Indigenous health in Australia

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Indigenous Australian health and wellbeing statistics indicate Aboriginal Australians are much less healthy than the rest of the Australian community. In 2010–11 the most common cause of hospital admissions for Indigenous Australians in mainland Australia was for kidney dialysis treatment.[1]

The 26% of Indigenous Australians living in remote areas experience 40% of the health gap of Indigenous Australians overall.[2]

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.[3]

Hospitalisation rate[edit]

Indigenous Australians go to hospital at a higher rate than non-Indigenous Australians.[4] In 2010-11, Indigenous Australians used hospitals 2.5 times more frequently than non-Indigenous people.[4] This rate comes from an age-standardised separation rate (hospital check-out) of 911 per 1,000 for Indigenous people.[4]

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.[4]

Life expectancy[edit]

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.[5]

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.[6] For Aboriginal and Torres Strait Islander women, the 20100 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.[6] Indigenous Australians are more likely to die at a younger age than their non-indigenous counterparts due to being un-healthy.[7]

Health spending on Indigenous health[edit]

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.[8]

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.[9] The Aboriginal and Torres Strait Islander population comprised 2.5% of the Australian population at this time.[9]

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.[9]

In 2010-2011, Governments funded 91.4% of health expenditure for Indigenous people, compared with 68.1% for non-Indigenous people.[9]

"Closing the gap" commitments[edit]

Main article: Closing the gap

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.[10]

Health status[edit]

Diabetes[edit]

In some areas of Australia, particular the Torres Strait Islands, the prevalence of type 2 diabetes among Indigenous Australians is between 25 to 30%.[11] In Central Australia high incidences of type-2 diabetes has led to high chronic kidney disease rates amongst Aboriginals.[12] The most common cause of hospital admissions for Indigenous Australians in mainland Australia was for dialysis treatment.[1] 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.[13] Compared with the general Australian population, Indigenous Australians develop type 2 diabetes at a younger age.[14]

Cancers[edit]

Indigenous Australians have much higher incidence rates than other Australians of cancers of the lung, liver, and cervix.[15] Indigenous Australians have much lower rates of cancers of the breast, colon and rectum, prostate, melanoma of skin, and lymphoma.[15] 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.[16] 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.[17] 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.[18]

Smoking[edit]

In 2008, 45% of Aboriginal and Torres Strait Islander adults were current daily smokers.[6] Smoking is one of the main factors contributing to chronic disease.[19] 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.[20] In 2010 the Australian Government have put in place a 10-year program aimed at improving the health of Indigenous and Torres Strait Island.[21] Pacific types of cancer including lung and cervical cancer occurs to 52% of indigenous women due to their smoking habit.[22]

Mental health[edit]

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.[6] 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.[23] Up to 15% of the 10 year life expectancy gap compered to non-Indigenous Australians has been attributed to mental health disorders[24] 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.[25] 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.[26]

Violence and accidents[edit]

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.[6]

Infant mortality[edit]

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).[6]

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).[6]

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).[6]

Pneumococcal disease[edit]

Indigenous Australians have a higher rate of Invasive pneumococcal disease (IPD) than the wider Australian population.[27] 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.[27]

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.[27]

Oral health[edit]

Until the 1980s Aboriginal children were recognised as having better oral health than non-Aboriginal children.[28][29] Today, average rates of tooth decay in Aboriginal children are twice as high as non-Aboriginal children.[28][29] 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.[29] A study performed in 2001-2002 showed that Indogenous Australian patients showed a higher ratio of missing or decayed teeth than European patients, but a lower ratio of filled teeth.[30]

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%).[29] In remote communities, those with diabetes were found to have over three times the number of missing teeth than those without diabetes.[29] Type 2 diabetes has been related to poor oral health.[31]

Changes in the Australian Indigenous diet away from a traditional diet, which had originally contained high levels of protein and vitamins.[32] 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.[28]

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.[33] Fluoridated water has been shown to prevent dental decay.[34]

Health dynamics[edit]

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.[6]

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.[6]

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.[3] The 11 risk factors considered together explain 37% of the total burden of disease experienced by Indigenous Australians.[3] The remaining 63% consists of a range of known and unknown risk factors, yet to be identified or quantified.[3]

Contemporary Indigenous diet[edit]

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.[35] Much of this burden of disease is due to extremely poor nutrition throughout life.[35]

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.[35] Similarly high per capita consumption of sugar-sweetened beverages has been reported among Aboriginal and Torres Strait Islander children at the national level.[35]

Studies have found that Indigenous Australian living in remote communities consume low levels of fruit, and high amounts of white bread.[35]

Cross-cultural miscommunication[edit]

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.[36]

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.[37][37][38]

See also[edit]

General:

References[edit]

