Evidence-based initiatives: impact of swimming pools

First posted on 29 October 2008 under Amata, Mimili, Pipalyatjara & Yalata.
This article has been updated and archived.
Tags: data and evidence, ear health, school attendance & swimming pools

poolmimiliSummary

Many children living in remote Anangu communities suffer from ear disease and hearing loss. Middle ear infections can affect a child’s education and social development and have “serious implications for vocational opportunities and mental health.”[i] Providing children with regular access to a properly-managed swimming pool may reduce the incidence and prevalence of infectious diseases and hearing loss.

In October 2008, the Federal Department of Health and Ageing allocated more than $600,000 for a
three-year investigation into the ear health of children in eleven Anangu communities. In four of
those communities, government-funded swimming pools operate. The investigation ran from 2009 to 2011. Its final report was released in October 2012. [ii]

The investigation found that the swimming pools had “no measureable benefit for ear health and hearing in school-aged children.”[iii]

A separate evaluation, examining the impact of swimming pools on the APY Lands, was completed in July 2009. Its findings were released in March 2010.[iv]

The Paper Trail

Background

In 2004, the Federal and State Governments provided funding for the construction and operation of 25-metre swimming pools in four Anangu communities: Amata, Mimili, Pipalyatjara and Yalata.[v] The first of those pools was officially opened on 28 October 2006.[vi] By late 2007, construction of the other three pools had been completed.[vii]

In explaining their support for these projects, both the State and Federal Governments highlighted the social, health and educational benefits that they expected the swimming pools to deliver, particularly:

  • sustained improvements in school attendance
  • reductions in the incidence of ear, skin and eye diseases and infections
  • recreational activities for communities with substance abuse and family violence problems.[viii]

Note: plans to construct a swimming pool – in the small community of Watarru – were abandoned in 2008.

Three-year investigation of ear health

In October 2008, the Federal Department of Health and Ageing granted $662,000 to the School of Medicine at Flinders University to undertake a three-year investigative study of:

the effect of swimming in salt-water chlorinated pools on the prevalence of middle ear infections amongst remote indigenous communities in the … APY Lands … and in other Anangu communities.[ix]

The Department indicated that the investigation would examine:

  • whether the benefits of swimming pools to hearing and ear health “are greater in younger Indigenous children” (aged 3 to 7) “than in older children” (aged 8 and over), and
  • “the natural history of otitis media with effusion (OME) and conductive hearing loss in Indigenous children as a function of their age (including any seasonal variation).”[x]

The three-year investigation ran from 2009 to 2011 and was conducted in collaboration with the State Department of Education and Child Development (DECD).[xi]

The investigation was expected to extend the findings of a smaller study conducted in remote Western Australian communities which had found that:

swimming in salt water chlorinated pools produced a major decrease in the prevalence of perforated eardrums, which are typically caused by middle ear infections.[xii]

In all, the South Australian investigation completed audiological and medical assessments of the ear at Yalata, Oak Valley and in nine communities on the APY Lands. The research team endeavoured to visit the majority of those communities twice a year over the three years.[xiii] In an effort to “capture possible seasonal effects of swimming pool use in relation to ear disease and hearing,” the visits were planned to take place at the start and conclusion of the swimming season; that is, in spring and autumn.[xiv]

As part of the study, the research team also considered communities which did not have swimming pools and compared them with those that did to determine “whether pool use really does improve ear health and consequently hearing.”[xv]

The investigation built on a five-year association between DECS’ Anangu Education Services and Flinders University’s School of Medicine wherein the School has conducted annual hearing assessments of school-aged children across the APY Lands. Commenting on that work, Associate Professor Linnett Sanchez, one of two audiologists working on the research project, said:

The level of middle ear disease and related conductive hearing loss is very high. More than 70% of school-age children fail a screening test of hearing and more than 30% of ears in this population have eardrum perforations, about half of which have active disease (discharging ears).[xvi]

