The issue of the welfare of Indigenous Australians living in very remote communities became politicised in 2005 when former federal Indigenous Affairs Minister Amanda Vanstone dubbed the communities “cultural museums”, and questioned the government’s ability to adequately service them. Politics aside, the effect on health of remote living is far from clear. A study from Andreasyan and Hoy points to a J-curve in mortality patterns for Indigenous Australians, with those living in very remote communities in the Northern Territory actually less likely to die than those in remote towns such as Alice Springs and Katherine, where death rates were up to 9 times higher than in the general Australian population (→ Patterns of mortality in Indigenous adults in the Northern Territory, 1998-2003: are people living in more remote areas worse off?).
A study of incidence of and survival after acute myocardial infarction (AMI) in the Northern Territory compared urban and rural Indigenous with non-Indigenous populations between 1992 and 2004 (You and colleagues, “Incidence and survival after acute myocardial infarction in Indigenous and non-Indigenous people in the Northern Territory, 1992-2004”). The non-Indigenous population experienced a 20% decline in AMI incidence, and improved survival (similar to the trends found in the general Australian population), and were more likely to survive AMI if they lived in an urban centre. Indigenous people, by contrast, experienced a 60% increase in AMI incidence. They did, however, share the improvement in survival rates, irrespective of place of residence.
Lessons from disaster
Victims of previous Australian disasters, such as the Ash Wednesday fires and the Bali bombings, can draw some comfort from the observation by McFarlane and Raphael that experience and research after these tragedies may help those dealing with the psychological fallout of the recent bushfires in Victoria. Crucial to the task ahead is drawing on these past experiences to inform a process that is bound to be long and difficult (→ After the fires: looking to the future using the lessons from the past).
Scope for prevention in Indigenous kidney disease
While some of the chronic conditions that contribute to the gap in life expectancy between Indigenous and non-Indigenous Australians are already established in childhood, this is unlikely to be the case with renal disease, say Haysom and colleagues (→ Natural history of chronic kidney disease in Australian Indigenous and non-Indigenous children: a 4-year population-based follow-up study). The group tracked a cohort of more than 2000 Aboriginal and non-Aboriginal schoolchildren in New South Wales for 4 years, successfully following up about 70%. At baseline (mean age, 8.9 years), Aboriginal children had higher rates of haematuria than non-Aboriginal children (86/1248 v 36/1018), but 4 years later they were no more likely to have any persistent risk factor. Overall rates of persistent risk factors were 1.9% (haematuria), 2.4% (albuminuria), 5.0% (obesity), 1.5% (systolic hypertension) and 0.2% (diastolic hypertension).
Vitamin D and calcium — still important
The balance of evidence remains in favour of calcium and vitamin D supplementation in elderly men and women, although the effect on bone mineral density is likely to be modest, say Sanders and colleagues in a joint position statement from three learned Australian and New Zealand bodies. Boosting calcium intake above the recommended levels (about 1300 mg/day for older people) is unlikely to be of additional benefit (→ Calcium and bone health: position statement for the Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia and the Endocrine Society of Australia).
Anecdotal reports that Australian newborns are getting bigger seem to be well founded. Using the NSW Midwives Data Collection, Hadfield and colleagues confirmed that, between 1990 and 2005, mean birthweight increased by 23 g for boys and 25 g for girls. The proportion of term babies born large for gestational age (> 90th centile) also increased — from 9.2% to 10.8% in boys, and 9.1% to 11.0% in girls. Maternal factors such as a decline in smoking, increasing age, and increasing rates of gestational diabetes provided a partial, but not complete, explanation for this interesting observation (→ Are babies getting bigger? An analysis of birthweight trends in New South Wales, 1990-2005).
Flogging a dead horse?
Some of the MJA’s most innovative research finds a home in the Letters to the Editor section. Worth careful consideration in this issue is the research letter from Large, which suggests that, with homicide rates much lower in Australia than in the United States, we might be better off concentrating our efforts on increasing kidney donation by live, rather than deceased donors (→ Homicide and rates of renal transplantation in the United States and Australia).
Another time . . . another place
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