The poor health status of
Aboriginal and Torres Strait Islander peoples

Can more Indigenous doctors make a difference?

by Noel Hayman*

According to the 1996 Australian population census, 353,000 individuals 
identified as Indigenous Australians, of these, 314,120 were of Aboriginal 
descent, 28,774 were of Torres Strait Islander descent and 10,106 
identified as being of both descent. This represents 1.8 per cent, 0.2 per 
cent and 0.06 per cent of Australia's total population respectively 
(Australian Bureau of Statistics, 1996).

As at 1996, the median age for the Indigenous population was approximately 
20 years, which compares with 34 years for the total national population.

Forty percent of Indigenous Australians were aged under 15 years compared 
to 21 percent of the total population, but more noticeable is that only 2.6 
per cent of the Indigenous population was aged 65 years or older which 
compared to 12 percent of the total Australian population (ABS, 1998). 

Indigenous health status

The Australian Aboriginal population in the 1970s was described as fourth 
world similar to those of other dispossessed Indigenous minority 
populations around the world. These include the Canadian and American 
Indians as well as the New Zealand Maoris.

But recent available health information from the American Indian Health 
Service and the New Zealand Health Information Service, would suggest that 
the American Indians and Maoris may no longer be part of the fourth world. 

The sad fact is that the Australian Aborigines have the poorest health 
status of all these groups as indicated by their shortest life expectation 
from birth.

Also alarming is that much has been documented on Indigenous health in 
Australia, but there has been no real, significant improvement in health 
status as indicated by a wide range of health indicators.

As at 1990-92 Aboriginal people had a life expectancy from birth of up to 
20 years shorter than their non-Indigenous counterparts (Australian 
Institute of Health and Welfare, 1994). 

Standardised mortality rates are generally between two and four times those 
of non-Aboriginal people for both males and females throughout Australia.

Age specific mortality ratios are highest for the young and middle-aged 
adults with males up to 11 times and females around seven times that of the 
total Australian population for these age groups.

Smallpox was one new introduced disease that devastated the Aboriginal 
population throughout Australia, with major epidemics in 1789 and 1829-30.

Other conditions having a significant impact on Indigenous health, include 
today's vaccine preventable diseases (measles, whooping cough, diphtheria, 
mumps), typhoid fever, scarlet fever, influenza, pneumonia, tuberculosis 
and venereal disease.

Since first contact there has been deliberate and systematic disempowerment 
of Indigenous people starting with the dispossession of their land.

The cultural significance of the relationship Aborigines have with their 
land is not realised by many non-Indigenous people.

This starts at birth and according to Grandmother's Law, which is 
traditional borning (birthing): the placenta is buried in the ground where 
the baby was born thus linking spirit, child, woman and country.

The non-Indigenous Australian population should be more aware of the way 
Aboriginal children were taken away from their families and put on 
missions, the so called Stolen Generation.

The resulting effect of this forced separation has been devastating to 
Aboriginal society with a downward spiralling pathway of poor health.

Forced dislocation has created an environment of social disruption where 
abuse of alcohol and other drugs has become prominent in Aboriginal 
communities.

In contrast the health status of the American Indians and the New Zealand 
Maoris has improved significantly over the past four decades. Age specific 
mortality ratios for both these Indigenous races are only one to two times 
that of their non-Indigenous counterparts for any specific age group 
examined.

Life expectation at birth for American Indians and Maoris is very similar 
and is approximately four years below all races in their respective 
countries.

The difference in life expectancy between the American Indians, New Zealand 
Maoris and the Australian Aborigines is between eight to 12 years.

This unacceptable large difference certainly indicates that current 
government policies and community attempts to improve Indigenous health are 
failing.

There needs to be a more unified approach by both government (Commonwealth, 
State and Local) and Indigenous communities in addressing Aboriginal and 
Torres Strait Islander health issues.

The infant mortality rate for American Indians has decreased by 85 percent 
from 1954 to 1988.

There has also been a significant decrease in infant mortality in 
Australia, but overall infant mortality rates still remain three to five 
times that of non-Aboriginal infants.

Socio-demographic features

Indigenous ill health is complex and can be related, amongst other factors, 
to inadequate housing and infrastructure, education, unemployment and a 
poor response to environmental health issues such as waste disposal, 
sanitation and hygiene.

Housing

A housing needs survey in 1987, which was conducted by the Aboriginal 
Development Commission, showed that 33 percent of Aborigines across 
Australia were either homeless or living in inadequate conditions.

It was estimated that an additional 16,179 dwellings and 157 hostels were 
needed to more adequately accommodate Aboriginal peoples at that 
time.

Seven percent of Aboriginal and Torres Strait Islander families in 
Queensland are homeless. A further three to four percent of families live 
in improvised dwellings especially in towns like Townsville, Cairns, Mt 
Isa, Torres Strait and Cooktown.