This earlier work generated important baseline data for the new three-year investigation.[xvii]

Final report released

In October 2012, the final report of the three-year investigation was released.[xviii]

The investigation – which had included assessing the hearing and ear health of more than 800 Anangu children – found that the four swimming pools – in Amata, Mimili, Pipalyatjara and Yalata – had “no measureable benefit for ear health and hearing in school-aged children”.[xix]

More broadly, the report noted that investigations conducted over the preceding nine years had documented:

no improvement in either ear health or hearing in school-age Anangu children. … our data demonstrate that there are large numbers of secondary students who have serious middle ear disease which remains untreated. Many of these older students struggle educationally and socially with disabling poor hearing.[xx]

The report described ear health problems as a “scourge on individuals and the Anangu communities” and called for collaborative action:

Otitis media and the hearing loss it causes must be tackled vigorously and collaboratively by the communities and their health and education services. [xxi]

Click here to download a copy of the final report (file size: 1.74MB)

On 4 December 2012, the Paper Tracker Radio Show spoke with the Chief Investigator (Associate Professor Linnett Sanchez) about the three-year investigation, its key findings and main recommendations.

A second, separate evaluation

The Department of Health and Ageing also funded a separate, two-year “evaluation of the sustainability and benefits of swimming pools” on the APY Lands.[xxii] The cost of the evaluation was $392,000.[xxiii]

Among other things, this second evaluation was designed to identify:

  • what community members value about having a swimming pool,
  • the factors that enable the provision and maintenance of safe, usable and financially viable swimming pools in remote communities,
  • the factors and conditions that need to be in place so that a pool’s health and social benefits can be realised and any problems avoided, and
  • any unintended consequences (positive or negative) that might arise from the introduction of a swimming pool and related initiatives.[xxiv]

The evaluation was conducted in four stages, each of which included consultation with key people in participating communities and voluntary health checks of children’s ears, eyes, noses and skin by a medical doctor.[xxv]

On 21 July 2009, the Department of Health and Ageing advised the Paper Tracker that it had received a copy of the final report of this second evaluation and was “currently considering its findings.”[xxvi]

On 23 December 2009, the Department further advised that it expected to publish a “de-identified” version of the report on its website “early in the new year.”[xxvii] The report was subsequently released in March 2010.

The report revealed that the evaluation had found:

  • no evidence to suggest that a “No School, No Pool” policy led to improved attendance rates,[xxviii]
  • the swimming pools appeared to have a “positive impact” on the condition of children’s skin,[xxix]
  • the swimming pools did not appear to have – as of July 2009 – an “impact on the ear health” of children in the participating communities,[xxx]
  • recruiting pool staff, including lifeguards, “was an ongoing challenge”[xxxi]
  • difficulties in recruiting and retaining pool staff in one community “had resulted in multiple unplanned pool closures,”[xxxii] and
  • none of the communities in which pools had been built had “the organisational infrastructure or expertise to take on” its management “at this stage”.[xxxiii]

Click here to download a copy of the full report (file size 274KB)

Swimming pools and school attendance

Funding for each of the pools on the APY Lands was provided under a Shared Responsibility Agreement (SRA) which was signed by the Commonwealth and State Governments and the local community:

Through these SRAs, the communities … agreed to implement ‘no school, no pool’ policies to support improved school attendance as part of their commitment to better educational outcomes for their children.[xxxiv]

In the case of Mimili community, as of October 2006, the ‘no school, no pool’ policy had seen the implementation of a simple but effective medallion system. At the end of each school day, students received a medallion with their name on it as proof of their school attendance. Only those children who had received the medallions were then allowed to use the pool.[xxxv]

On 10 September 2008, the Hon Sandra Kanck MLC (Democrats) asked the South Australian Government for an update on the impact of the three swimming pools constructed on the APY Lands. This included asking for a comparison of the school attendance rates in the pre and post construction period.[xxxvi]

Responding to this request in early February 2009, the State Government noted that:

