Australian Indigenous

Journal Articles

Bent, A. (1999).
Allied health in central Australia: challenges and rewards in remote area practice.
Australian Journal of Physiotherapy. 45, 203-212.

The aim of this descriptive study, undertaken in 1997 was to examine the prefessional environment and work practices of physiotherapists, occupational therapists and speech pathologists in public sector positions in Central Australia. All therapists identified in these positions were interviewed. The study indicates that incumbents value specific professional benefits associated with remote area practice, particularly the opportunity to work with Aboriginal people. However these recruiting advantages are diminished by a lack of management support - a key factor in the high turnover of staff. The findings of this study have implications for the development of strategies to improve support, and thereby retention, of allied health professionals and other workers in remote areas.
Australian Journal of Physiotherapy abstract

Bridge, C. (1999).
Midwifery care for Australian Aboriginal women.
Australian College of Midwives Incorporated Journal, September, 7-11.

Australian Aboriginal women have twice the number of still born babies as Australian non Aboriginal women and have babies who are five times more likely to die within the neonatal period. The perinatal mortality rate is three times higher and the infant mortality is more than five times the overall rate for babies of Australian Aboriginal women compared to Australian non Aboriginal women. These are the stark statistics compiled by the Midwives Notification System in Western Australia (1998). This paper discusses East Kimberley Aboriginal women and their life cycle. When compared with women of western culture the life cycle of Aboriginal women is uniquely different. The lives of traditional Aboriginal people are encompassed by cultural values and beliefs which determine, govern and affect who they are, where they belong and how they view the world. As an Aboriginal women who is conducting the antenatal/postnatal program in her community, the provision of culturally appropriate health care is based on these principals and values. Since the authors inception of this program, evidence suggests that the incidence of Aboriginal women's representation and first time attendance has increased.
Australian College of Midwives Incorporated Journal abstract

Briganti, E.M., Knight, J.F., Atkins, R.C., & McNeil, J.J. (1999).
Australians with renal disease: a new national survey. [Editorial].
Medical Journal of Australia, 170(11), 520-1.

This editorial briefly considers the impact of diseases of the kidneys and urinary tract on the Australian population and identifies gaps in the current understanding of their epidemiology. The editorial summarises the key findings of the Australian Kidney Foundation's recently released national epidemiological survey. It applauds the collection of detailed epidemiological data on end-stage renal disease (ESRD) but notes the scarcity of information on the aetiology, incidence and prevalence of many other renal and urinary tract diseases. The authors conclude that the Australian Kidney Foundation's survey will provide the evidence necessary to plan future treatment, prevention and research services.
Australian Indigenous HealthInfoNet abstract

Briscoe, A. (1999).
First National Indigenous Male Health Convention Ross River Conference.
Aboriginal and Islander Health Worker Journal, 23(6), Nov/Dec, 24-25.

Describes the first ever national male Indigenous health conference, at which 150 men from across Australia gathered at Ross River to discuss a range of health and social issues affecting Indigenous men in the 1990's. Discussion topics included youth suicide, role of Indigenous men, Indigenous gay mens issues, HIV and family violence. Several key note speakers from various health centres provided valuable information, and a number of workshop sessions were also held that enabled participants to provide input into particular issues. It was finally agreed that Indigenous men need to take control of their health needs. Other outcomes of the meeting reflected the need to develop a strategic approach to Indigenous male health while also beginning to address key needs of Indigenous men.
Australian Indigenous HealthInfoNet abstract

Butler,T., Spencer, J., Cui, J.S., Vickery, K., Zou, J., & Kaldor, J. (1999).
Seroprevalence of markers for hepatitis B, C and G in male and female prisoners - NSW, 1996.
Australian and New Zealand Journal of Public Health, 23(4), 377-384.

Objectives: 1. Establish the prevalence of markers for hepatitis B (HBV), C (HCV) and G (HGV) in a sample of male and female inmates. 2. Examine exposure to multiple viruses. 3. Compare risk factors for HGV infection with known risk factors for HBV and HCV.

Design: Cross-sectional random sample stratified by sex, age and Aboriginality. Inmates were screened for three hepatitis markers. Participants were 789 inmates (657 male, 132 female) in 27 correctional centres in New South Wales, 1996.

