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This paper examines the response of a regional body, the Institute for Urban Indigenous Health (IUIH), coordinating Aboriginal community controlled health organisations (ACCHOs) in south-east Queensland, to research evidence as they prioritise and plan services in response to internal economic and organisational factors, as well as external policy change. An event-based analysis of a quarterly management meeting of the IUIH allowed an exploration of how the IUIH uses a range of evidence to respond to the challenges faced within the Aboriginal community controlled health sector. The study identified three distinct but interconnected processes: (1) identifying evidence for change; (2) exploring and reframing this evidence; and (3) the application of this evidence at different levels of policy and practice. These processes were evident in each of the three major agendas addressed during the meeting, namely navigating current political change, reforming the ACCHO business model and reframing the available evidence for advocacy. The result has been the emergence of a new service delivery model, in which evidence supports accountability, change management, self-sufficiency and attempts to redefine community control.

Indigenous people globally remain resilient yet vulnerable to the threats of HIV. Although Australian Aboriginal and Torres Strait Islander peoples experience the worst health status of any identifiable group in Australia, with a standardized morbidity rate three times that of non-Indigenous Australians, the Australian response to HIV has resulted in relatively low and stable rates of HIV infection among Australia's Indigenous peoples. This paper examines the reasons for the success of HIV prevention efforts. These include early recognition by Indigenous peoples of the potential effect that HIV could have on their communities; the supply of health hardware (needle and syringe programs and condoms); the development and implementation of culturally-appropriate health promotion messages such as the internationally-recognized Condoman campaign; the inclusion of dedicated Aboriginal and Torres Strait Islander Sexual Health Workers in communities; and an inclusive policy and partnership approach. Furthermore, the efforts of peak Aboriginal health organizations including NACCHO and its member services and Indigenous programs in peak mainstream organizations like AFAO and its member organizations, have all contributed to prevention success. Efforts need to be maintained however to ensure an escalated epidemic does not occur, particularly among heterosexual people, especially women, and people who inject drugs. New ideas are required as we enter a new era of HIV prevention within the context of the new paradigm of treatment as prevention, and getting to zero new infections.

What impact has the NHMRC Road Map had on Aboriginal and Torres Strait Islander health? A review process now underway aims to find out.

Objectives: To obtain, through a survey, estimates of immunisation coverage in a birth cohort of Indigenous children, and to compare survey estimates with those obtained from the Australian Childhood Immunisation Register (ACIR) for the same birth cohort of Indigenous children., Methods: Cluster sampling of a birth cohort of two-year-old Indigenous children across Queensland, stratified according to accessibility/remoteness from services, was undertaken in 2003. An innovative method of identifying participants was used. Survey results of 10 vaccine doses were compared with ACIR data., Results: The survey obtained a 4% sample of the birth cohort (137 children). Universally recommended vaccines showed high levels of coverage at 12 and 24 months, and survey estimates were slightly higher than ACIR estimates. Diphtheria-tetanus-acellular pertussis vaccine dose 3 (DTPa3) coverage was 93.8% (95% CI 88.0-99.6) by 12 months on survey and 87.5% on ACIR. Coverage was not timely and a lag phase of 4-6 months occurred for each vaccine dose. Haemophilus influenzae type b vaccine dose 2 (Hib2), scheduled for the age of four months, reached 90% coverage by nine months of age in the survey children., Conclusion: Both methods reported here provided similar results., Implications: These data indicate that ACIR Indigenous reporting rates have increased and coverage estimates are comparable to those provided by a survey. Immunisation coverage appears to be high, and the main remaining challenge in further reducing vaccine-preventable disease in Indigenous children is to improve immunisation timeliness.

The health status of Australia's indigenous people remains the worst of any subgroup within the population, and there is little evidence of any significant improvement over the past two decades, a situation unprecedented on a world scale. Compared with non-indigenous Australians, adult life expectancy is reduced by 15-20 years, with twice the rates of mortality from heart disease, 17 times the death rate from diabetes and 10 times the deaths from pneumonia. Despite improvements in perinatal mortality, they continue to represent a major cause of death, with infant deaths up to 2.5 times higher than the general population. The problems of educational disadvantage and unemployment are reflected in twice the rates of smoking and high obesity levels. Seven percent of indigenous families are homeless, with many more in inadequate and overcrowded housing, sometimes lacking water or sewerage. Economic disadvantage is real: 23% worry about going without food. Nutritional deficiencies in children have resulted in failure to thrive, contributing greatly to the problems of pneumonia and infectious diseases. The remoteness and isolation of many Aboriginal communities limit education and employment opportunities. It is important to consider the historical context of Aboriginal and Torres Strait Islander people, in order to gain an understanding of current health problems. The impact of past policies and practices and the 'introduced diet' are reflected in the poor health outcomes described above. This session will explore some of the underlying historical, cultural, structural and political factors that can be linked to the current problems.