Indigenous Australians generally have poorer health than other Australians. Of particular concern is the continued high mortality rate from cardiovascular disease for Aboriginal and Torres Strait Islander people. Table 3 below describes mortality rates for Indigenous Australians which, in some cases, are up to three times that of non-Indigenous Australians. 98
|Indigenous Australian males||Indigenous Australian females|
|SMR (d)||SMR (d)|
|Coronoary heart disease||3.3||2.8|
|Rheumatic fever and rheumatic heart disease||15||23|
|Total cardiovascular diseases||3.1||2.7|
(a) Data are for Indigenous deaths for usual residents of Qld, WA, SA and NT.
(b) Deaths are based on year of occurrence of death for 2002-2004 and year of registration of death for 2005.
(c) The number of deaths has been averaged over the period 2002-2005.
(d) SMR (standardised mortality ratio) is the ratio of the observed number of deaths to the number of expected deaths if Indigenous Australians had experienced the same age- and sex-specific death rates as non-Indigenous Australians
Source: Australia's Health 2008 Australian Institute of Health and Welfare
Interviews with the Indigenous branch of the Baker IDI, Northern Territory and other jurisdictions and with the National Aboriginal Community Controlled Health Organisation highlighted specific risk points in the care continuum for Aboriginal and Torres Strait Islander Australians. Anecdotal information received in interviews supports known evidence and indicates clear inequities compared to non-Indigenous Australians. The largest contributor to the mortality gap between Indigenous and non-Indigenous Australians is CVD. This differs from contributors to morbidity, such as Sexually Transmitted Diseases, Mental Health and Oral Health.
While there are enhanced MBS items to support screening for disease, stakeholder consultation indicates that the system does not necessarily have the capacity to deliver treatment, particularly in the case of Indigenous Australians. Access issues are critical for Indigenous Australians, particularly access to services that are configured to address spiritual and cultural issues around health and well-being. This is an issue across urban, rural and remote Indigenous communities.
Although there have been improvements, Aboriginal and Torres Strait Australians are still sicker when they initially present to a health service with symptoms of CVD; they tend to stay in hospital longer and have more repeat admissions. Survival rates are lower as there is a lower likelihood that Indigenous Australians will make it to hospital within the optimal window for treatment.
Stakeholders note that if Indigenous Australians do survive their first CVD event they are less likely than non-Indigenous Australians’ to gain access to rehabilitation and angiography, coronary bypass and other invasive management. This is reflected in the poorer post-acute CVD survival rates for Indigenous Australians.
People with access to the private health system are more likely to receive specialist cardiology interventions than those reliant on the public sector. In the Northern Territory people from Alice Springs must travel to Adelaide for a specialist public procedure, which is personally difficult and an additional expense due to the cost of travel and accommodation. This is a particular burden for Indigenous Australians; strategies to improve access need to take these issues into account.
Access to rehabilitation is a significant contributor to reduced mortality; rehabilitation following a CVD event can reduce subsequent events and suffering by 30%. However traditional rehabilitation methods are not working for Indigenous Australians, particularly rehabilitation programs offered in the hospital setting and those based on rigid and inflexible programs. Stakeholder advice is that flexible family-based rehabilitation programs and risk reduction programs would be more effective than individually focused programs. An anecdotal example provided is that of a Cairns-based CVD rehabilitation program, run from the Wuchopperen Health Service by nurses, which has a 70 – 80% participation rate.
Aboriginal and Torres Strait Islander Australians have higher smoking rates; advice from stakeholder consultation is that in the Northern Territory approximately 50% of Indigenous people smoke.
Aboriginal and Torres Strait Australians have poorer access to health care generally, including poorer access to appropriate medicines exacerbated by a lack of systems to support medication compliance. Stakeholders advise that assertions about the lack of compliance of Indigenous Australians with treatment regimes mask a failure to provide clear information, support good choices and solve access problems. A project undertaken for the National Heart Foundation on Quality Use of Medicines for Indigenous Australians identifies the importance of tailoring CVD management programs for Indigenous Australians. 99
In November 2008, COAG agreed to the National Indigenous Reform Agreement (NIRA), which captures the objectives, outcomes, outputs, performance measures and benchmarks that all governments have committed to achieving through their various National Agreements and National Partnerships (NPs) in order to close the gap in Indigenous disadvantage. COAG has asked for advice on how the National Agreements and NPs will collectively lead to a closing of the gap and what further reforms are needed. COAG will work to develop a further reform proposal for consideration at the Closing the Gap COAG meeting to be held in 2009.
In addition, the Commonwealth and the States agreed to an Indigenous Health NP worth $1.6 billion over four years, with the Commonwealth contributing $806 million and the States $772 million. This proposal will contribute to addressing the COAG-agreed closing the gap targets for Indigenous Australians, closing the life expectancy gap within a generation and halving the mortality gap for children under five within a decade. The proposal includes expanded primary health care and targeted prevention activities to reduce the burden of chronic disease. 100
A number of the issues confronting Indigenous Australians also confront Australians from low SES and remote areas. This issue is noted in the work currently being undertaken by the Australian Government on Social Inclusion where poverty, deprivation and social exclusion are all identified as contributors to poor health outcomes.
98 Australian Institute of Health and Welfare, Australia’s Health 2008, Australian Government, Canberra: AIHW
99 National Heart Foundation of Australia (Brown, A on behalf of the Heart Foundation Pharmaceutical Roundtable). Ensuring the quality use of medicines among Indigenous Australians: key directions for policy, research and practice for cardiovascular health. Melbourne, Victoria, 2007.
100 Council of Australian Governments Meeting Communique, 29 November 2008, Canberra