Food security in Aboriginal and Torres Strait Islander communities in remote Australia during the COVID-19 pandemic: An analysis of print news media and press releases.

OBJECTIVE: This article aims to examine the framing of the issue of food security in very remote Aboriginal and Torres Strait Islander communities in print media and press releases during the beginning of the COVID-19 pandemic in 2020. METHODS: Newspaper articles were identified following a systematic search of the Factiva database, and press releases were identified from manual search of key stakeholder websites from January to June 2020 and analysed using a combined adapted framework of the Bacchi's What's the Problem Represented to be? Framework and the Narrative Policy Framework. RESULTS: A food delivery "problem" dominated representations in press releases, and food supply at store level had prominence in print media. Both presented the cause of food insecurity as a singular, identifiable point in time, framed the issue as one of helplessness and lack of control, and proposed policy action. CONCLUSIONS: The issue of food security was represented in the media as a simple issue requiring an immediate fix, as opposed to a complex issue requiring a systems-level and sustained policy response. IMPLICATIONS FOR PUBLIC HEALTH: This study will help to guide future media dialogue to impact on both immediate and longer-term solutions to food insecurity in very remote Aboriginal and Torres Strait Islander communities in Australia.

Uptake of the Australian Heart Health Check before and after the COVID-19 pandemic outbreak

IN AUSTRALIA, cardiovascular disease (CVD) is the leading cause of death and accounts for 9% of total disease expenditure ($10.4 billion).1,2 If current Australian guidelines were fully implemented, using absolute CVD risk assessment to guide the prescribing of medication for high-risk patients, an estimated $5.4 billion would be saved per year.3'4 MedicineInsight data suggest that only 17% of Australian patients aged 45-74 years attending general practice have the required risk factors recorded to enable an absolute CVD risk assessment, although this may not be representative and is limited to data recorded in specified fields.5 Health assessment Medicare Benefits Schedule (MBS) items are time-based consultation items targeted towards the prevention and management of chronic diseases that include taking a patient's history, physical measurements and providing management advice about medication and lifestyle change (Table 1). To increase the uptake of CVD primary prevention guidelines, a dedicated 'Heart Health Check' MBS item (699) was introduced on 1 April 2019, under which medical practitioners could claim a fee ($85.60) for a dedicated CVD risk consultation that lasts at least 20 minutes.6 Item 699 has a specific focus on identifying CVD risk factors and initiating CVD risk management strategies for high-risk patients. From April 2020 there have been multiple changes to the delivery of primary health services in response to the COVID-19 pandemic.7 Despite effective COVID-19 control measures in Australia, national general practitioner (GP) surveys conducted in 2020 and 2021 indicated a high impact of and concern about the pandemic, including the safety of staff, the rapid move to telehealth, reduced income due to a drop in patient presentation, increased workload during the vaccination rollout and inadequate government support, including a lack of safety equipment.8'9 In addition, the National Heart Foundation of Australia has estimated that 27,000 fewer Heart Health Checks were conducted due to COVID-19.10 As such, this study aimed to explore the uptake of Item 699 since its introduction and changes in existing health assessment item claims. Methods Study overview Publicly available databases were used for MBS item claims and population estimates.11 Data were available by age range, sex and state or territory. Because it was not possible to determine race or ethnicity, data for all adults aged >35 years were included in accordance with national guideline recommendations at the time of data collection for absolute CVD risk assessment in Aboriginal and Torres Strait Islander people aged >35 years and all other adults aged >45 years.3 MBS claims data for health assessment Items 699, 701, 703, 705, 707 and 715 were downloaded and compared between three time periods: the 12-month period before the introduction of Item 699 (1 April 2018-31 March 2019);the 12-month period after the introduction of Item 699 (1 April 2019-31 March 2020);and the 12-month period with COVID-19 outbreaks affecting the delivery of health services through primary care (1 April 2020-31 March 2021).12 Subsequently, health assessment item claims were assessed by age, sex and state/territory for the 24-month period after Item 699 was introduced (1 April 2019-31 March 2021).