  • the Mimili pool is the only one which has been open long enough to gather any ‘meaningful data’,
  • the school attendance rate at Mimili had risen from 63.7% in 2000 to 85% in 2007, and
  • while all the three swimming pools located on the APY Lands appeared to be having “a positive impact on the health of children in communities” it was “still too early to provide any conclusive data.”[xxxvii]

By 2009, however, school attendance in Mimili had fallen to 80% for primary students and 71% for secondary students.[xxxviii]

On 18 August 2010, the Paper Tracker asked the State Department of Education and Children’s Services for information:

on the extent to which the enforcement of a ‘no school, no pool’ policy [had] increased school attendance in [Amata, Mimili, Pipalyatjara and Yalata] during those periods when the swimming pools are operational.[xxxix]

In a reply dated 9 November 2010, the Department advised the Paper Tracker that it had:

not at this stage carried out an evaluation into the effectiveness of the ‘no school, no pool’ policy in regard to increased school attendance.[xl]

In August 2012, the findings of the three-year investigation into the ear health of children in eleven Anangu communities (see above) concluded that:

There was no significant difference in school attendance (whether measured by attendance rate or absolute attendance in the number of days) between children in Pool and Non-pool communities.[xli]

The report continued:

The capacity of the ‘No school No pool’ policy to significantly improve school attendance rates in remote Indigenous communities with pools may be seen as simplistic or overly optimistic given the recognised complexity of the issue of school attendance … Over-expectation of the benefits of … this strategy is unfortunate given the complexity of the issue. … cultural and socio-economic issues have particular bearing on lower school attendance rates in remote Indigenous communities. Further, it is recognised that the novelty of swimming pools lessens over time for students of all ages. Gender and cultural issues exert major effects on pool use by secondary students that makes the ‘No school No pool’ policy largely irrelevant.[xlii]

This article was last updated in December 2012. It has been archived and will no longer be updated. It will, however, remain accessible online as a source of background information for anyone wishing to undertake further research on this issue. Information included in the article was current at the time it was archived. Keep in mind, however, that Ministerial changes and names of departments, among other things, may have since changed.


[i] Gent, C. September 2008, “Flinders examines pool chlorine boost to indigenous kids’ hearing,” Flinders Journal, Vol 19.7, p1.

[ii] Sanchez, L. 7 October 2012. Letter to J. Nicholls.

[iii] Sanchez, L. 7 October 2012. Letter to J. Nicholls.

[iv] The report of this second evaluation was published online by the Federal Department of Health and Ageing in March 2012. The report’s title was: “Evaluation of the Sustainability and Benefits of Swimming Pools in the Anangu Pitjantjatjara Yankunytjatjara Lands (APY Lands) in South Australia. Final Report – de-identified”.

[v] Huntington, K. 30 September 2008. Letter and enclosure to Rev. P McDonald; Vanstone, A and Rann, M. 7 June 2005, “Third pool for APY Lands, ” joint media release; Patterson, K & Rann, M. 17 June 2005, “Joint government action gives Aboriginal people the powers to confront family violence and abuse,” joint media release.

[vi] Brough, M. 28 October 2006, “Pool delivers change in Mimili,” media release.

[vii] See: Government of South Australia, October 2008, “Progress on the Lands: Update on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands,” p9. Also: Yalata Community, February 2008, Yalata News: October 2007 – February 2008, p5.

[viii] See, for example: Vanstone, A and Rann, M. 7 June 2005, “Third pool for APY Lands, ” joint media release; Patterson, K & Rann, M. 17 June 2005, “Joint government action gives Aboriginal people the powers to confront family violence and abuse,” joint media release; Rann, M. 15 January 2008, “Pool resources to benefit Aborigines,” The Australian, p12.

[ix] Flinders University School of Medicine, 15 October 2008, “Can swimming pools improve indigenous children’s hearing?” Available online at: http://som.flinders.edu.au/news/feature/archive/f0054.htm Accessed 23 October 2008.

