Mr Frank Chief Executive Officer Australian Medical Council Limited PO Box 4810 Kingston ACT 2604 Dear Mr Frank AMC assessment on the education and training of Obstetricians and Gynaecologists

AIDA welcomes the opportunity to table a submission to the AMC assessment on education and training pathways and continuing professional development programs in obstetrics and gynaecology provided by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). The Australian Indigenous Doctors’ Association (AIDA) is the peak body representing Aboriginal and Torres Strait Islander doctors and medical students and advocates for improvements in Aboriginal and Torres Strait Islander health. AIDA works to achieve parity of Indigenous health professionals across the health sector, and works to shape a health system that is culturally safe, high quality, reflective of need and which respects and incorporates Aboriginal and Torres Strait Islander cultural values. In relation to medicine, the positive effects of Indigenous doctors for Indigenous peoples’ physical, emotional and cultural wellbeing have long been recognised by government and by other Indigenous and non-Indigenous stakeholders1

. There are around 80,000 doctors and around 175 of those are Aboriginal and Torres Strait Islanders. In terms of reaching parity we are looking at around 2000 additional Indigenous doctors. There are currently around 230 Aboriginal and Torres Strait Islander medical students.

AIDA is represented on approximately fifty government and non-government health, education and workforce groups, including the National Health Leadership Forum, the Close the Gap Indigenous Health Equality Steering Committee and a range of other Medical College groups. In doing so, AIDA is informed by a number of declarations which specify the value in and need to respect Aboriginal and Torres Strait Islander knowledges, systems and frameworks2

. These national and international covenants provide a framework to build equitable, sustainable and appropriate access to health services working toward the attainment of improved physical, environmental, cultural, social and emotional health and wellbeing outcomes.

Improving the health of Aboriginal and Torres Strait Islander people must be the responsibility and a priority of the medical workforce. A whole of sector approach needs to be adopted by the AMC leadership in recognition that all medical professionals have a responsibility to adapt their practice to improve patient engagement and health care

1 Minniecon D & Kong K (2005) Healthy Futures Defining best practice in the recruitment and retention of Indigenous medical students. AIDA, Canberra. 2 Declaration on the Rights of Indigenous Peoples (2007) http://social.un.org/index/IndigenousPeoples/DeclarationontheRightsofIndigenousPeoples.aspx

outcomes. This includes having knowledge of and respect for the cultural needs of Indigenous patients, and acknowledging the socioeconomic and cultural factors influencing the health of Aboriginal and Torres Strait Islander people3

.

AIDA recommends the AMC to adopt a more proactive, holistic, consultative and engaged approach to achieving their purpose, particularly around activities and outcomes affecting Aboriginal and Torres Strait Islander people. Importantly, given the health disparity between Indigenous and non Indigenous peoples, Aboriginal and Torres Strait Islander peoples should be at the front and centre of the purpose of the AMC “to ensure that standards of education, training and assessment of the medical profession promote and protect the health of the Australian community4

”.

Collaboration across the medical education and training continuum AIDA has formal partnerships with the national bodies responsible for the medical education and training of doctors from entry to medical school, through the junior doctor years, into speciality training and fellowship. We work closely with Medical Deans Australia and New Zealand and the CPMC to ensure that the medical education and training system is inclusive of Indigenous health content, is culturally appropriate and recruits, supports, mentors and graduates Aboriginal and Torres Strait Islander people into medicine and medical specialities. The partnership between AIDA and the Medical Deans commenced in 2005 and is widely recognised both internationally and domestically as exemplar. The most recently signed Collaboration Agreement between AIDA and CPMC5

provides an agreed framework to work with the Colleges over the next three years. AIDA encourages RANZCOG utilising the document as an overarching guiding framework when progressing Indigenous health matters.

