Diabetes care is still failing Aboriginal Australian people

Abstract

Georgina Kenyon reports that improved diabetes care is needed for Aboriginal and Torres Strait Islander people as two national diabetes societies celebrate anniversary years. Remote Aboriginal communities are still missing out on diabetic care available to other Australians, say health campaigners. Aboriginal Australian adults—30% of whom have type 2 diabetes—are now more than four times more likely to have type 2 diabetes than other Australians. Additionally, according to statistics from Diabetes Australia, Indigenous Australians are more than twelve times more likely to die from diabetes-related complications than are non-Indigenous Australians. “It is a terrible tragedy. Aboriginal people still suffer much worse from type 1, type 2, and gestational diabetes than white Australians. Aboriginal people require the same treatments as non-Indigenous people, but they still do not have the same access to treatment in either the city or in remote areas”, says Diabetes Australia's chief executive, Greg Johnson. Diabetes Australia Victoria (part of Diabetes Australia) celebrated its 60th birthday on March 23, and the Australian Diabetes Society (ADS) is celebrating its 40th anniversary this year. “We are now realising that there is a very strong need to better support Aboriginal women through pregnancy, as well as newborn children. We now know that this support will help reduce cases of diabetes”, says Johnson. He explains that doctors and health workers need to help women and babies to maintain a healthy weight, eat better, and have access to emotional support. In reaching out to more Aboriginal people, diabetes campaigners stress the need for closer collaboration between the Government, the medical sector, and Aboriginal leaders. On March 12, Aboriginal leaders and health experts gathered in the capital, Canberra, at the Aboriginal and Torres Strait Islander Peoples Diabetes Policy Forum to debate the key steps needed to improve access to health care for Aboriginal people. Participants at the forum made key recommendations for the next few years: increased screening and risk assessment in Aboriginal and Torres Strait Islander communities, targeted prevention for high-risk people, and better self-management and mentoring arrangements. The forum further identified the need for better education, employment, and housing. Diabetes Australia will be focusing on implementing more such programmes throughout the next few years. “We've found that local initiatives, at a community level, where Aboriginal health-care providers are involved do work”, adds Johnson. He gives the example of how Diabetes Australia is working with Aboriginal groups in Victoria using a feltman—an almost-life-size figurine—to educate Aboriginal people in a culturally sensitive way about what is happening inside their bodies when they have type 2 diabetes. “These soft approaches to health, in the form of preventative health campaigns, are vital for controlling the diabetes epidemic”, he explains. As a result, recent Queensland State Government cuts on social health programmes for Aboriginal people worry Johnson. Campaigners agree that Aboriginal health is as much about poverty and isolation as it is about access to medicines. The Government-backed National Aboriginal Community Controlled Health Organisation estimates that more than 13% of Indigenous people's homes don't have functioning water, waste, cooking, or cleaning facilities. Stephen Duckett, director of the Health Program at the Grattan Institute (a Melbourne-based think-tank), agrees that poor Aboriginal health is largely about social factors: “the risk of getting type 2 diabetes is based largely on social factors such as low income, poor diet, and when primary health care is limited, all of which are common among Aboriginal communities”. Duckett also advocates “more Aboriginal people trained in medicine and health care so they can help their own communities to combat health problems such as diabetes”. Recently, the Australian Institute of Health and Welfare (AIHW) released a report on Aboriginal health. The AIHW's findings show that between July, 2008, and June, 2010, the incidence of end-stage renal disease was higher in the Indigenous Australian population than in the non-Indigenous population, with the greatest (14·4 times) difference in the group aged 45–54 years. Meanwhile, the Australian Bureau of Statistics has begun the largest Aboriginal and Torres Strait Islander health survey to date. Many campaigners say that the health of Aboriginal people in urban areas is often better than that of those who live in remote communities, but a comprehensive survey such as this one is imperative to fully understand patterns of disease in these populations. This country-wide survey will have 30% more participants than did the 2004–05 survey into Australian Aboriginal health and will collect new information on exercise, diet (including bush foods), and measures of cholesterol, blood glucose, obesity, blood pressure, and iron. The first results of this survey are due to be released in September, 2013.