Area of study 1 Dot point 4 d Variations in the health status of population groups in Australia, including: Males and females Higher and lower socio-economic status groups Rural and remote populations Indigenous populations

The health of the Australian population in general Improvements have occurred in BOD and health status in the Australian population. Due to improvements in education, technology and research in the last 100 years, the life expectancy of the Australian population has increased from approximately> 57 years in 1901 82 years in 2011 Even so, there are inequalities across different population groups.

Indigenous populations Indigenous Australians make up 2.5% of the Australian population and experience poorer health status than the rest of the Australian population group. ABS & AIHW 2010 Life expectancy, 11 years less Infant mortality rates are 2 times higher BOD rates are 2 ½ times that of non-indigenous populations High or very high levels of psychological distress 2 times higher. Diabetes and high glucose levels are 3 ½ times higher Chronic kidney disease (long term loss of kidney function) 10 times higher. Death by injury is 3 times higher Dental decay is 2 times higher Estimates of life expectancy for 2005-07, 67.5 years for males(11 years difference) and 72.9 years for females (10 years difference). Indigenous Australians are more likely to die at every stage of the lifespan and at younger ages > 70% die before their 65th birthday compared to 20% for non indigenous.

Table 3.1 indigenous persons, selected chronic health conditions and risk factors, 2004-2005

Figure 3.1 Age distribution of deaths among Indigenous and non- indigenous Australians, 2001-05

Physical Social Mental How can a lack of education and low retention rates for children in indigenous communities impact on the dimensions of health of individuals? Physical Examples Social Mental

Indigenous programmes that aim to increase retention rates Pool for school Attendance for sport participation Lunchtime programmes St Patricks College Indigenous programme

Indigenous Health issues. View Fred Hollows DVD Issues in some indigenous communities Relevant Determinant Notes about the issue Trachoma- A disease of poverty and displacement Biological Behavioural Physical environment Social Environment What is trachoma? Chronic inflammation of the external lining of the eyelid. Infection is caused by the microbe chlamydia trachomatis which in the long term can lead to blindness. Eyelid turns in, scratching the cornea> scaring Treatment>antibiotics in the early stages or surgery

Indigenous Health issues. View DVD Stories from a children's hospital Issues in some indigenous communities Relevant Determinant Notes about the issue Lack of access to health care Biological Behavioural Social environment Physical Environment Rhematic fever- a disease that can occur following an infection caused by a streptococcus bacterium. If untreated, an infection such as ‘strep throat’ may lead to a delayed complication featuring widespread inflammation in other parts of the body, particularly the joints, heart, skin and brain. Children aged 5-14 years are at risk. High rates in indigenous communities in WA.

Indigenous Health issues. Issues in some indigenous communities Relevant Determinant Notes about the issue Poor housing and overcrowding Biological Behavioural Social environment Physical Environment

Indigenous Health issues. Issues in some indigenous communities Relevant Determinant Notes about the issue Kidney disease Ear infections High rates> self harm and suicide Drug use and chroming Biological Behavioural Social environment Physical Environment Ear disease rife in Queensland Indigenous communities. http://www.abc.net.au/news/video/2009/02/09/2486352.htm?site=southqld

View Utopia- click view Close the gap Closing the gap is a strategy that aims to reduce Indigenous disadvantage with respect to life expectancy, child mortality ,access to early childhood education, educational achievement, employment outcomes. Endorsed by the Australian Government in March 2008, Closing the gap is a formal commitment developed in response to the call of the Social Justice Report 2005 [1] to achieve Indigenous health equality within 25 years. To monitor change, the Council of Australian Governments (COAG) has set measurable targets to monitor improvements in the health and wellbeing of the Indigenous population. These targets focus on: health housing early childhood education economic participation and remote service delivery. The achievement of substantial improvements in the health and wellbeing of Indigenous people will depend largely on the effective implementation of these targets as they reflect some of the substantial disadvantages experienced by Indigenous people. https://www.youtube.com/watch?v=wMUkl3gE1Xc https://www.youtube.com/watch?v=5S8vjhZZE4w

Health status of Indigenous Australians- Australia has been least successful in addressing imbalance between life expectancy of indigenous and non-indigenous. Aboriginal and Torres Straight Islanders: Die at all ages at a younger age than other Australians e.g. under 30 years death rate is 4 times higher & 30- 64 death rate is around 7 times higher. Eye, sight, and musculoskeletal problems and respiratory and circulatory system conditions are more common. 66% of those who died in 2008 were under 65 years (non-indigenous deaths in this age group> 21%).

