Deadly Teeth
Transcription
Deadly Teeth
Artist: Daniel Joseph Deadly Teeth Promoting oral health in Gunditjmara Country Project Report (Phase 1) May 2012 Page |1 Contents Acknowledgements .................................................................................................................... 3 ............................................................................................................................................... 4 Executive Summary................................................................................................................... 4 ............................................................................................................................................... 5 Introduction ............................................................................................................................. 5 Gunditjmara Country ..................................................................................................................... 5 Deadly Teeth: ........................................................................................................................... 6 The beginning ........................................................................................................................... 7 Literature review ....................................................................................................................... 7 Values and Principles ................................................................................................................. 9 Deadly culture ........................................................................................................................ 10 Strategies .............................................................................................................................. 10 The tip sheet yarn ................................................................................................................... 11 Design ................................................................................................................................... 12 Eat well Tip card for Families ......................................................................................................... 12 Drink well Tip Card for Families ...................................................................................................... 12 Clean well Tip Card for Families ...................................................................................................... 13 Promotion .............................................................................................................................. 13 Distribution ............................................................................................................................ 14 Pre survey results ................................................................................................................... 16 Post survey results .................................................................................................................. 17 Future direction and additional support ...................................................................................... 18 Consultations ............................................................................................................................ 20 Rationale: The importance of good oral health .................................................................................... 22 Planning and policy context ...................................................................................................... 24 The determinants of oral health ................................................................................................ 25 Oral health inequality .............................................................................................................. 26 Oral health status.................................................................................................................... 28 References ............................................................................................................................. 30 Appendix................................................................................................................................ 32 Page |2 Table 1 project values and principles ........................................................................................... 9 Figure 1 Gunditjmara language groups, dialects and locations .................................................................. 6 Figure 2 Distribution map ......................................................................................................... 15 Figure 3. Resources currently used ............................................................................................ 17 Figure 4. Current resources cultural appropriateness ................................................................... 17 Figure 5 The impact of oral disease ........................................................................................... 24 Figure 6 Determinants of oral health .............................................................................................. 26 Page |3 Acknowledgements The Deadly Teeth Tip Cards for Families and the three acrylic art pieces where three years in the making (2008- 2011). Thanks go to the children, Elders and community health staff of Winda-Mara Aboriginal Corporation who worked on phase one of the “Deadly teeth” initiative. Special acknowledgment must go to Melissa Lillyst who initiated the pilot project in partnership with the Health Promotion Unit at Portland District Health. To the fantastic artist Daniel Joseph who brought all the ideas to canvas through his imagination and creative ability. Recognition needs to be given to Michael Bell, Dianne Bell, Daryl Rose, Ros Pevitt and Tanya Geier from Winda-Mara Aboriginal Corporation for the collaborative efforts on the easy to read information contained in the tip sheets. Professional support from local graphic designer Damon Yuill and the Program Print Company resulted in pulling together the final set of eye catching resources. Thanks is extended to the Health Promotion Unit at Portland District Health; Lynda Smith, Kristy De Rose, Carol Stewart and Rachael Moore, and also to Dental Health Services Victoria for their foresight in supporting what started as a small Smiles4Miles extension project in 2008. With thanks, Michael Bell Lynda Smith Chief Executive Officer Health Promotion Officer Winda Mara Aboriginal Corporation Portland District Health Heywood, Victoria Portland, Victoria A note on language: The term ‘Aboriginal’ when used in this document should be read as meaning Aboriginal and Torres Strait Islander people. The term ‘Indigenous peoples’ is used where material is drawn from the international context. Personal stories use the language of the storyteller. Page |4 Executive Summary The “Deadly Teeth” initiative is a partnership between Winda-Mara Aboriginal Corporation and the Health Promotion Unit at Portland District Health (“Deadly” meaning good). It is currently a work in progress and aims to address oral health as a “holistic concept” focusing on oral hygiene, nutritional intake, oral health literacy and access to dental services. It aims to provide a culturally appropriate health promotion initiative for Families with children between the ages of 0-5 years. The project originated as an extension project of Dental Health Services Victoria’s Smiles4Miles oral health project in 2008. It is hoped that a myriad of resources will be created or identified and used to improve knowledge and empower the community to take control over the issues which determine their oral health. Phase one of the project has been launched and consists of a set of three culturally appropriate Family tip sheets. Phase two is underway and aims to develop lay oral health promotion training for Indigenous community health workers. The training is based on the newly released nationally recognised Australian Government Department of Education, Employment and Workplace Relations oral health units of competency which include: o Recognise and respond to signs and symptoms that may indicate oral health issues o Support clients and groups to learn practical aspects of oral health care o Use basic oral health screening tools o Work effectively with Aboriginal and/or Torres Strait Islander people Page |5 Introduction Oral health is a vital part of general health and wellbeing and has a significant effect on quality of life. Dental health problems have persisted as a significant issue for Aboriginal children and young people in Victoria1. The Deadly Teeth oral health promotion initiative has been established to improve the oral health of children aged up to five years and their parents, carers and families who live in Gunditjmara country, South West Victoria, Australia. The initiative is driven by Aboriginal Health Workers at Winda-Mara Aboriginal Corporation with support from the Health Promotion Unit at Portland District Health. This project report will outline the context for oral health promotion in Victoria and the strategies that were adopted during phase one of the Deadly Teeth initiative: partnership and resource development. Firstly the Focus was to strengthen the relationship between Winda-Mara Aboriginal Corporation and Portland District Health through the development of a set of three culturally appropriate Tip Cards for Families. These resources will be used to spread deadly messages to promote oral health. Community consultation, participation and ownership have been a key approach during the creation of the Deadly Teeth Tip Cards for Families. The project report will conclude with recommendations to further develop the Deadly Teeth oral health promotion initiative. Gunditjmara Country Winda-Mara Aboriginal Corporation is located in the small town of Heywood, South West Victoria. It provides a broad range of services to the local Aboriginal communities in and around the far south west Victorian towns of Heywood and Portland in the Glenelg Shire and Hamilton in the Southern Grampians Shire. These areas are located within Gunditjmara country spanning the Page |6 Dhauwurd Wurrung and Djab Wurrung language groups with ancestral stories stretching back more than 30,000 years1 Figure 1 Gunditjmara language groups, dialects and locations (Victorian Aboriginal Corporation for Languages 2011) According to data from the Australian Bureau of Statistics Census of Population and Housing in 2006 a total of 482 persons in the Southern Grampians & Glenelg catchment self-identified as Aboriginal or Torres Strait Islander people, 370 in Glenelg Shire (1.9% of total persons in the local government area) and 112 in the Southern Grampians Shire (0.7% of total persons in the local government area). This includes Aboriginal and Torres Strait Islander people with Gunditjmara heritage and Indigenous people with heritage from all areas of Australia. In 2006 almost 60% of Aboriginal people were aged 25 years or less compared to about 30% of non-Indigenous people in the Southern Grampians and Glenelg catchment areas. Deadly Teeth: Children are dependent on parents and Family to support their oral health. Inadequate access to culturally appropriate oral health information, resources, services and oral health literacy limits the ability of Family to care for their children’s overall health needs. Healthy messages delivered to parents of a new born child have the potential to be adopted by the rest of the Family. The earlier positive health messages can be introduced the more likely Page |7 there is to be success. Good oral health habits can never be started too early and the messages being delivered to children have the potential to be adopted by the rest of the Family. Winda-Mara Aboriginal Corporation is a health and cultural service for the local Gunditjmara people. The links between the Gunditjmara people and their land, community and spirit is fundamental to health. Paying recognition and consideration to these connections is vital to all local health promotion initiatives. The “Deadly Teeth” health promotion initiative aims to generate messages that are stimulating, enjoyable and effective. The beginning In 2008, the Early Childhood Coordinator from Winda-Mara Aboriginal Corporation and a Health Promotion Officer at Portland District Health discussed the possibility of running a pilot Smiles4Miles oral health promotion program from Dental Health Services Victoria within the three local Indigenous playgroups in Heywood, Portland and Hamilton. They quickly realised there was a lack of culturally appropriate resources available to promote oral health. A coordinated approach was then taken to workshop with children, adults, Elders and local artist Daniel Joseph who produced three acrylic canvas paintings depicting key oral health messages for Family tip cards. The result was the ‘Wellbeing Fella’ eating well, drinking well and brushing well. A Portland District Health Promotion Officer and Post Graduate in Health Promotion student at University of Sunshine Coast commenced a “Deadly Teeth” Strategy Literature Review to critically investigate and examine oral health promotion programs used to address indigenous, rural and remote oral health issues in children 0-5 globally. The findings would be reflected upon to further support, develop and influence the “Deadly teeth” initiative. Literature review A strategy literature review produced an evaluative document on information presented in peer reviewed articles and journals