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This report addresses strategies and treatments found to help in addressing the harmful use of alcohol in Aboriginal and Torres Strait Islander communities. Foreword The consumption of alcohol at high risk levels is a national issue, however, the focus of this inquiry is the harmful use of alcohol in Aboriginal and Torres Strait Islander communities. Many reports and studies have recommended stemming the flow of alcohol to address the problems, but usually these works do not analyse why a person drinks at levels which cause them and their loved ones harm. The social and economic determinants of harmful alcohol use such as unemployment, poor housing, racism, trauma, poor education and peer pressure mean that Aboriginal and Torres Strait Islander communities are overly impacted by the harm caused by alcohol consumed at high levels. A recent Amnesty reports note that it costs $440,000 per year to keep one young person in detention in Australia. This report recommends that justice reinvestment strategies should redirect these resources to overcoming the deprivation and despair in so many Aboriginal and Torres Strait Islander communities. This report addresses strategies and treatments found to help in addressing the harmful use of alcohol. Community led solutions are always the key to uptake and success. Unfortunately slow government processes, for example approving community produced alcohol management plans and the short length of project funding often frustrates community initiatives. The magnitude of the problem caused by high risk consumption of alcohol is often hidden by the lack of collection of useful data for example at the time of hospital admissions, when children are put into out of home care because of their neglect, when people are incarcerated because of alcohol related crime and when children are born with Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Spectrum Disorder (FASD) at some of the highest rates in the world. The committee found examples of the world's best practice at places like Groote ...

Objectives Sugar-sweetened beverage (SSB) consumption in Australian Aboriginal and Torres Strait Islander people is reported to be disproportionally high compared with the general Australian population. This review aimed to scope the literature documenting SSB consumption and interventions to reduce SSB consumption among Australian Aboriginal and Torres Strait Islander people. Findings will inform strategies to address SSB consumption in Aboriginal and Torres Strait Islander communities. Methods PubMed, SCOPUS, CINAHL, Informit, Joanna Briggs Institute EBP, Mura databases and grey literature were searched for articles published between January 1980 and June 2018. Studies were included if providing data specific to an Australian Aboriginal and/or Torres Strait Islander population's SSB consumption or an intervention that focused on reducing SSB consumption in this population. Design Systematic scoping review. Results 59 articles were included (1846 screened). While reported SSB consumption was high, there were age-related and community-related differences observed in some studies. Most studies were conducted in remote or rural settings. Implementation of nutrition interventions that included an SSB component has built progressively in remote communities since the 1980s with a growing focus on community-driven, culturally sensitive approaches. More recent studies have focused exclusively on SSB consumption. Key SSB-related intervention elements included incentivising healthier options; reducing availability of less-healthy options; nutrition education; multifaceted or policy implementation (store nutrition or government policy). Conclusions There was a relatively large number of studies reporting data on SSB consumption and/or sales, predominantly from remote and rural settings. During analysis it was subjectively clear that the more impactful studies were those which were community driven or involved extensive community consultation and collaboration. Extracting additional SSB-specific consumption data from an existing nationally representative survey of Aboriginal and Torres Strait Islander people could provide detailed information for demographic subgroups and benchmarks for future interventions. It is recommended that a consistent, culturally appropriate, set of consumption measures be developed. ; Kathleen M Wright, Joanne Dono, Aimee L Brownbill, Odette Pearson, nee Gibson, Jacqueline Bowden, Thomas P Wycherley, Wendy Keech, Kerin O'Dea, David Roder, Jodie C Avery, Caroline L Miller

OBJECTIVES: Sugar-sweetened beverage (SSB) consumption in Australian Aboriginal and Torres Strait Islander people is reported to be disproportionally high compared with the general Australian population. This review aimed to scope the literature documenting SSB consumption and interventions to reduce SSB consumption among Australian Aboriginal and Torres Strait Islander people. Findings will inform strategies to address SSB consumption in Aboriginal and Torres Strait Islander communities. METHODS: PubMed, SCOPUS, CINAHL, Informit, Joanna Briggs Institute EBP, Mura databases and grey literature were searched for articles published between January 1980 and June 2018. Studies were included if providing data specific to an Australian Aboriginal and/or Torres Strait Islander population's SSB consumption or an intervention that focused on reducing SSB consumption in this population. DESIGN: Systematic scoping review. RESULTS: 59 articles were included (1846 screened). While reported SSB consumption was high, there were age-related and community-related differences observed in some studies. Most studies were conducted in remote or rural settings. Implementation of nutrition interventions that included an SSB component has built progressively in remote communities since the 1980s with a growing focus on community-driven, culturally sensitive approaches. More recent studies have focused exclusively on SSB consumption. Key SSB-related intervention elements included incentivising healthier options; reducing availability of less-healthy options; nutrition education; multifaceted or policy implementation (store nutrition or government policy). CONCLUSIONS: There was a relatively large number of studies reporting data on SSB consumption and/or sales, predominantly from remote and rural settings. During analysis it was subjectively clear that the more impactful studies were those which were community driven or involved extensive community consultation and collaboration. Extracting additional SSB-specific consumption data from ...

