Remote Indigenous Australians Research Articles

Prognostic value of coronary artery calcium scoring and computed tomography coronary angiography in remote Indigenous and non-Indigenous Australians

BackgroundThe long-term prognostic utility of coronary calcification and coronary artery disease on computed tomography coronary angiography (CTCA) in remote Indigenous and non-Indigenous Australians is not known. MethodsConsecutive patients undergoing CTCA from 2013 to 2017 in Central Australia were followed-up for major adverse cardiovascular events (MACE). Results347 patients were included (50 ± 12 years; 47% female; 39% Indigenous). 172 (50.0%) exhibited coronary calcification. CTCA demonstrated no coronary artery disease (CAD) in 137 (39.5%), non-obstructive CAD in 149 (42.9%), and obstructive CAD in 61 (17.6%) patients. Although Indigenous ethnicity was associated with coronary calcification and baseline CAD in age- and gender-adjusted models, this association was non-significant after accounting for comorbidities. Over 4.6 years (IQR 3.52–5.68) of follow-up, MACE incidence rates per 100 person-years were 2.92 (CI 1.92–4.44) and 0.48 (CI 0.18–1.27) in those with and without calcification respectively (p = 0.001), and 0.15 (CI 0.02–1.09), 1.32 (CI 0.69–2.54), and 6.23 (CI 3.81–10.16) in patients with no, non-obstructive, and obstructive CAD respectively (p < 0.001). Coronary calcification and obstructive CAD were associated with 5-fold (HR 5.25, 95% CI 1.66–16.59, p = 0.005) and 6-fold (HR 6.35, 95% CI 2.70–14.89, p < 0.001) greater hazards of MACE respectively in multivariable models, with no significant interaction by ethnicity in these associations seen. ConclusionsThe prognostic value of coronary calcification and CAD on CTCA amongst remote Indigenous individuals appears similar to that seen in non-Indigenous populations. Our data suggest that coronary artery calcium scoring and CTCA can be used to risk-stratify in remote settings where a normal study is associated with an excellent prognosis for at least two years.

Trust, culture and communication: determinants of eye health and care among Indigenous people with diabetes in Australia

IntroductionOur study aimed to identify factors that influence access to eye care and eye health outcomes for remote Indigenous Australians living with diabetes.MethodsIn collaboration with Indigenous Community-Based Researchers (CBR) and...

Potentially suboptimal prescribing of medicines for older Aboriginal Australians in remote areas.

To investigate the prevalence of polypharmacy, under-prescribing and potentially inappropriate medicine use among Aboriginal Australians living in remote Western Australia. Cross-sectional study. Six remote communities and the town of Derby in the Kimberley, Western Australia. Aboriginal people aged 45 years or more with complete medication histories. Proportions of patients with medicine histories indicating polypharmacy, potential under-prescribing of indicated medicines, or potentially inappropriate prescribing (including potential prescribing cascades or drug interactions). Complete medicine histories were available for 273 participants. The mean number of prescribed medicines was 5.1 (SD, 3.6). At least one form of suboptimal prescribing was identified for 166 participants (61%), including polypharmacy for 145 (53%), potential under-prescribing of at least one indicated medicine for 33 (12%), and potentially inappropriate prescribing for 54 participants (20%). Potential prescribing cascades or drug interactions were identified for 12 participants (4%). Potentially suboptimal prescribing affected more than half the participating older Aboriginal Australians from the Kimberley. If generalisable to other remote Indigenous Australians, the prevalence of polypharmacy, potentially inappropriate prescribing, and under-prescribing of indicated medicines is problematic, and suggests that older Indigenous people in remote areas are at risk of medicine-related harm.

Associations between Community Environmental-Level Factors and Diet Quality in Geographically Isolated Australian Communities.

