Lowitja institute

Health Literacy: an emerging agenda for Aboriginal and Torres Strait Islander health?

Health Literacy: an emerging agenda for Aboriginal and Torres Strait Islander health? Professor Ian Anderson Director Research and Innovation Lowitja Institute Director of Murrup Barak Melbourne Insitutte for Indigenosu Development & Onemda VicHealth Koori Health Unit, University of Melbourne

Overview • Context for the Health Literacy Agenda: • Aboriginal and Torres Strait Islander Burden of Disease • Aboriginal and Torres Strait Islander Policy Agenda • Two Case studies from the literature

Our Project • To develop culturally appropriate health literacy intervention focussing on CVD medications and communicating with health professionals about their use to meet evidence based care standards/targets • To implement the intervention in 5 primary care sites • To evaluate within the broader context of services and systems • To identify issues in relation to transferability and sustainability

Source: Nutbeam, D. (2008). ”The evolving concept of health literacy” Social Science and Medicine: 2072- 2078

Framing health literacy: 2 Health literacy as asset: • Role of health education and communication in developing competencies • Means of enabling individual to exert greater control over their health and range of personal, social and environmental determinants of health • Outcome of interventions that build empowerment in health decision making

Source: Nutbeam, D. (2008). ”The evolving concept of health literacy” Social Science and Medicine: 2072-207

ABORIGINAL AND TORRES STRAIT ISLANDER BURDEN OF DISEASE

National Burden of Disease Source: Vos, T et al (2007). “The Burden of Disease and Injury in Aboriginal and Torres Strait Islander Peoples 2003”.

Health Gap Source: Vos, T et al (2007). “The Burden of Disease and Injury in Aboriginal and Torres Strait Islander Peoples 2003”.

Risk and BOD Source: Vos, T., B. Barker, et al. (2008). "Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap" International Journal of Epidemiology : 1-8.

NT Burden of Disease Study • Mental health conditions, diabetes and cardiovascular disease account for 40% of the Aboriginal burden of disease • Highest proportion of DALY’s are in the age groups 25-54. Mental health conditions peaked in 15-24 yr age group. CVD peaked in the 35-44 year age group. Diabetes peaked in the 45-54 year age group.

Source: Zhoa Y et al (2009). “Burden of Disease and Injury in the Northern Territory”

Indigenous Health Gap • Health Gain for Indigenous Australians requires (amongst other things): • Action to address the social determinants of health • Reduction in individual health risk • Improved outcomes from health care

POLICY AGENDA & HEALTH LITERACY

• Council of Australian Governments Targets • Close the LE gap in a generation • Halve the child mortality gap in 10 years • Halve the literacy and numeracy gap • Halve the gap in employment outcomes within a decade • Halve the gap for Indigenous students in year 12 by 2020 • In five years all Indigenous four year olds in remote Indigenous communities will have access to quality early childhood education program

• COAG Reform Package: Commonwealth Component • Community healthy lifestyle programs. • Financial incentives for accredited primary care services to improve quality of care including best practice management of chronic disease. • Increase access essential follow-up services such as allied health, specialist care and Pharmaceutical Benefits Scheme (PBS) medicines. • Workforce initiatives.

• COAG Package: Commonwealth Tobacco Component • Regional coordinators to help communities develop local smoking reduction strategies and to coordinate initiatives across all levels of government, as well as health, education and other services. • Training for 1000 health and community development workers in relevant interventions to reduce smoking. • Access to quit smoking services for 13,000 Indigenous Australians, including individual, family and community-based programs over the four years.

• COAG Package: Commonwealth Tobacco Component • Funding to promote health lifestyles (Education and development kits will be developed by June 2010; Social marketing campaign programs will commence in 2010-11). • Funding for up to 105 healthy lifestyle workers to assist Indigenous individuals and families throughout Australia who are at risk of developing a chronic disease to reduce their risk of chronic disease • Funding to enhance access to quit-line services

• NT Chronic Conditions Prevention & Management Strategy • Individual, carer, and family centred care • Community capacity • Strategic supports to enable interventions to be effectively implemented • Interventions across the care continuum

• NT Chronic Conditions Prevention & Management Strategy • Action on social determinants of health • Primary prevention • Secondary prevention and early intervention • Self management support • Care for people with chronic conditions • Workforce planning and development • Information, communication and disease management systems • Quality improvement

Policy Agenda Health Services Infrastructure and Systems • Financing • Workforce • Quality of Care/Care Management Processes Social determinants & Risk Reduction Patient processes? • Self Management Support

Program Framework for Indigenous Chronic Disease - adapted from WHO Innovative Care for Chronic Conditions Framework Enabling Policy and Systems Links Healthy Health Communities Services Infrastructure Lifestyles programs Health care y He nit alt organisation Social Determinants m mu s h Co rtner T e Ca am re Pa Patients and Families Outcomes

Case Study One • Study of sustainability of outcomes in a chronic disease treatment program • Protocol: • review of clinical records over 6 years (3 in specialized treatment program and 3 years after it was integrated in PHC) • Time series analysis: Outcome measure BP (systolic and diastolic) • Bailie et al (2006): Investigating the sustainability of outcomes in a chronic disease treatment programme” Social Science and Medicine: 1661-1670.

Case Study One Key Findings • Improvement in BP control in first 6-12 months • Steady decline (with no significant difference in this decline in the pre and post program period)

Case Study One Possible reasons for observations • Non-pharmacological elements responsible for initial improvements • Routine repetition of treatment (important for health service impact) may have a negative impact on patient motivation

Case Study Two • Implementation of CQI within 12 Indigenous primary health care centres • 2 Annual cycles of assessment, feedback, action planning and implementation • Main process measures: adherence to guideline scheduled services; medication adjustment • Outcomes measures: HBA1C, blood pressure; total cholesterol;

Case Study Two Key Findings • Engagement by staff; system development • Increased adherence to scheduled services • Increased medication adjustment rates (from a low base) at one year, not maintained at two • Improved mean HBA1C, no improved BP and cholesterol

Case Study Two Author conclusions • QI acceptable and associated with systems improvements and some intermediate outcomes • Medication adjustment presents challenges • Greater emphasis on staff engagement; organisational commitment

Conclusion • The Aboriginal and Torres Strait Islander Burden of Disease and the Policy Agenda point to the need to focus on those processes and interventions that support patient engagement and empowerment in the care process • Health literacy provides an important frame for the development of practice

Lowitja institute

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