Collaboration across the medical education and training continuum With collaboration comes shared responsibility, and increased levels of leadership within the medical workforce are required. AIDA has formal partnerships with the national bodies responsible for the medical education and training of doctors from entry to medical school, through the junior doctor years, into speciality training and fellowship. We work closely with Medical Deans Australia and New Zealand, the Confederation of Postgraduate Medical Councils and the CPMC to ensure that the medical education and training system is inclusive of Indigenous health content, is culturally appropriate and recruits, supports, mentors and graduates Aboriginal and Torres Strait Islander people into medicine and medical specialities. These collaboration agreements are underpinned by the following principles: • Acknowledgement of the sovereignty of Aboriginal and Torres Strait Islander

peoples and their self determination, ongoing relationship with land and cultural continuity;

• Mutual regard and respect; • Inclusive consultation and decision making processes; • Valuing each others’ unique contributions; and • Cultural safety for all peoples in all spheres, with an understanding of the issues

for Aboriginal and Torres Strait Islander peoples.

3 Australian Medical Council. Good medical practice: a code of conduct for doctors in Australia. http://www.amc.org.au/images/Final_Code.pdf 4 Australian Medical Council http://www.amc.org.au/index.php/about 5 AIDA and CPMC Collaboration Agreement (2013) http://www.aida.org.au/cpmc.aspx

AIDA and CPMC Collaboration Agreement The signing of this Collaboration Agreement in July 2013 formalises collaborative efforts to: • train more Aboriginal and Torres Strait Islander medical specialists. • improve ways in which medical specialists work with Aboriginal and Torres Strait

Islander people. • mentor future Aboriginal and Torres Strait Islander leaders in medicine. This Collaboration Agreement6

sets key priorities agreed to by all Medical Colleges over the next three years, areas of work include:

• Establishing targets for Aboriginal and Torres Strait Islander Registrars and Fellows.

• Negotiate with the AMC for the inclusion of specific standards to address Aboriginal and Torres Strait Islander health.

• Develop joint position statements, media engagement and advocacy initiatives. • Ensure that College wide Aboriginal and Torres Strait Islander identification data is

collected and reported. AIDA asserts that if all fellows of RANZCOG developed a deeper understanding of the social determinants of Indigenous women’s health issues it would assist in improving Indigenous health outcomes. The responsibility to ensure registrars and fellows have the knowledge, attributes, understanding and skills to competently deliver effective health care to, with and for Aboriginal and Torres Strait Islander women, families and communities needs to be collectively shared within the College. At the same time, attention needs to focus on attracting and retaining Indigenous doctors to train with the College. Leading the way AIDA encourages the College to consider the education and training recommendations outlined in the National Aboriginal and Torres Strait Islander Medical Specialist Framework for Action and Report. Following on from the report, the CPMC has taken lead role in implementing the National Aboriginal and Torres Strait Islander Medical Specialist Project hosted by the Royal Australasian College of Surgeons working in collaboration with AIDA. For further information on this project visit http://cpmc.edu.au/natsim/. The Council of Presidents of Medical Colleges (CPMC) Indigenous Health Subcommittee (IHC) is co-chaired by Dr Maria Tomasic representing the CPMC and myself as AIDA President. The purpose of this Subcommittee is to lead the Indigenous health agenda on behalf of all colleges and the IHC’s objectives are to:

• increase the number of Indigenous doctors and medical specialists; • develop mentoring and other programs to support Indigenous medical students

and doctors in training; • enhance training in Indigenous health for doctors; and • establish collaborative cross-College projects designed to address the gap in

Indigenous life expectancy.

