Indigenous health in Australia
Indigenous Australian health and wellbeing statistics indicate Aboriginal Australians are much less healthy than the rest of the Australian community. In 1989, the National Aboriginal Health Strategy was created. In 2010–11 the most common cause of hospital admissions for Indigenous Australians in mainland Australia was for kidney dialysis treatment. A 2007 study found that the 11 largest preventable contributions to the indigenous burden of disease in Australia were from tobacco, alcohol, illicit drugs, high body mass, inadequate physical activity, low intake of fruit and vegetables, high blood pressure, high cholesterol, unsafe sex, child sexual abuse and intimate partner violence. The 26% of Indigenous Australians living in remote areas experience 40% of the health gap of Indigenous Australians overall.
- 1 Effects of colonisation
- 2 Hospitalisation rate
- 3 Life expectancy
- 4 Health spending on Indigenous health
- 5 Health status
- 6 Health dynamics
- 7 See also
- 8 References
- 9 Further reading
Effects of colonisation
European colonisation impacted the health of Indigenous Australians via land dispossession, social marginalisation, political oppression, incarceration, acculturation and population decline. The process began with the arrival of the British in 1788. With them came foreign diseases, dispossession, exploitation, warfare and violence for the Indigenous population, and the immediate effect was a widespread increase in mortality and disease. By the end of the 19th century, Indigenous Australians were greatly reduced in numbers and the survivors were largely confined to remote reserves and missions. They were associated in the public mind with disease, which led to exclusion from institutions and isolation from non-Indigenous society for fear of contamination. These colonial policies resulted in segregated oppression and a lack of access to adequate medical care, leading to further disease and mortality.
The Australian government proceeded to deny the Indigenous people of their civil rights, including property rights; the ability to work and receive wages; and access to medical care and educational institutions. Legislation also allowed for the separation of Indigenous families, with guardianship being awarded to government officials called Protectors. Indigenous children forcibly removed from their families under Protection legislation in the first half of the 20th century are referred to as the Stolen Generations. Many of these children were neglected, abused, and denied of an education. The Australian government forced the Indigenous populations to assimilate into the colonisers’ culture through schools and programs, where Indigenous languages were banned and any resistance to these practices could result in imprisonment or death. This process of acculturation has led to trauma, including historical, inter-generational, and social trauma. Issues such as anxiety, stress, grief, and sadness are produced from this trauma, which have led to higher suicide rates, violence, substance abuse and incarceration of Indigenous peoples today.
Social, political and economic factors that result from colonisation present barriers to quality healthcare, health education, and health behaviours. Acculturation has produced xenophobia, which has socially marginalized Indigenous people and excluded them from society. Social inclusion is a social determinant of health, and social marginalization allows for injustices against Indigenous people to persist. Political disempowerment prevented them from accessing social services, sickness benefits, and from voting until the 1960's. Socio-economic inequality has resulted in poor employment opportunities, housing, education and healthcare. One in seven Indigenous Australians reported difficulty in accessing healthcare for their children, which include transportation costs and prescription costs. Displacement and disenfranchisement prevents access to healthcare resources such as screening programs, and results in delayed or inadequate treatment. An example of this can be seen in the high rates of cervical cancer, where a meta-analysis of Indigenous women from Australia, New Zealand, Canada and the United States attributed these rates to “socio-economic disenfranchisement resulting from colonialism”, rather than genetics.
The displacement of Indigenous Australians to reserves and the isolation from society led to generations suffering from starvation and malnutrition. This has had profound effects on physical and intellectual development; Indigenous communities today in remote locations continue to suffer from malnutrition and chronic health problems, as well as lower levels of education. The persistence of inequality in educational attainment among contemporary Indigenous communities is viewed as a product of historical, political and social factors. European colonisers believed that Indigenous people were intellectually inferior, and education was thus denied as it was considered pointless. Low levels of education increase the likelihood of engaging in high risk health behaviors, as well as lower rates of participation in health screening and treatment. However, poor health behaviours and low utilization of healthcare resources can be due to a combination of many factors. Racial discrimination towards Indigenous peoples that stems from processes of colonialism leads to a cumulative exposure to racism, and this is related to negative health outcomes. It produces feelings of anger and shame, which limits active participation in the mainstream healthcare system and society at large.
