At the risk of a gratuitous self-plug, the use of these medicines in young children was one of the issues of concern that Ray Moynihan and I highlighted in our book, Ten Questions You Must Ask Your Doctor (Allen & Unwin, 2008). We came across several references raising concerns about these products’ use in children when researching the book back in 2007.

So the TGA is certainly not rushing the jump.

Nonetheless, the move will be such a challenge to accepted practices that it will need to be backed by a long-term educational campaign. So argues Ron Batagol, a Pharmacy and Drug Information Consultant.

He writes:

“In a move that is likely to provoke much spirited debate amongst doctors, pharmacists and, most importantly, the parents and carers who look after the day-to-day health issues of  young children in their care, the Therapeutic Goods Administration (TGA) has given notice that it is intending to  “upschedule” over-the-counter cold and cough products to Prescription Only for children under six years and Pharmacist Only for children aged between six and 12 years.

As part of the upscheduling exercise, the TGA has also recommended cough and cold medicines should not carry dosage instructions for children under six years old. The TGA says that this approach would bring the regulation of cough and cold preparations in Australia into line with measures in place in the UK and Canada.

After extensive  internal and external reviews of the evidence surrounding both  efficacy and safety in use, the proposed changes are stated by TGA to have been made ” in light of the current lack of evidence of efficacy and the historical profile of adverse drug reactions (ADRs) in Australia and overseas”.

It is certainly true, that the  consensus of informed opinion amongst paediatricians about the usefulness and propensity of side-effects of these products is in concurrence with the TGA assessment.

Now I must say that there is a whole fascinating social phenomenon associated with parents and carers buying cough ands cold products for children in their care.

This has, in fact,  been noted in the TGA External Review, where they raise the concept of  “social medication” which researchers have found is, in part, aimed at modifying child behaviour to more acceptable patterns, and in part a ‘coping strategy, and that cough and cold medicines were a common “social medication” in this respect’. Pharmacists at the “coal face” will be very familiar with this belief amongst their clients and the associated behaviour patterns.

Presumably, in recognition of  the social behavioural re-scheduling moves would certainly make them feel to some extent disenfranchised, turning on its head as it does, a long-held, even if erroneous, understanding that recommending a suitable cough and cold product for use by children served both a therapeutic and, as discussed, also a “social” function.

It seems to me that there will need to be long-term educational campaign on this issue, if the  proposed changes are adopted.

Indeed, TGA has said that the changes recommended would need to be widely promoted and explained to medical practitioners, pharmacists, parents and caregivers, and that particular efforts be directed towards educating consumers, medical practitioners and pharmacists that OTC cough and cold medicines have not been shown to be effective, and are potentially harmful in children under 6 years of age.

From recent discussions of this issue, when I raised it on our major pharmacy internet discussion website Auspharmlist, I have no doubt that at all that education and explanation will certainly be needed for many of my pharmacist colleagues, and their professional organizations!  This is, of course, quite understandable.

After all, on the face of it, the proposed issue is somewhat analogous to the lengthy but ultimately quite successful campaign over the past 5-10 years, to “educate” doctors and inform the broader community that antibiotics are not required to treat a whole range of common infections, and may ultimately promote bacterial resistance.

Five to ten years ago, of course, patients virtually demanded an antibiotic from their doctors in such situations.  These days, most patients are aware of this or, at least, do understand the situation when it is explained to them.

But, with TGA inviting responses from  stakeholder organisations, it is going to  require a huge effort to achieve the aims of broader community understanding of the rationale for the move by TGA to restrict availability of this group of widely-used, and generally well-regarded  infant and childrens’ medicines.”

Croakey’s North American correspondent, Dr Lesley Russell, writes:

“While an excellent discussion is underway on Croakey about the value of calorie labeling in tackling obesity, it has been shocking this week to confront front page news that the number of Americans who don’t have enough food is at an all-time high, largely as a consequence of the nation’s economic crisis.

