Disproportionate Rate of Diabetes among Aboriginal Australians - Case Study Example

 Socio-cultural Perspectives on Health Indigenous Australians have been found to have the fourth highest rate of Type Two diabetes in the world, a rate two to four times higher than the rate for non-indigenous Australians. Studies have estimated that between 10 and 30 per cent of aboriginal people are afflicted (Better Health Channel Team, 2005). The number of Aboriginal women that suffer with gestational diabetes is also two to three times higher than it is compared to the general Australian population. This disproportionate rate of diabetes among Aboriginal Australians is caused by multiple interconnecting issues including genetic vulnerabilities, lack of physical activity and from the conditions of poverty commonly experienced which leads to the lack of nutritional food and reduced access to medical care. Indigenous Australians have a gene structure that evolved from their long-established hunter-gatherer way of life. Their system is genetically geared so that body weight can be maintained during lean times. Modern foods are very different from what their bodies are genetically programmed to ingest which tends to make obesity, diabetes and cardiovascular disease more likely. Today’s Aboriginal diet has a lower nutritional value than they are genetically accustomed to and contains higher amounts of fats, sugars and carbohydrates which are the main causes of diabetes. Aboriginal children are undernourished due to an inadequate intake of healthy foodstuffs. It is widely considered that a nutritionally insufficient diet during childhood increases the risk of developing Type Two diabetes as an adult. Approximately sixty percent of Aboriginals are overweight and studies show that an obese person is 10 times more likely to develop Type Two diabetes than a person of normal weight (Better Health Channel Team, 2005). The Aboriginal people had led physically active lives for thousands of years but now there is no longer the need to actively hunt and gather. An inactive lifestyle contributes to higher rates of obesity and thus improved risk for the development of Type Two diabetes. Among Aboriginal women, the occurrence of gestational diabetes is more than two times higher than among other residents of Australia (Better Health Channel Team, 2005). Though this is a temporary form of diabetes, if contracted, it increases the risk of developing diabetes later in life. An Aboriginal woman is more likely to have a child with a low birth weight than is a non-Aboriginal woman as a result. Research indicates that low birth weight is also associated with an increased possibility of later developing diabetes. It is commonly acknowledged that there is a connection between people living in poor economic conditions and inherent problems of poor health care. Of all Australians, Aboriginals are the most economically underprivileged which makes them more susceptible to developing diabetes because of inadequate health care. They are financially and culturally unprepared to deal with the proper treatment of diabetes as well. In addition, for Aboriginals, especially those living in rural locations, medical care is inadequate putting this group at increased risk of complications as a result of untreated diabetes. Blindness, nerve damage and kidney failure are examples of serious complications due to unmanaged diabetes (Better Health Channel Team, 2005). Aboriginals represent two percent of the Australian population yet account for about nine per cent of all new patients experiencing kidney failure. According to an exhaustive 1998 study by Spencer et.al, Australian Aboriginals continue to experience an alarming rise in incidence of renal failure. The reason for this is “an unfortunate mix of racial predisposition aggravated by multiple adverse environmental and metabolic factors” (Hoy, 1998). Aboriginal kidney biopsy information taken at the University of Melbourne have shown a span of “pathological states underpinned by a remarkable increase in glomerular (part of the kidney through which urine is filtered) size of up to threefold normal” (Bertram, 1998). The fact that continual bacterial infections of ears, nose, chest, skin as well as prevalent intestinal parasites plague predominantly the Aboriginal population is widely acknowledged. Also well documented are the reasons behind this disparity of health and well-being as it relates to economic and dietary considerations. Following the enactment of equal pay and voting rights laws, Aboriginal unemployment rose leading to an increased sedentary welfare lifestyle. This combined with accessibility to foods that are high in fat and carbohydrates caused the obesity epidemic among these indigenous people. Overweight, out of work and forced into a culture which neither their minds nor their bodies were not ready for, the Aboriginals could only turn to alcohol to drown their sorrows. This, too was not available to them until relatively recently, thus their bodies’ internal organs have more difficulty processing a substance which is known to cause kidney disease in peoples whose ancestors have consumed sprits for many centuries. “Alcohol has several indirect but definite adverse renal effects” (Puddey et al, 1985). Alcohol also causes blood pressure to rise at about the same rate in both Aboriginal and non-Aboriginals. Obesity and alcohol have been shown to be significant causes for kidney disease that has directly resulted from diabetes (nephropathy). Both of these behavior-induced problems are very common amongst the Aborigines as is smoking which is also recognized in epidemiological surveys as “an independent risk factor for renal disease” (Hoy et al, 1997). It is normal and quite understandable for patients experiencing kidney failure to want to return to their families. How best to distribute dialysis to isolated regions is a challenge that has been successfully met by several medical units throughout