Indigenous Australians Research Articles

Racism and oral health inequities among Indigenous Australians.

Racial discrimination, which can be structural, interpersonal and intrapersonal, has causal links with oral health morbidity (dental caries, periodontal disease) and mortality (tooth loss). Racism impacts on oral health in three main ways: (1) institutional racism creates differential access to oral health services; (2) cultural racism, which is structurally pervasive, results in poorer psychological and physiological wellbeing of those discriminated against and; (3) interpersonal racism undermines important dental health service provider-patient relationships. Indigenous Australians have experienced sustained racial discrimination since European colonisation in the 1780s. This includes Government policies of land and custom theft, assimilation, child removal and restrictions on Indigenous people's civil rights, residence, mobility and employment. Australia failed to enumerate Indigenous people in the Census until 1967, with the 'White Australia' policy only ending in 1973. In our paper we posit that all minority groups experience racial discrimination that impacts oral health, but that this is amplified among Indigenous groups in Australia because of ongoing legacies of colonialism, institutional racism and intergenerational trauma.

Echocardiographic Screening Detects a Significant Burden of Rheumatic Heart Disease in Australian Torres Strait Islander Children and Missed Opportunities for its Prevention

Rheumatic heart disease (RHD) is almost entirely preventable, but its incidence in indigenous Australians remains one of the highest in the world. A community-based echocardiogram screening program of 862 Torres Strait Islander children identified 25 (2.9%) new cases of RHD. Among these 25 children, 5/7 (71%) prior acute rheumatic fever presentations had not been recognized. There was a history of microbiologically confirmed group A Streptococcus infection in 17/25 (68%) children with RHD compared with 9/25 (36%) controls (odds ratio [OR] [95% CI]: 3.78 [1.17-12.19], P = 0.03). This was more likely to be a skin swab (16/25 [64%] cases versus 6/25 [24%] controls) than a throat swab (1/25 [4%] cases versus 3/25 [12%] controls) (OR [95% CI]: 5.33 [1.51-18.90] [P = 0.01]), supporting a role for skin infection in RHD pathogenesis. Household crowding and unemployment were common in the cohort, emphasizing the need for prioritizing strategies that address the social determinants of health.

Comparison of diffusing capacity of carbon monoxide (DLCO) and total lung capacity (TLC) between Indigenous Australians and Australian Caucasian adults.

Background and objectiveCurrently there is paucity of evidence in the literature in relation to normative values for diffusing capacity of carbon monoxide (DLCO) and total lung capacity (TLC) among Indigenous Australians. Hence, in this study we assessed the DLCO and TLC parameters among Indigenous Australians in comparison to Australian Caucasian counterparts.MethodsDLCO and TLC values were assessed and compared between Indigenous Australians and Australian Caucasians matched for age, sex and body mass index, with normal chest radiology.ResultsOf the 1350 and 5634 pulmonary function tests assessed in Indigenous Australian and Australian Caucasian adults respectively, a total of 129 Indigenous Australians and 197 Australian Caucasians met the inclusion criteria. Absolute DLCO and TLC values for Indigenous Australians were a mean 4.3 ml/min/mmHg (95% CI 2.86, 5.74) and 1.03 L (95% CI 0.78, 1.27) lower than Australian Caucasians (p<0.01). Percentage predicted values were 15.38 (95% CI 11.59, 19.17) and 16.63 (95% CI 13.59, 19.68) points lower for DLCO and TLC, respectively. Lower limit of normal (LLN) values did not significantly differ between groups, however a significantly greater proportion of Indigenous Australians recorded values below the LLN in comparison to Australian Caucasians for DLCO (64 vs. 25%, p<0.01) and TLC (66 vs. 21%, p<0.01). Significant differences for the interaction of sex on DLCO and TLC were noted in Australian Caucasians, with reduced or absent sex differentiation among Indigenous Australians.ConclusionsThere are significant differences in DLCO and TLC parameters between Indigenous Australian compared to Australian Caucasians. Appropriate DLCO and TLC norms need to be established for Indigenous Australians.

Traumatic life events and risk of post-traumatic stress disorder among the Indigenous population of regional, remote and metropolitan Central-Eastern Australia: a cross-sectional study

ObjectiveTrauma is reported by 70% of the global population and 4% of those exposed develop post-traumatic stress disorder (PTSD), but data from Indigenous populations are limited. We aimed to determine...

