Palm Island Health Action Plan 2010 - 2015

Palm IslandHealth Action Plan2010–2015

Health for the people. Health by the people. The Palm Island way.

Palm Island Health Action Plan 2010–2015

The Palm Island Aboriginal Shire Council supports and encourages the dissemination and exchange of information. However, copyright protects this material. The Palm Island Aboriginal Shire Council has no objection to this material being reproduced, made available online or electronically, but only if it is recognised as the owner and this material remains unaltered. Inquiries to adapt this material should be addressed by email to [email protected]

ISBN 978-1-921707-18-6

Suggested Citation: Palm Island Aboriginal Shire Council: Palm Island Health Action Plan 2010–2015, Brisbane 2011.

mailto:reception%40palmcouncil.qld.gov.au?subject=

Closing the health gap for Palm Island people3


1. ForewordA healthy Palm Island has been a vision since the days of Turtle Dreaming.

This Palm Island Health Action Plan is a historic and ground breaking document that reflects those health aspirations and vision for our future.

Some Aboriginal and Torres Strait Islander communities have a community-controlled health service that can advocate for health and can deliver culturally appropriate health services. This plan is the first step in that direction for Palm Island. It takes our comments and concerns and proposes specific actions to improve our health status.

This plan shows what strong partnership between government and the people can achieve when everyone shares a commitment to closing the health gap between Aboriginal and Torres Strait Islander people and the rest of the Queensland population. Consistent with the Palm Island Close the Gap Statement of Intent, the Queensland and Australian Governments will work with us to provide strong, accessible and culturally capable health services and programs. In turn, we will take responsibility for our own health and the health of our children by attending regular health check ups and adopting healthier lifestyles. We will have a greater say over the design and delivery of health services in Palm Island and will start to take some control over our future.

A healthy Palm Island was a part of the community’s vision long before I became Mayor of Palm Island and it gives me great pleasure to see this first step on that journey. I would like to thank the Palm Island Aboriginal Shire Council members for entrusting the development of this plan to my leadership. The real challenge will be on following through and making it happen. I believe if we continue to work closely with health service providers and governments we can achieve greater control and better health outcomes. Together we will close the gap.

Health for the People. Health by the People. The Palm Island way.

Councillor Alfred Lacey

Mayor

Palm Island Aboriginal Shire Council


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AcknowledgementsCommunity consultations to inform this plan were undertaken by Leanne Ramsamy on behalf of the Palm Island Aboriginal Shire Council. Leanne wishes to thank Palm Island community members and service providers who participated in the consultations.

The Palm Island Health Action Plan was prepared by the following staff of Queensland Health’s Aboriginal and Torres Strait Islander Health Branch — Marianna Serghi, Monica Seini, Daniel Williamson, Sharon Driessens and Elizabeth Harding with Leanne Ramsamy. It was developed in consultation with Councillor Alfred Lacey, Mayor, Palm Island Aboriginal Shire Council and Mary Bonner, Chief Executive Officer, Townsville Health Service District.

The paintingThe original artwork in this document was created by Allan Palm Island specifically for this Palm Island Health Action Plan. Allan’s paintings of Palm Island’s marine life are in the permanent collection of the Queensland Museum.

“There is still a lot of bush tucker on Palm Island and people still hunt for traditional foods. This is one of the traditional foods and like all bush tucker has a strong connection to the health and wellbeing of people on Palm Island.” Mr Allan Palm Island—Traditional Custodian and artist.

Manbarra

The Palm Island Health Action Plan reflects the voices, aspirations and visions of the Palm Island people in closing the health gap between the Aboriginal and Torres Strait Islander people of Palm Island and the general population of Queensland — Health for the People. By the People. The Palm Island Way.



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Contents

1. Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

2. Statement of Intent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

3. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

4. Development of the Palm Island Health Action Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Policy and planning frameworks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Community engagement and stakeholder consultation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Scope of the Palm Island Health Action Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

5. Palm Island community profile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Health status of Palm Island people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Existing Palm Island health services and programs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

6. Action area one — Illness prevention and early intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

7. Action area two — Treating existing illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

8. Action area three — Better health services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

9. Action area four — Social determinants of health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35

10. Implementation, monitoring and review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37

Implementation principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Palm Island engagement and coordination strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Health service delivery — mutual obligation principles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

11. References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38

Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Glossary of terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Technical notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41



Figures

Figure 1 Proportion of synthetic population estimates, Indigenous status and age for Palm Island and Queensland, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Figure 2 Broad cause groups, burden of disease, Aboriginal and Torres Strait Islander Palm Island residents, 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Figure 3 Fatal and non-fatal contribution to the burden of disease, Aboriginal and Torres Strait Islander Palm Island residents, 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Figure 4 (a-f) Selected conditions contributing to the burden of disease for Aboriginal and Torres Strait Islander Palm Island residents, 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Figure 5 Pre-term births (less than 37 weeks gestation), 2003–2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Figure 6 Low birth weight (less than 2,500 grams), 2003–2008. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Figure 7 Births to teenage mothers (<20 years) 2003–2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Figure 8 Women who smoked during pregnancy, 2006–2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Figure 9 Risk factors contribution to the burden of disease, Aboriginal and Torres Strait Islander people, Australia, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Figure 10a Diseases of the respiratory system 2003–04 to 2008–09 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Figure 10b Chronic obstructive pulmonary disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Figure 10c Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Figure 11 Injury and poisoning 2003–04 to 2008–09. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Figure 12a Diseases of the circulatory system 2003–04 to 2008–09 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Figure 12b Ischaemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Figure 13a Diseases of the endocrine system 2003–04 to 2008–09 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Figure 13b Type 2 diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21


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Fundamental to improving health status is the increased involvement of Palm Island people in decisions affecting the planning, design and delivery of health services and programs. Meaningful engagement is essential to form a true partnership between Palm Island people and government service providers, and to improve access to quality health services that meet local needs. The Palm Island Health Action Plan includes both a stocktake of existing health services and programs on Palm Island and a record of community perceptions about Palm Island health services. It presents the health status data for Palm Island residents comparative to Aboriginal and Torres Strait Islander people across Queensland and non-Indigenous Queenslanders. This information is used to inform the actions required to improve health outcomes across four action areas including:

• prevention and early intervention

• treating existing illness

• better health services

• social determinants of health.1

Within the context of ongoing health reform, the Palm Island Health Action Plan is the first in a series of five-year plans that will contribute to achieving health equality for Palm Island people. In summary, the Palm Island Health Action Plan provides:

• a health profile of the Palm Island community2

• a stocktake of existing health services on Palm Island including the type and frequency of both resident and visiting health services and programs

• a record of the health concerns, aspirations and priorities articulated by the Palm Island community during extensive community consultation

• agreed strategies to address community health priorities and the leading causes of ill health, to improve access to health services and to increase the level of engagement in health planning and decision-making within the Palm Island community

• a mechanism for monitoring progress and reviewing priorities and strategies to inform future action.

3. IntroductionThe Palm Island Health Action Plan has been developed to:

• improve the level and quality of Queensland Health service delivery to Palm Island people

• increase access to Palm Island health services

• enhance the involvement of Palm Island people in the design and delivery of Queensland Health provided services.

It is the result of an agreement between Councillor Alfred Lacey, Mayor of Palm Island Aboriginal Shire Council (PIASC), and Queensland Premier Anna Bligh to develop a health action plan for Palm Island that reflects the health aspirations of the Palm Island community.It also commits government service providers and the community to working together to improve health services on Palm Island based on a shared vision, agreed health priorities and strategies to address identified health needs.

The National Health and Hospital Reforms establish Local Health and Hospital Networks and Medicare Locals to deliver regional health services to improve access to health services and ensure that health services are tailored to meet the needs of local communities. As such, this Palm Island Health Action Plan, including the community consultations, will be reflected in the forthcoming development of a broader regional plan for comprehensive health services to ensure the health status and health needs of Palm Island people are considered.

The primary objective of the Palm Island Health Action Plan is to ensure that health outcomes and access to health services for Palm Island people are equal to the wider Queensland population. A high level of commitment from the Queensland Government, the Australian Government and other key stakeholders is required to achieve lasting improvements in health status and to close the gap in health outcomes for the people of Palm Island.

1Note the social determinants of health (broader social and economic factors that impact on health outcomes) are identified in this plan. However, actions

to address the social determinants are confined within this document to those initiatives that are the responsibility of the health portfolio in recognition that broader initiatives to improve Aboriginal and Torres Strait Islander housing and education outcomes are being addressed through other mechanisms. 2

In this Plan, references to the Palm Island community are intended to mean the Aboriginal and Torres Strait Islander residents of Palm Island.



commits the signatories to:

• developing a comprehensive, long-term and evidence-based health action plan to address health inequality in Palm Island

• ensuring full participation of Palm Island people in initiatives to address their health — including developing and delivering primary health care on Palm Island

• working collectively to address the social determinants of health

• improving knowledge and understanding about what works

• ensuring that existing funding is effectively directed in order to:

— achieve better health outcomes

— maintain existing levels of funding

— direct new funding where possible to priorities identified in the Palm Island Health Action Plan

• achieving improved access to, and outcomes from, mainstream primary health care services

• ensuring primary health care services are available, appropriate, accessible, affordable and of good quality

• measuring monitoring and reporting on joint efforts to ensure that progress is being made.

Policy and planning frameworksPIHAP is strategically placed within the national Aboriginal and Torres Strait Islander health reform agenda which aims to close the gap in health outcomes between Indigenous and non-Indigenous Australians by 2033. Hence, PIHAP has been developed to be consistent with:

• the National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003–2013

During NAIDOC week 2009, Premier Anna Bligh and Councillor Alfred Lacey of Palm Island Aboriginal Shire Council (PIASC) agreed to progress a Health Service Plan3 for Palm Island. The proposed Health Service Plan has evolved into the Palm Island Health Action Plan (PIHAP).

The purpose of the PIHAP, is firstly, to highlight the health needs and aspirations identified by the Palm Island community, and, secondly to identify agreed actions for implementation by State, Australian and Local Governments in partnership with the Palm Island community to improve health outcomes on Palm Island.

To engage and secure stakeholder support a Palm Island Health Partnership Group (PIHPG) was established to oversee the development of the PIHAP. Representatives included:

• Palm Island Aboriginal Shire Council

• Townsville Aboriginal and Islander Health Service

• relevant divisions of General Practitioners, including Townsville General Practice Network and North West Queensland Primary Health Care

• Queensland Government (Queensland Health and Department of Communities)

• Australian Government (Townsville Indigenous Coordination Centre and Department of Health and Ageing).

The PIHPG participated through three separate and distinct sub-committees:

• community sub-committee

• service provider sub-committee

• funding agency sub-committee.

To progress health reform on Palm Island, the PIASC has made a commitment to providing leadership through a health-specific Statement of Intent between PIASC, the Australian Government and the Queensland Government. In summary, the Statement of Intent

4. Development of the Palm Island Health Action Plan

3Note the terminology ‘Health Action Plan’ has been adopted by the Palm Island Aboriginal Shire Council (PIASC) and has been used throughout

this document.

