Addressing cardiovascular inequalities among indigenous Australians

Alice Springs Hospital, Gap Road, Alice Springs *Email: [email protected] INTRODUCTION Growing international interest has focused attention on the need to overcome health disadvantage experienced by the world’s more than 370 million indigenous peoples [1]. Despite heterogeneity in history, culture, geography, sociopolitical context and in the relationships between indigenous people and their nation states, the existence of health and social disadvantage when compared to other populations within their countries remains almost ubiquitous [2]. Within Australia, the health and welfare of Aboriginal and Torres Strait Islander people (hereto referred to as ‘indigenous Australians’—see Figs. 1–2) remains our nation’s most obvious and enduring social and health divide [3]. Across virtually all social and health indicators, indigenous Australians live within poorer social environments and experience profoundly worse outcomes than non-indigenous Australians [4]. Despite representing only 2.5 per cent of the Australians population, indigenous Australians are overrepresented in the most disadvantaged strata of Australian society [5]. Indigenous children experience higher rates of mortality and morbidity, are more likely to be separated from their families, live in overcrowded housing and impoverished circumstances, and experience significantly worse educational outcomes than their non-indigenous counterparts. As adolescents, indigenous Australians experience higher rates of mental illness and suicide, are more likely to engage in drug taking and come into contact with the justice system. As adults, indigenous Australians are more likely to be unemployed, receive lower income, attain lower education levels and have higher morbidity and mortality from virtually all causes of disease and death. As a consequence, relatively few indigenous Australians survive beyond the age of 65 years. This high burden of disease is reflected in the demographic profile. The majority of indigenous Australians are aged less than 25 years, with a median age of 20 years (compared to 37 years in non-indigenous Australians) [6]. Life expectancy (LE) in the period 1996–2001, was approximately 59 years for indigenous males and 65 years for indigenous females. This is similar to that seen in Australian males and females almost a century ago [7], and compares to a current LE of 77 and 82 years among Australian males and females, respectively. Between the years of 2002–2006, about 70 per cent of deaths among indigenous Australians occurred prior to the age of 65 years, compared to only 20 per cent in non-indigenous Australians (Fig. 3). The principal contributor to this profound disparity in LE remains chronic diseases. Chronic diseases—including cardiovascular disease (CVD), diabetes and chronic kidney diseases—remain the leading causes of mortality and morbidity in Australia. Importantly, it is the massive differentials at young ages that define the mortality profile of indigenous Australians. As can be seen in Fig. 4, for both men and women between the ages of 35–54, mortality among indigenous Australians due to diabetes, for example, is between 20–35 times higher than it is among non-indigenous Australians. Collectively, chronic diseases account for almost 80 per cent of the life expectancy gap between indigenous and non-indigenous Australians [8].