Chronic disease in Aboriginal communities
Indigenous people worldwide suffer a greater burden of ill health than their non-indigenous counterparts. Aboriginal people in Australia are in general the least healthy of all indigenous people throughout developed countries experiencing a life expectancy seventeen years less than non Aboriginal Australians. There has been a plethora of research both nationally and internationally to why Indigenous people continue to suffer a greater burden of ill health. Research has shown a correlation between social determinants of health and poor health outcomes including increased prevalence of chronic diseases in social disadvantaged groups.
Chronic illness is a major challenge for the Australian health care industry with over three million Australians, or nearly one in seven, suffering from a chronic condition (2). Evident in the literature is that addressing chronic illness requires a rethink in the way we deliver health care, as chronic disease brings with it intricate and complex issues that challenge our current health care models.
The poor health status of Aboriginal people is well known, this was highlighted in the recent NSW Health Officer Report (CHO) (3)
Statistics from the CHO
- 12% of Aboriginal babies are born prematurely and similar proportions are born with low birth weights, with strong evidence linking low birth weight with chronic illness.
- Aboriginal people have higher rates of risk factors for chronic conditions such as smoking, obesity, physical inactivity and poor nutrition.
- Aboriginal people have higher rates of hospitalisation than non-Aboriginal people of NSW.
- rates of diabetes which are 2 to 4 times higher (see the Australian Institute of Health and Welfare publication Diabetes as a cause of death, Australia, 1997 and 1998)
- rates of heart, stroke and vascular disease which are two times higher (see the Australian Institute of Health and Welfare publication Cardiovascular Disease and Aboriginal and Torres Strait Islander Peoples)
- rates of renal disease which are 10 to 15 times higher (see the Australian Indigenous HealthInfoNet)
- deaths from heart disease at twice the rate. Within the 25-64 age groups this rises to 7-10 times higher (see the Australian Institute of Health and Welfare's publication Heart Failure... What of the Future?).
The social and environmental circumstances in which many indigenous Australians live create risk conditions (eg. poverty, poor housing, inadequate food supply), which predispose this population to the development of chronic diseases and the uptake of risk behaviours which may lead to physiological risk factors for chronic disease (see Factors Contributing to Chronic Disease in Aboriginal and Torres Strait Islander People below).
The range of biological and behavioural factors which are common to and increase a person's risk of developing diabetes, heart, stroke and vascular disease are outlined in the table below.
| Behavioural risk factors | Physiological/metabolic risk factors |
| Smoking Physical inactivty Poor diet and nutrition Excessive alcohol use |
Elevated lipids (high blood fats) Hypertension (high blood pressure) Hyperglycaemia (high blood sugar) Overweight and central obesity |
When several risk factors coexist, the risk of vascular disease is multiplied. Having one chronic disease can predispose the individual to another, for example cardiovascular disease is a common complication of diabetes. Hence a joint approach to chronic vascular disease is likely to be more effective and more efficient in Aboriginal communities.
Further, a holistic approach is more in keeping with indigenous concepts of health and illness than a separate body parts or single disease approach. It is anticipated that a coordinated and strategic whole of person approach should, over time, impact the delay in onset and reduced numbers of adverse health outcomes in vascular disease in Aboriginal people in NSW.