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service interventions are culturally capable and that local solutions are developed to meet identified local needs. This approach allows the community to become more informed about the health services available to them and more confident about using them. In recognition that leadership in health is best driven by local people within a culturally competent framework, PIHAP has been developed in consultation with the Palm Island community and directed and facilitated through the PIASC.

From the outset, the PIASC emphasised the community’s aspirations to influence and strengthen their direct involvement in health care planning and priority setting. Palm Island Mayor, Councillor Alfred Lacey, advocated for the priority development of a Health Action Plan for Palm Island that articulates the aspirations, vision and health priorities of the Palm Island community and specifies jointly agreed strategies to address identified health needs.

Stakeholders were jointly identified by the Mayor of PIASC and by the Aboriginal and Torres Strait Islander Health Branch, Queensland Health. Participants in the consultations included:

• community members and PIASC representatives

• health service providers including Joyce Palmer Health Service staff, GP Network members, Ferdy’s Haven Drug and Alcohol Rehabilitation Services, Sandy Boyd Hostel and the Townsville Aboriginal and Islander Health Service

• government representatives from the Australian Government Department of Health and Ageing, the Queensland Department of Justice and Queensland Health

• community organisations including Coolgaree (CDEP) Community Development Employment Projects, Australian Red Cross, Cathy Freeman Foundation, Police Citizens Youth Club, Bwgcolman Radio and the Palm Island Community Company.

• the Council of Australian Governments’ (COAG) National Indigenous Reform Agreement 2009 and relevant national partnership agreements — in particular the Indigenous Early Childhood Development National Partnership Agreement (IECDNPA) and closing the gap on Indigenous Health Outcomes National Partnership Agreement (IHONPA)

• the Queensland Government’s Making Tracks toward closing the gap in health outcomes for Indigenous Queenslanders by 2033: Policy and Accountability Framework and implementation plan for the period 2009–2010 to 2011–2012

• Queensland Health Aboriginal and Torres Strait Islander Cultural Capability Framework 2010–2033 (QHCCF).

These frameworks have several common themes which have also emerged during consultations with the Palm Island community and form the basis of the PIHAP action areas including:

• a focus on health promotion and illness prevention, better diagnosis and treatment

• addressing the risk factors for chronic disease

• improving the quality, availability and cultural capability of health services

• better service integration and coordination through improved health planning

• a focus on the broader social and economic factors that impact on health status.

In addition, the PIHPAP is informed by The Report of the Palm Island Integrated Services Modeling Project5 developed by James Cook University in June 2010 and funded by the Australian Government.

Community engagement and stakeholder consultationConsistent with current government commitments to Aboriginal and Torres Strait Islander health, PIHAP commits all levels of government and service providers to involving communities directly in decisions relating to the planning and implementation of health services and programs. Meaningful involvement by the community in health decision-making aims to ensure that health

5Elston J, Stirling J and Geia, L, 2010. The Report of the Palm Island Integrated Services Modelling Project, James Cook University, June 2010.

6 Ife, Jim and Tesoriero, Frank., Community Development, 3rd Edition, French’s Forest, NSW, 2006.



2. Which services and/or programs are working well?

3. If you had to improve the health services and programs on Palm Island what do you suggest would be required?

4. What would the target group be for new services and/or programs?

5. How could/would these new services and/or programs be funded?

Consultation outcomesIt became clear from the consultations, held from October 2009 to June 2010, that to achieve ‘Health for the people. Health by the people. The Palm Island way’ the community vision, aspirations and needs must be fundamental to all health planning and program implementation.

Consultation methodologyThe consultation methodology adopted was based on a social planning model6 whereby local people are actively involved in identifying their own health needs. The process used was to allow for open discussion from community members and service providers about the past, current and future health needs on Palm Island.This includes focus group sessions involving five or more people as well as discussions with individuals. The information provided has informed the key action areas of the PIHAP.

The following questions were the primary discussion points during the consultation:

1. What is health like on Palm Island now and what was it like in the past?

Community visionTo achieve equality in health status and life expectancy between the Aboriginal and Torres Strait Islander people of Palm Island and non-Indigenous Australians.

Community aspirations• Aboriginal and Torres Strait Islander people on Palm Island have control over their own health and

health services.

• There is full participation by the Palm Island community and its representatives in health planning and decision-making and in determining ways of improving their own health outcomes—Health for the people. Health by the people. The Palm Island way.

• There is meaningful partnership between government agencies, service providers and the Palm Island community and its representatives to identify health needs and local solutions.

• There is active and sustained collaboration with government agencies and service providers outside the health system to address the broader determinants that impact on achieving health equality.

• Available funding is allocated to target identified health needs.

• Mainstream health services have the capacity to deliver culturally capable health care for Palm Island people.

• Health care services are reliable, sustainable, available, appropriate, accessible, affordable and of good quality.


12

Scope of the Palm Island Health Action Plan During consultation needs were identified and strategies suggested to address issues that are related to health but sit outside the responsibility of the health system. PIHAP records the issues that were raised in consultation but proposes actions only in those areas that can be influenced by the health system. Broader issues that impact on health but that are outside the responsibility of the health system can be addressed through existing multi-agency structures—such as the Palm Island Negotiation Table and through the Palm Island Government Champion.

Several assumptions were made when developing this plan, including that:

• current services and resourcing levels will not be reduced

• service delivery arrangements described are current as at December 2010, but may change as a result of the COAG’s health reform measures

• the workforce necessary to implement strategies will be available

• there will be sufficient staff accommodation to house visiting health service providers.

During consultation, the majority of participants expressed satisfaction with some of the current health services and programs. However, they also expressed concern regarding the level of chronic illness which was perceived to be exacerbated by a lack of coordination between stakeholders, and limited health promotion and early intervention.

In addition, a range of issues impacting on health programs, services and systems were identified. The issues raised during consultation are presented in four action areas (see sections four to seven) and can be summarised as follows:

• Illness prevention and early intervention

health promotion and health education

maternal and child health and safety

dental health

nutrition

• Treating existing illness

treatment services for chronic disease

treatment services for emotional and social well being and mental health

treatment services for drug and alcohol use

treatment services for sexual health

treatment services for dental health

• Better health services

preferred service models

access to culturally appropriate primary health care

aged care and disability services

improved data and evidence

• Social determinants of health

housing

education

transport

environmental health.



HistoryPalm Island is situated on the east coast of Queensland—70km north-east of Townsville. The community of Palm Island was established in 1918 after a cyclone destroyed the Hull River Mission near the small sugar town of Tully in North Queensland. Over the next two decades some 1600 people from 42 different Aboriginal groups across Queensland, and a small number of Torres Strait Islanders, were removed by the State Government and sent to Palm Island. The two contemporary distinct Aboriginal and Torres Strait Islander groups include:

• the traditional owners — the Manbarra people

• the Bwgcolman — encompassing as one group all of the people historically moved to Palm Island by force or under past law enforcement policies.

PopulationIn July 2010, the Palm Island Aboriginal Shire Council completed a Population Survey of Palm Island that shows a total population of 30427. However, the information presented in this chapter is based on the 2008 Australian Bureau of Statistics Estimated Resident Population (ERP) figures to enable comparisons of health data between Palm Island, the Townsville Health Service District and Queensland. At 30 June 2008, the Synthetic Population Estimates of Palm Island was 2193 people of which 2113 identify as Aboriginal and/or Torres Strait Islander. The estimated Aboriginal and Torres Strait Islander resident population of Townsville Health Service District (excluding Palm Island) was 13 875 people and the estimated total Aboriginal and Torres Strait Islander resident population of Queensland was 152 527 people.8

5. Palm Island community profile

7Survey conducted by James Cook University for the Palm Island Aboriginal Shire Council in May/June 2010.

8Office of Economic and Statistical Research (OESR), Queensland Treasury, Synthetic Population Estimates by Indigenous Status, Queensland, 2008.

Figure 1 shows the age profile of the Palm Island population compared with the total non-Indigenous population of Queensland. Palm Island has a very young age profile with more than half the population (53 per cent) aged 24 years old and under, only 1.6 per cent of the population were aged 65 years and over. This is due primarily to higher fertility rates and deaths occurring at young ages. In 2008, 57.9 per cent of Aboriginal and Torres Strait Islander Queenslanders were aged 24 years and under and 2.8 per cent were aged 65 years and over compared with the non-Indigenous population of Queensland—where 33.5 per cent were 24 years and under and 12.6 per cent were aged 65 years and older.

Per cent

Age

grou

p

65+

60-64

55-59

50-54

45-49

40-44

35-39

30-34

25-29

20-24

15-19

10-14

5-9

0-4

Figure 1 — proportion of synthetic population estimates, Indigenous status and age for Palm Island and Queensland, 2008

Source: OESR8, Synthetic population estimates by Indigenous

status by age and sex for SLAs, 2008

Queensland non-Indigenous Palm Island Aboriginal and Torres Strait Islander

0 2 4 6 8 10 12 14

1.6

2.2

3.5

4.2

5.3

7.3

7.4

8.6

6.8

10.0

9.9

12.1

9.9

11.2

14


Burden of diseaseBurden of disease is the total significance of disease for a population measured in years of life lost to ill health and disability (known as disability-adjusted life years). The six leading contributors to Palm Island’s burden of illness and injury are:

• cardiovascular disease — particularly ischemic heart disease

• mental illness and substance use

• accident and injury

• type 2 diabetes

• neoplasms (cancers) — particularly lung cancer

• chronic respiratory disease — particularly chronic obstructive pulmonary disease and asthma.

These six conditions are responsible for 65 per cent of the total burden of disease for Palm Island. Figure 2 presents the total burden of disease for Aboriginal and Torres Strait Islander people on Palm Island10.

Health status of Palm Island peopleThe life expectancy gap between Aboriginal and Torres Strait Islander and non-Indigenous Queenslanders is currently estimated to be 10.4 years for males and 8.9 years for females in Queensland9. The average annual mortality rate for the period 2002–03 to 2006–07 for Aboriginal and Torres Strait Islander children who are less than five years of age is 2.04 times the rate for non-Indigenous children. This data is used to monitor progress towards achieving the two health targets under the COAG National Indigenous Reform Agenda by the Australian and Queensland Governments. Life expectancy and mortality data is unavailable for small communities such as Palm Island.

Burden of disease is an important summary measure of population health and is used to demonstrate the gap between the health status of Aboriginal and Torres Strait Islander people and the rest of the Queensland population. Burden of disease data for 2006 is presented for Palm Island by broad cause groups of conditions with a breakdown for specific diseases or conditions with each group (see Figure 2). The extent to which each cause group provides a fatal and non-fatal contribution to the burden of disease and injury is also presented (see Figure 3).

