Closing the gap

Question 1

What are key targets of the closing the gap?

Answer 1

It is multi state agreement aimed at addressing key determinents of health in aboriginals. To achieve indigenous health equality in 25 years.

health
housing
education 
Early childhood
Remote service delivery
economic partipation.

Question 2

How common is low birth weight in aboriginal children?

Answer 2

Twice as common in aboriginal children compared to other australians

Question 3

How common do aboriginal people die from injury and poisoning?

Answer 3

twice as common, self harm the leading cause of death from external causes.
Accounts for 15% of total disease burden

Question 4

Outline the impact of respiratory disease in the aboriginal population?

Answer 4

COPD, Pneumonia and invasive pneumococcal disease.

accounts for 9% of total disease burden

Question 5

What is the leading cause of death in indigenous AUstralians?

Answer 5

Cardiovascular disease 25% of deaths.

1.5 times more likely to die from CVD.

Question 6

How common is hypertension in indigenous australians?

Answer 6

27% have hypertension
Strong association with obesity, excess alcohol intake, age, high salt intake, low physical activity
High rates in remotes region and higher hospitalisation rate for hypertension.

Question 7

What is the impact of cancer in indigenous australians?

Answer 7

8% of disease burden.
Overall lower rates than non indigenous australians
rates high for lung and cervical cancer than bowel and breast cancer.
Lower survival rates for all types of cancers

Question 8

How common is diabetes in aboriginals?

Answer 8

1 in 10 over 18 years old will have diabetes

more common in remote australia

Question 9

Outline the risk factors for type 2 diabetes in aboriginals?

Answer 9

Hereditary, low birth weight, obesity, alcohol, intrauterine factors

Question 10

How common is kidney disease in aboriginal australians?

Answer 10

1 in 5 will have signs of kidney disease on blood or urine.

Question 11

How common is chlamydia in aboriginals?

Answer 11

3 times as common

Question 12

How common is gonorrhoea in aboriginals?

Answer 12

10 times as common

Question 13

How common is HIV in aboriginals?

Answer 13

4.2 per 100,000 persons

lower than the general population.

Question 14

How common is Hep B and Hep C in aboriginals?

Answer 14

Hep B - 2 times more common

Hep C - 3 times more common

Question 15

Define acute otitis media and chronic suppurative otitis media?

Answer 15

Otitis media = middle ear infection
Chronic suppurative otitis media= persistent perforation of TM with discharge and active infection last for several weeks.

Question 16

How much lower is the aboriginal life expectancy at birth?

Answer 16

ten years less
69 years for males
73 years for females

Question 17

What is the infant mortality rate in indigenous persons?

Answer 17

1.9 times higher than general population

Question 18

How common is overcrowding in indigenous households?

Answer 18

23% compared to 5% of non indigenous.

Question 19

How common are non functional housing utilities in aboriginal communities?

Answer 19

23% have non acceptable standard household utilities.

Question 20

Outline the problem of household tobacco exposure in aboriginal children?

Answer 20

130,000 0 to 14 year olds are exposed to daily smoker. 57% of children of this age. Compared with 26% in general population.

Question 21

Outline the obesity issue in aboriginals?

Answer 21

1.6 times more likely to be overweight or obese.

66% overweight or obese.

Question 22

Outline areas in indigenous health can a GP look to address in primary care to assist with ‘closing the gap’?

Answer 22

This includes addressing specific health outcomes and determinants of health.
Health outcomes needing attending include diabetes, kidney disease, hypertension, infectious disease, COPD, low birth weight.
Determinant of health we can address include housing, education, employment, tobacco smoking, alcohol, nutrition, obesity, drug and alcohol.

WHO
the social and economic environment,
the physical environment, and
the person’s individual characteristics and behaviours.

The determinants of health outlined by the WHO include the following

1. The social and economic environment,
2. the physical environment, and
3. the person’s individual characteristics and behaviours.

Actions GP’s can take to address health outcomes and determinants of health in Indigenous Australians include the following

• Recognising the inequality between indigenous and non indigenous health.
• Acknowledge that colonisation has lead to detrimental effects on the Indigenous population.
• Develop and apply a culturally sensitive approach to health promotion in Indigenous Australians.
• Secondary prevention - includes recognising health priorities include cardiovascular disease, hypertension, diabetes, renal disease, COPD, sexually transmitted infections.
• Primary prevention - smoking, alcohol, obesity, physical activity, nutrition, low birth weight, antenatal care, sexual health.

GP actions

• CAGE questionare to screen for alcohol use
• brief interventions for smoking cessation.
• Antenatal care - smoking and alcohol prevention
• Regular followup
• Be aware of compliance issues ie when treating diseases. For example strep throat consider using IMI penicillin.
• Recognise that overcrowding leads to higher rates of otitis media, infectious diseases, strep through, scabies, head lice.
• Nutritional screening
• Physical activity encouragement
• STI screening chlamydia
• Apply population screening for cervical cancer, breast cancer, bowel cancer.
• Immunisations
• Regular newborn checks
• Counselling and referral to social services.
• Primary and secondary prevention of renal disease.
• Screen for depression/anxiety
• Posters specific for domestic violence
• Drug and alcohol counselling.
• recognise region specific diseases ie Tb, Hepatitis, syphilis.

Question 23

What medicare incentives are available to help GP with addressing the close the gap?

Answer 23

Item number 715 aboriginal health assessments
PBS closing the gap co payment measure - for practices registered for indigenous health incentive payments. Aboriginal patients need to register for this. - This means there maybe a lower or nil PBS co payment for indigenous patients. Annotate closing the gap on the script.