Health risk factors

The factors contributing to the poor health status of Indigenous people should be seen within the broad context of the ‘social determinants of health' [1][2]. These ‘determinants', which are complex and interrelated, include income, education, employment, stress, social networks and support, social exclusion, working and living conditions, gender and behavioural aspects. Related to these are cultural factors, such as traditions, attitudes, beliefs, and customs. Together, these social and cultural factors also have a major influence on a person's behaviour.

The levels of these stressors and the indicators of the social disadvantage experienced by Indigenous people should be borne in mind in the interpretation of the following information about a number of specific health risk factors.

Nutrition

The nutritional status of Indigenous people is influenced by socio-economic disadvantage, and geographical, environmental and social factors [3]. Poor nutrition is a common risk factor for overweight and obesity, malnutrition, cardiovascular disease, type 2 diabetes, certain cancers, osteoporosis, and tooth decay [4][5]. The NHMRC has endorsed a number of dietary guidelines for infants, adolescents, adults, older Australians, women of childbearing age, and pregnant women [3]. The NHMRC guidelines recommend that adults consume a minimum of two serves of fruit and five serves of vegetables per day, selected from a wide variety of types and colours [6]. The guidelines also recommend including reduced-fat varieties of milk, yoghurts and cheeses, and choosing foods low in salt.

According to the 2004-2005 NATSIHS, 46% of Indigenous respondents aged 12 years or older living in non-remote areas consumed one serve or less of fruit per day, compared with 39% of non-Indigenous respondents [7]. Similarly, 42% of Indigenous respondents aged 12 years or older living in non-remote areas consumed two or more serves of fruit per day compared with 54% of non-Indigenous respondents. Almost two-thirds of Indigenous and non-Indigenous people aged 12 years or older living in non-remote areas reported consuming two to four serves of vegetables per day, but only 10% of Indigenous respondents and 14% of non-Indigenous respondents consumed five serves or more per day.

In remote areas the questions in the 2004-2005 NATSIHS were amended to whether the respondents usually ate fruit and/or vegetables each day. The proportions of people who did not consume these dietary items daily was substantially higher for Indigenous people aged 12 years and older living in remote areas than for those living in non-remote areas - 15% and 2% respectively for vegetable consumption, and 20% and 12% respectively for fruit consumption [7][8].

More than three-quarters of Indigenous people aged 12 years or older living in non-remote areas reported that they usually drank whole milk (including full-cream powdered milk), with only 20% drinking reduced fat and/or skim milk [8]. In contrast, 45% of their non-Indigenous counterparts consumed reduced fat and/or skim milk and 45% whole milk. The consumption of reduced fat and/or skim milk was very low (6%) among Indigenous people aged 12 years or older living in remote areas, with 87% reporting that they drank whole milk.

More than four-fifths of Indigenous people aged 12 years or older living in remote areas reported ‘sometimes' or ‘usually' adding salt after cooking, compared with two-thirds of those living in non-remote areas [8].

The 2004-2005 NATSIHS also addressed the question of food security by asking respondents whether they ran out of food in the 12 months before the survey. Approximately 24% of Indigenous Australians aged 15 years and older reported they ran out of food in the 12 months before the survey, compared with 5% of non-Indigenous Australians [9]. Those in remote areas were more likely to report having run out of food than those in non-remote areas (36% compared with 20%). Approximately 8% of Indigenous people reported they went without food when they couldn't afford to buy more, compared with 2% of non-Indigenous people.

Physical activity

The National Physical Activity Guidelines for Australians currently recommend at least 30 minutes of moderate activity on most, preferably all, days of the week to enhance health and reduce the risk of cardiovascular disease and other chronic conditions [10]. Insufficient levels of physical activity have shown to be a risk factor for cardiovascular disease, type 2 diabetes, certain cancers, depression, and overweight and obesity [11].

Data on the levels of physical activity of Indigenous people are limited [12]. After adjusting for differences in age structure, approximately 51% of Indigenous respondents in non-remote areas in the 2004-2005 NATSIHS reported their exercise level as sedentary (very low or no exercise), 27% as low and 21% as moderate or high, compared with 33%, 36% and 31% respectively of non-Indigenous Australians [9]. Sedentary or low levels of physical activity were highest among Indigenous people aged 45-54 years and 55 years and older (83% and 85% respectively); moderate or high levels of physical activity were highest among those aged 15-24 and 25-34 years (32% and 27% respectively). A higher proportion of Indigenous females than Indigenous males reported that their level of exercise was sedentary (51% compared with 42%).

