Volume 219 Issue 8

The spotlight is on the kidney health of Aboriginal and Torres Strait Islander peoples, with a new supplement published today in the Medical Journal of Australia. The supplement highlights the need for equity for Aboriginal and Torres Strait Islander people who require a kidney transplant and demonstrates the importance of engaging with Indigenous communities about their health and wellbeing needs. “Recorded rates of kidney failure requiring dialysis or transplantation among Aboriginal and Torres Strait Islander Australians have risen progressively over the past 40 years, remaining consistently higher than rates for non-Indigenous Australians,” wrote the authors, including Professor Jaquelyne Hughes, a clinical research professor at Flinders University and a consultant nephrologist. “Aboriginal and Torres Strait Islander people have age-adjusted incidence rates of kidney replacement therapy — dialysis or transplantation — eight to nine times higher than those of non-Indigenous Australians, with the median age of Aboriginal and Torres Strait Islander people who experience kidney failure being nearly 30 years younger than non-Indigenous people.” In light of this information and community and clinician prioritising, a 23-member National Indigenous Kidney Transplantation Taskforce (NIKTT) was commissioned in 2019. It has worked to improve access to the kidney transplant waiting list for Aboriginal and Torres Strait Islander peoples. “The taskforce looked within ANZDATA to learn about presenting a data pathway of clients and clinicians working together through the transplant assessments,” Professor Stephen McDonald, Chair of NIKTT, said. “Taskforce members also said they needed local support to improve the local pathway, and NIKTT supported seven local projects with a one-year equity and access sponsorship.” The NIKKT was tasked with reporting on the extent of effort to reduce cultural bias in the kidney transplant area. It worked with the Lowitja Institute, which produced a cultural bias report that identified a dearth of publications. This highlights how future health improvements in kidney transplantation should be designed and also publicly reports on cultural bias and the steps taken by the NIKKT to mitigate cultural bias influencing access to transplantation. It was therefore crucial to establish a national network of Indigenous Reference Groups; this was led by supplement co-author Kelli Owen, the national community engagement coordinator for the NKTT. “Although there have been so many efforts to improve kidney health outcomes for Aboriginal and Torres Strait Islander people, there has not been a coordinated approach to consultation on addressing these challenges or improving service delivery,” Ms Owen said. “The key focus of the Taskforce is embedding our people’s self-determination and authority into designing models of care to improve access to kidney transplantation. “Before the establishment of the Indigenous Reference Groups, there was very limited input by Aboriginal and Torres Strait Islander consumers into the processes of care in renal units and no input about care in kidney transplant units.” Health systems across Australia need to be empowered to embrace and work with Indigenous knowledges, the authors wrote. “For Aboriginal and Torres Strait Islander peoples living with kidney disease and after transplantation, the health system must embed true partnership, engagement and, most importantly, real change from existing verbal feedback that is backed by evidence,” Ms Owen said. The MJA’s cover page today also features a photo of message sticks. “The message sticks depicted on the cover of the MJA today were purchased for our Indigenous Reference Groups,” Ms Owen said. “The message sticks help keep formalities at a meeting, with only the person holding a stick being able to have the floor.” Professor Hughes said the message sticks and the MJA cover were a visible demonstration of the way the taskforce and communities and listening to each other and working collaboratively. “The taskforce was a fantastic opportunity for Aboriginal and Torres Strait Islander peoples to create change they needed in health care, with the Indigenous Reference Groups carrying the voice and message of our people back to the taskforce and onwards to Canberra,” Professor Hughes said. “We look forward to a commitment for continued support of the Taskforce, so that we can be sure that improved kidney health and wellbeing among all our people is seen in real improvements in peoples lives and captured in routine data reporting.” Read the research in the Medical Journal of Australia. The Medical Journal of Australia is a publication of the Australian Medical Association. Media contacts: The media is invited to contact Callum Macpherson, Media & Production Officer at SAHMRI on 0419 607 905 or Callum. Macpherson@sahmri.com.

Sam Hunt

The Medical Journal of Australia (MJA) has joined more than 200 health journals to urge the World Health Organization to declare the deadly climate change and nature crisis as a global health emergency. The journals from across the world have come together to simultaneously publish an editorial calling on world leaders and health professionals to recognise that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe. Co-authored by MJA Editor-in-Chief, Professor Virginia Barbour, the editorial argues that it is a “dangerous mistake” to respond to the climate crisis and the nature crisis as if they were separate challenges. The editorial is published in leading titles from around the world, including the MJA, The BMJ, The Lancet, JAMA, the East African Medical Journal, The National Medical Journal of India and the Dubai Medical Journal. Commenting on the editorial, Professor Barbour said that Australia must join other countries in taking action into this pressing issue. “The international academic community has spoken and it is clear that all governments must come together now to tackle the climate and nature crisis,” Professor Barbour said. “Here in Australia, we are seeing the effects of the accelerating climate crisis first hand. As we head into the southern hemisphere summer, Australians are only too aware of the potential for catastrophic events. The good news is that we can influence what happens in the future, but this will only happen through joint international action, including by Australia.” Human health is damaged directly by both the climate crisis and the nature crisis, with the poorest and most vulnerable communities often bearing the highest burden, the authors write. Rising temperatures, extreme weather events, air pollution, and the spread of infectious diseases are some of the major health threats exacerbated by climate change. For example, access to clean water is fundamental to human health, yet pollution has damaged water quality causing a rise in water-borne diseases, and ocean acidification has reduced the quality and quantity of seafood that billions of people rely on for food and their livelihoods. Biodiversity loss also undermines good nutrition and constrains the discovery of new medicines derived from nature, while changes in land use have forced tens of thousands of species into closer contact, increasing the exchange of pathogens and the emergence of new diseases and pandemics. Communities are healthier if they have access to high quality green spaces that help filter air pollution, reduce air and ground temperatures, and provide opportunities for physical activity. Connecting with nature also reduces stress, loneliness and depression while promoting social interaction — benefits that are threatened by the continuing rise in urbanisation. For Indigenous people, caring for and connecting with nature is especially important for their health.

Sam Hunt