Australian Indigenous

Overview of Indigenous health 2004

This overview is also available as a downloadable PDF using Adobe Acrobat.

Selected health conditions

• Eye health
• Ear conditions
• Oral health

Eye health

There has been progress in improving the eye health of Indigenous people, but many Indigenous people are still more likely than non-Indigenous people to suffer from preventable conditions, such as trachoma (a bacterial infection) [102, 103]. The eye health of many Indigenous people is also limited by difficulty in accessing optometrist or specialist services [104]. For those with refractive error, for example, the main issues are access to and utilisation of testing, cost of spectacles, the administrative difficulty of dispensing, and the repair of spectacles. Eye health can be affected by genetic factors, ageing, premature birth, diseases (such as diabetes) smoking, injuries, UV exposure and nutrition.

Extent of eye health problems among Indigenous people

Eye problems were among the conditions reported most commonly in the 2001 NHS [26]. For people living in non-remote areas, similar proportions of Indigenous (49%) and non-Indigenous people (51%) reported having some eye disorder as a long-term health condition. The proportion was slightly less (38%) for Indigenous people in remote areas. Differences between Indigenous and non-Indigenous people were highest in the middle adult years, with total or partial loss of vision being twice as commonly reported by Indigenous than by non-Indigenous people. Levels of hyperopia (long-sighted vision) were similar for Indigenous people (23%) and non-Indigenous people (22%) and the level of myopia (short-sighted vision) reported by Indigenous people was slightly less (17%) than that reported by non-Indigenous people (21%).

According to the WAACHS, 8% of Indigenous children aged 4-17 years did not have normal vision in both eyes (a level significantly lower than the 14% of children in the general population found in the 1993 WA Child Health Survey not to have normal vision in both eyes) [20]. Of the 4-17 year-old Aboriginal children without normal vision in both eyes, 58% used prescribed glasses or contact lenses.

In Australia , trachoma is found almost exclusively within the Indigenous population [103, 104]. It is difficult to develop an accurate map of where trachoma remains endemic because of the lack of systematic screening, but surveys have found high prevalences in communities in northern and central Australia , particularly the latter. A survey in a large central Australian community in late 1998 found that 40% of children aged less than 13 years had infectious trachoma [105]. In other places, such as Broome, Derby and Kununurra in the Kimberley region of WA, the prevalence of trachoma has declined [106].

Diabetic retinopathy is a complication of diabetes, which is a major health problem among Indigenous people (see above) [34]. Diabetic retinopathy, which involves damage to the small blood vessels in the retina, can impair vision and may cause blindness [102]. There are very limited data available on the prevalence of diabetic retinopathy in the Indigenous population [104], but a cross-sectional study in the Katherine region in 1993 and 1996 found that the crude prevalences of diabetic retinopathy (21%) and vision-threatening retinopathy (7-8%) among Indigenous people with diabetes were similar to those reported for non-Indigenous people with diabetes [107]. An evaluation of a non-mydriatic fundus camera among 164 Indigenous people with diabetes living in the Pilbara region of WA, diagnosed retinopathy in 74 out of 328 eyes (23%), with 35 eyes in need of laser treatment [108].

The risk of cataract increases as people age, particularly over the age of forty years. Surgery for cataract tends to be performed at a later stage for Indigenous people than for non-Indigenous people - when the condition is at a more advanced stage and causing greater visual impairment [109]. The proportion of Indigenous people who reported having cataracts in the 2001 NHS was 3% (age-adjusted), compared with 2% of non-Indigenous people [26]. Cataract was reported more frequently by Indigenous males (5%) than by Indigenous females (2%).

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Ear conditions

Ear infections are the most common type of illness in babies and young children, and three out of four children experience some form of otitis media (OM) by the time they are 3 years of age (National Institute on Deafness and Other Communication Disorders 2003). OM, which often occurs as a result of another illness (involving viruses or bacteria or both), is a common disorder in both developed and developing countries [110], but its form, onset, and natural history vary from population to population [111]. In developed countries, OM with effusion is prevalent and considered a major problem. In contrast, in developing countries acute and chronic suppurative forms of OM are much more common [112]. The pattern of OM observed among many Indigenous communities differs from that typically observed in the developed world, being more similar to that seen among disadvantaged populations in developing countries [113]. The high prevalence of OM among Aboriginal people is well established, and suppurative OM is of greatest concern.²¹

OM , particularly suppurative forms, is associated with some impairment of hearing, with major implications for language development and learning difficulties [112, 114]. The risk of permanent hearing loss increases if OM is not adequately treated and followed up. The hearing impairment associated with OM is generally conductive in nature²² and mild to moderate in degree, and may be intermittent or persistent depending on the middle-ear condition present at the time [112, 115].