[x] Kalisch, D. (DoHA) 14 January 2009. Letter to Rev P McDonald.

[xi] Sanchez, L. 21 October 2008, Email to J. Nicholls. Note: prior to October 2010, the department was known as the Department of Education and Children’s Services.

[xii] Flinders University School of Medicine, 15 October 2008, “Can swimming pools improve indigenous children’s hearing?” Available online at: http://som.flinders.edu.au/news/feature/archive/f0054.htm Accessed 23 October 2008.

[xiii] It is possible that the investigators may only be able to visit the communities of Oak Valley and Watarru once a year. All other communities will be visited twice yearly (Sanchez, L. 21 October 2008, Email to J. Nicholls).

[xiv] Sanchez, L. 21 October 2008, Email to J. Nicholls.

[xv] Flinders University School of Medicine, 15 October 2008, “Can swimming pools improve indigenous children’s hearing?” Available online at: http://som.flinders.edu.au/news/feature/archive/f0054.htm Accessed 23 October 2008.

[xvi] Flinders University School of Medicine, 15 October 2008, “Can swimming pools improve indigenous children’s hearing?” Available online at: http://som.flinders.edu.au/news/feature/archive/f0054.htm%20Accessed%2023%20October%202008. In another article, Associate Professor Sanchez indicates that 74% of children tested on the APY Lands had failed a standard hearing test (see: Gent, C. September 2008, “Flinders examines pool chlorine boost to indigenous kids’ hearing,” Flinders Journal, Vol 19.7, p1-2).

[xvii] Gent, C. September 2008, “Flinders examines pool chlorine boost to indigenous kids’ hearing,” Flinders Journal, Vol 19.7, p2.

[xviii] Sanchez, L. 7 October 2012. Letter to J. Nicholls.

[xix] Sanchez, L. 7 October 2012. Letter to J. Nicholls. See also: Sanchez, L. et al, 2012. An evaluation of the benefits of swimming pools for the hearing and ear health status of young Indigenous Australians: a whole-of-population study across multiple remote Indigenous communities, Adelaide: School of Medicine, Faculty of Health Sciences, Flinders University, pages iii to vi.

[xx]  Sanchez, L. et al, 2012. An evaluation of the benefits of swimming pools for the hearing and ear health status of young Indigenous Australians: a whole-of-population study across multiple remote Indigenous communities, Adelaide: School of Medicine, Faculty of Health Sciences, Flinders University, page vi.

[xxi]  Sanchez, L. et al, 2012. An evaluation of the benefits of swimming pools for the hearing and ear health status of young Indigenous Australians: a whole-of-population study across multiple remote Indigenous communities, Adelaide: School of Medicine, Faculty of Health Sciences, Flinders University, page vi.

[xxii] Kalisch, D. (DoHA) 14 January 2009. Letter to Rev P McDonald.

[xxiii] More precisely, the cost of the evaluation is: $392,727.50 (GST inclusive): Kalisch, D. (DoHA) 14 January 2009. Letter to Rev P McDonald.

[xxiv] Information provided by S. Riley, Healthcare Planning and Evaluation (see: Riley, S. 8 December 2008. Email and attachment to J. Nicholls)

[xxv] Information provided by S. Riley, Healthcare Planning and Evaluation (see: Riley, S. 8 December 2008. Email and attachment to J. Nicholls). See also: Healthcare Planning and Evaluation. 5 July 2009, “Evaluation of the Sustainability and Benefits of Swimming Pools in the Anangu Pitjantjatjara Yankunytjatjara Lands (APY Lands) in South Australia. Final Report – de-identified”, published online by the Department of Health and Ageing in March 2010, p4.

[xxvi] Savage, J (DoHA). 21 July 2009. Letter to Rev. P. McDonald.

[xxvii] Briscoe, A (DoHA). 23 December 2009. Email to J. Nicholls.

