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9. Aboriginal and non-aboriginal health

I.H. Burnley

The health survey discussed in this chapter, based on unpublished statistics of admissions to the Alice Springs hospital, includes persons from Alice Springs and its surrounding region. There is considerable interaction between Alice Springs and the camps, stations, and outstations in its hinterland. This is becoming increasingly the case for the Aboriginal people; therefore, the more appropriate focus of analysis here is the wider region, rather than just the township of Alice Springs. A wider profile of health status improves our understanding of the social well-being of both the remote European population in the arid centre of Australia and the encamped and only partially urbanized Aboriginal population, much of which had been displaced from traditional settlement and life-style and a considerable proportion of which had been attracted to the town and its vicinity because of perceived benefits, some of which were health services.

The Health of the Aboriginal Population

It is widely agreed that the Aboriginal population of Australia is not a modernized population in demographic terms, as it experiences a fertility level almost as high as that in many third world countries and a mortality level as high as that among indigenous populations of Latin America and some parts of south and west Asia. The non-Aboriginal population of Australia has passed through demographic transition, having moved from a pre-modern pattern of high fertility and relatively high mortality in the late nineteenth century, through declining mortality, followed by fertility declines to the low mortality and fertility situation that now prevails. The Aboriginal population on the other hand has not followed the classical demographic transition model, although there certainly has been recent fertility and mortality decline. The impact of European settlement and society dislocated many traditional man-land relationships, and in particular sustenance systems, so that for many Aboriginal people today, particularly the fringe dwellers, there is a less-balanced diet and nutritional intake than before European contact, expect that there was always hardship, as for any hunters and gatherers, in times of extreme drought. Further, many of the Aboriginal habitations outside traditional environments such as Arnhem Land are not connected to electric power reticulation or, more importantly, to a clean water supply.

Lancaster Jones (1963) documented very high levels of Aboriginal infant mortality in central Australia, higher than in most other parts of northern Australia, at 208 per 1,000 live births, one of the highest in the world. This was almost twice as high as that in the northern part of the Northern Territory in the late 1950s. As mentioned above, Aboriginal infant mortality fell steeply in the 1970s for the Northern Territory as a whole, but it is not known whether the rates for the southern part remain proportionately higher than in the north. The rapid increase in the number of Aboriginal people at many government settlements and mission stations has fostered conditions conducive to the rapid spread of diseases such as gastro-enteritis, dysentery, and pneumonia, all of which cause high mortality among Aboriginal infants and children. The infant mortality was also much higher for females than for males, a most unusual occurrence.

At levels of mortality experienced between 1958 and 1960, Lancaster Jones found that 12.8 per cent of males and 14.3 per cent of females in the Northern Territory died before the age of 1 year; 21 per cent of males and 20.3 per cent of females died before reaching age 40; and 57.4 per cent of males and 54.7 per cent of females died before reaching age 65.

A more recent morbidity survey of Aboriginal people in the south-west of Western Australia showed a high level of child malnutrition and high levels of alcoholism and related diseases among adults (House of Representatives Standing Committee on Aboriginal Affairs 1975) The specific problems were high Aboriginal infant mortality and morbidity, much of which was related to poor infant and child nutrition; growth retardation, also related to child malnutrition; leprosy; trachoma; tuberculosis; gastroenteritis; and respiratory and ear conditions. The most common cause for hospitalization of Aboriginal people was chest infections; over half of these were Aboriginal children. Respiratory tract infections, particularly in children, were seen to be associated with poor housing and overcrowding.

Nutritional deficiencies in Aboriginal children throughout Australia are well documented (Kirke 1969; Moodie 1969; Gracey 1973; Gracey and Hitchcock 1974). Malnutrition not only contributes to a high incidence of anaemias and specific biochemically-based illnesses but contributes directly to the hospitalization of children from respiratory infections. Another indicator of childhood undernutrition in a community is a high incidence of diaorrheal disease, and this illness is very common in the Alice Springs region, as shown below. Pneumonia can be related to both damp housing and also malnutrition (Forbes, Williams, and MacDonald 1973), and this disease is also common among young Aboriginal people in the Alice Springs region. Particular problems are lack of protein, certain vitamin and iron deficiencies, and low serum iron and folate deficiencies.

