Survey's grim findings on Indigenous health
Jodi Hoffmann Aboriginal people will continue to endure poor health and disadvantage unless a major shift in focus toward early child development is undertaken. This recommendation has emerged from the first of five volumes of the Western Australian Aboriginal Child Health Survey (WAACHS), released in Perth in June. This ground-breaking report is the most comprehensive survey undertaken of Indigenous children and aims to unravel the complexities associated with our higher mortality and illness rates compared with non-Indigenous Australians. It follows five years of planning and over two years in the field which saw 130 surveying staff (more than half being Aboriginal) knocking on more than 130,000 doors throughout the State. Designed to build a store of knowledge from which preventative strategies can be developed, to promote and maintain the healthy development and social, emotional, academic and vocational well- being of Aboriginal children, the survey included interviews with 11,300 family members, 2000 families and more than 3000 teachers, and involved one in five of all Aboriginal children in WA. Central to the completion of this report was the expertise included within the steering committee, comprising senior Aboriginal people from a diversity of backgrounds and organisations and led by Nyoongar man Ted Wilkes. Involved within Indigenous health for many years, Associate Professor Wilkes saw the compiling of the report as an important step in addressing the perception that the problem was too big to fix. No more excuses "This document means there can be no more excuses", he said. Although Professor Wilkes acknowledges that many of the issues are well known by Aboriginal people as a day-to-day reality, he believes the report provides a wider framework in which to tackle the issues. "Aboriginal people have heard the alarm bells ringing for years. This survey gives us the evidence we need for new strategies that look at the issue from a different direction to break the cycle of poor health — and that means we have to find ways to give our children a better start in life", he said. Comparing the Australian experience with other countries' Indigenous health records, Professor Wilkes said that the report highlighted how as a nation we have fallen behind Canada, New Zealand and the United States in narrowing the disparity between Indigenous and non-Indigenous populations over the past 30 years. The report has called for a national strategy to break the cycles of Aboriginal poor health — a strategy that looks beyond health to the resources needed for healthy child development. These include: * The physical environment (housing, clean water, sanitation and nutrition) * The levels of family income available to support children * The creation of human and psychological capital within the family (education and parenting skills) * The social capital available to individuals (cultural heritage and traditions, safer communities). Action within the health care system to improve outcomes wold include: * Improving nutritional knowledge and access to affordable nutritious food * Improving rates of contact of Aboriginal families and children with health services * Improving the availability of maternal health services and supports * Reducing the rate of early teenage pregnancy * Reducing rate of tobacco, alcohol and other drug use — particularly by pregnant women * Reducing the rates of childhood infectious diseases. The report has highlighted many of the factors that are adverse to healthy development, such as 13 percent of Indigenous children are born prematurely (general population 8 percent), 21 percent have poor growth in-utero (general population 13 percent), 11 percent are born to mothers under age 17 compared with two percent of the general population, and that 49 percent of mothers of Aboriginal children used tobacco during pregnancy, compared with 22 percent of the general population. Fiona Stanley, director of the Telethon Institute for Child Health Research and former Australian of the Year said, "It highlights some incredibly important results as to how to actually break the cycle of Aboriginal disadvantage by focusing on pregnancy and early childhood, particularly in relation to the kind of environments you need to surround children with to actually make a difference to their whole of life chances. We would like this to actually be the blueprint for an Aboriginal strategy for improving child and young health", Professor Stanley said. Third World "Some of the problems we've highlighted in this report in relation to alcohol, smoking, cultural value and otitis media (ear infections) — even just those four, you could see results within a very short time. We're talking within a year." The WA Aboriginal Child Health Survey has found that the recurrent infections that pose a major health risk to our children are compatible with Third World countries. Heather D'Antoine, a survey steering committee member and Kutunga Network manager, said that many of those infections had long-term consequences. "There's no doubt that ear infections are at epidemic rates, with 18 percent of Aboriginal children suffering from recurrent problems. In fact, in children aged 0-4 years, the rate is four times higher that what the World Health Organisation classifies as a serious health problem. What we are seeing is really alarming and a massive public health issue", she said. She said that there were serious implications for language development and learning given that for those suffering from recurring ear infections, 69 percent, have had at least one episode that has ruptured an eardrum, and 30 percent have abnormal hearing. She also noted that recurring chest, skin and gastro-intestinal infections worsened as the isolation increased. "These infections can have a big impact on the child's health and development. It is particularly distressing when we know how many of these recurring infections are preventable with appropriate treatment and environmental measures", Ms D'Antoine said. "We don't need to wait to make improvements in Aboriginal child health. It's about getting important health messages across in a culturally appropriate way." Professor Wilkes said: "Many of the problems faced by our children can have life-long consequences, yet a lot of these problems are preventable. We need to look at all the things it takes for children to grow healthy and happy. It's not a quick medical fix but means looking at their total environment and experiences so that they can have a fair start to life." Four more volumes of findings will be released over the next 18 months and will be used nationally to develop strategies to improve outcomes for Aboriginal families.* * * Koori Mail, June 2004 (abridged). The WAACHS is available from http://www.ichr.ruwa.edu.au