Figure 2 — broad cause groups, burden of disease, Aboriginal and Torres Strait Islander Palm Island residents, 2006

Per c

ent

18

16

14

12

10

8

4

2

0

Source: Queensland Health, unpublished data — see technical notes

Card

iova

scul

ardi

seas

es

Type

2di

abet

es

Acci

dent

and

inju

ry

Men

tal h

ealth

and

subs

tanc

eus

e

Neop

lasm

s

Chro

nic

resp

irato

rydi

seas

es

Cond

ition

s or

igin

atin

g in

the

perin

atal

per

iod

Resp

irato

ry tr

act

infe

ctio

ns a

ndot

itis

med

ia

Infe

ctio

us a

nd

para

sitic

dis

ease

s

Suic

ide

and

assu

lt

Nerv

ous

syst

em

dise

ases

Oth

er

17 12 11 9 9 8 4 4 4 4 4 15

9Australian Bureau of Statistics, Assessment of Methods for Developing Life tables for Aboriginal and Torres Strait Islander Australians, 2006,

cat no. 3302.0.55.003, November 2008. 10

Queensland Health, unpublished data (2006), Brisbane, 2009.



Cardiovascular disease is the largest contributor to the burden of disease for Aboriginal and Torres Strait Islander people on Palm Island (Figure 4(a)). The main contributors to the cardiovascular disease burden are ischaemic heart disease and stroke (approximately 70 per cent of the cardiovascular disease burden).

Mental illness is the second largest contributor to the burden of disease for Aboriginal and Torres Strait Islander people on Palm Island. The main contributors to the mental illness burden are anxiety, depression and alcohol dependence and harmful use (approximately 72 per cent of the mental illness burden).

The main contributors to the accident and injury burden for Aboriginal and Torres Strait Islander people on Palm Island are road traffic accidents, other unintentional injuries, suicide, self inflicted injury and homicide (approximately 87 per cent of the accident and injury burden.)

The main contributor to the diabetes burden of disease for Aboriginal and Torres Strait Islander people on Palm Island is Type 2 diabetes (approximately 80 per cent of the diabetes burden).

The main contributors to the chronic respiratory disease burden for Aboriginal and Torres Strait Islander people on Palm Island are chronic obstructive pulmonary disease and asthma (approximately 70 per cent of the chronic respiratory burden). See Figure 4 for details.11

Figure 3 shows the pattern of fatal and non-fatal contribution to the burden of disease for Palm Island residents presented in Figure 2. For example, cardiovascular disease contributes an estimated 17 per cent to the total burden of disease for residents of Palm Island with approximately 80 per cent of the burden being fatal and approximately 20 per cent being non-fatal. Whilst most of the burden of cardiovascular disease and cancers is fatal, much of the burden of diabetes, respiratory diseases and mental health and substance use problems lies in the reduced quality of life that comes from living with these conditions for many years.

Figure 3 — fatal and non-fatal contribution to the burden of disease, Aboriginal and Torres Strait Islander Palm Island residents, 2006

Per cent

Source: Queensland Health: unpublished data—see technical notes

Fatal burden Non-fatal burden

0 2 4 6 8 10 12 14 16 18

Nervous system diseases

Suicide and assult

Infectious and parasitic diseases

Respiratory tract infections and otitis media

Conditions originating in the perinatal period

Chronic respiratory diseases

Neoplasms

Type 2 diabetes

Accident and injury

Mental health and substance use

Cardiovascular diseases

48

76

58

38

66

36

95

42

85

28

79

11Queensland Health, Unpublished data (2006), Brisbane, 2009.

52

24

42

62

34

64

5

58

15

72

21


16

Figure 4 (a-f) — selected conditions contributing to the burden of disease for Aboriginal and Torres Strait Islander Palm Island residents, 2006

Source: Queensland Health: unpublished data — see technical notes

Figure 4 (a) — cardiovascular diseases contribution

Per c

ent

60

50

40

30

20

10

0

Rheu

mat

ic

hear

t dis

ease

Isch

aem

ic

hear

t dis

ease

Stro

ke

Infla

mm

ator

y he

art d

isea

se

Oth

er

Figure 4 (c) — accident and injury contribution

Per c

ent

Road

traf

fic

acci

dent

s

Oth

er tr

ansp

ort

acci

dent

s

Falls

Oth

er u

nint

entia

l in

jurie

s

Oth

er

Figure 4 (e) — neoplasms

Per c

ent

60

50

40

30

20

10

0

Lung

can

cer

Colo

rect

al

canc

er

Brea

st c

ance

r

Mou

th a

nd

orop

harn

yx c

ance

r

Oth

er

Figure 4 (b) — mental illness and substance use contribution

Per c

ent

50

40

30

20

10

0

Alco

hol

depe

nden

cean

d ha

rmfu

l use

Anxi

ety

and

depr

essi

on

Oth

er

Figure 4 (d) — diabetes contribution

Per c

ent

100

80

60

40

20

0

Type

1di

abet

es

Oth

er

Type

2di

abet

es

Figure 4 (f) — chronic respiratory diseases

Per c

ent

50

40

30

20

10

0

Chro

nic o

bstr

uctiv

e pu

lmon

ary

dise

ase

(CO

PD)

Asth

ma

Oth

er c

hron

ic

resp

irato

ry d

isea

ses

8 53 17 13 10

25 8 8 8 50

27 45 29

8 79 13

44 25 31

47 7 6 29 11

50

40

30

20

10

0



Figures 5-8 (below) provide information about the maternal and child health factors that impact on health outcomes for the infant and young child progressing into adulthood and compares data for Palm Island with:

• data for the Aboriginal and Torres Strait Islander population of the Townsville Health Service District (excluding Palm Island)

• data for the Aboriginal and Torres Strait Islander population of Queensland (excluding Palm Island)

• data for the non-Indigenous population of Queensland (excluding Palm Island)12.

Compared with the Townsville Health Service District and Aboriginal and Torres Strait Islander people state-wide, significantly more Palm Island mothers gave

Maternal and child healthPerinatal data is provided for pregnant Aboriginal and Torres Strait Islander women and their babies for the following indicators:

• pre-term births (less than 37 weeks gestation)

• birth weights less than 2500 grams

• women smoking during pregnancy

• babies born to teenage mothers (<20 years of age).

This data for Palm Island is compared with the 2003–2008 data for:

• pregnant Aboriginal and Torres Strait Islander women and their babies in the Townsville Health Service District (excluding Palm Island)

• pregnant non-Indigenous women and their babies in Queensland (excluding Palm Island).

Source: Perinatal Data Collection, Queensland Health, 2003-2008, (smoking mothers 2006–2008) unpublished–see technical notes

Figure 5 — pre-term births (less than 37 weeks gestation), 2003–2008

Per c

ent

Palm

Isla

nd(to

tal p

opul

atio

n)

Tow

nsvi

lle H

ealth

Se

rvic

e Di

stric

t

Que

ensl

and

Indi

geno

us

Que

ensl

and

non-

Indi

geno

us

Figure 6 — low birth weight (less than 2500 grams), 2003–2008

Per c

ent

25

20

15

10

5

0

Tow

nsvi

lle H

ealth

Se

rvic

e Di

stric

t

Que

ensl

and

Indi

geno

us

Que

ensl

and

non-

Indi

geno

us

Figure 7 — births to teenage mothers (<20 years), 2003–2008

Per c

ent

30

25

20

15

10

5

0

Tow

nsvi

lle H

ealth

Se

rvic

e Di

stric

t

Que

ensl

and

Indi

geno

us

Que

ensl

and

non-

Indi

geno

us

Figure 8 — women who smoked during pregnancy, 2006–2008

Per c

ent

80

70

60

50

40

30

20

10

0

Tow

nsvi

lle H

ealth

Se

rvic

e Di

stric

t

Que

ensl

and

Indi

geno

us

Que

ensl

and

non-

Indi

geno

us

18.3 11.5 10.7 6.2 50

22.6 19.4 19.2 5.0 50 66.0 51.9 53.1 18.0 50

18.9 10.6 9.8 4.6

12Queensland Health, Perinatal data collection, Queensland Health 2003–2008, (smoking mothers 2006–2008) unpublished

Palm

Isla

nd(to

tal p

opul

atio

n)

Palm

Isla

nd(to

tal p

opul

atio

n)

Palm

Isla

nd(to

tal p

opul

atio

n)

25

20

15

10

5

0

18


Of these, tobacco contributes 17 per cent to the health gap and one fifth of all Aboriginal and Torres Strait Islander deaths. Cardiovascular disease, lung cancer and chronic respiratory diseases are the leading causes of tobacco related mortality in Aboriginal and Torres Strait Islander people13.

Sexually transmissible infections (STIs) are a significant risk factor for reproductive health problems. Across Australia, chlamydia is the most common STI in both Aboriginal and Torres Strait Islander and non-Indigenous populations. In Queensland, the average rate of positive tests for the non-Indigenous population for chlamydia from 2005 to mid 2010 is 6.3 per cent. The average rate of positive tests for the Aboriginal and Torres Strait Islander population across Queensland for chlamydia for the same period is 11.5 per cent and on Palm Island is 12.8 per cent which indicates a higher level of chlamydial disease in the Palm Island population. A larger proportion of young people within the Palm Island population, a shortage of sexual health clinical staff, socio-economic disadvantage and the stigma associated with seeking treatment for STIs are significant factors.

birth to pre-term babies (less than 37 weeks gestation) and more Palm Island babies were delivered with birth weights of less than 2500 grams. This is despite a similar rate of attendance at ante-natal visits (70.3 per cent attendance on Palm Island compared with 76.2 per cent attendance for Aboriginal and Torres Strait Islander people state-wide). The number of young mothers (10-19 years of age) on Palm Island is similar to the number of young Aboriginal and Torres Strait Islander mothers within the Townsville Health Service District (excluding Palm Island) and state-wide. However, there is a significantly higher rate of Aboriginal and Torres Strait Islander women smoking at any time during pregnancy on Palm Island compared to Townsville and state-wide. Furthermore, a lower number of these women quit smoking after 20 weeks gestation (2.9 per cent on Palm Island and 4.0 per cent in Townsville compared with 5.7 per cent state-wide–although none of these differences are statistically significant). In addition, the 2006 burden of disease data estimates the number of incident (new) cases for specific conditions amongst Palm Island children aged 0-14 years of age as follows:

• otitis media (middle ear infection)—870 incident cases

• lower respiratory tract infections—480 incident cases

• upper respiratory tract infections—4500 incident cases

• diarrhoeal infections—3300 incident cases

• dental caries—340 incident cases.

Risk factorsThe leading risk factors for development of chronic disease are smoking, obesity, alcohol and drug misuse. Nationally, 11 risk factors together explain 37.4 per cent of total health loss in Aboriginal and Torres Strait Islander people which, if addressed, would significantly contribute to closing the health gap. These are:

• consumption of tobacco, alcohol and other drugs

• obesity, low rates of physical activity and nutrition

• high blood pressure and high cholesterol

• unsafe sex

• child sexual abuse and intimate partner violence.

