Burden of disease refers to the years of life lost as a result of premature death and disability.1 Every episode of a person experiencing either chronic disease or an acute episode adds to the total burden of disease in a given area. In Australia however, it is difficult to get a clear picture of the extent of the burden of disease because of its varied nature,2 a reliance on the self-reporting of physician-diagnosed diseases,3 and disparities between States and Territories in data collection. Information about burden of disease and health-care conditions that have a high impact on particular populations is important for effective allocation of health resources.2
In Queensland, challenges that face primary health-care service providers include inadequate focus on the prevention of chronic disease and patient self-management strategies, coupled with a need to improve workforce capacity.4 It is reported in the literature that health-care professionals, particularly nurses, are left to manage difficult situations with few resources, thus adding to their professional workload.5
As part of a broader study, this paper describes how nurses working in remote or isolated areas of Queensland experienced their role in addressing the local burden of disease. An analysis of findings generated in a multiple-case study is presented in the context of the literature.
A review of the literature using the key words listed for this paper failed to locate any studies that identified the role of nurses in addressing the burden of disease in remote or isolated areas of Queensland. It was found, however, that in order for nurses more generally to address burden of disease in their community, a multistrategy approach is required that includes: addressing equity of access to health care, focusing on both risk and protective factors, and promoting different sectors of the health-care system working together.6
Total burden of disease increases with remoteness from major urban centres. The health of people living in rural and remote areas of Australia is poorer than those in metropolitan areas,7 with people living in these communities having a 26.5% greater burden of disease than populations in major cities.1
International studies show that a large percentage of patients with chronic diseases do not receive effective therapy or have control over their illnesses.8–10 The greatest contributors to Queensland's burden of disease are chronic diseases such as diabetes, asthma,2,11,12 and arthritis,13 all of which rank among the seven national health priority areas.14 In remote or isolated areas of Queensland, cardiovascular diseases, road traffic accidents, injury, chronic obstructive pulmonary disease, diabetes6,15 and suicide16 are leading causes of death.
Risk factors such as smoking, alcohol consumption,17 inadequate fruit and vegetable consumption,1,18,19 physical inactivity, hypertension, high blood cholesterol and obesity also attribute to high mortality rates20 with a doubling of resultant hospitalizations projected over the coming decade.4 The burden of disease for individuals increases with more severe obesity because of their high susceptibility to develop a second and third morbidity.3 The burden of chronic disease also increases with the high cost of healthy food, particularly among people of low socioeconomic status.18 Prevention and effective management of chronic diseases and promotion of healthy habits are best addressed through an effective and ongoing relationship between health-care provider and patient,21 a situation in which nurses can play major role.
Queensland has the largest Indigenous population after New South Wales including over 60% of the total Torres Strait Islander population.22 In Australia, Indigenous people have higher rates of hospitalizations and a greater prevalence of chronic disease, in particular renal diseases.23 Indigenous Australians have a lower life expectancy than non-Indigenous Australians,14,24 with a 2.5 times greater burden of disease than the total Australian population.25
In 2003, the burden of disease and injury for Indigenous Australian children was 21% of the total burden of disease and injury for all Indigenous Australians.25 Rates of chronic health problems in Aboriginal and Torres Strait Islander children in remote Far North Queensland reflect the broader Indigenous population and are alarmingly high, which has created a situation that requires active public health interventions.26
A comprehensive primary health-care approach is the most effective way to address Indigenous health needs in Australia,27,28 in which adequate resources and well-supported staff are essential.29 Such an approach will go a long way towards addressing the total burden of disease in remote areas. A study in the Northern Territory found less than expected mortality and morbidity rates in an Aboriginal cohort, which was contributed to the standardized nature of primary health-care services provided.30 Factors that contributed to the good health of this cohort included community-controlled social and health-care delivery, successful prevention of chronic illness, and lower rates of obesity and smoking. The Federal Government has commissioned a National Primary Health Care Strategy that we hope will address many of the issues that we identified in the literature. In the future, such a strategy will place much more importance on addressing the burden of disease in Australia.31 In the meantime, it is of value to understand the role of health-care professionals in identifying and managing the burden of disease in remote and isolated communities.