[xxviii] Healthcare Planning and Evaluation. 5 July 2009, “Evaluation of the Sustainability and Benefits of Swimming Pools in the Anangu Pitjantjatjara Yankunytjatjara Lands (APY Lands) in South Australia. Final Report – de-identified”, published online by the Department of Health and Ageing in March 2010, p2.

[xxix] Healthcare Planning and Evaluation. 5 July 2009, “Evaluation of the Sustainability and Benefits of Swimming Pools in the Anangu Pitjantjatjara Yankunytjatjara Lands (APY Lands) in South Australia. Final Report – de-identified”, published online by the Department of Health and Ageing in March 2010, p1 & p14.

[xxx] Healthcare Planning and Evaluation. 5 July 2009, “Evaluation of the Sustainability and Benefits of Swimming Pools in the Anangu Pitjantjatjara Yankunytjatjara Lands (APY Lands) in South Australia. Final Report – de-identified”, published online by the Department of Health and Ageing in March 2010, p1.

[xxxi] Healthcare Planning and Evaluation. 5 July 2009, “Evaluation of the Sustainability and Benefits of Swimming Pools in the Anangu Pitjantjatjara Yankunytjatjara Lands (APY Lands) in South Australia. Final Report – de-identified”, published online by the Department of Health and Ageing in March 2010, p2.

[xxxii] Healthcare Planning and Evaluation. 5 July 2009, “Evaluation of the Sustainability and Benefits of Swimming Pools in the Anangu Pitjantjatjara Yankunytjatjara Lands (APY Lands) in South Australia. Final Report – de-identified”, published online by the Department of Health and Ageing in March 2010, p30.

[xxxiii] Healthcare Planning and Evaluation. 5 July 2009, “Evaluation of the Sustainability and Benefits of Swimming Pools in the Anangu Pitjantjatjara Yankunytjatjara Lands (APY Lands) in South Australia. Final Report – de-identified”, published online by the Department of Health and Ageing in March 2010, p2.

[xxxiv] Huntington, K. 30 September 2008. Letter and enclosure to Rev. P McDonald.

[xxxv] Parliament of South Australia, 2008, Annual Report of the Aboriginal Lands Parliamentary Standing Committee 2006/2007, pp226, p36-37.

[xxxvi] Ms Kanck also asked the Government for information on any measured health outcomes (Kanck, S. 10 September 2008, “APY Lands, Swimming Pools,” Hansard, Legislative Council, Parliament of South Australia, p27-28.

[xxxvii] The response continued: “Anecdotal reports from teachers and swimming pool staff certainly indicate a visible improvement in the skin and general health of children in the three communities during the summer season.” See: Gago, G. [February 2009] “Legislative Council: reply to question without notice. APY Lands Swimming Pools” Note: a copy of Minister Weatherill’s reply to Hon S Kanck’s questions was faxed to the Paper Tracker on 6 February 2009 by an assistant to Ms Kanck. As of 19 February 2009, this response had not been formally incorporated into the official Hansard record of the Legislative Council.

[xxxviii] See: Commonwealth of Australia, 2010. Planning together for Mimili’s future: APY Lands Remote Service Delivery, Local Implementation Plan, p13.

[xxxix] McDonald, P. 18 August 2010. Letter to C. Robinson (DECS).

[xl] DeGennaro, G (DECS). 9 November 2010. Letter to Rev. P. McDonald.

[xli] Sanchez, L. et al, 2012. An evaluation of the benefits of swimming pools for the hearing and ear health status of young Indigenous Australians: a whole-of-population study across multiple remote Indigenous communities, Adelaide: School of Medicine, Faculty of Health Sciences, Flinders University, page iv.

[xlii] Sanchez, L. et al, 2012. An evaluation of the benefits of swimming pools for the hearing and ear health status of young Indigenous Australians: a whole-of-population study across multiple remote Indigenous communities, Adelaide: School of Medicine, Faculty of Health Sciences, Flinders University, pages iv-v.

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