Responding to COVID-19 and Beyond: Key Recommendations for the Effective Public and Mental Health Response to Support the Well-Being of Aboriginal and Torres Strait Islander Peoples in Australia

The Australian response to COVID-19 demonstrates how Aboriginal and Torres Strait Islander leadership, partnership, and self-determination are critical in ensuring public health measures and pandemic response planning is effective for Aboriginal and Torres Strait Islander peoples. This chapter outlines the key evidence-based recommendations and actions developed by three national Aboriginal and Torres Strait Islander-led groups, in meaningful partnership with government, during the COVID-19 pandemic. The Aboriginal and Torres Strait Islander response to COVID-19, led by Aboriginal and Torres Strait Islander organisations and communities, has been renowned across the world. This highlights the importance of Aboriginal and Torres Strait Islander governance and leadership in leading the pandemic response for Aboriginal and Torres Strait Islander peoples and further illustrates the strengths of the Aboriginal and Torres Strait Islander response to COVID-19 when priority reforms are heard and implemented by government. Throughout this chapter, mental health and well-being responses related to COVID-19 are particularly emphasised. Mental health experts predict that the mental health and well-being issues exacerbated by the pandemic will persist for many years (Savage, Coronavirus: The possible long-term mental health impacts, 2020). The mental health and well-being impacts of COVID-19 are of particular significance to Aboriginal and Torres Strait Islander peoples, who experience significant well-being disparities associated with the historical, political, and social determinants of health, arising from colonisation (Dudgeon et al., Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, 2014). Together, the recommendations outlined here provide an effective base to plan for the long-term recovery of mental health and well-being of Aboriginal and Torres Strait Islander peoples from COVID-19 and ensure the preparedness of Aboriginal and Torres Strait Islander communities for future pandemics. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Vaccine success and challenges in northern Australia. (Special Issue: Infectious diseases in northern Australia.)

Aboriginal and Torres Strait Islander people living in rural and remote Australia have lower vaccine coverage rates and experience higher rates of notification and hospitalisations for vaccine preventable diseases than non-Aboriginal people. This paper explores important public health and research activities being undertaken in the Northern Territory to reduce this disparity in vaccine program performance, with a particular focus on rotavirus, meningococcal, human papilloma virus and COVID-19 vaccines.

Towards best practice during COVID-19: A responsive and relational program with remote schools to enhance the wellbeing of Aboriginal and Torres Strait Islander students

Purpose: From 2018, the Schools Up North (SUN) programme worked with three remote Australian schools to enhance their capability and resilience to support the wellbeing and mental health of Aboriginal and Torres Strait Islander students and staff. This paper explores the implementation of SUN during the first two years of COVID-19 (2020–2021). Method: Using grounded theory methods, school staff, other service providers and SUN facilitators were interviewed, with transcripts and programme documents coded and interrelationships between codes identified. An implementation model was developed. Results: The SUN approach was place-based, locally informed and relational, fostering school resilience through staff reflection on and response to emerging contextual challenges. Challenges were the: community lockdowns and school closures;(un)availability of other services;community uncertainty and anxiety;school staff capability and wellbeing;and risk of educational slippage. SUN strategies were: enhancing teachers' capabilities and resources, facilitating public health discussions, and advocating at regional level. Outcomes were: enhanced capability of school staff;greater school-community engagement;student belonging and engagement;a voice for advocacy;and continuity of SUN's momentum. Conclusions: The resilience approach (rather than specific strategies) was critical for building schools' capabilities for promoting students and staff wellbeing and provides an exemplar for remote schools globally.

Aboriginal and Torres Strait Islander Women's Access to and Interest in mHealth: National Web-based Cross-sectional Survey.

