Issue 17 / 16 May 2011

LONG-TERM goals are all very well, but not if they allow us to defer doing the things that need to be done right now.

Is it time the federal government shifted its focus away from the commitment to closing the 17-year gap in life expectancy between Indigenous and other Australians within 20 years to more realistic, short-term goals?

Last week’s federal Budget repeated the “close the gap” mantra, but didn’t provide a lot of detail on how this was supposed to happen.

Of course, we all want to see Indigenous Australians have the same life expectancy and other health outcomes as everybody else — and as soon as possible — but the focus on long-term goals at the expense of more achievable, immediate ones doesn’t necessarily serve them well.

And, let’s face it, the current government isn’t going to be around in 2031 to explain why the target wasn’t met.

What exactly the short-term goals should be will be open to debate, but you would want to see clinicians, researchers and — crucially — Indigenous people playing a central role in determining them.

Professor Wendy Hoy, professor of medicine at the University of Queensland and one of the world’s leading experts on indigenous health, argued in the MJA in 2009 that it was “implausible” to suggest the excess of chronic disease in Indigenous Australians could be extinguished within 20 years.

It could take generations to remedy the high prevalence of disease and associated risk factors in many communities, not to mention the health effects of entrenched socioeconomic disadvantage, she suggested.

The improvement in Aboriginal infant mortality over recent decades has been, as Professor Hoy told me last week, “a triumph”, though there is still some way to go before it equals that of other Australians.

But it has also brought with it an increased burden of chronic disease in later life, as those low birthweight and other frail infants who are now surviving early childhood go on to face higher risks of diabetes and cardiovascular and renal disease.

On top of that, we are only just starting to understand the epigenetic mechanisms that can transmit health risks across generations.

Factors such as poor maternal nutrition or smoking and drinking during pregnancy can cause genetic changes that compromise the health of, not just the fetus, but also its developing oocytes if it is female — thus extending the disadvantage to a third generation.

It’s easy to get depressed looking at the health statistics for Indigenous people in this country, but Professor Hoy emphasises there has been some progress and not just in infant mortality.

Aboriginal adult mortality is now falling in remote areas, she says, and rates of renal failure, while still unacceptably high, have stabilised over the past six years.

These are achievements that could be built on, if the government was prepared to set clear, specific targets for which it could be held accountable.

Now, I wonder why they might not want to do that …

Jane McCredie is a Sydney-based science and medicine writer.

Posted 16 May 2011

The MJA this week is devoted to Indigenous health issues.

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