Aboriginal and Torres Strait Islander peoples have a five times higher risk of developing dementia than non-Indigenous Australians. This is one symptom of a greater problem – Australia’s First Nations peoples have long experienced poorer health than other Australians due to continued social inequalities over generations, a situation common to First Nations peoples around the world.

Associate Professor Goldberg’s research focuses on dementia risk and reduction, working with First Nations people in North-West Tasmania. In partnership with the Circular Head Aboriginal community and other members of her UTAS team, this work is developing a model that can be applied more widely in Australia and overseas.

‘I’ve always been interested in preventing ill-health,’ says Dr Goldberg. ‘But money tends to be more readily available for rehabilitation services.

‘I came to the Wicking Centre in 2014 as part of a multidisciplinary team. My background in speech pathology led to an initial focus on oral health in older people, including those with dementia.

‘The most exciting thing about my work is keeping people healthier and reducing dementia risk,’ she says. ‘Tasmania has poor statistics in the area of health, especially for its remote and rural communities, and I’m playing a role in changing that.’

Circular Head Aboriginal community

Associate Professor Goldberg is working alongside the Circular Head Aboriginal community in Tasmania’s North-West to develop models of health prevention and education that will ultimately benefit communities around the world facing similar problems.

‘Since 2016, funding of $1.2 million has been secured for the Circular Head Aboriginal community to educate members about dementia and modifiable risk factors,’ says Dr Goldberg. ‘When I first met the chief executive of the community, Dianne Baldock, there was concern about the increasing number of people developing dementia. Funding was needed to talk about this in the community, to hear from the community about its concerns and to work together to address modifiable risk factors.

‘Circular Head is classified as rural and remote. Burnie is the nearest city, an hour’s drive away. Many medical services are provided by people who come periodically into the local area. The onsite general practice is staffed by non-Aboriginal doctors, and misunderstandings can arise regarding the care needed by Aboriginal patients. Such misunderstandings have contributed to Aboriginal people not going to the doctor.’

Dr Goldberg explains that with an Aboriginal population of about 900 in the Smithton area, there is an urgent need for Aboriginal primary healthcare workers. ‘We now have funding for some community members to complete studies to take on this role, as an important and valuable cultural bridge between the Aboriginal community and non-Aboriginal doctors.’

A roadmap for dementia

Wicking’s Preventing Dementia MOOC (massive online open course) is proving invaluable here.

‘We’re helping people in the community to take this free five-week course. We can then see what has been learned and how, and what can be done to change lifestyle factors to reduce risks for dementia. It also helps us work out what else may be needed in the MOOC to help First Nations people feel listened to and recognised.’

A national initiative is now being funded by the NHMRC and the National Institute for Dementia Research to create a Dementia Research Roadmap for Aboriginal and Torres Strait Islander people. Dr Goldberg is on the committee overseeing this project, and members of the Circular Head Aboriginal community are assisting with its development.

An island model with global implications

Dr Goldberg grew up in Tasmania but studied and worked for many years overseas. ‘I’ve come full circle. I left for the US to do my Masters and doctorate, and gained valuable clinical and administrative experience. It’s good to be able to bring those skills back to Tasmania.

‘Tasmania can work as a model for island communities elsewhere. The Tasmanian Healthy Brain Project spearheaded by Professor James Vickers is one example – it aims to help Tasmanians understand risk factors for health, including dementia, and to combat those.

‘Not enough high school students go on to university in Tasmania. We now have funding for eight Aboriginal students from Circular Head to study in the Bachelor of Dementia Care (BDC) developed by the Wicking Centre. This is a fantastic opportunity for these students, for their community, and for us in the BDC team, as the students’ participation brings a First Nations’ perspective to the course. There is further flow-on in that it draws attention to the fact that there are indeed Aboriginal people in Tasmania and how we can learn about their rich history, culture, and traditions.’

Associate Professor Goldberg aims first to broaden the research impact by involving more Aboriginal communities within the state. ‘I work closely with Dianne Baldock in Circular Head. Di is a co-author on any research publications and co-writer on grant submissions. Our work has implications for similar communities around Australia and the world.’