Many of the conditions that contribute to the overall profile of Aboriginal adult morbidity and mortality in the Northern East Kimberley and wider region have their antecedents in poor childhood and maternal nutrition. Measures of weight and height gain provide a standard public health measure of poor nutrition by yielding estimates of children who are underweight (for age) and those not growing well (below average weight for age). Unfortunately, according to the KHS, such data for the East Kimberley is very incomplete due to the number of short term/relieving staff who do not always appreciate the importance of data collection. According to KAMSC, added to this is the problem of slow computer links in the East Kimberley that induce health staff to enter no more data than absolutely necessary. Even though ‘failure to thrive’ data is considered a high priority, information on this is patchy at best, and consequently difficult to translate into systematic and reliable population rates.

However, one indicator which is available and that reflects increased risk of neonatal and infant morbidity and mortality is birth weight. This also reflects a number of preconditions including prematurity, poor maternal nutrition, high alcohol intake and smoking. In 2002, there were 92 Aboriginal births recorded at Kununurra hospital with a mean weight of 3,190 grams. While this is notably lower than the average weight of 3,444 grams for non-Aboriginal births at Kununurra in the same year, it is slightly above the mean weight of all Indigenous births in Western Australia in 1999, which was 3,078 grams (Nassar and Sullivan 2002). However, a more useful measure is provided by the prevalence of low birth weights indicated by the proportion of live births with a weight of less than 2,500 grams. This data is available for births at Kununurra in 2002 and reveals that 14% of all Aboriginal live births in that year were less than 2,500 grams (as was the case for Aboriginal births in Western Australia as a whole) compared to only 4% of all non-Aboriginal births. It is important to note that these relativities extend into childhood morbidity and beyond, and they reflect greater failure to thrive among Aboriginal children. For example, 31% of children aged 5 years and under who were registered as regular clients with the Ord Valley Aboriginal Health Service in 2003 were classified as ‘children at risk’­—an assessment that includes failure to thrive.

It has long been recognised that poor diet and nutritional status are strongly associated (along with other risk factors) with a variety of chronic, preventable, and non-communicable diseases that are highly prevalent in Aboriginal communities. Primary among these in later life are cardiovascular disease and diabetes, but malnutrition also forms part of the general complex of reduced resistance to infectious and other diseases and may engender its own morbidity profile. Not surprisingly, public health programs, especially those targeted at improving health outcomes among Aboriginal people, increasingly identify improved nutrition as an essential intervention. A prerequisite to successful intervention, however, is the identification of structural impediments to improved nutrition, many of which are behavioural and economic in nature, including patterns of household expenditure, store management, and food prices (Taylor and Westbury 2000).

In terms of overall morbidity, nutritional diseases loom large in the East Kimberley and therefore successful intervention in this area has considerable potential to assist in raising health status. Diet-related diseases (including dialysis) can be separately identified using appropriate ICD codes (Lester 1994: 223). If separations for dialysis are included, such diseases accounted for as much as 17% of all East Kimberley Aboriginal hospital separations between 1991 and 2001. If separations for dialysis are excluded, they accounted for 11% of all separations. The main diet-related diseases included intestinal infections, diabetes mellitus, non-infective gastroenteritis, ischaemic and other heart disease, and symptoms concerning nutrition, metabolism and development.

Part of the difficulty in improving dietary intake, and thereby raising nutritional status in East Kimberley Aboriginal communities, is the relatively high cost of foodstuffs compared to other parts of Western Australia, and in relation to low regional household incomes. Nutritionists from the Kimberley Public Health Unit have for a number of years organised the Kimberley Market Basket Survey to establish the relative fortnightly cost of feeding a family of five in various parts of the Kimberley compared to Perth, using a ‘standard’ basket of basic foodstuffs and household essentials. Results from this survey for the period 1992-1999 are shown in Table 7.11 for the three towns of the East Kimberley, for an average of selected East Kimberley communities (including Oombulgurri, Turkey Creek Roadhouse, and Wungkul from within the study region), for an average of selected West Kimberley communities, and for Broome and Perth. Also shown are the prices in East Kimberley community stores expressed as a ratio of prices in Perth.

Notwithstanding methodological problems in comparing process between places and over time due to variable coverage, and some averaging for missing items, it appears that prices in the East Kimberley, both in communities and in towns, were consistently higher than prices in the West Kimberley and in Broome by a factor of between 10% and 20%. However, the price differential between East Kimberley community stores and Perth was less equivocal with prices ranging from 60% to 80% higher. One solution to reducing such differentials that has been attempted elsewhere by organisations such as the Arnhem Land Progress Association in the Northern Territory, and Anangu Winkiku Stores in South Australia, is the integration and pooling of store management, policies, transport and supply to access bulk purchase discounts (Taylor and Westbury 2000: 28). Such an option has been canvassed by Wunan ATSIC Regional Council for stores in the East Kimberley with some evidence of support but only if decision making remains with individual managers and communities (BKR Walker Wayland 2001).

The other main childhood disease identified in clinic presentations data is chronic ear disease. In 2003, the OVAHS reported a prevalence rate for chronic ear disease of 8% among its 319 regular clients aged 0-5 years. More serious cases of ear disease result in hospitalisation and in 2000-2001, 100 hospital separations from the East Kimberley were diagnosed as diseases of the ear and mastoid process—more than one quarter of these (27%) involved infants, and as many as 80% were for children under the age of 15 years. For the most part, these separations were diagnosed as otitis externa, otitis media, and perforated eardrum.