Abstract
In summarising the current health status, the author examines the significance of ongoing backlogs in achieving adequate environmental health infrastructure, a continuing gap between ideal and actual staffing levels in health personnel, and difficulties in achieving better nutritional status in the population.
His looks at the estimation of mortality, the cause of death, hospital separations, hospitalisation diagnoses, primary health status, child health, nutrition, health-related quality of life assessment and primary health care services.
While health status generally reflects prevailing social and economic conditions in the region, there is a delay between any improvement in the latter and its possible effect on the former.
Information on the health status of Aboriginal people is gathered as a matter of course in the day-to-day operation of the health care system in the Northern Territory. Information at the regional level, as in the case of Thamarrurr, is not routinely available in the public domain. Consequently, data on the current health status of the Thamarrurr population was compiled, summarised, and made available by the Northern Territory Department of Health and Community Services (NTDHCS) in their role as a partner to the ICCP trial, and in response to a special request on behalf of the Thamarrurr Council.
As is often the case, there is a need for aggregation of some health data to at least SLA level (roughly equivalent to the Top End West Primary Health Care Access Program [PHCAP] zone) in order to produce statistically reliable health indicators. This is because of the relatively small size of the Thamarrurr population in a statistical sense. While this inevitably involves some loss of geographic detail, it nonetheless enables the estimation of some key indicators (notably here, the mortality rate), that otherwise would be unavailable. Morbidity rates, based on hospitalisation data, are calculated for Thamarrurr itself, although with a fairly brave proviso (following the evidence in Chapter 2) that estimated resident population figures and hospital admissions data are assumed to be sufficiently compatible for the former to be employed as a meaningful denominator for the latter.
The mortality rate can be used as a proxy measure of health status. While the usual residence of Aboriginal people is recorded in death statistics held by the ABS these are coded only to the SLA level. In the case of Thamarrurr, this refers to the Daly SLA. Between 1997 and 2001, a total of 88 Indigenous deaths were officially recorded for this area—59 male, and 29 female. With these data, it is possible to calculate a standardised Aboriginal mortality ratio for the Daly SLA to account for the quite different age structure of the Aboriginal population compared to the standard. The assumption here is that the resulting rate would be very similar to that calculated for Thamarrurr, if such a calculation were possible.
Given the relatively small size of the Aboriginal population in the Daly SLA, and the consequent unreliability of age-specific death rates, it is appropriate to apply indirect standardisation―as is the practise of the ABS (ABS 2002a: 107). This is calculated by applying published age- and sex-specific death rates for the total Australian population (ABS 2002a: 50) to the 2001 Daly SLA Indigenous ERP age/sex distribution. An annual figure for deaths in the Daly SLA is then estimated by averaging recorded deaths over the period 1997–2001 to account for annual variation. This observed figure of 18 Aboriginal deaths for the region is then compared to the expected number (five) derived from the application of the standard age-specific death rates. This produces a standardised mortality ratio for the Aboriginal population of 3.6, indicating in excess of three times more Aboriginal deaths in the region than would be expected if the mortality profile observed for the total Australian population were to apply.
In terms of an indirectly standardised Aboriginal death rate for the Daly SLA, this translates into 24 deaths per 1000, which is 18 per cent higher than the equivalent indirect rate of 20 deaths per 1000 calculated for Aboriginal people in the Northern Territory as a whole (Table 7.1). Higher male mortality accounts for all of this difference. Compared to the total non-Aboriginal population of the Northern Territory, overall Aboriginal death rates in the Daly SLA are four times higher. The comparable figure for all Aboriginal people in the Territory is 3.4 times higher. It is not surprising, then, to discover that the median age at death for Aboriginal people in the Daly SLA was only 46 years.
Table 7.1. Aboriginal and non-Aboriginal indirect standardised death ratesa for the Daly SLA and Northern Territory, 2001
|
Male |
Female |
Total pop. |
|
|---|---|---|---|
|
Aboriginal Daly SLA |
38.2 |
12.2 |
23.8 |
|
Aboriginal Northern Territory |
27.2 |
14.5 |
20.2 |
|
Non-Aboriginal Northern Territory |
N/a |
N/a |
6.0 |
Per 1000
Source: Calculated from ABS Deaths registration data, and information in ABS (2002a: 35, 87)