Community Size and Indigenous Life Expectancy

Many of you may have heard the Health Minister talk about the improvement in indigenous health. In a press release from his office faithfully copied verbatim in the Guild produced November 2006 Rural Pharmacy newsletter he told us that the “health of Indigenous Australians is improving”. What it actually showed us was modest gains in life expectancy. Not an increase in health, but a slowing down of the acceleration in rates of death in most areas.

That was part of a post (pdf) I wrote in April 2007 to Auspharm. The article quoted is “Long-term trends in Indigenous deaths from chronic diseases in the Northern Territory: a foot on the brake, a foot on the accelerator ” published by the Medical Journal of Australia (free registration required)

The MJA article goes on to state:

significant improvements in mortality due to communicable, maternal, perinatal and nutritional condition and injury”. The report then states: “Mortality from chronic diseases, however, does not appear to have played a role in life expectancy gains

To reinforce this message the conclusion goes on to say:

Dangers remain, however if increasing death rates from chronic disease are not reversed

If we look back even further to December 2005 we see a widely reported speech by the then Indigenous Affairs Minister Amanda Vanstone (full text here). As well as the now famous “cultural museum” quote she talks about the viability of the 1000 small settlements of less than 100 people (80% with less than 50). She raised three points.

• How viable are they really?
• While some are doing OK and helping with drug rehabilitation and maintenance of culture, others may be risky environments particularly for women and children
• What level of amenity can be expected to be provided to small settlements in some cases hundreds of kilometres from each other?

Do they have to be viable? What does that mean anyway?
Risky environments? My limited experience over 10yrs and most states and territories have given me the impression that the smaller the community the less risk the people feel. The desert people used to wander in small family groups. I suggest their laws and customs are built around this way of life and living in larger communities has not been beneficial.

Enough of my anecdotal evidence. Let’s head back to the Medical Journal of Australia, in particular an article titled “Lower than expected morbidity and mortality for an Australian Aboriginal population: 10-year follow-up in a decentralised community.

A ten year follow up. here’s the conclusion:

Contributors to lower than expected morbidity and mortality are likely to include the nature of primary health care services, which provide regular outreach to outstation communities, as well as the decentralised mode of outstation living (with its attendant benefits for physical activity, diet and limited access to alcohol), and social factors, including connectedness to culture, family and land, and opportunities for self-determination.

For those wanting to see the strength of the results:

Mortality in the cohort was 964/100 000 person-years, significantly lower than that of the NT Indigenous population (standardised mortality ratio [SMR], 0.62; 95% CI, 0.42–0.89). CVD mortality was 358/100 000 person-years for people aged 25 years or older (SMR, 0.52; 95% CI, 0.23–1.02). Hospitalisation with CVD as a primary cause was 13/1000 person-years for the cohort, compared with 33/1000 person-years for the NT Indigenous population.

Violet Petayrre Utopia
Violet Petayrre Utopia

We all know prevention is best for all chronic diseases. In overworked remote health services it is hard enough keeping up with the presentations that come in through the door, let alone doing some education. It seems (and further research is needed) that these smaller communities might be just the ticket to improving lifestyle and health. So it concerns me that there seems to be an attempt to close these smaller communities or outstations down.

At first glance there is good news. There has been an increase in funds allocated for housing as well as increased funding for chronic disease (The Australian 1 Dec 2008). However, Indigenous Affairs Minister Jenny Macklin has stated

priority for new houses would be given to big communities where the need was greatest and the economies of scale allowed for the construction of additional houses.

No assistance for outstations here. Will funds for the chronic disease programs also be directed to larger communities?

Also of concern is the recent Northern Territory review into outstations by Patrick Dodson. He completed two weeks of public hearings but, according to The Australian newspaper said it was a “clear fault in the process” that government representatives were not visiting any outstation communities and that no interpreting services in Aboriginal languages had been arranged. Sounds like a nong planned this it or it was designed to produce nothing substantial.

The article goes on to say:

There is widespread fear in Aboriginal communities that governments are intentionally starving outstations of resources to force people into larger towns.

Much of that fear can be traced back to the colourful language of Howard government indigenous affairs minister Amanda Vanstone, who called outstations “cultural museums” that should be shut down.

And so we come full circle.

Are we are so intent on “economies of scale” that we are going to close these smaller communities down? These same communities that may provide the biggest bang for the buck in keeping people healthy.

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Robbo is a pharmacist working with a very remote Aboriginal Health Service in the deserts of Western Australia. + Andrew Robbo Roberts

2 thoughts on “Community Size and Indigenous Life Expectancy”

  1. Nice post. I have been fortunate enough to go to many homelands/outstations and larger communities. My personal observations are that the homelands people are generally healthier and happier. Although, I wish there was more studies done on the subject than the couple on Utopia.

    I think the attitudes to the outstations/homelands being looked at purely on a cost benefits analysis says a lot about how mainstream Australia values (or doesn’t) Indigenous culture. You could probably argue that there are a lot of farms that are not viable. Imagine the outcry if so called fifth generation farmers were cut of from drought aid, Isolated Children’s Allowance and all the other benefits, because it would be more cost effective to deliver services in the cities.

    It is something the CIS and the Bennelong Society have really been pushing for and it is very frustrating.

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