BACKGROUND: Health programs delivered through digital devices such as mobile phones (mobile health [mHealth]) have become an increasingly important component of the health care tool kit. Aboriginal and Torres Strait Islander women of reproductive age are likely to be caring for children and family members and needing health care, but little is known about their access to and interest in mHealth. OBJECTIVE: The objectives of this study were to investigate Aboriginal and Torres Strait Islander women's ownership of digital devices, access to the internet, current mHealth use, and interest and preferences for future mHealth. We examined the factors (age, remoteness, caring for a child younger than 5 years, and level of education) associated with the ownership of digital devices, use of internet, and interest in using a mobile phone to improve health. This study also examines if women are more likely to use mHealth for topics that they are less confident to talk about face-to-face with a health professional. METHODS: A national web-based cross-sectional survey targeting Aboriginal and Torres Strait Islander women of reproductive age (16-49 years) was performed. Descriptive statistics were reported, and logistic regressions were used to examine the associations. RESULTS: In total, 379 women completed the survey; 89.2% (338/379) owned a smartphone, 53.5% (203/379) a laptop or home computer, 35.6% (135/379) a tablet, and 93.1% (353/379) had access to the internet at home. Most women used social media (337/379, 88.9%) or the internet (285/379, 75.2%) everyday. The most common modality used on the mobile phone for health was Google (232/379, 61.2%), followed by social media (195/379, 51.5%). The most preferred modality for future programs was SMS text messaging (211/379, 55.7%) and social media (195/379, 51.4%). The most preferred topics for future mHealth programs were healthy eating (210/379, 55.4%) and cultural engagement (205/379, 54.1%). Women who were younger had greater odds of owning a smartphone, and women with tertiary education were more likely to own a tablet or laptop. Older age was associated with interest to use telehealth, and higher educational attainment was associated with interest for videoconferencing. Most women (269/379, 70.9%) used an Aboriginal medical service and overall reported high rates of confidence to discuss health topics with a health professional. Overall, women showed a similar likelihood of selecting a topic in mHealth whether they were or were not confident to talk to a health professional about that. CONCLUSIONS: Our study found that Aboriginal and Torres Strait Islander women were avid users of the internet and had strong interest in mHealth. Future mHealth programs for these women should consider utilizing SMS text messaging and social media modalities and including content on nutrition and culture. A noteworthy limitation of this study was that participant recruitment was web-based (due to COVID-19 restrictions).

"I Don't Think It's on Anyone's Radar": The Workforce and System Barriers to Healthcare for Indigenous Women Following a Traumatic Brain Injury Acquired through Violence in Remote Australia.

Aboriginal and Torres Strait Islander women experience high rates of traumatic brain injury (TBI) as a result of violence. While healthcare access is critical for women who have experienced a TBI as it can support pre-screening, comprehensive diagnostic assessment, and referral pathways, little is known about the barriers for Aboriginal and Torres Strait Islander women in remote areas to access healthcare. To address this gap, this study focuses on the workforce barriers in one remote region in Australia. Semi-structured interviews and focus groups were conducted with 38 professionals from various sectors including health, crisis accommodation and support, disability, family violence, and legal services. Interviews and focus groups were audiotaped and transcribed verbatim and were analysed using thematic analysis. The results highlighted various workforce barriers that affected pre-screening and diagnostic assessment including limited access to specialist neuropsychology services and stable remote primary healthcare professionals with remote expertise. There were also low levels of TBI training and knowledge among community-based professionals. The addition of pre-screening questions together with professional training on TBI may improve how remote service systems respond to women with potential TBI. Further research to understand the perspectives of Aboriginal and Torres Strait Islander women living with TBI is needed.

Lessons Learned during a Rapidly Evolving COVID-19 Pandemic: Aboriginal and Torres Strait Islander-Led Mental Health and Wellbeing Responses Are Key.

As the world journeys towards the endemic phase that follows a pandemic, public health authorities are reviewing the efficacy of COVID-19 pandemic responses. The responses by Aboriginal and Torres Strait Islander communities in Australia have been heralded across the globe as an exemplary demonstration of how self-determination can achieve optimal health outcomes for Indigenous peoples. Despite this success, the impacts of pandemic stressors and public health responses on immediate and long-term mental health and wellbeing require examination. In December 2021, Aboriginal and Torres Strait Islander mental health and wellbeing leaders and allies (N = 50) attended a virtual roundtable to determine the key issues facing Aboriginal and Torres Strait Islander peoples and communities, and the actions required to address these issues. Roundtable attendees critically reviewed how the rapidly evolving pandemic context has impacted Aboriginal and Torres Strait Islander mental health and social and emotional wellbeing (SEWB). This paper presents an overview of this national collaborative consultation process, and a summary of the key issues and actions identified. These results build on evidence from other roundtables held in Australia during 2020, and the emerging consensus across the globe that Indigenous self-determination remains essential to Indigenous SEWB, especially during and following a pandemic.

