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TABLE 9.5. Cancer: Total Incidence

** Low morbidity significant at .01 Ievel.
* Low morbidity significant at .05 Ievel.

TABLE 9.6. Diseases of the Eye

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

TABLE 9.7. Diabetes Mellitus

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

In table 9.5, the age-specific rates for total incidence of cancer are shown. Morbidity rates were significantly low for Aboriginal males over 15 and females over 65. They were also low for non-Aboriginal men over 65 and women over 15. This possibly suggests a relative lack of exposure of Aboriginal people to carcinogenic agents, particular processed foodstuffs, for instance. Migration selectivity may have operated to some degree with the European population; whereas some persons with known heart complaints may risk migration, this may be less the case with known cancer because of its higher mortality rate after discovery relative to most forms of heart disease and the need for high level medical care. Otherwise, the significantly low non-Aboriginal female cancer levels are hard to explain.

Diseases of the eye are an endemic condition among Aboriginal people in many regions of Australia, and table 9.6 shows that this is also the case in the Alice Springs region. However, with the exception of conjunctivitis and ophthalmia, it appears to be relatively less common among Aboriginal children in this region than elsewhere. This may in part testify to the effectiveness of the hospital's paediatric unit in the screening and treatment of Aboriginal children. When Aboriginal children have been admitted for other reasons, they have also been screened and treated if eye conditions are also evident.

Conjunctivitis is highly contagious, and this would have been a factor in its spread among Aboriginal children. It was also significant among young European male children. For the Aboriginal people, a factor here may have been the lack of availability of medical practitioners for immediate care in the more remote communities around Alice Springs and the availability of only one general practitioner in Alice Springs. Cataract and other diseases of the eye were very prevalent among Aboriginal people over 45 years of age, especially among women.

Table 9.7 shows that diabetes mellitus was highly significant among Aboriginal people of both sexes at ages over 15, and especially for women over 45; it was also high with nonAboriginal men over 65.

With cerebrovascular disease, Aboriginal rates were above those of Europeans in New South Wales, but without statistical significance at the .05 level (table 9.8).

Tables 9.9 and 9.10 show the incidence of illnesses of a social and psychological type, through admission from accidents and violence. They indicate wider aspects of individual and community well-being. The most glaring finding is the high incidence of alcoholism among both Aboriginal people and Europeans. The male non-Aboriginal rates for persons over age 45 were higher than those of Aboriginal males, even though the latter had significantly high rates. Admissions from alcoholic psychosis, when persons have lost contact with reality altogether, were significantly high for Aboriginal males aged 15-44, but especially for European men aged 45-64. The high European alcoholism levels suggest the possibility of adverse life-style and weak social support systems in the town. In chapter 4 the survey results showed a deep concern for the excesses of alcohol consumption in Alice Springs, and this related to both black and white communities. This may be the case despite the overall satisfactory adjustment of migrants to the town in recreation and friendship formation discussed in chapters 4 and 5. The higher incidence for European males suggests a possible "social isolation" influence, and the sex imbalance shown in chapter 3 may be a factor here.

TABLE 9.8. Cerebrovascular Disease

- No incidence.

TABLE 9.9. Psychoses and Neuroses: Rates per 1,000 Population

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

TABLE 9.10. Accidents, Poisonings, and Violence

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

Among the various psychoses and neuroses, schizophrenia was significantly high for Aboriginal males aged 45-64, and other neuroses were significantly high among European men aged 45-64 and women aged over 65. It is possible that they reflect some of the problems of older persons in a remote community such as Alice Springs.

The incidence of violent actions within the Aboriginal population is clear from table 9.10, especially injuries resulting from fights, brawls, and rape, and from assault by cutting and piercing instruments. These may well have resulted from the influence of excessive alcohol consumption, and they appear to have been confined largely to conflicts and incidents within the Aboriginal community. With males especially, this high incidence of injuries resulting from assault was found across all adult age groups.

The incidence of motor accident admissions was highest for Aboriginal men aged 45-64, and for self-inflicted injuries the same age group had the highest incidence. Again the influence of alcohol may well have been involved, but in the case of self-inflicted injuries, suicide cannot be ruled out. The incidence of accidents caused by fire and burning is evident, indeed almost all admissions for this reason were of Aboriginal patients; although the incidence was below the .05 level of significance, so their reliability is questioned. The expected level in relation to fire was obtained by apportioning part of the aggregate rate and incidence to accidental and non-accidental injuries, which was all that was available for New South Wales. The accidents caused by fire may reflect the lack of sufficient understanding of volatile fuels and electricity especially in relation to the housing and living conditions of the Aboriginal population, with fires being used close to eating and sleeping locations within dwellings and shanties. In such dwellings, and even some Housing Commission dwellings, open wood or refuse fires are used as both a cooking and a heating agent. Volatile fuels and materials, improperly used, seem a likely agent for pyrotechnic catastrophe and provide a good example of the everyday level at which two culturally distinct communities have to meet.

Society, Environment, and Ecological Factors and Disease Incidence

Both childhood and adult morbidity among the Aboriginal population, as indicated by the Alice Springs hospital admission data, are high, and it can be confidently asserted are still a good deal higher than for equivalent indigenous groups in the United States and New Zealand (Moodie 1969, 1973). With the children, there is a complex of gastroenteritis, diarrhoea, respiratory infection, and malnutritionsometimes called (GERM)-which is well known in developing countries and was indeed the complex noted in Australia and Europe in the nineteenth century (Hetzel 1974). In the late 1960s, Kirke (1969) observed that in the Alice Springs hospital it was rare to see an Aboriginal child with a normal chest X-ray. A major complication of recurrent respiratory infection is chronic ear disease (otitis media). Indeed, in 1977-1978 there were 200 Aboriginal admissions for otitis media aged under 14 years. This was significant at the .01 level. However, the incidence of European admissions from otitis media was also very high: 130. The rate for Europeans was 15 per 1,000 under 14, and that for Aboriginal people 32 per 1,000, compared to 4.7 per 1,000 for the total population in New South Wales.

