Health risk factors
- Nutrition
- Physical activity
- Bodyweight
- Immunisation
- Breastfeeding
- Tobacco smoking
- Alcohol use
- Use of other drugs
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.
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 [3].
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
[4]. Poor nutrition is a common risk factor for
overweight and obesity, malnutrition, cardiovascular disease, type
2 diabetes, certain cancers, osteoporosis, and tooth decay [5,
6]. 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 [4].
Data from the 2001 NHS indicate that 57% of Indigenous respondents
in non-remote areas had a low daily fruit intake (47% non-Indigenous)
[7]. 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 [8].
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 [9]. 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 [10].
Data on the levels of physical activity of Indigenous people are
limited [9], but 49% of respondents in the 2002
NATSISS reported participating in some sport or physical recreation
activity in the previous 12 months [3]. 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 [7].
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 [11]. 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 [9].
A high BMI can be a result of poor nutrition, physical inactivity,
socioeconomic disadvantage, genetic predisposition, increased age,
and alcohol and tobacco use [9, 12].
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 [7].
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 [13].
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 [7].
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) [7,
8]. 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 [7].
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
[4]. It also has anti-infective properties and
contains immunoglobulins which provide some immunity against early
childhood diseases [14].
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 [7]. 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 [15].
Tobacco smoking
Smoking tobacco increases the risk of cardiovascular disease, some
cancers, lung diseases, and a variety of other health conditions
[11]. Passive smoking is also of concern to health,
with children particularly susceptible.
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%) [16].
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%) [3].
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 [15].
Alcohol use
Excessive alcohol use can contribute to liver disease, pancreatitis,
diabetes, some cancers, epilepsy [8] and cardiovascular
disease [11]. Alcohol use can also be a contributor
to injury and violence [11]. Abstinence from drinking
alcohol is advised for women when pregnant or breastfeeding [11].
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) [17].
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 [8].
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)
[3]. 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 [11]. 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 [16]. 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 [18].
High frequencies of poly-drug use have also been reported among
Indigenous injecting drug users in WA and SA [18,
19]. 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% [20].
Estimating the prevalence of petrol sniffing is difficult, because
sniffing patterns are often cyclical and populations fluctuate [18].
Petrol sniffing had been reported mainly from communities in Arnhem
Land, central Australia and the Goldfields region of WA [21].
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 [22].
References
1 Marmot M, Wilkinson R, eds. (1999) Social
determinants of health. Oxford: Oxford University Press
2 Wilkinson R, Marmot M, eds. (2003) Social
determinants of health: the solid facts. Second ed. Copenhagen,
Denmark: World Health Organization
3 Australian Bureau of Statistics (2004)
National Aboriginal and Torres Strait Islander Social Survey,
2002. (ABS Cat. no. 4714.0) Canberra: Australian Bureau of
Statistics
4 National Health and Medical Research Council
(2000) Nutrition in Aboriginal and Torres Strait Islander peoples.
Canberra: National Health and Medical Research Council
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 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
7 Australian Bureau of Statistics (2002)
National Health Survey: Aboriginal and Torres Strait Islander
results, Australia 2001. (ABS Catalogue no. 4715.0) Canberra:
Australian Bureau of Statistics
8 Australian Bureau of Statistics, Australian
Institute of Health and Welfare (2003) The health and welfare
of Australia's Aboriginal and Torres Strait Islander peoples 2003.
(ABS Cat no.4704.0, AIHW Cat no. IHW11) Canberra: Australian Bureau
of Statistics
9 National Centre for Monitoring Cardiovascular
Disease (2004) Heart, stroke and vascular diseases: Australia
facts 2004. Canberra: Australian Institute of Health and Welfare
10 Australian Institute of Health and Welfare
(2004) Physical inactivity, diet and body weight: results from
the 2001 National Health Survey. (No 1) Canberra: Australian
Institute of Health and Welfare
11 Australian Institute of Health and Welfare
(2004) Australia's health 2004: the ninth biennial report of
the Australian Institute of Health and Welfare. Canberra: Australian
Institute of Health and Welfare
12 Shannon C (2002) Acculturation: Aboriginal
and Torres Strait Islander nutrition. Asia Pacific Journal of
Clinical Nutrition;11(suppl):S576-S578
13 National Health and Medical Research
Council (2003) The Australian immunisation handbook. 8th
ed. Canberra: Commonwealth of Australia
14 Engeler T, McDonald M, Miller M, Groos
A, Black M, et al. (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
15 Zubrick SR, Lawrence DM, Silburn SR,
Blair E, Milroy H, et al. (2004) The Western Australian Aboriginal
Child Health Survey: the health of Aboriginal children and young
people. Perth: Telethon Institute for Child Health Research
16 Australian Institute of Health and Welfare
(2002) 2001 National Drug Strategy Household Survey: detailed
findings. (AIHW cat. no. PHE-41) Canberra: Australian Institute
of Health and Welfare
17 O'Leary C (2002) Fetal alcohol syndrome,
a literature review. Canberra: Commonwealth of Australia
18 Gray D, Saggers S (2003) Substance misuse.
In: Thomson N, ed. The health of Indigenous Australians.
South Melbourne: Oxford University Press:158-185
19 Shoobridge J, Vincent N, Allsop S, Biven
A (1998) Using rapid assessment methodology to examine injecting
drug use in an Aboriginal community: a collaborative project conducted
by the Aboriginal Drug and Alcohol Council, the Lower Murray Nungas
Club, and the National Centre for Education and Training on Addiction.
National Centre for Education and Training on Addiction and the
Aboriginal Drug and Alcohol Council
20 Gray D, Saggers S, Atkinson D, Carter
M, Loxley W, et al. (2001) The harm reduction needs of Aboriginal
people who inject drugs. Perth: National Drug Research Institute,
Curtin University of Technology
21 Brady M (1992) Heavy metal: the
social meaning of petrol sniffing in Australia. Canberra: Aboriginal
Studies Press
22 Aboriginal Drug & Alcohol Council
(SA) Inc, Shaw G, Mosey A, Gray D, Stearne AE (2003) 'They sniffed
and they sniffed and it just wasn't there': an evaluation of the
COMGAS Scheme. Adelaide: Aboriginal Drug and Alcohol Council
(SA) Inc.
This web site contains PDF documents that require the most current version of Adobe Reader to view. To download click on the icon below.
