Responding to health impacts of climate change in the Australian desert.

Climate change is likely to have a significant effect on the health of those living in the 70% of Australia that is desert. The direct impacts on health, such as increased temperature, are important. But so too are the secondary impacts that will occur as a result of the impact of climate change on an uncertain and highly variable natural environment and on the interlinking social and economic systems. The consequence of these secondary impacts will appear as changes in the incidence of disease and infections, and on the psychosocial determinants of health. Responding to the impacts of climate change on health in desert Australia will involve the active participation of a variety of interest groups ranging from local to state and federal governments and a range of public and private agencies, including those not traditionally defined as within the health sector. The modes of engagement required for this process need to be innovative, and will differ among regions on different trajectories. To this end, a first classification of these trajectories is proposed.

Tactics at the interface: Australian Aboriginal and Torres Strait Islander health managers.

Over the past thirty years in Australia, there has been a recognition of the need for increasing Aboriginal and Torres Strait Islander participation in the management of their health services as part of the strategy to improve the poor health of Australia's indigenous peoples. The proliferation of Aboriginal Community-Controlled Health Services and the vigorous advocacy of groups such as the National Aboriginal Community Controlled Health Organisation have significantly contributed to this recognition. This, combined with additional management opportunities in government service, has drawn attention to difficulties in recruiting and retaining appropriately experienced Aboriginal and Torres Strait Islander managers, particularly in the northern states of Australia.

Diabetes screening. Does it make a difference in the Aboriginal and Torres Strait Islander population?

BACKGROUND: The prevalence of diabetes in the Aboriginal and Torres Strait Islander population is relatively high. A high proportion of cases are undiagnosed. Diabetes is one of a number of increasingly prevalent chronic diseases which have been described collectively as a noncommunicable disease epidemic. OBJECTIVE: To review the existing literature relating to the actual or potential benefit of screening for diabetes in the Aboriginal and Torres Strait Islander population. DISCUSSION: There is a strong case for screening for diabetes as part of an opportunistic or planned periodic health examination (PHE). As well as fasting venous plasma glucose, this integrated approach should include assessment of weight, blood pressure, presence of microalbuminuria and hyperlipidaemia. General practitioners need to be sensitive to cultural issues and power relationships, as well as considering 'structural' impediments to good health, such as affordability and availability of nutritious food, rather than focus solely on individual 'lifestyle' issues.

Roles and activities of the Commonwealth Government University Departments of Rural Health.

Since 1996, University Departments of Rural Health (UDRH) have been established at Broken Hill, Mount Isa, Shepparton, Launceston, Whyalla, Alice Springs and Geraldton. Each UDRH is underpinned by Commonwealth funding for an initial period of 5 years. The role of the UDRHs is to contribute to an increase in the rural and remote health workforce through education and training programs, as well as a reduction in the health differentials between rural and urban people and between indigenous and non-indigenous peoples. A strong population health focus involving partnerships between existing health providers in a targeted region and the university sector underpins their operation. While UDRHs have been established as a means of addressing a national workforce problem, their organisational arrangements with universities and local service providers vary widely, as does the program mix of activities in education, research service development, facilitation and advocacy. This article outlines some of the activities and progress of the UDRHs to date.

The turmoil of aboriginal enumeration: mobility and service population analysis in a central Australian community.

This paper documents Aboriginal population change and mobility over time in a remote community in central Australia. The movement of population has implications for service delivery and resource allocation. Aboriginal population in the region is characterised by high mobility. We conducted four population surveys in a selected remote community over a 12 month period and categorised individuals into four mutually exclusive groups: residents, dual residents, visitors and absent residents. Based on these categories we developed two population classifications: actual and potential service populations. The potential service population was consistently higher than the Australian Bureau of Statistics (ABS) census figure. We question the use of ABS census estimates as appropriate population figures for determining resource allocation to remote communities. We quantify inter- and intra-community mobility. When the potential population is used as denominator, 35% of the population of this community was classified as inter-community mobile. Given this level of mobility we argue that: (1) Resources should be allocated to compensate health services for the additional time and resource requirements to deal with the high level of population mobility. (2) Health programs such as STD control, trachoma, scabies and other communicable diseases common in Central Australia should be coordinated and delivered as regional programs often crossing State/Territory borders.

Remote area health service delivery in central Australia: primary health care and participatory management.

This paper provides a description of initiatives and changes made in remote primary healthcare service delivery in Central Australia. These changes included the introduction of an orientation and Aboriginal cultural awareness program, revising the recruitment process to include communities in staff selection, developing policies and protocols to support practice, and increasing support for remote area staff through managers being out and about in remote areas. The change from centralised management to an increasingly decentralised participatory management model, and involving local communities and local staff in decision making, was initiated early in the change process and continues to be of prime importance. After 5 years of intensive effort, it is clear that despite these initiatives sustainable change has been elusive and some problems remain. Further change and development is necessary. A number of new initiatives are described, including a Menzies School of Health Research project that examines structural issues, which will provide direction for the future by providing better support for remote area staff and facilitating greater community participation.

An initial assessment of the risk approach to antenatal management in Malaysia.

This study was the first assessment of a nationwide risk approach system to antenatal management introduced to Malaysia in 1989. Three rapid, record-based surveys on three different study groups were conducted to determine risk factor prevalence, accuracy of risk assignment, action after risk assignment and the relationship of risk level and place of delivery. The most frequent risk factors were short birth interval, high parity and first pregnancy. Accuracy of risk assignment was highest at the lowest levels of risk and poorest at the highest levels. Women at the lowest levels of risk were more likely to be seen by a doctor than women at highest risk. These was a trend to deliver in hospital, rather than at home, as level of risk increased; but many women at high risk still delivered at home. Recommendations are made on modifications to the system prior to future evaluation.

PIP: In 1990 in Malaysia, 3 distinct surveys were conducted as part of an assessment of a nationwide risk approach system to prenatal management introduced in 1989. After history-taking and examination, a health worker completed a risk checklist, then determined what risk category the pregnant woman belonged to and assigned her chart a color code. Red means a life-threatening condition and immediate labor ward admission. Yellow means risk factors requiring antenatal monitoring and treatment by a physician. White means no risk, so the midwife or the community nurse can monitor the pregnant women. Green means that complications may occur and a senior nurse should monitor the woman's progress. The first survey included all pregnant women attending prenatal clinics in Pasir Mas District, Kelantan State, for the first time. The second survey was a retrospective check of the prenatal cards of all pregnant women attending these clinics within the same area over a 1-week period in January 1990. The third retrospective, record-based survey included all women who delivered in the study area during February 1990. Both the clinic staff and the study team classified 75% of the women as high risk. Only 44.4% of antenatal cards had a completed risk checklist, more than 33% of which were completed after the clinic. The most common risk factors were short birth interval (47.5%) and high parity (i.e., gravida 6 or above) (27.2%). Almost 50% of women coded green delivered at home, when they should have delivered at the hospital, suggesting that they disregarded clinic advice. Sensitivity of the code approach was better at a lower level of risk than at higher levels (71.2% for green vs. 43.2% for yellow and 0 for red). Misunderstanding of risk criteria or coding to own clinical judgment accounted for the incorrect coding by health staff. Overall, midwives were knowledgeable and competent. They knew their communities and clients well. Based on these findings, the researchers suggest replacing the risk checklist with at least 1 laminated reference checklist displayed prominently in the clinic. Further evaluation is needed.