6 AIDA and CPMC Collaboration Agreement (2013) http://www.aida.org.au/cpmc.aspx

AIDA and RANZCOG The RANZCOG reaccreditation submission (March 2013) acknowledges that ‘formal interactions with community and consumer representative agencies are at a relatively low level’ (page 24). To date AIDA has had very limited liaison with the College providing: • AIDA letter to RANZCOG regarding the RANZCOG training review March 2011.

http://www.aida.org.au/pdf/submissions/Submission_16.pdf (attachment one) • AIDA submission to the inquiry into Foetal Alcohol Spectrum Disorder April 2012.

http://www.aida.org.au/pdf/submissions/Submission_19.pdf (attachment two)

AIDA welcomes the opportunity to discuss ways in which we can collaborate. There is scope for the College and AIDA to work together in the design, planning, implementation and evaluation of medical education and training and continuing professional development programs to progress the health and well being needs of Aboriginal and Torres Strait Islander women. Further, AIDA is pleased to provide the following feedback for the AMC and RANZCOG’s consideration and development.

Effective ways of working

Where these strategies are not already in place, AIDA recommends the College to consider these practices where possible:

• Experience based learning activities and clinical placements in Aboriginal and Torres

Strait Islander health settings and services inclusive of resources to support the activity. • The establishment and support of formal internal collaborative working partnerships and

groups. • A whole of College approach, incorporating a shared and distributed leadership model,

eg the development of policy statements on Indigenous women’s health issues. • The correlation between Indigenous health and wellbeing and cultural safety is well

understood, valued and understood across the College. • The integration of clinical science/medicine and Indigenous health content. • Cultural immersion, some cultural awareness programs, and reflective learning activities. • Equip registrars with the skills to understand the historical and socio-cultural context in

which health issues occur, and who practice in a culturally safe manner in their encounters with Aboriginal and Torres Strait Islander people.

• Curriculum is updated and reviewed with input from Aboriginal and Torres Strait Islander representative/s.

• Indigenous health studies are examinable.

Areas requiring focused development AIDA encourages the College to incorporate the following to add to and strengthen RANZCOGs existing strategies:

• Dedicated time to effectively implement Indigenous health content. • Increase vertical integration and improve continuity of Indigenous health content. • Develop the capacity of the College to provide quality Indigenous health learning in

clinical contexts. • Indigenous health content to be user friendly to increase engagement, impact and

ongoing use of material and resources.

• Develop opportunities for personal insight development regarding culturally unsafe practices. Opportunities can be integrated into education and training and continuing professional development programs.

• Shared leadership roles within the College to effectively develop and integrate high level goals as well as specific Indigenous medical education and training initiatives.

• Prioritise strategies and initiatives that ensure that registrars, both Indigenous and non-Indigenous, and College staff are culturally safe and provide optimal education and employment environments for Aboriginal and Torres Strait Islander people.

• The development of case studies using the social determinants of health model, which promotes holistic and strengths based perspectives. Caution is recommended against pathologising and problematising individuals, it can lead to negative stereo-typing if not seen within a holistic framework addressing issues of power, environment, social, cultural and political aspects of health.

• Promotion of research projects being undertaken in Aboriginal and Torres Strait Islander health.

• Incorporate Aboriginal and Torres Strait Islander specific standards in the assessment and accreditation of RANZCOG education and training programs.

• The development of planning and consultation mechanisms with Indigenous organisations, including AIDA, on RANZCOG policies, standards and guidelines.

• RANZCOG prioritise the implementation of the AIDA CPMC Collaboration Agreement within the College context.

• Evaluation activities. For example, registrars baseline knowledge of Aboriginal and Torres Strait Islander health issues could be undertaken at the beginning, middle and end of their program to assess their knowledge, skill base and confidence levels in applying theory to real world situations.