Life expectancy Life expectancy at birth is lower than other Australians. According to ABS data in May 2011 the life expectancy gap between indigenous and non-indigenous is 11 years. In 2005-2007 LE at birth for Indigenous Australian males is 67.2 years, 11.5 years less than all Australian males. In 2005-2007 LE at birth for Indigenous Australian females is 72.9 years, 9.7 years less than all Australian females.

Mortality 66% of Indigenous Australians who died in 2008 were younger than 65 years, whilst only 21% of non-indigenous who died were under 65 years. Indigenous LE for 2007 was 67.2 years for men and 72.9 years for women. Prominent cause of death for indigenous males circulatory diseases> 26%, external causes (injuries)> 20% and cancer>10%. Prominent causes of death in non- indigenous males, CHD>17%, lung cancer>7% and stroke>6%. The largest contributors of death for indigenous females are, circulatory diseases. 26%, endocrine, metabolic and nutritional disorders> 18%, digestive diseases> 10%, injury related deaths are 3 times higher than non-indigenous. The largest contributors of death for non-indigenous females are CHD>15%, stroke> 10%, dementia, Alzheimer's disease>8%.

Infant mortality Indigenous infant mortality has declined between 1991 and 2008. It remains at 730 deaths per 100,000 live births, double that of all Australians> 413 deaths per 100,000 live births in 2010.

Burden of Disease In 2011-12, All Australian health findings> 12.4% had heart disease 1.5% had some form of cancer 4% reported some form of diabetes 13.6% had mental and behavioural conditions Indigenous Australian findings> 12% had long term heart or related condition. 125 had diabetes Cancer deaths are around 45% more common 3 times more likely to report a recent as a result of an attack by another person.

Biological determinants Indigenous Australians> Body weight: Higher rates of obesity at each lifespan stage, increasing risk of CVD, diabetes mellitus & osteoarthritis. 60% are considered overweight or obese> 1.2 times higher than non-indigenous Australians. 60% of indigenous people 15 years and older were overweight, 31% obese, with little difference in living location. Higher proportion of men are overweight/ obese (58%) than women (55%), increasing risk of kidney disease, type 2 diabetes, CVD. Thrift genotype theory> increased risk of insulin resistance and rapid weight gain in response to “famine or feast” existence. Historically his gene enabled individual to efficiently collect and process fat during periods of abundance in order to provision for periods of famine/shortage( feast or famine). I was an advantageous gene for hunter gatherer populations, especially women. The gene allowed them to fatten more quickly in times of abundance. Fatter individuals carrying the thrift gene would be able to survive in times of food scarcity. Unfortunately, in environments of abundant food ( western lifestyle) and less physical activity, the thrifty genotype gains weight rapidly> risking obesity and diabetes.

Being obese is linked to Syndrome X (combination of unhealthy factors/ conditions i.e. abdominal fat, low levels of good cholesterol, high levels of triglycerides , high HBP, high blood sugar levels with high insulin> body is resistant to effects of insulin> increases risk of diabetes and heart disease).

Biological determinants Hypertension: 1.7 times more likely to report hypertension, a risk factor for heart disease and stroke. Impaired glucose regulation: Higher rates of impaired glucose regulation. Indigenous Australians experience diabetes and high blood glucose level, 3.4 times higher than non-indigenous. They are more likely to experience diabetes at a younger age and die from it earlier than non-indigenous Australians. LBW: Mothers are twice as likely to give birth to low birth weight babies. In 2009 12. % of births were classified LBW, compared to 5.9 % for non-indigenous. Premature births are more likely at 13.3% compared to 8% for non- indigenous. In 2008 perinatal mortality rates for babies was 17.3 per 1000 live births, nearly 2 times that of non-indigenous at 9.7 per 1000 live births.