Background: Smoking prevalence remains high in Aboriginal and Torres Strait Islander Peoples. Indigenous peoples in countries colonised by Western nations prefer culturally-targeted anti-tobacco messages, yet only recently have messages been tailored for Australian Aboriginal and Torres Strait Islander Peoples. We conducted a national survey to determine how messages are being developed for Indigenous tobacco control. Method: Forty-seven telephone interviews were conducted with 44 of 53 eligible organisations. Twenty-two Aboriginal Medical Services (AMSs), 13 Government Organisations (GOs), four Universities and eight non-government organisations (NGOs) participated. Questions included targeting and theoretical approaches, community consultation, messages types and design, campaign types, cultural challenges, recommended actions, resources developed, pre-tests and evaluation. Findings: Responses were scored according to core components, and message features. Total scores (mean 10.9 ±SD 2.7) were not associated with organisation type. A community-orientated, bottom-up approach was popular (47%), 55% used a theoretical framework, 87% used a positive benefit appeal; 38% used threat messages, 72% conducted a pre-test and 53% evaluated programs. Cultural sensitivity for message development was divided into superficial (images, language, demographics) and deep structure (socio-cultural). AMSs were significantly more likely to report using more deep structures in message tailoring than NGOs (p<.05) and GOs (p<0.05). A non-linear principal component analysis revealed two dimensions accounting for 53% of the variation in findings. These dimensions were called "cultural understanding" and "rigour". Over 50% of the organisations had experienced cultural challenges in message development included issues raised due to the diversity of Aboriginal and/or Torres Strait Islander cultures for example with the use of Indigenous artwork, language, and stereotypes. Conflicts and delays caused some issues with program management; and the choice and use of role models was sometimes problematic. Conclusion: Features associated with successful anti-tobacco campaigns are reported by organisations Australia-wide for Aboriginal and Torres Strait Islander communities. This study has provided new insight into the current development of anti-tobacco messages in Australia by coupling the use of both cultural understanding and rigour to enable the growth of evidence based practice. Ideally tailoring should include theoretical, behavioural and cultural aspects with Indigenous advisors, to effect cessation. Superficial structures assist message 'fit'. Deep structures, significantly used by AMSs, are centrally processed and influence message salience. We recommend refinement of evaluation, pre-empting cultural challenges, and synergy by partnerships to achieve the goal of closing the gap on Indigenous health caused by tobacco smoking.

Objective: To analyse the implicit discourses within the COVID-19 policy response for Aboriginal and Torres Strait Islander remote communities. Method: This paper uses Bacchi's 'What is the Problem Represented to Be' framework to analyse the Emergency Requirements for Remote Communities Determination under Subsection 477(1) of the Biosecurity Act 2015 (Cth). Results: Despite the leadership of community-controlled health services and regional councils, and the actions of Aboriginal and Torres Strait Islander communities, the policy response constructs Aboriginal and Torres Strait Islander people as vulnerable and mobility as a problem that needs a law and order response. Conclusions: The policy response perpetuates an ongoing paternalistic discourse where Aboriginal and Torres Strait Islander people must be controlled for the sake of their health, informed by notions of Indigeneity as deficient. This stands in contrast with the work of community-controlled health organisations, advocacy by Aboriginal and Torres Strait Islander people for and against restrictions, and examples of communities protecting themselves. Implications for public health: Unilateral government intervention creates limiting discourses of Aboriginal and Torres Strait Islander people. In contrast, ongoing COVID-19 responses can build on the strengths of and work done by Aboriginal and Torres Strait Islander families, leaders, and communities.

