lack of information on the medicines supplied. As for quality use of medicine it is simply not there and largely because of the lack of access to a pharmacist to steer the process. In terms of a collaborative effort on the part of stakeholders there is a lot that could be done by manufacturers to ensure the client who receives a prescription for their product has the information needed to want to take the medicine.<br />
The Aboriginal population is spread across the continent with only a small number in the remote regions – around 150,000. This is not a lot for a politician to take an interest in and the ability of this consumer to lobby is negligible. It behoves us all, if we have a social conscience, to make an extra effort for these people who really have had a very hard time over the past 220 years. The manner in which additional product has been made available on the PBS through the special listings for ATSI people is also an inefficient use of public money and the perfect example of how many of the problems would be overcome with an in house pharmacy business. As an example Clotrimazole Cream – Item No 1017M – can be bought by the pharmacy from the manufacturer for $1.43. The same item when listed on the PBS costs the Government $11.26 or can be bought from an Internet pharmacy for $4 - $1.50 less that the Concessional co-payment. Given its own pharmacy the AHS could be making a much more efficient use of Government money with a pharmacist on site to provide information as happens in every other Approved Pharmacy across Australia.<br />
<br />
A solution has to be found to pay for the cost of dispensing at remote Aboriginal Health Services – the iniquitous situation that exists where there is a $3.73 shortfall between what the PBS is paying to supply a PBS item to mainstream Australia ($6.42) compared to the $2.69 for the same item to a remote Aboriginal person.<br />
<br />
<span style="font-size: large;"><b>Balance cost with information for maximum adherence </b></span><br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9jFShJMoc27zm3Qsi7ia9klAtm0O4EMbtAEAfa8KhMtVsM-GnPKw91poDw6DQMMg1YT0D0HmMTI3mFqTATbQl5riJqtixxN7f_mlsYsVFN_A5WIsJxkaZgu03jo4l_vaXIjeR/s1600/A+2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9jFShJMoc27zm3Qsi7ia9klAtm0O4EMbtAEAfa8KhMtVsM-GnPKw91poDw6DQMMg1YT0D0HmMTI3mFqTATbQl5riJqtixxN7f_mlsYsVFN_A5WIsJxkaZgu03jo4l_vaXIjeR/s320/A+2.jpg" /></a></div>The concentration on cost also has to be balanced against the need for information. There is currently a program to commence on 1 July, 2010 whereby Aboriginal people on Health Care Cards will get their benefits for no cost – and general beneficiaries will get their PBS medicines at Concessional rates. This will not solve the problem. For some people you might have to pay them to take something which they know nothing about. So reducing the co-payment will not necessarily result in patient compliance. Research conducted at the University of Newcastle has shown that there needs to be a lot more work on the impact of co-payments before any further changes are made. To me information is more important than cost – and that needs to be rectified first.<br />
<br />
<span style="font-size: large;"><b>Statistics needed</b></span><br />
Statistics are another area in Aboriginal health that needs attention. Under the Section 100 arrangements there are only 166 AHSs being supplied through 34 pharmacies but we are still not able to find out what is going where to make any regional comparisons or correlate this with health outcome information. In the NT we do not even know the value of the PBS spend even though Medicare Australia makes payments to every pharmacy supplying and dissects this by individual items.<br />
<br />
<span style="font-size: large;"><b>It does not have to be this way </b></span><br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgag5b58e5oMAuibquDH5Fhw5j3nCwKEkKK7d9YmIQM576niWefOizAUaPPJSaC5AAGKf98kM1rh8MT_xGuOCLydw-XZUx787LGfvnPfLaMOd_rzJxYGlNDMFSM5vXhyphenhyphen99bGnPb/s1600/Future_MDS.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgag5b58e5oMAuibquDH5Fhw5j3nCwKEkKK7d9YmIQM576niWefOizAUaPPJSaC5AAGKf98kM1rh8MT_xGuOCLydw-XZUx787LGfvnPfLaMOd_rzJxYGlNDMFSM5vXhyphenhyphen99bGnPb/s200/Future_MDS.jpg" width="200" /></a></div>Pharmacy practice to Aboriginal people does not have to be this way as it is possible to do the simple things well as was shown with the pharmacy at Nguiu on Bathurst Island, which was owned by the community controlled health board. Information systems allowed us to know what was going out, who prescribed it and with a label on every supply. However their has to be the infrastructure in place and this needs a certain will on behalf of the leaders to want to see it happen. On the Tiwi Islands compliance was improved significantly in less that two years and it is hoped that this will be able to replicate a model being developed at the Wurli Wurlinjang Health Service in Katherine that will bring into play technological advancements. You don’t know what you don’t know and the people involved in Aboriginal health have not experienced a pharmacy of the quality that exists in other parts of the country. We must all contribute to improve this situation as it is all possible.<br />
<br />
Thank you <br />
Rollo Manning<br />
rollom@iinet.net.au<br />
30th April 2010Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-28829202924291283442010-02-18T11:06:00.002+09:302010-02-20T08:39:43.545+09:30The inequity of the PBS to remote Aboriginal people<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgz4gMTLe5Yz_55uSAo-QCk1uq1XXsWzKHGFu51XGsD9rP7Nydgi8pDhZDe9Snlnj1T8Hi6b9iVBx8i8IUcE2O7yLuiPk8wZ_fOh1gyrkRiLfEXHIZOYpZ0JTnrqdOK2ONLVjpg/s1600-h/Dulcie_Hayley.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="164" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgz4gMTLe5Yz_55uSAo-QCk1uq1XXsWzKHGFu51XGsD9rP7Nydgi8pDhZDe9Snlnj1T8Hi6b9iVBx8i8IUcE2O7yLuiPk8wZ_fOh1gyrkRiLfEXHIZOYpZ0JTnrqdOK2ONLVjpg/s200/Dulcie_Hayley.jpg" width="200" /></a></div><br />
When every Australian can get a Pharmaceutical Benefit prescription dispensed and have access to the advice of a pharmacist it is taken for granted. Yes every one of the 22 million people in this country has access to a pharmacist in one of the 5,000 Approved Pharmacies around the Nation every time they have a script filled. In fact the PBS pays for that pharmacist to be there through the dispensing fee of $6.42 paid on each and every prescription dispensed..<br />
But what of the 150,000 Aboriginal and Torres Strait Islander people who live in remote places in Western Australia, Rural Queensland, the top and west of South Australia and the Northern Territory scattered across the 70 odd communities there? <br />
<br />
Ask any of them what a pharmacist is does or hangs out and they wouldn’t have a clue. They will never have seen one. They may remember the glossy looking shop in town when they had to go there for a medical purpose but chances are they wouldn’t have noticed because they were so intent on knowing whether they were going to get back home alive.<br />
<br />
Pharmacists do not exist in the remote Aboriginal health workforce, with a very few exceptions. The Government provides through the Section 100 Support Allowance a possible six monthly visit by a pharmacist with the grand sum of $4 million spent on this annually across 166 health services serviced by 34 community pharmacies.<br />
<br />
We have to get real and understand that these people not only deserve an equal deal to mainstream but probably require the help 10 times more because of their poor state of health.<br />
<br />
The PBS has to find some money to support the appointment of pharmacists located strategically around remote Australia where they can at least direct and train others towards a quality improvement process. Go to any of the 166 health services and you will find a pharmacy supply system that simply does not match current day practice standards. This is an indictment on the profession and requires urgent attention before someone goes to the UN claiming institutionalised racism.<br />
<br />
And okay – there cannot be pharmacists everywhere of course we know that – but then it is a matter of training persons to take the pharmaceutical care message out to people in their own language and using the basis of knowledge the person is coming from in their own cultural way. This is done in Africa (Zambia) through what is called Adherence Support Workers and a similar trial in Australia is hoped to be struck in Katherine (NT) this year to test the concept. If we cannot have pharmacists everywhere we can at least try to have their agents as ASWs trained in the need for compliance and the actions and interactions of popular medicines for the chronic diseases that are killing these people at a rate unknown in the developed world.<br />
<br />
It is all a matter of equity – and at the moment that does not exist.<br />
<br />
Unfortunately as in many areas of endeavour towards alleviating Indigenous disadvantage we tend to rest on our laurels with the 10% of good effort and put aside the 90% that are not benefiting.<br />
As Noël Pearson put it recently:<br />
“I’m sorry I can’t take my focus off the glass 90 per cent empty, rather than being thankful for the glass 10 per cent full. Because I know what that 90 per cent translates into when those beautiful children who miss out on the social justice ticket become adults. Jail. Ill health. Early death.” (The Weekend Australian 28th November 2009).Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-27943958794028181192009-12-30T10:49:00.004+09:302009-12-30T11:35:34.674+09:30The start of a new decade - lets do it!<div class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: left;"><strong><span style="font-size: x-large;">Click on image to view full slide</span></strong><br />