focussing on oral health promotion programs aimed at addressing and supporting oral health issues in indigenous children 0-five years. The selection criteria for reviewed documents were: nutrition, oral health education of children and family and water fluoridation. The review found that: Page |8 o Inadequate access to dental resources, oral health services and oral health care knowledge limits the ability for families to care for their children’s overall oral health needs2. o Poor practice in regards to infant bottle feeding habits and the use of pacifiers combined with the belief of some parents that primary teeth do not matter3, further impinges on children’s reduced oral health. o Children have a high dependency on parents and family to support their oral health needs3. Education of children alone will not result in a sustainable decline in risk behaviours. However, the earlier the interventions can be initiated the more likely you are of success.4 o One off programs with a setting based approach will not result in continual health for life behaviours2. Strategies worth considering include regular group and 1:1 education sessions, culturally appropriate services and staff, consideration of lay oral health promotion workers, video and media supports as well as policy development and water fluoridation advocacy and early years settings and supports with health promotion programs. It is imperative that oral health promotion is based on sound theoretical background. Working in mutual partnerships with Elders, appropriate professionals and agencies results in a health promotion initiatives based on the social determinants of health.5 Page |9 Values and Principles Based on the Red Lotus Health Promotion Model6 the following table explains the reasoning behind the study. Table 1 project values and principles Six Values and Principles of Modern Health Promotion supporting the “Deadly Teeth” initiative. Value Principle of modern health How promotion Philosophical Ecological science Using the science of ecology, which recognises that: . People exist in multiple ecosystems, from the individual level, to the family group, community and population level Recognition and consideration of the connection which indigenous peoples have with their land, people and spirit. . All parts within systems impact on each other; the whole of any system is greater than the sum of the parts. Holistic health paradigm Seeing health as a complex concept that includes physical, mental, spiritual and social aspects of wellbeing that relate to the whole person Considering all aspects affecting children’s overall oral health and wellbeing. Ethical Within the Glenelg Shire the indigenous population (according to Australian Bureau of Statistics in 2006) was 1.9%. promotion determined Prioritising work with people and communities that are most marginalised, vulnerable, disadvantaged and often regarded as ‘hard to reach’ based on by equity considerations of equity Active participation of people impacted by the issue Ensuring that the people most impacted by an issue are an integral part of all components of a health promotion change process that addresses the issue Technical Using a portfolio of strategies incorporating all action areas of the Ottawa Charter. Focus of health Portfolio of multiple strategies Collaborative governance and decision making Using models of governance and decision making that facilitate active and meaningful participation by all stakeholders Working in partnership with Winda-Mara and Dhauwurd-Wurrung Aboriginal community health services. Advocating for Healthy Public Policy, whilst working towards creating supportive environments by strengthening community action and developing personal skills whilst pressing to reorientate health services Collaborative partnership appreciating all participants’ skills, knowledge and input. P a g e | 10 Deadly culture Communities are complex and interrelated. The links between the Gunditjmara people and their land, community and spirit is fundamental to health. Paying recognition and consideration to these connections is vital to all local health promotion initiatives. The “Deadly Teeth” health promotion initiative aims to generate messages that are stimulating, enjoyable and effective. Collaborative governance and decision-making is ensured through a partnership between the Health Promotion Unit at Portland District Health & Winda-Mara Aboriginal Corporation with opportunities in the future to also work with Dhauwurd Wurrung Elderly & Community Health Services. Strategies A portfolio of multiple strategies was selected to address the action areas of the World Health Organisation’s Ottawa Charter for Health Promotion. Creating Supportive environments • Family tip cards designed for Indigenous Families by Indigenous Families, painted by a local Indigenous artist • Video and media supports • Advocacy for the inclusion of fluoride into the community water supply where fluoridation does not happen naturally Developing personal skills • Oral health education sessions for parents and Family held at Maternal Child Health centres and Indigenous health services when children are attending immunisation sessions Building public policy and reorienting health services • Policy development at local Indigenous playgroups, early childhood settings and preschools. This will support nutritious food consumption and tap water or plain milk as the preferred drink for children attending these services • Advocate for the inclusion of all dental services to be covered by Medicare P a g e | 11 • Cultural training for staff at non-Indigenous controlled health services and consideration of oral health promotion workers Strengthening community action • Oral health working party established with representatives of health, government and Indigenous controlled organisations in Gunditjmara country • Collaboratively advocate for the production of Indigenous specific oral health promotion programs and resources The tip sheet yarn In June 2011 Aboriginal Health Workers at Winda-Mara Aboriginal Corporation commenced spreading deadly messages to promote oral health, with support from the Health Promotion Unit at Portland District Health. The first process in the “Deadly Teeth” health promotion initiative was to produce a set of three colourful, culturally appropriate Tip Cards for Families promoting oral health for children aged up to five years, their parents and Families. The resources were officially launched at Winda-Mara on Wednesday 06th July 2011, during NAIDOC week celebrations. The Tip Cards for Families promote three key oral health messages. The ‘Eat well’ tip card promotes healthy eating behaviours because ‘deadly teeth need good foods’. The ‘Drink well’ tip card highlights the importance of drinking tap water and avoiding ‘bad drinks