chronic disease in multicultural queensland 08 09

8/12/2019 Chronic Disease in Multicultural Queensland 08 09

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Social Development Committee Inquiry

Submission addressing Chronic Disease in Queensland

The Ethnic Communities Council of Queensland (ECCQ) welcomes theopportunity to give input to the Social Development Committees inquiry intochronic disease in Queensland

ECCQ was esta!lished in "#$% to represent the interests of the many peoplefrom culturally and linguistically diverse !ac&grounds (C'D) who are part ofthe !road social community of Queensland and to promote multiculturalism

ECCQ is a voluntary not*for*profit community*!ased State pea& !ody with aStatewide focus and through affiliation with the Can!erra*!ased +ederation ofEthnic Communities Councils of 'ustralia (+ECC') contri!utes to national

policy and de!ate on all matters concerning ethnic communities andmulticulturalism

+or the last two years ECCQ has run a funded chronic disease programunder the 'ustralian ,etter -ealth .nitiative specially tailored to people ofdiffering cultural and linguistic !ac&grounds This su!mission draws on thate/perience e/pertise and findings

ECCQ would !e happy to provide any further information the Committee mayrequire or to provide further evidence in person if the Committee intends tohold any pu!lic hearings

0ours sincerely

Agnes Whiten OAMChairpersonECCQ


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Some background information on ECCQs Chronic Disease Preventionand SelfManagement Program for culturall! and linguisticall! diverse

"o"ulations#

ECCQs Chronic Disease Program for CA$D Communitiesis a three*yearprogram which commenced in 122$ .t is funded !y Queensland -ealth underthe Queensland Chronic Disease .mplementation Strategy 1223*12"3

%he main ob&ectives of the Program are to'

Enhance capacity of 456 sector to implement the strategy in a

culturally*appropriate manner Ensure coordination of regional and local level activities so resources

are shared Develop &ey indicators and measures in the 456 sector using

ethnicity*related data .dentify gaps and inefficiencies in service delivery

.n order to achieve the a!ove o!7ectives ECCQ8s Chronic Disease 9rogramhas had to develop an integrated cross*sector approach to chronic diseaseprevention and management at the state*wide level which then lin&s andsupports wor& at the regional and local levels !etween different partnersincluding:

Queensland -ealth 5eneral 9ractice Divisions

Community*Controlled -ealth Services Community -ealth 'gencies

;ulticultural Service 'gencies

%he Programs strategies are'

To develop a Chronic Disease Self*;anagement strategic plan that isappropriate to the needs of C'D communities across the State

To esta!lish a networ& of !ilingual community health promoters withthe capacity to support people with chronic diseases and their carers inthe community

To provide !ilingual health and


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(m"lementation of the Program also includes a range of sessions run b!multicultural communit! health )orkers on to"ics such as'

Chronic Disease Education Sessions

Culturally Tailored Healthy Eating Sessions

Physical Activity Sessions Measure Up Campaign Asthma Action Plan Eat Well Be Active or Bosnian Community

Chronic Disease in !ueensland"s CA#D population $ %esearch &ithBond University Medical School

*e"onses to issues raised in the (n+uir!s %erms of *eference

What ne) "rograms should be ado"ted to hel" Queenslandcommunities embrace healthier lifest!les,

The 'ustralian .nstitute of -ealth and =elfare states 122%:

Australia has one o the largest proportions o immigrant populations in the&orld' &ith an estimated ()* o the total population +),-. million people/ 0ornoverseas, Well over hal +.1*/ o these $ one in seven Australians $ &ere0orn in a non$English spea2ing country,

;igrants have certain health factors and diseases li&e all other 'ustralians

Due to language !arriers and possi!ly cultural differences and race*relatedpre*dispositions the hypothesis is that providing health care in a tailor*madeway will result in !etter health outcomes in these culturally and linguisticallydiverse (C'D) communities

