Chapter 137

### The health of Indigenous peoples

‘Closing the Gap’ is a long-term ambitious framework that builds on the foundation of respect and unity provided by the 2008 National Apology to the Aboriginal and Torres Strait Islander Peoples. It acknowledges that improving opportunities for Indigenous Australians requires intensive and sustained effort from all levels of government, as well as private and not-for-profit sectors, communities and individuals.’

Council of Australian Governments (COAG) 2008

The major health challenge in Australia (and several other developed countries) is the health status of Indigenous peoples, which continues to be significantly worse than that of other people. In some cases, it appears that the gap may be widening for women and narrowing for men.1

However, at the end of 2013 the average life expectancy for Aboriginal and Torres Strait Islanders was 69.1 years for men and 73.7 years for women (compared with others—79.9 years and 84.3 years, respectively).2

The commonest cause of death is cardiovascular disease, especially ischaemic heart disease which causes about 57% of these deaths.3 The contrast with other Australians is most marked at 25–54 years. Diseases of the circulatory system, injury and poisoning, respiratory illness and neoplasms continue to be important causes of death. Deaths from infectious diseases and genitourinary disorders continue to occur at much higher rates than among other Australians.

The increasing incidence of diabetes is of great concern, especially in those changing from a traditional diet to inappropriate Westernised diets. It is four times higher than for other Australians.4

The estimated lifespan prior to white settlement was 40 years, with the commonest cause of death being injury, particularly from warfare and murder. Thirteen per cent of all children died within the first year of life and 25% by the end of the fifth year.5 Records written by early settlers indicated that the Indigenous people appeared to be in good health and free from disease. It is estimated that the total Indigenous population was 750 000 in 1788. It had fallen to about 70 000 in the 1930s after 150 years of exposure to white civilisation. Significant causes were killing by the settlers (recorded as approximately 20 000) and disease predominantly.

The main diseases that decimated the population were smallpox (two severe epidemics: 1789 and 1829–30), influenza, TB (very severe), pneumonia, measles, varicella, whooping cough, typhoid and diphtheria. The Indigenous population is now estimated to be 670 000.

The level of infant and maternal mortality continues to be a concern. After great reductions in infant mortality rates in the 1970s there has been a levelling off, with rates remaining 3–5 times higher than those of other Australians. Despite some improvement, we all need to work to close the gap, and general practice is an ideal service to embrace this.6,7

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