Indigenous Australians go to hospital at a higher rate than non-Indigenous Australians. In 2010–11, Indigenous Australians used hospitals 2.5 times more frequently than non-Indigenous people. This rate comes from an age-standardised separation rate (hospital check-out) of 911 per 1,000 for Indigenous people.
The 2010–11 age-standardised separation rate for Indigenous people living in the NT was 1,704 per 1,000, 7.9 times the rate for non-Indigenous people. About 80% of the difference between these rates was due to higher separations for Indigenous people admitted for renal dialysis.
In 2005, the Social Justice Report reported a seventeen-year gap between the life expectancy of Indigenous Australians and non-Indigenous Australians. This prompted health and human rights activists to establish the 'Close the Gap' campaign, which focused on health equality for Indigenous Australians.
As of 2010, life expectancy for Aboriginal and Torres Strait Islander men was estimated to be 11.5 years less than that of non-Indigenous men – 67.2 years and 78.7 years respectively. For Aboriginal and Torres Strait Islander women, the 2010 figures show a difference of 9.7 years – 72.9 years for Aboriginal and Torres Strait Islander women and 82.6 years for non-Indigenous women. Indigenous Australians are more likely to die at a younger age than their non-indigenous counterparts due to being unhealthy.
Health spending on Indigenous health
In 2007/08, the Australian government focused mainly on decreasing 'overcrowding' within remote indigenous communities in endeavours to improve health in rural populations. The Implementation of Australian Rural Accommodation (ARIA) Programme was granted $293.6 Million over four years to induce a significant level of housing reform.
In 2010-2011, health expenditure for Aboriginal and Torres Strait Islander people was estimated at $4.6 billion, or 3.7% of Australia's total recurrent health expenditure. The Aboriginal and Torres Strait Islander population comprised 2.5% of the Australian population at this time.
Expenditure equated to $7,995 per Indigenous person, which was 1.47 times greater than the $5,437 spent per non-Indigenous Australian in the same year.
In 2010-2011, Governments funded 91.4% of health expenditure for Indigenous people, compared with 68.1% for non-Indigenous people.
"Closing the gap" commitments
The Council of Australian Governments has initiated the first multi-sector approach in regards to initiating strategies to overcome the large discrepancy between Indigenous and European health statistics. The plan's success is dependent on the level of collaboration between all levels of the Australian Government, Indigenous leaders/communities and the health sector.
In some areas of Australia, particular the Torres Strait Islands, the prevalence of type 2 diabetes among Indigenous Australians is between 25 and 30%. In Central Australia high incidences of type-2 diabetes has led to high chronic kidney disease rates amongst Aboriginals. The most common cause of hospital admissions for Indigenous Australians in mainland Australia was for dialysis treatment. Indigenous women experience twice the adjusted-age risk of gestational diabetes, thus leading to Indigenous women having a higher risk of developing type 2 diabetes after pregnancy and birth. Compared with the general Australian population, Indigenous Australians develop type 2 diabetes at a younger age.
Indigenous Australians have much higher incidence rates than other Australians of cancers of the lung, liver, and cervix. Indigenous Australians have much lower rates of cancers of the breast, colon and rectum, prostate, melanoma of skin, and lymphoma. The likelihood of death caused by cancer among Indigenous Australians was 30% higher than that of the death rates caused by cancer in non-Indigenous Australians. Although the incidence rate of lung, liver and cervical cancers are higher in the Indigenous population, only six per cent of Indigenous people over the age 65 sought hospitalization for cancer compared with ten percent of non-Indigenous people over the age of 65. Furthermore, BreastScreen Australia stated that between 2003 and 2004 only 35 per cent of 50- to 69-year-old Indigenous women took part in their breast cancer screening programs, compared to 56 per cent of non-Indigenous women in this age group.