Australia. A chronic ambulatory dialysis program has been in place for over a decade which was established by The Royal Perth Hospital in association with the tribal elders of Aboriginal communities along with regional medical and nursing staffs. “In Western Australia, since 1989, both Remote Area Dialysis Program (RAPD) and self-care haemodialysis have been delivered in areas up to 3500 km away from the parent nephrology unit. This has required some innovative technical approaches (such as inline water coolers, and repressurisation pumps) and training of staff to ensure cultural sensitivity (e.g., using photographic rather than written instructions, and showing respect for name avoidance after family deaths)” (Brown, 2003). This program provides access to dialysis treatment for the Indigenous Australians existing in distant areas of Western Australia who are afflicted with renal disease. “The (RADP) relocated traditional hospital services to remote communities and introduced home or community-based therapy” (Villarba & Warr, 2004). Renal transplantation is a more effective treatment than dialysis alone and usually provides the patient with a more favorable rehabilitation opportunity. It is also less expensive; however, its use is restricted because of the scarcity of donors. Tissue typing disparities between Aboriginal and non-Aboriginal populations precludes a large, ready supply of organs. Those that are available come from Aboriginal sources and therefore have the propensity to contain the same problems inherent with these people. In addition, renal transplantation is unsuitable to some recipients because of the problems associated with infections contracted under poor medical conditions in remote locations. Failing transplantation, the best alternative is self-care dialysis. These remote dialysis programs have proved their merit in that they have experienced post-operative complication and overall survival rates that approach and occasionally exceed those of urban dialysis units which treat non-Aboriginal populations. Remote dialysis is approximately 25 percent more expensive than urban self-care dialysis but 50 percent less than the cost of keeping a dependent, unhappy and rebellious Aboriginal patient in the city. However, there remain patients and regions where self-care dialysis is not feasible. “Hospital dialysis units can benefit from the use of Aboriginal liaison officers to improve cultural awareness, and to limit the sense of alienation for patients. Reorganization of renal referral patterns around geographical proximity rather than along State borders would also reduce the extent of dislocation” (Bertram et al, 1998). The primary focus involving the disproportionate kidney and diabetes problems facing Indigenous Australians is the improvement of living conditions. An improved economic environment; the availability of healthier food choices and enhanced educational techniques will result in much improved medical circumstances. “Improvements in lifestyle and medication compliance have been achieved in a sizeable proportion of communities with active programs, particularly where there is Aboriginal ‘ownership’ of the service” (Willis, 1995). The cost-benefit of remote dialysis is apparent. It has been theorized that for every year of dialysis delayed for just one patient, the resulting costs to society would pay the earnings of one Aboriginal health worker. Unfortunately, the successes that addressed the widespread malnutrition of Aboriginal children subsequently contributed to obese adults and thus a substantial increase in diabetes and liver disease. This anti-malnutrition program was implemented with good intention as is the current dialysis programs developed to reverse this trend although much more needs to be done (Margetts, 1998). Instead of attacking this issue from the end-result side, resolving economic, dietetic and social dilemmas would serve to solve the matters that initiated this disproportionate medical problem. Works Cited Bertram, J.F.; Young, R.J.; Seymour, A.E.; et al. “Glomerulomegaly in Australian Aborigines.” Nephrology. 1998. Better Health Channel Tean. “Aboriginal Health Issues – Diabetes.” (2005). Better Health Channel. June 13, 2006 Brown, Alex; Purton, Lynette; Schaeffer, Gabrielle; Wheaton, Gavin; & White, Andrew. “Central Australian Rheumatic Heart Disease Control Program: A Report to the Commonwealth.” The Northern Territory Disease Control Bulletin. Vol. 10, N. 1, (March, 2003). Center for Disease Control Northern Territory. Hoy, Wendy E.; Norman, R.J.; Hayhurst, B.G.; & Pugsley, D.J. “A Health Profile of Adults in a Northern Territory Aboriginal Community, with an Emphasis on Preventable Morbidities.” Australia New Zealand Journal of Public Health. Vol. 21, 1997, pp. 121-26. Hoy, Wendy E.; Mathews, J.D.; McCredie, D.A. et al. “The Multidimensional Nature of Renal Disease: Findings in a High Risk Australian Aboriginal Community.” Kidney Int. 1998. Margetts, C. & Morris, E. Cabinet Submission to the NT Legislature for Renal Services Funding. Darwin: Royal Darwin Hospital, February 1998. Puddey, I.B.; Beilin, L.J.; Vandongen, R.; et al. “Evidence for a Direct Effect of Alcohol Consumption on Blood Pressure in Normotensive Men: A Randomised Controlled Trial.” Hypertension. Vol. 7, 1985, pp. 707-13. Spencer, Janine L.; Silva, Desiree T.; Snelling, Paul; & Hoy, Wendy E. “An Epidemic of Renal Failure Among Australian Aboriginals.” Journal of the Royal Darwin Hospital and the Menzies Institute of Health Research. (1998). New South Wales, Australia: Australasian Medical Publishing Company. Villarba, A. & Warr, K. “Home Haemodialysis in Remote Australia.” PubMed. December 9, 2004. National Library of Medicine and National Institutes of Health. June 13, 2006 Willis, J. “Fatal Attraction: Do High Technology Treatments for End Stage Renal Disease Benefit Aboriginal People in Central Australia?” Australian Journal of Public Health. Vol. 19, 1995, pp. 603-9. Read More