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environmental health

Nov 11, 2014


Many thanks to Dr Rosalie Schultz, member of Doctors for the Environment, for this piece regarding the latest developments regarding “fracking” in the Northern Territory.

Dr Schultz writes:

I recently spoke on behalf of Doctors for the Environment Australia to the Commissioner on the Inquiry into Hydraulic Fracturing in NT, Mr Allan Hawke. This Inquiry was established in April 2014 to provide information to the NT government on a range of issues related to hydraulic fracturing “fracking”. It will report by the end of 2014.

Meanwhile, fracking is already underway in NT and continues as the Commissioner conducts the Inquiry.

Doctors for the Environment Australia (DEA) is an independent, self-funded, non-government, health advocacy organisation of medical doctors in all Australian States and Territories. Our members work across all specialties in community, hospital and private practices. We work to minimise public health impacts and address the diseases – local, national and global – caused by damage to our natural environment.

Northern Territory is quite different from the states of Australia. The population is 200,000  – less than one per cent of Australia. Aboriginal people make up one third of Northern Territorians.

Most Aboriginal Territorians live in remote communities, where they have lived since before time was measured. The land and landscape are the attractions of the NT. They attract the Aboriginal people, tourists and travellers whose visits outnumber locals, and non-indigenous Australians who make NT their home.

Because the NT is unique, the issues around fracking are unique.

Fracking allows exploitation of fossil fuels that are difficult to access. High pressure water, sand and chemicals are pumped into rock to open up fissures and allow gas or oil to be released through the fractures.

There is strong opposition to fracking in NT. Due to NT’s remoteness and small population, we are unlikely to be able to attract the large numbers of opponents who have actively protested against fracking elsewhere. In NT 1.21 million km2  of land is under application for oil and gas extraction. This area is bigger than France and Spain combined, and makes up 90% of NT’s total land area of 1.35 million km2.

The Minister for Mines, Mr Willem Westre van Holthe instituted the Inquiry into fracking. He has stated that the purpose of the Inquiry was “to better inform the community and hopefully provide some confidence that the industry in the Northern Territory can go ahead without any environmental issues occurring.”

However, community meetings held by the Inquiry’s Commissioner have not demonstrated support, but a distinct outcry against fracking. Meetings have heard a range of legitimate concerns and outrage at the government’s plans. Written submissions are available on the Inquiry’s website, but they do not capture the passion that is heard at public meetings.

Terms of reference for the Inquiry into fracking in NT were narrowly defined around fracking operations. The Inquiry missed the opportunity to consider the broader economic and energy environment in which companies seek to frack to extract gas resources.

The Inquiry’s Terms of Reference also failed to consider opportunities for renewable energy development. NT’s high levels of solar intensity mean that the region presents exciting opportunities for solar energy, including both small and large scale generation. Likewise, the huge subsidies that NT government provides to facilitate gas export through Darwin were also outside the scope of the Inquiry. These subsidies offset almost 80% of the industry royalties.

Fracking is an issue around the globe. Regional or national governments in Argentina, Austria, Bulgaria, Canada, Czech Republic, France, Ireland, New Zealand, Romania, Spain, South Africa, Australia’s state of Victoria and some states of USA have instituted bans on fracking. A moratorium was in place in NSW for six months in 2011. Moratoriums focus on concerns about water and land contamination, issues that have yet to be resolved.

There has been massive scale fracking in USA for over a decade. We have the opportunity to learn from their experience.

If fracking in USA leads to employment opportunities, an easy transition to renewable energy, and an improved economic situation, the wait for NT will be worthwhile. However, if we see a legacy of damaged land, water and people, we should focus investments elsewhere.

To assist in building public support for fracking, NT Government has launched an advertising campaign “Oil and Gas: It’s for all of us“. Ironically, NT oil and gas are mainly exported, and recruitment is seeking interstate and international labour.  Why this industry is “for all of us” is uncertain. It will certainly not be for all of our grandchildren.

Doctors for the Environment Australia is grateful to be heard by the NT Inquiry into Hydraulic Fracturing. We would like to see a long-term view of energy and economic options. A bigger picture is needed to work out where our energy future should be.