Remote Indigenous Australians experience disproportionately poor cardio-metabolic health, which is largely underpinned by adverse dietary intake related to social determinants. Little evidence exists about the community environmental-level factors that shape diet quality in this geographically isolated population group. This study aimed to explore the modifiable environmental-level factors associated with the features of dietary intake that underpin cardio-metabolic disease risk in this population group. Community-level dietary intake data were estimated from weekly store sales data collected throughout 2012 and linked with concurrent social, built, and physical environmental dimension data for 13 remote Indigenous Australian communities in the Northern Territory. Statistical analyses were performed to investigate associations. At the community level, store sales of discretionary foods were lower in communities with greater distance to a neighbouring store (r = −0.45 (p < 0.05)). Sales of sugar-sweetened beverages were lower in communities with higher levels of household crowding (r = −0.55 (p < 0.05)), higher levels of Indigenous unemployment (r = −0.62 (p = 0.02)), and greater distance to neighbouring stores (r = −0.61 (p = 0.004)). Modifiable environmental-level factors may be associated with adverse diet quality in remote Indigenous Australian communities and further investigations of these factors should be considered when developing policies to improve dietary intake quality in geographically isolated populations.

Development and Use of Prediction Models for Classification of Cardiovascular Risk of Remote Indigenous Australians

Cardiovascular disease (CVD) is the leading cause of death for Indigenous Australians. There is widespread belief that current tools have deficiencies for assessing CVD risk in this high-risk population. We sought to develop a 5-year CVD risk score using a wide range of known risk factors to further improve CVD risk prediction in this population. We used clinical and demographic information on Indigenous people aged between 30 and 74 years without a history of CVD events who participated in the Well Person's Health Check (WPHC), a community-based survey. Baseline assessments were conducted between 1998 and 2000, and data were linked to administrative hospitalisation and death records for identification of CVD events. We used Cox proportional hazard models to estimate the 5-year CVD risk, and the Harrell's c-statistic and the modified Hosmer-Lemeshow (mH-L) χ2 statistic to assess the model discrimination and calibration, respectively. The study sample consisted of 1,583 individuals (48.1% male; mean age 45.0 year). The risk score consisted of sex, age, systolic blood pressure, diabetes mellitus, waist circumference, triglycerides, and albumin creatinine ratio. The bias-corrected c-statistic was 0.72 and the bias-corrected mH-L χ2 statistic was 12.01 (p-value, 0.212), indicating good discrimination and calibration, respectively. Using our risk score, the CVD risk of the Indigenous Australians could be stratified to a greater degree compared to a recalibrated Framingham risk score. A seven-factor risk score could satisfactorily stratify 5-year risk of CVD in an Indigenous Australian cohort. These findings inform future research targeting CVD risk in Indigenous Australians.

Prognostic Value of Computed Tomography Coronary Angiography (CTCA) in Remote Indigenous and Non-Indigenous Australians

Prognostic Value of Computed Tomography Coronary Angiography (CTCA) in Remote Indigenous and Non-Indigenous Australians

Cannabis Use Among Remote Indigenous Australians: Opportunities to Support Change Identified in Two Waves of Sampling.

Background: Cannabis harms among Indigenous populations in Australia, New Zealand, Canada and the United States may be magnified by poorer health and heavy use. However, little direct evidence is available to evaluate cannabis' impacts. In communities in remote northern Queensland (Australia) where cannabis has become endemic, opportunities to support change were investigated.Methods: Opportunistically recruited participants (aged 15–49 years) discussed their cannabis use history in interviews in two waves of population sampling in Cape York (Queensland). Wave 1 included 429 people (235 males and 194 females); and wave 2 included 402 people (228 males and 174 females). Current users (used cannabis during the year before interview) described frequency of use, amount consumed, expenditure and dependence symptoms. Other substance use was recorded for 402 people at wave 2.Results: Wave 1: 69% reported lifetime use and 44% current use. Males (55%) were more likely than females (30%) to be current users (P < 0.001). Most (96%) current users described at least weekly use; nearly half (48%) were “heavy” users (≥6 cones/session at least once/week) and 77% met cannabis dependence criteria. Three communities spent up to $AUD14,200/week on cannabis, around $AUD2.0 million/year, or around 9% of community people's total income on cannabis. The majority (79%) of current users wanted to quit or reduce their cannabis use. Wave 2: no difference was observed in the proportion of lifetime (69%, |z| = 0.04, P = 0.968) or current cannabis users (39%, |z| = 1.39, P = 0.164); nor current use among males (71%, |z| = 0.91, P = 0.363) or females (62%, |z| = 0.36, P = 0.719). However, a significant reduction in current users by 15% (|z| = 2.36, P = 0.018) was observed in one community. Of 105 wave 1 current users re-assessed in 2, 29 (27%) had ceased use. These participants reported cost and family commitments as reasons to change and that social support and employment enabled abstinence. Current and lifetime cannabis use were closely associated with all other substance use, particularly tobacco and alcohol (both P > 0.001).Conclusions: High rates of heavy cannabis use in remote Australian Indigenous communities warrant action. Successful cessation among some individuals suggests that significant opportunities are available to support change even where cannabis use may be endemic.