Bodyweight

Breast milk, which is the natural and optimum food for babies, contains proteins, fats and carbohydrates at levels that are appropriate for an infant's metabolic capacities and growth requirements [3]. It also has anti-infective properties and contains immunoglobulins which provide some immunity against early childhood diseases [13]. The NHMRC recommends that as many infants as possible be exclusively breastfed until six months of age and that mothers then continue breastfeeding until 12 months of age [14].

According to the 2004-2005 NATSIHS, 79% of Indigenous children aged less than four years living in non-remote areas were reported to have been breastfed for at least some period [8]. This level is slightly lower than the 88% of non-Indigenous children aged less than four years who had been breastfed. A similar proportion of Indigenous and non-Indigenous infants had been breastfed for six to 12 months (19% and 22% respectfully) and for 12 months or more (13% and 14% respectfully). On the other hand, mothers of Indigenous children reported in the WAACHS that they were more likely to initiate breastfeeding and breastfeed for longer than mothers in the general population, particularly those living in more isolated areas [15].

The 2009 Footprints in Time - the Longitudinal study of Aboriginal children collected data from 11 sites (rural, remote and urban) around Australia in 2008-2009 [16]. Data on breastfeeding from this study showed that 22% of Indigenous infants had been breastfed for at least 12 months and there was a positive correlation between the length of breastfeeding and the relative isolation of the family.

Immunisation

In response to the greater burden of communicable diseases among Indigenous people, the NHMRC has endorsed a series of special guidelines and schedules for immunisation of vaccine-preventable diseases, which include some extra vaccinations [17][14].

Respondents to the 2004-2005 NATSIHS reported that 88% of Indigenous children aged 0-6 years living in non-remote areas were fully immunised against the vaccine-preventable diseases included in the relevant NHMRC vaccination schedule [8]. Based on available immunisation records, the level fully immunised would be somewhat lower, as the proportions for the separate vaccines were: diphtheria and tetanus (79%), whooping cough (74%), hepatitis B (83%), (79%), Hib (73%), and MMR (measles, mumps, and rubella) (85%).

Three-fifths of Indigenous people aged 50 years or older reported to the 2004-2005 NATSIHS that they had been vaccinated against influenza in the previous 12 months, with vaccination levels higher for people living in remote areas (80%) than for those living in non-remote areas (52%) [8]. All of these levels were higher than that for non-Indigenous people (46%). Similarly, vaccination levels for pneumonia in the previous 5 years were higher for Indigenous adults aged 50 years or older (remote: 56%; non-remote: 26%; all: 34%) than that for their non-Indigenous counterparts (20%).

Breastfeeding

Breast milk, which is the natural and optimum food for babies, contains proteins, fats and carbohydrates at levels that are appropriate for an infant's metabolic capacities and growth requirements [3]. It also has anti-infective properties and contains immunoglobulins which provide some immunity against early childhood diseases [13]. The NHMRC recommends that as many infants as possible be exclusively breastfed until six months of age and that mothers then continue breastfeeding until 12 months of age [14].

According to the 2004-2005 NATSIHS, 79% of Indigenous children aged less than four years living in non-remote areas were reported to have been breastfed for at least some period [8]. This level is slightly lower than the 88% of non-Indigenous children aged less than four years who had been breastfed. A similar proportion of Indigenous and non-Indigenous infants had been breastfed for six to 12 months (19% and 22% respectfully) and for 12 months or more (13% and 14% respectfully). On the other hand, mothers of Indigenous children reported in the WAACHS that they were more likely to initiate breastfeeding and breastfeed for longer than mothers in the general population, particularly those living in more isolated areas [15].

The 2009 Footprints in Time - the Longitudinal study of Aboriginal children collected data from 11 sites (rural, remote and urban) around Australia in 2008-2009 [16]. Data on breastfeeding from this study showed that 22% of Indigenous infants had been breastfed for at least 12 months and there was a positive correlation between the length of breastfeeding and the relative isolation of the family.