Results: Overall detection of each of the three screening markers was 35% for HBV, 39% for HCV and 10% for HGV. Exposure rates were higher in female prisoners than males. Increased rates of anti-HBc were observed in Aboriginal inmates compared with non-Aboriginals (54% cf. 27%); anti-HCV and HGV-RNA were comparable between the two groups (36% cf. 41% and 9% cf. 10%). Markers were significantly higher in female injecting drug users (IDU), particularly HCV (90% cf. 66%). Thirty-five per cent of inmates were unaware of their HCV status. For HBV, 72% did not report past or present exposure despite serological evidence to the contrary. The multivariate analysis identified Aboriginality, long-term injecting and injecting while in prison as risk factors for HBV. HCV risk factors were female sex, non-Aboriginality, institutionalisation and IDU-associated behaviours. For HGV, female sex and previous imprisonment were significant risk factors but IDU was not.

Conclusions: Blood-borne hepatitis viruses are common in prison inmates, particularly females (HBV, HCV and HGV), Aboriginals (HBV) and IDU (HBV and HCV). Infection can be related to a number of risk factors, which appear similar for HBV and HCV, but distinct from HGV.
Australian and New Zealand Journal of Public Health abstract

Butler, C., Rissel, C., & Khavarpour, F. (1999).
The context for community participation in health action in Australia.
Australian Journal of Social Issues, 34(3), 253.

The community's role in maintaining public health by participating in health service programs is examined. Topics include the government's past public health policies, the difference between geographical and relational communities, identifying communities' major health care issues, and the difficulties in defining community participation.
Australian Journal of Social Issues abstract

Carapetis, J. R., Currie, B. (1999).
Mortality due to acute rheumatic fever and rheumatic heart disease in the Northern Territory: a preventable cause of death in Aboriginal people.
Australian and New Zealand Journal of Public Health, 23(2), 159-163.

A study was conducted to determine the death rates and effect on premature mortality in the Northern Territory of acute rheumatic fever and rheumatic heart disease. Deaths due to acute rheumatic fever and rheumatic heart disease for the period 1979-1996 were ascertained from death certificates, a database of all patients with these diseases, and mortuary records. Of 182 deaths, 171 (94%) were in Aboriginal people. The mean age at death of Aboriginal people was 35.7 years, compared with 67.3 years in non-Aboriginal people. Premature mortality for Aboriginal people was more than four times that in developing countries.
Australian and New Zealand Journal of Public Health abstract

Clausen, L. (1999).
Drying up the creek.
Time International, August 23(34), 36.

The article reports differing views on the proposed reduction in liquor trading hours for the town of Katherine in the Northern Territory. The proposed model is based on the example of Tennant Creek, a nearby town which restricted liquor trading hours several years ago. The laws are encouraged by many people who encounter the effects of the town's extreme alcohol consumption on a regular basis. Others are sceptical of the ability of the laws to be effective, claiming alcohol abuse in outback towns is a deeper, more complex problem. All are greatly concerned about the alcohol-fueled social problems which are destroying their community.
Australian Indigenous HealthInfoNet abstract

Colagiuri, S., Miller, J.C.B. (1999).
The Metabolic Syndrome: from inherited survival trait to a health care problem.
Experimental and Clinical Endocrinology and Diabetes, 105(sup2), 54-60.

A critical role is proposed for the quantity and quality of dietary carbohydrate in the pathogenesis of the insulin resistance and hyperinsulinaemia which characterise the Metabolic Syndrome. We propose that an insulin-resistant genotype evolved to provide survival and reproductive advantages for the cold-climate, large- game hunters of the last Ice Age who consumed a low carbohydrate, high protein diet with periodic starvation. Insulin resistance would have minimised glucose utilisation by muscles thereby facilitating the preferential utilisation of glucose by the brain, foetus and mammary gland. Beginning about 10,000 years ago, following the end of the last Ice Age and the development of agriculture, dietary carbohydrate increased and the selection pressure for insulin resistance decreased in some groups. Agriculture began in the Middle East and spread throughout Europe long before it was developed elsewhere. Hence the prevalence of the insulin-resistant genotype decreased in Europeans and other groups exposed to a high carbohydrate intake for sufficiently long. Some geographically isolated groups such as the Pima Indians and Nauruans experienced conditions which further diminished the gene pool diversity and resulted in particularly insulin resistant populations. Traditional carbohydrate foods have a low glycaemic index and produce only modest increases in plasma insulin. However, the constant supply of highly refined high glycaemic index carbohydrate in modern diets results in postprandial hyperinsulinaemia. The insulin-resistant genotype is now disadvantageous and predisposes to the development of the Metabolic Syndrome.
Experimental and Clinical Endocrinology and Diabetes abstract

Coory, M. (1999).
Improving Indigenous health: social and environmental factors deserve as much attention as health services. [Letter].
Medical Journal of Australia, 170(4), 190.