that rot your teeth’. The ‘Clean well’ tip card reminds children and families that ‘deadly teeth need good care’ and encourages regular tooth brushing habits. In 2008 Winda-Mara Aboriginal Corporation worked in partnership with the Health Promotion Team at Portland District Health and Dental Health Services Victoria to pilot the Smiles4Miles oral health program in three local Indigenous playgroup sites. The program workers soon realised that there were no culturally appropriate oral health promotion resources for the local Indigenous community. In response, four oral health art workshops were held at Winda-Mara Aboriginal Corporation in Heywood. These were attended by children, Families, Elders, Aboriginal Health Workers, a local artist and the Smiles4Miles project worker from Portland District Health. Indigenous artist Dan Joseph attended the last workshop and became inspired by the children’s thoughts and ideas. Using his talent created three acrylic paintings depicting key oral health messages based on a Western diet. P a g e | 12 The three paintings would become the backdrop of the culturally appropriate oral health resources. The Tip Cards are designed for families with children up to 5 years old to improve oral health knowledge and promote access to dental services. The paintings feature an Indigenous “Wellbeing Fella” collecting bush foods, drinking water from a stream and brushing his teeth. These were interpretations of the Smiles4Miles defenders of the tooth characters Munch Girl, Water Boy and Brush Boy. The art work and copyright was purchased from Daniel Joseph by Portland District Health in late 2009. More workshops were held in the community to finalise the key messages using culturally appropriate language and words that were easy to understand. For example, the use of the words ‘deadly’ teeth is actually interpreted as meaning ‘good’ teeth in local Indigenous culture. A graphic designer was then employed to put together all the ideas gathered from the community. Design Eat well Tip card for Families Based on a Western diet key messages state that deadly teeth need good foods and help from Family; this includes making foods choices that are: • Low in sugar and acid • High in fresh fruit and vegetables • Low in processed/packaged foods • Low in take-away/fast-food. Drink well Tip Card for Families Deadly teeth need good drinks, this includes drinking: • Plenty of tap water • Plain milk Don’t have drinks that are high in sugar, like soft drink, fruit drinks, and cordials. P a g e | 13 Clean well Tip Card for Families Deadly teeth need good care: this includes: • Oral hygiene • Brushing twice a day and flossing • Visiting the dentist every year. Launch The ‘Deadly Teeth’ Tip Cards for Families were officially launched at Winda -Mara in July 2011, during NAIDOC week celebrations and at a Victorian Aboriginal Controlled Community Health Organisation (VACCHO) state wide community members meeting in Mildura. Promotion The resources and partnership between Winda- Mara Aboriginal Corporation and Portland District Health was presented at the 2010 International Arts & Health Conference in Melbourne and at a Community Capacity Building Workshop in Camperdown, Victoria as part of the Deakin University, Department of Health and the Department of Human Services Strategic Alliance program in March 2011. During June 2011 a media release was developed, distributed and subsequently published in: •VACCHO News Winter edition 2011 •Aboriginal & Islander Health Worker Journal July/ August 2011, volume 35- number 4. •Koori Mail, The voice of Indigenous Australia, Wednesday 10th August 2011 •Deadly VIBE magazine number 175, September 2011 •Australian Indigenous HealthInfoNet website: http://www.healthinfonet.ecu.edu.au/key-resources/promotion-resources?lid=21676 •SNAICC e-Bulletin (Secretariat of National Aboriginal and Islander Child Care) • 2011 Christmas edition of Health Matters quarterly magazine produced by the Victorian HealthCare Association. P a g e | 14 In October 2011 the Deadly Teeth Family Tip sheets initiative was one of three finalists in the 2011 Victorian Public Healthcare Awards under the Health Leaders: Secretary's Award for improving the health & wellbeing of Aboriginal people. Distribution Unintended consequences As of March 2012 orders have been placed by 6 agencies in the local district (Gunditjmara Country). Including: Winda-Mara Aboriginal Corporation in Heywood, Portland District Health, Dhauwurd-Wurrung Elderly and Community Health Service in Portland, Western District Health Service in Hamilton, South West Health Care in Warrnambool; and Kirrae Health Service in Purnim. Orders from agencies across Victoria as of March 2012 came from: The Aboriginal Community Development Unit at Dental Health Services Victoria in Melbourne (x 2), Gippsland & East Aboriginal Co-Operative Dental Clinic in Bairnsdale; Budja Budja Aboriginal Co-operative in Stawell, Healesville Indigenous Community Services Association, Rangers Community Health, Lilydale, Knox Community Health Service, Ferntree Gully and East Gippsland Primary Care Partnership Bairnsdale. Orders have also been placed from agencies across Australia, including: Indigenous Professional Support Unit, Yorganop- Western Australia, Walgett Aboriginal Medical Service, Rumbalara Dental Clinic, Mooroopna and Blue Mountain Aboriginal “Healthy For Life” Program, Hazelbrook- New South Wales, Flinders Island Aboriginal Association Incorporated- Tasmania and Bundaberg Youth Justice Service, Bundaberg -Queensland. Inquiries have also been received from the Northern Territory and South Australia. P a g e | 15 Figure 2 Distribution map Locally: Nationally: Warrnambool Melbourne (VIC) Ferntree Gully (Vic) Hazelbrook (NSW) Heywood Gippsland (VIC) Mildura (Vic) Flinders Island (TAS) Portland Stawell (VIC) Yorganop (WA) Bundaberg (Qld) Purnim Healesville (Vic) Walgett (NSW) Hamilton Lilydale (Vic) Mooroopna (NSW) P a g e | 16 Pre survey results Pre surveys were completed over the phone by all services that accessed/ purchased the “Deadly Teeth” Family tip sheets. Results show that out of the 17 services who have ordered the resources ten currently use some type of oral health promotion materials and seven services did not. Of the ten that did, only two services felt that the resources were culturally appropriate with one organisation stating that “They are now as we had to make our own”. When asked how the services will use the resources the following comments were made: “Show bags for Indigenous hospital patients. Close the Gap workers and Health Promotion Officers will regularly use” “Co-op dental unit for patients, Health Promotion Days, dental packs and playgroup” “To support early education and intervention for Indigenous children” “Include with annual health screening initiatives -Dental check list- Parent education resource on how to brush etc.” “Place resource on line for others to access- Oral Health Promotion. Health Promotion resource section -The number of overall page-views the AIH website received in the period 1 may – 31 July was 551,707. This translated into 159,300 visits to the website. As for health promotion resource pages, there were 53,456 page-views, and 17,508 visits” “Provide as a resource for a large indigenous population Boori playgroup, children and health check days” “Preschools, chronic and complex disease- engaging with community: Child and family health, working with the Primary health care sites, GP’s, early childhood services, Child and Family Health Nurse and a Community health centre, Photo: Michael Bell CEO at Winda-Mara Aboriginal Corporation with Health Practice Manager Janice Huggers at the launch of the ‘Deadly Teeth’ Tip Cards, June 20011. Workshops for family” “Promote culturally specific and Vic resources at assessment sessions with Budja Budja Community” P a g e | 17 “Mums and bub’s playgroup- parent work groups, health newsletter, child and maternal child health nurse once per month tooth brushing demo’s, visiting GP service” “Patience, outreach days- Health Promotion, celebration days” Figure 3. Resources currently used Is your organisation currently using any resources to promote oral health in children 0-5 years? Figure 4. Current resources cultural appropriateness Do you feel these resources are currently culturally appropriate? Yes Yes No No [Note: Total of 17 services completed the survey] [Note: Total of 17 services completed the survey] Post survey results Post surveys were carried out in April 2012. Of the eight post surveys returned 100% of services believed that the resources were culturally appropriate, would order the resources again and recommend them to others. How have resources been used? The resources had been used for; Community days, have been made available on information stands, handed out during children’s health assessment, made available at women’s health days to share with family, used at playgroups, festivals, and the ICACC Gathering event in Knox, Victoria and given to parent’s at dental clinics. They were also included in Closing the Gap information packs and show bags for various health days. P a g e | 18 “I am invited to attend health days in both metro and regional areas and take the resources with me, people love them- the art work, they always comment about how great it is”- Jacqueline Watkins, Aboriginal Community Development Worker, Dental Health Services Victoria. What has your client response been to the resources? “Client’s really like the colours and the pictures” – Health worker, Healesville Indigenous Community Services Association. “Loved them, art work great, parents happy with the easy straight forward information- easy to understand literature”. - Practice nurse, Dhauwurd-Wurrung Elderly & Community Health Service. “The community have commented that they are very culturally appropriate”- Knox Community Health Service. How could we improve the resources? The following suggestions were made as to how we could improve the resource. Follow up poster of each of the themes with short captions under them Tooth brushes with the designs on them A timer for children to brush their teeth with the art work on it Stickers with the characters. Maybe pocket size tip sheets How to brush your teeth tip card Maybe changing the colours to make the differences more noticeable? Future direction and additional support Since the development of the ‘Deadly Teeth’ Tip Cards for Families; Winda- Mara has hosted a dental clinic day for 25 community members at their Heywood centre with support from the Portland District Health Dental Clinic. This has now become an annual event and talks are currently underway to run a similar clinic at Dhauwurd-Wurrung Elderly & Community Health Service in Portland. Winda Mara and Portland District Health have commenced conversations with Dental Health Services Victoria to create lay oral health training for on the ground Aboriginal Health Workers. P a g e | 19 Winda Mara and Portland District Health also plan to promote the uptake of the new nationally recognised Australian Government Department of Education, Employment and Workplace Relations oral health units of competency to registered training organisations such as South West TAFE and VACCHO. These include: o CHCOHC404A Recognise and respond to signs and symptoms that may indicate oral health issues o CHCOHC402A Support clients and groups to learn practical aspects of oral health care o CHCOHC303A Use basic oral health screening tools o HLTHIR404D Work effectively with Aboriginal and/or Torres Strait Islander people In late October the “Deadly teeth” initiative was announced as one of the three finalists in the Victorian Public Health Care Awards 2011 recognising the two health services partnership in the Secretary's Award for improving the health & wellbeing of Aboriginal people. The Family tip sheets are the first step towards developing a holistic oral health promotion program focusing on the social determinants of health - the conditions, in which we are born, live, grow and work, including the health system! Which are mostly responsible for health inequalities – unfair and avoidable differences7. A portfolio of multiple strategies has been selected to address the action areas of the World Health Organisation’s Ottawa Charter for Health Promotion. To further enhance the “Deadly Teeth” Oral health Promotion Initiative by: Creating Supportive environments These include the Family tip cards designed for Indigenous Families by Indigenous Families, painted by a local Indigenous artist. Other strategies to be developed may include: video and media supports, advocacy for the inclusion of fluoride into the community water supply where fluoridation does not happen naturally. Developing personal skills Oral health education sessions for parents and Family. Building public policy and reorienting health services Policy development at local Indigenous playgroups, early childhood settings and preschools, and Indigenous health services. This will support nutritious food consumption and tap water or plain milk as the preferred drink for children/ Families attending these services, advocate for the P a g e | 20 inclusion of all dental services to be covered by Medicare, local cultural training for staff at nonIndigenous controlled health services, Lay oral health training with a strong health promotion focus for Indigenous health workers. Strengthening community action Oral health working party established with representatives of health, government and Indigenous controlled organisations in Gunditjmara country. Collaboratively advocate for the production of Indigenous specific