The extent to which policy interventions are perceived by individuals to effect an improvement in their quality of life is an emergent concern of health policy in Australia, including in regard to Aboriginal people (Brady, Kunitz and Nash 1997). This concern with measures of health that go beyond objective indicators such as morbidity and mortality is based on the recognition that a full assessment of health status should include physical, mental, social, and spiritual dimensions.

A more practical reason is the need for timely assessment of health interventions which may take a long time to translate into changes in conventional indicators of health status such as those compiled using hospitals separations data, especially at the whole-of-population level. Furthermore, it appears that many health treatments, while effective from a biomedical point of view, may actually compromise quality of life. An example is the treatment of end-stage renal disease, which requires the relocation of rural-based patients into towns for dialysis. In the East Kimberley context, this involves moving far from home to Broome or Perth with attendant difficulties in sustaining the comfort and care provided by family members. Individuals also have to adjust to living in an unfamiliar and institutional environment and financial hardships can be incurred, especially in terms of the wider caring responsibilities of family groups. All these factors can make treatment costly in terms of loss of quality of life, and may make non-compliance (and associated shortened life expectancy) preferable to adherence (Willis 1995).

In an attempt to discover individuals’ perceptions of their own health-related quality of life (QOL) in a routine way which can be repeated over time to monitor changes in condition, and produce results that are comparable with other groups, a number of standard instruments have been developed. These attempt to cover a number of QOL-related aspects of health, such as physical functioning, emotional wellbeing and support from family. Some of these instruments, such as the Medical Outcomes Trust Short Form 36 (SF-36) and its companion question on self-assessed health status within the main sample of the National Health Survey (NHS), are regularly used in Australia and are considered to be reliable, valid, and responsive to changes in clinical condition. While the same conclusion has been drawn for Indigenous people in urban settings, this cannot be claimed from data for remote communities where mainstream conceptions of quality of life and links to health status are indeterminate and poorly understood (ABS/NCEPH 1997).

As far as the East Kimberley is concerned such population-based assessments are scarce and, to date, derive solely from the application of self-assessed health status questions in the 1994 NATSIS. This used the standard global question asking, ‘In general, would you say that your health is excellent, very good, good, fair or poor?’ As in most other remote regions of Northern Australia, answers to this question in the East Kimberley appear somewhat counter-intuitive. For example, although 50 per cent of respondents in the Wunan ATSIC Region reported an illness in the two weeks prior to the NATSIS, and 25% reported one or more long-term illnesses, 48% considered themselves to be in very good or excellent health, while just one per cent described their health as being poor (ABS 1996: 17-19). Although this raises an obvious question of why people rate their health as good or excellent when the statistics show it to be otherwise, no research is available from the East Kimberley to provide an answer.