</div><div class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0VJsOC4V-FskoCS_RuIB40tb26_LigC5QdUwgT1es4i9axrPrFEedg1T3eSA_Rzz3M4052vq9CFIrJWlIRgK8xIQtsbmGDM7hrQvqIzg9H7fOUa69nx95iI-Lu4urUkxh28YI/s1600-h/Slide1.JPG" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" ps="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0VJsOC4V-FskoCS_RuIB40tb26_LigC5QdUwgT1es4i9axrPrFEedg1T3eSA_Rzz3M4052vq9CFIrJWlIRgK8xIQtsbmGDM7hrQvqIzg9H7fOUa69nx95iI-Lu4urUkxh28YI/s200/Slide1.JPG" /></a>Allow me to share with you my views on two key issues that I believe will help to favourably shape the future destiny for Aboriginal people living in remote communities. <br />
</div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; text-align: left;"><br />
</div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; text-align: left;">In this field we(white fellas) are learning all the time. <br />
</div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; text-align: left;"><br />
</div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; text-align: left;">I started in 1997 looking after the pharmaceutical supplies for the 6,000 people who lived across 23 communities to the East and West of the town of Katherine in the Northern Territory. <br />
</div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAKMG4-EmAIS-ULN1yifJhziajjUxn6BabOBkpOcEYtE15x9XMuuM7BIV2WJtDM_gDcn4Kgc6QSVu-Uf0dZaHfCJNK1ciJSQmg5BOlIMlZfD6H0ZzXzRfycZFn3pukpu8olmLq/s1600-h/Slide2.JPG" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" ps="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAKMG4-EmAIS-ULN1yifJhziajjUxn6BabOBkpOcEYtE15x9XMuuM7BIV2WJtDM_gDcn4Kgc6QSVu-Uf0dZaHfCJNK1ciJSQmg5BOlIMlZfD6H0ZzXzRfycZFn3pukpu8olmLq/s200/Slide2.JPG" /></a><br />
</div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; text-align: left;"><br />
</div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; text-align: left;">When I left there eight months later I thought if people took their medicines they would live longer.<br />
</div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; text-align: left;"><br />
</div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;">How wrong I was. <br />
</div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;"><br />
</div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;">And what a contrast to the views I now hold having obtained an understanding of the social determinants that impact so severely on the lives of these people. <br />
<div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBox0VlsjJTueXq68FK4WzvtrAc-w6GCHxF-USC6x7aRzP2mWhO_s965_vCy5BbKV2wNPi3AcQ4QYL9-1eA4VeA0uzD84RL3_59VghRVo0x0XrOq0ZC_G8QbpTR17mfujt8vKs/s1600-h/Slide3.JPG" imageanchor="1" style="clear: left; cssfloat: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" ps="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBox0VlsjJTueXq68FK4WzvtrAc-w6GCHxF-USC6x7aRzP2mWhO_s965_vCy5BbKV2wNPi3AcQ4QYL9-1eA4VeA0uzD84RL3_59VghRVo0x0XrOq0ZC_G8QbpTR17mfujt8vKs/s200/Slide3.JPG" /></a><br />
</div></div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;"><br />
The state of poverty being experienced is such that it is a continual struggle day by day to simply survive so any ideas of time spent thinking about the future is simply not there.<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSCIocw37iPT_gMW_4j0nWcNKFZ5uztxW_kkQMoYzUGNVBkebumy0sFvsPWO65BAu0riIu-JB4uwSbaOuVIncR_OSJu-e7GfkcudxJy2jEFIvk3qISK9hHQZfDSyrOKE04Pn44/s1600-h/Slide4.JPG" imageanchor="1" style="clear: left; cssfloat: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" ps="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSCIocw37iPT_gMW_4j0nWcNKFZ5uztxW_kkQMoYzUGNVBkebumy0sFvsPWO65BAu0riIu-JB4uwSbaOuVIncR_OSJu-e7GfkcudxJy2jEFIvk3qISK9hHQZfDSyrOKE04Pn44/s200/Slide4.JPG" /></a>For those who come to Darwin it is usually for medical treatment. If it is renal dialysis, as is the case for some 200 persons at any one time, the family comes too and begins a continual round of Centrelink, bank, housing, ID through Births Deaths and Marriages, Medicare and the dozen other agencies that go towards the social capital of a developed society<br />
.<br />
<div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;">I look forward to comments or support for what I call my two key elements to a future better life for all. <br />
</div></div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;"><br />
</div><div align="left" class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8jlmKeoxwPJaj8uMR_BDRA4GPTLVKcRMRuZRRMYgF-f3bjbvAhIjMfGQj-s5zu1UF9RKhZTKinxiGeZ_2lzjgvFXuAfOKsfFXN7qsWk6Pi6sNNGwLjo1LYwGepXLLrlH3UR9S/s1600-h/Slide5.JPG" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" ps="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8jlmKeoxwPJaj8uMR_BDRA4GPTLVKcRMRuZRRMYgF-f3bjbvAhIjMfGQj-s5zu1UF9RKhZTKinxiGeZ_2lzjgvFXuAfOKsfFXN7qsWk6Pi6sNNGwLjo1LYwGepXLLrlH3UR9S/s200/Slide5.JPG" /></a><br />
</div><div align="left" class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEge6ilLQxLV_QDIYce50Ykk5c7k_BAKlOCASuVCf4UOdLLb2hl2KUCuuK3oHh_JAiLJvRS4OO0bzTci6jfCWMlGeD41ht1lajoE9iGEaA5tUZJLopRkubTqTLKyiJznBgKP-Pa1/s1600-h/Slide9.JPG" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" ps="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEge6ilLQxLV_QDIYce50Ykk5c7k_BAKlOCASuVCf4UOdLLb2hl2KUCuuK3oHh_JAiLJvRS4OO0bzTci6jfCWMlGeD41ht1lajoE9iGEaA5tUZJLopRkubTqTLKyiJznBgKP-Pa1/s200/Slide9.JPG" /></a><br />
</div><div align="left" class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8BuFuxvsC3-kWwSezriRH6-hQGjmuaMOW7CsfzwGb0f0SV2VV-fa-tk80yioty_613DqEegG06ym5V4E7RkbJAtg9lhDKrsWmNhc2m0D6QLVPCPQS1mG4gBfP-CxPNzWb2Z2d/s1600-h/Slide6.JPG" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" ps="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8BuFuxvsC3-kWwSezriRH6-hQGjmuaMOW7CsfzwGb0f0SV2VV-fa-tk80yioty_613DqEegG06ym5V4E7RkbJAtg9lhDKrsWmNhc2m0D6QLVPCPQS1mG4gBfP-CxPNzWb2Z2d/s200/Slide6.JPG" /></a><br />
</div><div align="left" class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirYZOiPUk1B2VADIFZYxhUAOIuOqS5zPcWUDsQ5OnzdMocgI1Ji2-A3n_f9gxFi_zC-l_UXcle9MENPUjV2pBbXWIRIPMQt2kHvTmM5mHvC-U-jrRh7ZECECjuQFSqAUStVXWA/s1600-h/Slide7.JPG" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" ps="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirYZOiPUk1B2VADIFZYxhUAOIuOqS5zPcWUDsQ5OnzdMocgI1Ji2-A3n_f9gxFi_zC-l_UXcle9MENPUjV2pBbXWIRIPMQt2kHvTmM5mHvC-U-jrRh7ZECECjuQFSqAUStVXWA/s200/Slide7.JPG" /></a><br />
</div><div align="left" class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjan7sdRAB5ezUdFzoSHSUOvEqjGiL4Nmeef_sQ6i1YQ3QWIvm8LCz3IhgmGJkpMp0ocrVzRsOw7z0E6CHbjUtYx7qbkgsSmO5G0jlQQe7PA3dpNhnCR77cqk-9Ciqyc24_QAcj/s1600-h/Slide8.JPG" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" ps="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjan7sdRAB5ezUdFzoSHSUOvEqjGiL4Nmeef_sQ6i1YQ3QWIvm8LCz3IhgmGJkpMp0ocrVzRsOw7z0E6CHbjUtYx7qbkgsSmO5G0jlQQe7PA3dpNhnCR77cqk-9Ciqyc24_QAcj/s200/Slide8.JPG" /></a><br />
</div><div align="left" class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFjLN6IkhgP207riEqY-hzmpB7ErqrtCOiFPuWS-qkYb7FI1ZtuHwu6tHDZW5TpOHtRmXCvPbaqUHlPslhNGGTuuF7VF3UCrUUec1nSMM0iw9famj6rNVOBAFqPRR3LvNhqBBV/s1600-h/Slide10.JPG" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" ps="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFjLN6IkhgP207riEqY-hzmpB7ErqrtCOiFPuWS-qkYb7FI1ZtuHwu6tHDZW5TpOHtRmXCvPbaqUHlPslhNGGTuuF7VF3UCrUUec1nSMM0iw9famj6rNVOBAFqPRR3LvNhqBBV/s200/Slide10.JPG" /></a><br />
</div><div align="left" class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_tFK1v7ZMc1n0a9cbc0XGIC3TaW3RnYpm2HwVF_PMWHfiqUwoaGq-jOEkUZp_qbm2H3nYx5DPSfWnyoNMpsbpxWEYwNKB1eGd0Gh_hy_kBaSaN5ZXkSfQzB_VKcUsE8cw2CS1/s1600-h/Slide11.JPG" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" ps="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_tFK1v7ZMc1n0a9cbc0XGIC3TaW3RnYpm2HwVF_PMWHfiqUwoaGq-jOEkUZp_qbm2H3nYx5DPSfWnyoNMpsbpxWEYwNKB1eGd0Gh_hy_kBaSaN5ZXkSfQzB_VKcUsE8cw2CS1/s200/Slide11.JPG" /></a><br />
</div>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-25875896454187958942009-07-26T08:14:00.010+09:302009-07-26T12:09:38.993+09:30Promoting an early deathThe Australian public is exposed to some outrageous headlines attempting to excite them about <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRdyG4IfQ_2wbblQ7dsoji17CAn_fweWJUdic35EimDvjmLAmyGEwdTKkZyntxKsnkAUBaIQmU6H8JcUa_AYuI9JCs1pOyyMp2CcbskXpMsNWAarBssc8fisZYAHrTfCd7FiF3/s1600-h/Tobacco_Feature.jpg"></a>spending rorts by people in high places. Rarely though is it exposed <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5JjLql1LUP_vkX5LLuCT3kQha1C1I4OVenceW9EH2H74rt6235797ZHpIYd1U9EEf7KlNYdtJ48OI0hdu-GyVOjuJhPWT0yTgZju1oBJR-QAu_CUlYchafCFMl4dDc2eZLKnT/s1600-h/Tobacco_Feature.jpg"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 343px; FLOAT: right; HEIGHT: 157px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5362537152505091554" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5JjLql1LUP_vkX5LLuCT3kQha1C1I4OVenceW9EH2H74rt6235797ZHpIYd1U9EEf7KlNYdtJ48OI0hdu-GyVOjuJhPWT0yTgZju1oBJR-QAu_CUlYchafCFMl4dDc2eZLKnT/s200/Tobacco_Feature.jpg" /></a>to the enormous spending on death defying recklessness by people on tobacco products.<br /><br /><br />The headline (on right) is supposed to create anger that the Nation’s Prime Minister travels too much.<br /><br /><br /><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEvyuPgSR7vtgnIbeh_j1xFs6euZhAsrQOQnIWxnl8hmfJzoLyBMhkD_igJVzU1tXoGZ18HeJ0tD4x6v3iCI8me_2_I1B1PONTXuigMCyfxlGLRndQgYmDi5mx2t6KDhmuNaJe/s1600-h/Tobacco_feature4.jpg"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 200px; FLOAT: left; HEIGHT: 185px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5362537816918017314" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEvyuPgSR7vtgnIbeh_j1xFs6euZhAsrQOQnIWxnl8hmfJzoLyBMhkD_igJVzU1tXoGZ18HeJ0tD4x6v3iCI8me_2_I1B1PONTXuigMCyfxlGLRndQgYmDi5mx2t6KDhmuNaJe/s200/Tobacco_feature4.jpg" /></a>What about the other? (on left) – Would it raise an eyebrow or simply be put aside with a sigh and an exclamation of – “oh well – you have to die of something”. And after the death – “oh yes but he was a smoker” as if that makes it all right to smoke to death.