Review of Aboriginal Women s Health Check Day (AWHCD)

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1 April 2018 Review of Aboriginal Women s Health Check Day (AWHCD) Programme commenced from 2009 Tammy Yam Northern Sydney Central Coast

2 Acknowledgements Clients of Aboriginal Women s Health Check Day Members of Aboriginal Women s Health Check Day Committee Special thanks to: Aunty Sue - Cultural Advisor, Macquarie University Clinical Associate Professor Peter Shine - Director of Aboriginal Health Northern Sydney Local Health District

3 Presentation Overview Rationale - Breast Cancer/Screening Behaviour/Social Determinants Northern Sydney Aboriginal Population (2016 Census) Key Issues for NSLHD Barriers for accessing breast screening What is Aboriginal Women Health Check Day(AWHCD)? The First AWHCD Aboriginal Health NSLHD Community Focused Initiative Approach Partnerships & Consultations Outcomes participation/ trajectories Conclusions Important Take-home message

4 Rationale Breast cancer is the most commonly diagnosed cancer for Aboriginal and Torres Strait Islander women. 1 The disease is diagnosed at a more advanced stage and outcomes are generally poorer than in other Australians. Low participation rates in breast cancer screening and social determinants of health led us to confirm this poorly met health need among Aboriginal women in Northern Sydney. 1 Cancer Australia, National Aboriginal and Torres Strait Islander Cancer Framework, Cancer Australia, Surry Hills, NSW.

5 Breast Cancer In Australia, Aboriginal and Torres Strait Islander women are: 1 20% less likely to be diagnosed with breast cancer. 30% less likely to be hospitalised for breast cancer. 5-year relative survival was 81%. 1.3 times more likely to die from breast cancer. less likely to participate screening. 1 Australian Institute of Health and Welfare & Cancer Australia Cancer in Aboriginal and Torres Strait Islander peoples of Australia: an overview. Cancer series no.78. Cat. no. CAN 75. Canberra: AIHW.

6 Screening Behaviour Participation in Breast Screen Australia is lower for Aboriginal and Torres Strait Islander women than for non- Aboriginal women, 37% compared with 53% in The lower incidence but higher mortality rates, of breast cancer in Aboriginal women could be explained partially by the lower participation in breast cancer screening. 1 Australian Institute of Health and Welfare BreastScreen Australia monitoring report Cancer series no Cat. no. CAN 105. Canberra: AIHW.

7 The Social and Cultural Determinants of health It is important to address the social and cultural determinants of health as there are many drivers of ill health that lie outside the direct responsibility of the health sector. Close the Gap Steering Committee 1 Aspects of the broader social environment that can influence the capacity of individuals, families and communities to engage with health care and manage their own health. 2 For Aboriginal and Torres Strait Islander people, the social and cultural determinants of health may include support from family, community and church groups, connection to culture and country, and a sense of empowerment or self-efficacy. 2 1 Commonwealth of Australia National Aboriginal and Torres Strait Islander Health Plan , Australia, Canberra, ACT. 2 Cancer Australia, National Aboriginal and Torres Strait Islander Cancer Framework, Cancer Australia, Surry Hills, NSW.

8 Northern Sydney Aboriginal Population (2016 Census) 3,360 people in Northern Sydney reported being Aboriginal and Torres Strait Islander % of the total Northern Sydney LHD population. The Aboriginal population was younger than the NSLHD population with fewer older people. Only 26% (approx. 319) of the female population (1,228) is aged over 45 years of age. 2 1 NSLHD Australia First Peoples Lifecycle, Health and Wellbeing Plan. Sydney: Northern Sydney Local Health District, November NSLHD Aboriginal Health Services Plan , Sydney: Northern Sydney Local Health District, October 2013.

9 Key Issues for Northern Sydney Local Health District (NSLHD) According to the NSLHD Aboriginal Health Services Plan : 1 The Aboriginal population within Northern Sydney is relatively small and dispersed with few specialised services. The community has members of the Stolen Generations (ongoing mental & emotional health concerns, combined with chronic illness). A significant population of people are light-skinned appearance leads to questioning by service providers of the Aboriginal identity. Significant numbers of Aboriginal people from outside NSLHD use services in Northern Sydney including tertiary services at Royal North Shore Hospital. 1 NSLHD Aboriginal Health Services Plan , Sydney: Northern Sydney Local Health District, October 2013.

10 Barriers for accessing breast screening Effects of this low often marginalised population had led to specific barriers for Aboriginal people accessing health services. There were access barriers that related to perceptions of lack of cultural safety, respect and validation within mainstream health services. 1 For breast screening, it is highly likely that Aboriginal and Torres Strait Islander women in Northern Sydney are an unscreened and under screened group. 1 NSLHD Australia First Peoples Lifecycle, Health and Wellbeing Plan. Sydney: Northern Sydney Local Health District, November 2015.

11 What is Aboriginal Women s Health Check Day (AWHCD)? A grassroots program developed in 2009 to promote breast screening to Aboriginal and Torres Strait Islander women in Northern Sydney by providing a culturally appropriate environment while supporting them to have regular health checks to improve health and wellbeing.