Alcoholism and alcohol abuse by Aboriginal people have been found to arise from a number of interrelated causes: lack of employment opportunities; substandard housing; problems of absorption into education systems; social inertia and alienation; feeling of differentness; social rejection and social inadequacy; and lack of recreational facilities and opportunities. Alcoholism commonly has led to hospitalization from comas, epilepsy, psychosis, liver failure, and poor nutrition, and from trauma, such as falls, burns, and accidents. These illnesses were prominent in the Alice Springs region.

These are the more severe manifestations of ill health among the Aboriginal people and are not simply the patterns of a pre-modernized indigenous population but reflect dislocation from traditional society. Other specific illnesses are discussed below in the Alice Springs context.

Methodology

Individual case statistics from principal medical diagnosis at point of admission as in-patients to Alice Springs hospital were collated for the period 1977-1978 along with the age, sex, and ethnic origin (Aboriginal or non-Aboriginal) of the admissions. Access to the person's name and detailed case history was denied for reasons of privacy, but individual codes were provided by the Alice Springs hospital to allow analysis or separation of repeated hospitalizations by the same persons. Diagnoses registered were those under the World Health Organization's International Classification of Diseases.

For analysis of the local morbidity patterns, given that the base populations and disease frequencies in a number of instances were small, the Poisson probability distribution and two-tailed test of significance was applied to the disease data, in specific age and sex categories. This was done for the Aboriginal and non-Aboriginal populations separately for the two-year period. The observed number of admissions from particular disorders was compared to the expected number for the given age-sex specific group. The expected number was obtained by applying age-specific group. The expected number was obtained by applying age-specific, cause-specific morbidity rates for New South Wales calculated for the 0-4, 15-44, 45-64, and 65+ age groups (these were the ages in which the New South Wales data were grouped). Hospital admission morbidity data are not available for the whole of Australia; it was considered that the New South Wales data would be representative of the nation and adequate as a standard population with which the Aboriginal and non-Aboriginal morbidities could be compared. The magnitude of the difference between observed and expected numbers, relative to the size of the numbers allows a level of significance to be determined at the .05 or .01 level high, and at the .05 or .01 level low, that is, statistically high and low morbidity levels can be determined (McGlashan 1977). In the tables presented below, it is rates per 1,000 averaged over the two years 1977-1978 that are presented, while significantly high and low morbidity obtained by comparing observed and expected frequencies are asterisked.

The base populations for the Alice Springs region were obtained in the following way. The Alice Springs and McDonnell-Stuart Census regions for total population and Aboriginal populations were aggregated, since it is estimated that over 95 per cent of the Alice Springs hospital's patients were drawn from this combined area. The non-Aboriginal) population by age and sex was obtained by subtracting the Aboriginal age-sex distribution from the total population agesex distribution at the 1976 census. This population was then adjusted upwards to compensate for census underenumeration. Finally, this base population was projected forward to a mean population for the 19771978 period by applying national life table survival ratios and Northern Territory Aboriginal survival ratios calculated from the age-sex distribution of Aboriginal deaths 19761978. An estimate of the net internal migration gain to Alice Springs and region up until 1977-1978 and after 1976 was obtained from the 1979 population count, and apportioned to the 1977-1978 period.

Aboriginal and Non-Aboriginal Age and Sex Cause-Specific Morbidities 1977-1978

In the profiles of health, attention is first given to those illnesses common in pre-modern populations and societies. In table 9.1 rates per 1,000 population for infectious diseases of the intestinal system in the four age groups 0-14, 15-44, 45-64, and 65+ and by sex are shown. It will be noted that the highest rates and level of significance are with the Aboriginal population, especially children. Enteritis and other diarrhoeal diseases were particularly severe. These almost certainly reflected malnutrition. The salmonella infections reflect food poisoning and in turn unhygienic conditions for storage of food and utensils, a housing environment factor.

It is notable that for bacilliary dysentery the non-Aboriginal children and young adult women also had significantly high hospital admissions. As with the nutritional deficiencies, the great majority of Aboriginal intestinal admissions among children were in the age groups 0-1 and 17 1-2 years

TABLE 9.1. Infectious Diseases of the Intestinal System: Rates per 1,000 Population, 1978

** High morbidity significant at .01 level.
* High morbidity significant at .05 level
.. Very low incidence.
- No incidence.