Every year the Economic Research Service of the US Department of Agriculture compiles a report on Household Food Security.

The 2008 report released this week revealed that last year almost 50 million people in 17 million households (14.6% of all US households) were food insecure and families had difficulty putting enough food on the table at times during the year. This is an increase from 13 million households (11.1%) in 2007. The 2008 figures represent the highest level of food insecurity since national food security surveys were initiated in 1995.

Given that unemployment has risen from 7.2% at the end of 2008 to 10.2% today, this might now be an under-estimate of the number of people struggling to put enough food on the table.

The magnitude of the increase in food shortages, or in some cases outright hunger, has startled even anti-poverty advocates and those who have noticed the increasingly longer lines at food banks and soup kitchens.  It is especially concerning that so many children are going hungry.  In 2008 nearly 17 million children (4 million more than in 2007) lived in households where food was sometimes scarce, and children in more than half a million households faced “very low food security”.

The USDA did not actually use the word “hunger”, but President Obama did and in a statement yesterday, he called the report “unsettling.”  Others were even more forthright.  Mariana Chilton, a Drexel University public-health professor, said: “This is a catastrophe. This is not a blip. This recession will be in the bodies of our children.”

The fundamental cause of food insecurity and hunger in the US is poverty and a lack of resources to provide housing, food and health care.  The Obama Administration has taken action to help needy families through the American Recovery and Reinvestment Act of 2009, which provided a significant increase in nutrition assistance benefits for the 36.5 million people (half of whom are children) who participate in USDA’s Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program.

The USDA also has a National School Lunch program which serves 31 million children a healthy meal each school day – for some children in need, this is their most important meal that day. Also, nearly half of all infants in the US participate in the Special Supplemental Nutrition Program for Women, Infants and Children, or WIC program, which ensures mothers and their children have access to nutritious food.”

• Dr Lesley Russell is the Menzies Foundation Fellow at the Menzies  Center for Health Policy, University of Sydney/ Australian National  University and a Research Associate at the US Studies Centre, University of Sydney.  She is currently a Visiting Fellow at the Center for American Progress in Washington DC.

But Ron Batagol, a pharmacy and drug information consultant, says this will require us to examine some of our somewhat hypocritical attitudes towards breasts.

He writes:

“A meeting of Health Ministers on 13th. November has endorsed the Australian National Breastfeeding Strategy 2010-2015.

The Strategy recognises the biological, health, social, cultural, environmental and economic importance of breastfeeding and provides a framework for priorities and action for Australian governments at all levels to protect, promote, support and monitor breastfeeding throughout Australia.

Australia’s dietary guidelines recommend exclusive breastfeeding of infants until six months of age, with the introduction of solid foods at around six months and continued breastfeeding until the age of 12 months – and beyond if both mother and infant wish.

It is concerning that a longitudinal study of Australian children conducted in 2004 found that while 92 per cent of new borns were initially breastfed, by one week, only 80 per cent were fully breastfed. The study also indicated a steady decline each month with only 56 per cent fully breastfed at three months and 14 per cent at six months.

The new federal strategy would include increasing community acceptance of breastfeeding as a cultural and social norm, establishing breastfeeding support networks for pregnant women and improved breastfeeding training for health professionals.

But, since it has been estimated that over a quarter of Australians still think that breastfeeding in public is unacceptable, obviously there is still a long way to go!

And  I have to say that it’s quite paradoxical. In the post-modern world of the 21st century, when the fairer sex “frocks up”, as they call it these days, no one gives a second thought about exposed cleavage.  In fact, the dress designers have lead the charge to make the breasts the focal point of society’s attention when women’s attire is “out there” being critically scrutinised by all and sundry.

On the other hand, as we’ve seen in recent times, with unfortunate regular monotony, the sight of women, anywhere outside the confines of their own homes, trying to nourish their infants with the most natural of all beverages, mother’s milk, provokes an outcry of pompous indignation.

