Indigenous Australian children: educating for health

The conference also reignited the call for full implementation of the 1992 Council of Australian Governments Agreement.³ It decried the partial implementation of the Agreement, which endorsed national principles of equity and access to adequate and culturally appropriate service provision.

Although there have been significant advances in our medical treatment of Indigenous Australian children, these have had minimal impact on the many conditions that undermine these children's access to learning and literacy. For example, for at least the past 25 years, four to five hundred Indigenous children from remote communities have been admitted annually to the infectious diseases ward at the Royal Darwin Hospital. Associated comorbidities⁴ included dehydration (50%), malnutrition (60%), hypokalaemia (70%), iron deficiency (90%), anaemia (25%), pneumonia (24%-32%), chronic suppurative otitis media (37%), urinary tract infection (10%), and scabies (25%), often secondarily infected. All too often, chest disease is associated with chronic suppurative lung disease or bronchiectasis.⁵

Treatable hearing deficiencies in the context of poor general health are the major health-related contributors to poor literacy among Indigenous children.⁶ Chronic suppurative otitis media (CSOM) affects children's learning ability through temporary and recurring hearing loss, permanent hearing impairment, and language disorders. The World Health Organization indicates that populations with rates of CSOM of greater than 4% have a health emergency. Rates of CSOM are as high as 50% in some Indigenous communities. The Northern Territory Strategic Results Project showed that 79% of children tested had a hearing disability.²

Equally distressing is the fact that educational outcomes for Indigenous Australian children are actually deteriorating.² For example, in 1998, in the Northern Territory, 14% of Indigenous students progressed from Year 8 to Year 12, compared with 80% of non-Indigenous students. In 1998, 20% of Indigenous students achieved the national reading benchmark in the Northern Territory, compared with 78% of non-Indigenous students. Low educational attainment is also common to other urban and rural Indigenous communities. Failure to achieve literacy affects further ability to learn and to gain employment, and thus later health (see Box 2). International literature indicates that an additional year of education should reduce infant mortality by 7%-10%.⁷

Caldwell and Caldwell⁸ identify the importance of level of education on health in Third World countries, pointing to the relationship between increasing mother's education and decreasing child mortality. It appears that better-educated mothers are more likely to prevent accidents or sickness, prevent minor health problems from becoming major, and interact better with health services in obtaining the best outcomes. However, the particular problems of Indigenous Australians living in impoverished conditions within the First World are poorly understood.⁹ Trudgen outlines the sense of futility felt by Indigenous people who, after obtaining high school education and skills, find that these skills are inappropriate for the needs of their communities.¹⁰ Children with hearing problems are subjected to a dominant school culture that does not meet their cultural and language needs, and promotes a sense of failure and lowers self-esteem. This is the result of loss of control by Indigenous people, poor environmental circumstances, poor education, and a communication crisis between the dominant and Indigenous cultures.¹⁰

In order that Indigenous Australians regain control of their lives, their own solutions must be sought, heard, and acted upon as directly articulated, and not misinterpreted by policy and a particular economic agenda. We must bridge wide gaps in mutual understanding and develop partnerships between Indigenous Australians, governments, and health and education professionals.¹⁰ The major challenge is for the medical profession to acknowledge that health and education are key strategies in improving health outcomes for Indigenous Australians. Although there have been significant advances in our treatment of acutely sick Indigenous Australian children, we have failed to improve health and education outcomes. We have a responsibility, as do all Australians, to ensure that this iniquitous situation is not exacerbated further by the use of solutions that do not work for Indigenous communities. Only when we sit down and really listen — and hear — will we be able to work together to improve Aboriginal health and education.

Paul A Bauert
Paediatrician, Royal Darwin Hospital, Darwin, NT

Ngiare J Brown
Executive Officer
Australian Indigenous Doctors Association, Sydney, NSW

Bob Collins
Consultant to the Northern Territory Government on Indigenous Education
Darwin, NT

Carmel M Martin
Director of Health Services
Australian Medical Association, Canberra, ACT

1. Australian Medical Association. Position Statement on the links between health and education for Indigenous Australians. Canberra: AMA, 2001.
2. Collins B. Learning lessons. An independent review of Indigenous education in the Northern Territory. Darwin: Northern Territory Department of Education, 1999.
3. National commitment to improved outcomes in the delivery of programs and services for Aboriginal peoples and Torres Strait Islanders. Perth: Council of Australian Governments, 7 December 1992.
4. Ruben AR, Walker A. Malnutrition among rural Aboriginal children in the Top End of the Northern Territory. Med J Aust 1995; 162: 400-403.
5. Maxwell GM. Chronic chest disease in Australian aboriginal children. Arch Dis Child 1972; 47: 897-901.
6. Leach AJ. Otitis media in Australian Aboriginal children: an overview. Int J Pediatr Otorhinolaryngol 1999; 49 Suppl 1: S173-S178.
7. Acheson D. Independent inquiry into inequalities in health report, 1998. <http://www.official-documents.co.uk/document/doh/ih/part2b.htm> (September 1999).
8. Caldwell JC, Caldwell P. The impact of education on health. Proceedings of the conference "Learning lessons -- approaching Indigenous health through education"; Darwin, November 2000. Darwin: Australian Medical Association, NT Branch, 2000.
9. Gray A, Boughton B. Education and health behaviour of Indigenous Australians: evidence from the 1994 National Aboriginal and Torres Strait Islander Survey (NATSIS). Occasional Paper Series Issue No. 3. Casuarina, NT: Cooperative Research Centre for Aboriginal and Tropical Health, 2001.
10. Trudgen RI. Why warriors lie down and die. Adelaide: Openbook Publishers, 2000.

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