<br />No - it should not be like this.<br />The hackneyed old excuse that people have to take responsibility for their own health must be banned from use in a situation where people are legally allowed to buy products that are promoting a low life expectancy. By the time people “learn” to take personal responsibility for their actions thousands will have died from the effects of tobacco products and only the government of the day will be to blame for allowing this carnage to continue. Who will then say “sorry” in 50 years time?<br />A remote community of 2,500 population spends $80,000 a fortnight of a $500,000 welfare cheque on tobacco products. It is estimated that a further $80,000 is spent on Ganja. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdwerjNDNDCYzKmbgLBTURumNBr-vy_bvx8ls1qq12RbDgIj-NNl8CwLrojPrZ1QvP80Rq8YOolwWrFCUX1IkCgxP3LVhE77q3DYntyyIhTxQ1ISRsLylNzSr2JsnHrgm2KR2v/s1600-h/Tobacco_feature2.jpg"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 371px; FLOAT: right; HEIGHT: 275px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5362589267793313858" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdwerjNDNDCYzKmbgLBTURumNBr-vy_bvx8ls1qq12RbDgIj-NNl8CwLrojPrZ1QvP80Rq8YOolwWrFCUX1IkCgxP3LVhE77q3DYntyyIhTxQ1ISRsLylNzSr2JsnHrgm2KR2v/s200/Tobacco_feature2.jpg" /></a>(References available). 12 years ago the community store, takeaway and licensed club at Nguiu (Bathurst Island) was taking over 50% of its total revenue from beer and tobacco products. What of the others and where are the stats now? If anyone has them please speak up or is this vital market intelligence silenced by the same people that are profiting from the marketing of ill health?<br />And how good would it be if that same amount was being spent on community development activities or to facilitate the development of enterprises that would create employment opportunities. Yes that is right – something to do. Anyone who has (or does) smoke will know how much less is smoked when in a working environment that does either not allow smoking or is such that it is not possible to smoke. Imagine if of that 2,500 population there were suddenly 200 with a job – no time to smoke. If the money was put into a community fund a lot could happen.<br />As for the price of cigarettes – who cares?<br />A smoker will spend up to $15 a packet if they feel they need it. For all the debate about what difference the price makes, and how “price sensitive” is the marketplace – forget it. Not many smokers would know how much they paid for their last packet of cigarettes.<br />Just put the price up to $25 a packet and put the $10 a packet into a community fund.<br />If $80,000 a fortnight is being spent on cigarettes and people halved the amount they smoked – there would be (potentially) $40,000 a fortnight to go into a community fund for extra community development activities or an educational fund for school excursions. That is $ One million a year for a community fund from a self imposed tobacco tax. The cost benefit to the community is huge – what a headline that would make!<br />O<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgp5lm8DKzbxE9JrZC0_JyXM65xm96ddWp-LDBuORc5u6x34yEIFsJgRUukmgvI6u1O2Je-LDsbp_i35gFmm-1K006yTU84SwYIwvYEZMVcjyhzyluZ3IpBfg6U36EA41s1vlyB/s1600-h/Tobacco_feature7.jpg"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 200px; FLOAT: left; HEIGHT: 150px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5362589707195814562" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgp5lm8DKzbxE9JrZC0_JyXM65xm96ddWp-LDBuORc5u6x34yEIFsJgRUukmgvI6u1O2Je-LDsbp_i35gFmm-1K006yTU84SwYIwvYEZMVcjyhzyluZ3IpBfg6U36EA41s1vlyB/s200/Tobacco_feature7.jpg" /></a>nly drastic measures will bring about behavioral change and it is about time the authorities “bit the bullet” and did something drastic. Tinkering around the edges has produced no change and the situation still exists where people in these communities do not know what good health is.<br />Spend the money from the tobacco tax on promoting good health – but in the same vigorous way that McDonalds, Coke and Kentucky promote ill health and oh yes VB, Four Ex, Tooheys and Fosters too.<br />As for the remote community takeaway stores – some of them are just selling sickness. Bulldoze them all and create a “good health” store where at least the choices will be healthy ones.<br /><br />EndsRollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-66610710357395122172009-03-30T11:41:00.012+09:302009-04-01T15:55:25.348+09:30TRAINING FOR WORK<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFjPtoBQfQajTzDpdCANGV1Ecb291nKIUke4G0E5i1axUdP6SgZIDQdF5E6kVUCFomwb9VH-l043yELum5nlagW4mHh3BJYED-y5tSjkww9CrgMaWOEBThWkfI3gOXG94jmlm1/s1600-h/Why-Warrior.jpg"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUhUiImSmfbmRLq9kWqKYR49R6wt8HEaJ3j8XycQbnDPf1izB_BwY_9kPnSwx-bJd9iSosXzx3em8lWGBN-8Qcy7Ou66uAMU-pgl163NnNA-GeOkrZyFd-AqjrxS91pjA1z2qY/s1600-h/Oxfam.jpg"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 141px; FLOAT: right; HEIGHT: 200px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5318798318541795298" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUhUiImSmfbmRLq9kWqKYR49R6wt8HEaJ3j8XycQbnDPf1izB_BwY_9kPnSwx-bJd9iSosXzx3em8lWGBN-8Qcy7Ou66uAMU-pgl163NnNA-GeOkrZyFd-AqjrxS91pjA1z2qY/s200/Oxfam.jpg" /></a> <div><div><div>The contribution pharmacists can make to the National Close the Gap day to be held on 2 April is to commit to training an Aboriginal person to work in the pharmacy of an AHS and help to develop a system whereby Aboriginal people can understand medicines and their role in the management of chronic diseases. </div><div><br />Recent research in the Medical Journal of Australia (1) has shown that Aboriginal children are not predisposed to chronic diseases such as renal failure, diabetes or circulatory diseases and that these conditions are brought on by lifestyle choices in later life. </div><br /><div>As the Nation focuses on Close the Gap pharmacists too should be examining what they can do to contribute in a way that is more than just supplying medicines and feeling the day’s work has been done. </div><div><br />There is one trap that can easily be fallen into and that is imagining that everything should be done in the same way as it has been for western society – making the assumption that “they” can be like us. “We” have developed our culture - its norms and its customs after thousands of years of living in a world that has been constantly changing and with advances in transport, mode of living (houses), food sources and industrial activity. Aboriginal people too have developed there culture through the same time period but with the dramatic difference of being <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhn2HMwAqO-gDos8WL-Yf0ZQuey24MTKlypWt6z3Lf99RN94cM52bH_LXkLdMGOQwWzq2ioDKIIHNrtg6ggNG_MIsER5Vr5-HYUMy-G5TOvvP3yhmGiO1mTc-1eL6bT0TcD-LkC/s1600-h/Purchase-Book-Why-Warrior.jpg"></a>isolated from the rest of the population of the world. It is so different when there are no means <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8eATYSIyEkoOwaImIOlf3ABOIsNCmiWU-5B0w8ZoV3Btv7esNx7RpiGB4bhlLpkkIhb45tPv-Hr5Qisj2aquMbHK8pi8gmXdni_07gWbawqhmBmVxA1ApC3Qun9KJc70GQBev/s1600-h/Why-Warrior.jpg"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 151px; FLOAT: left; HEIGHT: 200px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5318801040351312802" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8eATYSIyEkoOwaImIOlf3ABOIsNCmiWU-5B0w8ZoV3Btv7esNx7RpiGB4bhlLpkkIhb45tPv-Hr5Qisj2aquMbHK8pi8gmXdni_07gWbawqhmBmVxA1ApC3Qun9KJc70GQBev/s200/Why-Warrior.jpg" /></a>of transport (the wheel was not even there); no metallic objects; no materials for housing; and food that had to be found day by day. To many of these people, especially in remote Australia, access to the developed world has only been available for the past 100 years and in some cases in the last 50 years. This is a minuscule period of time and the change to a different way of thinking has to be done gradually, with sensitivity to their beliefs, and in a manner that takes account of their view of the world. This was well described in the book by Richard Trudgen , “Why Warriors lie down and die” (2), and that has become a standard reading text for anyone entering the Aboriginal health industry across the North of Australia.</div><div><br />We have to understand where Aboriginal are coming from in their understanding of disease states, why they occur, what can be done to overcome the onset and the management practices (that suit their ways) and which will maintain a life that is symptom free.<br />It is not just a matter of devising a training course that embraces subject areas that have worked in western culture because they are there. There is little evidence to show that VET Certificate courses in business administration, community health, community services, health administration and others have produced workers who are able to understand the tasks needed to improve the workplace and its clients. Often Aboriginal people attend training because it is a condition of receiving a Centrelink benefit and afterwards do not even remember what the training course was or upon receipt of a certificate cannot recall having done the course. </div><div><br />The Department of Education Employment and Workplace Relations (DEEWR) is stacked with principles, guidelines, protocols and acronyms that point towards funding for training. The only trouble is there are not the jobs to be undertaken when the training is finished and whatever was learnt is quickly forgotten. </div><div><br />Pharmacy is at the sharp end of a revolution that will try and close the gap. It (pharmacy) is in an ideal position to develop WITH Aboriginal people training programs that help to bridge the gap and provide knowledge in a manner that can be used. It is no use trying to teach anyone the mode of action of an ACE inhibitor to control blood pressure and increase the flow of blood through the kidney without knowing: </div><div></div><div></div><div></div><div>a. What the kidney does?