Tobacco smoking

Smoking tobacco increases the risk of cardiovascular disease, some cancers, lung diseases, and a variety of other health conditions [18]. Smoking is also a risk factor for complications during pregnancy and is associated with preterm birth, small for gestational age babies, low birthweight, and perinatal death [19]. Passive smoking is also of concern to health, with children particularly susceptible to problems including middle ear infections, asthma, respiratory infections, reduced lung function, low birthweight, and sudden infant death syndrome [18].

In 2003, tobacco smoking was the leading cause of the burden of disease and injury among Indigenous Australians, responsible for 12.1% of the total burden and one-fifth of all deaths [20].

Half of Indigenous people (50%) aged 18 years or older reported to the 2004-2005 NATSISS that they smoked daily. Overall, the proportion of Indigenous men who smoke (51%) is slightly higher than the proportion of Indigenous women who smoke (49%) [8]. By remoteness, the level of smoking is slightly higher for people living in remote areas (52%) than for those living in non-remote areas (49%). The level of smoking among Indigenous people has not really changed since at least 1994 (52%) [21].

The proportions of people smoking daily were similar for Torres Strait Islanders (49%) and Aboriginal people (50%) overall, but the proportion of daily smokers among Torres Strait Islanders living in the Torres Strait area was lower (38%) [8].

In 2004-2005, after adjusting for differences in the age structures of the two populations, daily smoking was 2.2 times more common among Indigenous people aged 15 years or older than among their non-Indigenous counterparts [8]. Even greater rates of smoking have been reported among Indigenous mothers. In 2007, in the jurisdictions that provided data (NSW, Qld, WA, SA, Tas, the ACT and the NT), smoking during pregnancy was more than three times more common among Aboriginal and Torres Strait Islander mothers than among non-Indigenous mothers (51.8% compared with 14.8%) [22].

Surveys consistently reveal that the prevalence of smoking is higher among Indigenous people than among non-Indigenous people. The 2007 NDSHS, for example, found that 34% of Indigenous people aged 14 years or older smoked daily - just under twice the proportion of their non-Indigenous counterparts (19%) [23].

Alcohol use

Binge drinking places both the drinker and others at increased risk of injury and morbidity, while regular drinking at harmful levels leads to a significant increase in risk of chronic ill-health and premature death [24]. Alcohol consumption in pregnancy can result in a spectrum of harms for the unborn child; the risk of birth defects is greatest when there is high and frequent alcohol intake in the first trimester, but alcohol exposure throughout pregnancy can impact on the development of the foetal brain [25].

In 2003, alcohol was the fifth leading cause of the burden of disease and injury among Indigenous Australians, responsible for 6.2% of the total burden of disease (net 5.4%), and 7% of all deaths [20]. Just over one-fifth of burden due to injury and more than one-sixth of burden due to mental disorders was attributable to alcohol.

Surveys have shown consistently that Indigenous people are less likely to drink alcohol than non-Indigenous people, but those that do drink are more likely to consume it at hazardous levels [24][23].

The 2007 NDSHS found that 23% of Indigenous people aged 14 years and older were abstainers or ex-drinkers compared with 17% of non-Indigenous people aged 14 years and older [23].

Analysis derived from the 2004-2005 NATSIHS found that the proportions of people aged 18 years or older who had never consumed alcohol or had not done so for more than 12 months was 24% for Indigenous people and 15% for non-Indigenous people [8]. Seventeen per cent of Indigenous men and 11% of non-Indigenous men aged 18 years or older had never consumed alcohol or had not done so in the previous 12 months; the proportions for Indigenous and non-Indigenous females were 30% and 20% respectively.

Alcohol consumption at ‘risky' or ‘high risk' levels was more common among Aboriginal people aged 18 years or older (17%) than among Torres Strait Islanders in that age range (13%) (the difference is not statistically significant) [8]. The level of ‘risky' or ‘high risk' alcohol consumption was even lower among Torres Strait Islanders living in the Torres Strait area (9%).

In 2009, the NHMRC introduced revised guidelines that depart from specifying ‘risky' and ‘high risk' levels of drinking. The guidelines seek to estimate the overall risk of alcohol-related harm over a lifetime and to reduce the level of risk to one death for every 100 people [25]. For men and women, guideline one states that to reduce the risk of alcohol-related harm over a lifetime, no more than two standard drinks should be consumed on any day, and guideline two states that to reduce the risk of injury on a single occasion of drinking, no more than four standard drinks should be consumed. Guideline three recommends avoiding alcohol for those under 15 years, and delaying alcohol for those aged 15 to 17 years. Guideline four recommends pregnant and breast feeding women avoid alcohol.