POS-301 IMPROVING THE IDENTIFICATION AND MANAGEMENT OF KIDNEY DISEASE THROUGH AN INTEGRATED CLINICAL INFORMATION PLATFORM AND DECISION SUPPORT TOOL

Kidney disease in Australia disproportionally affects remote living Indigenous Australians, who experience end-stage kidney disease (ESKD) at rates up to 30 times higher than non-Indigenous Australians. In the Northern Territory the rates of kidney disease are particularly high, as are the concomitant diseases of diabetes and cardiovascular disease. Prevention and care coordination are severely challenged by a highly mobile population and rapid staff turnover in remote community health services. Patients with a high risk of developing kidney disease, and rapid progression to ESKD, are slipping through “the cracks” in our health system. To address this we designed and developed an integrated clinical information system for the early identification and risk stratification of people with chronic kidney disease using a rules-based engine. Territory Kidney Care (TKC) utilises a service orientated architecture that connects to existing primary and hospital based electronic health records, automatically and securely transferring relevant clinical information of select patients based on agreed criteria. The key functionality of the system is the ability to identify disease phenotype patterns from consolidated data, based on clinician defined algorithms. This facilitates timely recognition, prioritisation, and the ability to monitor progress and predict disease outcomes. We utilise an agile approach for algorithm development involving domain experts and evidence-based medicine. Algorithms used in the derived clinical decision support were tested and validated for efficiency and accuracy. TKC seamlessly consolidates primary and tertiary care information in real-time and derives clinically relevant summaries based on dynamic algorithm-based phenotyping. This allows automatic identification, prioritisation, and summation of relevant clinical information, augmenting clinical decision making. Significant time efficiencies have been demonstrated with a substantial reduction in administrative time in the collation and synthesis of complex information from multiple sources, reduction in requirement for remote community travel and earlier and targeted advice to the primary care provider in the management of complex conditions. Integrated systems of care which focus on prevention and care coordination, can slow the progression of kidney disease and reduce complications of inter-related illnesses such as diabetes and cardiovascular disease. TKC enhances primary health care with minimal resource impact, primarily because the system does not alter the primary health service user interface, require the adoption of additional technologies or completion of paper-based records.

Who is analysing what? The opportunities, risks and implications of using predictive risk modelling with Indigenous Australians in child protection: A scoping review

AbstractPredictive risk modelling using administrative data is increasingly being promoted to tackle complex social policy issues, including the risk of child maltreatment and recurring involvement with child protection systems. This paper discusses opportunities and risks concerning predictive risk modelling with administrative datasets to address Indigenous Australian overrepresentation in Australian child protection systems. A scoping review using five databases, and the Google search engine, examined peer‐reviewed and grey literature on risks associated with predictive risk models (PRMs) for racial and ethnic populations in child protection systems, such as Indigenous Australians. The findings revealed a dearth of research, especially considering Indigenous populations. Although PRMs have been developed for Australian child protection systems, no empirical research was found in relation to Indigenous Australians. The implications for utilising administrative data to address Indigenous Australian overrepresentation are discussed, focusing on methodological limitations of predictive analytics, and notions of fairness and bias. Participatory model development, transparency and Indigenous data sovereignty are crucial to ensure the development of fair and unbiased PRMs in Australian child protection systems. Yet, while PRMs may offer substantial benefits as decision support tools, significant developments – which fully include Indigenous Australians – are needed before they can be used with Indigenous Australians.

Empowering Indigenous Networks: Collaborative Governance and the Development of a Racial Vilification Code in the Australian Football League

Few Indigenous Australians played Australian Rules football at the elite level before the 1980s. As the number of Indigenous players increased, a network of those who refused to accept on-field racial vilification developed. Opportunities for change were also seized by the Australian Football League, through a collaborative governance approach that empowered Indigenous players to inform strategies for reconciliation and education, and the development of anti-vilification rules. The case provides information about how governance structures may generate resources that improve socio-economic outcomes for indigenous and other disadvantaged people.

The Australian Indigenous-led bush products sector: Insights from the literature and recommendations for the future.

The development of an Australian Indigenous-led bush products sector presents opportunities for Indigenous Australians to create new livelihoods, and build on existing enterprises, based on their unique knowledge systems and long established socio-cultural and environmental management practices. This review draws on Australian literature from 2005 to 2018 to establish a better understanding of the benefits that could result from the development of this sector in northern Australia; identify the key challenges that need to be addressed to facilitate sector development; and identify possible solutions. Insights reveal that while there are significant, and potentially self-sustaining opportunities offered by the development of the sector, these are unlikely to be realised without appropriate actions to resolve knowledge and skills gaps and address significant social, cultural and legal challenges. We propose a conceptual framework for the appropriate, sustainable and self-sustaining growth of the sector and end with policy and research recommendations to support growth.