Objective: To analyse the implicit discourses within the COVID‐19 policy response for Aboriginal and Torres Strait Islander remote communities. Method: This paper uses Bacchi's 'What is the Problem Represented to Be' framework to analyse the Emergency Requirements for Remote Communities Determination under Subsection 477(1) of the Biosecurity Act 2015 (Cth). Results: Despite the leadership of community‐controlled health services and regional councils, and the actions of Aboriginal and Torres Strait Islander communities, the policy response constructs Aboriginal and Torres Strait Islander people as vulnerable and mobility as a problem that needs a law and order response. Conclusions: The policy response perpetuates an ongoing paternalistic discourse where Aboriginal and Torres Strait Islander people must be controlled for the sake of their health, informed by notions of Indigeneity as deficient. This stands in contrast with the work of community‐controlled health organisations, advocacy by Aboriginal and Torres Strait Islander people for and against restrictions, and examples of communities protecting themselves. Implications for public health: Unilateral government intervention creates limiting discourses of Aboriginal and Torres Strait Islander people. In contrast, ongoing COVID‐19 responses can build on the strengths of and work done by Aboriginal and Torres Strait Islander families, leaders, and communities.

Objective: To create supportive environments to reduce sugary drink consumption and increase water consumption by partnering with remote Aboriginal and Torres Strait Islander communities in Cape York. Methods: This paper applied qualitative and quantitative methods to evaluate a co-designed multi-strategy health promotion initiative, implemented over 12 months from 2017 to 2018. Outcome measures included changes in community readiness, awareness of the social marketing campaign and changes in drink availability. Changes in store drink sales were measured in one community and compared to sales in a control store. Results: Community readiness to address sugary drink consumption increased in two of the three communities. Awareness of social marketing campaign messaging was high (56–94%). Availability of drinking water increased in all communities. Water sales as a proportion of total drink volume sales increased by 3.1% (p<0.001) while sugary drink volume sales decreased by 3.4% (p<0.001). Conclusions: A multi-component strategy with strong engagement from local government, community leaders and the wider community was associated with positive changes in community readiness, drink availability and sales. Implications for public health: Partnering with community leaders in the co-design of strategies to create environments that support healthy drink consumption can stimulate local action and may positively affect drink consumption.

Australians turn to the mainstream media to gain information, analysisand reasoning about events and issues on a daily basis. 'The news' has apowerful and permeating influence on how we all understand and make sense of the world around us. Notions of 'objectivity' and 'fact' in media traditionbelie the reality that the experiences and values of those who work in the media influence the way events and issues are portrayed. Like many Australians, those who work in the media may have ill-informed or prejudiced views of the historical and current experience of Aboriginal and Torres Strait Islander communities. Although there are many commentators, opinion columnists andothers who make overtly racist statements about Indigenous people, racism in the media also manifests in more subtle ways in everyday media practices of news gathering and the narrative structures of news reportage. There is an institutional racism in the media, an entrenched culture that represents issues and people in particular ways. It is as much about what is not reported as what is. Whether deliberate or unconscious, those working in the media have the power to marginalise and construct Indigenous communities as 'other', as associated with criminality or conflict. This power comes from the capacity to make connections, to represent events or issues in the context of pre-existing prejudices. This article explores the relationship between media reporting, political rhetoric and community attitudes, and the impact on Aboriginal andTorres Strait Islander people - from the way that legislation and policiesconcerning Indigenous people are formulated, to the way that Indigenouspeople are treated on a daily basis in the street, in the workplace, at school, and in the community.

The sexual abuses of Indigenous peoples are not a new phenomenon. Many historical documents attest to the active ruination of the sexual and reproductive health of Indigenous peoples in Australia; however, reproductive health is rarely considered to be an appropriate strategy through which Aboriginal and Torres Strait Islander people's lives can be improved. Reproductive health is essential for the replication and evolution of societies and therefore warrants close attention, especially as contemporary policy frameworks place Aboriginal and Torres Strait Islander women approximately 50 years behind non-Indigenous women in our capacities to practice individual autonomy in reproductive decision making, including the positive resolution of pregnancies and ensuring the health, dignity, security and autonomy of victims of gender-based violence. This paper is an examination of contemporary reproductive health issues for adolescents in Aboriginal and Torres Strait Islander communities and a call to action to assist young men and young women in particular to value and have every capacity to control their fertility.

The sexual abuses of Indigenous peoples are not a new phenomenon. Many historical documents attest to the active ruination of the sexual and reproductive health of Indigenous peoples in Australia; however, reproductive health is rarely considered to be an appropriate strategy through which Aboriginal and Torres Strait Islander people's lives can be improved. Reproductive health is essential for the replication and evolution of societies and therefore warrants close attention, especially as contemporary policy frameworks place Aboriginal and Torres Strait Islander women approximately 50 years behind non-Indigenous women in our capacities to practice individual autonomy in reproductive decision making, including the positive resolution of pregnancies and ensuring the health, dignity, security and autonomy of victims of gender-based violence. This paper is an examination of contemporary reproductive health issues for adolescents in Aboriginal and Torres Strait Islander communities and a call to action to assist young men and young women in particular to value and have every capacity to control their fertility.