Figure 9 — risk factors contribution to the burden of disease, Aboriginal and Torres Strait Islander people, Australia, 2003

Per c

ent

18

16

14

12

10

8

6

4

2

0

Low

frui

t and

ve

geta

ble

inta

ke

High

blo

od

pres

sure

Alco

hol

High

blo

od

chol

este

rol

Phys

ical

inac

tivity

Obe

sity

Toba

cco

13Vos T, Barker B, Stanley L, Lopez AD 2007. The burden of disease and injury in Aboriginal and Torres Strait Islander peoples 2003. Brisbane: School of

Population Health, University of Queensland.

Source: Vos et al 2007. The burden of disease and injury in Aboriginal and Torres Strait Islander people, 2003

4 5 6 7 12 16 17



Diseases of the respiratory system — in particular chronic obstructive pulmonary disease (COPD) and asthma — contribute 8 per cent to the burden of disease on Palm Island. Palm Island residents are hospitalised at a rate of 188.2 per 1000 populations for these diseases, which is five times the rate for Aboriginal and Torres Strait Islander people in the Townsville Health Service District (excluding Palm Island).

Hospital episodes of care by principal diagnosisMorbidity data to quantify the health status of Palm Island residents has been presented for the following conditions:

• chronic respiratory disease (with a breakdown for asthma and chronic obstructive pulmonary disease)

• accident and injury

• cardiovascular disease (with a breakdown for ischaemic heart disease)

• diseases of the endocrine (with a breakdown for type 2 diabetes).

The following graphs14 show the 2003–2004 to 2008–2009 average annual direct standardised rate per 1000 population (episodes of care) for selected conditions for Palm Island residents, which are:

• diseases of the respiratory system (particularly chronic obstructive pulmonary disease and asthma)

• injury and poisoning

• diseases of the digestive system

• disease of the circulatory system (particularly ischemic heart disease)

• endocrine diseases (particularly diabetes).

Figure 10 (a) — diseases of the respiratory system 2003–04 to 2008–09

200

150

100

50

0

Palm

Isla

nd

Tow

nsvi

lle H

ealth

Ser

vice

Di

stric

t, In

dige

nous

(e

xclu

ding

Pal

m Is

land

)

Que

ensl

and

Indi

geno

us

Que

ensl

and

non-

Indi

geno

us

Dire

ct s

tand

isat

ion

rate

per 1

000

popu

latio

n

Tow

nsvi

lle H

ealth

Ser

vice

Di

stric

t, In

dige

nous

(in

clud

ing

Palm

Isla

nd)

Source: Queensland Hospital Admitted Patient Data Collection 2003-2004 to 2008-2009 (unpublished data)–see technical notes

Figure 10 (b) — chronic obstructive pulmonary disease100

80

60

40

20

0

Palm

Isla

nd

Tow

nsvi

lle H

ealth

Ser

vice

Di

stric

t, In

dige

nous

(e

xclu

ding

Pal

m Is

land

)

Que

ensl

and

Indi

geno

us

Dire

ct s

tand

isat

ion

rate

per 1

000

popu

latio

n

Tow

nsvi

lle H

ealth

Ser

vice

Di

stric

t, In

dige

nous

(in

clud

ing

Palm

Isla

nd)

Que

ensl

and

non-

Indi

geno

usFigure 10 (c) — asthma

20

15

10

5

0

Palm

Isla

nd

Tow

nsvi

lle H

ealth

Ser

vice

Di

stric

t, In

dige

nous

(e

xclu

ding

Pal

m Is

land

)

Que

ensl

and

Indi

geno

us

Dire

ct s

tand

isat

ion

rate

per 1

000

popu

latio

n

Tow

nsvi

lle H

ealth

Ser

vice

Di

stric

t, In

dige

nous

(in

clud

ing

Palm

Isla

nd)

Que

ensl

and

non-

Indi

geno

us

14Queensland Hospital Admitted Patient Data Collection 2003–2004 to 2008–2009 (unpublished)

188.2 36.1 56.7 38.1 14.4

81.9 11.8 20.6 11.2 2.4

16.5 3.9 5.8 3.4 1.3


20

of care for accident injury and poisoning for the period 2003–2004 to 2008–2009 occurred in Palm Island people aged 20-59 years. In the Queensland non-Indigenous population 47 per cent of episodes of care were in the 20-59 year age group with a further 29 per cent of injury and poisoning occurring in people 60 years and older.

Cardiovascular disease (diseases of the circulatory system) contributes 16 per cent to the burden of disease on Palm Island. Of these, the most prevalent is ischaemic heart disease, which is also the leading cause of mortality for Aboriginal and Torres Strait Islander people and is linked to lifestyle factors such as smoking and obesity. Palm Island residents are hospitalised at a rate of 80.5 per 1000 population — approximately twice the rate of the Aboriginal and Torres Strait Islander population of Townsville Health Service District (excluding Palm Island). Approximately 70 per cent of episodes of care for cardiovascular disease occurred in people aged 20-59 years for Palm Island residents in the period 2003–2004 to 2008–2009. This is different to the age structure for the non-Indigenous population of Queensland where only 30 per cent of hospital episodes of care occurred in people aged 20-59 years and 70 per cent of episodes of care were for people aged 60 years and over. Similarly, where approximately 80 per cent of episodes of care for ischaemic heart disease occurred in the 20-59 year age group, just fewer than 28 per cent of episodes of care for ischaemic heart disease for the non-Indigenous population occurred in this age group. These figures are similar for the Aboriginal and Torres Strait Islander population across Queensland and show that Aboriginal and Torres Strait Islander people are being hospitalised for cardiovascular diseases at much younger ages than the rest of the population.

For the period 2003–2004 to 2008–2009 for Palm Island residents, approximately 30 per cent of hospital episodes of care for respiratory disease occurred in children aged 0-4 years. In the Queensland non-Indigenous population, only 19 per cent of hospital episodes of care occurred in children aged 0-4 years for the same period, with a greater number of cases occurring in people aged 60 years and over (41 per cent, compared with 19 per cent on Palm Island). Approximately 31 per cent of episodes of care for COPD occurred at ages 20-59 years in Palm Island residents for the same period, which is significantly different to the Queensland non-Indigenous population where only 13 per cent of episodes of care occurred in this age group. Similarly for asthma, 57 per cent of episodes of care occurred in people aged 20-59 years for Palm Island residents and 28 per cent of episodes are recorded for non-Indigenous people for the same period.

Injury and poisoning contributes 11 per cent to the burden of illness and disability on Palm Island. Of this, 47 per cent related to road traffic accidents. Palm Island residents are hospitalised at a rate of 103.3 per 1000 population which is three times the rate of the Aboriginal and Torres Strait Islander population of Townsville Health Service District (excluding Palm Island). Approximately 66 per cent of hospital episodes

Figure 11 — injury and poisoning, 2003–04 to 2008–09

Palm

Isla

nd

Tow

nsvi

lle H

ealth

Ser

vice

Di

stric

t, In

dige

nous

(e

xclu

ding

Pal

m Is

land

)

Que

ensl

and

Indi

geno

us

Que

ensl

and

non-

Indi

geno

us

Dire

ct s

tand

isat

ion

rate

per 1

000

popu

latio

n

Tow

nsvi

lle H

ealth

Ser

vice

Di

stric

t, In

dige

nous

(in

clud

ing

Palm

Isla

nd)

Source: Queensland hospital admitted patient data collection 2003-2004 to 2008-2009 (unpublished)—see technical notes

103.3 35.4 45.5 39.2 22.9

120

100

80

60

40

20

0



for residents of Palm Island which is significantly higher than that of the non-Indigenous population of Queensland where 37 per cent of episodes of care occurred in people aged 20-59 years. In the same period, approximately 76 per cent of episodes of care for Type 2 diabetes occurred in people aged 20-59 years for Palm Island which shows a very different pattern to that for non-Indigenous Queenslanders where only 18 per cent of episodes of care for Type 2 diabetes occurred in people aged 20-59 years.

Figure 12 (a) — diseases of the circulatory system, 2003–04 to 2008–09

Palm

Isla

nd

Tow

nsvi

lle H

ealth

Ser

vice

Di

stric

t, In

dige

nous

(e

xclu

ding

Pal

m Is

land

)

Que

ensl

and

Indi

geno

us

Que

ensl

and

non-

Indi

geno

us

Dire

ct s

tand

isat

ion

rate

per 1

000

popu

latio

n

Tow

nsvi

lle H

ealth

Ser

vice

Di

stric

t, In

dige

nous

(in

clud

ing

Palm

Isla

nd)

Figure 12 (b) — ischaemic heart disease

Palm

Isla

nd

Tow

nsvi

lle H

ealth

Ser

vice

Di

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Figure 13 (a) — diseases of the endocrine system, 2003–04 to 2008–09

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Figure 13 (b) — type 2 diabetes

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Type 2 diabetes is the most significant of the endocrine diseases for Aboriginal and Torres Strait Islander people. Type 2 diabetes is directly related to lifestyle factors such as smoking, poor nutrition and low levels of physical activity. Palm Island residents are hospitalised at a rate of 35.3 per 1000 populations for Type 2 diabetes. Approximately 73 per cent of episodes of care for endocrine diseases occurred in people aged 20-59 years for the period 2003–2004 to 2008–2009

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• Regional and local nutrition and physical activity workforce supports health promotion activities on Palm Island including the Living Strong Healthy Lifestyle Program and the Aboriginal and Torres Strait Islander Go for 2&5 social marketing campaign.

Maternal and child health• Midwifery Nurse Practitioner for antenatal and

post-natal services and visiting maternity services from The Townsville Hospital.

• Child Health Nurse.

• Indigenous Child Health Worker.

• Indigenous Women’s Health Worker.

• Young Parents Support Worker based in Townsville.

Dental health• Visiting dental service one day per week (dentist,

dental hygienist).

• Oral Health Therapist visits one day per week from Term 2 to provide services to school students and support oral health promotion in school curriculum.

• Resident full-time Indigenous Community Health Worker (currently dedicated to oral health) to support the visiting oral health team as a dental assistant and with oral health promotion activities.

Mental health and emotional and social wellbeing programs• Inpatient and outpatient mental health services

provided by the Palm Island Community Mental Health Team located on Palm Island five days per week (five full-time staff).

• Psychiatric clinics once a month.

• Child and Youth mental health clinic three days per week.

Alcohol, tobacco and other drugs• Drug and alcohol medical withdrawal through Joyce

Palmer Hospital.

• Outpatient (non-medical) withdrawal and pharmacy support through Palm Island ATODS Service (four full-time staff) including home visits, counselling and referrals to detoxification.

• Ferdy’s Haven Drug and Alcohol Rehabilitation Service.

