Household infrastructure in Aboriginal communities and the implications for health improvement

To the Editor: We were disappointed with the article by Bailie and Runcie on household infrastructure in Aboriginal communities.1 It has major methodological and ethical problems that, in our view, should have precluded its publication.

The data were not collected by a process which allows meaningful scientific analysis. In determining the state of health hardware, the authors did not outline the testing methods or how functioning of different items was assessed. No standardised procedure is evident within the process, no formalised training of those conducting the assessment is indicated, and there is no evidence that supervision or auditing of consistency was performed. In fact, these problems are acknowledged by the authors in a publication on the same project, in which they state: "There was no protocol for a number of steps in the data collection process. There was no protocol for what type of information was gathered by interviewing residents, nor for which resident was the most appropriate interviewee.

"The way data was collected varied between field officers, and the way an individual officer collected data varied between houses. Firstly, the items might be observed. Secondly, but not always, items may be tested for functionality (eg, by turning a tap on). Whether items were physically tested sometimes depended on how "clean" the house was. If it was clean, then the items were sometimes assumed to be functioning . . .".2

No amount of analysis can correct for such inadequacy in primary data. The authors dismiss this problem by referring to consistent patterns of data across different communities. This in no way addresses the problem of identifying the true level of hardware functioning. It simply suggests that measurement omission or error was widespread.

Even if the items tested did not require maintenance, this does not indicate that they were functioning adequately, as no defined and standardised tests were applied (see Appendix B, page 38, in reference 2).2

The article's ethical problems are masked by discussion about community confidentiality. The authors described an audit and assessment of health hardware without any attempt at intervention and improvement. This is in a setting where a method that links assessment and intervention has not only been established, but is now performed by different groups across a wide range of communities. In fact, this process is referenced by the authors.3

The article by Bailie and Runcie reinforces what is widely known — that Aboriginal housing is generally poor. There can be only two reasons for trying to assess the actual state of Aboriginal housing and health hardware. The first is to enable intervention to rectify the problem at the same time. The second is to enable future housing and infrastructure programs conducted by government to be technically targeted and subsequently assessed to determine whether improvement really is occurring. Unless the baseline status is accurately and reproducibly determined, then we will have no way of knowing whether such programs are actually making a difference.