Positive gains in indigenous health reversed: report

The latest government report card on indigenous health has shown some concerning trends, Linda Belardi reports.

Improvements in indigenous mortality rates have reversed in recent years, the latest government snapshot of indigenous health has revealed.

The report from Australia’s state and federal health ministers said that since 2001 there has been no significant change in the number of indigenous deaths, despite a 25 per cent decline in mortality achieved in the previous decade.

The data showed mortality rates for indigenous people have failed to keep pace with declining rates for other Australians, and as a result the significant closing of the gap in mortality experienced between 1991 and 2008 has largely eroded.

Mortality is a significant measure of the overall health status of a population, reflecting the incidence of chronic disease and injury.

The report said there had been improvements in indigenous deaths in WA, SA and the NT in the past 17 years to 2008, but progress had “slowed and possibly reversed in the last few years.”

“Overall, the evidence suggests that while the gap in indigenous mortality rates have narrowed by 24 per cent in the longer-term there has been a slowing of improvement in recent years.”

Noting this stagnating trend, the report called for sustained and increased effort by governments to close the gap. The report, released to the Australian government in August, measured progress against Australia’s Aboriginal and Torres Strait Islander Health Performance Framework. It found that high rates of chronic disease continued and in some cases worsened for indigenous people.

Notably, the mortality gap for cancer has significantly widened in both the short and long term. This is primarily due to declining mortality rates for non-indigenous Australians and slightly more cancer deaths among indigenous people.

Deaths from kidney disease have also increased dramatically and there has been no improvement for other conditions such as diabetes.

The report said indigenous Australians are presenting with very high and rising cases of kidney failure and very few received kidney transplants. Over the last decade the incidence of end stage renal disease has more than tripled.

Like other Australians, the report said the leading cause of death for indigenous Australians was circulatory disease, which accounted for 27 per cent of all deaths, followed by cancer at 18 per cent.

While deaths from circulatory disease declined significantly by 29 per cent between 1997 and 2008, in recent years there has been no further closing of the gap. The report recommended the need to better understand why GP visits for hypertension and cardiac check-ups were relatively low considering the high level of mortality.

While the picture painted for chronic disease was bleak, initiatives to reduce infant mortality have shown more progress.

Since the 1990s indigenous infant and perinatal mortality have declined at a faster rate than for other infants, and the Australian government appeared to be on track to meet its 2018 target to halve the gap in mortality for children under five.

Indigenous infant mortality declined by 55 per cent between 1991 and 2008 across WA, SA and NT and perinatal mortality by 34 per cent between 1999 and 2008.

“Although these rates remain considerably higher than for other Australians, the gap has closed significantly,” the report said.

However, the report noted that improvements were predominantly due to improved acute care rather than improvements in the health of mothers during pregnancy. For example, around half of Indigenous Australian women still smoke during pregnancy, which is three times the rate of other pregnant women. Significantly, in 2008 half of all Aboriginal and Torres Strait Islander Australians aged 15 years and over had a disability or long-term health condition. Physical disabilities were most common, accounting for one third of all reported disabilities, followed by sensory or speech disabilities (17 per cent) and intellectual disabilities (8 per cent).

While hospitalisation rates for indigenous people were 40 per cent higher than for other Australians, the report said this figure was less than expected given the much greater occurrence of disease and mortality within this population. Overall government expenditure in indigenous health also failed to match the much greater needs of Australia’s indigenous population, the report said.

On a per capita basis, average health expenditure for Aboriginal people was 31 per cent higher than the expenditure for other Australians. This is contrasted with measures of indigenous health status showing mortality rates, infant mortality and the occurrence of a broad range of diseases at rates 200 to 300 per cent higher than other Australians, the report said. n

The report, the Aboriginal and Torres Strait Islander Health Performance Framework, is available to download from the Department of Health and Ageing web site.

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