This letter to the Editor considers the policy implications for the lack of progress in Indigenous health. While acknowledging the necessity of accessible health services the letter emphasises the importance of social and environmental factors and need for appropriate remedies. The author warns against neglecting these factors simply because they are hard to change. He also warns against reliance on counselling and education, citing evidence that indicates that this is not the best approach for addressing poor health status in economically disadvantaged populations.
Australian Indigenous HealthInfoNet abstract

Daniel, M., O'Dea, K., Rowley, K.G., McDermott, R., & Kelly, S. (1999).
Glycated haemoglobin as an indicator of social environmental stress among Indigenous versus westernised populations.
Preventive Medicine, 29(5), 405-413.

Background: This study assessed whether glycated haemoglobin concentration, an indicator of psychogenic stress, differs between Indigenous populations and non-Indigenous reference groups.

Methods: Multivariate and stratified analyses were undertaken of cross-sectional data from multi-centre community-based diabetes diagnostic and risk factor screening initiatives in Canada and Australia. Population groups were Australian Aborigines (n = 116), Torres Strait Islanders (n = 156), Native Canadians (n = 155), Greek migrants to Australia (n = 117), and Caucasian Australians (n = 67). Measurements included fasting glycated haemoglobin (HbA(1c)) concentration, fasting and 2 hour post-load glucose concentrations, body mass index, waist-to-hip ratio, and demographic variables.

Results: Mean HbA(1c) concentrations were greater for Indigenous groups than for Greek migrants and Caucasian Australians (P < 0.0001). The covariate adjusted Indigenous versus non-Indigenous difference (95% CI) was 0.90 (0.58-1.22) percentage units, 18.2% higher for Indigenous people, Stratified analyses indicated greater HbA(1c) for Indigenous than for non-Indigenous persons with normoglycaemia (P = 0.009), impaired glucose tolerance (P = 0.097), and diabetes (P < 0.0001)

Conclusions: HbA(1c) concentrations are greater for Indigenous than for non-Indigenous groups. Social changes, low control, and living conditions associated with westernisation may be inherently stressful at the biological level for Indigenous populations in westernised countries.
Preventive Medicine abstract

Eades, S. (2000).
Reconciliation, social equity and Indigenous health. [Editorial].
Medical Journal of Australia, 172, 468-469.
Medical Journal of Australia full text article

Franks, C., Ewald, D. (1999).
Towards guidelines for outbreak investigations in central Australian Aboriginal communities.
Aboriginal and Islander Health Worker Journal, 23 (6) Nov/Dec, 5-7.

This article discusses an investigation into an outbreak of gastroenteritis among visitors to a remote central Australian Aboriginal community. After describing how the Public Health Service went about their investigation, it then discusses the importance of operating within a culturally appropriate manner and the implications of investigations that do not return perceived value to the community. The point is made that with any investigation of a community, social disruption will occur and a decision must be made as to whether the benefits of the findings outweigh the costs in terms of the goodwill and relationships between investigators and the Aboriginal community. It goes on to suggest guidelines for investigations of future outbreaks in central Australian Aboriginal communities which include: clarifying community commitment, weighing up the costs and benefits of the investigation, negotiating a time to visit, working directly with an Aboriginal health worker, giving prompt and appropriate feedback and providing encouragement and further assistance if required.
Australian Indigenous HealthInfoNet abstract

Guthrie, J.A., Dore, G.J., McDonald, A.M., & Kaldor, J.M. (2000).
HIV and AIDS in Aboriginal and Torres Strait Islander Australians: 1992-1998.
Medical Journal of Australia, 172, 266-269.
Medical Journal of Australia full text article

