Indigenous children in Australia: health, education and optimism for the future.

Lyons, Zaza ; Janca, Aleksandar

Introduction

Evidence of the relationship between health status and education demonstrates that lower levels of educational attainment are associated with poorer health outcomes throughout life (Case, Fertig & Paxson, 2005; Poulton et al., 2002; Sacker, Schoonb & Bartleya, 2002). Level of education has been found to be a powerful predictor of mortality and overall morbidity across the lifespan (Lleras-Muney, 2005), with people who have not completed high school at risk of a shorter life compared with those who do complete (Muller, 2002; Sundquist & Johansson, 1997). As well as being associated with a substantial reduction in educational outcomes, low socioeconomic status and poverty during childhood and adolescence are independent predictors of a number of illnesses including heart disease, cancer and diabetes (Albano et al., 2007; Kinsey, Jemal, Liff, Ward & Thun, 2008; Raphael, 2006). Children from such backgrounds are more likely to miss school due to illness, have poorer school performance and overall lower expectations about their educational achievements (Jackson, 2009).

The importance of early life experiences as a social determinant of health has been widely recognised by social researchers (for example, Raphael, 2006) and was endorsed in 2005 by the World Health Organisation, with the establishment of the Commission on Social Determinants of Health (World Health Organisation, 2010). The foundations of adult health are determined in early childhood with the impact of early development and education setting the scene for future health outcomes and educational achievement. Poor emotional support and stimulation can lead to reduced readiness for school, low educational attainment, problem behaviour and the risk of social marginalisation in later life (Wilkinson & Marmot, 2003).

In Australia, Indigenous children are disproportionately affected by poor health. The combined consequences of illness and social factors in this population have an adverse affect on educational outcomes for Indigenous children, resulting in lower levels of achievement and attainment compared with non-Indigenous children (Schwab, 1999). There has been growing evidence over the last few decades of considerable disparities between Indigenous and non-Indigenous Australians across a number of health and social determinants (Ring & Brown, 2003). Illnesses and diseases that are more prevalent among Indigenous children compared with non-Indigenous children contribute to a considerable burden of disease among these children and their families (Thomson et al., 2010). In addition, psychosocial factors such as overcrowded housing, domestic violence, greater interaction with the justice system, and alcohol and substance use negatively affect health status and mental and emotional well-being (Bailie & Runc, 2001). Other indices such as life expectancy, the rate of teenage pregnancies, and infant and maternal mortality demonstrate poorer outcomes for Indigenous Australians (Thomson et al., 2008).

Health status and educational achievement are inextricably linked but, for the most part, the two sectors operate independently of each other in the provision of health and educational services. This article discusses the health and educational status of Indigenous children and describes a range of programs and initiatives from both sectors that aim to improve outcomes for this population.

Health status of Indigenous children

Two overviews of Indigenous health status provide a comprehensive analysis of comparisons in health status and health risk factors between non-Indigenous Australians and Indigenous Australians. These reports draw upon a number of data sources including the 2006 census and various state and national databases related to morbidity and mortality (Thomson et al., 2010). There are several findings of relevance to Indigenous youth:

* the fertility rate for teenage Indigenous women is four times higher than for non-Indigenous women

* babies born to Indigenous women are twice as likely to be of low birthweight in comparison to those born to non-Indigenous women

* the infant mortality rate for Indigenous babies is higher than for non-Indigenous babies and ranges from 1.7 times higher in New South Wales to 2.9 times higher in Western Australia

* the rate of Indigenous male suicide (in those aged 15-24) is 3.4 times higher than for non-Indigenous, and 6.1 times higher for females

* injury and accident as a cause of hospitalisation is higher among both young Indigenous males and females than non-Indigenous Australians

* the incidence of tuberculosis in Indigenous children aged 0-4 years is 4.2 times higher than in non-Indigenous children, 4.8 times higher in the 5-14-year age group, and 13.9 times higher in the 15-24-year age group

* sexually transmitted infections (gonorrhoea, chlamydia and syphilis) are substantially higher among Indigenous Australians than among non-Indigenous Australians

* up to 70% of Indigenous children in some communities have skin infections

* otitis media (middle ear infection) is 2.8 times more common among Indigenous children than among non-Indigenous children

* the oral health of Indigenous children is substantially worse than that of non-Indigenous children.