<br />b. How it does it?<br />c. Why it is important?<br />d. What causes it to malfunction?<br />e. What needs to be done to prevent this?<br />f. How people should live to avoid kidney damage?<br />g. And finally what the drug will do in contribution to a good functioning kidney given that all, preventative measures have been exhausted.<br />Without this understanding the elements in training for a pharmacy technician in an Aboriginal Health Service could be useless because it is not relevant to the needs of the client. </div><div><br />In developing any training program the main focus has to be on the client (patient) and not what conforms to the downloadable training package available from the National Industry Training Council. Sure there is funding available for mainstream training packages but what use is that if the patient will still not understand why their kidneys have packed it in. There is a lot to be done in devising training programs that meet the needs. </div><div><br />The time to start is now. Play your part. Help to close the gap by demanding that training meets the needs of the client – not the criteria that works in mainstream.</div><div><br />Whether it is pharmacy technicians at urban Aboriginal health services, remote health clinics or as an adjunct to other health professionals make sure it meets the need – and that is not necessarily an already established training package. </div><div></div><div><br /><br />Footnotes<br />1) Patterns of mortality in Indigenous adults in the Northern Territory, 1998–2003: are people living in more remote areas worse off? Karen Andreasyan and Wendy E Hoy. MJA 2009; 190 (6): 307-311 </div><div><br />2) “Why Warriors Lie Down and Die” by Richard Trudgen. Aboriginal Studies Press. ISBN: 0-646-39587-4<br /></div><div><br /></div><div>Ends </div></div></div>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-38650726081032538152009-03-08T09:40:00.012+09:302009-03-08T10:15:37.579+09:30The Trachoma issue – what does it take?<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLwX-X2RdVSii-csXNYbrsZ8L7XAcJzFeMVsS_qti5CvmCN8tSmPS6KwNWQJAdhZe_7L3RQ7wDOrCbvw0-OKK4pRbWxDzEpKRYd4pjc71y_Ie7p3NdtD6HSt-WISmXz0BgvpmP/s1600-h/closethegap.gif"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 86px; FLOAT: right; HEIGHT: 96px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5310603551251449746" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLwX-X2RdVSii-csXNYbrsZ8L7XAcJzFeMVsS_qti5CvmCN8tSmPS6KwNWQJAdhZe_7L3RQ7wDOrCbvw0-OKK4pRbWxDzEpKRYd4pjc71y_Ie7p3NdtD6HSt-WISmXz0BgvpmP/s200/closethegap.gif" /></a> There are times when people involved in trying to close the gap in Aboriginal health hold up their hands in despair and scream “what does it take?”<br />Following the statement of achievements during February 2009 by Prime Minister Kevin Rudd to “Closing <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKO4YuXiuf8XTcvm57DacRufaHNhnG_gxqO-dYKWj-bnXf9kYDO3p1z6lr9olqwmV9quQlxztqOEWtuXA6gAXocOuIqf60GtaTiFOcCc9GrJ7G6p7DFvTcDHdsk1gA75J5m2vH/s1600-h/MSN_Nine_AMSANT.jpg"></a>the Gap” the Aboriginal Medical Services Alliance of the Northern Territory has called for a way to get the dollars promised to the ground as directly as possible.<br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTkVxsQQzKPbHV42Ytn499waAEcpsb-By_OyqUAfpI2_e4-DVWaw_hO9RQd_vMSY2OPa0MUY9wUkWB1OgSZGsrhL4-IQTYIAQ7MPk3DNLY8QFdFCgF3VohWjtScvjzVrJ5CO4b/s1600-h/AMSANT_Release.jpg"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhslkI2bhEguA2tDG-80GfR-6nQzsfYo9WDq2KMh1WtorNIR4R82FypQa8uFiIW9z0iTmvy-q0KRBdX3pMY-hady_cbPQagKF7JWHVWjHjLp-N8fjKr1Ec8hkokb_imZZRs_AMV/s1600-h/MSN_Nine_AMSANT.jpg"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 186px; FLOAT: left; HEIGHT: 200px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5310605266007797074" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhslkI2bhEguA2tDG-80GfR-6nQzsfYo9WDq2KMh1WtorNIR4R82FypQa8uFiIW9z0iTmvy-q0KRBdX3pMY-hady_cbPQagKF7JWHVWjHjLp-N8fjKr1Ec8hkokb_imZZRs_AMV/s200/MSN_Nine_AMSANT.jpg" /></a>Congratulations to AMSANT for the suggestion that a single authority accountable to the Parliament be established to deal with all matters pertaining to Aboriginal health and the funds that are promised for this use.<br />It is so often the public forgets the announcements, makes a judgment at the time and then waits for the next one assuming the previous has been actioned. It does not work that way. By the time a policy proposal moves along the three levels of government a time space of years has gone by and governments have changed meaning the proposal as it stood is probably lost.<br />This is where the AMSANT proposal makes so much sense - a direct line from politician announcement to program implementation on the ground by community controlled (not government controlled) health services.<br />In reality there has to be an agency that is holding governments and politicians accountable for the promises that are made. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7EOaT1cjOEPOcmGtoRyS0nTtbSdyQb2IkZ4pdLSzK2wy8YUqyMkKt96LE8KtQUnq4pEc4Q6QG1_Yt6Hu0JbXS0a8c6d6ynALHhCPpcQU319m0gqhO7qyfW4pU6YzJ89kgocNb/s1600-h/ABC_Rudd_Taylor.jpg"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 258px; FLOAT: right; HEIGHT: 235px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5310606560175319186" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7EOaT1cjOEPOcmGtoRyS0nTtbSdyQb2IkZ4pdLSzK2wy8YUqyMkKt96LE8KtQUnq4pEc4Q6QG1_Yt6Hu0JbXS0a8c6d6ynALHhCPpcQU319m0gqhO7qyfW4pU6YzJ89kgocNb/s320/ABC_Rudd_Taylor.jpg" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsg-qJ4BlF9dBRx4Igfaqq3EHFTCnI5wtG5jZNgu7dkhnFqNVi6LuwY8jKEoBwE4JUn1B6xUrm041YKe789z2AFVlQtg4JJRix_YC2FsPUd-ehPMpKlse7ugTNaSPcErTSGXzW/s1600-h/MSN_Nine_AMSANT.jpg"></a>As an example of just how hard it is to make things happen take a look at the problem of trachoma – a debilitating eye disease that can send people blind if not treated properly (and simply) with improved personal hygiene and Azithromycin.<br />Mr. Rudd also announced during the week that $58.3 million would be made available for eye and ear health with a focus on eradicating trachoma, a disease that leads to blindness. It has been eliminated in all other developed countries.<br />The PMs Media Release said (interalia)<br />“Our objective must be clear: to eliminate trachoma among Indigenous Australians within a finite timeframe”.<br />Now wind the clock back to 1997 when in The Age 27th June it is stated:<br />“Dr Wooldridge said the Government would spend whatever was necessary to fix what was preventable blindness striking 100,000 Australians. The minister said he was angry that after so long little had improved in relation to the eye health of Aborigines in remote communities”<br />And then in the SMH on 18th November:<br />“Aboriginal eye health …has worsened, with the rates of the blinding disease trachoma found to be 80 per cent among some children, and indigenous people 10 times more likely to be blind than other Australians.”<br />This followed a study, by the head of Melbourne University's Department of Opthalmology, Professor Hugh Taylor - the first such review in two decades – which found the eye health of Aborigines in remote communities had barely improved in that time.<br />To which Minister Woolridge’s office responded that:<br />"These things take time," he said.<br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-nXMc97JqcjGky1AiK9O66_p9tIimJkDQjyHyar7rguFX-64c5QfGkQZupaN8D4S4FPStqzEqzvTVGjV1w0vCxeSwsEjz8O2Fae-k_M4ZkBOit-X62Hci_2PQyojcmdJu4ewx/s1600-h/The+Age+March+1998.jpg"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 200px; FLOAT: left; HEIGHT: 138px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5310607334933267746" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-nXMc97JqcjGky1AiK9O66_p9tIimJkDQjyHyar7rguFX-64c5QfGkQZupaN8D4S4FPStqzEqzvTVGjV1w0vCxeSwsEjz8O2Fae-k_M4ZkBOit-X62Hci_2PQyojcmdJu4ewx/s200/The+Age+March+1998.jpg" /></a>The amount of money the government committed in March 1998 was $4.8 million but who remembers what happened, whether it worked and ask why this is still going on. (See on left extract from "The Age" March 1998)<br />The price has now increased to $58 million although that does include ear health.<br />Professor Hugh Taylor, the long time advocate for action on eye health must be really wondering how much time it needs for what should be a simple undertaking. Read the transcript of ABC Ockhams Razor program on 1st July 2001 on the link to the title of this article.<br />Pharmacists involved in Aboriginal health will know that it was the desire to have Azithromycin made free to remote living Aboriginal people that lead to the Section 100 supply arrangements for the entire PBS Schedule Yellow Pages. It was during the PMs visit to Maningrida (NT) in 1998 that prompted the action that lead to the implementation of this change in April 1999 and now follows to all remote Aboriginal Health Services.