Key features of a trauma-informed public health emergency approach: A rapid review.

COVID-19 is a major threat to public safety, and emergency public health measures to protect lives (e.g., lockdown, social distancing) have caused widespread disruption. While these measures are necessary to prevent catastrophic trauma and grief, many people are experiencing heightened stress and fear. Public health measures, risks of COVID-19 and stress responses compound existing inequities in our community. First Nations communities are particularly at risk due to historical trauma, ongoing socio-economic deprivation, and lack of trust in government authorities as a result of colonization. The objective of this study was to review evidence for trauma-informed public health emergency responses to inform development of a culturally-responsive trauma-informed public health emergency framework for First Nations communities. We searched relevant databases from 1/1/2000 to 13/11/2020 inclusive, which identified 40 primary studies (and eight associated references) for inclusion in this review. Extracted data were subjected to framework and thematic synthesis. No studies reported evaluations of a trauma-informed public health emergency response. However, included studies highlighted key elements of a "trauma-informed lens," which may help to consider implications, reduce risks and foster a sense of security, wellbeing, self- and collective-efficacy, hope and resilience for First Nations communities during COVID-19. We identified key elements for minimizing the impact of compounding trauma on First Nations communities, including: a commitment to equity and human rights, cultural responsiveness, good communication, and positive leadership. The six principles guiding trauma-informed culturally-responsive public health emergency frameworks included: (i) safety, (ii) empowerment, (iii) holistic support, (iv) connectedness and collaboration, (v) compassion and caring, and (vi) trust and transparency in multi-level responses, well-functioning social systems, and provision of basic services. These findings will be discussed with First Nations public health experts, together with data on the experiences of First Nations families and communities during COVID-19, to develop a trauma-integrated public health emergency response framework or "lens" to minimize compounding trauma for First Nations communities.

Examination of cataract surgical data: Is access equity improving for Aboriginal and Torres Strait Islander Australians?

Purpose: Persisting inequity in access to eye care for Aboriginal and Torres Strait Islander Australians has been well documented. Over the past decade, a number of frameworks and initiatives have worked towards improving access to eye care, though inconsistent data reporting and availability makes it challenging to form a coherent overview of actual increases in access, and progress towards the population-based needs. The paper will present an improved understanding of access to cataract surgery for Aboriginal and Torres Strait Islander Australians. Method(s): Publicly available cataract surgical data over the past decade, including Medicare statistics, public hospital data, Australian Institute of Health and Welfare annual Indigenous Eye Health Measures reports, state health data, and past analyses in the literature, is combined and analysed to present an overview of existing surgical delivery and access and a more nuanced consideration of cataract surgery needs for Aboriginal and Torres Strait Islander Australians. Result(s): Large variance has been identified across jurisdictions, across public and private settings, and across remoteness levels, suggesting significant differences in access. The combined analysis highlights challenges in access for cataract surgeries in metropolitan areas. Finally, impacts of COVID-19 on service provision and the existing backlog is considered. Conclusion(s): Differing access rates provide an ongoing challenge to organised ophthalmology, as well as the wider eye care sector and national, state and territorylevel programs and policies. The shared goal is to best support increasing the cataract surgery rates for Aboriginal and Torres Strait Islander Australians to populationbased needs.

Seeking to improve access to COVID-19 therapeutics in the remote Torres and Cape communities of Far North Queensland during the first COVID-19 omicron outbreak.

