Search

Abstract: Using the experience and reflections of a non-Indigenous clinician and researcher, Randolph Spargo, who has worked in remote Aboriginal Australia for more than 40 years, this paper tracks how [...]

Objective: To examine the impact of a multi-component health assessment on mortality and morbidity in Kimberley Aboriginal residents during a 13-year follow-up. Method: A population-based randomised controlled trial using linked hospital, cancer and death records to evaluate outcomes in 620 intervention and 6,736 control subjects. Results: The intervention group had a higher rate of first-time hospitalisation for any reason (IRR=1.37; 95% CI 1.25-1.50), a higher rate of injury-related hospital episodes (IRR=1.31; 95% CI 1.15-1.48) and a higher notification rate of alcohol-related cancers. There was a smaller difference in the rates of multiple hospitalisations (IRR=1.14; 95% CI 0.75-1.74) and no improvement in overall mortality compared with controls (IRR=1.08; 95% CI 0.91-1.29). Conclusions: There was no overall mortality benefit despite increased health service contact associated with the intervention. Implications: Although not influencing mortality rates, multi-component health assessment may result in a period of increased health service use in Aboriginal and Torres Strait Islander populations, thus constituting an 'intervention'. However, this should not be confused with systematic and sustained interventions and investment in community development to achieve better health outcomes.

In the first of two articles (see Brady in this issue) reviewing the field of Aboriginal alcohol use and misuse, the author describes tenacious stereotypes of Aboriginal drinking, and outlines problems that have until recently prevented the development of quantitative studies. The available research material indicates that while non-drinkers constitute a higher proportion of the surveyed populations, those Aborigines who are drinking are likely to be consuming alcohol at harmful levels. These findings, which are consistent with research on other indigenous groups in the Pacific and North America, are cause for concern, being associated with high levels of morbidity and mortality. The need for more systematic and reliable research, particularly longitudinal studies, is emphasised.

In Australia, the Royal Commission into Aboriginal Deaths in Custody has done more to draw attention to the experience of Aborigines nationwide than any of its many predecessors. In this first paper the author summarises findings of the Commission to date and draws attention to the wider contexts of suicides in custody by providing information on self-harmful behaviours and changing Aboriginal mortality patterns from the remote Kimberley region of Western Australia.

Statements regarding the absence of suicidal and other self-harmful behaviour among Australian Aborigines are now untenable. The preceding paper presented the wider context of suicides in custody by examining suicide and other self-harmful behaviour in the Aboriginal population of the Kimberley region of Western Australia. The emergence of suicide in that population was further located within an increase in deaths from non-natural causes over the last two decades. Following a brief history of the region, this paper develops an even wider context -- suicidal behaviour among indigenous groups elsewhere. The relevance of these findings to the trends among Kimberley Aborigines is explored, leading to the central theme of the paper, the importance of an understanding of the socio-historical context in evaluating emerging patterns of harmful behaviour, and their relationship to alcohol use. Results obtained during a survey of the patterns and consequences of alcohol use from a stratified random sample of 516 Kimberley Aborigines are presented. The author concludes by using the behaviours described in this and the preceding paper to examine the way in which Aboriginal 'problems' are constructed by the wider society, and 'solutions' defined.

Indigenous Australia and alcohol policy: meeting difference with indifference Maggie Brady UNSW Press, Sydney, 2004, 168 pp, ISBN 0868405353 Maggie Brady's latest book, Indigenous Australia and alcohol policy: meeting difference [...]