Fluctuations in money availability within an income cycle impacts diet quality of remote Indigenous Australians.

To consider the plausible nutritional impacts of fluctuations in money availability within an income cycle for remote Indigenous Australians. Community-level dietary intake (energy, micro/macronutrients) and expenditure on foods and beverages (F&B) were estimated over one year for three remote Indigenous Australian communities (Northern Territory, Australia) using monthly F&B transaction data. F&B that were likely to be consumed during a period within an income cycle when money was relatively limited (low money period (LMP) foods) were identified by panel consensus and scenario modelling was conducted to simulate the nutritional outcomes of a range of F&B selection responses to having an LMP. All scenarios resulted in reduced diet quality during the LMP relative to overall average diet values. Protein and fat energy percentages were reduced and carbohydrate energy percentage increased. Despite reduced expenditure, declines in energy intake were typically buffered due to the reduced energy cost ($AU/MJ) of the LMP diet. The micronutrient profile of the LMP diet was substantially poorer, such that additional key micronutrients dropped below population-weighted Estimated Average Requirements/Adequate Intakes. The modelling undertaken herein suggests that even a short period of low money within an income cycle may noticeably contribute to the reduced diet quality of remote Indigenous Australians and exacerbate lifestyle disease risk. Dietary strategies that are designed to respond to diets and expenditure during different income cycle periods, rather than the overall average diet and expenditure, should be considered for improving diet quality and reducing cardiometabolic disease risk in remote Indigenous Australians.

The diagnostic accuracy of the Kimberley Indigenous Cognitive Assessment (KICA) tool: a systematic review

The objective of this study was to conduct a systematic review of evidence for the accuracy of the Kimberley Indigenous Cognitive Assessment (KICA) tool in supporting the diagnosis of dementia in Indigenous Australian populations. Cross-sectional diagnostic accuracy studies of the KICA with an appropriate reference standard published to November 2015 were included. Comparison to an alternative cognitive assessment tool was required in non-remote populations. Case control analyses were excluded. Four studies were included: one of the KICA-Cog and KICA-Carer, one of the KICA Screen, and two of the modified-KICA. All tools developed for remote populations had a sensitivity of ≥76% and a specificity of ≥71% for the diagnosis of dementia. The KICA-Cog and KICA-Carer conducted in series had the highest sensitivity and specificity (91% and 94% respectively). In an urban and regional population, the mKICA had similar accuracy to the Mini-Mental State Examination (MMSE) (AUC 0.93, 95% CI 0.88-0.99 vs 0.94, 95% CI 0.89-0.99). Key risk of bias limitations related to lack of pre-determined cut-points and population selection methods. The use of the KICA in remote Indigenous Australians may assist in timely diagnosis of dementia in this population. Using the KICA-Cog and KICA-Carer in series may maximise specificity, decreasing false positive results without compromising sensitivity.

Strengthening food systems with remote Indigenous Australians: stakeholders' perspectives.

It is well accepted that actions to enhance food security and nutrition outcomes in remote Indigenous Australian communities have limited success when focusing on single factors and could far better be addressed by working across the whole food system. The formation of multi-sector groups to collectively work towards improved food security could facilitate this approach. This study sought to elicit the perceptions of a range of stakeholders on the enablers, barriers and perceived benefits of a multi-sector participatory approach that was developed and trialled with four communities to improve food security. Semi-structured interviews were used to collect data from 60 persons and transcripts were examined using thematic analysis. Findings revealed that there is support in engaging a diverse range of stakeholders in a process of community-led action to support incremental improvement. The employment and support of local community co-ordinators, the multi-sectoral and structured approach, the use of participatory tools, and the facilitation approach were identified as key enablers. Main barriers cited were competing demands and time restraints while a slowing in momentum and lack of timely communication of actions for follow-up were areas needing improvement. Perceived changes in the availability and accessibility of healthy food and improvements in retail practice were believed by participants to derive from (i) creating a supportive environment; (ii) bringing people together; and, (iii) increasing knowledge and capacity. This study offers insight into understanding where the opportunities are in supporting a multi-sectoral approach to improving food security in remote Indigenous Australia.

