A new systematic review led by Dr Julieann Coombes, Sr Research Fellow in the Guunu-maana (Heal), Aboriginal & Torres Strait Islander Health Program at The George Institute for Global Health, investigates why ‘leave events’ are higher among Aboriginal & Torres Strait Islander patients and makes recommendations to address this gap.

Leave events, Discharge Against Medical Advice (DAMA) or self-discharge, describe events where a patient leaves a health service before being seen by a health professional or before discharge by their clinician. Leave events are a public health concern resulting in poorer health outcomes.

Discharge from hospital against medical advice occurs at a rate four times greater for Aboriginal and Torres Strait Islander patients as compared to non-Indigenous Australians.

Understanding the causes of leave events among Aboriginal and Torres Strait Islander people is important to develop and implement culturally safe mechanisms for health services to better meet Aboriginal and Torres Strait Islander peoples’ health and wellbeing needs.

Dr Coombes says, “Leave events disproportionally impact Aboriginal and Torres Strait Islander people and are not interpreted by health professionals as an indirect measure of patient dissatisfaction or racism.”

The quantitative findings of our review show that leave events occur more often among young Aboriginal patients of male gender, with history of previous leave events and who live in low socioeconomic areas. 

Some of the causes highlighted in the review include lack of cultural awareness, racism, distrust of health system and procedures and communication issues including the use of medical jargon. Lack of availability and unstandardised role of Aboriginal workers was cited as a major barrier.

“Based on these qualitative findings, we have identified some recommendations to decrease leave events among Aboriginal and Torres Strait Islander people.. We believe having a higher number of Aboriginal and Torres Islander Strait people in the health force and decision-making is key to building trust and implementing strategies to provide health services that meet Aboriginal and Torres Strait Islander cultural needs,” adds Dr Coombes.

Some of the recommendations include:

• Hospital environment be more welcoming and services more friendly to patient cultural needs
• Implement Cultural awareness and cultural competency training
• Increase number and visibility of Aboriginal health workers
• Better communication with patients and patient education about hospital environments and procedures
• Involve families in health care provision
• Improve service coordination
• Address socioeconomic factors

Co-author on the paper Keziah Bennett-Brook asserts, “In Australia, health services are lacking cultural safety and capability when addressing Aboriginal and Torres Strait Islander people’s needs. The ongoing health gap between Aboriginal and Torres Strait Islander people and other Australians reflects the need for Australian health services to take these recommendations seriously in order to address this inequity.”

Access the full paper here.

The Department of Health and Social Care (DHSC) recently released its long-awaited first Women’s Health Strategy for England, following a Government consultation to which The George Institute, UK made two submissions, one in collaboration with Imperial College London. Aligned with The George Institute’s vision, the 10-year strategy commits to taking a life course approach to understanding how women and girls' health changes throughout their lives, from adolescence and young adulthood to later life. It rightly emphasises the need for tailored services involving social and health services, with in-person and remote services as best practices.  

Responding to the strategy, Prof Robyn Norton, Acting UK Executive Director and lead of the Institute’s research, implementation, and advocacy efforts aimed at improving the health of women and girls worldwide said: “We welcome the publication of this much-needed strategy, particularly the strong commitment to expedite evidence-building by commissioning new policy research units dedicated to women’s health, and the recognition that healthy ageing and long-term conditions such as cardiovascular disease are major issues for women. We strongly support the ambition to encourage disaggregation of health data by sex wherever possible and appropriate and would urge that data are also disaggregated by gender. Our research, and that of others, shows that women are less likely than men to receive evidence-based care, and experience worse health outcomes as a result.  

We are pleased to see a focus on collaboration, with the strategy clearly outlining the role of organisations such as NHS England, NIHR, NICE and Health Education England in improving the health and care system for women and girls, along with industry in the form of FemTech. The appointment of Professor Dame Lesley Regan of Imperial College London as the first ever Women’s Health Ambassador for England gives us confidence that women’s voices will be listened to, and we stand ready to support her in implementing the commitments outlined in the strategy.” 

Crucially, and aligned with The George Institute’s goal to support under-served populations, the strategy reiterates the Government’s commitment to tackling inequalities in women’s health, by increasing the participation of women in research, particularly women from ethnic minority groups, pregnant women, and lesbian and bisexual women. Enhancing information provision within educational settings and expanding the reach of health information to ensure it is accessible to all women will also help to address inequalities. 

Notwithstanding its strengths, the strategy fails to prioritise and resource non-communicable disease prevention and treatment in a gender-sensitive way. In the UK, dementia, acute coronary syndromes, cerebrovascular disorders, and chronic lower respiratory diseases are among the leading causes of death for women. It is crucial that women receive the same quality of care as men for these conditions and that interventions are gender-sensitive, equitable, and evidence-based. 

“We are also concerned by the lack of dedicated funding and omission of measurable indicators to support and monitor the instrumental changes that the strategy commits to – for instance, on measuring the impacts of mental health, healthy ageing, and long-term conditions on women. The strategy is a step in the right direction but is by no means enough on its own to make long-lasting improvements to the health of women and girls. We look forward to seeing funding commitments and a robust implementation plan shortly, and to playing our part in driving forward action.” 

An estimated 236,000 lives are lost globally due to drowning every year - almost 650 every day, 26 every hour. According to the World Health Organization’s (WHO) 2021, Regional Status Report on Drowning in South-East Asia, there were 48,774 deaths in India alone, 30% of which occurred in children under the age of 15.