oral health promotion programs and resources. Consultations In November 2011 the Deadly teeth working party was invited to speak at the ICAPS state wide forum Aboriginal Hospital Liaison Officers (AHLO) in Torquay, Victoria. After providing an overview of the Deadly Teeth initiative a brain storming session was held. Valuable information from workers from across the state was gathered in relation to their thoughts on further development of the initiative – their input was greatly appreciated. Policy, planning & funding • Philanthropic donations from dentists/cosmetic mainstream dentists • Donated time by mainstream dentists • Policy – allow Aboriginal people involved in the process of creating Tip Sheets to have ownership over program • Help plan events to promote service • Attend the next ‘Deadly in Gippsland Conference’ which will be in 2013 in East Gippsland. Heaps of funding bodies attend and are always looking to help fund projects that benefit community (or look for a conference similar to that in Melbourne) • Need to do partnership policy and planning with Victorian Aboriginal Health Service (VAHS) and Victorian Aboriginal Community Controlled Health Organisation (VACCHO). Maybe also on a state-wide level of policy • Traineeships leading to future employment for Aboriginal dental assistants • Develop an MOU between hospitals and local co-cops/AMS around servicing local Indigenous people. Could involve a day per month, for example, just for Koori patients P a g e | 21 Education, knowledge & skills to promote oral health • Encouraging children to clean teeth • Preventative approach to dental care • Too many myths, i.e. chewing gum • More education on baby teeth • Food and smoking • Sugar content in toothpaste • Family consultations • Young children requiring braces need a second option • Involve Aboriginal Hospital Liaison Officer (AHLO)/Aboriginal Health Worker (AHW) • Parent to teach children about brushing teeth • Oral health during pregnancy • Oral health checks at Child Care Centres. Continue to school • Finance/Training dollars • Promoted through health checks • Promoted through VACCHO • Orthodontics • Barrier for prisoners – don’t have access to oral health care • Oral health should be included in Tucker Talk Tips (VACCHO) • Health Worker training for Dental • Family Education • Link to traffic light messages • More pamphlets • Health workers to promote oral health • Link in with Wannik KESO’s to get knowledge to students at schools Culturally appropriate oral health resources • Need to have Aboriginal and Torres Strait Islander flag visually on the tip sheets • Network and work with VAHS Dental Service and ACCHOs • Place to add local details • Posters, business cards – promote service • School dental services program and health care card holders P a g e | 22 • Breast feeding – introduction to bottles (what’s in the feeding bottle?) • Your child and removal of primary teeth (general anaesthetic) • Education pack • Graphic images How to’s • • Why it is important • Language ,communication (effective, local vernacular) • Where to access • Regional relevance • Early education – young ones and carers • Family-wide targeting • Give-aways Access to dental care • Transport • Knowing who to contact and how • Cost (affordability for non HCC holders) • Distance • Time • More culturally accessible dental clinics across Victoria • Enabling access for Aboriginal families to dental clinics where there is not an Aboriginal Dental Clinic • Promotion through Aboriginal Health Workers • Promotion in schools through Aboriginal Education Workers Rationale: The importance of good oral health High-quality oral health is a requirement for physical and psychological health and wellbeing8 and comfortable participation in everyday activities9. It enables us to chew, swallow, sleep, speak, and socialise without active disease, embarrassment, pain and discomfort10. Oral diseases not only affect the mouth. They have been associated with cardiovascular diseases (8), diabetes (9), stroke (10) and pre-term low birth weight.9 (11) Poor oral health can therefore have significant impacts on general health and wellbeing and quality of life. Other impacts of oral disease include the economic costs of dental treatment to the individual and to the broader health system11. P a g e | 23 Maintaining oral health and dental intervention also has significant financial impacts. Dental caries (tooth decay) has been identified as the second most costly diet-related disease in Australia The economic impacts of dental decay have been compared to that of heart disease and diabetes12. From 2001-02 dental decay cost Australia 5.4 % of total health expenditure13. Good oral health behaviours learned in childhood can be translated to adulthood. Self-care practices are an important component of establishing good oral health behaviours, including brushing teeth13. Fortunately most oral health conditions, such as caries and periodontal disease, are largely preventable and if treated early can be reversed and cured. Dental caries (decay) are largely preventable but many go untreated resulting in dental decay being the highest preventable hospital admission for children. Dental treatment accounted for 6.2% of Australia’s total health expenditure in 2007-0814 . That equates to approximately 6.1 billion dollars! ‘Prevention is the cheapest, easiest, least invasive, and most appropriate ‘treatment’ option 9. Increased policy and interventions aimed at the prevention of dental caries would be cost beneficial. P a g e | 24 Figure 5 The impact of oral disease (Department of Human Services: Improving Victoria’s oral health 2007:9 (DHS 1999 cited in NACOH 2001 p. 5) Planning and policy context Australia’s National Oral Health Plan 2004-2013 Healthy Mouths Healthy Lives states that ‘oral health promotion should be part of health promotion plans at local, state and territory, and national levels’ (p. 17). Aboriginal and Torres Strait Islander people have been identified as one population group out of seven interrelated areas for action within an overarching population health framework in the national plan. Portland District Health identified oral health as one of three health promotion priority areas for its agency Integrated Health Promotion plan 2009-2012. The Southern Grampians and Glenelg Primary Care Partnership also identified oral health as one of five health promotion priority areas for the Primary Care Partnership Integrated HP catchment plan, 2009-201215. Portland District Health & SGG PCP were appointed as co-lead agents for this joint priority area, with the P a g e | 25 understanding that Portland District Health would focus on oral health promotion in the Glenelg Shire, and SGG PCP would focus on water fluoridation in the Southern Grampians Shire. Oral health is not specifically