Two Australias

The two pictures below show the “real” Australia: an iconic view of Sydney – 89% of Australians live in urban areas; and the urban settlement of Gumbalanya in West Arnhem Land Northern Territory. Both are Australia. The gap between these two is reflected in differences in health.

Since the beginning of the Commission on Social Determinants of Health, I have been citing the health statistics of Australian Aborigines to make the case for the different faces of poverty and disadvantage. No one in Australia is in any doubt that, on the whole, indigenous Australians live in poverty. Indeed, the figures I have quoted show a life expectancy gap of 17 years between indigenous and non-indigenous Australians. But, and it is a big but, infant mortality of indigenous Australians is “only” 12.5/1000 live births i.e really low on a global scale, albeit 2.5 times that of non-indigenous Australians. Australian Aborigines are carried off in shockingly large numbers by adult mortality: heart disease, lung disease, gastrointestinal disorders, cancer, nutritional and metabolic disorders, and violent deaths. These are “causes” that we do not usually associate with destitution.

 In a recent editorial in the Medical Journal of Australia, I argued that the real causes of the tragic health disadvantage of Australian aborigines can be found in the social determinants of health.

One particularly chilling statistic for Northern Territory comes from incarcerations. The imprisonment rate for the non-indigenous population is 160/100,000 (the figure I have in my head for the UK is 170/100,000); for the indigenous population it is 2100 – about 13 times as high. The prison population is more than 80% indigenous.

The Australian Human Rights Commission in 2008 produced figures of a 17 year gap in life expectancy. The Australian Institute of Health and Welfare recently, 2011, changed that to 11.5 years. Not, they said, because things had improved but because they changed the way they did the calculations. I suppose it matters because the earlier figures, which I quoted on an Australian Broadcasting Commission (ABC) interview, show indigenous Australians to be worse off compared to non-indigenous than similar comparisons in New Zealand, Canada, and the USA.

Over 1999-2003, in Queensland, South Australia, Western Australia and the Northern Territory, 75% of Aboriginal and Torres Strait Islander males and 65% of females died before the age of 65 years compared to 26% of males and 16% of females in the non-Indigenous population. Whatever the life expectancy figures there is a long way to go.

Two faces of Australia. Iconic view of Sydney (with my brother and niece) and the urban settlement of Gumbalanya in West Arnhem Land Northern Territory.