The Special Issue on Indigenous health

This issue of the Australian and New Zealand Journal of Public Health is devoted to the health of Indigenous people. Most of the papers are from Australian authors and address the health of Australian Aboriginal and Torres Strait Islander people. These papers give us a better understanding of what happens in Australia and contribute to the competence of public health professionals in the field. They also add to the growing international literature on the health of Indigenous people.

The articles published here, and the research methods used, can inform researchers and practitioners in New Zealand and internationally, provided readers take account of differences in national or community context. We welcome any articles that explore and contrast the experience in Australia with that in other countries. Synthesising evidence from different countries could help by pointing to where we have enough clear evidence for policy changes and where we need to focus our attention in future research.

The issue starts with two papers on Maternal and infant health. In Australia's interior, many communities are remote from the hospital care that many of us take for granted. Malinda Steenkamp and colleagues analyse the inadequacy of measures for assessing the care that mothers receive, especially those mothers who do not want to leave their communities to go to urban hospitals, an issue often reported by Aboriginal people in relation to accessing diagnosis and treatment. Elizabeth Comino and co-authors describe the meticulous way in which they established a cohort study of maternal and infant health in an urban setting in south-west Sydney. They emphasise the value of respect and reciprocity, and community participation.

Diabetes is one of the Chronic illnesses addressed in the next section. Joan Cunningham used a nationally representative sample of Indigenous Australians to show that socio-economic disadvantage does not fully explain health disparities, including rates of diabetes. Other factors like racism, stress, loss and grief also need attention. Zhiqiang Wang and Wendy Hoy provide evidence that measuring C-reactive protein provides a relatively simple way to predict cardiovascular disease in Aboriginal Australians. Geoffrey Spurling and colleagues focus on the risk of visual loss in Indigenous Australians, given the high rate of diabetes. They show that retinal photography can provide an effective screening tool for use in both urban and remote settings.

The section on Alcohol starts with an introduction by Dennis Gray and colleagues for a research program that is analysing the literature on alcohol-related problems among Indigenous Australians. One focus is on residential rehabilitation (Kate Taylor and colleagues) and another focuses on the need for high quality brief interventions in primary health care (Anthony Shakeshaft and colleagues). Bianca Calabria and co-authors show why alcohol is such a key policy issue by analysing the harm associated with excess alcohol consumption.

In the section on Health behaviours, we have grouped together a range of articles that relate to what we might call lifestyle. Reducing transmission of sexually transmitted infections and HIV/AIDS requires safer sex practices, and in turn this requires appropriate health promotion programs and accessible sexual health services. Patricia Fagan and Paula McDonell found these to be inadequate for remote-living young people in Queensland. Given the importance of physical activity for prevention of poor health, the findings by Josephine Gwynn and colleagues that Australian Aboriginal and Torres Strait Islander children are more active than other Australian children, based upon the use of a validated self-report measure, is encouraging. Two articles on tobacco consumption follow with David MacLaren and co-authors arguing that tobacco consumption in remote Aboriginal communities can be estimated using retail sales data, despite the challenges involved. Rosalind Butler and colleagues used a similar approach conducting a 12-month audit of tobacco sales in isolated communities. While smoking rates are a cause for concern, these data show low overall tobacco consumption, raising the issue of whether pharmacotherapies are likely to add much to smoking cessation programs in these settings.

The last section focuses on Opportunities for change. Emma Croager and colleagues describe a short, culturally relevant cancer education course developed for training Australian Aboriginal health workers. The course increased both knowledge and confidence. The use of brief intervention kits for reducing SNAP risk factors (smoking, poor nutrition, alcohol misuse and physical inactivity) is an attractive idea but Anton Clifford and colleagues argue that important components are missing from some kits and others may not be culturally appropriate. Angela Durey addresses the most difficult challenge: dealing with racism in Aboriginal health care. Can this racism be reduced by educating health professionals and students to deliver culturally respectful health care? She argues that racism is a cultural construction, discursively reproduced, and deeply harmful to health. Programs targeting racism seem to have short-term effects but longer-term effects are still unclear. Anti-racist initiatives need additional support, including programs to end race-based inequities in health. Lastly, Yuejen Zhao and colleagues draw on long term monitoring of disease to give us the good news is that mortality rates have declined for Indigenous people in the Northern Territory. But there is little cause for celebration: people are living longer but with a greater burden of disease because of an increase in the problems that echo throughout this special issue: diabetes, depression, nephritis/nephrosis, suicide and sense organ disorders. The authors raise the issue of how best to continue monitoring not only mortality rates but also the burden of disease.