The impact of social and psychosocial factors on the health of Indigenous children

From early childhood, infectious diseases are significantly more common among Indigenous children than among non-Indigenous children (Carville, 2007). Diseases such as otitis media, rheumatic heart fever and rheumatic heart disease, gastroenteritis and respiratory infections (described below) are highly prevalent among Indigenous children and cause a high burden of disease (Carville et al., 2007). Some of these are regarded as diseases of poverty and are comparatively rare in developed countries and among non-Indigenous children in Australia (Carapetis, Brown, Wilson & Edwards, 2007).

There is a range of risk factors that contribute to high rates of infectious disease among Indigenous children. Overcrowded, inadequate housing and living conditions characterised by poor sanitation, lack of access to electricity and clean drinking water, inadequate rubbish disposal, faulty sewerage systems and poor dust control provide opportunity for the spread of infectious diseases among families and communities (Bailie & Runc, 2001; Coates, Morris, Leach & Couzos, 2002). Under these circumstances, the ability of families to undertake basic hygiene requirements and activities of daily living such as showering, laundry, domestic cleaning and waste removal is severely compromised, which enables the spread of infectious disease among households and communities.

As well as greater susceptibility to infectious disease, social and psychosocial factors are also detrimental to Indigenous health and well-being. Poor nutritional status, lack of access to health services, a high prevalence of tobacco smoking, adverse effects associated with adult drug and alcohol use, domestic violence and sexual, physical and emotional abuse all further contribute towards a spectrum of disadvantage and dysfunction experienced by a proportion of young Indigenous people (Australian Bureau of Statistics, 2006). This cycle of disease and disadvantage negatively affects Indigenous children in a number of areas of their life and contributes significantly towards the lowered educational achievement of Indigenous children through the primary and secondary school years.

Illnesses commonly experienced by Indigenous children

Otitis media, or middle ear infection, can be either an acute or a chronic condition and is very common among Indigenous children (Coates, Morris, Leach & Couzos, 2002). Studies estimate the prevalence of chronic suppurative otitis media to be between 23% and 70% compared with approximately 5% in non-Indigenous children (Rothstein, Heazlewood & Fraser, 2007). A review of acute otitis media in children in the Northern Territory found that the prevalence was approximately 31% (Morris et al., 2007) and that, on average, an Indigenous child can expect to have 32 months of middle ear disease compared with three months for a non-Indigenous child.

Acute rheumatic fever is an autoimmune consequence of infection with bacteria that commonly causes sore throat. It causes an acute generalised inflammatory illness that can affect several parts of the body, usually the heart, joints, brain and skin. Once the patient has recovered from an acute episode of rheumatic fever, longer term heart damage--specifically to the mitral and aortic valves--may be sustained, resulting in rheumatic heart disease (Carapetis, Brown, Wilson & Edwards, 2007). The highest rates in the world of both acute rheumatic fever and rheumatic heart disease are found among Indigenous Australians and children, with those aged between 5 and 15 years and living in rural and remote areas most likely to be affected.

Gastroenteritis is a common illness that most children will experience at least once during their childhood years. But Indigenous children, particularly those who live in regional and remote areas, suffer much higher rates of gastroenteritis than non-Indigenous children and it is a major cause of hospitalisation for them (Dean, 2003). Between 1995 and 2004 the Northern Territory notification rate for Indigenous children was almost three times that for non-Indigenous children with children under one year accounting for 56% of cases (Schultz, 2006). Furthermore, the length of hospitalisation for gastroenteritis for Indigenous children is significantly higher than for non-Indigenous children, adding to the overall burden and impact of the disease (Dean, 2003).

Respiratory infections are also a common health problem among Indigenous children. In the Northern Territory, respiratory disease is the most common disorder in children under five years (Chang et al., 2000). Infection rates of bronchiectasis and invasive pneumococcal disease among children in central Australia have been found to be significantly higher among Indigenous children than among non-Indigenous children in both remote and non-remote areas (Chang et al., 2000; Peat & Veale, 2001).

Social and emotional well-being of Indigenous children in the school environment

In an Indigenous context, the concept of social and emotional well-being describes a holistic view of health recognised by many Indigenous people. Traditionally, health encompasses more than just the physical health of an individual--the social, emotional, spiritual and cultural well-being of the whole community is essential for the good health of individuals within the community (Garvey, 2008).

