15. Indigenous perspectives

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CHAPTER 15. Indigenous perspectives

I ntroduction

It might be said that, in a book such as this, perspectives from the world’s First Peoples should be included. This expectation might also be said to be underscored by the fact that despite there being an estimated 370 million Indigenous peoples ¹ in the world, living in more than 70 countries, and representing ‘a rich diversity of cultures, religions, traditions, languages and histories’, Indigenous peoples ‘remain on the margins of society’ ( The Indigenous World 2006 International Work Group for Indigenous Affairs 2006 — cited in WHO 2007d, with reference to IWGIA 2006). Worryingly, Indigenous peoples are grossly over-represented ‘among the world’s vulnerable groups, suffering low incomes, living in poor conditions and lacking adequate access to employment, education, safe water, food and health care services’ (International Council of Nurses [ICN] 2003b: 1). Furthermore, although epidemiological data is ‘scanty’, what data do exist point to the following health impacts on Indigenous peoples (ICN 2003b: 1; see also Hughes 2003):

▪ Life expectancy at birth is 10–20 years less than for the overall population in a country.

▪ Infant mortality rates are 1.5 to 3 times greater than the national average.

▪ Malnutrition, often associated with land displacement and contamination of food supplies, and communicable diseases (malaria, yellow fever, dengue fever, cholera, tuberculosis) affect a larger proportion of Indigenous peoples.

▪ Substance abuse (smoking, alcohol, drugs), cardiovascular diseases, diabetes, unintentional injuries and domestic violence are significant health and social problems. Many are associated with lifestyle changes resulting from acculturation.

Commensurate with these demographics, the impacts on Australian Indigenous health have been conservatively estimated as follows (noting that, due to incomplete data, it is suggested that the disparities shown may, in some instances, be greater than has been estimated):

▪ Life expectancy at birth is 17 years less than for the non-Indigenous Australian population.

▪ The median age at which death occurs in Indigenous Australians is between 42.4 years and 54.3 years, being the age below which 50% of people die.

▪ Infant mortality rates in children under 1 year of age are around twice that of the national average.

▪ Babies born to Indigenous women are more than twice as likely to be of low birth weight than are those of non-Indigenous women.

▪ Maternal mortality rates are almost five times higher than the ratio for non-Indigenous women.

▪ Cardiovascular disease is a leading cause of death for Indigenous males and females, with the number of deaths recorded being 3.1 times more for Indigenous males and 2.6 times more for Indigenous females than non-Indigenous persons (male and female).

▪ Diabetes is a significant health problem among Indigenous people and although it is not possible to reach a single estimate of prevalence, it is nonetheless estimated that in Indigenous peoples aged 35–44 years, the prevalence of diabetes is five times higher than that reported for non-Indigenous Australians, with associated mortality rates being 23 times that of non-Indigenous Australians.

▪ Death rates from chronic kidney disease are 10 times higher than for non-Indigenous people, with Indigenous males between the ages of 25 and 34 years and 45 and 54 years recording 38 and 31 times the rate for non-Indigenous males, and Indigenous females recording 57–58 times the rate for non-Indigenous females.

▪ Suicide rates are approximately 40% higher than the general population.

▪ Communicable diseases (including tuberculosis, pneumococcal disease and parasitic diseases) are all more prevalent than in the non-Indigenous population and constitute a significant burden of ill-health and suffering on Indigenous peoples.

▪ Unintentional injuries and domestic violence are all significant health and social problems that constitute a significant burden of ill-health and suffering on Indigenous peoples.

▪ Educational attainment is half that of the non-Indigenous population.

▪ Unemployment is around five times the rate of the non-Indigenous population.

▪ Median family income for Indigenous peoples is slightly more than just one-half of that for non-Indigenous people (Thomson et al 2007).

According to Thomson et al (2007), there is no doubt that there have been significant improvements in health in some areas. However, in other areas of health there has also been a marked deterioration. On this point, Thomson and his team write ‘the gap between the health status of Indigenous people and that of other Australians is still very, very wide’ (Thomson et al 2007: 31). Citing a report by Oxfam Australia (2007), they further point out that a recent comparative analysis of national health data for Indigenous populations in Australia, New Zealand, Canada and the US has found that ‘Australia ranks bottom in the league table of first-world nations working to improve the health and life expectancy of Indigenous people’ (Thomson et al 2007: 39).

In light of these and similar figures, there is a strong case to be made for Indigenous health to be treated as ‘a special moral imperative’ for which we all share collective responsibility (Morgan & Allen 1998). In keeping with this imperative, as Morgan and Allen (1998) persuasively argue in relation to the health of Australian Aboriginal peoples, health

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