Indigenous health
Looking beyond the numbers
As we approach national Sorry Day (May 26) and Reconciliation Week (May 26–June 3) there are plenty of reminders that health is still one of the main areas of inequity for Australia’s Indigenous population. Four studies published in this issue expand the pool of bad news, but also carry messages for a brighter future.
Glycaemic control is the key to the prevention of diabetes complications, but in practice it can be hard to achieve, as McDermott et al discovered when they audited the diabetes registers of primary healthcare centres in Indigenous communities in Torres Strait, Cape York and the Northern Territory (→ Diabetes care in remote northern Australian Indigenous communities).
Diabetes also increases the risk of coronary heart disease, and Indigenous Australians are at greater risk of both these conditions. Wang and Hoy sought to quantify the effect of diabetes on the incidence of coronary heart disease in Aboriginal Australians over time, with some unexpected findings . . . (→ Association between diabetes and coronary heart disease in Aboriginal people: are women disadvantaged?)
Less unexpected were the findings of Condon et al (→ Long-term trends in cancer mortality for Indigenous Australians in the Northern Territory). They looked beyond their analysis of cancer-related mortality among Indigenous people to enlighten us on what this says about social change and possible cancer control strategies.
According to Zhao et al, estimates of the burden of disease are a better basis for planning health resource allocation than mortality statistics (→ Burden of disease and injury in Aboriginal and non-Aboriginal populations in the Northern Territory). With this in mind they went to the Northern Territory (which has the dubious honour of having the greatest burden of fatal disease and injury in Australia) to quantify the problem using DALYs (disability-adjusted life-years).
Telling the story
Sorry Day is a good time for truth-telling. An inspiring article about the efforts of one Australian to get Aboriginal health on the MJA’s agenda a few decades ago prompted us to think about the way we represent Indigenous issues in the Journal today (Thomas (→ The upsurge of interest in Indigenous health in the 1950s and 1960s)). Armstrong and Van Der Weyden outline our newest initiative in “Indigenous health: tell us your story” . . . And what’s it like for Indigenous people trying to access healthcare? Like it or not, say Henry et al, there are elements of our healthcare system, as well as our society, that are intrinsically racist (→ Institutional racism in Australian healthcare: a plea for decency).
Piecing it together
We know that population screening for colorectal cancer will reduce the impact of the disease, but the best means of screening is still being debated. According to Viiala and Olynyk this topic is like a jigsaw puzzle, with one important "piece" being sigmoidoscopy (→ Screening sigmoidoscopy for colorectal cancer: further pieces in the jigsaw).
Buying best practice
A confusing aspect of the new childhood vaccination schedule is that, after a decade of full public funding, some of the vaccines now recommended by the NHMRC must be paid for by the parents. In “Vaccines: the new Australian best-practice schedule”, immunisation experts Burgess and McIntyre explain why the vaccines are recommended — regardless of cost.
The great pretender
It has been associated with such diverse conditions as dermatitis herpetiformis, diabetes, infertility and epilepsy, and, according to Duggan, it’s the “syphilis” of the 21st century! Turn to Duggan’s article to discover the identity of this bread-and-butter medical condition.
Teaching tip 2
Although they should be fertile grounds for enquiring minds, hospitals, surgeries and clinics don’t always make the best teaching and learning platforms. In “Teaching on the run tips 2: educational guides for teaching in a clinical setting”, Lake and Ryan discuss how to create a good educational environment for your junior colleagues, regardless of the circumstances.
All about androgens
Last, but not least, in our MJA Practice Essentials — Endocrinology series comes Handelsman and Zajac’s contribution on the use of androgen replacement therapy in men (→ 11: Androgen deficiency and replacement therapy in men). It’s a strong ending for the series, which we hope will add brawn to the brain of your practice.
A bit of support
In 2000, the RACP joined forces with federal, NSW and Victorian health authorities to test a Clinical Support Systems model. They tested the model, combining clinical practice improvement with evidence-based medicine, in four large projects involving 17 centres in 3 states. Our Supplement details some of the results, lessons and plans for the future (→ Achieving better practice — the Clinical Support Systems Program).
Another time ... another place...
We spend hours treating over-fed neurotics (and quite rightly so), whilst others in the community are suffering from malnutrition. If the life of a white citizen is threatened by fire, flood, starvation or thirst, then the Army and Air Force are called to his aid within hours (and quite rightly so); but the starving natives under similar circumstances depend upon inadequate charity.
Barry E Christophers [letter) MJA 1957; 1: 659-660