HealthBulletin

Australian Indigenous HealthBulletin
Vol 4 No 4 October 2004 - December 2004: ISSN 1445-7253

A peer-reviewed electronic journal from the Australian Indigenous HealthInfoNet

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This section of the Bulletin contains peer reviewed general summaries of Indigenous health and reviews of specific topics. If you would like to contribute to this section, please see Notes for contributors or contact us.

Overview of Indigenous health 2004

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' [136, 137]. 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.

Information about some of these determinants is available (see 'The context of Indigenous health'). As well, the 2002 NATSISS collected information about stressors experienced by Indigenous people in the previous 12 months [11].

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, geographical factors, environmental and social factors [138]. Poor nutrition is a common risk factor for overweight and obesity, malnutrition, cardiovascular disease, type 2 diabetes, certain cancers, osteoporosis, and tooth decay [46, 139]. The National Health and Medical Research Council (NHMRC) has endorsed a number of dietary guidelines for infants, adolescents, adults, older Australians, women of childbearing age, and pregnant women [138].

Data from the 2001 NHS indicate that 57% of Indigenous respondents in non-remote areas had a low daily fruit intake (47% non-Indigenous) [26]. However, most Indigenous respondents reported a high to medium daily vegetable intake (83%) compared with a slightly lower proportion of non-Indigenous respondents (77%). Indigenous respondents were more likely to consume whole milk (instead of low fat alternatives) than non-Indigenous respondents, and were more likely to add salt after cooking [12].

Physical activity

The National Physical Activity Guidelines for Australians currently recommend at least 30 minutes of moderate activity on at least five days of the week to reduce the risk of cardiovascular disease and other chronic conditions [25]. 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 [140].

Data on the levels of physical activity of Indigenous people are limited [25], but 49% of respondents in the 2002 NATSISS reported participating in some sport or physical recreation activity in the previous 12 months [11]. This level of physical activity is higher than that documented in the 2001 NHS, in which 71% of Indigenous people and 68% of non-Indigenous people aged 15 years or older reported being sedentary or practising low levels of exercise [26].

Bodyweight

Body mass index (BMI - weight in kilograms divided by the square of height in metres) is the usual measure for classifying a person's weight for height [19]. Being overweight (BMI between 25 to 29.9) or obese (BMI >= 30) increases a person's risk for cardiovascular disease, type 2 diabetes, respiratory diseases, renal disease, certain cancers, osteoarthritis, pregnancy complications, and psychosocial problems [25]. A high BMI can be a result of poor nutrition, physical inactivity, socioeconomic disadvantage, genetic predisposition, increased age, and alcohol and tobacco use [25, 141].

According to the 2001 NHS, the age-adjusted prevalence of overweight among Indigenous respondents aged 18 years and over living in non-remote areas was 64% compared with 50% for non-Indigenous people [26]. Indigenous people were nearly twice as likely to be obese than other Australians: 31% compared with 16%.

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 [142].

According to the 2001 NHS, full immunisation coverage for Indigenous children under 7 years of age was generally lower than that for non-Indigenous children in non-remote areas [26]. Approximately 66% of Indigenous children were fully immunised for diphtheria and tetanus (78% non-Indigenous), 60% for whooping cough (73% non-Indigenous), 12% for hepatitis B (12% non-Indigenous), 71% for polio (84% non-Indigenous), 46% for Hib (73% non-Indigenous), and 78% for measles, mumps, and rubella (87% non-Indigenous) [12, 26]. The influenza vaccination level for Indigenous adults aged 50 years or older (51%) was similar to that for their non-Indigenous counterparts (47%). For pneumonia, 67% of Indigenous adults aged 50 years or older had never received vaccination, compared with 84% of non-Indigenous adults in that age group [26].

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 [138]. It also has anti-infective properties and contains immunoglobulins which provide some immunity against early childhood diseases [143].

Surveys indicate that a majority of Indigenous women breastfeed their babies. According to the 2001 NHS, 77% of Indigenous children aged under 4 years living in non-remote areas were reported to have been breastfed for at least some period [26]. This level is slightly lower than the 87% of non-Indigenous children aged less than 4 years who had been breastfed. 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 [20].

Tobacco smoking

Smoking tobacco increases the risk of cardiovascular disease, some cancers, lung diseases, and a variety of other health conditions [19]. Passive smoking is also of concern to health, with children particularly susceptible.

Population surveys consistently reveal that the prevalence of smoking is higher among Indigenous people than among non-Indigenous people. The 2001 National Drug Strategy Household Survey, for example, found that 45% of Indigenous people aged 14 years or older smoked daily - more than twice the proportion of their non-Indigenous counterparts (19%) [144].

According to the 2002 NATSISS, just over half (51%) of the Indigenous population aged 15 years or older reported being smokers, a similar proportion to that reported in the 1994 NATSIS (52%) [11]. Similar proportions of men and women were current daily or regular smokers (51% and 47%). For both men and women, the highest levels were reported for those aged 25-44 years. In the WAACHS, the proportion of mothers of Aboriginal infants who used tobacco during their pregnancy was twice the level of mothers in the general population [20].

Alcohol use

Excessive alcohol use can contribute to liver disease, pancreatitis, diabetes, some cancers, epilepsy [12] and cardiovascular disease [19]. Alcohol use can also be a contributor to injury and violence [19]. Abstinence from drinking alcohol is advised for women when pregnant or breastfeeding [19]. Consumption in pregnancy can affect the unborn child leading to foetal alcohol syndrome (comprising abnormalities such as growth retardation, characteristic facial features, and central nervous system anomalies, including intellectual impairment) [145].

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 [12]. According to the 2002 NATSISS, 15% of Indigenous people aged 15 years or older reported risky/high risk alcohol consumption in the previous 12 months (similar levels in non-remote and remote areas) [11]. The proportions were higher for Indigenous males than females (17% compared with 13%) and highest for males aged 45-54 years (22%) and for females aged 35-44 years (19%).

Use of other drugs

Illicit drugs (such as marijuana, heroin, ecstasy and cocaine), volatile substances (such as glue, solvent and petrol) and the non-medical use of prescribed drugs are risk factors for ill-health and can cause death [19]. In addition to the risk of drug overdose, illicit drug use can contribute to a variety of health conditions (for example, HIV/AIDS, hepatitis C virus, low birthweight, malnutrition, infective endocarditis, poisoning, suicide, and self-inflicted injury).

According to the 2001 National Drug Strategy Household Survey, around 57% of Indigenous respondents in urban areas aged 14 years or older reported having tried at least one illicit drug compared with 37% of non-Indigenous respondents [144]. The percentage of current users of cannabis among Indigenous respondents (13%) was higher than that of non-Indigenous respondents (8%).

Studies among non-random samples of Indigenous people who inject drugs have raised concerns about the young age at which injecting commences, and about the safety of injecting practices [146]. High frequencies of poly-drug use have also been reported among Indigenous injecting drug users in WA and SA [146, 147]. It has been estimated that the prevalence of injecting drugs increased in WA in the period 1994-2001: the percentage of Indigenous people who had ever injected was probably between 4.5% and 6% in 2001, with the percentage of current injectors between 3% and 4% [148].

Estimating the prevalence of petrol sniffing is difficult, because sniffing patterns are often cyclical and populations fluctuate [146]. Petrol sniffing had been reported mainly from communities in Arnhem Land , central Australia and the Goldfields region of WA [149]. There appears to be a shift recently in the geographic distribution of petrol sniffing, however, with a reduction in the Eastern Goldfields region of WA but endemic occurrence in the south-east Kimberley region of WA, in northern Queensland and in parts of central Australia and Arnhem Land [150].