AIDA would be pleased to discuss ways in which we can work together to support current Indigenous registrars and to encourage our members to consider undertaking a fellowship with the RANZCOG. Along with this submission, the priority areas outlined in the CPMC Collaboration Agreement provide a platform to discuss and explore other issues of common interest. Please contact Mr Romlie Mokak, AIDA Chief Executive Officer by email Romlie@aida.org.au or phone on 02 6273 5013. Yours sincerely

Dr Tammy Kimpton President 12 August 2013

Dr Ted Weaver Chair Training Program Review Working Party Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) College House 254 – 260 Albert Street East Melbourne VIC 3002 Dear Dr Weaver Thank you for your letter dated 14 January 2011, inviting the Australian Indigenous Doctors’ Association (AIDA) to comment on the RANZCOG Training Program Review. Introduction AIDA is a not-for-profit, non-government organisation dedicated to the pursuit of leadership, partnership and scholarship in Aboriginal and Torres Strait Islander health, education and workforce. There are approximately 150 Indigenous medical graduates and 160 Indigenous medical students in Australia. As Indigenous medical practitioners, we offer a special combination of clinical and cultural competence and expertise, and have a unique and central role in advocating for, and improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples. We are keen to ensure that the needs of Indigenous communities and their respective health needs are articulated, protected, advocated for and respected. AIDA is represented on approximately fifty government and non-government health, education and workforce groups, including the National Indigenous Health Equality Council, the Close the Gap Indigenous Health Equality Steering Committee, as well as a range of Indigenous Health Committees (Australian Medical Association (AMA), Royal Australasian College of Physicians (RACP), Royal Australian College of General Practitioners (RACGP), Royal Australian and New Zealand College of Psychiatrists (RANZCP), Royal Australasian College of Surgeons (RACS). We work closely with Medical Deans Australia and New Zealand, the Committee of Presidents of Medical Colleges and the Australian Medical Council to ensure that the medical education and training system is inclusive of Indigenous health content, is culturally appropriate and recruits, supports and graduates Aboriginal and Torres Strait Islander people into medicine and medical specialties.

The health of Indigenous mothers and their babies The poor health of the Indigenous population in Australia is well documented. Some issues relating to the relatively poor health of Indigenous mothers and their babies is outlined below:

• Aboriginal and Torres Strait Islander babies continue to experience poor perinatal outcomes, thereby compromising their developmental wellbeing. Indigenous perinatal statistics remain at twice that of the non-Indigenous population for rates of preterm birth, low birth-weight and perinatal mortality.1

• Birthweight and prematurity contribute directly to the higher death rate among

babies of Aboriginal and Torres Strait Islander women. Aboriginal and Torres Strait Islander women tend to have more babies and have them at younger ages than non-Indigenous women. The peak age group for births to Indigenous women was 20-24 years compared with 30-34 years for all women; the birth rate among teenage Indigenous women was more than four times the rate for all teenage women 2,3.

• In the period 2001-2004, the total per cent of low birth weight babies (less

than 2500g) to Indigenous mothers was 13%4. Risk factors for low birth weight include socioeconomic disadvantage, the size and age of the mother, the number of babies previously born, the mother’s nutritional status illness during pregnancy and the duration of the pregnancy. A mother’s alcohol consumption and use of tobacco and other drugs during pregnancy can also impact on the size of her baby. Tobacco, in particular, has a major impact on birthweight5.

• In the period 2001-2004, the total per cent of preterm births (less than 37

weeks) to Indigenous mothers was 14%6.

• In Australia in 2003-2005 six (10%) of the 60 maternal deaths where Indigenous status was known were of Indigenous women (Indigenous status was not reported in 8% of the deaths). Reflecting the higher rate of confinements, the maternal mortality ratio for Indigenous women in 2003-2005 was 21.5 deaths per 100,000 confinements, almost three times higher than the ratio of 7.9 per 100,000 for non-Indigenous women For direct maternal deaths, the ratio for Indigenous women was 7.2 per 100,000 compared with 3.6 per 100,000 for non-Indigenous women.7

1 Australian Bureau of Statistics (2007) Births 2006, Australian Bureau of Statistics, Canberra.

1 ABS-AIHW (2008), The Health and Welfare of Australia’s Aboriginal and Torres Strait

Islander 2 Australian Bureau of Statistics (2007) Births 2006, Australian Bureau of Statistics, Canberra.

