The first few lines in any article on indigenous health in Australia are the statistics. Indigenous Australians have an average life expectancy 17 years less than the average Australian. The incidence of chronic disease is higher, the death rate from cardiovascular disease is at least 2.7 times higher than the rest of the population etc etc. An aboriginal man in Australia will live on average for only 59 years.
Statistics, statistics. Put this in some context. Five men aged between 35 and 45 years from a population of just over 2000 people spread over several small communities died in a 10 day period ending on Boxing Day. Sorry camps have sprung up and funerals have started. Whilst funerals can be a social occasion, seeing family you may not have seen for a while, you have to wonder about the effect on people from what seems to be a continual cycle of grief.
How do you assess Mental Health in an indigenous population with a different view if health and of the world? The Kimberley have developed some tools, but how can you be sure they are validated correctly and will they be suitable for use in other indigenous populations?
Some years ago the Western Australian Aboriginal Child Health Survey commenced looking at over five thousand indigenous children in Western Australia. The report consisted of several volumes focusing on different areas. Volume 2 looked at the social and emotional wellbeing of young aboriginal West Australians. There were many statistics in the report and the downloadable summary is worth a read. One group of statistics I hink is quite depressing.
The factor most strongly associated with high risk of clinically significant emotional or behavioural difficulties in children was the number of major life stress events (e.g. illness, family break-up, arrests or financial difficulties) experienced by the family in the 12 months prior to the survey.
So how many major life stresses do indigenous kids have each year?
Just over one in five children (22%) were living in families where 7 or more major life stress events had occurred over the preceding 12 months. These children were five and a half times more likely to be at high risk of clinically significant emotional or behavioural difficulties than children in families where 2 or less life stress events had occurred.
If you were aged from 4 to 11 years and had 7 or more major life stressors you had a 42% chance of developing clinically significant emotional of behavioural difficulties. If you were between 12 and 17 years old you had only a 34% chance of developing clinically significant emotional or behavioural difficulties if you were in a family that had experienced 7 or more life stress events in one year.
These culminate in risk taking behaviour in adolescence and adulthood.
In the report there is a small positive. It seems that in the more remote areas where a more traditional way of life and greater family supports occur that the traumatic events do not take such a toll.
Children living in areas of extreme isolation were one-fifth as likely to be at high risk of clinically significant emotional or behavioural difficulties compared with children in the Perth metropolitan area.
In remote desert regions many of these communities are quite small, from a few hundred down to about 30 or so people. In the Northern Territory communities this small are called outstations or homelands and the Northern Territory Government (and the previous federal government before them) is looking at closing them down.
I have commented previously about the health benefits shown from living in the small outstations of Utopia where the population had a better quality of life, better health and greater life expectancy than normal for an aboriginal population.
I concluded the article titled “Community Size and Indigenous Life Expectancy” with:
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.
Being remote and small may be the way to keep both your physical and mental health.
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