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.