<br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwlonUSY0Xbpsa7qeqBkU2iDhoD3qankUovCi8KrziNnAd3VvCRC7BW9BqnL3J9Kn0DUk1WliwiKBwVS0tdRkhczBVRtzQfi68RtQKueniJ0mad-HI5V92-ItUBrCWYdBOajBg/s1600-h/Kimberley0906_Day11+046.jpg"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 200px; FLOAT: right; HEIGHT: 150px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5310608467874469906" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwlonUSY0Xbpsa7qeqBkU2iDhoD3qankUovCi8KrziNnAd3VvCRC7BW9BqnL3J9Kn0DUk1WliwiKBwVS0tdRkhczBVRtzQfi68RtQKueniJ0mad-HI5V92-ItUBrCWYdBOajBg/s200/Kimberley0906_Day11+046.jpg" /></a> Picture on right shows the writer assisting the RFDS Nurse at Tablelands Station in the Kimberley administer Azithromycin suspension to children diagnosed by the visiting doctor with Trachoma.<br />This column supports the AMSANT call for a National Aboriginal Health Authority and calls on pharmacy organisations to give their support to the proposal by agreeing to work with it in ensuring the quality use of medicine is exemplary in whatever programs it administers.<br />Close the Gap is not just about life expectancy – it is about reducing the distance between the politicians announcements of money being available and that money then being used on the purpose for which it is intended with the minimum of administration in between.<br />With two levels of health bureaucracies (Australian and State/Territory governments) dealing with programs and even then it not being delivered the total sum quickly diminishes.<br />The Aboriginal community controlled sector needs support in responding to such calls.<br />In the Northern Territory there are 47 government controlled health clinics as against 26 community controlled. This gap needs to be narrowed also until they are all community controlled and using the money directly that is voted through the Parliament for spending on improving Aboriginal health.Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-82473507997479088812009-02-09T14:49:00.044+09:302009-02-10T14:07:41.050+09:30Aboriginal towns stark contrast to mainstream<div><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAD5pYPGAJf4RRe8fvNh0uroqIz0JLnI8YRe9rKdjrBrXsWcY12dYMUwWyeNcxZuPGjeFpqI1K-dGbF7EcF0yWUb6s5AO-4GYb3jxh7WlJ8jqt1Dt3kWwF8y0HvM_RdWw6yRmy/s1600-h/Oz_New_lease_life.png"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 197px; FLOAT: right; HEIGHT: 144px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5301019718131554818" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAD5pYPGAJf4RRe8fvNh0uroqIz0JLnI8YRe9rKdjrBrXsWcY12dYMUwWyeNcxZuPGjeFpqI1K-dGbF7EcF0yWUb6s5AO-4GYb3jxh7WlJ8jqt1Dt3kWwF8y0HvM_RdWw6yRmy/s320/Oz_New_lease_life.png" /></a> Governments must open their eyes and do something to create the infrastructure needed to have a thriving economy in remote Aboriginal towns across the north of Australia. There is no need to keep thinking that one store, a couple of takeaways and a fuel outlet is all that is needed and then say the people must move to the jobs if they want to work for a living!<br /><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div>Indications are something is going to happen - it is a matter of when and how!<br />There is no reason to believe that Aboriginal people do not need the retail outlets and service facilities that the rest of Australia takes for granted. Regrettably that is all many people know because that is all they have seen living in isolation to the rest of the population. </div><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimSNLWifhu3sghy_jws6OJu07G9G-5I244VCFraVWVp_BWEu216tLNaM21r_hqLPs79UR93knsMqHuLC1cmVjGFGOWBCv3crSJJSjDWYJyXLl4OxW3t097ebI6fHikJDjNETr_/s1600-h/SnagIt2.jpg"></a></div><div>A comparison of an Australian country town, Boorowa in NSW, with Galiwin’ku on Elcho Island shows up some sharp contrasts.<br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg27RPGknpHMQY9TKczOIXBd1pzwiCY8Ob9BGoWTEu_jix6TpQ6DSMrHfM-Qu5PJ6dmklPaDEwQiST_dfGFkpZtjet36o_Wwduz0wcQOo2NGkqnFnl73GpQNpMru1qo9FXA0Zq5/s1600-h/Boorowa.jpg"></a></div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKq-nnbMTjaVtuI2WTJ_u_qZS4K9KAFY1ejplK5Q30bYn-qRlynK_tGqG4FjlQQFQTMKhKbWmCLKQz6zhljjzkzf3JkTVi2nA6MQQaG0Nd2GxCNLUmoNPvpPQGHREkqbmzrqZB/s1600-h/Galiwinku.jpg"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 178px; FLOAT: right; HEIGHT: 202px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5301019289759846530" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKq-nnbMTjaVtuI2WTJ_u_qZS4K9KAFY1ejplK5Q30bYn-qRlynK_tGqG4FjlQQFQTMKhKbWmCLKQz6zhljjzkzf3JkTVi2nA6MQQaG0Nd2GxCNLUmoNPvpPQGHREkqbmzrqZB/s320/Galiwinku.jpg" /></a> Population of both places 2,000 people </div><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5f_ZD7_A7dSSSJXvCyKPOA6fkHL3yzM_0y5EpQ7KsP-bh1h0SnjYTPXVrsqU50POloSsSljvfrMY38tOOTslGKtVkReeAf1qnRR7zFkG1zU2x9KJ1zJDLl9Z29sh1AbGNMsO_/s1600-h/Boorowa.jpg"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 204px; FLOAT: left; HEIGHT: 156px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5301021864664502002" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5f_ZD7_A7dSSSJXvCyKPOA6fkHL3yzM_0y5EpQ7KsP-bh1h0SnjYTPXVrsqU50POloSsSljvfrMY38tOOTslGKtVkReeAf1qnRR7zFkG1zU2x9KJ1zJDLl9Z29sh1AbGNMsO_/s320/Boorowa.jpg" /></a></div><div>If it looks as though Boorowa is the bigger<br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg27RPGknpHMQY9TKczOIXBd1pzwiCY8Ob9BGoWTEu_jix6TpQ6DSMrHfM-Qu5PJ6dmklPaDEwQiST_dfGFkpZtjet36o_Wwduz0wcQOo2NGkqnFnl73GpQNpMru1qo9FXA0Zq5/s1600-h/Boorowa.jpg"></a></div>of the two – it is - in terms of number of houses. 950 for 2,000 people compared to Galiwin’ku with 152 houses.</div><div>Then you really know what over <u><span style="color:#0000ff;">c</span></u>rowding” means! 8.5 persons per house at Galiwin’ku compared with 2.4 in Boorowa.<br /></div><div></div><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-lgI7q9A6jn4bdpwclvzx7ia2QZshtAiAjARPmXh7DzpujQO_WHV_VoHND1_DzepSsZe83r3q10b9AfRjPJC-K2I2KzF71eO0SvysZ6tiUZgVA9cnfbAkz6qjw1pt_-F0pVhb/s1600-h/hotel.jpg"></a></div><div></div><div><div>The biggest contrast in terms of retail opportunities is the number of<br />businesses - be they retail or service.</div></div><div>Galiwin’ku has just five retail outlets. One store, three takeaways and a fuel bowser. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwrP20eAz7GFbmCx_R6fiFm9FBaFKIZqF9WLZ7Bhaibm2lX7pQ1qrniIqhelBiWWhNMzjxy-ALQi_5c__hpgCsmT-4qllGntD5O5_U6MVHpCkga3Orc7WIFJyed9Md3xdeK8Qx/s1600-h/Pharmacy.jpg"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 183px; FLOAT: right; HEIGHT: 150px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5300696782056306514" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwrP20eAz7GFbmCx_R6fiFm9FBaFKIZqF9WLZ7Bhaibm2lX7pQ1qrniIqhelBiWWhNMzjxy-ALQi_5c__hpgCsmT-4qllGntD5O5_U6MVHpCkga3Orc7WIFJyed9Md3xdeK8Qx/s320/Pharmacy.jpg" /></a><br />Boorowa on the other hand has 15 retail outlets as well as three<br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-lgI7q9A6jn4bdpwclvzx7ia2QZshtAiAjARPmXh7DzpujQO_WHV_VoHND1_DzepSsZe83r3q10b9AfRjPJC-K2I2KzF71eO0SvysZ6tiUZgVA9cnfbAkz6qjw1pt_-F0pVhb/s1600-h/hotel.jpg"></a></div>hotels - (none at Elcho), three motels (none at Elcho), eight café/restaurants (none at Elcho) other retail stores including a pharmacy - pictured right - and the gathering of service clubs, special interest groups and supporting organisations mainstream Australians take for granted.<br />Overall the strength of social capital in Boorowa is huge compared with Galiwin’ku where it has been decimated over the past 100 years as a result of colonisation. There were people living in North East Arnhem Land in the 1930s who did not know the “south” had been settled by the British. They thought Japanese (from pearling) and Asians (from trepang) were the only other people on the planet.(1)<br />The people of Galiwin’ku are from 15 different clan groups that were at loggerheads years ago and have been thrust together in a “community” with no help in <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnSfdTKGxEAdmYRMKOcPE2R_PskD6h9dyTueupCxnQ2sfxp5WhgafI186q3sTeM1Sw-rsCaMmkp4IFLZ2eSF051rjs17Q1P0E4w2G-8mlUDh3Eb4KmseXoNS1blG9Bt3LYur_-/s1600-h/Booklet.JPG"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 79px; FLOAT: left; HEIGHT: 153px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5300674002968364674" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnSfdTKGxEAdmYRMKOcPE2R_PskD6h9dyTueupCxnQ2sfxp5WhgafI186q3sTeM1Sw-rsCaMmkp4IFLZ2eSF051rjs17Q1P0E4w2G-8mlUDh3Eb4KmseXoNS1blG9Bt3LYur_-/s320/Booklet.JPG" /></a>developing their alternative social networks, activities or sporting opportunities. There is football club run by a group under the auspice of the Council but with little opportunity for the player to have a say in how it is run. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqTlqkPyHr9sx2rBqyLqDaDhmuE1BY6CeruBu88heOtDeGyec4jjiDwXJx6aV-6G6kcORctKL8r3zCDoXcBJlwhK_P0B8sZ0_AoIl0VSI4G31IUGxplOclzuDz3MRUKHI_Zzkp/s1600-h/Guest+House.jpg"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 213px; FLOAT: right; HEIGHT: 124px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5300675549438606706" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqTlqkPyHr9sx2rBqyLqDaDhmuE1BY6CeruBu88heOtDeGyec4jjiDwXJx6aV-6G6kcORctKL8r3zCDoXcBJlwhK_P0B8sZ0_AoIl0VSI4G31IUGxplOclzuDz3MRUKHI_Zzkp/s320/Guest+House.jpg" /></a><br />The clan groups are the focus of social gatherings.<br />The 24 page booklet (pictured left) lists all the shops, services, clubs, festivals, history and attractions of Boorowa.<br />Galiwin’ku does not have ONE motel. Only a “guest house” that many walk away from on first sight. (Pictured right)<br />The following table gives a comparison of other indicators (2) :<br /><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 416px; DISPLAY: block; HEIGHT: 292px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5300977591832040306" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhA0VxRndyUOPZKRvkSTjf0Hg-vVmHaAHTNvAjvjUCxaeSXtUP5ihkD-VUqgMS4YmqlWg_tvbTjaB7OswRgbRv-oykKRurRLgspadR4w5R6ltlrDKUQLZsuaqb4zWhdz9c_fxZf/s320/Indicators.jpg" /></div><div>It does not have to be this way and yet for some reason governments over the past 30 years have believed remote living Aboriginal people only need the most fundamental of services to make their communities thrive.