Depression, childhood trauma, and physical activity in older Indigenous Australians.

Indigenous Australians experience higher levels of psychological distress compared to the general population. Physical activity is a culturally acceptable approach, associated with reduction of depressive symptoms. The protective properties of physical activity for depressive symptoms are yet to be evaluated in older Indigenous Australians. A two-phase study design comprised of a qualitative thematic analysis following a quantitative regression and moderation analysis. Firstly, a total of 336 Indigenous Australians aged 60 years and over from five NSW areas participated in assessments on mental health, physical activity participation, and childhood trauma. Secondly, a focus group of seven Indigenous Australians was conducted to evaluate barriers and facilitators to physical activity. Regression and moderation analyses examined links between depression, childhood trauma, and physical activity. Thematic analysis was conducted exploring facilitators and barriers to physical activity following the focus group. Childhood trauma severity and intensity of physical activity predicted depressive symptoms. Physical activity did not affect the strength of the relationship between childhood trauma and depression. Family support and low impact activities facilitated commitment to physical activity. In contrast, poor mental health, trauma, and illness acted as barriers. Physical activity is an appropriate approach for reducing depressive symptoms and integral in maintaining health and quality of life. While situational factors, health problems and trauma impact physical activity, accessing low-impact group activities with social support was identified to help navigate these barriers.

Reshaping forest management in Australia to provide nature-based solutions to global challenges

ABSTRACT It is time to move beyond the era of conflict and develop a new shared vision for the management of Australia’s public forests. We need more holistic approaches that encompass all forest values across the landscape, rather than the current approach of dividing public forest management up across different government agencies. More collaborative approaches will be required to galvanise the resources, skills and knowledge that enables this shift in shared governance. Recent bushfires in Australia have heightened concerns that the management of public forest lands has largely failed to ensure the health of forest ecosystems, build resilience, and secure a promised balance between economic, social and environmental values. Investment in efforts to adapt forest management to address climate change has been limited; and empowering and increasing the role of Indigenous Australians in forest management could be significantly improved. Furthermore, the COVID-19 pandemic has highlighted the need to improve the resilience of regional communities to major shocks and stresses caused by factors that encompass market dynamics, supply-chain disruptions and natural disasters. Three key strategies are proposed to strengthen forest management in Australia: first, establishing new shared governance models that bring together government agencies with Indigenous Australians and actors from the private sector and civil society; second, extending active and adaptive management across forest landscapes that builds resilience in our forests, local communities and society; and third, integrating traditional knowledge with scientific evidence and innovative technologies to enhance forest management for improved resilience and other outcomes.

‘More than a Thought Bubble…’

‘More than a Thought Bubble…’

Bubbles

Bubbles

Atrial Fibrillation in Remote Indigenous and Non-Indigenous Individuals Hospitalised in Central Australia

The epidemiology of atrial fibrillation (AF) amongst Indigenous populations remains poorly characterised. We studied hospitalisations for AF in Central Australia, the most populous Indigenous region in the country. Patients with a diagnosis of AF admitted to Alice Springs Hospital, the only secondary health care facility and provider of cardiac care in remote Central Australia, were identified from 2006 to 2016. Age and gender-specific hospitalised AF prevalence, comorbidities, and CHA2DS2-VASc scores were ascertained. Of 57,056 admitted patients over the study period, 1,210 (2.1%; 46% Indigenous) had a diagnosis of AF. For Indigenous and non-Indigenous individuals <45 years, hospitalised AF prevalence per 10,000 population was 105 (CI 84-131) and 50 (CI 36-68) in males (ratio=2.10), and 98 (CI 77-123) and 12 (CI 6-23) in females (ratio=7.92), respectively. For Indigenous and non-Indigenous individuals ≥65 years, hospitalised AF prevalence per 10,000 was 1,577 (CI 1,194-2,026) and 2,326 (CI 2,047-2,623) in males (ratio=0.68), and 1,713 (CI 1,395-2,069) and 1,897 (1,623-2,195) in females (ratio=0.90). Indigenous individuals had higher rates of cardiometabolic comorbidities, particularly at younger ages. CHA2DS2-VASc scores were greater in Indigenous individuals, particularly those <45 years (2.5±1.5 versus 0.7±1.1, p<0.001). The prevalence of hospitalised AF amongst Indigenous people in remote Central Australia was significantly higher than in non-Indigenous individuals, particularly in younger age groups and females. Indigenous individuals with hospitalised AF also had a markedly greater prevalence of cardiometabolic comorbidities and elevated stroke risk. These data suggest that AF may be contributing to the gap in morbidity and mortality experienced by Indigenous Australians.