Human T-lymphotropic virus 1
In central Australia, Indigenous Australians have human T-lymphotropic virus 1 at a rate thousands of times higher than non-Indigenous Australians.
In 2008, 45% of Aboriginal and Torres Strait Islander adults were current daily smokers. Smoking is one of the main factors contributing to chronic disease. Amongst Indigenous Australians 1 in 5 mortalities are caused by smoking. If the number of smoking Indigenous Australians is reduced to equal the number of non-smoking non-Indigenous individuals there is a potential decrease of 420 mortalities among Aboriginal and Torres Strait Islanders. In 2010 the Australian Government have put in place a 10-year program aimed at improving the health of Indigenous and Torres Strait Island. Pacific types of cancer including lung and cervical cancer occurs to 52% of indigenous women due to their smoking habit.
In 2010, the rate of high or very high levels of psychological distress for Aboriginal and Torres Strait Islander adults was more than twice that of non-Indigenous Australians. A 2007 study found that the 4 largest preventable contributions to the indigenous mental health burden of disease were – alcohol consumption contributing the most, followed by illicit drugs, child sexual abuse and intimate partner violence. Up to 15% of the 10 year life expectancy gap compared to non-Indigenous Australians has been attributed to mental health disorders. Mental health should be taken into consideration in the Aboriginal concept of health and well being. The status of the mental health issue is difficult to define as there are little sources for evidence in Aboriginal health in Australia. In the incidence of children and the elderly many problems tend to be hidden. Some of the behavioural problems encountered tend to be linked to neurodevelopment delay and a failing education system.
Violence and accidents
Aboriginal and Torres Strait Islander Australians, particularly males, are far more likely than the rest of the community to experience injury and death from accidents and violence.
The Aboriginal and Torres Strait Islander infant mortality rate varies across Australia. In New South Wales, the rate was 7.7 deaths per 1,000 live births in 2006-2008, compared with the non-Indigenous infant mortality rate of 4.3 deaths per 1,000 live births. In the Northern Territory, the Aboriginal and Torres Strait Islander infant mortality rate was over three times as high as the non-Indigenous infant mortality rate (13.6 deaths per 1,000 live births compared with 3.8 deaths per 1,000 live births).
Male Aboriginal and Torres Strait Islander infant mortality in the Northern Territory was about 15 deaths per 1,000 live births, while female Aboriginal and Torres Strait Islander infant mortality was 12 deaths per 1,000. For non-Indigenous males the rate was 4.4 deaths per 1,000 births and for females it was 3.3 deaths per 1,000 (ABS 2009b).
Between 1998 and 2008 the Indigenous to non-Indigenous rate ratio (the Aboriginal and Torres Strait Islander rate divided by the rate for other Australians) for infant mortality declined in the Northern Territory an average of 1.7% per year, while the rate difference (the Aboriginal and Torres Strait Islander rate minus the rate for other Australians) almost halved from 18.1 to 9.8 deaths per 1,000 births, which suggests that the gap between Aboriginal and Torres Strait Islander and non-Indigenous infant mortality in the Northern Territory has reduced (ABS 2009b).
Indigenous Australians have a higher rate of Invasive pneumococcal disease (IPD) than the wider Australian population. In Western Australia between 1997–2007, the IPD incidence rate was 47 cases per 100,000 population per year among Aboriginal people and 7 cases per 100,000 population per year in non-Aboriginal people.
After the introduction of a pneumococcal conjugate vaccine (7vPCV), total IPD rates among Aboriginal children decreased by 46% for those less than 2 years of age and by 40% for those 2–4 years of age. Rates decreased by 64% and 51% in equivalent age groups for non-Aboriginal children.
Until the 1980s Aboriginal children were recognised as having better oral health than non-Aboriginal children. Today, average rates of tooth decay in Aboriginal children are twice as high as non-Aboriginal children. Between 1991 and 2001, the rate of tooth decay amongst Aboriginal children living in metropolitan areas fell, going against the increase in child tooth decay in remote areas. A study performed in 2001-2002 showed that Indigenous Australian patients showed a higher ratio of missing or decayed teeth than European patients, but a lower ratio of filled teeth.