mentioned as a health promotion and prevention action in the Barwon South Western Closing the Health Gap Plan 2009-13, as a key area for primary health care in the Victorian Aboriginal Health Plan 2009 or in the health promotion framework for Victorian Aboriginal communities presented in the Life is health is life, Taking action to close the gap document16. However, since the recent release of the Evidence-Based Oral Health Promotion Resource14 by the Victorian Government Department of Health, the profile of oral health promotion has started to rise and reach the policy and planning arena. With the aim of keeping people well through focusing on lifestyle-related risk and protective factors, the Victorian Public Health and Wellbeing Plan 2011-2015 has identified improving oral health as one of nine public health priority issues for promoting the health of Victorians. The determinants of oral health The wide range of determinants of oral health, including risk and protective factors are presented in Figure six. The determinants of oral health includes the economic, political, social and physical environmental conditions in which people are born, live, grow and work, as well as personal factors such as individual health behaviours and the systems in place to deal with oral disease17. These circumstances are mostly responsible for oral health inequalities – unfair and avoidable differences in health status. P a g e | 26 Figure 6 Determinants of oral health (Watt and Fuller, p31 cited in Rogers 2011) The social determinants of Indigenous health18 also specifically include cultural and spiritual factors, family and community connections, connection to country, freedom from race-based discrimination and the historical context of land dispossession, the stolen generation, social exclusion, legislations and policies of protection and assimilation. By understanding and addressing the social determinants of Indigenous health the Aboriginal concept of health is recognised and includes the social, emotional and cultural well-being of the whole community, not just physical well-being, through a whole-of-live view and the cyclical concept of life-death-life16. Oral health inequality In a recent evidence-based review Rogers explains that oral disease and oral hygiene behaviours is often associated with socio-economic disadvantage14. Care must be taken when making these assumptions as population data may not properly distinguish between Indigenous people living in urban, rural or remote environments and areas with low population density and low proportions of Indigenous people. However, this may indicate an association between poorer oral health status for Indigenous Australians and social and economic disadvantage. P a g e | 27 Risk and protective factors The major behavioural risk factors for oral disease include tobacco smoking, dietary intake high in sugar, acid and alcohol, injuries, poor oral hygiene and timely visits to professional dental care services.14 Historically Aboriginal children were considered to have good oral health with little or no oral disease18,14,19. Since the arrival of Europeans in Australian in 1788 lifestyle practices and the dietary intake of many Indigenous Australians has changed dramatically9. Traditional diets high in fibre and protein have been largely replaced with cariogenic foods that are rich in refined and fermentable carbohydrates9 (sugary foods). Gunditjmara people living in the Glenelg and Southern Grampians Shire may also have elevated risk of poor dental health outcomes due to limited fluoridation levels in the public water supply. Fluoridation is considered to be a cost-effective way of preventing dental decay9,19. Fluoridation of water supplies varies, with fluoride occurring naturally in Portland’s water supply but not in other major towns such as Heywood and Hamilton. Other areas may be reliant on tank water with no or minimal fluoridation. These differences in levels of water fluoridation are generally implicated in caries levels. Fluoridation has been nationally recommended for small rural communities to prevent tooth decay12. ‘Poorer access to timely dental care resulting in either no care or care that is delayed until the disease process has reached an advanced stage and tooth extraction is required’ o Access to culturally appropriate dental care9 o Annual community visits by school dental service (it is unclear when the last visit was to the Southern Grampians & Glenelg catchment areas.) The availability and affordability of dental services can also contribute to the poor oral health outcomes for children18. These obstacles include long waiting lists for health care card holders, access to public dental services; excessive out of pocket costs for people on medium to low incomes and inadequate oral health specialists available in rural and remote areas.19 P a g e | 28 Although it is vital to maintain routine oral hygiene behaviours to prevent tooth decay9 this was not a traditional part of Indigenous lifestyles before European settlement. Appropriate oral health care includes frequent tooth-brushing with fluoridated toothpaste. A range of preventative factors contributes to oral health in childhood, including improved diet, oral hygiene, regular brushing and water fluoridation20. Oral health status All the above factors have led to increased risk and prevalence of dental decay and disease for Aboriginal and Torres Strait Islander people9. ‘Oral health problems faced by Indigenous peoples are worsening and require practical long-term solutions’21 Oral health issues for Aboriginal children now exceed levels for the general population22,23. They are more likely to have a higher prevalence and number of decayed teeth and tooth surfaces in deciduous and permanent teeth at all ages (past and/or present) 24 and an overall higher severity of decay9. Aboriginal children aged 6 years have been found to have an average of 3.7 teeth with caries compared to 1.5 teeth for their non-Indigenous counterparts23,25. Indigenous children and adults have lower level of fillings, suggesting that service utilisation was lower and proportion of untreated caries substantially higher9. They have a higher prevalence of missing teeth and lower age pattern of hospitalisation for dental care and extraction25,9. Although data sources are largely incomplete and are not nationally representative, smaller geographical studies have found an average difference of twice the level of tooth decay (caries) in both deciduous and permanent dentition and higher levels of untreated oral diseases compared to non-Aboriginal children27,26 ,25,23,9. There is no comprehensive statistical data on the oral health status of children in the Southern Grampians & Glenelg catchment28. Data recorded under the School Dental Program uses very small sample