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Introduction

  • The indigenous population in Australia is not a homogenous group
    • 350 different cultures in 1788 when the Europeans arrived, most still exist
      • Eg: Sydney group is known as the Eora people: 29 different groups
  • Social factors affect health, particularly important in the indigenous population

Aborigine spread

  • At time of colonisation, thought to have a population of 750 000-1.5 million people
    • Spread all over Australia
  • Disease was brought by the Europeans
    • Ie: measles, smallpox, flu, typhoid, gastric disease
    • Reduced the population to ~80000 people
  • Children and land were dispossessed
    • Every aspect of life was dominated
  • Infant mortality was high
    • 1950s, Aborigines were still considered a dying race
    • Protection policy - Aboriginal children were made wards of the state
  • Modern times
    • Aboriginal populations have gathered in cities
      • Many Aborigines live in Sydney
      • 2/3 live in Southern QLD and NSW

1960s onwards

  • Infant mortality decreased in the 1960s
    • There was an increase in the number of young Aboriginal people
  • 1990s, saw a number of ageing Aborigines for the first time
    • At 75 years, mortality becomes similar to that of non-indigenous people
      • Explanations: survive this long due to better childhood opportunities, health and nutrition
  • Current population of Aborigines (by census) – 517 000
  • Aborigines have become highly urbanised; people congregating in the large population centres. Most Aborigines live in Blacktown (South Western and Western Sydney), but higher proportion in remote regions

Changes 1960s onwards

  • Access to human rights and self-determination: entitled to social security benefits (1959-1966)
  • Increased access to healthcare and services
  • Opportunities for education and other development
    • However, up until 1978, in NSW, Aborigines could still be excluded from schools
    • Even now, access is different. Most Aborigines do not have equal access to education
  • Commonwealth right to voting
  • Enumeration (census)
  • Racial discrimination, reduced by laws
  • Formal wage discrimination ended
  • Formal apartheid removed (pools, movies, etc)
  • Commonwealth power to over-ride the states obtained
  • Constitution of Australia described Aborigines as fauna until 1990s
  • Land rights (e.g. land council movement; Wik decision)
    • Significant change in land rights in 1990s

The gap

  • There are many differences in terms of health outcomes in the statistics for Aboriginal populations vs non-indigenous populations
  • This gas is particular large, and doesn’t follow the trend in other countries where their indigenous have a comparable level of health
    • Thought to be due to a lack of a treaty (a symbolic acknowledgement of what happened)
    • In Australia, there is no recognition that the land was not terra nullius, ie that the land did belong to the Aborigines
  • Large gap in life expectancy, unlikely to close in a short period of time

Aborigines before the European settlers arrived

Life expectancy

  • The non-indigenous community has a large ageing population (population coffin)
    • By 2020, children born are likely to have a life expectancy of 100
  • Indigenous population (population pyramid)
    • Not many people reach old age
    • Most people die in their 40s and 50s (“50% die by 50”)
    • Those that reach 75+ had a nutritionally sufficient childhood
  • Average life expectancy of an Australian baby is 82, indigenous baby: 62 (same as the 1930s Australian population)
  • Lagging behind non-indigenous and behind indigenous peoples of other countries. Part of this is because we're not counting all of the indigenous people

Deaths

  • Non-indigenous people
    • People die when they’re old
  • Aboriginal people
    • People die as children or in middle age(generally all ages except teens)
  • This means that living in big cities doesn’t necessarily protect you

Positives

  • Old Aboriginal people are strong and well
    • Eg:70 year olds are often the primary carers of babies(great grandchildren)
  • The Aboriginal people is a resilient people
    • Overcame the hostile natural environment of Austrlaia
    • Overcame more recent abuse by European colonisers

Birth weight

  • Aboriginal and Torres Strait Islander mothers have a lower mean birth weight than non-indigenous mothers
    • Not necessarily related to remoteness
  • Aboriginal babies with non-Aboriginal mothers, show little inter-regional variation
  • Aboriginal babies are 2x more likely to be low birth weight babies
  • Other trends:
    • Overall increase in LBW babies can be attributed to teenage pregnancy
    • Mortality rates have decreased
  • LBW increases risk of complications (e.g. respiratory distress), and of diseases later in life. Reduces life expectancy