Homelessness is a major concern in the larger rural areas with the so 
called "Park People".

Overcrowding of houses is also a significant problem associated with the 
ill health of Indigenous communities. There are 61 percent of households in 
rural Queensland having six or more persons per house with three bedrooms 
or less.

This compares with only five percent of all Queensland households having 
six or more residents, but in contrast the majority of cases have three or 
more bedrooms per dwelling.

Employment

The Labour Force Status and Educational Attainment report by the Australian 
Bureau of Statistics (1994) found that the overall unemployment rate for 
Queensland's Indigenous population was 33 percent which is much higher than 
the rate of 10 percent for all Queenslanders.

Also this report stated that 31 percent of those Indigenous people working 
were employed in a Community Development Project scheme; 53 percent of jobs 
were provided by the government sector with the remaining people employed 
in the private sector.

Besides Aboriginal and Torres Strait Islander people having higher 
unemployment rates, they also have higher rates of imprisonment.

Aboriginal and Torres Strait Islander people are 19 times more likely to be 
incarcerated than non-Indigenous people of Australia, for Queensland the 
rate is about 17 times.

Education

School participation rates for Aboriginal and Torres Strait Islander people 
are poor and are lower than all Queensland rates, particularly in senior 
high school.

For Indigenous people participation rates fall off significantly as age 
increases. Overall, females have a slightly higher participation rate than 
males.

According to the National Aboriginal and Torres Strait Islander Survey 
(1994) only 0.1 percent and 1 percent of Queensland's Aboriginal and Torres 
Strait Islander people attained a postgraduate qualification or a bachelor 
degree respectively, compared to 2.7 percent and 7.1 percent of all 
Queenslanders.

There needs to be a significant improvement in education levels before 
sufficient numbers of Aboriginal and Torres Strait Islander people can 
graduate in professions such as medicine and law.

Examining these statistics one can assume that Governments continue to 
struggle in delivering adequate education to Indigenous people.

Remoteness should not be a barrier to education.

Can Indigenous Doctors help `turn the tide' on the poor health of their 
people?

As an Aboriginal doctor, I believe Indigenous doctors can help improve the 
health status of their people.

For example, in my work which is exclusively in Indigenous Health, 
operating from a mainstream health service (Inala Community Health Centre, 
Brisbane) one of the first things that I noticed was the poor access of 
Indigenous people to this centre.

At the commencement of my employment only about 12 Indigenous clients 
visited the centre on a regular basis.

After conducting focus groups with the local Aboriginal & Torres Strait 
Islander community, reasons why people were not attending the centre were 
identified and from this information an intervention strategy (with 
community participation) was introduced in 1995 aimed at improving 
Indigenous access.

In the first year of operation, 890 patient consultations were completed, 
this increased to 1,569 in 1996-97 and 2,369 patient consultations in 1997-
98.

It was evident from a recent satisfaction questionnaire that the reason 
Indigenous patients attend the clinic was because the staff are Indigenous, 
and in particular that I am an Aboriginal doctor and therefore more 
understanding of their needs.

Due to the high mortality and morbidity of Aboriginal and Torres Strait 
Islanders from diabetes, a specific clinic has been implemented at Inala 
Community Health and I am pleased to be able to state that most patients 
have improved their glycaemic control due to the efforts of an Indigenous 
Health team approach.

I am positive that other Indigenous doctors can contribute to the 
improvement in the health status of all Aboriginal and Torres Strait 
Islander people.

But I must stress that it is up to the individual doctor if he or she wants 
to pursue a career in Indigenous Health, but if they don't, pressure from 
either community or governments should not be aimed at changing their 
minds.

Whatever field of medicine Indigenous doctors choose, they will always 
remain important role models for other Indigenous people considering career 
opportunities in health.

Need for more Indigenous Doctors

Currently there would be only 30 Indigenous doctors in Australia with 
between 50 to 60 Indigenous students in medical schools across the country.

Australia is doing poorly in graduating Indigenous doctors.

For example, the INMED (Indians into Medicine) program at the University of 
North Dakota has graduated 100 Indian doctors.

This is only one medical school in North America and at this university 
five places for Indigenous students in each of the four years of the course 
are funded by the federal government.

The Commonwealth Government in Australia should he funding programs such as 
INMED so that more Indigenous Australians are graduating as doctors.

* * *

*Noel Hayman is a medical practitioner and is Program Leader, Indigenous 
Health, QE11 Hospital Health Service District, Brisbane.

Acknowledgements to New Doctor, the journal of the Doctor's 
Reform Society, where this article was first published. Full details of 
references were provided by the author in the original article. They are 
available from The Guardian on request.