References

  1. Carson B, Dunbar T, Chenhall RD, Bailie R, eds. (2007) Social determinants of Indigenous health Crows Nest, NSW: Allen and Unwin
  2. Marmot M, Wilkinson R, eds. (1999) Social determinants of health Oxford: Oxford University Press
  3. National Health and Medical Research Council (2000) Nutrition in Aboriginal and Torres Strait Islander peoples: an information paper Canberra: National Health and Medical Research Council
  4. Australian Institute of Health and Welfare (2002) Australia's health 2002: the eighth biennial report of the Australian Institute of Health and Welfare Canberra: Australian Institute of Health and Welfare
  5. National Public Health Partnership (2001) National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000-2010 and first phase activities 2000-2003 Canberra: National Public Health Partnership
  6. National Health and Medical Research Council (2003) Dietary guidelines for Australian adults Canberra: NHMRC
  7. Australian Health Ministers’ Advisory Council (2008) Aboriginal and Torres Strait Islander health performance framework report 2008 Canberra: Department of Health and Ageing
  8. Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05 Canberra: Australian Bureau of Statistics
  9. Australian Institute of Health and Welfare (2008) Aboriginal and Torres Strait Islander health performance framework, 2008 report: detailed analyses Canberra: Australian Institute of Health and Welfare
  10. National physical activity guidelines for adults (brochure) (2005) Department of Health and Ageing
  11. Australian Institute of Health and Welfare (2004) Physical inactivity, diet and body weight: results from the 2001 National Health Survey Canberra: Australian Institute of Health and Welfare
  12. Australian Institute of Health and Welfare (2004) Heart, stroke and vascular diseases: Australian facts 2004 Canberra: Australian Institute of Health and Welfare
  13. Engeler T, McDonald M, Miller M, Groos A, Black M, Leonard D (1998) Review of current interventions and identification of best practice currently used by community based Aboriginal and Torres Strait Island health service providers in promoting and supporting breastfeeding and appropriate infant nutrition Canberra: Commonwealth Department of Health and Family Services
  14. Dietary guidelines for children and adolescents in Australia: incorporating the infant feeding guidelines for health workers. (2003) National Health and Medical Research Council
  15. Zubrick SR, Lawrence DM, Silburn SR, Blair E, Milroy H, Wilkes T, Eades S, D'Antoine H, Read AW, Ishiguchi P, Doyle S (2004) The health of Aboriginal children and young people Perth: Telethon Institute for Child Health Research
  16. Department of Families Housing Community Services and Indigenous Affairs (2009) Footprints in time: the longitudinal study of Indigenous children—key summary report from Wave 1 Canberra: Department of Families, Housing, Community Services and Indigenous Affairs
  17. The Australian immunisation handbook (2008) National Health and Medical Research Council
  18. Australian Institute of Health and Welfare (2008) Australia's health 2008: the eleventh biennial health report of the Australian Institute of Health and Welfare Canberra: Australian Institute of Health and Welfare
  19. Ashdown-Lambert JR (2005) A review of low birth weight: predictors, precursors and morbidity outcomes Journal of the Royal Society for the Promotion of Health; 125(2): 76-83
  20. Vos T, Barker B, Stanley L, Lopez A (2007) Burden of disease and injury in Aboriginal and Torres Strait Islander peoples: summary report Brisbane: Centre for Burden of Disease and Cost-Effectiveness: School of Population Health, University of Queensland
  21. Australian Bureau of Statistics (2004) National Aboriginal and Torres Strait Islander Social Survey, 2002 Canberra: Australian Bureau of Statistics
  22. Laws P, Sullivan EA (2009) Australia's mothers and babies 2007 Sydney: AIHW National Perinatal Statistics Unit
  23. Australian Institute of Health and Welfare (2008) National Drug Strategy Household Survey 2007 : detailed findings Canberra: Australian Institute of Health and Welfare
  24. Australian Bureau of Statistics, Australian Institute of Health and Welfare (2008) The health and welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008 Canberra: Australian Bureau of Statistics and Australian Institute of Health and Welfare
  25. National Health and Medical Research Council (2009) Australian guidelines to reduce health risks from drinking alcohol Canberra: National Health and Medical Research Council
 
Last updated: 14 December 2009
 
Return to top