3 ABS-AIHW (2008), The Health and Welfare of Australia’s Aboriginal and Torres Strait

Islander Peoples, Commonwealth of Australia, Canberra. 4 AIHW (2005), Indigenous mothers and their babies: Australia 2001-2004, AIHW, Canberra.

5 Australian Indigenous HealthInfoNet (2008), Births and pregnancy outcome,

http://www.healthinfornet.ecu.edu.au/html/html_overviews/overviews_our_births.htm 6 AIHW (2005), Indigenous mothers and their babies: Australia 2001-2004, AIHW, Canberra.

7 Burns J, Maling CM, Thomson N (2010) Summary of Indigenous women's health. Retrieved

[23 March 2011 from http://www.healthinfonet.ecu.edu.au/women-review

Feedback to the RANZCOG Training Program Review AIDA has consulted with those of our membership who have an interest in this area, and provide feedback as follows. The need for trainees to understand Indigenous women’s health issues

• The desired outcome of the RANZCOG training program is to produce O&G specialists who have an understanding of the health disparities in maternal health, as highlighted above, to understand the historical and socio-cultural context in which these health issues occur, and who practice their craft in a culturally safe manner in their encounters with Aboriginal and Torres Strait Islander women.

• It is our understanding that the trainees’ curriculum currently contains one

online module on “Culture & women’s health issues” which includes a small section on Aboriginal and Torres Strait Islander women. There is potential for this module to be significantly improved to provide a more comprehensive coverage of the health issues of Aboriginal and Torres Strait Islander women, particularly as these issues are very complex. The module needs to be user friendly for busy registrars so that they will effectively engage with it and gain a useful understanding of Indigenous health issues.

• We would strongly suggest that that any review and update of this module should be undertaken with the input of an Aboriginal and/or Torres Strait Islander person.

• Indigenous health issues should be examinable. If not, this gives give a message to trainees that it is not important.

• Well designed case studies can be an effective learning tool, but caution needs to be undertaken in avoiding a superficial and stereotypical understanding of the issues. Case scenarios that perpetuate negative stereotypes without examining underlying issues should be avoided. There is scope to present trainees with cases that challenge trainees’ thinking and perhaps preconceptions about Indigenous women’s issues, and that highlight a holistic approach to health care.

• Trainees’ baseline knowledge of Aboriginal and Torres Strait Islander women’s health issues should be considered in this context, and taken into account in reviewing the Indigenous health content of the curriculum. Knowledge should be vertically integrated from their medical school education. Questioning their depth of knowledge on entering the training program may help inform this process. For example, a question along the lines of "What do you know about health concerns specifically relating to Indigenous women in your surrounding community". Consideration should also be given to how Indigenous health issues can be better incorporated into the Fellowship CME, to again vertically integrate the Indigenous health knowledge base.

• We would encourage RANZCOG to explore opportunities for registrars to gain clinical experience working in the field of Aboriginal and Torres Strait Islander health, whether through Aboriginal Community Controlled Health Organisations, or placements in areas with a high proportion of Aboriginal and/or Torres Strait Islander population, e.g. outreach services to central Australia, Top End, Far North Queensland.

• As a research project is a compulsory component of training, trainees should be encouraged to consider projects in the field of Aboriginal and Torres Strait Islander health.

• We strongly encourage RANZCOG to consider how it may incorporate cultural competency training into its curriculum. There are examples RANZCOG could look to in other medical colleges, and this issue is being explored as part of the CPMC Indigenous health subcommittee (see section below).

