Low incomes mean high health risks for Indigenous Australians
Can a good address and a six-figure salary protect you from life-threatening illness? A newly published paper in the February edition of the prestigious journal, Social Science and Medicine (Vol 58:4), says yes.
Researchers, concerned that Indigenous Australians have kidney disease rates nine times higher than other Australians, began looking at how low income and poor housing get under the skin to cause disease.
Indigenous Australians are disadvantaged, relative to other Australians, over a range of socio-economic and health measures ranging from post-school educational qualifications (11% vs 31%), unemployment (23% vs 9%) and the likelihood of owning their own home (31% vs 71%) to life expectancy (56 vs 76 for men, 63 vs 82 for women).
Dr Alan Cass, Senior Research Fellow at The George Institute for International Health, and one of the paper's authors, says we have long known indigenous people world-wide suffer higher rates of serious disease, but have never looked so comprehensively at the pathways from disadvantage to such diseases.
"Kidney disease is a key issue for Indigenous populations", said Dr Cass. "We explored links between where people live, their educational and employment opportunities, their access to health care and the risk of developing severe kidney disease. Are you really on a path to serious illness just because you grow up in a remote Indigenous community? If so, how can we change this?"
Dr Cass, who spent four years as a kidney specialist in remote Australia, says although advanced kidney disease is irreversible, earlier intervention can slow or stop its progress. "In urban centers, dialysis or transplant treatment is generally available. In remote communities — where one in five Indigenous Australians live — the situation is very different. Because sick people must leave their communities to receive dialysis, most remain hundreds of kilometers from home for the rest of their lives," said Dr Cass. "This has a devastating impact on them, their families and communities."
The researchers suggest six "pathways" leading to severe kidney disease. "Indigenous populations in Australia, New Zealand, Canada and the United States share a history of dispossession, poverty, poor access to health care, and reduced educational and employment prospects. The evidence strongly supports a link between house crowding, streptococcal skin infections and scabies, leading to kidney disease, an example of a direct pathway between poor housing conditions, which exist throughout much of remote Australia, and the development of serious illness", he said.
"We must look at long-term solutions rather than a quick fix. The increased risk of serious disease among Indigenous Australians could potentially result from the accumulation of factors from before birth, through childhood into adulthood. The interaction of recurrent infection, diabetes, obesity and high blood pressure is key to the high rates of severe kidney disease."
"Prevention programs in remote communities should include food supply initiatives to improve access to affordable, healthy food", said Dr Cass. "Community-based treatment programs can achieve better control of blood pressure and diabetes and prevent kidney disease. We need a coordinated, national approach to stop the continuing increase in death and disability and the continuing rise in health care costs."
Dr Cass is currently a key collaborator on the NHMRC-funded IMPAKT study, looking at Indigenous Australians' access to kidney transplantation. IMPAKT is one of The George Institute's collaborative studies looking at how to remove barriers to the delivery of best-practice health care for all Australians.
An abstract of the article, Exploring the pathways leading from disadvantage to end-stage renal disease for Indigenous Australians can be found below.
Media Contact: Emma Orpilla, The George Institute for International Health.
Ph: 02 8238 2424 or eorpilla@george.org.au