The Sundarbans, West Bengal is one of the largest active delta regions in the world and is home to one of the world’s most underserved populations. It also has the highest reported global drowning mortality rate in the world. A key highlight of The George Institute’s work in India has been galvanising communities at the centre of drowning risk mitigation in the Sundarbans. A 2020 community-based survey conducted by The George Institute in collaboration with the Child in Need Institute (CINI) in the Sundarbans region of West Bengal, India, reported that there are nearly 3 drowning deaths among 1-9 year old children each day. 

To mark this World Drowning Prevention Day on July 25th, we globally present a deep dive episode under our The Scan Podcast Series, Dr Jagnoor Jagnoor discusses the table of influence in drowning prevention with global experts. Drowning is an issue that affects every nation in the world, and its scale and impact have been recognised at the global level with the adoption of a UN’s historic resolution to address it in 2021.  In this conversation, the speakers draw on their experiences of drowning prevention in India, Africa, and the UK to consider how best to strengthen regional actions such that it is inclusive, responsive to lived experience, and context specific. We can all act together to end drowning.

Emphasising towards “owning” the problem that persist; our experts reflect on the need to reach the root causes of the problem that can help identify core solutions around drowning prevention. Drowning is multi-sectorial; the better way to eradicate the issue is by reaching the ground levels and the factors associated with it. It starts with prioritising equity and inclusion to safeguard communities globally against the silent epidemic of drowning.

"Swimming isn’t just a sport, it’s a vital life-saving skill and drowning prevention tool that can save lives. One that a large percentage of people in Black and Asian communities are missing. Anyone can drown but no one should have to. All communities should receive equitable access to vital water safety education. Not all communities are starting from the same point. When talking about inclusion, we must think about equitable access." - Danielle Obe, Chair of The Black Swimming Association (BSA)

“Research conducted in the field gives us a lot of insight into what is actually happening there. Because sitting at the central or state level, you cannot really know what is happening at the ground level. So researchers feed into the system important, valuable messages” - Dr Tanu Jain, Deputy Director General, Directorate General of Health Services, Ministry of Health and Family Welfare, Ministry of Health and Family, Government of India

What is a UN’s historic Resolution on Global Drowning Prevention?

On 28th April 2021, the United Nations adopted a historic Resolution on Global Drowning Prevention, calling on countries around the world to recognise and take action to prevent hundreds of thousands of drowning deaths each year. The Resolution was proposed by the Governments of Bangladesh and Ireland, and co-sponsored by 79 countries, including Australia and India.

The Resolution encourages countries to develop national drowning prevention plans and programming, in line with interventions recommended by the World Health Organization (WHO), and to ensure enactment and enforcement of water safety laws. Other actions include the promotion of public awareness and behaviour change campaigns; research and development innovative drowning prevention tools and technology; and capacity-building through international cooperation.

“We need to run where others are walking. We have to be able to very quickly get the resources that we need to generate the evidence around the issue but also start intervening in those areas where we have enough information to begin to intervene.” - Dr Olive Kobusingye, Director of the Trauma, Injuries and Disability programme, Makerere University School of Public Health, Kampala; Distinguished Fellow, The George Institute for Global Health

“In the global health research, we often talk about equity from a low-middle-income country perspective, but we hardly ever look above the gradient of inequity within our communities in a high-income country context.” -  Dr Jagnoor Jagnoor, Co -Director WHO Collaborating Centre on Injury Prevention and Trauma Care and Head, Injury, The George Institute, India

Prof Alta Schutte has won the 2022 Harriet Dustan Award presented by the American Heart Association’s Council on Hypertension. The renowned award and lecture recognise female investigators who have made outstanding contributions in the field of hypertension.

A Professorial Fellow in the Cardiovascular Division at The George Institute, Prof Schutte is Principal Theme Lead of Cardiac, Vascular and Metabolic Medicine at UNSW Medicine & Health.

She was nominated for the award by Prof Rhian Touyz, Editor-in-Chief of the journal Hypertension and Executive Director and Chief Scientific Officer of the Research Institute of the McGill University Health Centre, Canada.

“It’s a huge honour. I’m grateful to be selected among some brilliant women scientists round the world contributing to the important field of hypertension – the leading cause of death worldwide,” Prof Schutte said.

Prof Schutte has established herself as a leading researcher and advocate on reducing blood pressure globally. She has served as President of the International Society of Hypertension and is part of several international partnerships including the NCD Risk Factor Collaboration and Global Burden of Disease study. She also sits on the Steering Committee of the May Measurement Month blood pressure awareness campaign of the International Society of Hypertension.

She has extensive experience in population-based studies with a focus on raised blood pressure and cardiovascular disease and has made significant contributions to raising awareness for global action on raised blood pressure, including publishing over 400 papers and book chapters.

Prof Schutte has played a major role advancing hypertension research in low- and middle-income countries, winning several accolades including the Africa Union Award of Excellence 2019 and the South African Ministerial Award as the Distinguished Senior Woman Scientist.

As invited author of the Lancet Commission on Hypertension in 2016, she played a major role in highlighting Africa’s enormous rise in hypertension coupled with low awareness rates. This informed their key message that “every adult should know their blood pressure”. The Commission’s paper had major impact, with recommendations adopted by policies on four continents, the Copenhagen Consensus and the WHO.

“Recently I recognised that blood pressure control rates in Australia are surprisingly low compared to other countries. This is why I am directing my energy towards establishing a National Hypertension Taskforce, working with the Australian Cardiovascular Alliance and the High Blood Pressure Research Council of Australia. This Taskforce would convene national expertise from multiple disciplines and sectors to chart a roadmap to improving blood pressure awareness and control in the country,” she says, elaborating on her current work.

Prof Schutte will receive the award at the American Heart Association’s Hypertension 2022 Scientific Sessions in California in the US in September 2022.