A 2003 study found that complete loss of all natural teeth was higher for Aboriginal people of all age groups (16.2%) compared to non-Aboriginal people (10.2%). In remote communities, those with diabetes were found to have over three times the number of missing teeth than those without diabetes. Type 2 diabetes has been related to poor oral health.
Changes in the Australian Indigenous diet away from a traditional diet, which had originally contained high levels of protein and vitamins. High in fibre and sugar and low in saturated fats – to a diet high in sugar, saturated fats and refined carbohydrates has negatively affected the oral health of Indigenous Australians.
A 1999 study found that the water in rural and remote areas of Australia is less likely to be fluoridated than metropolitan areas, reducing access for many Aboriginal communities to fluoridated water. Fluoridated water has been shown to prevent dental decay.
Aboriginals experience a high level of conductive hearing loss largely due to the massive incidence of middle ear disease among the young in Aboriginal communities. Aboriginal children experience middle ear disease for two and a half years on average during childhood compared with three months for non indigenous children and if untreated it can leave a permanent legacy of hearing loss. The higher incidence of deafness in turn contributes to poor social, educational and emotional outcomes for the children concerned. Such children as they grow into adults are also more likely to experience employment difficulties and find themselves caught up in the criminal justice system. Research in 2012 revealed that nine out of ten Aboriginal prison inmates in the Northern Territory suffer from significant hearing loss.
A number of factors help to explain why Aboriginal and Torres Strait Islander people have poorer health than other Australians. In general, Aboriginal and Torres Strait Islander people are more likely to have lower levels of education, lower health education, higher unemployment, inadequate housing and access to infrastructure than other Australians.
In particular, crowded housing has been identified as contributing to the spread of infectious diseases. Aboriginal and Torres Strait Islander Australians are also more likely to smoke, have poor diets and have high levels of obesity.
A 2007 study found that the 11 largest preventable contributions to the indigenous burden of disease in Australia were tobacco, alcohol, illicit drugs, high body mass, inadequate physical activity, low intake of fruit and vegetables, high blood pressure, high cholesterol, unsafe sex, child sexual abuse and intimate partner violence. The 11 risk factors considered together explain 37% of the total burden of disease experienced by Indigenous Australians. The remaining 63% consists of a range of known and unknown risk factors, yet to be identified or quantified.
Contemporary Indigenous diet
Poor-quality diet among the Indigenous population is a significant risk factor for three of the major causes of premature death in Indigenous Australians – cardiovascular disease, cancer and type 2 diabetes. Much of this burden of disease is due to extremely poor nutrition throughout life. A 2013 study of Indigenous dietary patterns in Northern Territory communities found there was a high expenditure on beverages and corresponding high intake of sugar-sweetened beverages coupled with low expenditure (and low intakes) of fruit and vegetables. Similarly high per capita consumption of sugar-sweetened beverages has been reported among Aboriginal and Torres Strait Islander children at the national level.
Studies have found that Indigenous Australians living in remote communities consume low levels of fruit, and high amounts of white bread.
Among the factors that have been at least partially implicated in the inequality in life expectancy between Indigenous and non-Indigenous people in Australia are cultural differences resulting in poor communication between Indigenous Australians and health workers.
According to Michael Walsh and Ghil'ad Zuckermann, Western conversational interaction is typically "dyadic", between two particular people, where eye contact is important and the speaker controls the interaction; and "contained" in a relatively short, defined time frame. However, traditional Aboriginal conversational interaction is "communal", broadcast to many people, eye contact is not important, the listener controls the interaction; and "continuous", spread over a longer, indefinite time frame.
Hospital partnerships with traditional healers
- Opal (fuel), fuel developed to stop petrol sniffing
- Race and health
- New World Syndrome
- Health in Australia
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