Cover Letter
Dear Sir/Madam
Submission to the Review of the Northern Territory Emergency Response
The Menzies School of Health Research (Menzies) is Australia’s leader in Indigenous and tropical health research. Menzies’ evidence-based approach leads to ways to better prevent, treat and diagnose disease and to show how the social and physical environments in which health care is delivered can be improved for better health outcomes. Menzies’ areas of expertise include Indigenous child and mental health, the social determinants of health such as housing and poverty, tropical and emerging infectious diseases, preventable chronic diseases and increasingly, International health.
As a scientific research organisation Menzies takes an evidence-based approach which relies on the gathering of baseline data, monitoring and evaluation; with the aim of providing evidence for necessary changes to policy and practice. This submission is based on available evidence about the impact and effectiveness of the Emergency Response.
Two of our staff, Drs Ross Andrews and Peter Morris, are members of the Commonwealth Government’s Northern Territory Emergency Response Child Health Check Initiative Evaluation Indigenous Advisory Group. We have already therefore had some, albeit limited, opportunity to provide input to the evaluation.
The purpose of our submission is to 1) draw to the attention of the Review Board evidence from research projects that can provide some insights into the impact and effectiveness of the NT Emergency Response; and 2) demonstrate Menzies’ skills, experience and willingness to partner the Commonwealth and NT Governments in designing, monitoring and evaluating actions aimed at long term improvements to the safety and wellbeing of children, and general improvements to health and education outcomes for residents of remote communities and camps in the NT.
The issues covered in this submission are:
- Child health checks, medical follow-up and treatment, based on studies
already provided to the Progress of the Northern Territory Emergency Response
Child Health Initiative: Health Conditions and Referrals report
(Progress report)1; and on the Audit and Best Practice for Chronic Disease (ABCD) project results; - Monitoring the health impact of housing programs based on a project surveying the impacts of NT housing programs in remote communities;
- Enhancing education, based on Menzies’ new research agenda around bringing together health and education;
- Income management, based on Menzies’ research with remote Aboriginal community stores and takeaways;
- Substance misuse, based on based on research examining the impacts of substance misuse on communities and families;
- Cultural issues based on Menzies’ experience preparing researchers and practitioners to work with Indigenous communities;
- The importance of proper project design, data gathering, monitoring and evaluation based on Menzies’ broad experience.
Menzies’ detailed response is attached. A summary of our findings is that:
- The initial emphasis of the NT Emergency Response on health screening of Indigenous children resulted in data that are of questionable quality, and was misplaced: the initial emphasis should have been on follow-up and treatment for children with known but neglected health problems; and on improving approaches to long term prevention strategies.
- The Commonwealth should consider providing supportive infrastructure to the existing immunisation services within the NT, to support prevention strategies.
- Monitoring the health impact of housing programs is possible, and should now be initiated.
- The NT Emergency Response’s limited focus on enhancing education will not be sustainable or effective unless supplemented by measures to improve a complex of factors denoting “school readiness”.
- Positive interim reports of the impact of Income Management are based on data of limited quality and scope. More rigorous monitoring should at least be based on analysis of store turnover and also include the interviews with Aboriginal residents whose income has been quarantined.
- Rather than focus on the reduction of supply of alcohol, a comprehensive substance misuse strategy needs to incorporate a broader perspective, including demand reduction and harm minimisation, in order to have a long term effect.
- Cultural awareness and preparation and use of cultural protocols were inadequate in the early stages of the NT Emergency Response and should be a priority in future plans.
- Purpose-designed data collection and monitoring and evaluation programs are essential and should now be initiated.
We have doubts about the quality and reliability of the data collection overall within the NT Emergency Response, and whether the processes met current standards for community-based research. It is therefore our general conclusion that most of the data collected so far will only allow limited and far from definitive conclusions to be made about the impact of the NT Emergency Response.
Any evaluation must also take into account the opportunity cost, and the difficult question must be asked as to what could have been achieved if funding had, for example, been used to support community-based primary health care services, translational research, or a raft of other evidence-based interventions instead.
The Review should ensure, since the Emergency Response is likely to continue in some form for the medium term at least, that an appropriate program design, data collection, monitoring and evaluation mechanism is set up from now on. With its wealth of experience and expertise Menzies would be pleased to assist in the design, implementation and evaluation of the Emergency Response’s next phase.
Yours sincerely,
Professor Jonathan Carapetis Director
1. Progress of the Northern Territory Emergency Response Child Health Initiative: Health Conditions and Referrals Australian Institute of Health and Welfare and Australian Government Department of Health and Aging (AIHW 2008)