The Business of Health IV

I generally like the way Deirdre Macken writes for the AFR. She has the happy knack of making the most mundane report appear interesting. Her piece in the Weekend AFR is no exception.

She discusses the Australian Institute of Health and Welfare’s 2002 report, in particular the disparities that exist between different socio economic groups. She says, “a boy born into a poor family in Australia will live 3.6 years less than a boy born to wealth; and in this shortened life, he’s more likely to suffer mental problems, wrestle with smoking and drinking, spend less time getting fit and more time with doctors.”

Unfortunately, with the exception of ‘spending more time with doctors’, our indigenous populations suffer much worse than the average Australian. And, whether we like it or not, most of the health problems experienced by Aborigines are as a direct result of lack of funding in remote areas. So the whole debate about the fiscal responsibility of ATSIC has a direct bearing on the business of health in rural and remote Australia.

In order that readers better understand the figures some of the stats in the report include;

Australia’s Health 2002 P198

The Indigenous population in Australia is estimated at 386,049, based on 1996 Census figures, representing 2.1% of the total Australian population. More than half of all Indigenous people live in New South Wales and Queensland, with the majority residing in urban areas. New South Wales has the greatest number of Indigenous people (110,000) and the Northern Territory has the highest proportion of Indigenous people, at approximately 28% of all residents. Almost 20% of the total Indigenous population live in areas that are classified as very remote, compared with only 1% of the other Australian population.

The Indigenous population is much younger than the general population. In 1996, the median age for Indigenous people was 20 years, compared with a median age of 34 years for the total Australian population. Fertility is higher [with] Indigenous women giv[ing] birth at younger ages than other Australian women. In the period 1996-1998, over 80% of Indigenous mothers had babies before the age of 30. The comparable figure for other Australian mothers was 54%. The estimated life expectancy at birth for Aboriginal and Torres Strait Islander males and females is 19-20 years lower than for other Australians. In the period 1997-1999, the life expectancy at birth for the Indigenous population was estimated to be 56 years for males and 63 years for females. In contrast, the life expectancy at birth for all Australians was 76 years for males and 82 years for females. (ABS 2000c).

Ms Macken goes on “Looking at all the major cancers, the organisation found that survival rates for people in Sydney’s salubrious areas of the northern and eastern suburbs were considerably higher than for those in the city’s west. Survival rates for those in remote areas were even worse. In the states far west, only 54 % survive cancer compared with 67% of those from the northern suburbs of Sydney.” You think those living in the west of NSW have problems !

In the four jurisdictions where mortality data are reliable, the 1997-1999 age-specific death rates for Aboriginal and Torres Strait Islander peoples were higher than the all- Australian rates in every age group. The largest relative differences in age-specific death rates occurred for ages 35-54, where Indigenous rates were 5 to 6 times higher than all-Australian rates. There were also substantial differences between the 25-34 and 55-64 age groups, where the Indigenous age-specific death rates were 3 to 5 times higher than the all-Australian rates.

Deirdre goes on, “The poor have always suffered health problems more than the rich, but in a wealthy society the fact that this discrepancy exists, and is getting wider, should be much more worrying than the broader polarisation.”

And, for me at least, the most concerning feature of the disparity in health spending is the affect on children.

The health of children is strongly associated with the socioeconomic status of their family. Children from families with lower socioeconomic status tend to have poorer health. Aboriginal and Torres Strait Islander children have a higher risk of disease and injury and have higher death rates than other Australian children. Between 1998 and 2000, the infant mortality rate of Indigenous babies was 14.9 deaths per 1,000 live births, almost three times that of the total infant mortality rate (4.8 per 1,000 live births). Low socioeconomic status and poor living conditions associated with higher rates of pre-term and low-birthweight babies all contribute to the higher mortality rates.

There are also regional disparities in health status. The substantially higher proportion of Indigenous children who live in remote areas and their generally lower health status mean that the overall health status of children in remote areas is affected by the health status of Indigenous children.

I think it’s time that everybody, particularly the politicians, stopped worrying about the activities of the ATSIC leadership and immediately take steps to ensure that sufficient funding is applied at the grass roots level to ensure that the lower socio economic status of people who live in remote areas is not translated into higher risks of disease and awfully elevated mortality.

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Dave Ricardo
Dave Ricardo
2022 years ago

Quite so, Wayne, but more spending on health clinics and whatnot (which I support strongly) isn’t going to help the indigenous population unless they get off the grog, stop the substance abuse and drive more safely, preferably while sober. (They have very high death rates from motor vehicle accidents.)

When the adults set the example on booze and drugs, as adults are meant to do, the children will have a better chance of following. And there might be a bit more money to buy the children some vegetables and other basics of good health.

The present ATSIC leadership doesn’t have a lot of good form on tackling these basic issues.
.

Tys
Tys
2022 years ago

Wayne has there been any study done on Aborigines with middle class backgrounds to see whether they have a life expendancy closer to the mainstream population?

In Victoria we don’t really get much coverage on the issue. Do most Indigenous families want to move to areas with a higher population density (and therefore more doctors/hospitals) or do they generally prefer to remain in the remote areas?

Do you have a summary of the main causes of deaths?

