The Health and Wellbeing of Indigenous Australians

Question 1

Aboriginal Social Structure

*Note: approx 1 million ABTSI in AUS

Answer 1

Peoples
Language group
Clan
Band
Family

(PLCBF)

Question 2

History of Indigenous Australians
- BMI
- Diet
- BP, CHD, Cholesterol, Diabetes

Answer 2

• BMI = <20 (physically fit)
• Diet = 1 main meal/day, high fibre, potassium, magnesium & calcium. Low fat and sodium. Slowly digested carbohydrates.
• Low fasting glucose & cholesterol. No evidence of diabetes, CHD or BP issues.

Question 3

What were the consequences of post European colonisation?

Answer 3

Mistreatment
Dispossession
Slavery
Conflict
Massacres
Illness
Social disruption
Lack of cultural understanding

Question 4

Health effects post colonisation and three main risk factors?

Answer 4

• Android obesity (holding fat in the abdominal/chest/arms)
• hypertension
• Body mass and BP increase with age
• Type 2 (non-insulin dependent diabetes mellitus)
• CHD
• Elevated triglycerides & low HDL
• Hyperinsulinemia (insulin resistance)

Risk factors
- Dietary behaviours
- Physical inactivty
- Overweight and obesity

Question 5

Median age for Indigenous vs Non-Indigenous?

Answer 5

Median Indigenous = 23
Median Non-Indigenous = 38

Significantly more skewed towards the lower age bracket for Indigenous (not many make it beyond 65)

Question 6

Life expectancy Difference

Answer 6

Males (2015-17)
Indigenous = 71.6
Non-Indigenous = 80.2
Difference = 8.6

Females
Indigenous = 75.6
Non-Indigenous = 83.4
Difference = 7.8

Previous (2005-2007)
Males = 11.5
Females = 9.7

Note: access to health care, economic status etc are all factors but infant mortality is one of the biggest contributors

Question 7

Factors contributing to chronic health conditions in Indigenous groups (HBP RE HEN)

Answer 7

1. Historical
2. Biomedical risks eg BP, lipids, BMI
3. Psychosocial/cultural eg racism, depression, family/community violence
4. Risk behaviours (smoking, diet, < PA)
5. Environmental (housing, isolation, food, lack of transport)
6. Health care system (eg access & $$)
7. Economic (unemployment & poverty)
8. Non-modifiable risk (age, gender, etc)

Contributes to chronic conditions (15% of ABTSI have heart disease - leading cause of death)

Question 8

Dietary behaviours (fruit and veg intake compared to non-indigenous). Main barriers.

Answer 8

2x as likely to report no usual daily fruit intake than Non-Indigenous. 7x as likely to report no daily vegetable intake.

Barriers - cost and access to variety of fresh food.

Question 9

Does not eat Vegetables daily
- Remote (Indigenous)
- Non- Remote (Indigenous)
- Non-Indigenous

Answer 9

Remote = 15%
Non-Remote = 2%
Non-Indigenous = 1%

Question 10

Does not eat fruit daily
- Remote (Indigenous)
- Non- Remote (Indigenous)
- Non-Indigenous

Answer 10

Remote = 21/22%
Non-remote = 13%
Non-Indigenous = 7%

Question 11

What percentage of Indigenous Australians are sedentary?

Answer 11

50% (approx 32% of non-Indigenous)

Question 12

Overweight percentages

Answer 12

34% Males
24% Females

Question 13

Obese percentages

Answer 13

28% Males
34% Females

Question 14

Poor dietary behaviours, physical inactivity and obesity are risk factors associated with several preventable chronic diseases including:

Answer 14

CVD
Hypertension
Type 2 diabetes

Question 15

Percentage with atleast one long-term health condition rising from ….% of Inidgenous children <14 years to ….% of those over 55 years

Answer 15

44%
97%

If they make it beyond 60, then 75-80% have 3 or more long term health condition.

Question 16

Respiratory (Lung) disease prevalence & smoking prevalence

Answer 16

27% of population = lung disease
>51% smoke

Question 17

Diabetes prevalence

Answer 17

12% (4% in non-Indigenous)

Question 18

Renal incidence

Answer 18

76 per 100,000 (2008)
Doubled from 31 per 100,000 (1991)

Question 19

Heart Disease

Answer 19

12% prevalence
Years of life lost = 24%

Question 20

Model of Care For Aboriginal People
(RFIT & ETCS)

Answer 20

Black = Aboriginal Health Contribution to the Model.

• Referral
• Follow up
• Identification
• Trust

Red = Performed by non Aboriginal providers eg community health, GP, etc

• Education
• Treatment
• Clinical Indicators
• Screening and assessment

Yellow = Aboriginal person, family and community

Question 21

Results of a 12 week study in women attending gym classes and nutritional education…

Answer 21

Decreased body weight, BMI, BP and no change in CRP. 40% compliance.

Question 22

Hunter gather lifestyle intervention result

Answer 22

improved glucose and insulin to a 75 OGTT

Question 23

Walking group study for diabetes

Answer 23

Protected from increases in plasma glucose and triglycerides

Question 24

Benefits of Indigenous youths participating in PA

Answer 24

3.5 times more likely to report good general health and 1.6 times more likely to have no probable serious mental illness

Question 25

UTS 12 week intervention for Indigenous communities

Answer 25

Day 1: Assessed anthropometry, blood pressure, venous blood, and glucose response (75g)

Day 2: Cycle Ergometry (peak oxygen consumption and workload)

Prescritpion
- Wednesday 45 min combined gym session (strength and cardio)
- Friday 60 minutes of boxing
- Sunday - 60 mins of small sided games eg touch football, futsal

Intensity = 70-85% MHR. Session RPE collected at end of every session

(W1-6 = 2 session & W7-12 = 3 sessions)

Question 26

Results of the UTS intervention for Indigenous communities

Answer 26

1% reduction in mass (kg)
3% reduction in waist cirumernece
3% reduction in WHR (waist-hip ratio)

Lower insulin concentrations, small reduction in the amount of glucose and the rate of reduction. Less insulin required to remove glucose from the blood.

V02 peak > (pre = 30 & post = 35)
Peak workload > (pre=240 & post= 270) Duration (pre = 9.5 and post = 11)

Question 27

What were the 3 main factors improved in the UTS intervention for Indigenous communities

Answer 27

Glucose regulation
Anthropometry
Aerobic capacity

Question 28

Initiatives to promote sport and exercise in Indigenous communities

Answer 28

The Elite Indigenous Travel and Accomodation program (EITAAP)

Indigenous Marathon Project

NRL - Indigenous All-stars & Indigenous round

AFL - Indigenous round

NRL - NSW state knock out health challenge