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Patterns of mortality in Indigenous adults in the Northern Territory, 1998–2003: are people living in remote areas worse off?

David J Scrimgeour
Med J Aust 2009; 190 (10): 545.

To the Editor: I read with interest the article by Andreasyan and Hoy,1 in which lower Aboriginal mortality rates were found in “very remote areas” compared with “remote areas” in the Northern Territory. In a previous article,2 I reported a similar finding from national data, based on information published by the Public Health Information Development Unit at the University of Adelaide.3 Thirty years ago, in this Journal, Morice outlined the health benefits that accrue for Aboriginal people moving away from larger settlements to live in smaller, decentralised communities where they can care for their country.4 There is an increasing literature to demonstrate that Aboriginal people living in smaller communities have better health than those living in larger settlements and regional towns.

These findings have policy relevance, but they appear to be ignored by policymakers. The current Australian Government is continuing previous policies that do not support decentralised communities, but rather encourage their residents to move to larger communities or regional centres, where mortality is higher. These policies appear to be heavily influenced by allegations based on narrow economic arguments that the lack of “jobs” in small remote communities is a reason for them to be closed down.5 A minister in the previous federal government derided smaller remote communities as “cultural museums”.6

It is disturbing to note that a recent major Australian Government policy announcement stated that funding for the next 6 years

. . . will support improvements to the delivery of services across 26 remote locations across the Northern Territory, Western Australia, Queensland, New South Wales and South Australia. These locations represent some of the largest concentrations of Indigenous Australians in remote Australia.7

Apparently, over 1100 smaller communities will not receive new funding. This is likely to accelerate the drift from small communities to larger settlements and towns, increasing exposure to health risks. Evidence from the Journal and elsewhere suggests that this drift will increase Aboriginal mortality.

The current Australian Government has made a commitment to “close the gap” between Aboriginal and non-Aboriginal life expectancies. The Prime Minister has also stated that his government’s policies will be based on evidence.8 Yet current policies ignore the evidence for the health benefits that accrue to Aboriginal people living in small decentralised communities. These policies also ignore the known health risks associated with larger settlements. Consequently, such policies may widen rather than close the gap.

David J Scrimgeour, Senior Lecturer
Discipline of Public Health, University of Adelaide, Adelaide, SA.
Reference Text: 
Andreasyan K, Hoy W. Patterns of mortality in Indigenous adults in the Northern Territory, 1998–2003: are people living in remote areas worse off? Med J Aust 2009; 190: 307-311.
Reference Order: 
1
PubMed ID: 
19296811
Reference Text: 
Scrimgeour D. Town or country: which is best for Australia’s Indigenous peoples? Med J Aust 2007; 186: 532-533.
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2
PubMed ID: 
17516903
Reference Text: 
Glover J, Tennant S, Page A. The impact of socioeconomic status and geographic location on Indigenous mortality in Australia 1997–1999. Occasional Paper Series: No. 1. Adelaide: Public Health Information Development Unit, 2004: 40.
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3
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Reference Text: 
Morice R. Woman dancing dreaming: psychosocial benefits of the Aboriginal outstation movement. Med J Aust 1976; 2: 939-942.
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4
PubMed ID: 
1035404
Reference Text: 
Johns G. No job no house: an economically strategic approach to remote Aboriginal housing. Canberra: Menzies Research Centre, 2009. http://www.mrcltd.org.au/research/indigenous-reports/No_Job_No_House.pdf (accessed Mar 2009).
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5
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Reference Text: 
Australian Broadcasting Commission. Vanstone says remote Indigenous communities becoming “cultural museums”. AM [radio program], 9 Dec 2005. http://www.abc.net.au/am/content/2005/s1527233.htm (accessed Mar 2009).
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6
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Reference Text: 
Australian Government Department of Families, Housing, Community Services and Indigenous Affairs. Closing the gap on Indigenous disadvantage: the challenge for Australia. http://www.fahcsia.gov.au/sa/indigenous/pubs/general/documents/closing_the_gap/p3.htm (accessed Mar 2009, link updated May 2009).
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7
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Reference Text: 
Rudd K. Address to heads of agencies and members of senior executive service, Great Hall, Parliament House, Canberra. 30 Apr 2008. http://www.pm.gov.au/media/Speech/2008/speech_0226.cfm (accessed Mar 2009).
Reference Order: 
8
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