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Table of Contents
Section 1: Social determinants of cardiovascular disease
Burden of heart disease in Indigenous population
Social determinants of health
Section 2: An intervention to address social determinants of Heart disease
sectors involved in the intervention
Cardiovascular disease (CVD) is currently the major health issue which is a concern for all Australians; however, CVD impacts the Indigenous Australians at a much higher level than the rest of the Australian population (AIHW, 2019). Heart diseases are the number one cause of avoidable deaths among Indigenous Australian population (AIHW, 2019). CVD is an umbrella term for illnesses and conditions relating to the circulatory system that affects the heart vessels and other parts and functions of the body.CVD consist of Coronary heart disease, which includes hypertension, rheumatic heart disease, and strokes (World Health Organization, 2019).
The aim of this report is to present a comprehensive study on cardiovascular health of Indigenous people in Australia. The report consists of general information on social determinants of circulatory health, and how these determinants contribute to the burden of heart diseases on the Indigenous population. It provides information on the prevalence and mortality rate of cardiovascular disease. It discusses the method of intervention to improve Indigenous health and a non-government health sector that can participate in the intervention.
The third major cause of burden of disease in Australia is CVD. The major reason the life expectancy gap in the year 2008-12 between non- Aboriginal and Aboriginal Australians was cardiovascular disease and it is the leading factor contributing to deaths. The health survey for the Aboriginal and non-Aboriginal Australians conducted in 2018-19 reported that 15% of all Aboriginal people in Australia self-reported their long-standing circulatory disorders. Out of this percentage, 14% were males, and the rest 17% were females. 5.5 % of Aboriginal males and 4.9% of Aboriginal females reported vascular diseases and strokes. In the data of those who self-reported about their circulatory disorders, an increase in prevalence was noted from 1.9% of age group 0-14 years to 56% for age group 55 years to older 5.4% of Aboriginal people who live in non- remote locations and 4.9% of those who live in remote locations reported having heart conditions and strokes (Australian Indigenous Health Bulletin, 2019).
This show Aboriginals who live in non-remote locations bear more burdens of heart diseases than those living in remote locations.
Congenital heart defect (CHD) is the major health issue that has impacted the health of Aboriginals. CHD has become the major cause of Aboriginal deaths. In the year 2018, 390 people died altogether from NSW, Qld, WA, SA, and the NT which accounted for 12% of all deaths with a mortality rate of 117 per 100,000 (World Health Organization, 2019). 105 deaths cerebrovascular disease was recorded. The mortality rate of people dying due to cerebrovascular disease was 44 per 100,000. Nearly 24% of Aboriginal deaths were caused by CVD. The age-standardized death rate because of CVD for Aboriginal people was 271 per 100,000. Out of all CVD types, CHD was the major cause of most deaths which accounts for 55% of CVD deaths, the rest of the heart diseases accounts for 17% of deaths. Cerebrovascular disease -17%, hypertensive diseases -4.6%, RHD- 3.4%, and other diseases of the circulatory system - 3.3%. Between 2009-2013 and 2014-2018, the rate of deaths due to CHD dropped down by 11% from 133 deaths per 100,000 to 118 deaths per 100,000 people (Australian Indigenous Health Bulletin, 2019).
Aboriginal Australians suffers socio-economic disadvantage. The average income in the household of Indigenous Australian was 62 % of what non-Indigenous Australians were earning. The Indigenous unemployment rate was 20% higher than that of non-Indigenous Australians. Aboriginal students were more likely to drop out and not finish schooling than non-Indigenous students (AIHW, 2018).
Inadequate education is related to poor health status as it lowers down the ability of an individual to utilize information related to health and leads them to make poor health decisions. Low levels of income restrict the Aboriginal population of people from accessing health care facilities and medicines due to lack of employment poverty arises within the indigenous communities.A poor diet of newborns due to poverty causes chronic diseases which affect their health later in life (AIHW, 2016).
In 1989 the national health strategy for Aboriginal population, it is stated that health of Aboriginal people is connected to ‘knowing that they have control of themselves, their living environment and surroundings. The health of Aboriginal population is not just linked with access to hospitals, doctors, medicines, etc (AIHW, 2018).
It is now known that the health of an individual especially those of Indigenous people are linked with social factors such as control of their environment, their native lands and their health. Indigenous people are very likely to develop chronic heart illnesses if they perceive that they do not have control over their lives and due to inadequate knowledge of health and chronic illnesses. This leads to stress contributing to substance abuse, heart diseases, and mental health issues (AIHW, 2018).
One half of Aboriginal youth of age 15 years and older indulged in daily smoking and substance abuse due the environment of stress around them. One Aboriginal youth in every six reported to consume liquor at high levels. Elevated rates of hospitalization in the year were reported for Indigenous people due to chronic stress. (AIHW, 2018)
Empowering Indigenous populations by supporting their cultural practices instead of banning them and pressuring them to change their ways their customary laws and styles of governance needs to be accepted and supported. Giving them access to their lands, establishing Aboriginal controlled community health centers are some of the ways to give the Indigenous population their power and control back in their hands. The Aboriginal communities would have the opportunity to exercise control over their health through these services and make their own health decisions, address issues, and propose health agendas (FHF, 2011). This can be done through focusing on the education of the indigenous people in regard to health and spreading awareness through campaigns.
