Diagnosing Australia’s indigenous health gap

Some experts argue for a cultural approach to health spending in light of high costs and poor outcomes.

Indigenous Australians have average lifespans a decade less than the general population [AFP]

Sydney, Australia – Healthcare in Australia is among the best in the world. Medicare – the country’s public health system – provides universal medical care and hospital cover to residents, while the private health system insures more than half the population, and sold services worth $26m to 10,000 medical tourists in 2013.

The country also spends $5bn on medical research annually and is responsible for breakthroughs such as the ultrasound, in vitro fertilisation and nano-robots just 1.5 billionths of a metre in size, used to detect drugs or viruses in the blood.

However, not everyone enjoys good health in the land down under. According to the World Health Organisation (WHO), Australia’s 670,000 Aboriginals and Torres Strait Islanders suffer from diseases found nowhere else in the developed world – like trachoma, a form of preventable blindness.

One third of indigenous Australians die by the age of 45, while their average life expectancy is more than a decade less than non-indigenous Australians. The rate of rheumatic heart disease among indigenous Australians is the highest in the world – 75 times higher than the rate of their non-indigenous counterparts.

In the Pilbara region of Western Australia, where half a billion tonnes of iron ore is mined for export every year, 70-80 percent of indigenous children suffer partial deafness from ear infections. In the state of Queensland, where a coal boom is prompting multi-billion-dollar expansions of railways and ports, indigenous children as young as 14 are hanging themselves and are 10 times more likely to commit suicide than non-indigenous children.

Indigenous Australians are four times more likely to suffer from diabetes and 12 times more likely to die from it, while a University of Melbourne study shows more than one in three are diabetic. Obesity is widespread among indigenous adults, while 20 percent of indigenous children have either had their growth stunted because of malnutrition or are “wasted” – the term for being grossly underweight.

Gastroenteritis, kidney disease, depression, influenza – the list of chronic diseases goes on and on and paints a picture of a catastrophic failure in public healthcare that has been compared to a form of medical apartheid.

“Our people are dying and our elders are dying, and that has an impact on the transfer of culture and language and that is a real concern,” said Dr Tom Calma, founder of the Close the Gap Campaign of Indigenous Health Equality. “Rates of diabetes are actually increasing. The gap between indigenous and non-indigenous health is not closing. In fact it is widening.”

Utopia denied

Earlier in January, 4,000 people amassed in a Sydney park for the launch of Utopia, the fourth documentary on the plight of indigenous Australians by London-based journalist John Pilger. It’s named after a barren Aboriginal homeland in the Northern Territory visited by Pilger: a place of abject poverty where people live in dilapidated homes made of cancer-causing asbestos; where kitchens, bathrooms, running water, sanitation and electricity do not exist; where children sleep head-to-toe on soiled, broken mattresses; and where cockroaches crawl into their ears.

I think it's quite shocking to have this level of poverty and lack of basic facilities in one of the richest countries in the world.

by Salil Shetty, Secretary General of Amnesty International

“When I made my first film about indigenous Australia in 1985, The Secret Country, I never thought that in 2013 I’d be making another film and saying in effect, so little had changed,” Pilger said. “Indeed, when we were making some of Utopia we actually confused some of the old footage with the new.”

Health expenditure for indigenous Australians was AUS$4.6bn ($4bn) in 2010-11 (the most recent figures available), or 3.7 percent of total health spending for a group comprising 2.5 percent of the population. That amounts to AUS$8,000 per person per year ($7,028) – 32 percent more than the AUS$5,440 spent every year on non-indigenous Australians. And while the premium may seem generous, it belies the shameful state of indigenous health in Australia and successive governments’ inability to make significant change.

“I think it’s quite shocking to have this level of poverty and lack of basic facilities in one of the richest countries in the world,” Secretary General of Amnesty International Salil Shetty tells Pilger in Utopia. “So to suggest that after decades you can’t solve the problems in a country that’s absolutely not short of resources means that the problem is somewhere else.”

“Sometimes in my darker moments,” adds Professor Jon Altman, an anthropologist at the Australian National University, “I actually think addressing the indigenous problem in Australia is beyond the capacity of Australia and that we actually need overseas aid.”

Outside thinking

The average spending for indigenous Australians on public hospital services in 2010-11 was AUS$3,630 ($3,190) – more than double the AUS$1860 ($1,634) spent on non-indigenous Australians. This points to an over-reliance on hospitalisation and a failure to deliver primary care that can prevent serious illnesses in indigenous communities.

The Fred Hollows Foundation, an Australian NGO that has restored the sight of more than a million people in the poorest parts of Africa, Asia and Australia, is lobbying for the provision of low-cost spectacles it says would address 54 percent of the eyesight problems of indigenous Australians.

“Indigenous people with limited eyesight tend to be unemployed and have a negative economic impact on their families, as someone has to stay home from work or school to care for them,” said foundation spokesperson Shaun Tatipate. “They also tend to die a lot younger. But with corrective vision, the change in terms of quality of life is significant. They’re able to work, provide for their families, to hunt, to fish and contribute to their community and participate in their cultural way of life.”

Simple things, like better nutrition, can also play a huge role. The peak body for indigenous-controlled services in the Northern Territory, the Aboriginal Medical Service Alliance, wants the government to subsidise remote stores to stock healthier products and fruit and vegetables, which are prohibitively expensive. It’s also one of a host of groups promoting a return to “bush tucker” – food sourced from indigenous plants, animals and fish, rich in protein and complex carbohydrates but low in fats and sugars.

Helping them get the message out is Darwin-based record company Skinnyfish. In the coming months, it will release 22 short films featuring indigenous actors who use comedy and music to promote the benefits of good nutrition and bush tucker. The first film in the series, Sugar Man, premiered earlier this month in Galiwinku, a remote community of 3,000 people that buys 600 litres of soft drinks a day.

“We know the film has already had a serious impact because we’ve heard about people and kids in the community talking about the issues around excess-sugar consumption well after it screened,” said Skinnyfish co-founder Mark Grose. “Isn’t that is the aim of any public health campaign?”

The need for cultural awareness in public health initiatives was seconded by University of Western Australia Associate Professor Pat Dudgeon, Australia’s first registered indigenous psychologist.

“We’re sick and tired of people doing research on us that never makes any difference and only adds to the sense of hopelessness in communities,” Dudgeon said.

“For there to be an improvement in indigenous health, there has to be a cultural aspect present in health programmes. Studies from around the world have shown when you engage indigenous people in cultural reclamation and self-identification, there is far more retention.”

Source: Al Jazeera