12 AWHCD Flyer

13 The First Aboriginal Women s Health Check Day (AWHCD) In 2009, the first AWHCD was delivered in partnership with Northern Sydney LHD, the Aboriginal Social Planner Local Government and non-government organisations. A small group of 7 unscreened and under-screened Aboriginal & Torres Strait Islander women attended. The feedback was positive that they felt safe and comfortable about breast screening in a group-setting.

14 First AWHCD 2009 Photo Gallery

15 Aboriginal Health NSLHD In 2014, AWHCD is conducted twice a year and all programs are run by NSLHD Aboriginal Health service with local community input and advice. 1. Royal North Shore Community Health Centre (St Leonards) 2. Hornsby Ku-ring-gai Hospital, Bungee Bidgel Aboriginal Health Clinic (Hornsby) Bungee Bidgel is an NSLHD Aboriginal Health Service clinic at Hornsby Hospital GP Unit. This GP service has supported the AWHCD event since 2014.

16 AWHCD Flyers (2017)

17 Community Focused Initiative Approach Established a trusted relationship by offering a culturally safe place for local Aboriginal women using incentives such as refreshment, pampering massage and free health promotion gifts, etc. The most recent event offered women a range of preventative health checks including breast screening, Paps Smear, dental checks, lung function, bladder & kidney checks and diabetes. Health talks were introduced - breast screening, smoking cessation, oral health, heart health & healthy food choices with practical tips preventing chronic diseases.

18 Community Focused Initiative Approach - Diagram Endorsement from Elders, Aunty Sue culturally appropriate flyers/artworks word of mouth promotion, Aboriginal media etc Cultural activities Health check activities culturally safe screening environment with incentives eg. refreshment, fried rice & massage introduce other health checks Paps test Follow ups & referrals Consultations Partnership of health services and NGO providers AWHCD Community based Wellbeing program Endorsement & funding from NSLHD health services

19 Flyers (2014)

20 Promotion A range of strategies were used to promote this initiative: Culturally appropriate flyers (printed & electronic) via AWHCD members Word of mouth Aboriginal and Islander Health Worker Journal Koori Mail & Koori Radio Websites - Australian Indigenous HealthInfoNet 2015 (Yarning Places)

21 Partnerships & Consultations AWHCD is a community network facilitated by Aboriginal Health Northern Sydney LHD with representatives from Macquarie University; Sydney North Primary Health Network; Legal Aid and NSLHD including, Oral Health and Women s Health Services. We recognise the importance of a strong partnerships between NSW Local Health Districts (LHDs) and Aboriginal Community at the local level by: 1. Work collaboratively identify women s health needs 2. Consultation with local Aboriginal community and Aboriginal workers

22 AWHCD 2012 Photo Gallery

23 AWHCD 2015 Photo Gallery

24 Outcomes Steady increase in participation of breast cancer screening as a result of this health initiative. The Aboriginal and Torres Strait Islander women in Northern Sydney aged has increased their biennial participation rate by 7.3% from 27.1% ( ) to 34.4% ( ) as shown in Figure Data Source: Cancer Institute NSW Sydney April 2018

25 Upward Trajectories NSLHD 7.3% NSW 4.1%

26 Conclusion Evidence suggests that the poor cancer outcomes for Aboriginal and Torres Strait Islander people can be improved by culturally inclusive and respective environments such as community health and well being programs to ensure that specific barriers and needs are addressed as well as boost breast screening participation.

27 Important take-home message: Building trust through partnerships. Trust takes time! Don t give up, even though the turnout is small Who/Where are your Gatekeepers? Community-based well-being program is the way to go! Transportation is an important factor. Aboriginal media Aboriginal Health Worker Journal, Koori Mail, Koori Radio & websites Cool incentives - goody bags, health diaries, Aboriginal products (hand creams, massage oil, tea, hair treatment) manicure, massage, bra-fitting, raffles etc.

28 References Australian Institute of Health and Welfare & Cancer Australia Cancer in Aboriginal and Torres Strait Islander peoples of Australia: an overview. Cancer series no.78. Cat. no. CAN 75. Canberra: AIHW. Australian Institute of Health and Welfare BreastScreen Australia monitoring report Cancer series no Cat. no. CAN 105. Canberra: AIHW. Cancer Australia, National Aboriginal and Torres Strait Islander Cancer Framework, Cancer Australia, Surry Hills, NSW. Cancer Institute NSW Commonwealth of Australia National Aboriginal and Torres Strait Islander Health Plan , Australia, Canberra, ACT. NSLHD Aboriginal Health Services Plan , Sydney: Northern Sydney Local Health District, October NSLHD Australia First Peoples Lifecycle, Health and Wellbeing Plan. Sydney: Northern Sydney Local Health District, November 2015.

29 Author s Contact Tammy Yam Marketing & Recruitment Officer NSCCLHD Tammy.Yam@health.nsw.gov.au

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