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As the proportion of older people increases within populations, financial demands related to the cost of health service delivery threaten global stability. This population trend challenges the traditional approach to health service delivery to older populations. This article presents the Australian context as a case study to argue that the application of a health promoting settings approach to aged care may lead to improved well-being for older people to the extent that the periods of chronic morbidity often associated with aging can be compressed into an ever shorter period of time. Promoting an ecological perspective to aged care suggests that there is no need to manage older people in isolation, as is common practice, but as integral to the way society lives, works, and plays. The article maps parallels between characteristics of health promoting settings such as Health Promoting Schools and the aged living and care industry, arguing that the setting encompassing services for the elderly is a prime location for the establishment of a new health promotion setting. Supporting life opportunities for our aged is central to such an approach. More broadly, an ecological approach orients us toward the connection between environment and health, and encourages increased attention and action within the aged living and care sector on reducing environmental impacts of this growing population. As such, the application of this approach to the aged living and care sector has the potential to reduce the threat that a dependant older population has on global sustainability.

The economic and social implications of population trends make it an imperative for the aged care industry to develop frameworks to facilitate healthy ageing, the compression of disease and a more productive, active older population. Ecological health promotion delivered through a settings-based approach has been found to be a useful means to promote population health across a number of settings. Such an approach could offer both a framework to organize the many worthwhile strategies and practices being implemented for healthy ageing and a suite of concrete processes to engage stakeholders in such endeavors. In this regard, residential aged care facilities exhibit many of the characteristics of other settings such as schools and workplaces and, as such, should be developed as a health promoting setting. This paper asks whether residential aged care could become a health promoting setting for the ageing population?

Radical changes in the biosphere and human interaction with the environment are increasingly impacting on the health of populations across the world. Diseases are crossing the species barrier, and spreading rapidly through globalized transport systems. From new patterns of cancer to the threat of global pandemics, it is imperative that public health practitioners acknowledge the interdependence between the sustainability of the environment and the sustainability of the human species.* Why are issues of global and local sustainability of increasing importance to the public's health?* Why do issues of sustainability require new practices within the professions of public health?* How can future and current public health practitioners develop those new practices?Drawing on scientific evidence of global and local environmental changes, Sustainability and Health offers a thorough background and practical solutions to the overlapping issues in environment and health. It examines potential and existing responses to global and local environment and health issues, involving individuals, community, industry and government. The authors introduce a range of emerging conceptual frameworks and theoretical perspectives, link IT and epidemiology and explain how scoping can link program design, delivery, data collection and evaluation in projects from their very beginning. Public health practitioners need to be able to manage health issues that cut across environmental, economic and social systems and to develop the capacity for leadership in facilitating change. Incorporating learning activities, readings, international case studies and an open learning approach, this is a valuable resource for students of public and environmental health, as well as medical, environmental and health science professionals.

Mainstream mental health services in Australia have failed to provide culturally appropriate care for Aboriginal and Torres Strait Islander people despite several national reports and policies that have attempted to promote positive service development in response to the calls for change from the Aboriginal and Torres Strait Islander communities. In light of this situation, this article considers the ideas of Frantz Fanon and their potential for promoting cultural safety (Ramsden, 2002) in mainstream mental health services. This article argues that Fanon's ideas provide a conceptual strategy for nurses that prompts reflection and establishes a critical theoretical perspective linking power imbalance and inequitable social relationships in health care, thus complementing the aims of cultural safety. The purpose of this critical reflection is to guide nurses' understanding of the relationship between colonization and health status in order to change their attitudes from those that continue to support current hegemonic practices and systems of health care to those that support the health of Aboriginal and Torres Strait Islander people.

