CRCATSIH Program 1: Healthy Start, Healthy Life

Program Leader: Ross Bailie/Gail Garvey
Program Manager: Liz Izquierdo
Administrative Support Officer: Alana Gall

What’s the program about?

‘Healthy Start, Healthy Life’ is focused on improving the delivery of health care to Aboriginal and Torres Strait Islander people.

The program aims to develop knowledge and evaluate tools and resources to reduce risk, promote health and support best practice in the prevention, early detection and management of chronic illness. Research supported by our predecessor organisation, the Cooperative Research Centre for Aboriginal Health (CRCAH), has established that chronic conditions – such as diabetes and cardiovascular disease – account for 70 per cent of the health gap between Aboriginal and Torres Strait Islander people and other Australians.[1]

As well as supporting the development of new approaches to tackle chronic illness across the life-cycle, Program 1 aims to find ways to make the transition of an innovation from research into widespread practice as straightforward and rapid as possible.

Download Program 1 Poster (Nov 2011)

Scope:

Priority areas include:

• Reducing the incidence of chronic illness, e.g. through encouraging better nutrition and greater exercise.
• Lowering the risk associated with tobacco consumption.
• Improving the early detection and effective management of chronic illness.
• Delivering better maternal and child health outcomes.

Stakeholders:

Program research activities involve collaborations with Aboriginal and Torres Strait Islander community controlled health care providers. The Lowitja Institute also plays a general brokerage role for mainstream health organisations wishing to partner with community controlled health care providers, either in research or in the delivery of services.

Current research:

• One21seventy workforce development
• Quality of Care – National Research Partnership
• Support for Aboriginal and Torres Strait Islander Cancer CRE (Centre for Research Excellence)
• Chronic condition management strategies in Aboriginal communities 
• AIMHI resources publication
• Implementation of innovations in Aboriginal and Torres Strait Islander health

Future research:

• Phase 1 clinical trial of a vaccine for group A Streptococcus bacteria
• Standardisation of diagnostic protocols for early detection of rheumatic heart disease
• Continuous quality improvement (CQI) initiatives
• Health Promotion
• Child and maternal health initiatives

Current research

One21seventy workforce development
One of the major pieces of infrastructure that exists to help support the uptake of innovations into practice is the Brisbane-based One21seventy National Centre for Quality Improvement in Indigenous Primary Health Care. This is a small service provision organisation established in 2009 as a spin-off from the CRCAH-funded ABCD (Audit and Best Practice for Chronic Disease) project. One21seventy provides a not-for-profit service that supports Aboriginal and Torres Strait Islander primary health care services to use and benefit from continuous quality improvement (CQI) tools and techniques.

There are now 172 health centres around Australia registered to use One21seventy’s services. With the support of the Lowitja Institute, One21seventy is also delivering training to staff in participating health centres to enable them to use One21seventy products and services at the highest level. Some 500 primary health care staff have received training since 2010 and courses are ongoing.

Quality of Care – National Research Partnership
While One21seventy continues the service provision role formerly carried out by the ABCD project, research to support health centres improve the quality of their care is continuing through the ABCD National Partnership. Funded by the NHMRC, the partnership is examining variations in quality of care through extensive analysis of data collected by One21seventy-registered health services. The project brings together the peak Aboriginal community controlled health service body, the relevant health department and a lead research institution to support the development of research capacity in community health services.

Support for Aboriginal and Torres Strait Islander Cancer CRE (Centre for Research Excellence)
Cancer is the third leading cause of death for Australia’s First Peoples and the second largest contributor to life years lost [2], but it rarely features as a specific concern in health policies and strategy documents. To address this, the Lowitja Institute sponsored a Roundtable that brought together leading cancer experts, service providers, Aboriginal and Torres Strait Islander cancer survivors, advocacy groups and community representatives to identify  priorities in cancer research. One of the outcomes from the gathering was the need for a nationally integrated approach to tackling cancer. This resulted in the development of a funding proposal for a CRE in Aboriginal and Torres Strait Islander Cancer, and in March 2011, the Lowitja Institute hosted a Quality Assurance workshop to improve the proposal submission.

Chronic conditions management strategies in Aboriginal communities
This collaborative project involves Flinders University, the Aboriginal Health Council of SA and three health services in SA. Using participatory action research design and mixed methods, this project demonstrated the clinical effectiveness of structured client-centred chronic condition management strategies, identified barriers and enablers, and supported development of helpful resources. (See CRCAH Chronic conditions management strategies project page.)

AIMhi resources publication
This project aims to improve outcomes for remote Indigenous clients of mental health services in remote Top End communities over five years. Two key interventions are planned over the five years: development of two-way mental health promotion resources (for health professionals, clients and carers) and development of new approaches to service delivery.  (See CRCAH AIMhi project page.)

Implementation of innovations in Aboriginal and Torres Strait Islander health
This project seeks to identify success factors and barriers to the widespread implementation of innovations in Aboriginal and Torres Strait Islander health care, and to form an evidentiary basis for the implementation component of Program 1.

Future research

Phase 1 clinical trial of a vaccine for group A Streptococcus bacteria
Group A Streptococcus (GAS, Streptococcus pyogenes) is a bacterial pathogen responsible for a range of diseases including rheumatic fever and rheumatic heart disease. A vaccine has been developed and is ready for a phase 1 human clinical trial in healthy adults to assess the safety and immunogenicity of this formulation.

Standardisation of diagnostic protocols for early detection of rheumatic heart disease
The Lowitja Institute will be providing support for PhD research on this topic, with the research due to commence in September 2011.

Continuous quality improvement (CQI) initiatives
This includes two initiatives: a national appraisal on CQI and the planning of a CQI conference in the first half of 2012.

Health Promotion
This initiative will include the implementation of health promotion tools developed, using a CQI approach, to suit Aboriginal and Torres Strait Islander needs and a training material package for widespread use of the tools in health care centres and other likely settings (e.g. less clinical settings).

Child and maternal health initiatives
A number of initiatives, including a Roundtable, are being developed in this key research area. See calls for expressions of interest.

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References

1. T. Vos, B. Barker, L. Stanley & A. Lopez 2003, The Burden of Disease and Injury in Aboriginal and Torres Strait Islander Peoples, University of Queensland, Brisbane.

2. Australian Bureau of Statistics (ABS) & Australian Institute of Health and Welfare (AIHW) 2008, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, ABS and AIHW, Canberra.