To the Editor: In a recent article,1 Scrimgeour showed the differences between death rates in Aboriginal people and in the general Australian population. He used the Accessibility/Remoteness Index of Australia (ARIA)2 to show that Aboriginal people in remote areas generally had higher death rates than those near major health facilities. However, this widely used tool is inaccurate when applied to some health facilities.
Cherbourg Aboriginal community (population about 2600) is located in the South Burnett district of south-eastern Queensland, 260 km by road from Brisbane. It has a 10-bed hospital with two resident doctors. There are several small towns (population 1000–3000) in the district. Two have hospitals with no full-time medical staff. The main centre is Kingaroy (population about 12 000), 50 km from Cherbourg. It has a 60-bed hospital with resident staff, but no specialists or consultants. There are general practitioners but no medical specialists in the district, although some specialists visit for a day or so per month. Most patients needing specialised services go to public hospitals in Brisbane (220 km away [from Kingaroy]), Toowoomba (170 km away) or Nambour (140 km away), where waiting lists are long. Children go to children’s hospitals in Brisbane, either by road (a 3-hour journey) or by helicopter.
The ARIA index ranges from 0.0 (major city) to 12.0 (very remote area). Cherbourg (classed with Murgon, 5 km from Cherbourg) has an index of 2.9 and Kingaroy, 2.6. The cities of Darwin, Cairns and Townsville, all with major hospital and health facilities, have an ARIA index of 3.0, while Alice Springs, which also has a major hospital and specialists, has an ARIA index of 6.0. Clearly, the remoteness index is not a good indicator of the availability of local specialist health services.
The ARIA classification is widely used. The anomaly of the South Burnett and Cherbourg Community may (or may not) be the only problem with the index. Until such anomalies are corrected and ARIA is validated, any results derived using the index should be treated with caution.
- Alan E Dugdale
- Department of Paediatrics and Child Health, University of Queensland, Brisbane, QLD.
- 1. Scrimgeour D. Town or country: which is best for Australia’s Indigenous peoples? Med J Aust 2007, 186: 532-533. <MJA full text>
- 2. Measuring remoteness: Accessibility/Remoteness Index of Australia (ARIA). Revised edition. Canberra: Commonwealth Department of Health and Aged Care, 2001. (Occasional papers: New Series No. 14.) http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/9E3A2AAA51E74 D2ACA256F1800575941/$File/ocpanew14.pdf (accessed Aug 2007).