Oh, yes, excuse me, I forgot!  On a plane, with all those complete strangers sitting in close proximity? In the sacrosanct and hallowed corridoors of Parliament of all places!  And for God’s sake, worst of all, in a 5-star restaurant – a place where other people pay good money to sit down, quaff a fine wine or three and gourmandise their way through their mouth-watering degustation.

Suddenly, the notion of these mammary glands doing what they were actually created to do in a “public place” is deemed to be titillating, and breastfeeding is transmogrified into something wicked and evil.

Yet, 28 years ago, a worldwide Marketing Code was established for synthetic milk formulas, because millions of infants died in developing countries where well meaning mothers tried to copy their emancipated, more affluent counterparts by preparing formulas despite lack of clean water, refrigeration or education about how to make up the feeds.

So now, breast-milk  is “in” again- transported in  unbreakable packages, and satisfying consumer demand- all in all, the perfect 21st century product, with breast-fed babies having better immunity, and better long-term medical benefits than their bottle-fed buddies.

One can only live in hope that, as a society we may become a little less hypocritical and to try to remember why these mammary appendages were given to women in the first place.

Surely that’s not too much to ask, is it?”

The paper says that 46 per cent of the state’s secondary students have registered for the Maths Online tutoring program. Nationally, more than a third of Australia’s 1.46 million secondary students have registered for the program since March this year.

When students open the program on computers they see the McDonald’s logo and the words: “Proudly provided by your local McDonald’s restaurant.”

Federal Education Minister Julia Gillard has reportedly commended the firm. And she’s a former Opposition health spokeswoman!

It really makes you wonder whether all the talk about cross government action to tackle obesity is just that. Talk. And pretty insincere talk at that.

So what do the public health crowd think?

Nutritionist Dr Rosemary Stanton writes:

“Parents have a right to know why the education of their children has passed from the government to vested interests.

McDonald’s haven’t sponsored this (and other) programs out of the goodness of their hearts. They want customers. Their sponsorship of this program also means that teachers won’t feel free to criticise McDonald’s, their products and even their marketing methods.

It’s also unlikely that governments who are now obligated to McDonald’s will do anything to bite the hand that feeds them. And our young trusting children will also think McD’s are good guys – or their teachers and parents wouldn’t endorse their products.

Are our education departments really so thick that they can’t see through this? And are we happy for sell our children to McDonalds?”

***

Jane Martin, a Senior Policy Adviser to the Obesity Policy Coalition and Professor Elizabeth Waters from the University of Melbourne, write:

“The Maths Online tutoring program is ostensibly supported by local McDonald’s stores, however it is likely McDonald’s funded the website and its development, and paid for expensive advertisements on prime time television – adding value to their positioning around corporate social responsibility.

Obesity prevention groups are concerned about this development because McDonald’s is in the business is selling burgers and fries, not education. This is a backdoor way to ensure that their branding reaches children, under the guise of education.

If the company was truly serious about providing tutoring to children, they should do this without using the distinctive McDonald’s branding.

The reach of the program, outlined in the press today, illustrates what good value this is for McDonald’s – particularly to target secondary school children.

This is a group who have more independence with their food choices as they are less likely to be under the control of parents and beginning to make independent decisions about what they eat, and how they spend their money, when they are out with their friends.

The recommendations of the recently released Preventative Health Taskforce strategy have acknowledged the importance of protecting children from the promotion of unhealthy food.  This example illustrates how the internet and educational programs are being utilized by fast food companies to reach and influence young people. This is an underhanded way to create and build a relationship with young people and the McDonald’s brand.

This is a situation which is more common in the United States, but likely to be something that we see more of if restrictions are phased in on junk food marketing to children through commercial television.”

PostScript: Jane Martin and Elizabeth Waters have sent in this additional comment:

“There is also evidence that migrant families new to Australia, and those with low literacy, may think that these sponsored programs mean that schools and governments support McDonalds and implies that McDonalds products are healthy.  This “halo” effect is similar to when McDonalds is placed in children’s hospitals – people think that the franchise provides financial support to the hospital, that the food is healthier and its presence means they are also more liklely to purchase the fast food.