DEA considers that current assessment, monitoring and regulation of unconventional gas activities are not adequate to protect the health of current and future generations of Australians. There is no requirement for health risk assessment prior to projects occurring.

Both DEA and the Australian Medical Association have called on Australian governments to ensure that unconventional gas projects are subject to rigorous and independent health risk assessments.


May 29, 2014


At the National Press Club yesterday, Health Minister Peter Dutton spoke of the importance of evidence in formulating health policy.

I wonder if his advisors are reading The Medical Journal of Australia, which this week has published a study from the NT concluding that:

“Improving access to primary care in remote communities for the management of diabetes results in net health benefits to patients and cost savings to government.”

The authors report below that creating barriers to access to primary care through a co-payment will have adverse consequences for the health of Indigenous Australians in remote NT communities. (And, as we’ve already heard at Croakey, these concerns are not limited to the NT).


Improving access to primary care is a win-win  

Dr Susan Thomas, Dr Yuejen Zhao, Dr Steven Guthridge and Professor John Wakerman write:

A new study published in the Medical Journal of Australia provides solid evidence that better access to primary care in remote Northern Territory communities saves money by preventing costly hospitalisations and improves health for Indigenous patients with diabetes.

This has to make sense to budget conscious politicians.

The Northern Territory has a large proportion of Indigenous residents, many of whom live in remote communities.  They experience high rates of diabetes, often with serious complications, disability and death.

Indigenous people were hospitalised for potentially avoidable causes at four times the rate of non-Indigenous people between 1998-99 and 2005-06.

This was largely due to the complications of diabetes. Diabetes and related chronic diseases account for a large proportion of hospital resources as well as having broader social costs through loss of productivity and the impact on community and family life.

Primary care is an effective and efficient way of providing basic health services that promotes health and prevents illness.  There is considerable international evidence that primary care is cost effective, meaning that it delivers value for money with better health outcomes at less cost to the health system.

We looked at how often more than 14,000 Indigenous remote residents with diabetes used primary care over a ten year period, and measured resulting health outcomes and hospitalisations.

We found that patients who visited primary care services  2-11 times a year (medium utilisation) had far fewer hospitalisations, lower death rates and fewer years of life lost ( a measure of premature mortality) than patients who visited less than twice a year (low utilisation).

Overall, compared to patients with low utilisation of primary care, those with medium utilisation had lower rates of hospitalisation per person (1.1 vs 5.0), fewer avoidable hospitalisations per person (0.64 vs 2.69), a lower death rate per 100 population (0.99 vs 3.23) and fewer years of life lost per person (0.24 vs 1.0). This trend was most evident for patients with more complicated diabetes.

The study also calculated the savings to health systems when primary care was used by Indigenous patients 2-11 times a year.

We found that investing $1 in this level of primary care use saved $12.90 in hospital costs. Expressed another way, the cost of preventing one hospitalisation for diabetes was $248 for those patients that used primary care 2-11 times a year. That is much less than the average cost of one hospitalisation at $2915.

The NT is a unique place with a small population spread over vast remote areas. There are few doctors, limited health infrastructure and higher costs associated with transport, housing and salaries. This poses challenges for providing primary care and contributes to higher costs compared to urban areas.

Policy implications
Despite these higher costs, this study found primary care was still cost effective. The study has a number of significant policy implications.

In the Northern Territory where needs are high, encouraging access to primary care services will result in better health outcomes and fewer costly hospitalisations for Indigenous patients with diabetes.

Failure to capitalise on the cost saving benefits of primary care or creating additional access barriers through a co-payment, will mean a continuation of poor health outcomes for Indigenous Australians in remote Northern Territory communities.

The results are also of interest for other high need populations including those in other states and territories.

For these groups, programs that improve access to primary care may also deliver better outcomes and overall health system savings.

This study adds to the international evidence that improved access to primary care in a variety of settings makes sense both financially and in terms of health outcomes.

Authors’ details
• Dr Susan L Thomas, Senior Research Fellow (1,3)
• Dr Yuejen Zhao, Principal Health Economist (2) and Adjunct Senior Research Fellow  (1,3)
• Dr Steven L Guthridge, Director (2) and Adjunct Associate Professor  (1,3)
• Professor John Wakerman, Director (1) and Chief Investigator (3)

1.      Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, NT
2.      Health Gains Planning Branch, Department of Health, Darwin, NT
3.      Centre of Research Excellence in Rural and Remote Primary Health Care, Bendigo, Vic.