INTRODUCTION: The first outbreak of the omicron variant of COVID-19 in the Torres and Cape region of Far North Queensland in Australia was declared in late December 2021. A COVID-19 Care at Home program was created to support the health and non-health needs of people with COVID-19 and their families throughout the mandatory isolation periods and included centralising the coordination and delivery of COVID-19 therapeutics. The therapeutics available included one intravenous monoclonal antibody (sotrovimab) and two oral antiviral therapies: nirmatrelvir and ritonavir (Paxlovid®) and molnupiravir (Lagevrio®). This article describes the uptake and delivery of this therapeutics program. METHODS: COVID-19 cases were documented in a notification database, screened to determine eligibility for COVID-19 therapies and prioritised based on case age, vaccination status, immunosuppression status and existing comorbidities, in line with Queensland clinical guidelines. Eligible cases were individually contacted by phone to discuss treatment options, and administration of therapies were coordinated in partnership with local primary healthcare centres and hospitals. RESULTS: A total of 4744 cases were notified during the outbreak period, of which 217 (4.6%) were deemed eligible for treatment after medical review. Treatment was offered to 148/217 cases (68.2%), with 90/148 cases (60.8%) declining treatment and 53/148 cases (35.8%) receiving therapeutic treatment for COVID-19. Among these 53 cases, 29 received sotrovimab (54.7%), 20 received Paxlovid (37.7%) and four received Lagevrio (7.5%). First Nations people accounted for 48/53 cases (90.6%) who received treatment, and COVID-19 therapeutics were delivered to cases in 16 remote First Nations communities during the outbreak period. CONCLUSION: The COVID-19 Care at Home program demonstrated a novel, public health led approach to delivering time-critical medications to individuals across a large, remote and logistically complex region. The application of similar models to outbreaks and chronic conditions of public health importance offers potential to address many health access inequities experienced by remote Australian First Nations communities.

A Culturally Responsive Trauma-Informed Public Health Emergency Framework for Aboriginal and Torres Strait Islander Communities in Australia, Developed during COVID-19.

The Coronavirus Disease 2019 (COVID-19) pandemic impacted peoples' livelihoods and mental wellbeing. Aboriginal and Torres Strait Islander peoples in Australia continue to experience intergenerational trauma associated with colonization and may experience trauma-related distress in response to government responses to public health emergencies. We aimed to develop a culturally responsive trauma-informed public health emergency response framework for Aboriginal and Torres Strait Islander peoples. This Aboriginal and Torres Strait Islander-led study involved: (i) a review of trauma-informed public health emergency responses to develop a draft framework (ii) interviews with 110 Aboriginal and Torres Strait Islander parents about how COVID-19 impacted their lives, and (iii) a workshop with 36 stakeholders about pandemic experiences using framework analysis to refine a culturally responsive trauma-informed framework. The framework included: an overarching philosophy (cultural humility, safety and responsiveness); key enablers (local leadership and Eldership); supporting strategies (provision of basic needs and resources, well-functioning social systems, human rights, dignity, choice, justice and ethics, mutuality and collective responsibility, and strengthening of existing systems); interdependent core concepts (safety, transparency, and empowerment, holistic support, connectedness and collaboration, and compassion, protection and caring); and central goals (a sense of security, resilience, wellbeing, self- and collective-efficacy, hope, trust, resilience, and healing from grief and loss).

Vaccine success and challenges in northern Australia

Aboriginal and Torres Strait Islander people living in rural and remote Australia have lower vaccine coverage rates and experience higher rates of notification and hospitalisations for vaccine preventable diseases than non-Aboriginal people. This paper explores important public health and research activities being undertaken in the Northern Territory to reduce this disparity in vaccine program performance, with a particular focus on rotavirus, meningococcal, human papilloma virus and COVID-19 vaccines. Copyright © 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the ASM. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Designing to Support Remote Working Relationships with Indigenous Communities

Linguistic research with speakers of Aboriginal languages usually takes place though face-to-face interaction. The success of these interactions depends on relationships between scholars and Aboriginal people, relationships which are built up over an extended period. During the COVID-19 pandemic, researchers have often been prevented from travelling to remote Aboriginal communities, making it difficult to sustain these relationships and continue the collaboration. We describe an appliance design for supporting consultations between outside scholars and remote community members. Requests are framed as personal invitations via a asynchronous video messaging and delivered to the remote participant via "Lingobox", a portable appliance akin to a multimedia answering machine. The device is being used with speakers of the Kunwinjku language in an extremely remote region of northern Australia. © 2021 ACM.