RANZCOG representation on the Committee of Presidents of Medical Colleges (CPMC) Indigenous health subcommittee AIDA would like to draw to the attention of the reviewers, the Committee of Presidents of Medical Colleges (CPMC) Indigenous Health Subcommittee. The Subcommittee is co-chaired by AIDA President, Associate Professor Peter O’Mara and Professor Geoffrey Metz on behalf of CPMC. You will be aware that RANZCOG is represented by Dr Marilyn Clarke. The subcommittee has produced a report, National Aboriginal and Torres Strait Islander Medical Specialist Framework for Action and Report, attached. The report makes a range of recommendations, including those about curriculum and cultural competency:

� To develop a learning module or modules in Indigenous health, based upon the principles of vertical integration, using existing examples from General Practice and Psychiatry and consistent with recommendations from the Med Ed 2009 conference. The CDAMS National Indigenous Health Curriculum should be drawn upon here.

� To develop a training module to support AMC accreditation teams to

adequately assess College standards of cultural competence.

AIDA recommendations to the RANZCOG Training Program Review

• That Indigenous women’s health be given a higher priority within the RANZCOG training program as follows:

a) A separate and detailed training module for RANZCOG trainees; b) an Indigenous health professional be involved in its design; c) the module content is examinable.

• That the College facilitate opportunities for registrars to gain experience working in the field of Aboriginal and Torres Strait Islander health;

• That the College encourage research projects in the field of Aboriginal and Torres Strait Islander health;

• That the College be guided by the recommendations of the National Aboriginal and Torres Strait Islander Medical Specialist Framework for Action and Report, referred to above, with a view to increasing its recruitment of Indigenous fellows.

• That the College engage with the Australian Indigenous Doctors Association (AIDA) to discuss ways in which it might increase recruitment of Indigenous fellows.

In 2008, AIDA made a submission to the Maternity Services Review Board, to which we would like to draw to the attention of the College. The submission is attached, and can also be viewed at the AIDA website at: http://www.aida.org.au/pdf/submissions/Submission_9.pdf AIDA believes that in order to improve the highly unsatisfactory status of Indigenous women’s health that specialists need to have a better understanding of Indigenous maternal issues. In addition, developing the workforce by attracting more Indigenous doctors to train with the College would be an important step towards achieving this goal. AIDA would be pleased to discuss with the College, ways in which we could work together to encourage our members to consider undertaking fellowship with RANZCOG. For example, a number of Colleges have participated in AIDA Symposiums in recent years. If you have any questions in relation to the above, please do not hesitate to contact Mr Romlie Mokak, Chief Executive Officer, AIDA, (02 6273 5013) in the first instance.

Yours sincerely

Associate Professor Peter O’Mara President Australian Indigenous Doctors’ Association 31 March 2011

Mr Graham Perrett MP Committee Chair Committee on Social Policy and Legal Affairs House of Representatives PO Box 6021 Parliament House Canberra ACT 2600

Australian Indigenous Doctors’ Association (AIDA)

Submission in response to the inquiry into Foetal Alcohol Spectrum

Disorder (FASD) The Australian Indigenous Doctors’ Association (AIDA) welcomes the opportunity to comment on this inquiry and I appreciate the extension of time granted to AIDA to provide these comments. AIDA is the nation’s peak body for Aboriginal and Torres Strait Islander doctors and medical students, and advocates for improvements in Indigenous health in Australia. Currently, there are an estimated 160 Indigenous doctors and 218 Indigenous medical students in Australia. As Indigenous medical practitioners, we have a distinctive and central role in advocating for, and improving the health and wellbeing of Aboriginal and Torres Strait Islander people. AIDA recognises that FASD is the leading cause of intellectual disability in Australia. FASD has lifelong effects ranging from brain damage and growth development to social and behavioural problems, and significantly impacts on Aboriginal and Torres Strait Islander people and communities where rates of FASD are consistently higher1. Prevention The National Health and Medical Research Council Guidelines around alcohol and pregnancy recommend abstinence as the safest option for pregnant women2. AIDA would support this recommendation, given that safe levels of drinking during pregnancy have not been established. FASD may not just be related to 'excessive alcohol consumption' and education campaigns should reflect this. FASD among Aboriginal and Torres Strait Islander people must be addressed from a holistic perspective. Just as the physical, psychological, economic and societal impacts of FASD reverberate through families and communities, the causes of excessive drinking extend well beyond the circumstances of the individual. It is the product of a complex mix of interrelated socio-economic and cultural factors including dispossession and trans-generational grief, isolation, poverty and trauma.