Association Between Indigenous Status and Severity of Coronary Artery Disease: A Comparison of Coronary Angiogram Findings in Patients With Chest Pain Presenting to a Regional Hospital Emergency Department

Coronary artery disease (CAD) remains the leading cause of death amongst Indigenous Australians accounting for 12.1% of all deaths in this population. However, there is little evidence to suggest that Indigenous status is an independent risk factor for the development of coronary artery disease. This study assessed the association between Indigenous status and the severity of CAD in patients presenting with chest pain at a regional hospital emergency department. This was a retrospective single-centre audit over 12 months from January to December 2017. Charts were reviewed for both Indigenous and non-Indigenous patients 18 years and older who presented with chest pain and subsequently underwent an invasive coronary angiogram. Multivariable logistic regression was performed to examine the association of Indigenous status with the severity of CAD. Indigenous patients are 2.7 times more likely to experience significant CAD compared to non-Indigenous patients (Adjusted odds ratio [AOR]=2.73, 95% CI [1.38, 5.39], p≤0.001) even after adjusting for other risk factors. Those aged 65 years and older are more prone to significant CAD (AOR=2.96, 95% CI [1.12, 7.78], p=0.03), while women were less likely to have significant CAD compared to men, (AOR=0.46, 95% CI [0.27, 0.78], p<0.01). In this study cohort, our analysis indicates that there is a strong association between Indigenous status and significant coronary artery disease, independent of the increased burden of traditional cardiovascular risk factors among Indigenous Australians.

Kidney health equity for Indigenous Australians: an achievable goal.

Ameliorating the inequitable burden of kidney disease that is experienced by Aboriginal and Torres Strait Islander peoples is an achievable goal. Genuine and committed partnerships between the Australian government, health-care providers and Aboriginal and Torres Strait Islander peoples are imperative to maximize the success of health equity initiatives.

Oral health changes among Indigenous and non-Indigenous Australians: findings from two national oral health surveys.

Historically, Indigenous Australians experienced poorer oral health than non-Indigenous Australians. We aimed to ascertain if Indigenous Australian oral health improved relative to non-Indigenous oral health between the 2004-06 and 2017-18 National Surveys of Adult Oral Health (NSAOH). Both NSAOHs were population-based cross-sectional surveys of Australian adults aged 15years or more. In both surveys, representative samples of adults were drawn through a three-stage, stratified sample design within metropolitan and regional areas in each state/territory. Frequencies of Indigenous and non-Indigenous self-reported and clinical oral health variables were ascertained, and differences were calculated between the 2004-06 and 2017-18 NSAOHs. Ninety-five per cent confidence intervals were calculated and weights were used to account for the complex sampling methodology of both surveys. In 2004-06, 229 Indigenous and 13882 non-Indigenous Australians provided self-report data, and 87 and 5418 of these had dental examinations, respectively. In 2017-18, 334 Indigenous and 15392 non-Indigenous Australians provided self-report data, and 84 and 4937 of them had dental examinations respectively. Between the surveys, relative to their non-Indigenous counterparts, Indigenous Australians experienced greater levels of: inadequate dentition (4.2%), experience of toothache (4.8%), problem-based dental attendance (4.5%) and 1+ teeth decayed, missing or filled (4.4%). The gap between poor self-reported and clinical oral health between Indigenous and non-Indigenous Australians was greater in the more recent survey.

Poor self-rated oral health associated with poorer general health among Indigenous Australians