Existing Palm Island health services and programsA stock take of existing resident and visiting health services delivered on Palm Island was undertaken in September 2010. It is clear that there is a discrepancy between community perception of services available and those reported by service providers as being available. There are several factors that may account for this disconnect. Funding might be available for health programs and health staff but services may be interrupted due to an inability to fill vacancies. The appointments system for visiting services may not be effective. One example of this is dental health where community members have called for the dentist to be available for an additional day as the appointment schedule for current visits is often fully booked, and the dental health team reports that whilst appointments are made there is a high rate of non-attendance and consequently the existing service is under-utilised. A review of existing health service availability and utilisation is recommended. A summary of health services and programs available to Palm Island people as at December 2010 is listed below.

Chronic disease• Two Cardiac Outreach positions and a Pulmonary

Rehabilitation position based in Townsville.

• Two Chronic Disease Care Coordinator positions based in Townsville.

• Visiting Diabetes Services, Diabetes Educator and an Advanced Health Worker based in Townsville.

• Satellite haemodialysis service and Chronic Kidney Disease outreach.

• Visiting Chronic Kidney Disease Team.

• Visiting Cardiac Services.

• Visiting Eye Health Clinic.

Nutrition and physical activity• Visiting nutritionist advises the Palm Island store

on ways to improve the supply, placement and promotion of healthy foods.

• Red Cross breakfast program.

• Visiting Physical Activity Project Officer based in Townsville.



Environmental health• The Palm Island Vet Program entitles dog owners to

unpaid veterinary services (PIASC).

• The Palm Island Horse Program includes the installation of fencing and a vet to treat horses (PIASC).

• A weekly visiting vet service for treatment of small animals (PIASC).

• Training of local people in Rural Operations and Animal Control and Regulation (PIASC).

• Medically supervised withdrawal — including counselling and rehabilitation programs through an intensive day-patient withdrawal service located in Townsville.

• Assertive outreach, assessment, counselling and referral.

• Health promotion and diversionary activities through women’s groups and men’s groups.

• Queensland Indigenous Alcohol Diversion Program provided in Townsville to support Palm Island residents appearing in the Magistrates Court for alcohol related offences and links with probation and parole twice a week.

Sexual health• Indigenous sexual and reproductive health workers

(two positions, male and female — vacant).

• Sexual health nurse.

• Needle and syringe program (provided by ATODS Team).

• Visiting mobile women’s health service.

Program Professional services Frequency

Joyce Palmer Hospital services

Emergency and acute care 15 bed inpatient facility, Emergency Department, Queensland Ambulance Service

24 hours, 7 days a week

Joyce Palmer health service outpatient clinics

Chronic Disease

Chronic wound care Nurse led clinic Monday – Friday

Cardiac services Cardiologist, cardiac registrar, cardiac scientist 6 times a year

Rheumatic Heart Disease Nurse led clinic Weekly

Diabetes services Nurse educator, dietician, endocrinologist Monthly

Chronic Kidney Disease team Dietician, social worker, nurse practitioner, nephrologist Monthly

Gastroenterology Gastroenterologist Every 2 months

Rheumatology Rheumatologist Every 2 months

Allied Health

Physiotherapist Physiotherapist Weekly

Ophthalmology and optometry Ophthalmologist, registrar, optometrist, clinical nurse × 2, administration staff × 2 Twice yearly

Ultrasound clinic Sonographer Monthly

Podiatrist Podiatrist Monthly

Australian Hearing Audiologist × 2 Every 2 months

Older person allied health Occupational therapist, speech pathologist Monthly


24

Child and Maternal Health

Antenatal Nurse practitioner Monday – Friday

Child Health Clinical nurse Monday – Friday

Child Development team Dietician, Aboriginal liaison officer, speech therapist, physiotherapist, occupational therapist Every 3 months

Paediatric Paediatrician and paediatric registrar Monthly

Paediatric Cardiologist Cardiologist, cardiac scientist Annually

Australian Hearing Audiologist × 2 Every 3 months

Community Health Services

Community Health Clinical nurse consultant, health workers × 5 (3.4 FTE) Monday – Friday

Mobile Women’s Health Service Nurse practitioner Monthly

HACC Services Coordinator, home care workers x2 (1.6 FTE) Monday – Friday

Dental

Oral Health Dentist (0.2 FTE), 1FTE Indigenous community health worker dedicated to oral health Tuesdays

Sexual Health

Sexual Health Clinical nurse Monday – Friday

Sexual Health Sexual health medical consultant Monthly

Alcohol, Tobacco and Other Drugs (ATODS)

ATODS Social worker, clinical nurse, health worker and support worker Monday – Friday

Mental Health

Mental Health team Clinical nurse consultant, clinical nurse, Indigenous mental health workers × 3 Monday – Friday

PsychiatricPsychiatrist Monthly + fortnightly video link

Psychiatric registrar Fortnightly clinic + fortnightly link

Child Youth Mental Health

Indigenous child and youth mental health worker (0.6 FTE) 3 days per week

Child and adolescent psychiatrist (0.1 FTE) 1 day per fortnight

Child youth clinician (0.2 FTE) 1 day per week

School based services

Youth Health School based youth health nurse Monday – Friday

Hearing Health Screening School based nurse and health worker To meet school requirements

Dental Dental hygienist (health promotion/education) Wednesdays in term 2

Other services external to Joyce Palmer Hospital

Queensland Ambulance Service Ambulance and first aid response 7 days per week

Sandy Boyd Hostel — aged care and disability — PIASC Registered nurse/manager, enrolled nurses, carers 7 days per week

Ferdy’s Haven — Drug and Alcohol Rehabilitation

Chief executive officer, finance services manager, social worker, male caseworker, female caseworker, weekend caseworker, casual caseworker.

7 days per week

Palm Island Aboriginal Shire Council

Health liaison worker, environmental health worker, animal management worker 5 days per week

Link-up Case worker 1 day per week



activities are planned including:

• diabetes awareness

• young person’s screening

— health education relating to sexual health, skin cancer, marine stingers and women’s health.

The uptake of health checks, particularly adult health checks, is relatively low. The maternal and child health services currently provided on Palm Island are predominantly hospital based specialist services. Monthly obstetric and gynaecology clinics are held and a midwife visits from Townsville from Monday to Thursday weekly. A number of services, including birthing, are provided in Townsville, meaning babies are delivered on Palm Island only in emergency situations. A birth suite with ultrasound machine and resuscitation cot is available for emergency births.

Feedback from community consultationsPreventing chronic disease — health promotion and health education

Comments• Heart and kidney disease is a concern.

• People only go to the health service when very sick.

• There are a lot of people with diabetes, high blood pressure, high cholesterol, skin problems.

• There are a lot of young people with diabetes (32 years old and younger).

• Palm Island Community Company (PICC) and Red Cross intend to work together to establish a committee to talk about (separately) men’s business and women’s business.

Closing the gap in health outcomes between Aboriginal and Torres Strait Islander people and the rest of the Queensland population requires a major effort in addressing the risk factors for chronic disease across all age categories. In order to prevent illness, effective screening, early diagnosis and timely intervention in disease management and treatment is required. Important strategies to prevent illness and to allow for early diagnosis and treatment include:

• raising awareness about healthy lifestyles and the impact of risk factors on health outcomes through health promotion and education initiatives

• participating in adult and child health checks to identify early any health problems that will require treatment and follow-up

• supporting the provision of healthy foods through school and community shops and at sporting and cultural events

• supporting smoke-free environments and quit smoking efforts through community based initiatives

• establishing physical activity initiatives, catering for all fitness levels and for all age groups

• promoting the availability of health clinics across the community and the importance of regular contact with health services

• effective maternal and child health services for a healthy and strong start to life for Palm Island babies.

A comprehensive primary health care and preventative approach on Palm Island would be in line with what is occurring state-wide, nationally and internationally. Research indicates that health systems with a strong primary health care focus are more efficient and achieve lower rates of hospitalisation, fewer inequalities, better health outcomes and lower mortality15.

There is currently limited health promotion and health education occurring on Palm Island although this has been recognised and a number of health promotion

6. Action area one — illness prevention and early intervention

15 World Health Organization (WHO) Report, Primary Health Care: now more than ever, calls for a return to primary health care to help align health systems to deliver

better performance and equity, Geneva 2008.

26


• Young mothers having babies — some not going to hospital to have checks.

• The Women’s Day on Palm Island was a great success — Red Cross is looking at establishing a women’s group/committee/board.

Identified needs and suggested actions• Women’s health programs and services to enhance

antenatal and postnatal care.

• A community based mother and baby program and/or service to be established to conduct cooking classes and parenting programs and services. This would be separate from the hospital acute care program and would focus on health promotion and illness prevention.

• Access to contraception.

• A women’s group to be established to address women’s health concerns relating to contraception, parenting, sexual health and social welfare.

Domestic violenceComments• The Townsville domestic violence service for women

does a good job; a lot of home visits are done.

• The hospital is a good support for people suffering domestic violence.

• The Kootana Women’s Shelter is closed. It needs a new name due to de-registration.

• Financial debt and abuse due to financial tensions and credit card loans are high.

• The women’s shelter in Townsville is full. These services are now used for medium and long term accommodation rather than crisis management accommodation which increases the problem on Palm Island.

Identified needs and suggested actions• A women’s shelter on Palm Island to replace the

Kootana (women’s shelter on Palm Island).

• Crisis counselling and relationship counselling.

Youth health and safetyComments• Homeless children 10-17 years (numbers about 60)

are roaming the streets, breaking in for food during the night; sleeping at the jetty or other places in the community; not going to school.

Identified needs and suggested actions• More health awareness programs about alcohol,

smoking, nutrition, and diet/food, especially for people over the age of 30.

• Dental health promotion and prevention.

• More community events around healthy food — e.g. in Sweden the government pay ‘social enablers’ to help the community to improve diet.

• A position in the community to provide information to people who would like help — e.g. dietician.

• Parenting education and information on reproductive and sexual health for the carers (aunties or grandmothers are carers) as well as the parents.

Food/nutritionComments• Food is expensive – the food in the government

owned store is not subsidised.

• There is no markdown on healthier foods — e.g. bananas and avocados.

• There are no specials at the shop.

• Store prices too high for large families.

• Food vouchers could be introduced by the store

• The Coolgaree Farm could sell direct to the public or supply to the shop — all workers studying Cert II in horticulture.

• In the mission days Palm had a market garden that supplied fruit and vegies to Townsville Hospital and other mainland agencies. Queensland Health should consider Coolgaree again as a supplier of fresh fruit and vegies to the store.

Identified needs and suggested actions• Longer store hours.

• A restaurant, a butcher shop and bread shop.

• Access to healthy alternative foods.

Maternal and child healthComments• Current antenatal care good and there is a

nice midwife.

• 1990 plan for the new hospital included two full-time midwives so birthing could happen on the Island, however this did not happen. Birthing now happens at Townsville although some mothers have their babies on the Island.



employed 24/7. The concept is to keep the children out of Child Safety. PICC will be managing the service. Children who are under a child safety order will be housed at this service.

• PICC have a program to pick up children after hours and drop them off at home.