sizes of under 60 children per local government area29 and does not identify Aboriginal status. P a g e | 29 Dental conditions were rated in the top-ten Ambulatory Care Sensitive Conditions for the catchment, with the 2nd and 3rd highest rates per 1000 persons for the Southern Grampians and Glenelg Shires respectively15. ‘The recent Child Dental Health Survey showed that dental caries experienced in Aboriginal children in consistently higher, in on the rise and more extensive destruction of deciduous teeth occurs when compared to non-Aboriginal children. In 2010 the Victorian Department of Education and Early Childhood Development released a report on the health of Aboriginal Children in Victoria It stated that 38% of Aboriginal children aged 0-14yrs have teeth & gum problems, only 39% brush twice a day or more and 30% have never visited a dentist30. P a g e | 30 References 1 Weir JK. The Gunditjmara land justice story. Canberra; Native Title Research Unit, Australian Institute of Aboriginal and Torres Strait Islander Studies: 2009. 2 Oral health comparisons between children attending an Aboriginal health service and a Government school dental service in a regional location. EJ Parker, LM Jamieson. University of Adelaide School of Dentistry Published 02 May 2007 available from: http://www.rrh.org.au 3 A brief review of indigenous Australian health as it impacts on oral health Nicole martin-Iverson, Andrea Phatouros, Marc Tennant, Australian Dental Journal 1999; 44(2):88-92 4 Indigenous Australian dental health: A brief review of caries experience. Nicole martin-Iverson, Tom Pacza, Andrea Phatouros, Marc Tennant Australian Dental Journal 2000; 45 ;( 1): 17-20 5 Dental self-care and dietary characteristics of remote-living Indigenous children.4 LM Jamieson, RS Bailie, M Beneforti, CR Coster, AJ Spencer. Australian Research Centre for population oral health, The University of Adelaide, 6 Red Lotus Health Promotion Model Values and Principles Lilly O’Hara and Jane Gregg] 7 World Health Organisation 8 National Advisory Committee on Oral Health. Healthy mouths healthy lives: Australia’s National Oral Health Plan 2004-2013. Adelaide: Australian Health Ministers’ Conference and Government of South Australia. 9 Williams S, Jamieson L, MacRae A, Gray C. Review of Indigenous Oral Health. Australian Indigenous HealthReviews No. 7 April 2011. Australian Indigenous HealthInfoNet. 10 Commission on Social Determinants of Health. Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva; World Health Organisation: 2008. 11 Victorian Government Department of Human Services (DHS). Improving Victoria’s oral health. Melbourne; DHS: 2007. 12 Commonwealth Department of Health and Ageing. National Aboriginal and Torres Strait Islander Oral Health Workshop Report. Canberra; Commonwealth Department of Health and Ageing: 2003. 13 Australian Institute of Health & Welfare (AIHW), Dental Statistics and Research Unit, Jamieson L, Armfield J, Roberts-Thomson 2007. Oral health of Aboriginal and Torres Strait Islander children, Dental Statistics and Research Series No. 35. AIHW Cat. No. DEN 167. Canberra; AIHW: 2007. 14 Rogers JG. Evidence-based oral health promotion resource. Melbourne; Prevention and Population Health Branch, Government of Victoria, Department of Health: 2011. 15 Southern Grampians and Glenelg Primary Care Partnership, Population Health and Wellbeing Report 2009 16 Victorian Health Promotion Foundation (VicHealth). Life is health is life. Taking action to close the gap. Victorian Aboriginal evidence-based health promotion resource. Carlton: Victorian Government Department of Health and Vic Health: 2011. 17 Commission on Social Determinants of Health. Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva; World Health Organisation: 2008 18 Mungabareena Aboriginal Corporation and Women’s Health Goulburn North East (WHGNE). Using a health promotion framework with an ‘Aboriginal lens’. Making two works work. Wodonga; Mungabareena Aboriginal Corporation & WHGNE: 2008. 19 Jamieson LM, Armfield J, Roberts-Thomson KE. Oral health of Aboriginal and Torres Strait Islander children. Canberra; Australian Institute of Health and Welfare: 2007. 19 Barrett MJ. Features of the Australian Aboriginal dentition. Dental Magazine and Oral Topics. 1968; 85:15-18. P a g e | 31 20 Ehsani JP, Bailie R. Feasibility and costs of water fluoridation in remote Australian Aboriginal communities. BMC Public Health 2007;7…. 21 Campbell TD. Food, food values and food habits of the Australian Aborigines in relation to their dental conditions. Part V. Dental tooth decay. Australian Dental Journal 1939; 43:177-98. 22 Roberts-Thomson K. Oral health of Aboriginal Australians. Australian Dental Journal 2004; 49:151-3. 23 Roberts-Thomson KF, Spencer AJ, Jamieson LM. Oral health of Aboriginal and Torres Strait Islander Australians [Addressing Diseases of Disadvantage – Editorial]. Medical Journal of Australia 2008; 188(10); 592-3 24 Brennan DS, Roberts-Thomson KF, Spencer AJ. Oral health of Indigenous adult public dental patients in Australia. Aust Dent J 2007; 52: 322328. 25 Jamieson LM, Armfield JM, Roberts-Thomson KF. Oral health of Aboriginal and Torres Strait Islander children. Canberra: Dental Statistics and Research Unit, Australian Institute of Health and Welfare, 2007. (AIHW Cat. No. DEN 167; Dental Statistics and Research Series No. 35.) 26 Cooper MH, Schamschula RG, Craig GG. Caries experience of Aboriginal children in the Orana Region of New South Wales. Australian Dental Journal 1987; 32:292-94. 27 Davies MJ, Spencer AJ, West, Water A, Simmons B. Dental caries among Australian Aboriginal, non-Aboriginal Australian-born, and overseasborn children. Bulletin of the World Health Organisation 1997; 75:197-203. 28 Willder S, Nelson J, Gray R. Research advice by Professor Morgan M and Associate Professor Marino R Oct 2011.“Indigie Grins” Dental Health Services project number 4/2010 29 Dental Health Services Victoria Clinical Analysis & Evaluation Unit cited in DHS 2009 30 Oral Health and Denticare National Health Reform: the VHA view February 2010 P a g e | 32 Appendix Oral Health Family Tip Cards – Order Form It is estimated that print runs will be 3oth September and 31st March each year depending on demand. Item name Quantity Total cost Drink Well Family Tip Sheets (min 100$30.00) Eat Well Family Tip Sheets (min 100$30.00) Brush Well Card size: 10cm x 21cm Total cost of order: $.................. (Cost correct as of May 2012) Family Tip Sheets (min 100$30.00) (Includes GST) Name of Organisation: Contact person: Address: Email: Phone: Please send order to: Portland District Health Health Promotion Unit 33 Otway Street, Portland, Victoria, 3305 Or email to: [email protected] Phone enquiries: (03) 55221198 Your organisation will be emailed or faxed an invoice on receipt of your order.