The high otitis media levels in both Aboriginal people and Europeans may be due to different etiologies or secondary causes, although the high incidence among Europeans is more difficult to explain. Earlier studies suggested that malnutrition per se plays little or no part among Aboriginals, and lack of certain specific proteins may do so in a genetic fashion (Willis 1975). In the more crowded cities of northern England, chronic suppurative upper respiratory tract infection has been found to be the factor which determines the high incidence of chronic ear disease. While recurrent respiratory infection influences chronic ear disease among Aboriginal people, an environmental influence of a different type may be present: secondary infection often occurs through bowel organisms. The Aboriginal child frequently lives "close to the earth," often playing in the dust and earth. This is one probable source of deleterious organisms; another is the water holes where the children swim, now often polluted by excessively heavy use by rangeland cattle.

Very clearly, the large burden and wide variety of communicable infections is the principal and most obvious feature differentiating the health risks of Aboriginal and European peoples in central Australia, as elsewhere in Australia. It is possible, however, that the chronic diarrhoea (table 9.1), which has a much higher incidence in the Aboriginal population, is associated with intestinal mucosal atrophy and gluten and lactose intolerance, the former of which is reversible (Walker-Smith and Reye 1971), demonstrating further, as with accidents by fire, the as yet unsatisfactory co-existence of two distant and distinct cultures. Other illnesses that are not infectious have severe incidence among the Aboriginal people. Iron deficiency anaemias were common among Aboriginal children and women of child-bearing age in the Alice Springs region, and have frequently been severe enough to require transfusion. It is likely to be associated not only with dietary iron deficiency but also with iron loss, malabsorption, and frequent marrow depression from recurrent acute infections (Frith, Hausfeld, and Moodie 1974). To what extent these were endemic conditions prior to European contact and associated changes in life-style and general ecology is not known.

A number of studies have shown that growth-retarded Aboriginal children have a depressed humoral immune function and delayed antigen recognition (Jose et al. 1975). These findings may well explain the frequency and severity of recurrent infection from major causes of morbidity such as pneumonia and chronic ear disease in Aboriginal children. The distinct Aboriginal disease pattern appears to be mainly the result of a cyclic interaction between environment, infection, nutrition, and immunity. The cyclical pattern may be a mechanism operating in the sequence: primary protein malnutrition * immune defect repeated bowel infection, resulting in malabsorption of nutrients from the bowel into the bloodstream * secondary malnutrition (Moodie 1977).

The high incidence of diabetes mellitus among Aboriginal people in the Alice Springs region may result from malnutrition and obesity (Wise et al. 1976). It has been argued that diabetes tends to be prevalent in certain indigenous groups undergoing urbanization, such as the Pima Indians in Arizona (Bennett et al. 1971). In the 45-64 age group, the incidence among Aboriginal people in the Alice Springs region was over 10 times that of the Europeans and of the New South Wales rates, a differential very close to that also found in northern South Australian Aboriginal communities. Diet is almost certainly a factor, with a change, among those influenced by urbanization, to low-fibre cereal products and away from traditional high-fibre carbohydrates, such as spiniflex flour. White wheat flour may in the short- and medium-term be less absorbable.

Pneumococcal disease was shown to have a very high incidence among Aboriginals in the Alice Springs region, especially among children and infants. The pneumococcus is generally believed to be the most important cause of adult pneumonia as well as infant otitis media (Douglas and Riley 1979). In London, studies showed a strong correlation between low temperatures and the onset of such pneumonia; these conditions are experienced in the central Australian winter, with sub-zero temperatures overnight. At this time of year appropriate heating, especially in the shanty fringe settlements and encampments, is almost nonexistent. In the London studies (Payling Right and Payling Right 1945), mortality rates correlated with poverty and poor housing, and rose sharply when the mean temperature of the coldest day of the week fell below 4.4 C. Cold immersion lowers pulmonary anti-bacterial activity, allowing pneumococcal infection to spread. Overcrowding, such as occurs in many Aboriginal encampments, facilitates the spread of infection, especially in cold conditions. The diurnal range in temperature in summer may also be influential. An antecedent viral respiratory infection, such as is common among Aboriginal people, may also make severe pneumococcal viral infection more possible.

Several factors are almost certainly involved in the association between alcoholism and pneumococcal pneumonia. Alcoholic stupor may lead to aspiration, and acute intoxication may lead to impaired leucocyte mobilization, thus allowing the spread of the damaging pneumococcal infection.

It appears that demographic transition theory, which is in itself a theory of modernization, partially explains the Aboriginal and non-Aboriginal morbidity differential in the Alice Springs region. The Aboriginal population is not modernized in a demographic sense and exhibits many of the disease patterns of traditional and pre-industrial populations, whereas the non-Aboriginal population displays patterns of modernized societies and life-styles. However, demographic transition theory fails to explain some of the morbidity trends found in the region, such as higher respiratory risk and dysentery in the non-Aboriginal population than found elsewhere in Australia and heart disease among Aboriginal people. Some of the "pre-modern" and "modern" patterns among the Aboriginal population arise in a complex sequence from structural factors and dislocation, and developmental theory may have some relevance, especially to evaluation of the impact of an assertive, market-oriented culture on a traditional society, with its consequent displacement and disintegrative effects.

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