<br />It is shameful that in 2009 these towns have chronic unemployment, illiteracy among children, poor health through overcrowded houses and phenomenal amounts of boredom that leads to domestic violence, drug abuse and general anti social behaviour.<br />This is the profile of a town where only 10% of the population has reached Year 10 level at school. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2o2RAF6MDjk5CaKJmtZFPfzVr6vIraosFfZsE7CirTt1kLzMRD4BzlKRbjJN-sKu-QyP21Ija3yYAQfKnj0wH4zvCUE13bwR7KCa-djz2LfzpANiIB7013E2UsYZUAa5iS_i0/s1600-h/alpa_store_large.jpg"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 193px; FLOAT: right; HEIGHT: 136px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5300699127657531842" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2o2RAF6MDjk5CaKJmtZFPfzVr6vIraosFfZsE7CirTt1kLzMRD4BzlKRbjJN-sKu-QyP21Ija3yYAQfKnj0wH4zvCUE13bwR7KCa-djz2LfzpANiIB7013E2UsYZUAa5iS_i0/s320/alpa_store_large.jpg" /></a><br />The retail store - with no competition - is under no commercial pressure to do better - although the one at Galiwin'ku is community controlled and does its best (pictured right).<br />It is hard to expect a child to want to go to school when all they see is chronic unemployment and no industries that attract their desire</div><div>as a future career path. </div><div>As Noel Pearson put it in an article in The Australian in August 2008:<br /><em>"You can educate people as much as you like, but if they've got no jobs to go into, as a young Aboriginal 10 year-olsd told me<strong>"Why do we need to be</strong> <strong>educated if there's nothing for us, there's no future"."</strong></em></div><div>The answer lies in developing enterprises which the people themselves want to see happen and <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhm_Jyon7XuD4_H2YpkCeAt2x5Yh1kXnDFbWy_1XF_HAtRFzqqI3spatEzS1z-fqMoS5Oln692iYSCl3qhCQowiRiCgpn3femAJ8-14jLjXbIWEq-1be9BzSEgxo9gUCT0pUEhw/s1600-h/Ernesto.bmp"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 122px; FLOAT: right; HEIGHT: 187px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5300700570152740178" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhm_Jyon7XuD4_H2YpkCeAt2x5Yh1kXnDFbWy_1XF_HAtRFzqqI3spatEzS1z-fqMoS5Oln692iYSCl3qhCQowiRiCgpn3femAJ8-14jLjXbIWEq-1be9BzSEgxo9gUCT0pUEhw/s320/Ernesto.bmp" /></a>where they are responsible for that development. </div><div>In the world of “Enterprise Facilitation”, and as promoted by Ernesto Sirolli through his Sirolli Institute (3) based in Canada, the facilitator has no original ideas of their own – they all come from the people – and – only work with people who want to be helped. It remains to be seen whether this approach will work in remote Aboriginal towns but it is worth a try. </div><div>Let’s face it – nothing else has worked over the past 100 years so why not ENTERPRISE FACILITATION a la Sirolli. </div><div>Remote living Aboriginals need some dreams. The dreams they had have been destroyed by Governments with a passion to have them be like us. </div><div>What needs to be done is foster and facilitate their dreams so success can come and by example the children will at last see a reason to want to go to school.<br />The Enterprise Facilitator helps people to live their dreams and provide them with the answers they need to achieve their goals.<br />Aboriginal people in the main have been to Darwin, they spend a lot of money at stores of all types and sizes. K-Mart and Target are popular as is The Good Guys and Harvey Norman. The amount of money being spent is mind boggling for people who are allegedly living in a state of poverty. For the ones that do not waste their money on grog, gunja and drugs there is plenty of disposable income left for clothing, electrical goods and gadgets, sporting accessories and music.<br />The big retailers are benefitting but there is no reason why a wider variety of shops in the town would not succeed given the obvious demand.<br />A concerted effort on the part of the Australian society (including government) is needed to bring these Aboriginal towns up to the same level of services as the towns mainstream Australians call home. </div><div>This has to happen so the playing field is level when a comparison is made between the two cultures. </div><div>References:<br />1. Mcintosh, I., & Burrumarra, D. (1994). The whale and the cross: conversation with David Burrumarra MBE. Darwin, Historical Society of the Northern Territory. </div><div>2. Australian Bureau of Statistics: 2006 Census QuickStats. Boorowa and Galiwin’ku </div><div>3. Ernesto Sirolli: Ripples from the Zambezi: Passion, Entrepreneurship, and the Rebirth of Local Economies. New Society Publishing, British Columbia, Canada</div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-89778787805562045522008-11-04T05:36:00.009+09:302009-01-22T06:32:43.102+09:30Equity needed in PBS supply to Aboriginal patients<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD7-8XWJewk_Ems8xiBP5ECTMiEyHth8V-v_z8bkGb1LHTG9MiAqjTeJRps-333vx41A8fb1O5h9EcLu_XGVJ8Hvhky6HE7PvCMhstFOt-Hgg7K2B9RyFfHY_FZ6O03d2f8xDx/s1600-h/Rollo+at+display1+011004.jpg"><img id="BLOGGER_PHOTO_ID_5264529159850921218" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 147px; CURSOR: hand; HEIGHT: 196px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD7-8XWJewk_Ems8xiBP5ECTMiEyHth8V-v_z8bkGb1LHTG9MiAqjTeJRps-333vx41A8fb1O5h9EcLu_XGVJ8Hvhky6HE7PvCMhstFOt-Hgg7K2B9RyFfHY_FZ6O03d2f8xDx/s320/Rollo+at+display1+011004.jpg" border="0" /></a><br /><div><div><div>Let me tell you a story –<br />…the story of the Pharmaceutical Benefits Scheme and Aboriginal people in urban and <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9dynw2QKy_S2xdVlBTTpasnU-rK9VVbF-ToPeLKNkKxxpj5p9G7CodC-7JBZKRPYWXoyDygieUZ5XsGy8dLMO1q1ytWSAl76KLth_KG8JKYUGjvbBqrSRxoK4dBa26wmSEH5z/s1600-h/Linda_White.jpg"></a>remote areas.<br /><br />Pharmacy services in Australia have evolved over the past 50 years following a model of retail dominance. Emerging from the 1960s when the compounding of medicines in all forms gave way to manufactured product the pharmacy profession ceased to be the wise old man of the mortar and pestle and exchanged this for the emerging technology of retail business management.<br />For a time in the early 1970s through to the 1990s the shop based dollar turnover dominated through the “front of shop” sales of anything from coffee and asparagus to health and beauty aids. The franchised style of branded chains came out of the individually owned businesses of the earlier “master pharmacists”.<br />More recently the pendulum has swung the other way and dispensary turnover is exceeding the front of shop due to the enormous change in retail shopping behaviour influenced by the supermarkets. In an attempt to counter this pharmacists’ have turned their stores into supermarkets. With some deft political maneuvering they too have been able to have legislation passed that means it is illegal to have a pharmacy in a supermarket but okay for a supermarket to be in a pharmacy!<br />The driver of the force that created a unique retail profile combining the retailing with the professional services was driven (and continues to be driven) by the union for pharmacy owners – the Pharmacy Guild of Australia. The organisation is now in its 80th year after having been initiated in New South Wales in 1928 in response to news that the powerful Boots the Chemist chain in the United Kingdom was considering entering Australia to overpower the dominance of a “pharmacist owned” policy. So it happened that bullions of gold were exchanged for political favors and the same principle still applies today as the powerbrokers of the ancient establishment continue to disperse their wealth in successful endeavors to maintain the highly anti competitive practice of retaining the pharmacist only owned policy in all jurisdictions except the Northern Territory.<br />In that “State” the law allows an Aboriginal health service to own a pharmacy business so long as it has Ministerial approval. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsQKQQBXosAo50VPYLfijCBskBBwDryZbn-qJwXf0HW7Rfgw8QnQeSaxhm2iSNe4qSRQZCiH7mG5LNHEo5kboYnwlqrgGtpDykz5GYHm4FJaVr4jxuR_0V5umwJBq4TAKo-uyG/s1600-h/Linda_White.jpg"><img id="BLOGGER_PHOTO_ID_5264528517132250386" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; WIDTH: 190px; CURSOR: hand; HEIGHT: 133px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsQKQQBXosAo50VPYLfijCBskBBwDryZbn-qJwXf0HW7Rfgw8QnQeSaxhm2iSNe4qSRQZCiH7mG5LNHEo5kboYnwlqrgGtpDykz5GYHm4FJaVr4jxuR_0V5umwJBq4TAKo-uyG/s320/Linda_White.jpg" border="0" /></a><br />In 2004 the Pharmacy Guild convinced the NT Labor Government that it was out of step with the rest of Australia by not having a pharmacist only ownership rule. In point of fact and following National Competition Policy (NCP) principles it was the rest of Australia that was out of step with the NT (by default) being the only place that conformed to NCP guidelines.<br />A lobby to retain the opportunity to allow Aboriginal health services to own a pharmacy was successful and with the help of the Independent Member for Nelson, Gerry Wood MLA, the clause to allow this to happen was passed and the NT became the only place in Australia where someone other than a pharmacist could own a pharmacy. The remainder of the restrictions were carried into legislation by stealth following the Pharmacy Guild claims that it HAD to be changed to meet NCP principles.