To the Editor: A letter by Scrimgeour1 in the 18 May 2009 issue of the Journal praised an earlier study by Andreasyan and Hoy2 for adding to the evidence that Indigenous people living in small communities (known as “outstations” or “homelands”) in very remote areas are healthier than those living in larger settlements. I believe this was an error. The study found that mortality was lower in both outer regional areas and very remote areas than in remote areas.2 But, unfortunately, this tells us nothing about outstations. The Accessibility/Remoteness Index of Australia (ARIA) classification used by the authors groups larger remote communities and their outstations together — categorising both as “very remote”.
Scrimgeour is not alone in overstating the evidence for better health among Indigenous people living in smaller communities. The possible health benefits associated with living in outstations has become a major argument against the Australian Government’s plan to create 26 remote “hubs” that will receive improved services (to the likely detriment of smaller communities)3 and the related plan of the Northern Territory Government to develop 20 larger remote communities.4 For example, Tom Calma, Aboriginal and Torres Strait Islander Commissioner at the Australian Human Rights Commission, was reported as saying that there was “a strong body of research showing that people on homelands lived longer, healthier lives”.5 Calma seriously overstated the evidence we have to date, which consists of two studies from Utopia in central Australia and one study of land management practices in an Arnhem Land community.6-8 Although this research is encouraging, we are a long way from determining the causes of better health among sections of those two communities, and whether residence at outstations/homelands or land management practices are associated with better health in other communities as well.
There are many reasons for supporting the growth of outstations, and health may be one of them, but it is crucial that those in the field of Indigenous health get this right. Rather than jumping the gun, we need more research into the effects of outstation life on health and wellbeing.
- 1. Scrimgeour D. Patterns of mortality in Indigenous adults in the Northern Territory, 1998–2003: are people living in remote areas worse off [letter]? Med J Aust 2009; 190: 545. <MJA full text>
- 2. Andreasyan K, Hoy WE. Patterns of mortality in Indigenous adults in the Northern Territory, 1998–2003: are people living in more remote areas worse off? Med J Aust 2009; 190: 307-311. <MJA full text>
- 3. 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/default.htm (accessed May 2009).
- 4. Northern Territory Government. Working future. http://www.workingfuture.nt.gov.au/index.html (accessed May 2009).
- 5. Skelton R. Homelands plan faces massive backlash. The Age (Melbourne) 2009; 23 May: 3. http://www.theage.com.au/national/homelands-plan-faces-massive-backlash-20090522-bic7.html (accessed Sep 2009).
- 6. McDermott R, O’Dea K, Rowley K, et al. Beneficial impact of the homelands movement on health outcomes in central Australian Aborigines. Aust N Z J Public Health 1998; 22: 653-658.
- 7. Rowley K, O’Dea K, Anderson I, et al. Lower than expected morbidity and mortality for an Australian Aboriginal population: 10-year follow-up in a decentralised community. Med J Aust 2008; 188: 283-287. <MJA full text>
- 8. Burgess C, Johnston F, Berry H, et al. Healthy country, healthy people: the relationship between Indigenous health status and “caring for country”. Med J Aust 2009; 190: 567-572. <MJA full text>
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