Indigenous health

Jul 21, 2011


Continuing a Croakey series on the digital revolution and health….

As mentioned in a recent post, the online revolution is creating new opportunities for telling the stories of those who haven’t always had a fair deal from the mass media.

The post prompted public health blogger Kishan Kariippanon to send details of this innovative project in the NT that is “giving Indigenous communities a chance to tell their stories in their own way”.

The NT Mobile Journalism project is funded by the Federal Government. The concept was developed by Ivo Burum of Burum Media Pty Ltd. Burum is also involved in a similar project for school students, MySchool Mojo.

Continue reading “Citizen journalism as an Indigenous health intervention?”


Jul 22, 2010


The former editor of the BMJ, Dr Richard Smith, recently recommended ten lessons for global health, including that the rich can learn from developing countries.

He wrote that there are many examples of innovation in poorer countries spreading to developed countries, and that poorer countries have a better chance of building sustainable health systems because they don’t have the inertia and vested interest of the top heavy systems built in developed countries.

Perhaps the report below – about e-health innovation by Aboriginal health services in the NT – is an example of this rule.

Greg Henschke, of the Aboriginal Medical Services Northern Territory, reports:

“The NT is a unique place. We’ve had invasions, colonisations, salutations, neglectful situations and interventions. Wouldn’t it be nice if we could actually get some technology happening up here that would help with Comprehensive Primary Health Care delivery and to Close the Gap in Aboriginal Health?

Well the Katherine West Health Board (KWHB) and the Aboriginal Medical Services Northern Territory (AMSANT) are proving that smart technology such as IPads can help with grassroots health service delivery. Continue reading “How the IPad is improving health service delivery in the NT”

Croakey has previously reported on efforts by Minister Macklin and colleagues to undermine a study from the Menzies School of Health Research that casts doubts on the benefits claimed for income management in NT Aboriginal communities.

The campaign against the Menzies study has been hotting up, reports my Crikey blogging colleague Eva Cox, a prominent critic of the Government’s plan to roll out income management more widely. She writes:

“Yesterday a media release from Macklin and Snowden triumphantly claimed: The number of people being supported through income management has reached 17,000 under the Northern Territory Emergency Response (NTER). This compares with 1,400 people on income management in November 2007.


The language of this document follows an extraordinary report and session of senate estimates last Friday when staff from the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) did a very suss demolition job on the Menzies data casting doubt on the value of income management. Continue reading “The Government campaign against researchers who dared question income management”

health ethics

Dec 15, 2008


Paul Smith, the political editor of Australian Doctor magazine, has been investigating the Australian Crime Commission’s operations in NT Indigenous communities:

Last month the Australian Crime Commission – usually tagged by journalists as the nation’s most powerful crime fighting body – fell foul of the law for the second time in the space of eight weeks. At issue was an aspect of its “special intelligence” operation into child abuse and domestic violence in NT’s indigenous communities.

As those of you who have been following the saga know, the commission has been using its coercive powers to get hold of patient records. Much of it was going on in secret, with those targeted by the ACC silenced by
the use of various gagging orders employed by the commission. The only reason we now know about, is that two Aboriginal health clinics when approached by the ACC refused to hand over all the records demanded,
opting to seek the protection of the courts.

The Federal Court handed down its judgement on the appeal by the first clinic (referred to as NTD8 in the court transcripts) in October. The judgement on the second clinic (NTD9) came out at the end of the
November. In both cases it ruled the commission had failed to take the interests of the children as its primary consideration in wanting to seize the records and therefore the commission was in breach of
Australia’s obligations under the UN Convention on the Rights of the Child.

There remain many unanswered questions principally because those ACC gagging orders are still in force, preventing the doctors and managements of the clinics from talking about the case in public.

First of all we don’t know how many other clinics were also approached by the ACC during its special operation. There have been rumours that it’s been more than 20. But because no-one is talking, we don’t know how many of these clinics capitulated under threats of imprisonment. Presumably, if the ACC has seized the files of other children using the same legal notices it employed at the two clinics that went to the
Federal Court, there are good grounds for saying the ACC probably has in its possession quite a lot of illegally-obtained material relating to patients who have yet to be told that much of their intimate medical
history has been trawled through by ACC officers.