Identified needs and suggested actions• Need night security patrol .

• More activities are needed for kids.

• There is a lack of funds to support homeless children. Red Cross runs a breakfast program.

• Kids practise holding their throats like they have seen in the video ‘Flatline’ (self-asphyxiation).

• A Youth Diversionary Centre was originally coordinated by Kootana Women’s Shelter but it is closed now.

• The Department of Communities has established a ‘safe house’ on Palm Island. House parents will be

16Subject to availability of resources.

17Blue text denotes initiatives that are already being actioned.

* With a focus on smoking, drug and alcohol misuse, sexual and reproductive health, dental health, nutrition and physical activity, and the importance of health checks, screening and immunisation.

Required health action Lead agency

In partnership with... Timeframe

1.1 Increase promotion and provision of adult and child health checks and other health screening (including follow-up). QH PIASC July 2011

1.2 Invite the Deadly Ears Program to provide ear health services to Palm Island children.17 PIASC QH

February 2011 — Funding available through Deadly Ears Program

1.3 Develop and implement social marketing campaigns and health information in multiple community settings to target the risk factors for chronic disease.* QH PIASC December 2011

1.4Establish a multi-disciplinary outreach mobile primary health care service to focus on home visits, health promotion and preventative health care targeting the major disease groups and the risk factors for chronic disease.*

QH PIASCTo be funded from February 2011 IHONPA

1.5 Prioritise training for all health staff in preventative health approaches. QH December 2011

1.6 Hold smoke-free community events that focus on healthy food and exercise. PIASC QH December 2011

1.7 Advocate for subsidised fresh food at the local store. PIASC December 2011

1.8

Fund a young parent support worker to establish a women’s group as a mechanism for maternal and reproductive health promotion, parenting support, infant care and nutrition classes for ante and post natal mothers on healthy food and non-smoking choices for mother and baby.

QH PIASC

Young Parent Support Worker to be funded from April 2011 to July 2014 — IECDNPA

1.9 Strengthen maternity services on Palm Island and consider establishment of a primary maternity service. QH PIASC July 2012

1.10 Develop a bush medicine garden for the treatment of skin infections. PIASC December 2011

1.11 Establish a youth drop in centre and increase the number of sports and recreational activities available to youth and adults of all ages. PIASC DoC July 2012

1.12Increase the number of youth camps, implement a volunteer program to support gender and age based youth programs and activities, including homeless youth.

PIASC DoC July 2012

Agreed actions16


28

particularly to introduce dental health promotion and prevention, and preferably with enhanced training opportunities for local community members.

Feedback from community consultationsTreatment services for chronic disease

Comments

See previous section.

Identified needs and suggested actions• More visits by allied health teams — e.g. Podiatrist.

Treatment services for emotional and social wellbeing and mental healthComments• There are too many suicides in the community.

• The crisis and relationship counselling program that used to be on the island was stopped.

• There is lots of stress/trauma/domestic violence.

• The Mental Health Service is undergoing a restructure, is well supported from Townsville and operates on a walk-in basis.

Identified needs and suggested actions• Crisis and relationship counselling program and

conflict resolution.

• Psychologist.

Treatment services for alcohol, tobacco and other drugsComments• The ATODS Service is working well but needs both a

clinical and health promotion focus.

• Since the pub closed binge drinking has increased

Health promotion and illness prevention must be complemented by effective diagnosis and treatment to support people who are already ill. It is well documented that Aboriginal and Torres Strait Islander people have poorer outcomes of care than non-Indigenous people18. For example, the survival rates for non-Indigenous cancer patients are higher than for Aboriginal and Torres Strait Islander people. There are many reasons for this, including lack of access to services, tests and procedures. Aboriginal and Torres Strait Islander people are likely to attend health services much later and often with multiple or complex conditions, when earlier diagnosis and treatment would have provided a better chance of recovery. Health service providers must ensure that there is:

• appropriate treatment to follow screening checks, access to appropriate tests, procedures and medication

• appropriate recall systems in place to support people’s access to health programs.

Community members must take responsibility for:

• making and attending health appointments when they are unwell

• ensuring they make and attend regular health checks when they are well

• complying with medication and other treatment

• taking preventative measures — such as immunisation and regular exercise.

The Palm Island community have identified several areas for treatment service enhancement including:

• more frequent allied health services

• a visiting psychologist to support grief and loss counselling, crisis and relationship counselling

• opal fuel and comprehensive drug and alcohol diversionary activities and rehabilitation

• expansion of the dental service for Palm Island —

7. Action area two — treating existing illness

18Queensland Health 2010. Making Tracks toward closing the gap in health outcomes for Indigenous Queenslanders by 2033 – policy and accountability

framework, Brisbane 2010.



Identified needs and suggested actions• A sexual health clinic located away from or with a

separate entrance to the health service.

Treatment services for dental healthComments• There are not enough dental health services.

• There used to be a dentist that lived on the Island but not anymore.

Identified needs and suggested actions• A permanent dental service.

• Increased visits for dental health team.

and alcohol induced seizures are common.

• The grog of choice is wine and rum over beer (easier for smuggling).

• Since the Alcohol Management Plan (AMP) marijuana use and injecting has increased.

• Nine and ten year olds are smoking cigarettes and marijuana. Four out of ten people smoke marijuana.

• Police search bags off the Townsville ferry but marijuana coming in by boat and the plane is not checked.

• Sniffing on Palm Island goes back to the 1960s and was a big thing in the 1980s. Then it stopped and started again recently maybe since the AMP was introduced. In Townsville, sniffers are males and females 30+ years. On Palm it is the young ones. Some kids have been sent to Alice Springs for rehabilitation.

• Introduction of speed — taken by a select group.

• A high percentage of people are spending a lot of money on cigarettes.

• The Red Cross is looking at gambling problems; kids are also gambling.

• Diversionary Centre cannot take children under 18 years.

Identified needs and suggested actions• Opal fuel to help address sniffing*.

• A comprehensive drug and alcohol rehabilitation service similar to Stagpole Street in Townsville.

• Diversionary programs especially for young people and others who need support.

Treatment services for sexual healthComments• There is a high impact of sexual transmitted

diseases.

• Death threats have been given to the RN and AHW due to contact tracing.

• Improved systems and delivery model on sexual health are also required.

* This issue will be considered in the forthcoming regional plan for health services.

30


Agreed actions19



2.1 Review weekend access to the Chronic Wound Clinic established in 2010. QH PIASC July 2011

2.2 Strengthen discharge follow-up for post-operative patients on return to Palm Island. QH PIASC July 2011

2.3 Enhance crisis and relationship counselling, conflict resolution and establish grief and loss support groups. QH PIASC July 2011

2.4

Enhance existing dental health services by increasing community engagement and promoting the availability of services, maintaining the current oral health workforce effort and enhancing the skills set of all health workers in oral health clinical care and health promotion.

QH PIASC December 2011

2.5 Establish a multi-disciplinary allied health model of care and service delivery system for the Palm Island community. QH PIASC

Funded from February 2011– IHONPA

2.6 Strengthen Indigenous drug and alcohol treatment programs for young people and their families. QH PIASC, DoC

Funded from February 2011– IHONPA

2.7

Enhance the professional development and training for the sexual health workforce—e.g. Deadly Sex Congress. Prioritise training for the sexual health nurse through the Townsville Sexual Health Service to support safe contact tracing.

QH Funded from April 2011–QH

2.8 Prioritise filling sexual health worker vacancies. QH PIASC Funded from July 2010–QH





Island. However, a consistent and stable approach to leadership within the Palm Island Health Service has achieved a 50 per cent reduction in agency nursing. Further strategies to address health worker vacancies and provide training and development opportunities for local people need to be addressed at state and local levels.

Enhancing and empowering the Aboriginal and Torres Strait Islander workforce to play an active leadership role in advancing health locally is a high priority for both the community and the Aboriginal and Torres Strait Islander health workforce. Health workers will require regular ongoing knowledge and skill development. Having a highly skilled Aboriginal and Torres Strait Islander health workforce will reinforce and support local leadership in health planning and community involvement. Meaningful community participation in health service planning, design and delivery can be enhanced through capacity building in health governance.

Closing the gap in Aboriginal and Torres Strait Islander health on Palm Island will be assisted by local ownership, leadership and trust in culturally appropriate programs and services. Changing the relationship between the community and health providers, and changing the way the health service offers health programs and activities will increase access to, and confidence in, the health care system. Building trust in the health service requires staff to establish an understanding of the cultural context and cultural makeup of the community. Improving the cultural capability of health centre staff and the cultural sensitivity of health programs will assist community members to overcome their reluctance to utilise the current services. The Queensland Health Aboriginal and Torres Strait Islander Cultural Capability Framework 2010–203321 provides the tools for enhancing the cultural effectiveness of the Queensland Health workforce on Palm Island.

Rates of access to health services for Aboriginal and Torres Strait Islander people in Queensland are low and people tend to present late and in poor health. Improving access to culturally appropriate and equitable health services is essential and can be improved through better planning, integration and coordination. Involving community members in the planning, design and delivery of health care programs is an important way to improve access to, and the effectiveness of, health services.

The current service model of health care is a combination of community health, general practice, allied health and specialist health services, including limited health promotion through the Joyce Palmer (Palm Island) Hospital (JPH). At the time of writing this document, there were four doctors (3.8 full time equivalents) at Joyce Palmer Hospital, one of whom was Aboriginal with family connections on Palm Island. There is a high rate of Aboriginal health worker vacancies (six vacancies, 13 employed), 12 nurses employed by Queensland Health and a high number (eight) of agency nurses.

It is evident from consultations that acute hospital activities are perceived by the Palm Island community to take precedence over primary health care and preventative work and that the role of the community health staff (Aboriginal Health Workers and Registered Nurses) is dominated by hospital based care. This level of focus on acute and emergency care has the potential to limit the time community health staff can devote to health promotion, prevention and early intervention programs. It can also limit the community’s involvement with the health system to only seeking treatment when very ill. Palm Island residents have stated that they would like to access services that are located in non-hospital settings including home visits.

Attracting and retaining a suitably trained and culturally capable health workforce continues to pose significant challenges for the provision of health services on Palm

8. Action area three — better health services

21Queensland Health 2010. Aboriginal and Torres Strait Islander Cultural Capability Framework 2010–2033.


32

Identified needs and suggested actions• The hospital could put up notices about the different

programs run by the hospital/community health near the store or announced on community radio.

• Upgrade the waiting room to remove the hard, cold metal seating, magazines and flowers should be in the waiting room.

• A pharmacy is needed.

• Risk management triage is needed. Health workers should do client checks prior to seeing the doctor.

• Intercom system required so people don’t have to yell out people’s names.

• Need a dressing clinic or maybe there could be home visits for things like dressing changes.

• Acute and community/primary health needs to be separated.

• Home visits and outreach programs.

• Doctors could be located as a General Practice service at the right side of the building (or elsewhere).