Ken Parish
Ken Parish
2022 years ago

I agree generally with Dave Ricardo’s comments. However, both Dave and Wayne are guilty of promulgating a broadly held misconception about ATSIC. Although I have a very low regard for ATSIC (as readers of this blog would know), the fact is that it doesn’t have funding or other responsibility for the core health budget in any part of Australia. This was mentioned in passing in last week’s Four Corners program:

PETER GEORGE: ATSIC’s been controversial since day one. Labor set it up in the face of trenchant Coalition opposition in response to calls for a national Aboriginal voice, but its decisions can be overruled by the Government. It has absolutely no control over the core health and education budgets – in fact, no control over a massive 82% of all Aboriginal funding.
But in 13 years, it’s become a focus for all the failures that, by most social benchmarks, show Australia’s 400,000 Indigenous people to be amongst the most underprivileged in the developed world.
BOB COLLINS, ATSIC REVIEW BOARD: You expect criticism, but it would be nice to have it a bit better informed on occasions. I mean, ATSIC are continually copping the blame for their failure to deliver programs that they’re not responsible for. And so far as program delivery is concerned, ATSIC have always been a supplementary provider of programs. I mean, the majority of programs that are delivered for Indigenous people are delivered by State and Territory governments – the lion’s share.
Of course, ATSIC could and should have funded a range of community-based preventative schemes, especially in alcohol and substance abuse and domestic violence, and should be condemned for failing to do so. However, the primary responsibilities rest with:
(a) individuals and families; and
(b) state and territory governments.

Blaming ATSIC in this particular area is a convenient cop-out.

cs
cs
2022 years ago

Another Deirdre Macken reader. Goood one.

Geoff Honnor
Geoff Honnor
2022 years ago

The Aboriginal health stakeholdership is represented in innumerable government collaborative and consultative fora and committees – NACCHO, the Aboriginal health and medical services etc – into which not insignificant public funding streams now flow.

Given some involvement with the area over the years I have to say that the desire to get indigenous bums on comittee seats has been pursued with a fervour in directly inverse proprtion to getting useful health outcomes from that engagement.

As in most other areas of collaborative activity between comunity and government, indigenous health has been bedevilled by a seeming preference for rhetoric over results. It’s not just about the indigenous component either. The health bureaucracy is notoriously ponderous in focussing it’s attention on pragmatic public health initiatives.

I agree with Ken that ATSIC has been to one side of these endeavours. Unfortunately however, the ATSIC culture seems to be all-pervading.

One thing is pretty clear to me: If you’re going to tackle a public health crisis, you’re going to need a whole-of-government approach to do it effectively. I think it’s time to stop buggering around with piecemmeal approaches and start engaging with reality.

Dave Ricardo
Dave Ricardo
2022 years ago

Ken,

I know that health budgets are the responsibility of health departments. I know ATSIC was designed to be all talk and no responsibility. My point was the ATSIC leadership doesn’t even spend a lot of time acknowledging the problem.

Geoff,

I can only but admire the self-sacrifice implicit in your call to “stop buggering around”.

Geoff Honnor
Geoff Honnor
2022 years ago

Well thanks Dave, but your praise is misplaced. I’m not currently engaged with any aboriginal health initiatives, so my exhortation won’t involve any personal sacrifice on my part…;)

woodsy
woodsy
2022 years ago

I never said that ATSIC is directly responsible for health funding, but implied that the way they developed policies and set priorities greatly influenced how the ATSIC budget is spent. It could be said that the obsession with buying back land at any price, other commercial activities of the ILC and IBA and the waste endemic in the administration of regional councils, are all diverting focus, if not money, from health care on the communities. And therefore reiterate my points “the whole debate about the fiscal responsibility of ATSIC has a direct bearing on the business of health in rural and remote Australia.” And it’s more important that those responsible cease the rhetoric and “immediately take steps to ensure that sufficient funding is applied at the grass roots level”.

Indeed the rhetoric is not confined to the politicians, the health administrators seem hell bent on knowing exactly who and how many peolple are dying but don’t seem to worry much about trying to ameliorate the problem as is shown by this introduction to the report;
Even with the improvements in the quality and quantity of data now available there remain signi

Ken Parish
Ken Parish
2022 years ago

Dave,

You can at least take comfort in the recent remarks of Dubbya and the Pope. The Philosophy Department of the University of Woolloomoolloo is alive and well; you’re not its sole surviving faculty member.

woodsy
woodsy
2022 years ago

And before anybody points out that I start too many sentences with ‘And’, I know and will try to reduce the number in future; BTW Geoff what does ….. ;) mean ?

Dave Ricardo
Dave Ricardo
2022 years ago

Ken,

whaddya mean by that crack about the University of Wooloomoolloo? My name isn’t Bruce.

Ken Parish
Ken Parish
2022 years ago

Wayne,

Don’t get too paranoid about starting sentences with “and”. I frequently start sentences with “but”. But I do it quite deliberately, because I subscribe to George Orwell’s rules, and rule 6 in particular. In practice, however, I often forget them especially in blog posts, because the blogosphere’s expectation of immediacy doesn’t usually allow the time for reflection and revision I need to produce elegant, refined prose, which too often results in clumsy, convoluted sentences like this one. Here are Orwell’s rules:

(1) Never use a metaphor, simile, or other figure of speech which you are used to seeing in print.
(2) Never use a long word where a short one will do.
(3) If it is possible to cut a word out, always cut it out.
(4) Never use the passive where you can use the active.
(5) Never use a foreign phrase, a scientific word, or a jargon word if you can think of an everyday English equivalent.
(6) Break any of these rules sooner than say anything outright barbarous.

Geoff Honnor
Geoff Honnor
2022 years ago

And I use “and” to start sentences on a constant basis. I think Orwell’s 6th rule is particularly sound advice.

Wayne ;-) is shorthand for a sly/salacious/knowing and/or ironic wink.