1 Alcohol and Pregnancy Project (2009) Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder: a Resource for Health Professionals. Perth: Telethon Institute for Child Health Research. 2 National Health and Medical Research Council (2009) Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Canberra: Commonwealth of Australia. Page 67.

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A public health approach is required, that is primary, secondary, and tertiary prevention efforts. Key elements of this approach should include population level health promotion messages regarding alcohol, pregnancy and early childhood development as well as issue specific health literacy. At risk families and communities also need to be identified and followed up with tailored interventions across the life cycle, not just in the antenatal periods. Community ownership is critical and can be fostered through ongoing consultation and engagement. For example, the Marulu Project initiative is a community driven strategy in the Fitzroy Valley in Western Australia to address FASD. To ensure the project remains culturally appropriate and targeted, the community is engaged in every step through intensive consultation processes3. Education and awareness initiatives must also target health and medical professionals. Too often medical students and doctors aren't equipped to recognise, diagnose, and manage FASD especially at the less obvious end of the spectrum where signs and symptoms may be related to developmental delay or behavioural issues. Intervention Early recognition of FASD is critical to reduce the effects of long term damage. To encourage early recognition, there should be improved identification and diagnostic systems, specifically a uniform diagnostic tool that is adopted nationally. Once developed, there should also be formal training for both students and health professionals to use the diagnostic tool. Where women have been informed of the risks of drinking during pregnancy and have not acted on this advice; AIDA would encourage the committee to consider how best the health system can then assist these women with minimising the risk of excessive alcohol consumption to themselves and their unborn child. Education and training for health professionals working in the justice system in particular should be strengthened to ensure those affected by FASD are supported, managed and treated appropriately. Management Health services, community, employment, and education sectors should work collaboratively to support individuals and families affected by FASD. This cross- sector support could be delivered more efficiently if FASD is acknowledged as a disability. Health services for Aboriginal and Torres Strait Islander people, particularly those that include detoxification and rehabilitation, also should be accessible and enhanced to cater effectively for pregnant women and their families. Indigenous health workers are often well placed to facilitate consultation with community, and to design and implement strategies regarding health promotion and prevention of FASD. The wider health workforce needs to be clinically and culturally qualified to address FASD across the prevention, intervention and management spectrum.

3 J Latimer, E Elliott, J Fitzpatrick, M Ferreira, M Carter, J Oscar and M Kefford (eds) (2010) Marulu The Lililwan Project Fetal Alcohol Spectrum Disorders Prevalence Study in the Fitzroy Valley: A Community Consultation, The George Institute for Global Health.

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Recommendations:

1. Targeted education campaigns for at-risk Aboriginal and Torres Strait Islander families and communities be developed and implemented in collaboration with local communities

2. Education campaigns adopt a whole of community responsibility approach

and incorporate underlying socio-economic factors contributing to Foetal Alcohol Spectrum Disorder

3. Education and awareness initiatives target health and medical professionals

4. A uniform diagnostic system be adopted nationally and formal training for

health professionals in its implementation

5. The need to develop initiatives/programs to identify, refer and provide treatment and care for women who are drinking during pregnancy

6. Foetal Alcohol Spectrum Disorder be acknowledged as a disability

7. Services for Aboriginal and Torres Strait Islander people be supported,

improved and be made more accessible for individuals affected with Foetal Alcohol Spectrum Disorder and their families and carers.

AIDA would welcome the opportunity to discuss this submission in further detail. The contact person in the AIDA Secretariat is Ms Leila Smith, on phone 02 6273 5013.

Associate Professor Peter O’Mara President 12 April 2012