Access to culturally appropriate primary health careComments• Would like the mix of the team to be locals and

non-locals.

• Want to see Aboriginal local people in the RN and Doctor positions.

• I like the doctors but would like to see an increase in the number of Aboriginal doctors.

• Enroled nurses, registered nurses and medicine training for health workers needed.

• People decide who they want to engage with.

• There is a high turnover of staff — people are sick of new staff and re-visiting their health profiles with new staff.

Feedback from community consultations

Preferred service modelComments• Have seen it all before—in 1990 there was a Health

Action Plan—intention was for Health Workers to move from the clinic to the schools, do home visits, community campaigns and community health awareness. The Health team started doing plays in the community courtyard, visited old people at home. The new hospital was built to house primary health care health workers at the front and hospital behind, but the whole space has been taken by acute and allied health.

• Do not want any more fly in fly out health professionals like dentists.

• People with sexual or mental health problems will not visit the health staff due to open area consultation.

• During the day the hospital service is fine, but weekend is emergency only. After hours people do not feel comfortable attending. If a dressing needs to be done everyday on weekends staff tell people to come back on Monday.

• After hours the nurses talk down to people.

• There are long waiting times (two to three hours).

• Most people only use the hospital for flu needle, children’s immunisation and women’s check up.

• At the hospital they just ask for the client’s Medicare card then straight to the Doctor and panadol is always given.

• Some people do not accept the Western medicine model, some clients get sick from the medication.

• Clients are not completing appointments on the mainland which could be helped if TAIHS could support clients who are attending hospital specialist appointments in Townsville.

• Lack of confidentiality (privacy) when attending clinics—staff should not be reading client files.

• Support a community control health service for Palm Island which would include Coolgaree Advisory Groups in its organisational structure and have a men’s group on health and women’s group on health.

• Would like to see home visits like Blue Care.



Identified needs and suggested actions• Culturally appropriate service delivery needed.

• Cultural Awareness Program for new staff specific to Palm Island.

• Customer service training for the hospital administrative staff, greeting people with a smile is important.

• Support with accommodation and appointment attendance for Palm Island dialysis patients attending The Townsville Hospital.

Aged care and disability servicesComments• There is a lot of injury and disability.

• People should be provided with medical aid equipment because it is not possible to rent them.

• Health workers should get out of the clinic and do home visits, blood sugars, blood pressure checks because some people do not have transport or are too old or disabled to go to the clinic.

• Need to take the old people out.

• The old people get bored with the same food every day.

Identified needs and suggested actions*• Disability services are needed because there is a lot

of injury and disability on the Island.

• Activities and programs are needed for Sandy Boyd (aged care) residents; take the clients fishing or make a vegie patch.

• Vary the food for Sandy Boyd residents–they need a variety of food, meat plus fish and rice.

*These issues will be considered in the forthcoming regional plan for health services.

34


Agreed actions22



Engagement and collaboration

3.1

Identify and implement a package of strategies to enhance community engagement and participation in the planning, design and delivery of health services and programs for Palm Island including (but not limited to):• consistent representation from PIASC and the Palm Island community on

the management committee of the Palm Island health service• provision of regular reports to the management committee on the provision

and utilisation of available resident and visiting health services• the establishment of a Palm Island Health Services Coordination Group

that is representative of all health provider organisations. The group will meet quarterly to strengthen:– collaboration, health service planning and coordination– intersectoral initiatives targeting the determinants of health.

PIASC and QH

Other health providers and relevant government agencies

June 2011

3.2Develop a Memorandum of Understanding between Joyce Palmer Health Service and TAIHS to support people being referred to Townsville Hospital and specialist appointments.1

QH TAIHS July 2011 (in progress)

Health service review and reform

3.3

Cultural Capability training for all health service staff to promote cultural awareness, culturally capable clinical practice, orientation to the Palm Island community for new and/or visiting staff, and training for all staff in client confidentiality.

QH and PIASC

Funded from February 2011 – QH CCF

3.4

Conduct an organisational review of the current Palm Island Health Service including opening hours, provision of pharmacy services and frequency of visiting services to inform future health service and workforce planning and structural reform.

QH PIASC Funded from February 2011 — IHONPA

3.5 Implement an effective patient recall system, computerise patient records and data collection and support their use as a care planning tool. QH July 2012

3.6 Establish a separate location or separate entrance for sexual health clinics. QH December 2011

3.7 Upgrade the Palm Island Health Service waiting room. QH Upgraded in July 2010

3.8 Implement the Audit and Best Practice In Chronic Disease (ABCD) tool in Palm Island Health Service. QH July 2011 — funded

under IHONPA

Increasing access

3.9Identify and implement mechanisms for promoting the availability of clinics and programs through message boards in locations frequented by community.

PIASC QH Underway (from Sept 2009)

3.10Continue to reinvest all monies generated from Section 19(2) Medicare arrangements to support primary health care refinement and expansion for the Palm Island community.

QH PIASC Already occurring





PIHAP concentrates on the determinants of health which can be influenced by the health system and on supporting better links across agencies at a local level to improve health outcomes. Issues that are outside the scope of the health system but which are important in influencing health outcomes, such as improving school retention rates and reducing overcrowding, are not addressed in this plan. These issues can be addressed through existing multi-agency structures and through the Palm Island Government Champion, or by direct liaison with the relevant agency.

Feedback from community consultations

HousingComments• Housing/overcrowding—child safety issues exist.

• 17 people per household raised as a priority with the previous Council.

• Department of Housing had relocation program for Palm Island people to move/relocate to Townsville.

Identified needs and suggested actions• New homes are required in the community; need

fences on houses.

EducationComments• Poor numeracy and literacy.

To close the gap in health outcomes complementary effort is required in other social policy areas, including transport, housing and education. It is well documented that there are multiple and inter-linked causes of health disadvantage which need to be addressed simultaneously.24

Health status is affected by:

• the impact of risk factors (e.g. — smoking, nutrition and physical activity and drug and alcohol misuse)

• health system performance (e.g. — culturally inappropriate services)

• socio economic factors (e.g. — poverty, unemployment and education)

• environmental factors (e.g. housing, sewerage and water quality, and adequate food storage)

• socio political factors (e.g.— removal from land and/or family)25.

For the community, the interaction of these factors in contributing to health status is very real, yet they are not considered often enough in the planning and delivery of health services. Poverty and the associated issues of low education levels, substandard housing and lack of employment opportunities are recognised in PIHAP as key social determinants of health. Low education levels and lack of employment and business opportunities contribute to low incomes, overcrowded living conditions and stress, which impact on the health and wellbeing of individuals and families. Children living in overcrowded conditions exacerbated by low nutrition levels and not enough sleep are less likely to have good education outcomes. Transport has been identified by the community as a priority issue, which impacts on access to health services and programs and detracts from continuity of health care. Palm Island is a large, geographically dispersed community, yet there are no public transport services.

9. Action area four — social determinants of health

24Steering Committee for the Review of Government Service Provision 2009, Overcoming Indigenous Disadvantage: Key Indicators 2009, Productivity

Commission, Canberra. 25

Queensland Health 2010, Making Tracks toward closing the gap in health outcomes for Indigenous Queenslanders by 2033 – policy and accountability framework, Brisbane


36

Identified needs and suggested actions• A dedicated bus service is required to pick up

patients for appointments, improve access to health services, and possibly provide outreach services.

Environmental healthComments• There are too many dogs, horses and pigs on

the Island.

• There are animals roaming the streets, no-one looks after them but they are all owned.

• Yabulu mining company (nickel mine) mangroves are being affected. CSRIO to test the mangroves.

Identified needs and suggested actions• Need parenting skills training.

• Need local training for book keeping, governance and other committee and corporate support.

• Need school talks on hygiene.

Transport Comments• There is no bus (public transport) on Palm Island.

• The ambulance picks up some people for pre-booked or hospital appointments.

• The hospital bus does pick up patients but only for travel to Townsville.

Agreed actions26



4.1 Parenting skills training. QH PIASC

Young Parent Support Worker to be funded from April 2011 to July 2014—IECDNPA4.2 School talks on hygiene.

4.3 Expand the capacity of transport within Palm Island to facilitate access to health services and programs. PIASC QH Funded from February

2011 – IHONPA

4.4 Publicise the compulsory registration of dogs and cats and the free veterinary services available under the Palm Island Vet Program. PIASC April 2011

4.5 Fill the vacancy for the Animal Management Project Officer position. PIASC July 2011





The group will also oversee the review and revision of PIHAP from 2012 and will be a point of contact for solving issues across agencies relating to the broader determinants of health. It will also contribute to inter-agency discussions and raise health issues for resolution, as required, with the Palm Island Government Champion.

The Palm Island Health Consumers Working Group is one of a range of consumer and community engagement mechanisms to be established by the Local Health and Hospital Network in consultation with the Medicare Local. Other consumer and community engagement options will be developed to strengthen local community participation in health care management and planning.

Health service delivery—mutual obligation principles• Health services and programs to be provided by local

Aboriginal and Torres Strait Islander people and supplemented by non-Indigenous service providers resident on Palm Island.

• Where this is not possible, regular visiting health services should aim to utilise the same personnel so that provider-client relationships can be established and maintained.

• To encourage access, visiting health services should be provided at predictable times and special (non-regular clinics) should be widely promoted.

• Health service design and delivery should be informed by the needs and aspirations of the local community.

• Health service delivery should be conducted in a culturally sensitive way by culturally capable health practitioners and support staff.

• Clients should make every effort to attend regular appointments for checkups and treatment.

• Community members should encourage the regular staging of, and participation in, smoke-free community events promoting good health, nutrition and physical activity.

Implementation principlesImplementation of agreed actions included in the PIHAP will be underpinned by the following implementation principles:

• Closing the health gap for Aboriginal and Torres Strait Islander residents of Palm Island is a shared responsibility requiring a strong partnership between community members and representatives, service providers and governments.

• Full participation by the Palm Island community and its representatives in the planning and implementation design decisions relating to PIHAP actions and initiatives.

• Engagement with the Palm Island Health Services Coordination Group (see below) and the Palm Island Health Consumers Working Group to identify health needs and local solutions.

• Active and sustained cross agency collaboration in partnership with the Palm Island Aboriginal Shire Council to address the broader determinants that impact on achieving health equality.

Palm Island engagement and coordination strategy The primary mechanism for engaging the Palm Island community in health planning, design and delivery of health services, and in monitoring and reviewing progress against PIHAP will be the Palm Island Health Services Coordination Group — to be established by the Palm Island Aboriginal Shire Council. This group will take the place of the current Palm Island Health Partnership Group and its sub-committees.

The Palm Island Health Services Coordination Group will include representation from the Palm Island Aboriginal Shire Council, health service provider organisations and the Queensland and Australian Governments. The group will be informed by a Palm Island Health Consumers Working Group(s) of Palm Island community members who utilise health services — to be established by the Palm Island Aboriginal Shire Council.