  1. ^ a b "Hospitalisation". Australian Indigenous HealthInfoNet. Department of Health and Ageing. Retrieved 11 July 2013. 
  2. ^ Vos T, Barker B, Begg S, et al. Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap, The International Journal of Epidemiology 2009; 38: 470-477.
  3. ^ a b c d Theo Vos, Bridget Barker, Lucy Stanley and Alan D. Lopez, 2007. The burden of disease and injury in Aboriginal and Torres Strait Islander peoples: Summary report. Brisbane: School of Population Health, The University of Queensland, p. 9.
  4. ^ a b c d [Australian Institute of Health and Welfare (2012) Australian hospital statistics 2010-11. Canberra: Australian Institute of Health and Welfare.]
  5. ^ Rosenstock, A. Mukandi, B. Zwi, A.B. Hill, P.S. (2013). "Closing the gap: Competing estimates of Indigenous Australian life expectancy in the scientific literature". Australian and New Zealand Journal of Public Health. doi:10.1111/1753-6405.12084. 
  6. ^ a b c d e f g h i j "Measures of Australia's Progress, 2010". Australian Bureau of Statistics. 9 January 2013. Retrieved 29 June 2013. 
  7. ^ cheng, margaret (1 November 2007). "Aboriginal workers key to indigenous health in Australia". the lancet. doi:10.1016/S0140-6736(07)61648-1. Retrieved 2015-04-15. 
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  9. ^ a b c d [Australian Institute for Health and Welfare 2013. Expenditure on health for Aboriginal and Torres Strait Islander people 2010-11. Health and welfare expenditure series no. 48. Cat. no. HWE 57. Canberra: AIHW.]
  10. ^ The Little Red Yellow Black Book. Canberra, ACT 2601: Aboriginal Studies Press. 2012. p. 38. ISBN 9781922059147. 
  11. ^ Lauren Day (9 May 2012). "Doctor wins medal for diabetes treatment". ABC News. Australian Broadcasting Corporation. Retrieved 10 July 2012. 
  12. ^ Gail Liston (1 March 2012). "Diabetes drug breakthrough hope for Indigenous". ABC News. Australian Broadcasting Corporation. Retrieved 10 July 2012. 
  13. ^ Chamberlain, C., McLean, A., Oats, J., Oldenberg, B., Eades, S., Sinha, A. (2014). "Low rates of postpartum glucose screening among Indigenous and non-Indigenous women in Australia with gestational diabetes.". Maternal and Child Health Journal. doi:10.1007/s10995-014-155-3. 
  14. ^ Maple-Brown, L. J., Sinha, A. K., & Davis, E. A. (2010). Type 2 diabetes in indigenous australian children and adolescents. Journal of Paediatrics and Child Health, 46(9), 487. doi:10.1111/j.1440-1754.2010.01844.x
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  22. ^ the lancet, the lancet (2013-08-03). "Indigenous health in Australia—moves in the right direction". The Lancet (British edition). doi:10.1016/S0140-6736(13)61654-2. Retrieved 2015-04-15. 
  23. ^ Theo Vos, Bridget Barker, Lucy Stanley and Alan D. Lopez, 2007. The burden of disease and injury in Aboriginal and Torres Strait Islander peoples: Summary report. Brisbane: School of Population Health, The University of Queensland, p. 10.
  24. ^ The Lancet,Mental health and disadvantage in Indigenous Australians. The Lancet(British Edition) 380,9858.pg1968,doi: 10.1016/50140-6736(12)62139-4
  25. ^ Brown, Ron (09/10/2008). "Australian Indigenous mental health". Australian and New Zealand Journal of Mental Health Nursing. doi:10.1046/j.1440-0979.2001.00189.x. Retrieved 2015-04-15.  Check date values in: |date= (help)
  26. ^ Hunter,E.,2014 Mental health in Indigenous settings:Challenges for clinicians[online] Australian Family Physician 43,1/2 pp 26-8
  27. ^ a b c ["The Changing Epidemiology of Invasive Pneumococcal Disease in Aboriginal and Non-Aboriginal Western Australians from 1997 through 2007 and Emergence of Nonvaccine Serotypes", Lehmann D, Willis J, Moore HC, Giele C, Murphy D, Keil AD, Harrison C, Bayley K, Watson M, Richmond P. Clin Infect Dis. 2010 Jun 1;50(11):1477-86. doi: 10.1086/652440.]
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  34. ^ [Australian Dental Association (2005) ‘The Public Health Benefits of Water Fluoridation’, National Dental Update, November.]
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  36. ^ The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples, 2003.
  37. ^ a b Zuckermann, Ghil'ad; et al. (2015), ENGAGING - A Guide to Interacting Respectfully and Reciprocally with Aboriginal and Torres Strait Islander People, and their Arts Practices and Intellectual Property (PDF), Australian Government: Indigenous Culture Support, p. 12, retrieved 25 June 2016 
  38. ^ Walsh, Michael (1997), Cross cultural communication problems in Aboriginal Australia, Australian National University, North Australia Research Unit, pp. 7–9, retrieved 25 June 2016