Hanna, J.N.,Warnock, T.H.,Shepherd, R.W., & Selvey, L.A. (2000).
Fulminant hepatitis A in Indigenous children in north Queensland.
Medical Journal of Australia, 172, 19-21.
Medical Journal of Australia full text article

Hoy, W.E., Baker, P.R., Kelly, A.M., & Wang, Z. (2000).
Reducing premature death and renal failure in Australian Aboriginals. A community-based cardiovascular and renal protective program
Medical Journal of Australia, 172, 473-478.
Medical Journal of Australia full text article

Laming, A.C., Currie, B.J., DiFrancesco, M., Taylor, H.R. & Mathews, J.D. (2000).
A targeted, single-dose azithromycin strategy for trachoma.
Medical Journal of Ausralia, 172, 163-166.

Objective: To evaluate the impact of treating children with acute trachoma and their contacts with oral azithromycin.

Design: Open, uncontrolled, prospective evaluation of a community-based treatment strategy.

Setting: Central Australian semi-desert Aboriginal community (1995-1996).

Participants: 216 school- and pre-school children aged 6 months and up to 15 years.

Intervention: All children with acute trachoma and their contacts (co-resident siblings aged between 6 months and 15 years) received single-dose oral azithromycin suspension (20mg/kg, to a maximum of 1000 mg). Main Outcome measure: Prevalence of acute trachoma (World Health Organisation trachoma diagnostic criteria). Results: Trachoma prevalence at baseline was 42% (71/169) and 55% (18/33) for school children and preschool children, comprising 77 with follicular trachoma and their 47 contacts, were treated with azithromycin over an 8-week period. Acute trachoma prevalence in school children fell to 22% at 6-8 months (P<0.0001) and was 31% at 12 months (P<0.05 compared with baseline). Pre-school children were followed up for 6 months after treatment, and their trachoma prevalence fell from 55% to 25% (P<0.05). Further treatment was given to children with trachoma at 12 months, and the point prevalence of trachoma for school children at 24 months was 34%.

Conclusion: In contrast to mass-treatment strategies, significant reductions in trachoma prevalence at 6 months were achieved by screening 35% of community members (216) and treating 20% (124). The subsequent prevalence support the need for more comprehensive treatment programs, including health promotion efforts and to improve living conditions.
Medical Journal of Australia abstract

Leach, A.J. (1999).
Otitis media in Australian Aboriginal children: an overview.
International Journal of Pediatric Otorhinolaryngology, 49(sup1), S173-S178.

Remote and rural Australian Aboriginal children achieve lower standards of numeracy and literacy than their non-Aboriginal peers. The reasons are complex, but extraordinarily high rates of conductive hearing loss (>50%) are, in part, responsible for poor classroom success. In addition to the burden of acute bacterial respiratory illness (highest rates of invasive pneumococcal disease in the literature), chronic disease affects virtually every young child. In the Aboriginal community studied, otitis media commenced within 3 months of birth for all infants, progressed to chronic suppurative otitis media in 60% and did not resolve throughout early childhood. Our findings, supported by mathematical modelling, show that the vicious cycle of endemic chronic otitis media is perpetuated by high carriage rates of multiple species and multiple types of respiratory bacterial pathogens, by high cross-infection rates, and thus, by early age of pathogen acquisition and prolonged carriage. Long-term damage to respiratory mucosa, possibly linked to later chronic bronchitis and bronchiectasis, follows a constant series of infections by each of the concurrently held pathogens, without periods of recovery. Overcrowding and poor hygiene promote this vicious cycle. Medical and social options for intervention are limited by poor resources, low expectations for health and a complex biology that includes antibiotic resistant pneumococci.
International Journal of Pediatric Otorhinolaryngology abstract

McCaughan, G.W., & Torzillo, P.J. (2000).
Hepatitis A, liver transplants and Indigenous communities. [Editorial].
Medical Journal of Australia, 172, 6-7.
Medical Journal of Australia full text article

McDermott, R. (1999).
Outcomes-based resource allocation for indigenous health services: a model for Northern Australia?
Health Policy, 39(1), 69-78.

