In Western Australia as a whole, the largest rates of Aboriginal deaths are seen in diseases of the circulatory system, respiratory diseases, endocrine disorders (especially diabetes) and injury and poisoning (Watson, Ejueyitsi and Codde 2001). Given that these five disease categories accounted for 75% of such deaths during the 1990s, standardised death rates for each of these conditions have been calculated by the WA Department of Health for each of the health service regions of Western Australia to enable spatial comparison (ibid). One such region is the East Kimberley and results are presented in Table 7.4 to provide comparison between the East and West Kimberley and the State average. Three indicators are provided: the age-standardised rate per 1,000 population (ASRs); person-years of life lost per death; and the rate ratio between the Aboriginal and non-Aboriginal ASRs recorded for each region.

The East Kimberley stands out as having higher Aboriginal mortality rates for circulatory diseases, respiratory diseases and injury and poisoning (which together account for more than half of all Aboriginal deaths in Western Australia) than those recorded for the West Kimberley and for the State as a whole. However, in terms of relative rates compared to locally recorded non-Aboriginal deaths, the East Kimberley records by far the highest gap in death rates for all five disease categories, especially in regard to diabetes-related deaths. A further measure of the greater burden of mortality in the East Kimberley is provided by the relative person-years of life lost which are greatest in the East Kimberley for all leading causes of death except for respiratory diseases and indicate the generally younger age at death in this region compared to elsewhere in Western Australia.

This profile of mortality confirms the trend towards ‘lifestyle’ diseases as the primary cause of death first noted by Gracey and Spargo (1987) in their review of the state of Aboriginal health in the Kimberley as a whole from 1970 to 1985. Interestingly, it was this review of the shift in health status that triggered a series of letters to the Medical Journal of Australia (volume 146: 610) regarding the lack of reference to increased alcohol consumption in the region and its likely contribution to morbidity and mortality. Since that time, the development of an aetiological fraction methodology, involving estimation of the proportion of an illness or injury that can be attributed to a risk factor such as alcohol consumption (Holman et al. 1990), has enabled the calculation of alcohol-caused deaths and hospitalisation in Western Australian health service areas for the period 1984-1995 (Unwin et al. 1997).

In the East Kimberley region, a total of 65 deaths were caused by alcohol over the period 1984-1995. This represented approximately 15% of total Aboriginal deaths each year. Of these deaths, 60% were due to alcohol-related diseases such as liver cirrhosis and stroke, and 40% were due to road injuries, assaults and suicide. More importantly, the number of alcohol-caused deaths per head of population was significantly higher in the East Kimberley region (63 per 1,000) compared to the State average (20 per 1,000), and the observed number of alcohol-caused deaths was also significantly higher than the number expected based on the State rate. Indeed, the East Kimberley had the highest crude rate of alcohol-caused deaths of all health service areas in Western Australia (Unwin et al. 1997).