Abstracts of the Australasian Association for Academic Primary Care Annual Research Conference, AAAPC

The proceedings contain 101 papers. The topics discussed include: exploring the health seeking narratives of Assyrian refugee women living with chronic pain;can introducing a 'COIL program' enhance medical students' awareness regarding the relevance of cross-cultural communication skills in healthcare?;diagnosing doctor Google: investigating the relationship between cognitive bias and information behavior in older Australians accessing vaccine-related online information;patterns of multimorbidity show strong association between many chronic condition pairs;adult obesity management in Australia: how can we bridge the gap between guidelines and current general practice?;adaptive research practices in a pandemic: what have we learned during COVID-19?;culturally safe ways of working with Aboriginal and Torres Strait islander peoples in focus groups on sensitive topics;and supporting resilience and recovery: understanding general practitioners' perspectives on trauma-informed care for survivors of domestic and family violence.

How Australia improved health equity through action on the social determinants of health. (Special Issue: Australia in 2030: what is our path to health for all?)

The fantastic journey laid out in this chapter offers glimmers of hope for what the future could bring if there was committed social and policy action on the social determinants of health equity. Sadly, the reality is that social and health inequities and environmental degradation are getting worse, shining a light on the continuing fundamental ruptures in today's society. However, a systems perspective reminds us that nothing is static, and that the shifting political and economic sands due to COVID-19 provide an important window of opportunity to collectively change the system such that communities are able to live with good health, dignity and in an environmentally sustainable way.

Conducting a Global Quadruple Aim Thematic Analysis of Telemedicine Performance in Rural Indigenous Populations and Evidence-Based Recommendations for Improvement

As telehealth is a growing form of healthcare delivery across the world, particularly after the COVID-19 pandemic, it’s impact on patient populations particularly in aboriginal and rural communities boasts many questions. As the health disparities between aboriginal groups living in rural areas on reserves and the rest of the Canadian demographics remain to be mountainous, telemedicine is often seen as the new way forward in reducing these healthcare gaps. Presently, much research has been conducted on these cohorts, particularly in the health equity atmosphere. However, much of this research lacks a comprehensive framework or tool in which it analyzes the efficacy of outcomes. In this review paper, the quadruple aim – the ideal standard of care which North American health systems seek to conform to – will be used to analyze telemedicine performance, and assert evidence-based recommendations for improvement. Therefore, this paper seeks to conduct a thematic analysis on the various issues and barriers to telemedicine delivery and usage in aboriginal populations with respect to the quadruple aim as well as identifying evidence-based solutions to alleviate some of these concerns and bolster care.

Translating and Evaluating a Physical Activity Program for Aboriginal Elders on Noongar Boodjar (Country) - A Longitudinal Study.

Objective: The primary aim of the study was to translate and evaluate the impact of a Physical Activity (PA) program on the physical function of older Aboriginal Elders on Noongar Boodjar (Country). Methods: A longitudinal design framed within an Indigenous methodology. Two groups, one metropolitan and one regional, of Aboriginal Elders, aged ≥45 years, participated in the Ironbark PA program. This comprised weekly strength and balance exercises followed by yarning circles. Physical function (primary outcome) and functional ability, cardiovascular risk factors (weight, waist circumference), falls efficacy and health-related quality of life were measured at baseline 6, 12 and 24 months. Data were analyzed using generalized linear mixed effects modeling. Results: Fifty-two Elders initially enrolled and of those, n = 23 (44.2%) Elders participated regularly for 24 months. There was a 6-month gap in program delivery due to the COVID-19 pandemic. Participants made significant improvement in physical function at 12 months compared to baseline: [short physical performance battery (SPPB) at baseline, 8.85 points (95% CI 8.10, 9.61); 12 months 10.28 (95% CI 9.44, 11.13), p = 0.001: gait speed at baseline 0.81 ms-1 (95% CI 0.60, 0.93); 12 months 1.14 (95% CI 1.01, 1.27), p < 0.001]. Some sustained improvement compared to baseline was still evident at 24 months after the 6-month gap in attendance [SPPB 9.60 (8.59, 10.60) p = 0.14, gait speed 1.11 (0.95, 1.26) p < 0.001]. Cardiovascular risk factors showed a non-significant improvement at 12 and 24 months compared to baseline. All participants reported that they enjoyed the program, found it culturally appropriate and would recommend it to others. Conclusion: Older Aboriginal people showed sustained improvements in physical function after engaging in a culturally appropriate PA program. Culturally appropriate PA programs provide safety, security and choice for older Aboriginal people to engage in evidence-based PA.