Wide differentials continue to exist in mortality rates and other health outcomes between Aboriginal and non-Aboriginal Australians. In the Northern Territory (NT), where Aborigines make up 24% of the population, the all-causes age-adjusted standardised mortality ratio for Aborigines compared with non-Aborigines has remained above 3 since the late 1970s, with significant regional variations. During 1995 an expenditure analysis was undertaken for primary health care (PHC) services in different regions of the NT and compared withmortality ratios. At the same time, a method for needs-based funding was being developed which could replace the existing historical funding arrangements. In the first instance, the application of a simplified version of this Resource Allocation Formula (RAF) resulted in a significant shift of resources for new prevention program funding to regions of relatively high mortality and low per capita PHC expenditure. However, developing RAFs to redistribute at the margin within the NT is likely to generate further inequities between NT programs and counterparts in other states. If outcomes-based resource allocation is to be meaningful nationally, the reference point for the RAF should be national average PHC expenditure rather than existing state averages. There is a need for a combined approach to outcomes-based planning which takes into account both the equity arguments of resource allocation models and efficiency arguments to maximise health gains. Some of these arguments are explored in this paper.
Health Policy abstract

McDermott, R., Rowley, K.G., Lee, A.L., Knight, S., & O'Dea, K. (2000).
Increase in prevalence of obesity and diabetes and decrease in plasma cholesterol in a central Australian Aboriginal community.
Medical Journal of Australia, 172, 480-488.
Medical Journal of Australia full text article

McLean, M.J., Condon, J.R. (1999).
A single issue program in an isolated area: mammography screening in Darwin, NT.
Australian and New Zealand Journal of Public Health, 23(4), 357-361.

A process evaluation of the Northern Territory (Australia) mammography program, NT Breast Screen (NTBS), during its initial 18 months of operation is described. During this time, 2,882 screening mammograms were performed; 98 women were recalled for assessment (3.4%). The program was well accepted by clients and general practitioners. NTBS faced challenges because of its small and dispersed population, a lack of local radiologists with mammographic experience and the conflict with other pressing health issues, particularly in Aboriginal health. Despite these challenges, the program functioned effectively during its initial 18 months.
Australian and New Zealand Journal of Public Health abstract

Omeri, A., Ahern, M. (1999).
Utilising culturally congruent strategies to enhance recruitment and retention of Australian Indigenous nursing students.
Journal of Transcultural Nursing, 10(2), 150-5.

This article reviews the literature pertaining to the recruitment and retention of Indigenous students in undergraduate nursing programs. It notes the significant role that Aboriginal and Torres Strait Islander nurses may play in efforts to improve the health and wellbeing of Indigenous people but expresses concern at their scarce numbers. The article considers the factors that influence the low numbers of Indigenous nursing students at Australian universities and makes recommendations for change. To improve the recruitment and retention of Indigenous nurses the authors propose a number of culturally meaningful strategies that address curriculum design and faculty education in transcultural nursing.
National Aboriginal and Torres Strait Islander Health Clearinghouse abstract

Patterson, K.M., Holman, C.D.J., English, D.R., Hulse, G.K., & Unwin, E. (1999).
First-time hospital admissions with illicit drug problems in Indigenous and non-Indigenous Western Australians: an application of record linkage to public health surveillance.
Australian and New Zealand Journal of Public Health, 23(5), 460-463.

Some 10,533 first admissions among 16,294 total admissions mentioning any of 19 groups of illicit drug problems were identified using linked hospital separation data from the WA Health Services Research Linked Database. The objective was to monitor incidence rates of first-time hospital admission with an illicit drug problem in the Indigenous and non-Indigenous populations of Western Australia in 1980-1995. Trends in age-standardisation rates showed two distinct features: a rapid acceleration in first-time admission rates commencing from about 1991; and a cross-over of the rates in Indigenous and non-Indigenous people. The results are consistent with data on the rising use in injectable amphetamines and other illicit drugs especially among Aboriginal people.
Australian and New Zealand Journal of Public Health abstract

Patton, G.C., Moon, L.J. (2000).
The health of young Australians. [Editorial].
Medical Journal of Australia, 172, 150-151.
Medical Journal of Australia full text article

Roberts-Thomson, R.A., Roberts-Thomson, P.J. (1999).
Rheumatic disease and the Australian Aborigine.
Annals of the Rheumatic Diseases, 58(5) May, 266-270.

Objective: To document the frequency and disease phenotype of various rheumatic diseases in the Australian Aborigine.

Methods: A comprehensive review was performed of the archaeological, ethnohistorical and contemporary literature relating to rheumatic disease in these Indigenous people.

