The Link Between Primary Health Care and Health Outcomes for Aboriginal and Torres Strait Islander Australians
Utopia, Northern Territory124Aboriginal people in remote Australia have argued for many years that living in outstations on their own land is an important basis for their good health. This argument has been dismissed in the recent past, with homelands being seen as inefficient in terms of resources and worse, as attempts to preserve ‘cultural museums’.
Fortunately, one of the methodologically strongest attempts to measure changes in the health of an Aboriginal community at a local level took place in exactly this kind of environment: the Utopia region of the Northern Territory, some 250 kilometres north east of Alice Springs.
The traditional owners of the Utopia region were displaced from their lands into overcrowded remote communities and fringe camps of major towns during the 1950s and 1960s. In the 1970s, however, they gained freehold title to their land and returned to it, adopting a dispersed way of living in 16 outstations spread over 10,000 square kilometres of country. In re-establishing themselves on their traditional lands, the people of Utopia also set up a community-controlled primary health care service, Urapuntja, to provide health care to the outstations.
Two important studies have been published documenting the health of the Utopia communities. The first, published ten years ago, compared the health outcomes of people at Utopia (which was not named in the article) with those of people living at a large centralised Aboriginal community in Central Australia (also unnamed in the article).125
The first study found real differences in health status between adults in the two communities, with Utopia residents having significantly lower mortality largely due to lower rates of alcohol related injury. They also had significantly lower hospitalisation rates, were less likely to have diabetes (although not significantly so), and had a lower average BMI (body-mass index).
These health benefits were taken to be largely the result of the more active outstation lifestyle with its higher level of reliance on bush foods, plus living away from the ready availability of alcohol. The cultural aspects of people living in harmony with the land and their own holistic concept of health were also seen to be important contributing factors.
Ten years later, a follow up study looked specifically at mortality rates since 1995 and trends in risk factors.126 This study has confirmed the results of the earlier study, finding that all cause and cardiovascular disease mortality rates were lower at Utopia than for Northern Territory Indigenous people in general (although all cause mortality was still significantly worse than for non-Indigenous Territorians). There were also significant reductions in some risk factors, especially for cardiovascular disease, such as impaired glucose intolerance, high cholesterol, and smoking (in men); and a relatively low rate of hospitalisation for cardiovascular disease.
This study went beyond the earlier one to examine in more detail what might contribute to the better health of Utopia residents. In particular, the researchers looked at some of the social determinants of health to see if they might explain the difference. However, on all the usual measures – unemployment, low income, overcrowding, lack of education – Utopia fared somewhat worse than the NT Indigenous average; obviously if their health was better than average it was not due to the usual social determinants of health.
Instead, they conclude that outstation living with a better diet and greater physical activity, plus living more harmoniously with culture, family and land contributed to better health. However, they importantly identified the existence of the community-controlled Aboriginal Medical Service, and its provision of outreach (rather than just centre-based) care and chronic disease management and prevention programs such as well-person’s health checks as an important contributor to better health.
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- Lower mortality:
-lower rates of alcohol related injury
- Lower hospitalisation rates:
-low rate of hospitalisation for cardiovascular disease.
-lower rates of injury and infection
- Lower diabetes rates
- Reductions in some risk factors
-less high cholesterol
-lowered smoking in men;
-lower BMI (body-mass index);
-lower rates of hypertension in male non-diabetics
- Outstation living:
-greater physical activity
-distance from alcohol sources
- Community living
- Cultural factors:
- Primary health care:
-chronic disease prevention, early detection and management
124 Our thanks to Professor Kerin O’Dea for her participation in our key practitioner panel and her discussion of the findings from Utopia.
125 McDermott, R., K. O'Dea, et al. (1998). "Beneficial impact of the Homelands Movement on health outcomes in central Australian Aborigines." ANZJPH 22: 543-658.