WHY SHOULD INDIGENOUS COMMUNITIES BE AMONG THE HIGHEST PRIORITY POPULATIONS FOR MENTAL HEALTH AND WELLBEING RESOURCING AND ACTION IN THE FACE OF CLIMATE CHANGE, AND WHAT SOLUTIONS CAN THEY CONTRIBUTE TO THE WIDER COMMUNITY?

Objectives: To identify: (1) which population groups are most vulnerable to climate change health and mental health (MH) impacts? (2) In strengths rather than deficit framing, which should be the highest priority populations for MH and well-being prevention, clinical amelioration and community mobilisation? (3) What factors contribute to the highest-level priority due to vulnerability to climate change MH impacts? We suggest the populations with the highest social determinants gaps, health comorbidities and over-incarceration. Findings: The extremes are often found in both the most urban and the most remote settings. Why are culturally strong, proud and resilient Indigenous communities still so prone to climate change-related events? Especially as Aboriginal and Torres Strait Islander communities have achieved so much, leading Australia and the world, for the first 16 months of COVID-19 outcomes in Indigenous communities? Conclusion: In terms of the approach taken to improving the MH and well-being of most Indigenous and other priority populations most vulnerable to climate changerelated events, we need a better balance between traditional cultural-healing approaches, communitycontrolled and clinically determined solutions. Indigenous communities can contribute considerably to MH and well-being solutions for themselves and for the wider community.

Murradambirra Dhangaang (make food secure): Aboriginal community and stakeholder perspectives on food insecurity in urban and regional Australia.

BACKGROUND: It is widely acknowledged that the invasion by colonial powers of the Australian continent had profound and detrimental impacts on Aboriginal Communities, including food security. Policies of successive governments since European arrival have since further exacerbated the situation, with food insecurity now affecting 20-25% of Aboriginal and Torres Strait Islander people. Food insecurity contributes to long-term impacts on health, in particular diet-sensitive chronic diseases. This study aimed to describe Aboriginal community and stakeholder perspectives on food insecurity to get a better understanding of the key contributing factors and recommendations for potential strategies to address this issue in Aboriginal communities in urban and regional Australia. METHODS: Semi-structured interviews were conducted with 44 participants who were purposively selected. This included Aboriginal people in two communities and both Aboriginal and non-Aboriginal stakeholders from local food relief agencies, food suppliers, schools, and government in an urban and regional location in NSW. A conceptual framework was developed from literature on food security, and sensitizing concepts of availability, affordability, accessibility and acceptability or the lack thereof of healthy food were used to elicit responses from the participants. Interview transcripts were analysed thematically. RESULTS: All participants felt strongly that food insecurity was a major problem experienced in their local Aboriginal communities. Five core areas impacting on food security were identified: trapped in financial disadvantage; gaps in the local food system; limitations of non-Aboriginal food relief services; on-going impacts of colonization; and maintaining family, cultural and community commitments and responsibilities. Participants suggested a number of actions that could help ease food insecurity and emphasized that Aboriginal values and culture must be strongly embedded in potential programs. CONCLUSIONS: This study found Aboriginal families in urban and regional Australia are experiencing food insecurity on a regular basis, which is impacted by a range of socio-economic, environmental, systemic and cultural factors, as reported by the participants. Study findings highlight the need to address system level changes in the food environment and acknowledge Aboriginal history, culture and food preferences when considering the development of programs to alleviate food insecurity among Aboriginal people.