The school environment provides the opportunity for children to build self-esteem and confidence, both through academic achievement and positive interactions with peer groups. Negative experiences can result in psychological distress that can affect school performance, the development of friendships and positive interactions with peers. There is limited evidence that attending school affects Indigenous children in terms of stress and negative experiences. The 2008 National Aboriginal and Torres Strait Islander Social Survey (Australian Bureau of Statistics, 2008) provides information from Indigenous children aged 4-14 years in relation to school attendance, health and illness, and positive and negative contact with the police. The survey found that approximately 65% of children reported experiencing at least one stressor in the previous 12 months, the most common of which was the death of a close family member (22%), followed by problems keeping up with school work (20%) and being scared by an argument or by someone's behaviour (19%). The survey also demonstrated a link between stress and health, with children who are less stressed reporting better overall health compared with those with greater levels of stress (Australian Bureau of Statistics, 2008).

Findings from the Western Australia Aboriginal Health Survey, conducted between 2000 and 2002, showed that 20.5% of Indigenous children compared with 7% of non-Indigenous children aged 12-17 years were at risk of clinically significant emotional or behavioural difficulties. The main difference between Indigenous and non-Indigenous children related to conduct difficulties. The survey also found that 9.0% of Indigenous females and 4.1% of males had attempted suicide in the previous 12 months (Blair, Zubrick & Cox, 2005).

Bullying at school is a significant stressor for Indigenous children with almost a third of respondents to the Western Australia Aboriginal Health Survey, conducted between 2000 and 2002, reporting that they had been bullied at school (Zubrick et al., 2005). The 2008 National Aboriginal and Torres Strait Islander Social Survey found that 11% of children surveyed reported being bullied because of their Aboriginality. For 34% of these children, bullying had affected their school attendance, and for 17% it had influenced their school performance. Bullying is associated with psychological disturbance, with children who are bullies and with victims of bullying both particularly susceptible to anxiety, depression, psychosomatic complaints as well as higher risks of binge drinking and substance use (Forero, McLellan, Rissel & Bauman, 1999; Kaltiala-Heino, Rimpela, Rantanen & Rimpela, 2000; Kumpulainen, Rasanen & Henttonen, 1999).

Indigenous school attendance, retention and educational achievement

For children to achieve even basic levels of educational competency, regular school attendance is imperative. But high rates of infectious disease combined with growing up in an unstable environment characterised by disadvantage and dysfunction often have adverse effects on regular school attendance for Indigenous children, which affects their potential for educational achievement (MCEETYA Taskforce on Indigenous Education, 2001). Recurrent acute and chronic ear infections leading to conductive hearing loss, especially in the first few years of life, can lead to multiple problems in the school environment: in particular, speech and language delays (Leach, 1999; Williams & Masterson, 2010). Such problems have a negative impact on a child's ability to learn and interact positively with friends and peers, resulting in social isolation and seclusion. Consequently, truancy, anti-social behaviour and lack of achievement in literacy and numeracy in the early years is common (MCEETYA Taskforce on Indigenous Education, 2001).

Retention to the upper school years has long been recognised as a major issue in the provision of education to Indigenous children and their subsequent achievement in reading, literacy and numeracy (Australian Bureau of Statistics, 2005). While there have been improvements over the last 10 years or so, poor attendance, particularly at secondary level, remains an issue. The National Schools Statistics Collection shows that, while there is a 3% difference in retention rates between Indigenous and non-Indigenous children up to Year 9, by Year 12 this has grown to 33% (Australian Institute of Health and Welfare, 2008). Despite the many initiatives implemented to deal with absenteeism among Indigenous students, it persists as a major concern for education policy-makers and educators (Bourke, Rigby & Burden, 2000).