Extent of ear disease among Indigenous people

The level of ear disease and hearing loss among Indigenous people remains higher than that of the general Australian population, particularly among children and young adults [112, 116].

In the 2001 NHS, Indigenous people reported more ear and hearing problems (18%) than did non-Indigenous people (14%) with an increasing prevalence with age [26]. Importantly, the proportions of young people with ear and hearing problems were much higher for Indigenous than non-Indigenous people: 11% compared with 5% for people aged 0-14 years and 13% compared with 5% for those aged 15-24 years.

The more detailed information collected by the WAACHS reveals that 18% of Indigenous children aged 0-17 years had recurring ear infections [20]. Children 0-11 years were more likely (20%) to have recurring ear infections than children aged 12-17 years (14%). Abnormal hearing was reported by carers for 7% of the children aged 4-17 years. Of children with recurring ear infections with discharge, 28% had abnormal hearing compared with 1% of those without ear infections.

These differences are not fully reflected in overall hospitalisation rates for ear and hearing problems, which were similar for Indigenous and non-Indigenous people in 2000-01 [12]²³. There were, however, more separations for Indigenous people (67%) due to otitis media than for non-Indigenous people (60%). For Indigenous hospitalisations, a further 14% were for ear problems due to perforation of the tympanic membrane (compared with 7% for non-Indigenous people).

As is the case with knowledge about most specific health conditions, the most valuable information about ear disease comes from specific studies, which have found particularly high levels of OM among Indigenous people living in rural and remote communities and lower levels for those living in urban areas (see Burrow and Thomson (2003) for a detailed review of the various studies). OM can affect Indigenous babies within weeks of birth and a high proportion of children will continue to suffer from CSOM throughout their developmental years [117].

Studies have found particularly high levels of otitis media ( OM ) among Indigenous people living in rural and remote communities and lower rates for those living in urban areas [116]. OM can affect Indigenous babies within weeks of birth and a high proportion of children will continue to suffer from CSOM throughout their developmental years [117]. Individual studies have documented very high levels of CSOM in some Indigenous communities. The WHO has identified a prevalence of CSOM of greater than 4% as being ' a massive public health problem' requiring 'urgent attention' [119, p.29] : some Indigenous communities had a prevalence up to 10 times higher than this [114, 118].

The higher levels of OM that Indigenous people experience in their childhood years are reflected in a higher frequency of hearing loss, which have been documented in numerous studies (see Burrow and Thomson (2003) for a detailed review of the studies).

As with many other areas of Indigenous health, this massive public health problem will be solved 'only with urgent attention to improving housing and access to running water, nutrition and quality of care, and giving communities greater control over these improvements' [114, p.178]

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Oral health

Oral health is defined as 'a standard of health of the oral and related tissues that enables an individual to eat, speak, and socialise without active disease, discomfort, or embarrassment and that contributes to general wellbeing' (UK Department of Health 1994). Thus, it is more than simply the absence of disease in the oral cavity: it is a standard of oral functioning that enables comfortable participation in everyday activities.

Two major threats to oral health are dental caries and periodontal diseases. Dental caries is caused by acid-producing bacteria living in the mouth, which proliferate on sweet and sticky food [120]. Caries is reversible in its early stages, but, if untreated, can cause irreversible damage. Periodontal diseases (affecting the gums) are caused by bacterial infection associated with poor oral hygiene, infrequent dental visits, age, smoking, low education and income levels, and certain medical conditions [120], especially diabetes mellitus [121] and osteoporosis [122].

Extent of oral health problems among Indigenous people

Most information available about oral health in the Indigenous population relates to dental caries among children, and there is limited information about the oral health of adults. Generally the extent of caries in deciduous teeth among young Indigenous children has been increasing, whereas it has been declining for their non-Indigenous counterparts [123].

According to the WAACHS, an estimated 19% of Aboriginal and Torres Strait Islander children were reported by their carers to have holes in their teeth [20] . Prevalence of cavities was lowest for children 0-3 years (8%) and highest for children aged 4-7 years (31%). Carers reported 28% of children had ever had a tooth filled and almost one-in-ten had had a tooth removed because it was not amenable to restorative dental care.

In the Child Dental Health Survey, Northern Territory 2000, considerably fewer Indigenous children than non-Indigenous children were found to have had no history of caries [124]. Indigenous children up to the age of 9 years old had approximately 3 to 4 times more decayed teeth than non-Indigenous children and dmft scores (for deciduous teeth) one-and-a-half to two-and-a-half times higher (two indices are used to measure caries: 'dmft' is the number of deciduous (baby) teeth (t) that are decayed (d), missing due to caries (m), or filled due to caries (f); and 'DMFT' is the corresponding index for permanent (adult) teeth.). For permanent teeth, Indigenous children had a higher mean number of decayed teeth and a higher mean DMFT score.