BackgroundOral diseases negatively impact general health, affecting physical, psychological, social and emotional wellbeing, and ability to give back to community. The relationship between poor oral health, and general health and wellbeing among Indigenous Australians has not been documented. Working in partnership with seven Indigenous communities in South Australia, this study aimed to: 1) quantify self-rated oral health and health-related quality of life and; 2) investigate associations between poor self-rated oral health and general health among Indigenous Australian adults.MethodsData was collected from a large convenience sample of Indigenous Australians aged 18+ years from Feb 2018 to Jan 2019. General health-related quality of life, as the main outcome variable, was measured by calculating disutility scores with the five individual EQ-5D dimensions (EuroQol instrument: EQ-5D-5L), then classified as ‘no problem’ and ‘at least one problem’. Self-reported oral health, as the main explanatory, was dichotomised into ‘fair or poor’ and ‘excellent, very good or good’. Multivariable log-Poisson regression models were used to estimate associations between poor self-rated oral health and general health by calculating mean rate ratios (MRR) for disutility scores and prevalence ratios (PR) for individual dimensions, after adjusting for social-demographic characteristics and health-related behaviours.ResultsData were available for 1011 Indigenous South Australian adults. The prevalence of ‘fair or poor’ self-rated oral health was 33.5%. The mean utility score was 0.82 (95% CI: 0.81–0.83). Compared with those rating their oral health as ‘excellent or very good or good’, those who rated their oral health as ‘fair or poor’ had a mean disutility score that was 1.6 (95% CI: 1.1–2.2) times higher, and the prevalence of at least one problem ranged from 90 to 160% higher for individual EQ-5D dimensions.ConclusionsFair or poor self-rated oral health among Indigenous persons in South Australia was associated with poor general health as measured by EQ-5D-5L disutility. The relationship was especially evident with respect to mobility, self-care and anxiety/depression. The findings emphasise the importance of oral health as predictors of general health among Indigenous Australians.

Occurrence and timely management of problems requiring prompt intervention among Indigenous compared with non-Indigenous Australian palliative care patients: a multijurisdictional cohort study

ObjectivesAnticipation and prompt relief of symptoms among patients with a life-limiting illness is a core element of palliative care. Indigenous Australians commonly encounter cultural barriers in healthcare that may impair...

The Top End Sleepiness Scale (TESS): A New Tool to Assess Subjective Daytime Sleepiness Among Indigenous Australian Adults.

PurposeTo illustrate the utility of a newly developed culturally safe and clinically relevant subjective daytime sleepiness assessment tool “Top End Sleepiness Scale” (TESS) for use among Indigenous Australians.Patients and MethodsThe TESS questionnaire consists of pictorial representations of 6 items representing daily activities that would induce daytime sleepiness specific for Indigenous Australians living in the regional and remote Australia. Consecutive adult Indigenous patients who consented to pilot the TESS questionnaire prior to undergoing a diagnostic polysomnography (PSG) at the Top End Health Service region, Northern Territory of Australia were assessed. The TESS questionnaire was evaluated for its correlation in predicting obstructive sleep apnea (OSA) according to apnea-hypopnea index.ResultsEighty-two patients were included. The majority (70%) had moderate to severe OSA (AHI ≥15). Patients were aged in their mid-40’s (45.47 95% CI (42.9, 48.05)) with a tendency to obesity (median BMI 33.67 IQR 30.86, 38.95) and a high prevalence of chronic conditions (72%) (hypertension, diabetes or heart disease). The TESS showed high internal consistency (Split half Spearman correlation=0.71, Cronbach’s α =0.81), and a cut-off value ≥3 resulted in sensitivity 84%, specificity 38%. Comparison of area under the curve for TESS to Epworth Sleepiness Scale (ESS) in this sample showed the TESS to have greater sensitivity and specificity overall, which approached significance (p=0.072) when cut-off values of ≥3 and ≥8 (TESS & ESS respectively) were used. The sensitivity and specificity for TESS was also comparable to the other currently used questionnaires, such as the Berlin Questionnaire, STOP-BANG and OSA 50.ConclusionCurrently, there are no subjective daytime sleepiness assessment toll available specifically for Indigenous population. The proposed TESS sleepiness screening tool represented in this study can potentially complement or adopted alongside other existing questionnaire, which may offer greater utility in the assessment of sleep disorders among Indigenous people.

Workfare and food in remote Australia: ‘I haven’t eaten… I’m really at the end…’

ABSTRACT Food security is influenced by various factors and policy settings. The related concept of food sovereignty, which emphasizes the rights of communities to ‘define their own food systems’, is also informed by political power. For Indigenous Australians, food security and food sovereignty are intimately linked with connections and access to land and water, which have been systematically disrupted under settler colonialism. Social policies continue to disrupt these connections and undermine access to food. In this paper, we explore relationships between food security, food sovereignty, and Australia’s remote ‘workfare’ policy, the Community Development Programme (CDP), which disproportionately affects Indigenous Australians. We find that CDP undermines food security and food sovereignty by influencing the conditions for access to land, income, time and power. A lack of coordination across food and social policies creates complex, negative impacts, but sovereignty is central to improving Indigenous Australians’ wellbeing and outcomes across food and work.