<br />The fact that the clause allowing AHSs to own a pharmacy has not been utilized to improve the way Aboriginal people access pharmacy services is more because of a lack of understanding of how to make it happen rather than an acknowledged acceptance that it is not needed.<br />In point of fact the manner in which pharmaceuticals are delivered to Aboriginal clients of AHSs does not match up to National Medicine Policy principles. Aboriginal health services (AHS) could well do with an injection of pharmaceutical know-how through the employment of pharmacists in their primary health services to close the gap between what is available to mainstream Australians compared to Aboriginal clients of community controlled health services.<br />The Pharmaceutical Benefits Scheme (PBS), the primary funder of essential pharmaceuticals to the Australian community, has discriminated against Aboriginal Australians living in remote places since the introduction of special arrangements in 1999 to allow AHSs in certain remote locations to access a full range of PBS items without having to pay a cost to the client but also without the full dispensing fee allowed to the rest of Australia.<br />Across Australia there is the legislative requirement to have a pharmacist employed at every pharmacy. This means the PBS supply is supervised by a pharmacist and a “professional fee” is built into the remuneration from the Australian Government to allow this to happen. It is the PBS that is employing the pharmacist through the remuneration structure.<br />From the 1st August 2008 the fee paid to pharmacists was $5.99 and in addition to that they receive $1.02 to record the safety net for a client on each prescription dispensed - a fee which is meant to be voluntary for the client but rarely offered. If the cost of the PBS medicine is below the threshold for Government subsidy the client pays the lot and the pharmacy builds into the cost an amount of $3.63 simply because it is not being subsidised by the Government. This is also meant to be voluntary and explained to the client but rarely is. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBDxcifWjwfn_PWHFtCEVbkPWdSrnYzdPOEE58UkghmoBgLf74cro3uAEsAfFydOZNnJQ2rsbvZaSBHQk3CwXPe_R6S6K2xD9qOMhM9QgMmv4isqy0LEww4VXm-NxKfCrfiUpz/s1600-h/Fortress+Bronger.jpg"><img id="BLOGGER_PHOTO_ID_5264527103087630050" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 295px; CURSOR: hand; HEIGHT: 240px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBDxcifWjwfn_PWHFtCEVbkPWdSrnYzdPOEE58UkghmoBgLf74cro3uAEsAfFydOZNnJQ2rsbvZaSBHQk3CwXPe_R6S6K2xD9qOMhM9QgMmv4isqy0LEww4VXm-NxKfCrfiUpz/s320/Fortress+Bronger.jpg" border="0" /></a><br />When a medicine listed on the PBS prices out at $20 it means that more than half the cost is going to the pharmacy in fees without even the cost of the medicine being covered. If that cost is less than $5.00 (which can easily be the case) the gross profit margin to the dispensing pharmacy is 300%.<br />Such charges are being incurred by Aboriginal clients across Australia who live in urban areas and access medicines through a retail pharmacy or from their AHS which in turn is paying these fees to their supplying pharmacy.<br />In remote areas the situation is different again and in most respects worse. Unlike the rest of Australians who access PBS through an approved pharmacy to dispense PBS the AHS will have a “pharmacy” of its own which accesses, stores and dispenses medicines under State/Territory legislation. The acquisition of the PBS medicines to the AHS is at no cost and the retail pharmacy (that is approved) will supply in bulk the medicines and not contribute to the dispensing process. In fact the supplying pharmacy will only receive $1.14 an item compared with the rest of Australia’s fee of $6.50 as outlined above.<br />The question can well be asked “what happens to the difference?”<br />The difference between $5.99 and $1.14 (= $4.85) is the amount the Australian Government saves when a PBS medicine is supplied to an Aboriginal client attending a remote health clinic.<br />National Medicines PolicyAddressing the National Medicines Policy (NMP) it is possible to determine how well the pharmaceutical service supply function to Aboriginal client’s matches up to that provided to the rest of Australia visiting a general practice clinic, multi purpose health service, GP Super Clinic or similar health service delivery facility. The pharmaceutical service will be supplied by a retail pharmacy or in a few instances a private pharmacy business on the site of the health facility.The Department of Health and Ageing website states the following re the NMP: The overall aim of the National Medicines Policy is to meet medication and related service needs, so that both optimal health outcomes and economic objectives are achieved. The Policy has four central objectives:<br />timely access to the medicines that Australians need, at a cost individuals and the community can afford;<br />medicines meeting appropriate standards of quality, safety and efficacy;<br />quality use of medicines; and<br />Maintaining a responsible and viable medicines industry.<br />ACCESS<br /><div><div><div>– on the question of access there can be no dispute. Aboriginal clients in both urban and remote locations have ready access to PBS medicines through a nearby retail approved pharmacy.<br />STANDARDS </div><div>– there should be no question of doubt on quality as State/Territory Poisons legislation requires proper adequate and safe storage situations for all human medicines.<br />QUALITY USE OF MEDICINE </div><div>– this relates to the manner in which the client is supplied the medicine and whether they are assisted in understanding matters such as why it has been prescribed; what it will do; whether there are side effects; how it will assist them get better; the importance of dose related times and circumstances; and why it is essential for improving the diagnosed disease together with any co-related measures such as diet, exercise or avoiding foods, alcohol and other substances. </div><div>In the management of acute illness this is crucial especially with infections and antibiotics or topical treatments.In the case of chronic disease the QUM process will well make the difference between extending the life span of the individual or an early and premature death.A prescription for medicines in the treatment of chronic disease is usually a prescription for life and must be understood as such if the measure to “close the gap” to be successful. It should be of interest in this discussion that the responsibility of Government in the National Medicines Policy is stated as being:<br />Governments, their agencies and committees are responsible for:• developing and implementing the National Strategy for QUM; • coordinating relevant government programs; and• investigating and developing appropriate structures, funding mechanisms, legislation and environments that support QUM.<br />RESPONSIBLE AND VIABLE INDUSTRY</div><div>A “responsible” industry, both retail and manufacturing, should have some social responsibility apart from the required financial motive in its dealings. The fact that both sectors allow the current state of pharmacy services to Aboriginal people to continue with no proactive support in bringing about change indicates a lack of concern for this marginalised sector of the population.<br />It could well be said that Governments have failed to hold up their end of the NMP and QUM agreement when it comes to Aboriginal Australians in both urban and remote environments. In addition the retail and manufacturing sector have allowed a situation to continue which would simply not be tolerated if inflicted upon mainstream Australians in urban areas. The total thrust behind change for Aboriginal clients for the PBS must come from those sectors that know how it should be being provided. The AHSs themselves have never experienced a “good” pharmacy service and thus do not know what they don’t know.<br />The essential planks of a good pharmacy service at an Aboriginal Health Service could thus be summarized as follows:<br />ACCESS – ready access to all PBS medicines to provide optimum treatment for its clients.<br />STANDARDS – storage and transport of products in a safe and secure manner<br />QUALITY USE OF MEDICINES - information added to ensure client is able to take advantage of medicine to extend life expectancy<br />INDUSTRY co-operation to enhance the value of the pharmacy service from both the manufacturing and retail sectors of the pharmaceutical industry. Academia can also play a part in practice research to evaluate best practice models and evidence based outcomes.<br />Continual dialogue is needed between the Aboriginal health sector and Government policy makers. If the gap is to be closed pharmacists can play a big role in making it happen.<br />So far there is little evidence that this is taking place.</div></div></div></div></div></div>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0tag:blogger.com,1999:blog-12040314.post-82266177281704112912008-08-04T10:16:00.007+09:302008-08-04T11:16:48.769+09:30Jobs the best form of welfareProvide empowerment through work<br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwX69M0O2NixNj2N4NIQM3GcFBtoW_fvGeIroIvRFTd3rrjB1sVe6-N0FjplGBbqGXyVjKw92qs5fvyBGTSpQ4tEhW24ce6WtgtR0K8B41WigyT0i0QHh_3zDHNKmat0hmpMSa/s1600-h/2005-04-22%2520Work%2520tests%2520dole%2520aborigines%2520226.jpg"><img id="BLOGGER_PHOTO_ID_5230459530476596082" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; WIDTH: 194px; CURSOR: hand; HEIGHT: 181px" height="173" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwX69M0O2NixNj2N4NIQM3GcFBtoW_fvGeIroIvRFTd3rrjB1sVe6-N0FjplGBbqGXyVjKw92qs5fvyBGTSpQ4tEhW24ce6WtgtR0K8B41WigyT0i0QHh_3zDHNKmat0hmpMSa/s320/2005-04-22%2520Work%2520tests%2520dole%2520aborigines%2520226.jpg" width="168" border="0" /></a> The best and most cost effective way of alleviating poverty and delivering social security to disadvantaged people is to help them get a job<a title="" style="mso-footnote-id: ftn1" href="http://www.blogger.com/post-create.g?blogID=12040314#_ftn1" name="_ftnref1">[1]</a>.