Dental decay in deciduous and permanent teeth of Indigenous children living in SA in 2001 was about twice the level for non-Indigenous children, and the proportion of dental decay that was untreated was also greater [12]. An earlier study in South Australia found that the lowest levels of dental decay in Indigenous children were in remote communities (mean dmfs = 1.0), with higher levels in other non-metropolitan areas (mean dmfs = 7.9) and in Adelaide (mean dmfs = 5.2) [125].

The mean number of teeth affected in Indigenous children aged 5-6 years living in the Anangu lands in the cross-border region of WA, SA and the NT (3.2) was more than twice that of children in the total Australian population (1.44) [126]. Compared with the decline in deciduous caries for children in the total population since 1987, A n angu children aged 5-9 years had experienced a 42% increase in the mean number of teeth affected. A n angu adults experienced low levels of dental caries, but tooth loss was found more frequently among adults with diabetes (mean 5.51) than non-diabetics (mean 1.53), and severe periodontal disease was more prevalent among diabetics (79%) than among non-diabetics (13.8%).

The extent of tooth loss and periodontal disease is higher among older Indigenous people than among their non-Indigenous counterparts [123]: around 16% of older Indigenous people had no natural teeth, compared with 10% of non-Indigenous people [127]. The extent of tooth loss results partly from the relatively poor periodontal health of Indigenous people aged 35 years or older [128]. The most common periodontal condition in Indigenous people aged less than 45 years accessing public dental services and Indigenous dental clinics was the presence of calculus (tartar) [12]. For people aged 45 years or older, 23% had periodontal pockets (space between the root of the tooth and the gums) of 6mm or more, and 25% had periodontal pockets of 4-5mm.

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Disability

According to the WHO's International Classification of Functioning, Disability and Health (ICF), disability is an umbrella term for impairments, activity limitations and participation restrictions [129]. Impairments are 'problems in body function or structure such as significant deviation or loss'; activity limitations are 'difficulties an individual may have in executing activities'; and participation restrictions are 'problems an individual may experience in involvement in life situations' [129, pp.7-10]. The ICF recognises that how these aspects impact on an individual are influenced by the 'physical, social and attitudinal environment in which people live and conduct their lives' [129, pp.16-17]. Thus, ICF emphasises functioning rather than disability, and views it as an outcome of interactions between health conditions (diseases, disorders and injuries) and contextual factors [130]. It also brings together the classifications of health and disability.

The AIHW is working on the application of the ICF to the classification of disability in Australia (see, for example, National Community Services Data Committee, 2004 [131]). However, much of the information available in Australia about functioning (disability) is based on the previous classifications that focused on disability and handicap. Much of this information is derived from the periodic surveys conducted by the ABS, but these surveys have never included sufficient numbers of Indigenous people to enable any definitive conclusions about disability.

The extent of disability among Indigenous people

There have been few studies of disability in the Indigenous population, but evidence suggests that the level of disability and handicap among Indigenous people is likely to be much higher - 'perhaps at least twice as high as' - that of the total population [132, p.223].

This estimate is consistent with a study undertaken in 1991 in the Taree area of New South Wales [133, 134]. The study, which followed the methodology used by the ABS in its national surveys of disability, found that 227 (25%) of the 907 Indigenous people living in households in the Taree area had one or more disabilities [133]²⁴. After adjustment for differences in the age structures of the Indigenous and non-Indigenous populations, the levels of reported disabilities among the Indigenous regular residents of the Taree area were 2.5 times higher for males and 2.9 times higher for females than for males and females in the total Australian population. Almost one-fifth (19%) of regular Indigenous residents reported having a disability of the sense organs, such as hearing loss (8.4%) or loss of sight (1.4%). The next most frequently reported disabilities were 'disorders of the musculo-skeletal system and connective tissues' (16%), 'circulatory system disorders' (15%), and 'respiratory system disorders' (13%). Bearing in mind that the study excluded people living in health establishments and institutions - whose residents would be expected to have higher levels of disability - the levels of disability reported were much higher than those for the total Australian population.

Virtually nothing is known about the overall level and types of disability among Indigenous people in other parts of Australia, but, given the overall levels of ill-health among Indigenous people and the fact that many of the known risk factors for disability are present at high levels in the Indigenous population, the levels documented for the Taree area provide a useful conservative 'working basis' until similar studies are undertaken in other parts of the country [135]²⁵.

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Last updated: 12 January, 2005