Tackling the decade differential in Aboriginal health

Professor Alex Brown HEALTH

The life expectancy gap between Aboriginal and Torres Strait Islander people and other Australians sits at around 10 years, a decade long difference which Prime Minister Malcom Turnbull described as “unacceptably wide” earlier this year, as he stressed the huge challenge involved in closing that gap.

It’s a challenge however that the newly appointed Chair in Aboriginal Health within the Sansom Institute for Health Research at UniSA, Professor Alex Brown, is keen to resolve within the current life span of Aboriginal adults.

As a world recognised leader in Aboriginal health, and holding a dual position – combining his research role at UniSA with his continued role as Deputy Director and Program Leader of Aboriginal Research at SAHMRI – Professor Brown outlines the forensic focus of his research aimed at determining why the life expectancy gap exists, from which steps can be taken to narrow it.

“The reality is there are lots of gaps in Aboriginal health. What we’ve tried to focus ruthlessly on is the life expectancy differential because that’s where we think we can make a big difference in a short to medium time frame,” Prof Brown says.

“Going down this path has highlighted the role of chronic diseases in Aboriginal communities and individuals because that accounts for 80 per cent of that life expectancy differential. Heart disease accounts for a third of that 80 per cent, and that’s why we are in the cardiovascular space.

“Our initial research was around understanding the burden and inequalities related to the treatments and outcomes of cardiovascular conditions in Aboriginal people.”

Disparities such as higher rates of Aboriginal patients being discharged from hospital against medical advice, and the reduced likelihood of Aboriginal people receiving angiograms when they attend hospitals with cardiac problems, are examples of the inequalities in health care and treatment plans that Prof Brown mentions.

Prof Brown’s team has programs of work focused on heart disease inequalities, related to coronary artery disease, and rheumatic heart disease – particularly prevalent among Aboriginal children – and the focus of this research is in South Australia.

“The more you delve into the heart story the more you realise there are particular relationships with other chronic conditions. This has opened our diabetes research, the chronic kidney disease story, the role of chronic high inflammation, and our interests in psychosocial factors. We’ve become more broad in terms of the chronic conditions we focus on and the interplay of their determinants,” Prof Brown says.

“We have a very strong program of work around diabetes – understanding it from a health system perspective – what is the health system’s role in driving inequalities and poorer outcomes in the Aboriginal population, how can we improve the quality of care that is provided, including support services whether in primary care or hospitals.

“We have a focus on understanding the determinants, not just of the development of diabetes – many of those are known – diet, lifestyle, but we feel there’s a role of exposure to stress and grief and loss and its propensity to facilitate develop of chronic disease in individuals.

“We also want to understand how different factors impact on the likelihood of people with diabetes developing complications such as end stage renal disease, heart attacks, retinopathy, the propensity to develop infectious diseases, and peripheral vascular disease.

“We have an interest in all of those areas with projects looking at diabetes and diabetic complications in Aboriginal people ranging from clinical factors to social and genomic factors. This will be a large focus of our work over the next five to ten years and this is flagship work in Aboriginal health in our State."

Research that Prof Brown has been engaged in, published last month, shows that despite the high prevalence of chronic disease, access to, and use of, primary healthcare services by Aboriginal and Torres Strait Islander Australians is often far lower than would be expected.

The lack of culturally appropriate healthcare services, and the cost of seeking healthcare were cited as some of the broad reasons to explain the low attendance.

The impetus for healthcare providers to commit to the process of building and maintaining relationships was identified as one of the outcomes of this research, the result of which would lead to stronger Aboriginal engagement with healthcare services, with the consequent flow on effect of better provision of health care.

“It is enormously challenging work – Aboriginal people suffer major impediments to healthy development and healthy life and there are social factors at play.

“The ability of people to get ahead in life, coming from a starting point of disadvantage, is difficult – poverty plays a role in chronic disease development, as well as accessibility of services and care that can make a difference, and it influences outcomes once people have developed diseases.

“A lot of people say our focus should be on the next generation – Aboriginal children, and we concur and support that but the reality is you can’t grow up kids without the support of parents, grandparents, strong communities.

“Making a difference to the lives of adults who have chronic disease now is the best way to help develop the next generation of Aboriginal children.”

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