Under the ACC’s gagging powers, the management at those clinics (which may have been approached) would also face imprisonment or fines if they reveal the truth. In fact, they face imprisonment or fines for simply
acknowledging they had been issued with notices by the ACC. This causes some absurdities. When Australian Doctor asked the NT government last month to say if its clinics had been told to hand over records by the ACC, it said after consulting its lawyers that legally it could not
answer the question. Take that as a “yes” then.

There are important reminders worth making for anyone who thinks this story is simply about bloody minded doctors undermining attempts by the commission to bring perpetrators of child abuse to justice.

The ACC says it has not sought these records to investigate any specific crime, abuse or act of violence against a child or anyone else. The ACC has said it wants the medical records (and this applies to the records
of adult patients as well as those of child patients) to create a picture of the extent of abuse in Aboriginal communities.

It told the Australian’s Paul Toohey in October: “The reason we want access to the data not just on Implanon but more widely on STIs, violence and sexual abuse is to build a better understanding of the
nature and extent of issues surrounding sexual abuse and underage sexual activity, assault, violence and related injuries.

“There’s little evidence-based understanding at a regional, state or national level of what’s occurring within those communities because the data in relation to underage sexual activity, abuse and violence is
often not disclosed in detail beyond the health provider. This prevents governments from developing a comprehensive understanding of the issues and may result in funding solutions and interventions being developed based on incomplete or inaccurate data.”

The identities of these children – their names, addresses and information about treatments and their medical conditions – were needed because the ACC is trying to “track how children, who are in crisis,
move between different systems” – for instance, the police system, the education system and, say, Family and Community Services.

The legal battle between the ACC and the clinic NTD9 came about precisely because the clinic’s doctors judged that the patients (both children and adults) were not in crisis. Routinely handing over records
to federal crime investigators, when the patients were not at risk, would, if it ever became known, destroy the trust the patients had in the clinic. Dr John Boffa, a GP at the clinic, warned in a written
affidavit to the Federal Court of a public health disaster if patients stopped attending.

The clinic offered what appears to be a sensible compromise: allow an independent third party made up of doctors to go through its records. If the third party thought specific children/adults were at risk, then the
clinic would hand over the records to the ACC or the police. In that way patient confidentiality (and patient trust in the clinic) would be protected.

The ACC has yet to explain why but the offer was never taken up.

The ACC’s declared aim to track the way individuals track across “different systems” seems very far removed from its image as the nation’s most powerful crime fighting agency. Does this job require
steamrolling through patients’ privacy rights to confidentiality; for the commission’s use of its extensive powers of secrecy and coercion? Is it necessary for doing all this to be done behind the backs of patients
and their families in communities already distrustful of policing and government?

Clearly the methodology concerned John Reeves, the Federal Court judge who ruled on the case of NTD9 last month.

He wrote in that judgment: “Given the very personal nature of the medical records sought it is not difficult to see that the disclosure of information of this kind could cause acute embarrassment to the Aboriginal children concerned and may have implications for their relationships with other persons.

“I should add that the ACC’s answer that they will be protected because this invasion of their interests is to be kept confidential does not in my view make it any more acceptable. After all, medical records in
general, let alone those dealing with a person’s sexual health or activities, are generally among the most personal about an individual.”

He went on to rule the ACC was breaching its legal duty to take the interests of the children as its primary interest in obtaining the records.

But he said he had no basis on which to prevent the adult records being seized by the ACC. That is interesting. It raises this question: surely if the disclosure of intimate information causes acute embarrassment for Aboriginal children, should the disclosure of “intimate information” of
Aboriginal adults be treated differently under the law?

The clinic is expected to appeal to the High Court.

All these issues are likely to run. The declaration that the ACC has been acting illegally is sufficiently alarming to suggest the commission needs to be held to public account. Clearly, with the amount of secrecy
surrounding the ACC which has silenced the people running health services in the NT from speaking out, that is not being done through the normal media channels. Politicians, there to represent the public
interest, including the interests of Aboriginal communities, need to start asking questions and hold the ACC to some form of public account.