Within reach

Many factors that contribute to worse health outcomes from Indigenous people can be improved with better access to information and care. An effort is under way to provide what’s needed. 

Indigenous Australians suffer from higher rates of illness and disability than other Australians, as well as having higher mortality rates and shorter life expectancies. These discrepancies are often referred to as the health gap.

Chronic diseases account for a large proportion of this gap, and many of these illnesses are associated with social and economic disadvantages in housing, education and employment.

The state, territory and federal governments are committed to closing the health gap through measures such as the Council of Australian Governments’ (COAG) Closing the Gap in Indigenous Disadvantage program. The specific target is “to close the gap in life expectancy within a generation (by 2031)”.

Indigenous Australians experience a greater burden of disease and injury than non-Indigenous people. In 2003, burden of disease rates showed that the Indigenous population carried 3.6 cent of the total Australian disease burden despite making up only 2.4 per cent of the population.

Chronic ailments were major contributors to this burden for Indigenous people:

• cardiovascular disease (17 per cent)
• chronic respiratory disease (8 per cent)
• diabetes (8 per cent)
• cancers (7 per cent).

Life expectancy at birth for Indigenous Australians is lower than for other Australians by an average of 10 years, Australian Bureau of Statistics data from 2013 shows. Figures for 2010-12 show that life expectancy for Indigenous men is 69.1 years (10.6 years lower than for non-Indigenous men) and life expectancy for Indigenous women is 73.7 years (9.5 years lower than for non-Indigenous).

Chronic diseases contribute to higher mortality rates among Indigenous people within a given age group and life expectancy is shorter than for other groups, Australian Institute of Health and Welfare 2011 figures show. About 80 per cent of the mortality gap between Indigenous and other Australians aged 35-74 years is due to chronic diseases. Among males aged 35-54 years, almost 75 per cent of the mortality gap is due to chronic diseases. This percentage rises to almost 95 per cent among males aged 55-74 years. Among females chronic diseases account for 79 per cent of the mortality gap in the 35-54 years age group and 95 per cent in the 55-74 years age group.

The chronic diseases that contribute to the mortality gap include:

• ischemic heart diseases (22 per cent)
• diabetes (12 per cent)
• diseases of the liver (mainly from alcoholic liver disease) (11 per cent)
• cancers (specifically lung cancer and those of the digestive organs, the lip, oral cavity and pharynx) (11 per cent)
• other forms of heart disease (such as heart failure and cardiomyopathy) (6 per cent)
• chronic kidney disease (6 per cent)
• chronic lower respiratory diseases (mainly chronic obstructive pulmonary disease) (6 per cent)
• cerebrovascular disease (5 per cent).

(Australian Institute of Health and Welfare 2011)

Many of the diseases that contribute to the burden of disease and the gap in life expectancy are caused in part by the same risk factors:

• tobacco use
• excessive weight and obesity
• physical inactivity
• alcohol abuse
• poor nutrition.

The fact that each of these risk factors is modifiable and preventable suggests that prevention could play an important role in closing the gap. Therefore, targeted prevention activities to reduce the burden of chronic disease are included in the COAG plan. As the council has written, “The National Healthcare Agreement commits to Indigenous Australians achieving better health outcomes, comparable to the broader population, with the Indigenous Health National Partnership expanding primary healthcare and targeting prevention activities to reduce the burden of chronic disease on Indigenous Australians.”

The management and treatment of chronic diseases in Indigenous people is fundamentally the same as for non-Indigenous people; however, there are cultural and practical differences that require consideration.

For example, an Indigenous patient who does not speak English as a first language may have difficulty understanding treatment regimes and medication dosages. An Indigenous patient who lives in a remote community will not have regular access to complementary allied health services or pharmaceutical treatments.

INTRO PARS FOR EXAMPLES: The Close the Gap campaign, which brings together a range of peak Aboriginal and non-indigenous health bodies, was launched in 2007 and aims to reduce current health inequalities by 2031.

Australian nurses and midwives have played a large role in this campaign, becoming integral to its success. Here are the stories of two nurses and a midwife who are making a difference.

Resources on the web

Culturally appropriate guidelines, tools and resources for the management and treatment of chronic diseases in Indigenous people are valuable tools that can assist in improving patient outcomes.

The Australian Indigenous ClinicalInfoNet (clinicalinfonet.net.au) is a new website that puts those tools within reach. The aim is to help in the prevention and management of chronic disease in Indigenous people by bringing together guidelines, patient education resources and administrative information. The ClinicalInfoNet is a central repository for information on cancer, cardiovascular disease, diabetes, kidney disease and respiratory ailments. A simple search of the website will provide healthcare providers with a selection of publications or resources specific to their needs. Resources can be downloaded and printed for patient use or viewed online.

Kathy Ride is project manager at Australian Indigenous ClinicalInfoNet. She is a registered nutritionist who has been working in Indigenous health for more than five years.

Resources on the web

Culturally appropriate guidelines, tools and resources for the management and treatment of chronic diseases in Indigenous people are valuable tools that can assist in improving patient outcomes.

The Australian Indigenous ClinicalInfoNet (clinicalinfonet.net.au) is a new website that puts those tools within reach. The aim is to help in the prevention and management of chronic disease in Indigenous people by bringing together guidelines, patient education resources and administrative information. The ClinicalInfoNet is a central repository for information on cancer, cardiovascular disease, diabetes, kidney disease and respiratory ailments. A simple search of the website will provide healthcare providers with a selection of publications or resources specific to their needs. Resources can be downloaded and printed for patient use or viewed online.

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