Many schools, including those in NSW, have introduced policies and programs in these settings to ensure consistency in the approach around the promotion of healthy lifestyles.  This is undertaken by ensuring a healthy food supply in schools, through the curriculum and within broader school community.  The relationship with McDonalds and the educational curriculum creates inconsistency and undermines these policies and messages.”

Below he gives two pertinent case studies of the potential benefits that could flow from healthcare identifiers – in tracking potential adverse effects from influenza vaccination, and in improving child protection. He writes:

“It’s very good news that the government will pay to have an extra two million Australians vaccinated against the seasonal influenza. Let’s overlook the matter that these vulnerable groups could have been offered free annual injections well before this.

We do need to concentrate our attention on provisions for the future. There are two issues, crucial to the planning of vaccination for influenza, about which we know almost nothing.

One is whether or not the current vaccine for seasonal influenza affords any protection against the new H1N1 variant.

The first question, then, is resolved by looking at the data. But, where is that data and who is responsible for collating it into evidence of effectiveness?

The second issue is vital for success of any plan to vaccinate the whole population against the new variant. The World Health Organisation has stated, very clearly, that any program of immunisation against the new variant must be followed with rigorous surveillance in order to identify any harmful outcomes of vaccination. That’s because it is highly likely that entirely new methods of vaccine production will be used and citizens will be exposed to synthetic, novel molecules.

If the new variant remains in its present state and runs through the population without any greater morbidity and mortality than any other variety of influenza, the community will have plenty of time to be involved in proposed plans. However, in the event of increased deaths of healthy young people, buttons will be pushed to accelerate a program of mass vaccination. In that scenario of heightened concern, it may be suggested that arguments for the usual, cautious process will be out- weighed and that short-cuts should be taken.

Now is the time to address the matter of post-marketing surveillance of new vaccines.

Who pays for it, who collects the data, who owns the data and will it be scrutinised by methods accessible to the public?

These questions apply to surveillance after any event that may effect the future healthof individuals. Post-event surveillance may be of great value to both commercial operations and to planning for improved public health. The usefulness of data for either scenario depends on the usual factors – accuracy and timeliness.

Considerations of accuracy can be split, for simplicity, into those applied to the events and those applicable to persons. From my removed perspective, data on events are accommodated within hierarchical coding systems. Data on persons, however, need to be understood and sanctioned by citizens who have little knowledge of archetypes.

I find it odd, then, that the next phase of understanding and planning for a national identification system for persons – Department of Health and Ageing’s consideration of Healthcare identifiers and privacy legislative proposals  – will accept submissions but “submissions will not be made publicly available but will be shared with relevant government agencies to inform jurisdictional consideration of national privacy arrangements”.

That exclusion does not do much to encourage people or groups to add to the discussion.

Another oddity is that, in general waffle about healthcare identifiers, a notion has been allowed to travel when it is patently untrue. The idea has been promoted, without any attempt at qualification or detail, that the Medicare Number is a de facto identifier. Well, it is, of course, but by default only.

The Medicare Number, as it stands, has been explicitly excluded as a unique identifier. Medicare is proposing a 16-digit identifier, as we understand from DoHA.

There’s a similarity, in that people may be asked to accept the IHI as just a longer version of the existing ten-digit number. If they’d specified a 16-character string (alphas and numerals) maybe we’d feel more confident.

I’d like to think there can be common agreement at COAG that every step on the way to a national electronic health & social record, in which a national identification scheme is the first essential, would assist child protection services.

Let me give an example. Suppose a young woman out driving gets tested at a roadside drug-bus. She tests positive for cannabis. The police check her data and find she is on a single mother pension with three children under six years, none of whom are with her. She claims there is a responsible adult minding the kids at her home while she is out for a short errand. The police have been able to access consolidated data on the family, and see they have been under watch by child protection in another State.

