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Why closing the gap in heart disease requires a re-think from health services

Dr Lesley Russell, Menzies Centre for Health Policy, University of Sydney/Australian National University, writes:

Forty years ago, heart disease accounted for a quarter of all Australian deaths.  Since then, due largely to reduced tobacco use and better treatments, the incidence of heart disease has steadily decreased and today only 17 percent of deaths are attributed to heart disease.  Those who do suffer a heart attack and are admitted to hospital are now 75 percent more likely to survive than in 1992.

As a recent paper in the Medical Journal of Australia shows, that good news story does not apply to Indigenous people living in the Northern Territory. The incidence of heart disease in this population, which was similar to the national average in the early 1990s, has increased every year since then and is now three times higher than that in the general population.  Indigenous Territorians have a 44 percent higher risk of death from heart attack than non-Indigenous Territorians.

The incidence of heart attacks in younger people, aged 20-39 years, is ten times higher in the Indigenous population, and while non-Indigenous people who live in the more urban areas of the Territory have less heart disease and are less likely to die from a heart attack, there is no such urban protection for the Indigenous population.   There is no evidence that the situation is any different elsewhere in Australia.

There are many factors that influence this ‘cardiac gap’, including higher rates of risk factors such as smoking and co-morbidities such as diabetes and kidney disease, lower levels of compliance with clinical management plans, having affordable access to medicines, and delays in hospital presentation.

Indigenous hospital patients are less likely to get diagnostic and therapeutic procedures such as angioplasty and bypass surgery and less likely to attend a cardiac rehabilitation program when they leave hospital.

The gaps that must be bridged are as much about culture and language as they are about the provision of services and resources.  It is not just about whether there is ready and affordable access to primary and acute care and rehabilitation services – which for the rest of the population halves the death rate from heart attack – it’s about whether these services are delivered in an equitable way that is culturally suitable and acceptable for Indigenous people.

In particular work is urgently needed to characterise and address the nature, level, sources and consequences of institutional and interpersonal discrimination in the health care system in order to reduce unfair treatment, ensure equitable care and improve outcomes for Indigenous patients.

* This article was previously published in the Canberra Times

Comments 1

  1. Jon Hunt says:

    Really Indigenous health is a completely different topic in itself. To point out that cardiovascular disease is more prevalent and has poorer outcomes than elsewhere is true, but it’s a bit obvious because we know that just about every disease is worse and has poorer outcomes than elsewhere. I personally think that trying to address specific diseases is an inefficient way of dealing with these issues, mainly because it doesn’t address the more fundamental causes of their poorer health which are social, historical and cultural.

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