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INTRODUCTION

‘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 its Indigenous peoples, which continues to be significantly worse than that of other Australians.

The 2017 AIHW figures estimated the average life expectancy for Aboriginal and Torres Strait Islander males was 69.1 years (a gap of 10.6 years compared with other Australians) and 73.7 years for women (a gap of 9.5 years).1

The commonest cause of death is cardiovascular disease, especially ischaemic heart disease which causes about 57% of these deaths.2 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.

One in nine adults have type 2 diabetes—a prevalence 3.3 times higher at any age than the general population.3

Records written by early settlers indicated that the Indigenous people appeared to be in good health, probably better than the majority of new arrivals transported from England. The total Aboriginal population has been estimated as 750 000 in 1788. It fell to about 70 000 in the 1930s after 150 years of exposure to white civilisation. Significant causes were deaths at the hands of the settlers (recorded as approximately 20 000) and infectious disease.

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 Aboriginal and Torres Strait Islander population is now estimated to be 700 000.

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 setting to embrace this.4,5

It is important to understand that Aboriginal and Torres Strait Islander people have a diverse range of different cultures, with each group needing a special understanding of its cultural issues. This understanding is best gleaned from local community members and groups.

Practitioners working in primary health care in rural and remote areas in Central and Northern Australia are advised to use the ...

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