Since 1989 under the National Literacy and Numeracy Plan, federal and state governments have collaborated in the dissemination of national reading, writing and numeracy benchmark data for all students in Years 3, 5, 7 and 9. In 2008 this was updated to become the National Assessment Program in Literacy and Numeracy (NAPLAN) and the first round of testing under this new plan was undertaken in May 2008 (Australian Curriculum Assessment and Reporting Authority--ACARA, 2010). The 2010 NAPLAN report consistently demonstrates disparities between Indigenous and non-Indigenous students in Years 3, 5, 7 and 9 in the areas of reading, writing, spelling, grammar and punctuation, and numeracy. Indigenous students living in remote or very remote locations were found to have the lowest performance in all academic areas assessed. Table 1 shows comparative data of the percentage of Indigenous and non-Indigenous students who performed 'at or above the national minimum standard' in the 2010 NAPLAN tests and shows the differences in performance among Year 3, 5, 7 and 9 students (ACARA, 2010).The NAPLAN reports are as yet unable to demonstrate any longitudinal trends. The first round of testing was conducted in 2008 and the method of assessment and presentation of results differs from the National Literacy and Numeracy Plan. But the 2007 National Literacy and Numeracy Plan report shows trends over time in the proportion of students achieving or exceeding the benchmarks for reading, writing and numeracy. For Year 3 students, 73% of Indigenous students achieved the benchmark for reading in 1999 compared with 81% in 2007. Figures for writing were 67% compared with 77% and numeracy, 74% compared with 79%. In Year 5 the trend for reading was 59% in 1999, compared with 68% in 2007, writing, 75% compared with 79% and numeracy, 63% compared with 65%. In Year 7 the trend for reading was 60% in 2001 compared with 65% in 2007, writing, 74% in 2001 and 2007 and numeracy, 49% compared with 46% (MCEETYA, 2007).

While there have been improvements over the last 10 years or so, the disparity between Indigenous and non-Indigenous students on basic levels of educational achievement remains an ongoing issue.

Government policies and strategies in the Indigenous education and health sectors

The provision of primary and secondary education to Indigenous students presents significant challenges for educational policy and leadership at both a national and state level. In addition to issues related to health and social disadvantage previously described, there are a number of other factors that further increase the complexity of providing education to Indigenous children, particularly those in rural and remote regions. These factors include English being a second language; frequent involvement of children in cultural traditions and participation in sorry business; staffing difficulties and retention of staff; remoteness and access to schools; importance of community involvement in programs of education; socio-economic factors; and the cultural relevance of the learning environment (Henderson, 2002). In common with mainstream education, the provision of Indigenous education also takes place against a background of frequent policy and administrative changes, the integration of curriculum changes, the implementation of national strategies such as benchmarking, and the recognition of involvement of the community and parents in education (Blackmore, 1998).

In recognition of the complexities involved in providing Indigenous education, successive federal and state governments have developed a wide array of policies, frameworks, strategies and programs designed to meet the specific needs of Indigenous education and improve educational outcomes for these children. While this may appear as a step in the right direction, Gray and Beresford (2008) caution that the sustainability of policies is undermined by a number of interacting factors. These include policies that are crisis driven and lack sound, strategic planning; a confusing overlap between State and Federal responsibilities; difficulties for schools in maintaining relationships with other stakeholders; lack of training for teachers involved in Indigenous education; and limited community participation in education.

In an attempt to improve Indigenous educational outcomes, the National Aboriginal and Torres Strait Islander Education Policy was developed in 1989. This policy provides the foundation for Indigenous education programs and is endorsed by all state and territory governments. The policy has identified four major goals:

* involvement of Aboriginal and Torres Strait Islander people in educational decision-making

* equality of access to education services

* equity of educational participation

* equitable and appropriate educational outcomes (Commonwealth Department of Education, Employment and Workplace Relations, 2010).

DEEWR also has a raft of strategies focused on Indigenous education, including the Indigenous Youth Mobility Program, the Literacy and Numeracy Initiative and the Indigenous Youth Leadership Program. While these policies and programs demonstrate a commitment to Indigenous education, independent evaluation is lacking and it is not possible to estimate their effectiveness both in terms of meeting goals and improving overall outcomes for Indigenous students (Commonwealth Department of Education, Employment and Workplace Relations, 2010).

One of the most significant federal policies directed towards Indigenous health to have been developed in recent years is the Close the Gap campaign. This campaign has its foundation in the 2005 Social Justice report in which the Aboriginal and Torres Straits Islander Social Justice Commissioner stated that it was unacceptable to tolerate the wide disparities between Indigenous and non-Indigenous health status. Recommendations were made to end the 'Indigenous health crisis' and in 2007, as a means of tackling this crisis, the Close the Gap campaign was launched.

