1. Patterns of Health and Illness in Indigenous Australian Communities Dr Ross Bailie Associate Professor in Public Health Dr Ross Bailie Associate Professor in Public Health Flinders NT Clinical School Flinders NT Clinical School Menzies School of Health Research Menzies School of Health Research Ph 08-89228835 or 08-89228196 Fax 08-89275187 email: ross.bailie@menzies.edu.au

2. Learning Objectives Patterns of morbidity and mortality Underlying determinants

3. Performance Objectives To use your understanding of patterns and determinants of health and illness in your everyday practice with Indigenous people

4. Sources of Information and Acknowledgements Australian Indigenous Health Infonet web site Health Infonet web site Australian Indigenous Health Infonet web site Health Infonet web site

5. Definition of Indigenous status An Aboriginal or Torres Strait Islander is a person of Aboriginal or Torres Strait Islander descent who identifies as Aboriginal or Torres Strait islander and is accepted as such by the community in which he or she is associated. http://www.healthinfonet.ecu.edu.au/html/html _keyfacts/keyfacts_faq.htm http://www.healthinfonet.ecu.edu.au/html/html _keyfacts/keyfacts_faq.htm (Barnes, White, & Ross 1997)

6. Population distribution Total estimated Indigenous population ~418,800-476,900 (projection for June 2000 based on the 1996 census) 2.2-2.5% of the total Australian population Total estimated Indigenous population ~418,800-476,900 (projection for June 2000 based on the 1996 census) 2.2-2.5% of the total Australian population http://www.healthinfonet.ecu.edu.au/html/html _keyfacts/keyfacts_faq.htm http://www.healthinfonet.ecu.edu.au/html/html _keyfacts/keyfacts_faq.htm

7. Indigenous Non-Indigenous Age group Percentage of population

8. Population distribution (continued) Age distribution related to patterns of health and illness Age distribution typical of a developing country population Chronic diseases occur at a relatively young age Age distribution related to patterns of health and illness Age distribution typical of a developing country population Chronic diseases occur at a relatively young age

9. Standardised Mortality Ratios for selected causes of death, WA, SA, NT (1995-97) CAUSE OF DEATH MalesFemales Circulatory2.92.5 Injuries3.23.5 Respiratory5.26.0 Cancer1.41.4 Endocrine6.112.0 Digestive5.15.5 All causes3.03.0 CAUSE OF DEATH MalesFemales Circulatory2.92.5 Injuries3.23.5 Respiratory5.26.0 Cancer1.41.4 Endocrine6.112.0 Digestive5.15.5 All causes3.03.0

10. State/Total TerritoryIndigenousPopulationRatio WA24.16.53.7 SA12.64.92.6 NT19.411.51.7 State/Total TerritoryIndigenousPopulationRatio WA24.16.53.7 SA12.64.92.6 NT19.411.51.7 Infant mortality rates for the Indigenous and total populations, WA, SA, and the NT, 1996 (infant deaths per 1000 live births)

11. Morbidity Respiratory disease Injury Cardiovascular disease Diabetes Renal disease Respiratory disease Injury Cardiovascular disease Diabetes Renal disease

12. Morbidity (continued) Metabolic syndrome Communicable disease Cancer Metabolic syndrome Communicable disease Cancer

13. Births and pregnancy outcome Fertility rates Low birth weight Fertility rates Low birth weight

14. Trends Widening disparity Contrast with other countries Widening disparity Contrast with other countries

15. Determinants of Health Status Colonial history Education Employment Income Housing Colonial history Education Employment Income Housing

16. Determinants of Health Status (continued) Relative and absolute disadvantage Control Relative and absolute disadvantage Control

17. Education Poor attendance, retention, and outcomes Geographic variability Poor attendance, retention, and outcomes Geographic variability

18. Percentage of NT students achieving national reading benchmarks in 1998 (from Learning lessons - An independent review of Indigenous education in the Northern Territory) NT Student GroupYear 3Year 5 Non-Indigenous, Urban82%78% All students, Urban78%71% Indigenous, Urban54%36% Indigenous, Non-Urban6%4% NT Student GroupYear 3Year 5 Non-Indigenous, Urban82%78% All students, Urban78%71% Indigenous, Urban54%36% Indigenous, Non-Urban6%4%

19. Links between health, education and socio-economic status Vicious cycle

20. Employment Unemployment > 2 x higher Pastoral industry Racism Education Unemployment > 2 x higher Pastoral industry Racism Education

21. Employment (continued) Unskilled labour CDEP Unskilled labour CDEP

22. Income Low paid jobs Government payments Low paid jobs Government payments

23. Housing and physical environment Infrastructure Urban/rural/remote disparity Infrastructure Urban/rural/remote disparity

24. Conclusion Marked disparities in health status Underlying determinants Strategies Marked disparities in health status Underlying determinants Strategies