10. Implementation, monitoring and review

38


Sources Australian Bureau of Statistics 2006. 3238.0.55.001—Experimental Estimates of Aboriginal and Torres Strait Islander Australians, June 2006.

Elston J, Stirling J and Geia, L, 2010. The Report of the Palm Island Integrated Services Modelling Project, James Cook University, June 2010.

Ife, Jim and Tesoriero, Frank, (2006). Community Development. 3rd Edition.

Palm Island Aboriginal Shire Council, Australian Government Department of Health and Ageing and Queensland Health, Close the Gap in Health Status on Palm Island, Statement of Intent, 2010.

Queensland Government, Department of Communities 2010. Quarterly report on key indicators in Queensland’s discrete Indigenous communities April–June 2010.

Queensland Health 2010. Making Tracks towards closing the gap in health outcomes for Indigenous Queenslanders by 2033—policy and accountability framework, Brisbane 2010.

Queensland Health 2010. Aboriginal and Torres Strait Islander Cultural Capability Framework 2010–2033.

Queensland Health, Perinatal Data Collection, Queensland Health, 2003-2008, (smoking mothers 2006–2008)— unpublished.

Queensland Health: S Begg. M Bright, C Harper, Burden of disease and health-adjusted life expectancy in Health Service Districts of Queensland Health, 2006. Queensland Health: Brisbane 2009 (unpublished).

Office of Economic and Statistical Research (OESR), Queensland Treasury, 2009—synthetic estimates by Indigenous status, by age and sex for Statistical Local Areas, 2000–2008.

Steering Committee for the Review of Government Service Provision 2009, Overcoming Indigenous Disadvantage: Key Indicators 2009, Productivity Commission, Canberra.

Vos T, Barker B, Stanley L, Lopez AD 2007. The burden of disease and injury in Aboriginal and Torres Strait Islander peoples 2003. Brisbane: School of Population Health, The University of Queensland.

World Health Organization (WHO) Report, Primary Health Care: now more than ever, 2008.

11. References



GlossaryBurden of disease is the total significance of disease for a population measured in years of life lost to ill health and disability.

Chronic diseases such as ischaemic heart disease, Type 2 diabetes, renal disease, hypertension, stroke and chronic respiratory disease can be grouped together as they have common underlying risk factors. These include poor nutrition, inadequate environmental health conditions, alcohol and drug misuse and tobacco smoking.

DALY (Disability Adjusted Life Year) refers to the years of life that are lost due to premature mortality or disability.

Early intervention is recognising a health problem as soon as possible and intervening to stop the harm the problem will cause.

Health gap is the difference between the Aboriginal and Torres Strait Islander burden of disease estimates and those for the general population.

Morbidity refers to ill health in an individual and to levels of ill health in a population or group.

Mortality rate refers to the number of deaths registered in a given calendar year expressed as a proportion of the estimated resident population at June 30 of that year.

Palm Island community, Palm Island people refers in this document to Aboriginal and Torres Strait Islander people resident on Palm Island.

Primary health care is the health care available to the general community in their local area. It is the first point of contact between the community and the health care system. Primary health care in Queensland is provided through general practitioners, government operated community health services and primary health care clinics, the Royal Flying Doctor Services, public and private dental health services and Aboriginal and Torres Strait Islander Community Controlled Health Services. It also includes some outpatient services provided by a general hospital.

Resident health services refers to health services provided on Palm Island by people who live on the island.

Visiting health services refers to fly-in fly-out services.


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AbbreviationsAHW – Aboriginal Health Worker

ATODS – Alcohol, tobacco and other drugs

COAG – Council of Australians Governments which includes the Prime Minister of Australia and the Premier of each state and territory government.

CDEP – Community Development and Employment Program

DALY – Disability Adjusted Life Year

DoHA – the Australian Government Department of Health and Ageing

DoC – the Queensland Government Department of Communities

FTE – Full-time equivalent (refers to staffing levels)

IECDNPA – the Council of Australian Governments’ Indigenous Early Childhood Development National Partnership Agreement signed by all Premiers and the Prime Minister in 2008 and for which funding is available for close the gap early childhood development initiatives.

IHONPA – the Council of Australian Governments’ Indigenous Health Outcomes National Partnership Agreement signed by all Premier and the Prime Minister in 2009 and for which funding is available for close the gap health initiatives.

JPH – Joyce Palmer Hospital

PIASC – Palm Island Aboriginal Shire Council

PICC – Palm Island Community Company

PIHAP – Palm Island Health Action Plan (this document)

PIHPG – Palm Island Health Partnership Group established to oversee the development of the Palm Island Health Action Plan.

QH – Queensland Health (the Queensland Government Department of Health)

QHCCF – Queensland Health Cultural Capability Framework

STI – Sexually transmissible infection

TAIHS – the Townsville Aboriginal and Islander Health Service

THSD – Townsville Health Service District



visits where gestation period was 32 weeks or greater. Pregnant women where ante-natal visits were not stated were excluded.

Numerator: Number of pregnant women who attended at least 5 antenatal visits and gave birth at 32 weeks gestation or more, resulting in at least one live or still born baby for the period 2003 to 2008.

Denominator: Total number of pregnant women who gave birth at 32 weeks or more gestation resulting in at least one live or stillborn baby for the period 2003 to 2008.

Calculation: 100 x (numerator/denominator)

Measure: Smoking during pregnancy

Includes pregnant women who reported their smoking status as yes at any stage during pregnancy. Pregnant women whose smoking status was not recorded were excluded.

Numerator: Number of pregnant women who gave birth who indicated that they smoked at any time during pregnancy for the period 2006 to 2008.

Denominator: Total number of pregnant women who gave birth for the period 2006 to 2008.


Measure: Quit smoking by 20 weeks

Includes pregnant women who reported their smoking status at 20 weeks as more than 10 cigarettes, less than 10 cigarettes, or none. The quit rate was defined as the number of women reporting not smoking of the total number of those pregnant women reporting their smoking status at 20 weeks. Pregnant women whose smoking status at 20 weeks was not recorded were excluded.

Numerator: Number of pregnant women who indicated that they smoked no cigarettes at 20 weeks gestation for the period 2006 to 2008.

Denominator: Total number of pregnant women who reported smoking ever during pregnancy who gave birth for the period 2006 to 2008.


Measure: Maternal age

Includes pregnant women aged 10-19 years. Pregnant women whose age was not stated were excluded.

Numerator: Number of pregnant women 10-19 years for the period 2003 to 2008.

Denominator: Total number of pregnant women who gave birth for the period 2003 to 2008.

Technical notesMeasure: Perinatal data

Inclusions/exclusions:

• For Palm Island, there is no breakdown for Indigenous status.

• For the Townsville Health Service District data was analysed for Aboriginal and Torres Strait Islander pregnant women and babies only and excluded Palm Island pregnant women and babies.

• For Queensland (Indigenous and non-Indigenous) data was analysed for pregnant women and babies, however Palm Island pregnant women and babies were excluded from both Queensland Indigenous and non-Indigenous analysis.

• The analysis excludes all interstate/overseas and not stated for district of usual residence, not stated for Indigenous status was excluded from the Townsville Health Service District, Queensland Indigenous and non-Indigenous analysis.

• Data was analysed for the period 2003–2008.

Measure: Low birth weight <1500gm–1500gm to 2499gm

Includes all live born singleton babies born to women where the babies birth weight was <2,500gm for the period 2003 to 2008 by pregnant women’s place of usual residence. Babies where baby weight was not stated were excluded.

Numerator: Number of low birth weight (<2,500g) live born singleton babies born to pregnant women for the period 2003 to 2008.

Denominator: Total number of live born singleton babies born to pregnant women for the period 2003 to 2008.


Measure: Pre term babies = gestation – <37 weeks

Includes all live born singleton babies born to women where gestation period was less than <37 weeks for the period 2003 to 2008 by pregnant women’s place of usual residence. Babies where gestation period was not stated were excluded.

Numerator: Number of pregnant women who gave birth to a singleton live born baby where the gestation period was less than 37 weeks for the period 2003–2008.

Denominator: Total number of pregnant women who gave birth to a singleton live born baby for the period 2003 to 2008.


Measure: Ante-natal visits

Includes pregnant women who had five or more ante-natal


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Codes: ICD 10AM – Principal diagnosis codes for conditions included in the analyses:• E00-E90 – Endocrine, nutritional and metabolic

diseases

– E11 – Type 2 diabetes

• I00-I99 – Diseases of the circulatory system

– I20-I25 Ischaemic heart diseases

• J00-J99 Diseases of the respiratory system

– J44 Chronic obstructive pulmonary disease

– J45 Asthma

• S00-T98 Injury, poisoning and certain other consequences of external causes.

Measure: Burden of disease and injury data (2006)

Source: Queensland Health – unpublished data

Burden of disease and injury is an important summary measure of population health and is the gap between the current health situation and an ideal where everyone lives into old age, free of disease and disability. This gap can be measured by disability-adjusted life years (DALYs). The DALY gives a richer picture than that provided by traditional mortality and hospital statistics by combining both fatal (premature mortality) and non-fatal (disability) outcomes into a single measure. One DALY is one year of ‘healthy’ life lost by either premature death or disability. DALYs have a mortality component, years of life lost due to premature mortality (YLL), and a disability component, years of life lost due to disability (YLD) associated with disease or injury.

The calculation for the DALY is below:

DALY = YLL + YLD

YLL = number of deaths x standard life expectancy at age of death

YLD = incidence x duration x severity weight


Measure: Morbidity data for selected chronic conditions

Source: Queensland Health – Queensland Hospital Admitted Patient Data Collection (QHAPDC), unpublished data

1. Admitted patient episodes of care based on:

– Place of usual residence of patient Queensland only.

– Queensland acute public and private hospitals.

– Excludes unqualified newborns, posthumous organ procurement and boarders.

– Principal Diagnosis and aggregated into ICD 10AM Chapters.

2. Data for 1 July 2003 to 30 June 2009 financial years.

Analyses:

• Data for interstate/overseas and not stated residents was excluded from analyses.

• Data was age standardised using:

– the Australian 2001 standard population

– Population for 2003 to 2008 by Indigenous status was used (Synthetic Population Estimates by Indigenous status by age and sex for SLAs 2000 to 2008 – produced by Office for Economic and Statistical Research (OESR), Queensland Treasury).

• Palm Island is a total population (includes Indigenous Indicator: Indigenous, non-Indigenous and not stated).

• Indigenous Indicator – ‘not stated’ was excluded from analysis for Townsville Health Service District (including and excluding Palm Island) and Queensland (Indigenous and non-Indigenous) analyses.

• Data are presented as an Annual Average Direct Standardised Rate per 1,000 population for 2003–2004 to 2008–2009.

Note: These data do not represent prevalence of each condition in each area, rather the number of episodes of care for each condition. As such, they are not a count of unique individuals. Some patients will have several episodes of care for the same disease or injury.

Documents

Palm Island Health Action Plan 2010 - 2015