Stripping the Indigenous population of control over themselves and their lives triggers permanent negative health outcomes such as chronic stress which weakens the heart and body's immune system gets impacted, weakening the circulatory and metabolic systems associating with a spectrum of health issues especially that of heart (AIHW, 2019). Through the intervention of community-controlled health services and NGOs. The indigenous people would posses enough knowledge to be careful of their health and learn about chronic illnesses they suffer from. It would restore their health. Several positive health impacts associated with this intervention likely to include a better diet, physical fitness, improved mental health etc.
The social determinant addressed by the intervention mentioned above is the low education and due to which low levels of employment among the indigenous people. The NGOs provide the indigenous people with appropriate knowledge which equips them to take control of their health and reach out for medical care. This also encourages them to quite their bad habits as it affects their health.
The Indigenous work of Aboriginal communities emphasis on handling the social determinants affecting health and supporting the Aboriginal-controlled organizations and health services. NGOS can be involved in the intervention to help improve Indigenous health through a series of relating holistic health projects which would require community engagement and their development, literacy and education, nutrition, women's health, and addressing the underlying major reasons of health inequity.
Studies have shown that NGOs can have a high positive impact on the health of Indigenous health when they gain in-depth knowledge of their cultural practices and how government aids to help them. NGOs can provide the indigenous community with information and knowledge that they can trust. Through the campaigns held any NGOs the indigenous communities can learn about health and gain knowledge and education to prepare them to fight off illnesses, receive appropriate treatment and gain a better control over their health (Fred Hollows Foundation, 2011).
There is a high burden of CVD among the Indigenous population as the mortality rate and the prevalence of CVD is high among Aboriginal people in Australia. The reasons for disadvantages in cardiovascular health for Indigenous people are complex and lay in the impacts of social determinants such low levels of employments and education and knowledge. Lower socioeconomic status increases high-risk behaviors for CVD such as poverty, smoking, risky alcohol intake, poor diet, and physical inactivity. Low levels of knowledge and education causes the indigenous people to lose control of their health and not know how to take care of their diets and health. All of these factors impact Aboriginal people disproportionately. The public health intervention of restoring their control over their lives, health, and land by introducing Aboriginal controlled health services would prove to be effective. The intervention would be more effective if supported by NGOs. It would bring down the stress levels of the Indigenous people. Although the perception of control is one of the several factors which influence the circulatory health of Aboriginal people, it would surely bring improvements in lowering down the burden of CVD.
Australian Institute of Health and Welfare. (2018). Aboriginal and Torres Strait Islander Health Performance Framework (HPF) report 2017. Retrieved from https://www.aihw.gov.au/reports/indigenous-australians/health-performance-framework/contents/tier-2-determinants-of-health/2-14-indigenous-people-with-access-to-their-traditional-lands
Australian Human Rights Commission. (2007). Social determinants and the health of Indigenous peoples in Australia – a human rights-based approach. Retrieved from https://humanrights.gov.au/about/news/speeches/social-determinants-and-health-indigenous-peoples-australia-human-rights-based
Australian Institute of Health and Welfare. (2019). Better Cardiac Care measures for Aboriginal and Torres Strait Islander people: fourth national report 2018–19. Retrieved from https://www.aihw.gov.au/reports/indigenous-australians/better-cardiac-care-measures-18-19/contents/table-of-contents
Australian Institute of Health and Welfare. (2019). Cardiovascular disease. Retrieved from https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/cardiovascular-health-compendium/contents/what-is-cardiovascular-disease
Australian Indigenous Health Bulletin. (2019). Review of cardiovascular health among Aboriginal and Torres Strait Islander people. Retrieved from https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22media%2Fpressrel%2F6QG66%22
Australian Institute of Health and Welfare. (2016).Social determinants of Indigenous health. Retrieved from https://www.aihw.gov.au/getmedia/d115fe0f-9452-4475-b31e-bf6e7d099693/ah16-4-2-social-determinants-indigenous-health.pdf.aspx
Cornell, S, (2002).The importance and power of Indigenous self-governance: Evidence from the United States', Speech, Indigenous Governance Conference. Retrieved from https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22media%2Fpressrel%2F6QG66%22
World Health Organization. (2019). ICD-11 for mortality and morbidity statistics: diseases of the circulatory system. Retrieved from https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f426429380
World Heart Federation. (2017). Cardiovascular risk factors. Retrieved 30 May 2017 from https://www.world-heart-federation.org/resources/risk-factors/
The Fred Hollows Foundation. (2011). Non-government organizations best placed to improve Indigenous health. Retrieved from https://www.hollows.org/au/latest/non-government-organisations-best-placed-to-improve-indigenous-health
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