Evaluation of a culturally adapted training course in Indigenous e-mental health.

To report the impact of the Indigenous e-mental health training course 'Yarning about Indigenous Mental Health using the AIMhi Stay Strong App'. Participants were trained in e-mental health and the use of one of the first culturally adapted e-mental health interventions - The AIMhi Stay Strong App. Between October 2013 and December 2014, 138 participants completed the 'Yarning about Indigenous Mental Health using the AIMhi Stay Strong App' training course and 130 completed pre- and post-training questionnaires to explore knowledge and confidence in a number of areas trained. Paired t-tests showed significant improvements across all measures of skill and knowledge except for confidence in using computers. E-mental health is a relatively new development that may contribute to improved access to mental health services for rural and remote Indigenous Australians, particularly where such tools are culturally adapted. Whilst current knowledge and use of e-mental health tools in this group of Northern Territory service providers was limited, perceived knowledge and confidence in use was significantly improved following training.

Low birth weight and large adult waist circumference increase the risk of cardiovascular disease in remote indigenous Australians — An 18 year cohort study

Low birth weight and large adult waist circumference increase the risk of cardiovascular disease in remote indigenous Australians — An 18 year cohort study

The relationship between number of primary health care visits and hospitalisations: evidence from linked clinic and hospital data for remote Indigenous Australians.

BackgroundPrimary health care (PHC) is widely regarded as essential for preventing and treating ill health. However, the evidence on whether improved PHC reduces hospitalisations has been mixed. This study examines the relationship between PHC and hospital inpatient care in a population with high health need, high rates of hospitalisation and relatively poor PHC access.MethodsThe cross-sectional study used linked individual level PHC visit and hospitalisation data for 52 739 Indigenous residents from 54 remote communities in the Northern Territory of Australia between 1 July 2007 and 30 June 2011. The association between PHC visits and hospitalisations was modelled using simple and spline quadratic regression for key demographics and disease groups including potentially avoidable hospitalisations.ResultsAt the aggregate level, the average annual number of PHC visits per person had a U-shaped association with hospitalisations. For all conditions combined, there was an inverse association between PHC visits and hospitalisations for people with less than four clinic visits per year, but a positive association for those visiting the clinic four times or more. For patients with diabetes, ischaemic heart disease or renal disease, the minimum level of hospitalisation was found when there was 20–30 PHC visits a year, and for children with otitis media and dental conditions, 5–8 visits a year.ConclusionsThe results of this study demonstrate a U-shape relationship between PHC visits and hospitalisations. Under the conditions of remote Indigenous Australians, there may be an optimal level of PHC at which hospitalisations are at a minimum. The authors propose that the effectiveness of a health system may hinge on a refined balance, rather than a straight-line relationship between primary health care and tertiary care.

Transposing reform pedagogy into new contexts: complex instruction in remote Australia

This article draws on the outcomes of a 4-year project where complex instruction was used as the basis for a reform in mathematics teaching in remote Aboriginal communities in Australia. The article describes the overall project in terms of the goals and aspirations for learning mathematics among remote Indigenous Australians. Knowing that the approach had been successful in a diverse setting in California, the project team sought to implement and evaluate the possibilities of such reform in a context in which the need for a culturally responsive pedagogy was critical. Elements of complex instruction offered considerable possibilities in aligning with the cultures of the remote communities, but with recognition of the possibility that some elements may not be workable in these contexts. Complex instruction also valued deep knowledge of mathematics rather than a tokenistic, impoverished mathematics. The strategies within complex instruction allowed for mathematical and cultural scaffolding to promote deep learning in mathematics. Such an approach was in line with current reforms in Indigenous education in Australia where there are high expectations of learners in order to break away from the deficit thinking that has permeated much education in remote Australia. The overall intent is to demonstrate what pedagogies are possible within the constraints of the remote context.