The officer in charge of the drug-bus detains the woman while they request a car to call at her home. The woman is told that uniformed officers will attempt to get someone to answer the door, and if there is no reply they will enter. They do knock, they hear only a child, so they go in to find an adult male in a back room of the house, intoxicated. If there were enough resources, that situation would require that social services remove the children immediately to a place of safety.

I guess every healthcare worker can envision situations where their work, and the general welfare of people, would be improved by good data. To that end, the more we can provide input to this current discussion about health identifiers, the better will be the outcomes.

I suggest we ought, collectively, send the cops round to DoHA and demand an audience, so this matter can be discussed out in the open.”

• Trevor Kerr is a retired medical microbiologist, now working part-time for a community health service

Meanwhile, Professor Peter McIntyre, Director, National Centre for Immunisation Research and Surveillance of Vaccine-Preventable Diseases, is concerned that the focus upon swine flu and pregnancy may be distracting attention from the risks of influenza generally for pregnant women. He writes:

“Pregnant women are at risk – not just from swine  influenza, as highlighted in the media in recent days, but from influenza of  any kind.

“Ordinary” seasonal influenza is also still circulating. Both vaccines and antiviral drugs are important.

With respect to vaccines, influenza vaccine has been recommended by  the National Health and Medical Research Council for women in pregnancy for  almost 10 years – but few receive it.

This is  probably related to both lack of familiarity with the whole notion of  vaccines in pregnancy by practitioners caring for pregnant women, as well as reluctance on the part of many, if not most, women to receive any treatment  in pregnancy, either vaccine or drug.

Therefore  it is important to emphasise that there is no theoretical or data-based  reason to expect any adverse effects from vaccines which do not contain  live organisms in pregnancy. In partcular, influenza vaccines are safe in pregnancy. The primary rationale  is to provide protection for the mother but there is accumulating evidence that some protection is probably also afforded to the baby after birth.

Once a swine influenza vaccine is available, pregnant women will be a priority risk group, something which has been emphasised by recent publicity concerning severe cases in pregnant women.

It is important to remember that  vaccines for “ordinary” influenza are available now  and are  recommended for pregnant women, who are especially at risk in the later stages of pregnancy, and that professional and public attitudes to using influenza  vaccines in pregnancy need to change now.

With respect to antiviral drugs, it is important that pregnant women  see their doctor early if influenza is a possibility as anti viral treatment  is most beneficial early. Pregnant women also need to see their doctor if it  is possible that their children have influenza, as this may be an opportunity  for even earlier treatment. Given the potential severity of influenza in  pregnancy, the benefits of treatment clearly exceed the risks.

Regarding risks for Indigenous communities, we know that influenza  rates generally are much higher in Indigenous children and adults, with  hospitalisations for influenza and pneumonia 3.5 times higher than in  non-Indigenous Australians.

The biggest  difference is in 25-49 year olds, where the rates are 8  times higher. This younger adult group is the very group now coming to light  with swine flu but has been evident as an important  risk group in earlier data.  This is  reflected in the recent announcement by the Commonwealth that free influenza vaccine will be provided under the National Immunsation Program for all  Indigenous adults from 15 years of age as well as for all persons from 6  months of age who have conditions placing them at increased of severe  influenza.

This group at increased risk, as mentioned above, includes pregnant women. This is especially so for pregnant Indigenous women, where we know that there are high rates of respiratory and ear disease in babies very early  and that mothers themselves are significantly more likely to have health problems. The  increased risk relates not only to medical conditions, but to general living conditions, and other risk factors such as high rates of  cigarette smoking.

Indigenous people should be a priority  group for access to both antivirals and to vaccine for the swine flu, when it  becomes available. For the whole  community, communication about risks and benefits will be crucial.”