Syndrome X

Behavioural determinants Indigenous Australians: More likely to smoke cigarettes than non-indigenous. Alcohol abuse is more common> although more indigenous abstain from alcohol. Alcohol is linked to obesity, type 2 diabetes, CVD, liver disease and injury. Illicit drug use is more wide spread at 25%, compared to non-indigenous at 14.2%. Petrol sniffing is still a concern. Drug use is associated to higher cases of blood-borne infections, LBW, malnutrition, mental illness and injury. Physical activity levels are lower, increasing risk of diabetes and CVD. Current diet is high in processed CHO and saturated fats. Combined with inactivity, this increases risk of obesity, CVD, some cancers and diabetes mellitus. Indigenous populations suffer higher rates of STI’s, 85 times higher than non-indigenous. Indigenous children aged I year, have lower rates of immunisation> 83% compared with 92% in non-indigenous, increasing risk of infectious diseases e.g. measles, mumps, whooping cough.

Physical environment Poorer quality and overcrowded housing 2006, 31% indigenous housing required major repair and replacement. Housing posed risk of injury, disease and mental health issues. Most of the housing was substandard with regards to drinking water, shelter and sanitation. 22% lived in overcrowded housing with strain on bathroom, kitchens and laundries. Overcrowding is associated with higher rates of smoking. Overcrowding is associated with unhygienic living conditions, increasing risk of influenza, infections> scabies, intestinal infections and parasites. Poorer quality water and sanitation systems 48/148 indigenous communities drinking water failed testing of water quality( 2006 Community housing and infrastructure needs survey). 2006 40% experienced sewerage leak or overflow> lack of clean water and sanitation increases risk of infectious diseases i.e. gastroenteritis, diarrhoea, dysentery, cholera, risking children health especially. Those in rural and remote areas have reduced access to fluoride in drinking water> dental decay. High rates of tobacco use, exposes children to passive smoking.> 2008 16% 0-3 year old and 23% of 4-14 year old children lived with someone who smoked inside the house. (15 year old and older> 26%) Poorer infrastructure, including poorer road quality Increased risk of injury and death due to unsealed roads and poor lighting. 70% of indigenous people live in rural and remote areas, therefore are exposed to environmental risk factors> road quality, distances to travel, higher speed limits, poor availability of road services, risk of collision with livestock and wildlife, alcohol use, less wearing of seat belts. Reduced access to recreational facilities. Lack of access to recreation an d health care facilities. Lower access to and use of health services and resources i.e. Medicare funded PBS drugs, private GP’s>26% live in remote areas compared to 2% for non-indigenous> reduced access/ conditions go untreated.

Social Determinants Indigenous Australians are more likely to experience Low SES. Low SES results in lower incomes , poorer education achievement, lower rates of home ownership and higher unemployment levels. The average weekly income $460 compared to nonindigenous $740. (NATSISS)> lower income impacts on access to quality food, housing healthcare and wellbeing. Poorer educational achievements>45.4% of indigenous students who started year7 finished year 12 compared to 77.3%. In 2006 – indigenous populations were 3 times more likely to be unemployed>16% compared to 5%. Unemployment is linked to reduced wellbeing, increased CVD, mental health problems and lung cancer. Low SES groups are at greater risk taking behaviour i.e. smoking and alcohol misuse, leading to obesity, diabetes, CVD and lung cancer. “No community is more socially excluded than Australia’s indigenous people”, ALP 2007. “Social exclusion also results from racism, discrimination and unemployment”. WHO Indigenous Australians are 3.4 times more likely to report food insecurity compared to general population in major cities. Cultural barriers decrease the rate of many indigenous accessing modern medicine> associating hospitals with death.

Summary of the determinants of health status of Indigenous Australians