Haemophilus influenzae type b carriage in Indigenous children and children attending childcare centers in the Northern Territory, Australia, spanning pre- and post-vaccine eras

This paper investigates Haemophilus influenzae type b (Hib) carriage in Indigenous children and children attending childcare centres in the Northern Territory of Australia, 1992–2005. More than 10 years after the introduction of the Hib conjugate vaccine, Hib carriage persists in Indigenous children (3.4%, 2003–2005) and children attending childcare centres (0.2%, 2004). This is the first Australian study to examine Hib carriage spanning the pre- and post-vaccination eras. Increasing carriage rates contribute to Hib disease resurgence especially in those with higher disease burdens, such as remote Indigenous Australians, ongoing carriage surveillance provides a sentinel warning system for invasive disease. Background Following the introduction of H. influenzae type b (Hib) conjugate vaccine to Australia in 1993 as a three dose (2, 4, 12 month) schedule, the incidence of Hib disease decreased dramatically in children, especially in those aged under 5 years. We investigate Hib carriage in Indigenous children and children attending childcare centres from the Northern Territory (NT) of Australia between 1992 and 2005. We report Hib carriage rates in this well vaccinated population, with previously documented high rates of invasive disease. Methods Hib carriage was reviewed in nasopharyngeal or nasal swabs collected between 1992 and 2005; from over 2000 children (61% Indigenous) aged 0–6 years enrolled in 7 otitis media or carriage surveillance studies in the NT. Results More than 10 years after the introduction of the Hib conjugate vaccine, Hib carriage persists at low levels, but at a higher rate in Indigenous children (3.4%, 2003–2005) than children attending childcare centres (0.2%, 2004), in the NT of Australia. Conclusions This is the first Australian study to examine Hib carriage spanning the pre- and post-vaccination eras. Ongoing carriage surveillance provides a sentinel warning system for invasive disease. This notifies public health professionals of potential invasive disease, creating early warning systems for intervention if Australian Indigenous children or children attending childcare centres are to follow current international trends associated with high rates of carriage preceding invasive disease—despite high vaccination rates. Internationally there is growing concern that increasing carriage rates are the driving force behind Hib disease resurgence especially in those with higher disease burdens, such as remote Indigenous Australians. Changes to the vaccination schedule from PRP-OMPC (PedvaxHIB ®), to PRP-T (2, 4, 6, 12 months) from January 2010—may affect carriage and in time, invasive disease rates. This work is important for national and International comparisons as well as feeding back information to vaccine policy makers of the Hib carriage environment throughout this period.

Risk factors for cardiovascular disease do not fully explain differences in carotid intima–media thickness between Indigenous and European Australians without diabetes

To investigate whether cardiovascular risk factors can explain the higher carotid intima-media thickness (CIMT) in Indigenous compared with European Australians. Cross-sectional study in three subgroups. Non-diabetic urban European (n = 86), urban Indigenous (n = 69), and remote Indigenous (n = 60) Australians aged 25-64 years. CIMT, age, sex, anthropometry, blood pressure, smoking status, fasting glucose and insulin, haemoglobin (Hb)A1c, homocysteine, C-reactive protein (CRP), lipids, urinary albumin and creatinine. CIMT and levels of risk factors, except fasting glucose and total cholesterol, worsened across the three groups. Log(n) fasting insulin [beta = 0.022, 95% confidence interval (CI) 0-0.0439], age (beta = 0.006, 95% CI 0.004-0.007), gender (female beta = -0.005 vs. male, 95% CI -0.084 to -0.026), mean arterial pressure (MAP) (beta = 0.001, 95% CI 0.001-0.002) and ethnicity/location [urban Indigenous (beta = 0.027, 95% CI -0.010 to 0.064 vs. European); remote Indigenous (beta = 0.083, 95% CI 0.042-0.123 vs. European)] explained 41% of variance in CIMT. Significant interactions were seen for ethnicity/location with age (P = 0.014) and MAP (P = 0.018). Age was consistently associated with CIMT across the three populations, and was associated with larger increments in CIMT for the Indigenous subgroups (beta = 0.007, 95% CI 0.005-0.009 urban; beta = 0.007, 95% CI 0.004-0.010 remote) compared with Europeans (beta = 0.003, 95% CI 0.002-0.006) in models including age, sex and MAP. MAP was only associated with CIMT in the remote Indigenous subgroup. After adjusting for selected risk factors, CIMT in remote Indigenous participants was still higher than in Europeans. The slope of the association between age and CIMT steepened from urban Europeans to remote Indigenous.

