5.5 Aboriginal health and health care
Before discussing the biological and behavioural risk factor prevalence levels of Aborigines in Bourke (see chapters 6 and 7), some mention needs to be made of their current health status. In this study the health status of adult Aborigines was evaluated by assessing current patterns of Aboriginal and non-Aboriginal mortality and
Aboriginal adult survivorship; and by determining community levels of adult morbidity, health care services use, and familial support. Although this appraisal is rather limited, it does provide some insight into the existence of community mortality and morbidity differentials and the reliance of Aborigines on health care services and family members for medical care, support, and advice.
5.5.1 Direct estimates of Aboriginal and non-Aboriginal mortality
Although no outright comparisons have been made of regional differences in mortality, death rates for the western New South Wales population (as for the populations of other rural areas of the state) as a rule seem to be higher than those for the total New South Wales population. These differences are generally assumed to be a result of the higher proportion of Aborigines and lower proportion of ethnic-bom Australians in rural areas. To test whether these assumptions are correct, potential differences in the levels of Aboriginal and non-Aboriginal mortality were assessed using information collected on all deaths and their causes in Bourke and Brewarrina from 1979 to 1988.
Differences in Aboriginal, non-Aboriginal, and total New South Wales mortality
regimes were evaluated by constructing life tables and age- and cause-specific mortality rates. As in chapter 4 when comparing changes in Aboriginal mortality over time (see section 4.3.2), life expectancy was evaluated by constructing a measure of standard
o
error around each e x value (the life expectancy at age x) so as to provide reasonable estimates of the possible variability in life tables caused by small numbers and to compare Aboriginal with non-Aboriginal expectation of life. Age- and cause-specific rates were appraised by constructing relative risk ranges based on a ratio of the
Page 153 Aboriginal or non-Aboriginal rate to the 1986 total New South Wales rate. Finally, to limit the effects of small numbers, age intervals were grouped and the calculation of relative risk ranges was limited to a small selection of relevant causes of death and to age- and cause-specific rates based on five or more deaths.
For the 1979-1988 period, Aboriginal life expectancy at birth in Bourke and Brewarrina was 47 years for males and 61 years for females and was notably lower than figures calculated for Aboriginal males and females in western New South Wales, 1984-1987 (see Tables A1.14 and A1.15 in Appendix 1). In fact, these figures represent a
significant gap of six years for males and five years for females between community and regional life expectancies at birth. Among females, this difference is not significant after 34 years of age; while among males, it remains significant at all ages. Non-
Aboriginal life expectancy at birth in these two communities was estimated to be 76 years for males and 84 years for females. However, these figures are probably fairly inaccurate because of the small number of deaths occurring at younger ages and the large number at older ages (see Table 5.7). Non-Aboriginal sex-specific life
expectancies in these two communities are probably much closer to figures for the total New South Wales population in 1986 of 73 years for males and 79 years for females (Australian Bureau of Statistics, 1988c). Nevertheless, Aborigines in Bourke and Brewarrina can expect to live approximately 20 years less than their non-Aboriginal counterparts.
Substantial disparities in the levels of Aboriginal and non-Aboriginal crude and age- specific mortality also exist in these two communities. As shown in Table 5.6, when differences in the Aboriginal and total New South Wales age structures are
standardized, Aborigines have a death rate for males which is six times and for females which is almost three times the total New South Wales rate in 1986. In comparison, males and females in the non-Aboriginal population of Bourke and Brewarrina have death rates which are slightly lower than or the same as the total New South Wales
population. Aborigines also have much higher age-specific death rates than non- Aborigines (see Table 5.7). Among males, Aboriginal rates were found to be higher than non-Aboriginal at all ages with the difference in relative risk of death being highest between the ages of 25 and 64 years; while among females, the most prominent
differences in age-specific death rates were found for those under one year of age and 45 years of age and over.
When cause-specific death rates are compared, the most apparent difference between Aborigines and non-Aborigines in the two communities is in their rates of circulatory system diseases (see Tables 5.8 and 5.9). Among Aborigines, the rate of death from heart disease was at least five times higher for males and at least two times higher for females than the rates for their non-Aboriginal or total New South Wales counterparts. As a rule, Aboriginal cause-specific death rates tend to be much higher than non- Aboriginal or total New South Wales rates; while non-Aborigines tend to have cause- specific death rates very similar to or lower than those experienced by the total New South Wales population.
These results clearly suggest that the Aboriginal as opposed to the non-Aboriginal mortality regime is the most important factor in increasing the overall level of mortality in Bourke and Brewarrina. Aborigines have appallingly high death rates, especially during adulthood and most notably from circulatory system diseases; while non- Aborigines have age- and cause-specific death rates very similar to those found among the total New South Wales population. These non-Aboriginal rates indicate that even if there is a lower proportion of ethnic-bom Australians among the non-Aboriginal
population in Bourke and Brewarrina, this lower proportion has little effect on the overall level of mortality.
Page 155 Table 5.6 Crude and standardized death rates1 and standardized mortality ratios2 for Aborigines and non-Aborigines living in two western New South Wales communities3,
1979-1988, and the total New South Wales population4, 1986, by sex.
Males Females
A b o r i g i n a l, 1 9 7 9 - 1 9 8 8
Total number of deaths 116 55
Crude death rate 17.4 8.0
Standardized death rate 49.3 20.3
N o n - A b o r ig i n a l , 1 9 7 9 - 1 9 8 8
Total number of deaths 184 95
Crude death rate 6.9 4.1
Standardized death rate 7.3 5.4
N e w S o u t h W a l e s , 1 9 8 6
Total number of deaths 22,571 19,596
Crude death rate 8.2 7.1
S t a n d a r d i z e d m o r t a l it y r a tio
Aboriginal standardized rate 603 287
to New South Wales crude rate (504 - 727) (219 - 385)
Non-Aboriginal standardized rate 90 76
to New South Wales crude rate (78 - 105) (62 - 94)
1. Rates are deaths per 1,000 population per year. Aboriginal and non-Aboriginal crude death rates were directly