Professor Boyd Swinburn, professor of population health at Deakin University and Director of the WHO Collaborating Centre for Obesity Prevention, has sent in the following critique of the report:

“The Parliamentary Inquiry on Obesity served up a largely evidence-free set of weak recommendations for obesity prevention.  The Committee took a feather duster approach to the prevention part of their brief, lightly touching all options without disturbing the status quo.  They dismissed the mountain of direct and indirect evidence that marketing increases junk food consumption and obesity and instead plumped for two programs which cost hundreds of millions of dollars and have no evidence for any effect on reducing obesity.

Indeed, the Active After School Communities program and the Stephanie Alexander Kitchen Gardens are not even aimed at reducing childhood obesity.  Their websites claim that the AASC ‘aims to engage traditionally non-active children in structured physical activities and to build pathways with local community organisations, including sporting clubs’ and ‘The aim of the Kitchen Garden Program is pleasurable food education for young children’.  Excellent programs at achieving their aims, no doubt, but in no way should they form the backbone of programs to turn around the serious problem of childhood obesity.

Add to that the solid backing the Committee gave to education, information and social marketing approaches and you have a full house of photo opportunities and weak strategies.

The Committee did not seem to get the point that obesity is not a knowledge deficit disorder which can be solved with a bit of information. Leaving the obesogenic environments to a few guidelines and industry self-regulation is a recipe for the continuing upward trend in Australian fatness.

But the public get the point.  They understand.  They are not taken in by the ‘pull-up-your-socks’ solutions (led by the former Health Minister Tony Abbott), or the ‘public-health-advocates-are-baddies’ cries (led by conservative think tankers like Chris Berg), or the ‘trustworthy-food-industry-is-making-big-changes’ claims (led by the Australian Food and Grocery Council).

The public are not that stupid.  Opinion polls consistently show that 80-90% of the public want stronger restrictions to cut the amount of junk food advertising seen by children.  This level of support far exceeds the support for bans on tobacco advertising when that legislation was being drawn up.

It is time for the politicians to look at the evidence, listen to the people and do something meaningful about obesity prevention, especially childhood obesity.

‘Marketing works’.  These are the first words of the US Institute of Medicine’s comprehensive review of the evidence on junk food marketing to children.  Indeed, the global food industry would not be spending $10 billion annually on marketing targeting children if it was not getting increased sales for its money.  They are very smart people working in a highly competitive industry with all the evidence of the effects of their marketing campaigns on sales at their finger tips. They make hard-nosed, evidence-based decisions and they keep investing.  Big time. This is strong indirect evidence of the effects of marketing on consumption even though we never get to see the raw data.

The other part of the evidence chain that links junk food marketing to obesity is the incontrovertible evidence that diets high in junk food put children at risk of unhealthy weight gain.

Aside from the piles of evidence reviews on the topic, it is also question of ethics and children’s rights.  In an age of burgeoning childhood obesity, to allow multinational companies to continually bombard children with sophisticated marketing techniques to get them to pester their parents to buy them the very foods that promote obesity is downright unethical.

We may not see junk food marketing as an ethical issue in 2009 because is just the cultural wallpaper all around us.  Remember, we used to live and work in rooms filled with tobacco smoke and thought it was just normal.

However, in 2019, or maybe 2029 if we continue along this slow route to action, we will look back and wonder in disbelief at lack of leadership shown by our current politicians as they tip toe around with their feather dusters, avoiding the piles of evidence, deaf to the public, but kowtowing to the demands of the food industry.”

The Australian Indigenous Doctors Association has sent the letter below to all MPs in the NT.  It also mentions the impact of the NT Intervention, and deserves to be widely read by policy makers everywhere – not only in the NT.

RE: MANDATORY REPORTING REQUIREMENTS IN THE NORTHERN TERRITORY

The Australian Indigenous Doctors’ Association (AIDA) is deeply concerned about the implementation of Section 26 of the Northern Territory’s Care and Protection of Children Act 2007, in particular, its potential negative impact on Aboriginal and Torres Strait Islander young people, their families and communities.