Table 9.2 shows admissions due to nutritional deficiences and anaemias. The highly significant incidence among young Aboriginal people is very clear. Aboriginal women aged 15-44 also had significantly high admissions from iron deficiency anaemias and other anaemias. High levels of alcohol intake may have been influential here. The avitaminoses deficiency results from malnutrition and poorly balanced diet.

In all the tables, the rates and ratios in Alice Springs are for first admissions. Since every person had a separate code number it was possible to determine the number of readmissions in the 1977-1978 period. Whereas readmissions in the period were generally below 5 per cent, those for avitaminoses and anaemias were over 12 per cent among Aboriginal children under age 14. This suggests a return to conditions of malnutrition after discharge and the inability of parents to materially improve or balance diets for their children.

In table 9.3, admission rates for persons with respiratory illnesses are shown. The most striking feature is the incidence of pneumococcal pneumonia among Aboriginal people, especially among children and infants. Indeed, it is estimated that in 1977-1978, 8.5 per cent of all Aboriginal children in the Alice Springs region under age 15 became in-patients at the hospital for pneumococcal pneumonia. Rates were also very high for other ages under 65.

TABLE 9.2. Nutritional Deficiencies and Anaemias

** High morbidity significant at .01 level.
* High morbidity significant at .05 level
.. Very low incidence.
- No incidence.

Higher levels of pneumococcal pneumonia were significant for nonAboriginal males aged under 14, between 45 and 64, and over 65. A possible influence here may be the contrast between interior airconditioned temperatures and external summer temperatures and associated contrasts in humidity, a relationship suggested by Saini 11971) in northern Australian mining towns where summer temperatures are severe. Non-Aboriginal female acute bronchitis and bronchiolitis were also significantly above average for the over 65 age group as was the chronic bronchitis level for males in the same age group. The same relationship may be involved here, although other influences cannot be ruled out, such as alcoholism and poor diet resulting from life-style, rather than the malnutrition resulting from disadvantage and poor nutritional knowledge, which was high with the Aboriginal population.

It was hypothesized that for heart and related diseases the Aboriginal patterns would differ from the non-Aboriginal levels and would show a lower incidence. Their health and mortality incidence resembles that of pre-modern or transitional populations and societies and indigenous groups elsewhere. Table 9.4 suggests that this view was only partly valid. Incidence of high blood pressure was high for both Aboriginal and non-Aboriginal people in the 15-64 age range, especially for Aboriginal males and females aged 15-44 and for Aboriginal females aged 45-64.

Acute myocardial infarction was a significant factor for non-Aboriginal males aged 45-64. This suggests the possibility of a stress factor operating within the non-Aboriginal population, or a life-style influence. It was shown in chapter 5 that a large component of the Alice Springs population was migratory, and it may be that mobility has resulted in self-neglect as far as regular medical checkups, balanced diet, and life-style are concerned (myocardial infarction, failure of the heart muscle, is the "heart attack," often fatal, at the core of coronary heart disease).

TABLE 9.3. Respiratory Illnesses

** High morbidity significant at .01 level.
* High morbidity significant at.05 level.
- No incidence.

Symptomatic heart disease levels were highly significant at ages below 65 among Aboriginal people of both sexes and among non-Aboriginal males. Hypertensive heart disease levels were also high among Aboriginal people in the 45-64 age group, especially males. Other ischaemic heart disease levels were also high with Aboriginal people of both sexes over age 45 and with non-Aboriginal males and females in the 45-64 age group.

TABLE 9.4. Heart and Related Disease, 1977-1978

** High morbidity significant at. 01 level.
* High morbidity significant at .05 level.
- No incidence.

While acute myocardial infarction levels among the Aboriginal population were not significantly high, they in fact conformed with those in the total New South Wales population at premature ages. In other words, the Aboriginal people had begun to acquire the increasingly prevalent disease of modern, urbanized populations- myocardial infarction-and a number of other heart complaints commonly conceived as being stress-related or associated with affluent or industrial life-styles. Heart conditions among Aboriginal people may also relate to social disintegration and alcoholism.

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