Progress made on Closing the Gap

Morgan Liotta

12/10/2021 5:01:23 PM

Latest AIHW figures show the health gap is narrowing between Aboriginal and Torres Strait Islander people and non-Indigenous Australians.

Two young Aboriginal girls eating ice-cream.
Aboriginal and Torres Strait Islander children born in 2018 are expected to live around 80% of their lives in full health.

Aboriginal and Torres Strait Islander people continue to experience higher rates of health inequities and a disease burden 2.3 times the rate of non-Indigenous Australians.
But the latest report from the Australian Institute of Health and Welfare (AIHW) shows the gap is narrowing.
The report measures the burden of diseases and injuries by the number of years of healthy life lost through living with an illness or injury (non-fatal burden) and years of life lost through dying prematurely from an illness or injury (fatal burden).
These are used to measure disability-adjusted life years (DALY), which has seen a marked improvement.
Between 2003 and 2018, there was a 15% reduction in the total burden for Aboriginal and Torres Strait Islander people, mostly driven by a 27% decline in fatal burden.
The rates of non-fatal burden remained stable, with the gap increasing slightly by 6.6% during the same period. 
Dr Tim Senior, a GP and Medical Advisor for RACGP Aboriginal and Torres Strait Islander Health, told newsGP the report offers some interesting and promising insights in relation to reaching national Closing the Gap targets.
‘This [15% decrease] is good news for the first of the Closing the Gap targets: “Everyone enjoys long and healthy lives”,’ he said.
‘The importance of separating out the fatal and non-fatal contributions to DALY shows how much we have to achieve still in keeping people well, rather than just helping them live longer.
‘So many of the Closing the Gap targets are about living well, and living the lives they would choose to live without limitations being imposed by poor health.’
The AIHW also identified progress in life expectancy, with Aboriginal and Torres Strait Islander children born in 2018 expected to live around 80% of their lives in full health – 56 years of the 70 years of average life expectancy for males and 58.8 years of the 74.4 years for females.
Dr Senior emphasises that although this outcome is positive news, it is important to recognise Aboriginal and Torres Strait Islander people’s lived experiences in relation to overall health burden.
‘On the surface this report is of burden of disease as it applies to individuals,’ he said.
‘But the findings, and therefore recommended policy outcomes, can only be understood in the context of people’s lived experience and environment.
‘It’s the only way we can explain the difference in the rankings of types of disease with mental health appearing so high for Aboriginal and Torres Strait Islander people, and it’s the only way we can understand what gets called “modifiable risk factors”.
‘The health system can be responsible for some of this − and has probably started on this journey, looking at that improvement in fatal disease burden − but so much of this burden depends on factors outside the health system.’
The AIHW found that almost half (49%) of the disease burden for Aboriginal and Torres Strait Islander people is potentially avoidable, cementing the value of preventive health and modifiable lifestyle factors across all populations.
In 2018, risk factors contributing to the most burden were tobacco use (12%), alcohol use (10%), overweight and obesity (9.7%), illicit drug use (6.9%) and dietary factors (6.2%).
Tobacco use was the leading risk factor for both males and females and contributed the most to fatal burden, with over 800 deaths (23% of all deaths) in 2018. Alcohol use contributed the most (9.2%) to non-fatal burden.
These modifiable risk factors, Dr Senior says, are the ‘most important’ on GPs’ radar.
‘GPs have the ability to modify these risk factors, especially in the context of a long-term therapeutic relationship,’ he said.
‘When they see a patient who identifies as Aboriginal or Torres Strait Islander, GPs and practice staff can make sure they ask about these risk factors and start up a conversation that enables that person to make changes.’
Dr Senior says it again comes back to the person’s lived experiences, with risk factors highly dependent on the circumstances in which people live.
‘There is almost always a reason that people continue to smoke or eat unhealthily … that is due to their social circumstances,’ he said.
‘The conversations we have with our Aboriginal and Torres Strait Islander patients are much more effective when we recognise this, tailor our advice to the patient’s circumstances, and also advocate for them, both individually and in policy.’

When looking at disease burden, it is important to consider ‘lived experiences’ of Aboriginal and Torres Strait Islander people, according to Dr Tim Senior.
In 2018, Aboriginal and Torres Strait Islander people lost 240,000 years of healthy life, the AIHW report reveals.
This figure is made up of 53% living with illness or injury (non-fatal) and 47% dying prematurely (fatal), representing a shift from fatal to non-fatal burden as the biggest contributor to total burden between 2003 and 2018.
The majority (63%) of the total burden in 2018 was attributed to chronic diseases and injury, made up of:

  • mental and substance use disorders (23%)
  • injuries, including suicide (12%)
  • cardiovascular diseases (10%)
  • cancer (9.9%)
  • musculoskeletal conditions (8%).
Coronary heart disease continues to be the leading individual cause of disease burden, but it has also shown the largest reduction over time, dropping by 48% between 2003 and 2018.
Decreases were also recorded for type 2 diabetes, stroke, rheumatoid arthritis, hearing loss, and chronic obstructive pulmonary disease.

When broken into gender cohorts, Aboriginal and Torres Strait Islander males experienced a greater rate of total burden than females across all age groups.
In 2018, males experienced 1.4 times the rate of fatal burden than females, with alcohol use disorders − ranked second in males – more than three times the amount of burden than for females.
Suicide and self-inflicted injuries ranked fourth among males and was more than three times the amount of burden than for females, while the burden of coronary heart disease was almost twice for males compared with females.
Females, however, experienced more burden from anxiety − ranked second − and depressive disorders, compared with males.
With the report providing evidence that the gap is narrowing between Aboriginal and Torres Strait Islander people and non-Indigenous Australians, Dr Senior said it does give ‘a measure of confidence’ going forward.
‘However, the report also shows where we need future policy action,’ he said.
‘The improvement in fatal burden of disease shows that we are getting better at treatments for chronic diseases and better at treatment of acute deteriorations in chronic diseases, and this is probably a sign of progress in the health system itself.’
Dr Senior said the ‘huge gap’ that persists for mental health and substance use disorders, which contribute a large part of the burden for children and adolescents, reaffirms that the circumstances in which Aboriginal and Torres Strait Islander people live are a ‘major cause’ of their disease burden.
‘We need to take note of this and provide really accessible, affordable and culturally appropriate social and emotional wellbeing care to all communities across Australia,’ he said.
‘In addition, unless we ensure that people can expect not to live in poverty, to live in acceptable housing, to have meaningful relationships to Country, family and community, to have meaningful work, and generally have control over their own lives, we will not see an improvement in the burden of disease.
‘When we start to make changes like this, I will be more confident.’
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