With increasing implementation of casemix-based funding for hospitals, quantitative data were needed to confirm the clinical impression that treating Aboriginal (compared with non-Aboriginal) inpatients consumes significantly more resources. Utilisation data, collected over a three-month period in 10 hospitals, were used to determine a cost per inpatient episode, which was grouped according to AN-DRG-3 to give a cost per AN-DRG for Aboriginal and Torres Strait Islander (ATSI) patients and non-ATSI patients. ATSI patients had consistently longer average length of stay and significant variation in relative frequency of admissions, compared with non-ATSI patients, with higher prevalences of infectious diseases. Degenerative and neoplastic conditions were more common in non-ATSI patients. There were significant differences in casemix-adjusted costs per patient episode (ATSI, $1856; non-ATSI, $1558; P < 0.001). Our study has quantified differential resource consumption between two Australian populations, and highlights the need for recognition of some hospitals' atypical populations and special funding requirements.

© 2018, © 2018 Griffith University. Democratic governance is premised on the belief that all citizens are empowered to shape the society in which they live. Over generations, Aboriginal and Torres Strait Islander peoples have maintained that Australian democratic practice does not live up to this ideal, contending that the state's legal and political framework does not empower them with the capacity to have their voices heard and their interests considered in the processes of government. However, non-Indigenous Australians remain suspicious of Indigenous-specific political and legal mechanisms designed to rectify this structural fault. In this paper, I argue that this suspicion–and Australia's governance framework more broadly–arises from a particular conception of democratic theory that marginalises Aboriginal and Torres Strait Islander peoplehood. If, as the Uluru Statement from the Heart calls for, Australia's political institutions are to be rebuilt so as to empower Aboriginal and Torres Strait Islander peoples 'to take a rightful place in [their] own country', that conception of democratic theory must first be revealed and re-centred. Multinational federalism offers one path towards a more equitable future.

 Aboriginal and Torres Strait Islander people strongly assert that health research has contributed little to improving their health, in spite of its obvious potential.  The health concerns of Aboriginal and Torres Strait Islander people were largely ignored in early research published in the MJA, which ref ected broader colonial history and racial discourses. This began to change with the demise of scientific racism, and changed policies and political campaigns for equal treatment of Indigenous people after the Second World War.  In response to pressure from Aboriginal and Torres Strait Islander people and organisations, in parallel to broader political struggles for Indigenous rights since the 1970s, there have been signif cant and measurable changes to Aboriginal and Torres Strait Islander health research. Many of these changes have been about the ethics of health research.  Increasingly, Aboriginal and Torres Strait Islander researchers, communities and organisations are now controlling and decolonising health research to better meet their needs, in collaboration with non-Indigenous researchers and research organisations. ; Associated Grant:Australian Research Council Discovery Indigenous Award.

As the oldest continuous living civilizations in the world, Aboriginal and Torres Strait Islander peoples have strength, tenacity, and resilience. Initial colonization of the landscape included violent dispossession and removal of people from Country to expand European land tenure and production systems, loss of knowledge holders through frontier violence, and formal government policies of segregation and assimilation designed to destroy ontological relationships with Country and kin. The ongoing manifestations of colonialism continue to affect food systems and food knowledges of Aboriginal peoples, and have led to severe health inequities and disproportionate rates of nutrition-related health conditions. There is an urgent need to collaborate with Aboriginal and Torres Strait Islander peoples to address nutrition and its underlying determinants in a way that integrates Aboriginal and Torres Strait Islander peoples' understandings of food and food systems, health, healing, and well-being. We use the existing literature to discuss current ways that Australian Aboriginal and Torres Strait Islander peoples are portrayed in the literature in relation to nutrition, identify knowledge gaps that require further research, and propose a new way forward. Curr Dev Nutr 2020;4:nzaa080.

The Summary of tobacco use among Aboriginal and Torres Strait Islander peoples is a plain language publication that provides summarised and updated information from the Review of tobacco use among Aboriginal and Torres Strait Islander peoples (2020). It provides key information about tobacco use among Aboriginal and Torres Strait Islander peoples in a style that is easy to engage with and is particularly useful for health workers and those studying in the field as a quick source of general information about: the context of tobacco use and how common tobacco use is how smoking affects health the burden of disease and deaths from tobacco use impacts on community and culture factors relating to tobacco use related government policies and strategies tackling smoking programs.