The Close the Gap campaign is a coalition of Indigenous and non-Indigenous health and human rights organisations and a partnership between governments and Indigenous people and their representatives. It has two major goals: firstly for all state and territory governments to prioritise Indigenous health and set out timeframes for doing so; secondly, to generate a range of Close the Gap Indigenous health equality targets. The following major targets have been identified:

* to close the life expectancy gap within a generation

* to halve the mortality gap for children under five within a decade

* to halve the gap between reading, writing and numeracy within a decade.

These targets arose from the recognition of the complexities of dealing with Indigenous disadvantage and the recognition of the need to have a multifaceted approach to overcoming these complex problems (Human Rights and Equal Opportunity Commission, 2008). The 2010 Close the Gap Shadow report describes progress that has been made over the last two years. The report accepts that, while progress has been made on some policy and administrative fronts, little has been achieved in terms of developing a comprehensive plan that will begin to meet the primary aims of the campaign (Hinton, 2010).

While federal and state government based initiatives are welcomed as potential long-term solutions for overcoming Indigenous disadvantage, they are representative of a top-down approach to tackling the issues. There is plenty of scope from within both the health and educational sectors for the implementation of strategies and policies that may be able to make important contributions at a community level to benefit Indigenous children and their families in the shorter term. Robust school leadership that recognises and is prepared to overcome the challenges in schools attended by Indigenous children is essential if meaningful change is to occur. In addition, health programs to deal with the specific problems experienced by Indigenous children are needed in order to improve health status and give children the opportunity to achieve their potential in the classroom.

Barriers and challenges in Indigenous leadership and education

From an educational perspective it is clear that educational leaders who work with Indigenous students are faced with a number of unique barriers and challenges. The development of an effective style of leadership is crucial for Indigenous schools to succeed and improve educational outcomes for students. Considering the challenges and complexities of Indigenous education leadership, it is likely that a mix of different leadership styles, specifically transformational and distributed leadership, are necessary to effectively govern schools attended by Indigenous students.

Transformational leadership motivates others to perform at levels they had not thought possible and sets challenging expectations in order to encourage others to achieve more, motivating followers and empowering them to satisfy their needs and develop their own leadership potential (Bass & Riggio, 2006). It involves charisma and vision on the part of the leader; inspiration of followers by the leader; individualised consideration, where a respectful relationship is developed between leader and follower; and intellectual stimulation, where new ideas are developed and enacted. While transactional leaders are more effective in stable and predictable environments, transformational leaders will seek new ways of working and work proactively rather than reactively. Evidence of the effectiveness of transformational leadership has been assessed by Lowe, Kroeck and Sivasubamaniam (1996) in a meta-analysis. It was found that characteristics such as charisma, individualised consideration and intellectual stimulation were better predictors of effective leadership than the transactional scales of contingent reward and management.

Distributed leadership enables people to work together to pool their initiative and expertise, producing an outcome where the product or energy is greater than the sum of their individual actions (Bennett, Wise, Woods & Harvey, 2003). Distributed leadership supports the theory that all individuals, including teachers, parents and the wider community, have some expertise that is distributed throughout the organisation, creating a mutually trusting and supportive environment. Evidence has shown it to be effective in improving literacy rates among Indigenous students (Timperley, 2005) and in schools that face challenging circumstances (Harris & Chapman, 2002). Both transformational and distributed styles of leadership have potential to be effective in the Indigenous setting and--combined with attributes such as the ability to empower staff, to create stable, safe learning environments, to recognise the importance of team work and building relationships, and to commit to the long term in order to make a difference--such school leaders--principals--may be able to make an enduring change in outcomes for Indigenous students (Duignan & Gurr, 2007).

Principalship in a general context is subject to a range of barriers that influence the recruitment and retention of leaders. Being a principal is perceived as having a negative effect on personal and family life, and as making excessive demands for efficiency and accountability by society and the educational system. There is seen to be a lack of necessary preparation or expertise for the position and inadequate knowledge to do the job properly, and a reluctance to forfeit the relationship with students and other staff, resulting in a preference to continue teaching in classrooms (d'Arbon, Duignan & Duncan, 2002). Teacher shortages, high staff turnover, time spent on attending to administrative duties, the issues associated with low-performance schools and greater accountability add to these dilemmas (Macbeath, 2006). These pressures can have adverse effects on principals, leading to stress-related health problems and burn-out. In the context of Indigenous educational leadership, there are a number of additional challenges facing principals. These include geographical remoteness, dealing with the health, nutritional issues and social disadvantage faced by the children, and teacher recruitment and retention.