Children

  • 38% of Indigenous population are children 0-14, vs 19% of non-indigenous population
    • Indigenous children are 5% of all Australian children, vs Aborigines being 2.6% of entire population

Causes of child mortality

  • Indigenous population vs non-indigenous population
    • Conditions in the perinatal period–3xhigher
    • Ill defined conditions likeSIDS–5xhigher
    • Congenital malformations–1.6x higher
    • Injury/poisoning–3x higher
    • Respiratory disease–7.2xhigher(related to otitis media)
    • Infectious diseases (4% of Aborigines in this country die because of infectious/parasitic diseases that are eradicated in everyone else)
  • There has been a significant decline in infant mortality in both indigenous and non-indigenous, but huge gap between the two

Disease 0-14

  • Similar rates in: skin, musculoskeletal, eye, respiratory disease
  • Different rates in ear diseases (this often can lead to long term developmental problems)
  • 40% of all children have a long term condition (including asthma, allergies)
  • Hospitalisations
    • Higher in Aboriginal kids, in particular to do with skin diseases
  • NB: drug use is an important issue: especially Marijuana in adolescents

Aboriginal health today

  • 2.5% of Australia's population is Aboriginal, over-represented in poor health indicators, and under-represented in education and good health indicators, huge socioeconomic gap (also in remote-urban gap)
  • Most don't get acceptable levels of formal or informal education (family busted apart)
  • This contrasts with other "Fourth World" peoples - Native Americans, Canadians and Maoris
    • Indigenous peoples from all countries get a hard run

Epidemiological health transitions

  • Stage of epidemics (high mortality, small population, up to 1750)
  • Stage of receding infections
    • Falling infant mortality, fertility, younger population (from about 1750 to 1900s)
  • Stage of degenerative diseases
    • Zero population, ageing population (from about 1900 onwards)
  • Stage of delayed degenerative disease
    • Declined in systemic disease (ageing of the aged, from about 1960s)

Epi transitions in brief

  • 19th century - infants/children, infectious disease
  • 20th century - young/middle age, degenerative disease (cancer and CVD)
  • 21st centure - old old people, delayed degenerative disease (dementia)

Population pyramid

  • Is flattening, people from baby boomers are becoming older, consuming more resources
  • Birth rate flattening, less young people
  • Non indigenous people die at the end of their lives (80s etc)
  • Aborigines die earlier of things that were eliminated from previous epi transitions in everyone else (e.g. infectious disease and CVD, degenerative diseases that are now lower in other people)
    • Many of these inflammatory processes etc start during pregnancy and the first few years of life - this is where you set up peoples' health for the rest of their life
    • Population curve = younger (<14), pyramid shaped
    • Very high infant and chilhood mortality, and many young deaths (19-60)

Methods for closing the gap

  • Healthcare that is culturally appropriate and commensurate (equal) to need
  • Increased health practitioners in indigenous health settings
  • Increased responsiveness of mainstream healthcare to indigenous needs
  • Increased maternal and child healthcare
  • Increased funding for the basics of health:
    • Nutrition, physical activity, fresh food, healthy lifestyles, adequate housing, not smoking, drugs, drinking
  • National targets and benchmarks – that can be monitored to achieve equity
  • Increase education and opportunity, 1% of Aboriginal people are in the health workforce, vs 6% non-indigenous

Hospitalisations children 1 to 14

  • Skin diseases can lead to rheumatic heart disease

Higher aboriginal risk of developing dementia

  • Dementia is an outcome measure/proxy for how children had grown up

Death rates

  • Being Aboriginal is a separate risk factor than poverty in determining death rates
    • Non-Aboriginal women who are very poor still have better health outcomes for themselves and their children than rich Aboriginal women
    • You can be poor but healthy, safe and secure
    • Intergenerational disparity - non-Aboriginal people who are less qualified can get jobs more easily than Aboriginal people who are more qualified (ingrained inequality)
    • Although discrimination is not the only cause of the issue, it is a big contributor (e.g. Indigenous people afraid to seek medical help because of racism)

Note

  • To inspire change, need to capture the hearts and minds of individuals
  • Decreasing stereotypes is of the most importance
  • 1⁄4 indigenous people don’t know where their next meal comes from