Human beings need each other for their continued existence, both as individuals and as a species; moreover, without continued existence, they can not attain perfection: whereby it follows that they need each other precisely in order to attain perfection. Thus, the perfection, the completion of each individual, depends on other individuals of the species, and thus man must have intercourse and association with the sons of men, based on mutual assistance. Without this, he will stray from the way of justice and fall into inequity. [Nasir al-Din Tusi, 1300] ********** INTRODUCTION This quotation represents the thoughts of an Iranian philosopher from the 13th century and refers to the community as a means for one's existence leading ultimately to excellence, justice, and equity. The notion of community is therefore more than just the sum of individuals striving for certain goals and objectives. It is a way of life which brings about harmony, balance, and perfection in life. The aim of this article is to describe two community development metaphors and how they are practiced at Yooroang Garang: School of Indigenous Health Studies, an educational institution of higher education in Australia. The models have developed through collaborative work with Australia's indigenous people over many years. "Both Ways Education," described by Yunupingu (1993), involves an ongoing collaborative process between the teacher and the learner through a continuous educational discourse. This discourse leads to clarification and extension of cultural knowledge from both the western and Australian indigenous world views, which are mutually recognized and shared in the classroom. "Both Ways Education" has been used to develop the metaphors presented in this article. The explanation of certain aspects of these metaphors are common to western models of community development (Capra, 1982). The unique aspect described in this article, however, has to do with the way these models can be used to enhance one's understanding of the concept of community development. [FIGURE 1 OMITTED] THE TREE This metaphor has been chosen to represent community development; to Aboriginal people, the tree represents the relationship of land to the outside world. The tree is significant as an important source of food and shelter for Aboriginal people. The tree is introduced to students on posters during lectures by comparing different parts of the tree to different parts of the community development process. The land has a deep and significant place in the lives of Australia's indigenous communities. Aboriginal people believe that their spiritual ancestors created the world. The activities of these ancestors created the mountains, rivers, animals, plants, and trees (Horton, 1994). Land is understood as mother, which each person has a responsibility to care for and protect. Aboriginal people see themselves as "... part of the symbolic continuum of the landscape" (Tacy, 1995, p. 14). This means that community development can only proceed when there is a deep respect for the land since people are so integrally connected to that land. Roots are the foundation of a tree. They penetrate through the soil, giving strength to the tree. The roots act as a source of energy; roots nurture the tree and facilitate growth. In this model the roots represent every community development project's connection to the land and its people. The community development worker plants seeds that develop into roots, which connect the project to the indigenous community. It often takes a long time to establish a project in the community through collaboration and cooperation. Community control and ownership of the process is paramount to the success of the project and the strength of the connections. The survival of the project depends on the time and energy the worker puts into developing these connections. If the established roots into the community are too shallow, thin, and inappropriate, then there is a significant chance of the project being derailed. …

The changing health system in Thailand has provided Thai people with more equitable opportunities in accessing health care services. As a result of medical practitioner shortages and a strong desire for nurses to expand their scope of practice, the Thailand Nursing and Midwifery Council (TNC) plans to increase the number of nurse practitioners at master degree level to staff primary care units (PCUs) and Health Centres around the country. Nursing master degree curricula in Thailand are currently offered using the traditional on-campus face-to-face mode of delivery and have low numbers of student enrolments. Furthermore, research indicates that many graduate nurses in Thailand are seeking entry to master degree curricula, but accessibility, convenience and availability of curricula locally are limiting enrolments. Nursing education globally is a dynamic and iterative process. Educational curricula are based on the principles of adult learning, continuing professional education and life-long learning, which advocate flexible and learner-oriented education. Flexible learning, which has the ability to closely match the professional and academic needs of the learner, has the potential to lead nursing education toward meeting the TNC policy and health system reform in Thailand. It is essential that nursing education in Thailand be revolutionised, embracing flexible delivery modes by traditional higher education providers. This paper presents a new model of health care service delivery and the mechanism used to integrate the principles of flexible learning into a new master degree curriculum for nurse practitioners (NPs) in Thailand.

Objective: It is well established that people who work with clients who are dependent on substances need to be well equipped to deal with challenging and complex situations. Our research explores the experience of alcohol and other drug workers (AODW) in order to identify how successful Australia's teaching institutions are at preparing AODWs to meet this challenge. Design: Interviews were conducted to ascertain the perceived gaps in existing training programs and the perceived training needs of AODW. Using a qualitative research approach in-depth interviews were conducted with more than 20 counsellors working in six AODW rehabilitation centres in regional New South Wales. Results: There was a perception among all workers that their training had been inadequate and that the preparation for employment in AODW settings had not meet the felt needs of grass-roots workers leaving them to learn through experience. Conclusion: Considering the recommendations of both national and state policies on AODWs in Australia there is an urgent need to develop courses relevant to the needs of workers as suggested by respondents to this research.

This article reports on a needs analysis undertaken to determine the educational needs of nurses and health workers in East Timor. The needs analysis, which used a theoretical framework described by Wass (1994), was conducted in both Australia and East Timor. It addressed the current health status of the East Timorese people and the educational requirements of East Timorese nurses and village health workers. Utilizing interviews, field observations and data from the World Health Organization and the United Nations, the following four categories of needs were assessed: felt; expressed; comparative; and normative. The findings document the almost complete destruction of the health infrastructure in East Timor and demonstrate the urgent need for assistance in the re-establishment and enhancement of nursing and primary health care education programmes. A series of recommendations outlining nurse and village health care worker education programmes are proposed.