The oral health status and treatment needs of Indigenous adults in the Kimberley region of Western Australia

The oral health of Indigenous Australians, whether urban or rural, is significantly poorer than their non-Indigenous counterparts, and it would be expected that the oral health of rural and remote Indigenous Australians would be particularly poor, although the extent of this extra disadvantage has not been thoroughly documented. The aim of this study was to assess the oral health status and oral health needs in a sample of adult residents of selected towns and remote communities in the Kimberley region of North-west Australia. A cross-sectional survey (dental examinations and oral health questionnaires) was carried out. Rural and remote communities in the Kimberley region of Western Australia. Adults in four selected communities. The mean Decayed, Missing and Filled Teeth (DMFT) score for all participants was 9.8 (SD 8.3). The mean DMFT increased with increasing age. Only 7.3% of people were caries-free. A total of 13% of participants had periodontal pockets of 6 mm or more, and only 3% had no periodontal disease. More than a third (37%) of all participants had advanced periodontal disease. Only 21% of participants did not need any dental treatment. The oral health of Aboriginal and Torres Strait Islander people are listed as one of the priority areas of Australia's National Oral Health Plan. Based on the above results, oral health is clearly an important priority in the Kimberley.

Comment: Neoliberal Stories of Racial Redemption

It is a long time since I have addressed issues of New World racism directly and even longer, if ever, since I have had much to say about this issue in the United States as opposed to the Caribbean. For the last 15 years my eyes have been trained mostly on Australia and the issues of racialization brought by European invasion of the continent. Nonetheless, Baca's topic struck me as familiar for the fact that the disconnect he identifies between advancement through civil rights (circa 1960s and the early 1970s), and a current and continuing deterioration of life chances among the poor and black, rings equally true for Australia. The Australian version of this has been dramatized recently in reports of remote indigenous communities that focus entirely on individual pathologies and suggest that the only right that indigenous Australians can or should have now is to be incorporated (by policy-forced migration) into an urban (unemployed) mainstream. Among Australian anthropologists, the response to this apparent disconnect between increased legal rights and diminishing life chances also parallels that in the United States as Baca describes them: the current period is seen as bad in relation to a previous good one, a 'neo-liberal' present contrasted with a recent past of land rights and 'self-determination' (roughly the 1960s through the 1980s). In Australia, this earlier period also saw the rise of a nationwide indigenous bureaucratic group, sometimes called the 'Indigenous Sector,' that seems to parallel the rise of an African American professional middle class in the United States. For Australia, the story of good period followed by bad comes undone when it is noted that the rise of Australia's Indigenous Sector coincided with the full incorporation of remote (and poorer) indigenous Australians into the welfare state and welfare dependency. In the 1990s, when federal government experimented with time limits on unemployment benefits, indigenous Australians received a 'remote area exemption' from such measures. However, this situation was hardly good.

From Indigenous Cultural Recognition to Economic Mainstreaming: A Case Study of Indigenous Australian Communities

Significant (2007) policy prescriptions were proposed solutions for the social problems of Australian remote Indigenous communities. These are contiguous with certain descriptions of contemporary neoliberal policy orthodoxy. Though these ideas are viewed by advocates as constituting a ‘new’ approach to Indigenous affairs they resemble policy approaches which have encouraged Indigenous assimilation into a 'mainstream' society. Such an approach seems like common-sense from within this mainstream neoliberal world-view, but when viewed critically is epistemologically flawed, culturally chauvinistic, and contains within it the seeds of more rather than less problems. This paper examines contemporary views of Australian Federal Government policy intentions for remote Indigenous Australians. It critiques some specific value-based interpretations of Indigenous behavior and the processes which are assumed strategies for behavioral change. The paper highlights logical issues in such policy approaches and ends in some general recommendations for social policy.

Remote Indigenous Australians with cataracts: they are blind and still can’t see

Aboriginal and Torres Strait Islander people are three times more likely than non-Indigenous Australians to report vision loss due to cataracts, but are four times less likely to have cataract surgery. To increase access for Aboriginal and Torres Strait Islander people to cataract surgery, we need to identify the barriers to current services and trial strategies to overcome these barriers. Barriers to cataract surgery exist at the health service, community and individual level. Health service factors include infrastructure, cost, and provision of interpreters, escorts and transport. Community factors include social support, perceptions about the success of surgery, and beliefs about the causes of cataracts. Individual factors include ignorance that cataracts can be cured, fear of surgery or poor outcome, and comorbidity. Strategies proven to increase uptake of cataract surgery in other countries could be trialled in remote Australia.