Support for leadership in Indigenous education

Support for leadership in the provision of Indigenous education has been gaining momentum over the last 10 years or so. In 2000, the federal government launched the Dare to Lead project in recognition of the differences and difficulties in providing education to Indigenous students (Commonwealth Department of Education, Employment and Workplace Relations, 2008). Dare to Lead provides 'a network of support for school leaders to work effectively with current programs and to initiate new models of activity, which will result in improved outcomes for

Indigenous students'. There are now well over 5000 coalition member schools connected to clusters called 'Action Areas' involved in the initiative. One of the goals of the project is to achieve sustainable change in this regard. This project focuses on improving educational outcomes for Indigenous students through increasing and supporting effective school leadership. A recent interim report shows that, after three years, the proportion of Indigenous students in Year 5 member schools achieving above the benchmarks for reading, writing and Year 12 completion had improved. A number of other achievements were also reported including improvements in the number of schools inviting Indigenous guest speakers to assemblies; 'welcome to country' at major gatherings and events; and professional development with an Indigenous focus (Commonwealth Department of Education, Employment and Workplace Relations, 2008).

A further example of positive investment in Indigenous education is the development of the Stronger Smarter Institute by inspirational Indigenous educational leader and advocate, Chris Sarra. This institute, jointly funded by the Queensland University of Technology, the Queensland Department of Education, Training and the Arts, and the Commonwealth Department of Education, Employment and Workplace Relations is underpinned by the Stronger Smarter Leadership Program, which was designed to 'challenge and support leadership at all levels of education to improve outcomes for Indigenous students'. The institute believes that culturally competent leadership is required in order for Indigenous children to attain excellence and for schools to transform. Culturally competent leadership understands culture from an Indigenous perspective; it facilitates dialogue, professional conversation and learning, as well as a collaborative process for doing things in new ways, and processes to ensure success; it also identifies complex challenges; and optimises leadership capability and the contribution of community members (Gorringe & Spillman, 2008). Participants in the program learn to improve educational outcomes for Indigenous students by developing cultural competence, supporting school transformation and, through research, document progress to demonstrate positive changes (for more information about the institute, see the Queensland University of Technology website at <http://www.strongersmarter.qut.edu.au>).

Community-based health programs

In the health sector, there is recognition that community-based programs that work collaboratively with Aboriginal organisations are essential if the health of Indigenous children is to improve (Gracey, 2007). A number of positive programs and initiatives have been implemented as a means of improving the health of Indigenous children, all of which have been supported by members of the local communities including Aboriginal health workers, general practitioners, parents and elders. As well as support from health providers, the majority of these programs also depend on the support of local schools, demonstrating the importance of integration between the two sectors in order to provide a more holistic response to specific problems at the local level.

The No Pool, No School policy adopted by several remote communities links improvement of health problems and school attendance. In 2000, swimming pools were opened in two Aboriginal communities in Western Australia. Children who attend school each day are provided with a pass to use the pool after school. Evaluation showed that the prevalence of ear, skin and respiratory infections reduced significantly, and that school attendance rose significantly in both communities as a result of the pool policy (Silva et al., 2008; Lehmann et al., 2003). The provision of pools in communities has now become more common and evidence of health benefits is growing. Due to the success of this program in Western Australia, a partnership between the state government, Royal Life Saving, the Telethon Institute and BHP Billiton has seen an extension of the No Pool, No School program to approximately six remote communities (Tate, 2010).

An educational program aimed at improving outcomes for Indigenous children with asthma resulted in a substantial improvement in the use of asthma medications and improved knowledge in asthma symptoms and long-term management (Chang et al., 2000). In the Northern Territory, the prevalence of scabies in a remote community was significantly reduced--from 38% before the program to less than 10% by the end of the program--by treating children with permethrin cream (Carapetis, Connors, Tarmirr, Krause & Currie, 1997).

Other successful programs include the Good Food, Great Kids Program, a collection of community nutrition projects that were implemented in the Yarra Valley in Victoria from 2002 to 2004. One of these involved participation from two schools, which established kitchen gardens and a breakfast program. As well as improving nutrition, the children learnt about growing food and their local history and culture (Australians for Native Title and Reconciliation, 2007).