Chronic disease is a current and growing challenge for national and statehealthcare systems 'ccording to CDC >S' 122? the world is facing anepidemic of unparalleled proportions The prevalence of chronic diseases inmigrant populations is widely recognised ('!ate and Chandalia 122?@ ,all etal 122"@ '.-= 122%a@ ,ischoff and =anner 122A) ,all et al referred to theprevalence of renal disease in the >B .ndo*'sian community as an

epidemic

=hile chronic diseases are widespread in 'ustralian society large inter*individual inconsistencies e/ist in their prevalence and outcomes Chronicdiseases are most prevalent in older and disadvantaged population groups6ne of the si/ target groups in the Queensland Chronic Disease Strategy1223*12"3 are people from C'D !ac&grounds

There are difficulties and comple/ities in delivering effective health services tonon*English spea&ing !ac&ground populations !ecause cultural and language!arriers impede the identification targeting and delivery of health services
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's a result C'D populations often e/perience a higher !urden of disease ata systemic level such as lac& of access to services and lac& of appropriateinformation to ma&e informed decisions impacting significantly on their healthand quality of life

The health of culturally and linguistically diverse populations in Queenslandand 'ustralia is not monitored systematically and very limited data isavaila!le

The perception of health and ill health is significantly different amongstdifferent cultural groups determined !y their cultural !eliefs and concepts ofhealth

+urthermore it has !een found that people from C'D !ac&grounds are lessli&ely to rate their health as e/cellent or very good when compared to other'ustralians (Queensland -ealth 122F)

.n addition the mor!idity patterns differ across regions +or e/ample people!orn in the South 9acific region the ;iddle East


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To develop cultural competency a system needs to:

value diversity

have the capacity for cultural self*assessment

!e conscious of the dynamics that occur when cultures interact

institutionalise cultural &nowledge@ and

adapt service delivery so that it reflects an understanding of the

diversity !etween and within cultures

,ased on these findings ECCQs Chronic Disease 9rogram has developed a

;ulticultural Community -ealth =or&er (;C-=) model in chronic diseaseprevention and self*management which ensures cultural appropriateness andacceptance in any health services delivered to these target populations

's highlighted in the worldwide literature review conducted !y Queensland-ealth ,ond >niversity ;edical School and ECCQ ;C-=s have differenttas&s in different settings Such tas&s can include direct individual contact withpatients group education or supporting health care professionals ;C-=sachieve positive outcomes in several ways:

" increased participation of C'D populations in health programs

1 improved communication with the C'D populations and !etter

transfer of information (education)

? supporting health care professionals in esta!lishing !etter relationships

with C'D populations

F gaining trust !ecause of shared language nation of origin migration or

refugee e/periences

3 cultural ha!its and &nowledge

% understanding of medical concepts and terminology

'merican research (Kerrant Lon +riederichs*+itMwater ;oore 1223)elicitsperceived !arriers to active self*management Depression weight pro!lemsand o!esity difficulty e/ercising fatigue poor physician communication lowfamily support pain and financial pro!lems were the most frequently noted!arriers to active self*management


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6!viously communication is a ma7or pro!lem and this is a clear issue inchronic disease self*management in C'D populations as well .n itselfCDS; programs are effective in populations of different !ac&grounds

Hesearch in -ong Bong (Siu Chan 9oon Chui 122$) shows that CDS;

delivered to C'D populations is 7ust as effective as when it is delivered toother populations Hesearch in Lictoria (Swerrisen ,efrage =ee&s Kordan=al&er +urler ;c'voy Carter 9eterson 122%) also shows that CDS;programs can !e delivered effectively to C'D populations

What enhancements can be made to service deliver!- "articularl!im"rovements that foster coordinated a""roaches and )hich focus on"revention and earl! intervention,

;ost of the current investment into Queenslands significant C'D populationis directed towards short*term funding This is highly pro!lematic as

addressing chronic disease requires long*term change especially with themore disadvantaged communities which includes many C'D communities

,ased on the availa!le literature review conducted !y ECCQ and Queensland-ealth culturally adapted programs are not only effective !ut also it isincreasingly evident necessary

These education programs will lead to less pressure on the health caresystem with essentially the same health status outcomes The efficacy ofprograms depends not only on the specific population !ut also on the conte/tof the targeted population

This is especially the case for some C'D communities dependant on theirhealth literacy levels and English language proficiencies which often need to!e improved !efore some of the general chronic disease issues can !eeffectively addressed