<br />Sounds simple but true.<br />A job creates a feeling of empowerment as the person is at last in charge of their own future destiny and is not dependent on the State for a livelihood. Children brought up by parents without a job do not have role models to drive their intent to a better future and the state of poverty the family is forced to live under is detrimental to all concerned. <span style="color:#3366ff;"><strong> ( 2)<br /></strong></span>So it was that since the mid 1970s when welfare payments Aboriginal people in Australia started there has been a decline of social capital in remote Aboriginal communities that has continued ever since with the jobs that used to be done by Aboriginal people now being done by non-Aboriginals.<br />Reverend Steve Etherington, pastor with the Uniting Church and school teacher for many years in a remote community in the Northern Territory summed it up this way in a paper prepared for the Bennelong Society<a title="" style="mso-footnote-id: ftn2" href="http://www.blogger.com/post-create.g?blogID=12040314#_ftn2" name="_ftnref2">[3]</a>:<br />“IF YOU READ NO FURTHER THAN THIS…<br />It’s about jobs: not overcrowding.<br />It’s about jobs; not about culture or ethnicity or missions, or history.<br />It’s about jobs: not about grog and drug abuse.<br />It’s about jobs: it’s not even about child abuse.<br />All these are merely symptoms of long-term unemployment.<br />It’s about jobs.”<br />There is little evidence of anything being done towards encouraging communities to take charge of their own future. All that is evident is the old and long term frowned upon dominant culture <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2Su-GBOVt8BY9fJ5KAoBu283y9Xal1juuQBifQhhkbFINIbi8lqKivQkEnvWzMABeAqrfm1XhesEz6YCEfoczBXE9CgJ5hRBg35AW7q_m3s6NFhA6Ef3nGsZmkPjW3-Z26PEe/s1600-h/Twiggy+et+al.jpg"><img id="BLOGGER_PHOTO_ID_5230465354045543586" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" height="124" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2Su-GBOVt8BY9fJ5KAoBu283y9Xal1juuQBifQhhkbFINIbi8lqKivQkEnvWzMABeAqrfm1XhesEz6YCEfoczBXE9CgJ5hRBg35AW7q_m3s6NFhA6Ef3nGsZmkPjW3-Z26PEe/s320/Twiggy+et+al.jpg" width="349" border="0" /></a>wanting Aboriginal people in their communities to “be like us” – it will never happen.<br />There is a need for programs such as that announced on 4th August 2008 which are positive, focused on the individual and actionable at community level. While the planning still has to happen the prospect of real co-operation between the government, private corporate sector and Aboriginal communities is a plus.<br />It is probably time to go back in history and read the writings of people like A P Elkin in the mid 1930s. It is all there. We need to pay attention to the past to plan a better future and one of the failings of the past 30 years is to ignore what has gone before.<br /><div>It is all there.<br />We should use the experience of wise people who have been there and done that. The words of John Singleton back in 1979 still apply in 2008 as they did in 1979. He wrote in The Bulletin:<br /><a name="OLE_LINK14"></a><a name="OLE_LINK13"></a><a name="OLE_LINK16"></a><a name="OLE_LINK15">“…every time I look at one of those bearded university-trained southern do-gooders, I wonder if they will ever realise that they can never solve the Aboriginal problem because they are the problem”.</a><br />There is a need to engage with communities in a meaningful way. Stop “fly in – fly out” visits and genuinely be prepared to live amongst them to understand the way they think.<br />Government at the three levels needs to review what its role should be in enterprise/economic development. It is likely that the interference at the local level by trying to micromanage the spending of public money is having an adverse effect on motivating local people to act.<br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihmwuOIRLn8SpmXwrjPkS4zuv8uGtUf_A4lgAucQ-jY8UiTAFFIWeTJ8czIVBWlWC0aWfecyuLX9_KEr4DsYusNl2jvHH-S9AIMbb5Bu5DFSZWvswFueVSI8e0WzsId-5l-P9e/s1600-h/Job_train_agencies.jpg"><img id="BLOGGER_PHOTO_ID_5230463616167995602" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihmwuOIRLn8SpmXwrjPkS4zuv8uGtUf_A4lgAucQ-jY8UiTAFFIWeTJ8czIVBWlWC0aWfecyuLX9_KEr4DsYusNl2jvHH-S9AIMbb5Bu5DFSZWvswFueVSI8e0WzsId-5l-P9e/s320/Job_train_agencies.jpg" border="0" /></a>Mark Latham<a title="" style="mso-footnote-id: ftn3" href="http://www.blogger.com/post-create.g?blogID=12040314#_ftn3" name="_ftnref3">[4]</a>, writing in 2002 said “…inequality and social exclusion have become …entrenched in our society, despite high levels of welfare spending. The welfare state has been built around bureaucratic structures instead of around the capacities of people. It has placed its dead hand on innovation and self-help in disadvantaged neighborhoods.”<br />There is a need to provide “seed” funding to catalyse establishment of core business functions for emerging enterprises. The early availability of “seed” funding is necessary to build capacity at the local level and take the opportunity of initiatives that come from the grassroots.<br />A “bottoms up” approach is needed with government seeing its role as providing the infrastructure to allow enterprise to grow with the assistance of local facilitators paid by government in the same way that “business enterprise centres” came about 30 years ago in mainstream communities.<br />A pharmacy enterprise in a remote community has the opportunity of providing jobs, training and a cash flow from the provision of medicines under the government paid for Pharmaceutical Benefits Scheme. The opportunity to put to work all the knowledge a pharmacist has obtained through their undergraduate experience should make this a richly rewarding experience for young pharmacists. There are other opportunities especially if the industries that used to be there are listed and returned to produce the products they did in yesteryear. Things like a bakery, poultry farm, market garden, saw mill or cleaning service.<br />An analysis of the comparable shopping opportunities between an established country town in New South Wales with a remote community in the Northern Territory shows that for a comparable population base the NT community has only five retail outlets compared to 18 in the NSW country town. Another way at looking at this is to wonder how much of the retail spend stays in the town (in NSW) compared with the amount that goes out of the remote community because of the fewer businesses being owned by people external to the community.<br />If there is a budding entrepreneur in a remote disadvantaged community they only need to look around and see who is making the money out the products consumed and ask themselves why they could not be doing the same.<br />The jobs could be there if there was a planned co-operation between government, private<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpZeCLeu1UtuSBGGgMPsKsCkbQqPrse_XtIqpA7BoRh8b7DC2-aml1Oouh4M8ldD3NcyKflEkG4was3IgUBZJiQoSVXZzU884sQuf4IlaMCugJqAezMQGn1nHYfXhC_XZpuYcf/s1600-h/closethegap.gif"><img id="BLOGGER_PHOTO_ID_5230461492551785890" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpZeCLeu1UtuSBGGgMPsKsCkbQqPrse_XtIqpA7BoRh8b7DC2-aml1Oouh4M8ldD3NcyKflEkG4was3IgUBZJiQoSVXZzU884sQuf4IlaMCugJqAezMQGn1nHYfXhC_XZpuYcf/s320/closethegap.gif" border="0" /></a> sector and local people. It is possible that money put into job creation could have a more lasting impact on improving better health outcomes than money being put into new health clinics or the provision of primary health care staff, including doctors.<br />To look at the world through the eyes of the people is essential if useful opportunities are to be made available for those same people to develop their own potential. Young people especially need role models to look up to who work and set an example. Against all indicators this is not happening. By example they must be shown that there can be businesses in remote communities that will help the hours in a day pass more pleasurably than by doing nothing. This is also the ONLY way to solve the attendance at school problem. Show children why they must go to school. A child cannot be blamed for not seeing a need for school when the adults do nothing all day long.<br />The example is the key.</div><div> </div><div><a title="" style="mso-footnote-id: ftn1" href="http://www.blogger.com/post-create.g?blogID=12040314#_ftnref1" name="_ftn1">[1]</a> “…the fact remains that the best way to get out of poverty is a job.” ACOSS president Andrew McCallum in Annabel Crabb, “Labor plan to help poor buy shares”, The Age, 7 May 2002. </div><div>(2) Cartoon acknowledgement Nicholson Cartoons at <a href="http://www.nicholsoncartoons.com.au/"><span style="color:#3366ff;">www.nicholsoncartoons.com.au</span></a> "The Australian" newspaper.<br /><a title="" style="mso-footnote-id: ftn2" href="http://www.blogger.com/post-create.g?blogID=12040314#_ftnref2" name="_ftn2">[3]</a> <a href="http://www.bennelong.com.au/occasional/etherington2007.pdf">http://www.bennelong.com.au/occasional/etherington2007.pdf</a> Accessed 2nd August 2008<br /><a title="" style="mso-footnote-id: ftn3" href="http://www.blogger.com/post-create.g?blogID=12040314#_ftnref3" name="_ftn3"></a><br />[4] Mark Latham. “From the suburbs. Building a nation from our neighbourhoods”. Pluto Press 2003</div>Rollo Manninghttp://www.blogger.com/profile/03255004741118411885noreply@blogger.com0