The averaging of indicators of disadvantage does nothing to help understand the plight of remote living Aboriginal people in Australia.
There are some 140,000 persons living “in remote” out of a total population of 520,000 claiming Aboriginal heritage – that is 26%.
The majority of Australia’s “Aboriginal people” live in urban areas of the cities and towns with access to education, health services, employment opportunities and the lifestyle of mainstream Australians. They have been born and raised in those developed environments and so have access to facilities to improve their life. The majority have succeeded.
By contrast, the remote living Aboriginal people who make up the 140,000 that live in communities may have never seen a train or tram, caught a bus or attended a movie cinema for entertainment. Their view of the world is entirely different from their cousins in the towns and cities. To them the world is little or no education, over crowded houses, one store with a limited range of fresh food and people who come and go delivering health services. It is a “world view” that the average Australian cannot imagine.
Nearly all of the remote living Aboriginals are full blooded Aboriginal people with no mixed blood and thus with the full gene compliment of the original race of people. Western culture has added its genes to the pool that make up the remainder of the Aboriginal population thus making comparisons difficult on the basis of genotypes.
So why is it that when analysing the “gap” - disadvantage, life expectancy or disease incidence the all Aboriginal statistic is given?
Surely the Australian Bureau of Statistics knows by now who is who – it is after all since 1967 that Aboriginal Australians have been included in Census data. So long as statistics are averaged across all Aboriginal persons a skewed picture will be obtained and the contrast between the two population cohorts not appreciated by the policy makers.
A good example of this was the PBS QuMAX/s100 Forum recently held in Melbourne with pharmacists from all over Australia gathered to learn about and discuss quality use of medicine programs to Aboriginal (and Torres Strait Islander) people in Australia. Thus pharmacists dealing with these two world views were thrust together and expected to understand each others target audiences as if they were the same. It has to be recognised by the policy makers and program planners that this is not the case and it is only when it is taken into account that realistic programs can be put in place.
The statistic is given that in 2006 deaths and hospitalisations caused by cardiovascular disease for indigenous Australians were double the rates of non-indigenous Australians[1]; or that Aboriginal and Torres Strait Islander people are much more likely to develop complications (e.g. pneumonia and ear damage) from respiratory tract infections[2].
Such sweeping statements do nothing to help understand the degree of Aboriginality that makes up the cohort from which such conclusions have been drawn. It must be possible to draw a distinction between the remote living Aboriginal people and urban living persons. The Pharmaceutical Benefits Scheme for one thing is done differently and the medicine use for remote Aboriginal people is through special arrangements using Section 100 of the National Health Act to supply medicines directly to the Aboriginal Health Services. This would allow an analysis to be done on the supplies that are paid for by Medicare to the supplying Approved Pharmacies in either hospitals or the community. But alas, after three years of trying the Centre for Chronic Disease at the University of Queensland has been denied access to the Medicare data.
At the above mentioned Forum in Melbourne it was stated that the three most prescribed medicines for “Aboriginal people” were Metformin, Atorvastin and Salbutamol. This was from CTG prescriptions and should have been possible to correlate with the usage through the s100 arrangements - but no – there is no such data available even though the scheme has been operating for 12 years.
This writer knows that from the data of one Aboriginal Health Service[3] in a remote location the usage shows the top three supplied medicines are Ramipril, Atorvastin and Amoxycillin. Such a figure should be available from supplies to all AHSs.
The final piece of information that demonstrates the point of this article is life expectancy.
When averaged out across the total population of Aboriginal Australians the 17 year gap is identified. This means the Aboriginal person has a life expectancy of 62 years for males and 67 for females.
However if the age at death is looked at for Aboriginal people in the Northern Territory[4] the median age at death for males is 51 years (15 years less than non Indigenous) and females is 55 years (20 years less than non Indigenous). A stark contrast to the “average” over the total population. When remote locations are taken into account the difference is even greater.
In the words of Professor Wendy Hoy, Director of the Centre for Chronic Disease in Brisbane:
“The quickest way to “narrow the gap” is to reduce disease burden and deaths in remote areas, where rates are much higher than in Indigenous people living closer to population centres”.
Ends
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