Hecognising C'D issues does not mean one single strategy for all C'Dgroups along the lines of (for e/ample) youth rural


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The contri!utions of hospitalisation episodes from C'D populations to thehospitalisation !urdens for cardiovascular diseases (European 4orth 'fricanand !orn in Central or South 'merica) and dia!etes mellitus (people !orn inthe 'mericas and the ;iddle East) is greater than that from the 'ustralian*!orn population

-ospitalisations for renal failure are a ma7or factor in the !urden ofhospitalisations This can !e e/plained !y the fact that patients with renalfailure utiliMe hospital services on a regular !asis (in some cases daily)

.t is li&ely that the high num!er of episodes in the data!ase is contri!uted !y alimited num!er of patients

The strong representation of patients !orn in 'sia and 6ceania in thisdiagnosis group needs further e/ploration -ypertension dia!etes andidiopathic &idney diseases are thought to !e the main contri!utors to this

phenomenon -ypertension and dia!etes are particularly suita!le targets forearly intervention strategies in these vulnera!le populations

The high !urden of end*stage renal disease could also !e lin&ed to availa!leand accessed health services in the earlier stages of chronic renal disease(9ugsley 1223) This needs to !e investigated in further detail to providerecommendations for improvement of health service delivery

-ospitalisations for cardiovascular diseases occur more frequently inimmigrants !orn in 'frica South and Central 'merica and Europeancountries

.t is &nown from the literature that !lac& 'fricans have high incidence rates ofhypertension and cere!rovascular diseases such as stro&e (6pie 1223) Theslightly higher episode rate in European*!orn immigrants compared to'ustralian*!orn patients needs further investigation

The literature reports an increasing trend in the incidence of dia!etes in 'sianpopulations often related to increasing ris&s of o!esity and changes oflifestyle (Coc&ram 1222)

Early detection and prevention of dia!etes in at*ris& immigrant populationsmight prove to !e an effective strategy to reduce the !urden ofhospitalisations for cardiovascular diseases and end*stage renal failure

The data show that immigrants from C'D regions are hospitalised mostly inthe larger ur!an areas This means that it is useful to target interventionsaimed at C'D populations in the ur!an centres

C'D matters should always !e responded to as part of overall populationhealth strategies This should not !e perceived as as&ing for specialtreatment !ut rather to ensure equity of outcome for everyone


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C'D*related research in this area has 7ust started to !e recognised asimportant@ however much more needs to !e done to ensure research onhealth issues for the population as a whole includes sufficiently large C'Dsamples to !e statistically significant

Deriving assessments or conclusions from samples that are not large enoughto !e statistically significant runs the ris& of generating misleading or incorrectassumptions which is worse than having no information at all

Hesearch on C'D strategies also has to include C'D issues in regionalareas including the capacity of services in regional and rural areas to addressC'D issues and needs

What "rograms should be ado"ted to encourage children and !oung"eo"le to develo" and maintain individual res"onsibilit! for their o)nhealth and )ellbeing throughout their adult lives,

Hesearch !y the Centre for Culture Ethnicity N -ealth shows there is a widelyheld view that C'D communities have traditionally !een under*representedin physical activity programs

.mportantly the 4ational -ealth Survey Summary in 122" reported thatpersons !orn in Southern and Eastern Europe 4orth 'frica and ;iddle Eastreport lower level of physical activity as well as persons !orn in 'sia

Some of the feed!ac& given !y community mem!ers includes a view thatmany C'D youth have difficulty accessing sporting and other facilities andthey have pro!lems meeting the cost of using these spaces including pu!liclia!ility issues+rom our consultations with nine ethnic communities ('ra!ic spea&ing,osnian +ilipino 5ree& .ndian Samoan Spanish spea&ing Sudanese andLietnamese) it is apparent that having culturally appropriate programs run !ytrained multicultural health wor&ers wor&ing in partnership with healthprofessionals is an essential element to ensure C'D people participate in and have equal access to participate in physical activity and healthy lifestyleprograms (ECCQ 9hysical 'ctivity Heport 122#)

chronic disease in multicultural queensland 08 09

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