Results: No evidence was found to suggest that rheumatoid arthritis (RA), ankylosing spondylitis (AS), or gout occurred in Aborigines before or during the early stages of white settlement of Australia. Part of the explanation for the absence of these disorders in this indigenous group may relate t the scarcity of predisposing genetic elements, for example, shared rheumatoid epitope for RA, B27 antigen for AS. In contrast, osteoarthritis appeared to be common particularly involving the temporomandibular joint, right elbow and knees and most probably was related to excessive loading in their hunter gatherer lifestyle. Since white settlement, high frequency rates for rheumatic, systemic lupus erythematosus, and pyogenic arthritis have been observed and there are now scanty reports of the emergence of RA and gout in these original Australians.

Conclusion: The occurrence and phenotype of various rheumatic disorders in Australian Aborigines is distinctive but with recent changes in diet, lifestyle, and continuing genetic admixture may be undergoing change. An examination of rheumatic disease in Australian Aborigines and its changing phenotype may lead to a greater understanding of the aetiopathogenesis of these disorders.
Annals of Rheumatic Diseases abstract

Tonkin, A.M., Bennett, S. (1999).
Cardiovascular disease at the turn of the century. [Editorial].
Medical Journal of Australia, 170(9), 408-410.

Mortality from cardiovascular diseases has dropped 64% in Australia since the 1960s, yet cardiovascular deaths still make up 41% of all deaths. The prevalence of overweight, smoking, inactivity, and other preventable risk factors for heart and blood vessel disease remains very high. Among Indigenous Australians, the death rate from cardiovascular diseases is nearly twice that in the general population. Lifestyle modification, specific therapy, and risk factor assessment must all be included in prevention programs.
Medical Journal of Australia abstract

Wake, D., Martin, K., & Dineen, J. (1999).
Yarlparu: on sorrow and grief. [Talking to the families of dying Aboriginal people].
Australian Nursing Journal, 6(9), 16-18.

This article describes the various traditional mourning practices adhered to by central and northern Australian Indigenous people before and after the death of a loved one. The authors note the misunderstandings that can arise between Western health care professionals and grieving Indigenous people. They recommend that the Western health care system adopt a liberal attitude and show compassion and respect for the rituals of Indigenous Australians.
Australian Indigenous HealthInfoNet abstract

Walton, S.F., Choy, J.L., Bonson, A., Valle, A., McBroom, J., Taplin, D., Arlian, L., Mathews, J.D., & Currie, B. (1999).
Genetically distinct dog-derived and human-derived Sarcoptes scabiei in scabies-endemic communities in northern Australia.
American Journal of Tropical Medicine and Hygiene, 61(4), 542-547.

Overcrowding is a significant factor contributing to endemic infection with Sarcoptes scabiei in human and animal populations. However, since scabies mites from different host species are indistinguishable morphologically, it is unclear whether people can be infected from scabies-infested animals. Molecular fingerprinting was done using three S. scabiei-specific single locus hypervariable microsatellite markers, with a combined total of 70 known alleles. Multilocus analysis of 712 scabies mites from human and dog hosts in Ohio, Panama and Aboriginal communities in northern Australia now shows that genotypes of dog-derived and human-derived scabies cluster by host species rather than by geographic location. Because of the apparent genetic separation between human scabies and dog scabies, control programs for human scabies in endemic areas do not require resources directed against zoonotic infection from dogs.
American Journal of Tropical Medicine and Hygiene abstract

White, A. (1999).
Stories for sharing.
Aboriginal and Islander Health Worker Journal, 23(6), Nov/Dec, 26-27.

This article is written by a first year graduate medical student at the University of Queensland who focused on the Aboriginal community of Yarrabah for a one month elective unit. His work involved research as well as practical experience within the community. As a result of this experience, the student has realised that health is a culturally relative term, and health issues may be different for Indigenous Australians. He concludes with two points which he believes should be central to the aim of raising the health profile of Indigenous Australians, ie to have a sense of pride and identity, and for health workers to understand the great diversity of Indigenous people within Australia. He also points out that without first hand experience, it is very difficult to realise how crucial social change is as a precursor to change in health status.
Australian Indigenous HealthInfoNet abstract

Last updated: 10 April, 2003