AIDA believes that the legal obligation to report sexual activity of young people under the age of 16, irrespective of the consensual nature between same-aged peers, will disproportionately affect the Indigenous population living in the Northern Territory.  Indigenous young people are likely to engage in sexual activity at an early age(1).  Further, Indigenous females have a higher fertility rates than non-Indigenous females and are more likely to give birth during their teenage years(2).  These factors indicate that Indigenous young people will be reported for engaging in sexual activity at a higher rate than their non-Indigenous peers.

AIDA acknowledges that the purpose of this legislation is to protect young people from sexual abuse and is not racially driven.  Nonetheless, the likely consequence of mandatory reporting is that young people will avoid seeking advice from doctors and health care providers for fear of being reported for sexual activity.  This will have devastating implications for the sexual and overall health of a population already at a significant disadvantage in terms of health outcomes.  The likely impacts on health include, but are not limited to the following:

o Increased rates of STIs
o Late presentations for pregnancy and antenatal care
o Reduced opportunities to provide counselling or referrals for drug and alcohol issues
o Reduced detection of chronic diseases
o Delayed identification of mental health problems

AIDA believes that the likely surge in reporting of sexual activity of young people will have a reverberating impact on families, communities, and the health and community sector in the Northern Territory.  AIDA is concerned that there may be inadequate measures in place to support Indigenous families and communities during the process of reporting and subsequent investigation.  What assurance is the Northern Territory Government providing to families and communities that they will be supported in a culturally-sensitive and culturally-appropriate manner?

AIDA is also concerned that the mandatory reporting requirement has the potential to cause serious long-term damage to families and communities already under severe strain.  AIDA recently conducted a health impact assessment of the Northern Territory Intervention and our interim findings show that communities have suffered cultural, social and emotional harm3 as a consequence of the measures and this has led to a hardening of mistrust between communities and the Australian Government and dominant Western culture.  The issue of trauma and retraumatisation is a real concern in the context of the Northern Territory Intervention and we urge the Northern Territory Government to give this due consideration in the implementation of mandatory reporting.  We take hope from the Australian Government’s commitment to partnership and ‘resetting the relationship’ between Indigenous and non-Indigenous Australians and we hope that the Northern Territory Government will consider whether the mandatory reporting requirements will contribute towards this goal.

Against the backdrop of the Northern Territory Intervention and given the layers of trauma that exist in many Indigenous communities, it is more important than ever before that a healing approach be adopted to deal with child abuse issues.  Such an approach would build on the strength, wisdom and expertise of Aboriginal and Torres Strait Islander people and communities.  We hold serious concerns that the mandatory reporting requirement will further perpetuate a perception of all Indigenous people as abusers or victims and, like the Northern Territory Intervention, it is unclear if this will result in the successful investigations of child abuse.  In the meantime, it will be difficult to mend the breach of trust and confidentiality that has occurred in adhering to the mandatory reporting requirements.

In light of the potential harm to Indigenous health and wellbeing, we urge the Northern Territory Government to reconsider its approach to mandatory reporting and factor in the need to formally assess the impacts of this legislation through a legislative review.  Clearly, the Northern Territory Government has a duty of care to ensure that the concerns that we have raised – alongside the concerns already raised by our colleagues
in the health and medical profession – are given full and proper consideration.

Yours sincerely
Associate Professor Peter O’Mara
Acting President
Australian Indigenous Doctors’ Association

1. National Centre in HIV Epidemiology and Clinical Research. Bloodborne viral and sexually transmitted infections in
Aboriginal and Torres Strait Islander People: Surveillance Report 2007. National Centre in HIV Epidemiology and Clinical
Research, The University of New South Wales, Sydney, NSW. 2007. p 11-20

2 Australian Bureau of Statistics and Australian Institute of Health and Welfare, 2008. The Health and Welfare of
Australia’s Aboriginal and Torres Strait Islander Peoples 2008. Cat. No. 4704.0. Canberra. p 75 -98

3 AIDA submission to the NTER Review Board (2008) http://www.aida.org.au/pdf/AIDA_SubmissionNTERRB.pdf