The Mount Theo Program is an outstation treatment and diversion program set up to assist young Indigenous people recover from the effects of petrol sniffing in Yuendumu in the Northern Territory. The program has cared for more than 400 young people since its inception in 1994 and has been widely successful in reducing the number of petrol sniffers in the town. Prevention programs have also been implemented with the establishment of several youth programs, and this multifaceted approach has been effective in overcoming what was in the past a major social and health issue (Preuss, Preuss & Brown, 2006).

There is no doubt that there is a growing 'grassroots'-led approach to overcoming health problems in Indigenous children at the local level. But a multidisciplinary approach involving support from health providers, schools, parents and elders is essential if these programs and initiatives are to reach their full potential and achieve long-term goals and objectives.

Conclusions

Indigenous children have poorer outcomes on a number of health and educational variables than non-Indigenous children. They suffer disproportionately from a number of common infections and other illnesses that cause a significant amount of ill health from an early age. In addition, they are exposed to social disadvantage and dysfunction, which further compounds their overall health status and social and psychosocial functioning. Evidence demonstrating a correlation between educational attainment and health status suggests that policies and programs within these sectors have the potential to contribute positively to improving the lives of Indigenous children.

For decades, the impact of social and educational determinants on the health of Indigenous children has been widely recognised by both federal and state governments. It is encouraging to note that there have been a number of important initiatives aimed at improving both the educational status and the health and social and emotional well-being of Indigenous children. These include the National Assessment Program in Literacy and Numeracy, National Aboriginal and Torres Strait Islander Education Policy, and the Close the Gap campaign. More recently, support for Indigenous education and leadership has been gaining momentum with the implementation of the Dare to Lead project and the Stronger Smarter Institute.

While these are welcome and positive initiatives that demonstrate a commitment towards Indigenous advancement, the intractable link between health and education requires policy-makers to work in partnership across agencies if outcomes for Indigenous children are to improve. The implications of treating each area of Indigenous disparity as a stand-alone problem ignores the complexity, interrelated nature and spectrum of overall disadvantage experienced by a high proportion of Indigenous people.

A coordinated and holistic governmental approach that acknowledges and considers the complex interactions between these and other areas of Indigenous service provision will ensure that enduring and sustainable changes are made for the betterment of Indigenous families and children. In addition, there is a need for funding for small-scale, community-led initiatives that aim to tackle local problems at a grassroots level to be available to schools and health service providers. Importantly, support for Indigenous educators and health providers that focuses on developing and supporting leadership roles is fundamental to overcoming the challenges and barriers that have served as obstacles in the past.

Finally, there should be rigorous evaluation of ongoing strategies, programs and activities in order to develop a better understanding of the innovation, commitment and investment that is required to enhance educational and health outcomes for Indigenous children. This will go a long way towards securing an optimistic future for our Indigenous children and ensuring that future generations are able to reach their full potential.

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Zaza Lyons

Aleksandar Janca

School of Psychiatry and Clinical Neurosciences, University of Western Australia

Zaza Lyons is Assistant Professor in the School of Psychiatry and Clinical Neuroscience, University of Western Australia. Email: zaza.lyons@uwa.edu.au

Aleksandar Janca is Winthrop Professor and Head of the School of Psychiatry and Clinical Neurosciences, University of Western Australia.

Table 1 Percentage of Indigenous and non-Indigenous students
performing 'at or above the minimum standard' in the 2010 NAPLAN
tests

                           Year     Indigenous     Non-Indigenous
Academic area             level    students (%)     students (%)

Reading                   Year 3        75               95
                          Year 5        66               93
                          Year 7        77               96
                          Year 9        64               93

Writing                   Year 3        79               97
                          Year 5        70               95
                          Year 7        70               94
                          Year 9        59               89

Spelling                  Year 3        66               92
                          Year 5        71               93
                          Year 7        74               94
                          Year 9        67               91

Grammar and punctuation   Year 3        66               94
                          Year 5        65               94
                          Year 7        64               93
                          Year 9        63               92

Numeracy                  Year 3        77               95
                          Year 5        71               95
                          Year 7        77               96
                          Year 9        70               94

Source: ACARA (2010).