Searching for solutions

Originally published in ANU Reporter, 14 February 2012.

Collaborative research is helping to shed light on how to close the gap on Indigenous health disadvantage, writes SIMON COPLAND.

We hear a lot about ‘closing the gap’ between Indigenous and non-Indigenous health outcomes. With a 12-year difference in life expectancy between non-Indigenous and Indigenous males, and child mortality rates up to four times higher in Indigenous communities, Indigenous disadvantage is considered to be one of Australia’s biggest health problems.

But what we often don’t hear about is the gap between Indigenous people who live in rural areas and Indigenous people who live in urban areas.

Indigenous people living in urban areas have the lion’s share of many conditions affecting Indigenous communities, including around 60 per cent of the burden of cardiovascular disease, diabetes cases and cancers, as well as a staggering 83 per cent of mental health issues.

Despite this, only 10 per cent of research in Indigenous health focuses on urban communities. For Professor Emily Banks, a researcher at the National Centre for Epidemiology and Population Health, this means a significant lack of data to help find solutions to these health problems.

That’s a gap that a team of researchers, including Banks, working with Aboriginal communities and Aboriginal Community Controlled Health Services, are working to close. This collaboration has recently been awarded $2.5 million in funding through the Australian Primary Health Care Research Institute to establish the Centre for Research Excellence in Urban Aboriginal Child Health.

The project builds on a research program called SEARCH – the Study of Environment on Aboriginal Resilience and Child Health. It calls on Banks’ experience in epidemiology – the study of the distribution of diseases – that began very early in her career.

“Most of my immediate family are scientists, so I just assumed that I would be a scientist. I decided to do a medical degree and by about my third year in I started to get interested in epidemiology.

“What I found was that when I started working in hospitals I noticed a lot of people asking ‘why isn’t someone talking to me about why I got sick?’ Questions about the underlying causes of a person’s illness were often left unanswered.

“I felt epidemiology was the best way to answer some of these questions.”

Banks’ interest in answering these questions has led her to work on large long-term health studies. She was part of the research team on The Million Women Study in the United Kingdom, which found a significant increase in risk of breast cancer in women using hormone replacement therapy; and is the Scientific Director of the 45 and Up Study in Australia, which has collected health data on 267,000 men and women aged 45 and over in New South Wales.

She says she enjoys the challenge of identifying important trends in large groups.

“I’ve always found, for the particular work I do, that you need to make a really big investment in building collaborations and gathering data on a lot of people. That lays the foundation for an in-depth understanding in the long term,” she says.

“I came back to Australia to translate the work I did on large cohort studies in the United Kingdom. That’s why we started the 45 and Up Study.

“At the same time, however, I really wanted to contribute to the major public health issues facing the country and that includes Aboriginal health.”

SEARCH, which is the first large-scale study into the health and well-being of Aboriginal children living in urban communities in New South Wales, was born out of a partnership between researchers and Aboriginal communities.

Sharon Nicholson-Rogers is the Aboriginal Study Manager of SEARCH. She says that the project is a collaborative, community-led initiative.

“SEARCH grew out of the Coalition for Research to Improve Aboriginal Health, CRIAH, which is a collaboration between the Aboriginal Health and Medical Research Council and the Sax Institute. CRIAH conducted an extensive community consultation process asking Indigenous communities in New South Wales what sort of research they wanted to see,”says Nicholson-Rogers.

“The community wanted research that followed people in the long term, and which focused on children – their families and their environment. So an individual focus, but one which produced a much more holistic picture.

“What the communities really wanted was the opposite of fly-in/fly-out research. They wanted something that was committed to the long term, so a full picture of the health issues facing the community could be developed. The communities also identified priority health issues, like ear health and social and mental wellbeing.”

Professor Banks adds that a key part of SEARCH is that it is community initiated and responds to community priorities.

“Aboriginal Data Collection Officers will collect data about children at different Aboriginal Community Controlled Health Centres across the state. Aboriginal Knowledge Brokers will then work with the centres and community to identify targets for change and provide support to make those changes. That will really be a community initiated process.”

For Banks, doing it right requires a long-term focus.

“Although it takes a long time, it is the only way to achieve something meaningful and lasting for the community, and if that helps to close some of those gaps, then I know that we will have done our part of the job.”

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