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Regional health needs

Characteristics of Miwatj Health’s Clients

The Aboriginal clients of Miwatj Health typically have English only as a third or fourth language, have low incomes, are strongly linked with traditional culture, may have little western schooling, often live in over crowded accommodation and probably do not have stable ongoing employment. Of course there are many individual exceptions to this picture, but it is broadly accurate in a population sense.

The western economy of the region is dominated by two large mines, one on Groote Eylandt and the other at Nhulunbuy. Historically Aboriginal people have been excluded from active participation in the mining economy, and there are indications that Aboriginal communities closest to the mines and the mining towns may in fact have a worse health status than many of the more isolated (homeland) communities.

Nevertheless, a hybrid Yolngu economy has emerged in recent years based on a combination of small-scale tourism ventures, commercial art and craft, land management activity, mining royalties, a range of local enterprises including a regional airline and the annual Garma Cultural Festival. In this way, and through some highly articulate spokespeople, Yolngu are involved in the modern world while also tied to land and tradition.

The health profile of the indigenous population of the Miwatj region accords with the generally poor health status of Aboriginal people in the NT as a whole. Disadvantaged from the start by a low birthweight, an Aboriginal child from this region typically faces much higher rates of infectious diseases, anaemia, pneumonia, otitis media, skin diseases, rheumatic heart disease, dental problems and so on than a non-Indigenous counterpart .

In the causal interplay between child health and chronic illness, the longer outcome is very high rates of chronic diseases, particularly type 2 diabetes, cardiovascular disease, renal disease, lung and other cancers.

This is not the place for an exhaustive list of health statistics, but just two figures from a nearby community will tell the story. At community A, a Yolngu community not far from Nhulunbuy, data recorded in Miwatj Health’s patient database describes a prevalence rate for type 2 diabetes of 30% and a prevalence rate of anaemia among children from 6 months to 5 years of age of 89%. Just these two statistics should be enough to declare an ‘emergency’. Community A has an excellent health clinic but is not far from the supermarkets and alcohol outlets of Nhulunbuy, and has very high rates of smoking, including maternal smoking.

Chronic illnesses dominate the client files of Miwatj Health, and they are just as prevalent among the Yolngu residents of ‘dry’ communities as they are among those clients who live and drink in the long-grass on the fringes of Nhulunbuy. But it was not always like this: 50 years ago these diseases were rare among Yolngu.

Health Needs of Miwatj Health’s Clients

A Yolngu view of health is that the underlying cause of illness is disruptions in social relationships - which are ultimately based on relationships with land – and they see the poor health they have experienced since the opening of the bauxite mine and the construction of Nhulunbuy in the late1960s/early 1970s as evidence of this.

Historically, the main response of Yolngu to threats to their health and wellbeing in recent decades has been to develop their homeland centres, small family-based settlements on traditional land away from the alcohol and other harmful influences of Nhulunbuy and the ex-missions. The understanding that homeland centres are a way to counter illness continues among Yolngu today.

As a community controlled organisation, Miwatj Health is bound to take this community perspective into account, and so must both provide clinical individualised medicine while also tackling the social determinants of health.

From a public health perspective, the key point is that most of the chronic diseases which fill the files of Miwatj Health are preventable. The evidence from many populations over many decades is overwhelming: chronic diseases can be prevented, and also to a large extent managed once contracted, by modifying lifestyles – in particular, we know that changes in exercise, diet and cigarette smoking would prevent a major portion of today’s chronic illness deaths . Achieving such changes is, of course, not easy, but it is fundamentally important to note the agreement between the western view that exercise and diet is the answer and the Yolngu view that homeland centre life is the answer.

The conclusion from the above discussion is that an important part of Miwatj Health’s service provision must involve taking health outside the clinic, to bring it into people’s daily lives though health promotion, education and related activities. The community-based public health programs of Miwatj Health aim to achieve this in such areas of eye health, ear health, nutrition, and tobacco. There is a need for many more, but funding is not available.

Improvements in medicine over the past two or three decades have meant that it is now possible to manage many chronic diseases far more effectively than in the past. Modern drugs can drastically reduce mortality from such previously-fatal illnesses as cardiovascular disease, and the idea that patients can now self-manage their illnesses through compliance with medication regimes is seen as best practice in chronic disease care.

Until recently, Miwatj Health had focused solely on providing an acute care service. Systems did not exist in the Nhulunbuy clinic to allow long-term care planning and there was little pressure from either clients or funding bodies to improve the quality of service provision in this direction. In the past few years, however, the Commonwealth Government has placed a greater emphasis on quality improvement processes in Aboriginal health services and the most recent significant Commonwealth Indigenous health program, the Healthy for Life program, requires improvements in the quality of service provision and requires that this be measured in terms of quantitative client outcomes.

In 2008 Miwatj Health is on the verge of making a major shift in this direction – the aim is to reduce the resources put into an acute care service and increase the resources put into long-term care planning. With the quality improvement processes it is currently undergoing in its clinic operations, Miwatj Health expects by 2008 to be providing a best practice health care in terms of long-term care planning for chronic diseases.

The prevention and management of chronic diseases is one of two broad areas which Miwatj Health aims to focus on in the long-term. The other is improving child and maternal health. Like chronic illness, this will require improved service provision both in the clinic and outside the clinic in the communities. Key aims in this area will include earlier presentation by pregnant women, lower rates of pregnant women’s tobacco and alcohol consumption, an improvement in average birthweight, improved childhood malnutrition and anaemia data, lower rates of childhood infectious disease, and so on.

It is anticipated that Miwatj Health will gain funding from the Office of Aboriginal and Torres Strait Islander Health’s (OATSIH’s) Healthy for Life program in early to mid 2008. This will allow a greater degree of planning and greater amount of resources to be put into long term care planning and evidence-based strategies in relation to chronic illnesses and child and maternal health.

The mix of services provided by Miwatj Health is therefore a combination of clinical services with a focus on long-term care planning while also providing acute care when necessary, complemented by community-based programs aimed at the underlying risk factors for chronic illnesses and child and maternal health. The level of funding required to provide adequate services in any of those areas is far more than Miwatj Health receives, and on a per capita basis the Miwatj region is underfunded even in comparison with the other OATSIH planning regions in the Northern Territory.

© Miwatj Health Aboriginal Corporation 2007