PUBH6000: Cardiovascular Disease and Indigenous Australians Report

This report investigates the prevalence and impact of cardiovascular disease (CVD) among Indigenous Australians, highlighting it as a significant health disparity. The introduction establishes CVD as a major health issue, emphasizing the higher incidence among Indigenous populations compared to non-Indigenous Australians. The report explores the burden of CVD, including specific diseases like coronary heart disease, and examines prevalence, mortality rates, and social determinants. Social determinants such as socioeconomic status, health inequalities, and the social gradient are analyzed as risk factors. The report proposes an intervention, the Medical specialist outreach assistance program (MSOAP), to address these determinants by improving access to healthcare services and education. The education sector is also suggested as an important sector to be incorporated into the intervention. The report concludes by reiterating the prevalence of CVD and the effectiveness of the proposed intervention in preventing and minimizing the effects of CVD among Indigenous Australians.

Running head: Cardiovascular Disease 1
Cardiovascular Disease Among Indigenous Australians
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Introduction
Cardiovascular disease (CVD) is the major influencing factor in the variation of the
health between Indigenous and non-Indigenous Australians. The inequalities in health among the
Indigenous and non-Indigenous Australians have been reported by the World Health
Organization as the most significant (Commission on Social Determinants of Health, 2015). The
Indigenous Australian population has the highest incidence of CVD compared to their non-
Indigenous counterparts. There is, therefore, a need to explore the prevalence of Cardiovascular
Disease and social determinants such as socioeconomic status, employment, health inequalities,
and social gradient among the Australian Indigenous population. This also affects their life
expectancy. This essay will also propose an intervention to help prevent and reduce
cardiovascular disease among the Australian Indigenous population. More specifically, the
intervention will address accessibility to quality healthcare services, affordability, and health
inequality. Another relevant sector that can be incorporated into the intervention apart from the
health sector will as well be examined.
SECTION ONE
Burden of Cardiovascular Disease among Indigenous Australians
Cardiovascular disease (CVD) comprises of the diseases that affect the heart or blood
vessels. The condition is characteristic of accumulated fatty deposits within the arteries and an
increased rate of blood clots. Some of the diseases categorized as CVD and affecting the
Indigenous Australians include coronary heart disease, cerebrovascular disease, congenital heart
disease, hypertension among others.
Prevalence and Mortality

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Chronic heart-related diseases were 1.2 times and 1.4 times more prevalent among the
Indigenous males and females respectively than the non-Indigenous Australians (Gray, Brown,
& Thomson, 2012). All the age groups of the Indigenous community were much more affected
by CVD than their counterparts with the Indigenous population having an earlier age of onset
than non-Indigenous people. 12% of all the Indigenous people examined by the National
Aboriginal and Torres Strait Islander Health Survey (McMahon, Wycherley, O'Dea &
Brimblecombe, 2017) experienced acute heart or associated condition. Those residing in the
remote areas were relatively affected more (14%) than those living in towns (11%). The
prevalence of CVD among the Australian Indigenous population is also measured in terms of the
hospitalization rates. According to the statistical reports of 2008-2009, Indigenous Australians
were hospitalized twice more than their non-Indigenous community in all the age groups.
Moreover, the young and middle adults aged 35 to 54 were more affected than other age groups
(AIHW, 2015).
Cardiovascular disease is the major cause of mortality among the Indigenous population
in most of the Australian states. The Indigenous Australians are twice likely to succumb to CVD
than the non-Indigenous Australians. Additionally, the mortality rates were much higher among
the Indigenous Australians in all the age groups, with a significant disproportion among middle-
aged adults (Marmot, 2011).
Social Determinants of Cardiovascular Health Among Indigenous Australians
The social determinants of health imply the close association between resultant health
and the living and working surroundings that influence the social settings. The existing

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Indigenous social determinants of health act as risk factors for cardiovascular diseases. Examples
include socio-economic position, health inequalities, education among others.
Social-economic status
Studies show that the Indigenous populations are the lowest income group across all ages
compared to their non-Indigenous counterparts (AHMAC, 2015a). For instance, the mean gross
household income for the non-Indigenous population was $585 per/ week compared to that of the
Indigenous Australians $364 per/week. Moreover, the rate of unemployment of three times
higher for Indigenous community than their counterparts. The highest level of school among the
Indigenous community for year 9 and 12 were 30% and 50% respectively. The distinct disparity
in the health of the Indigenous community is attributable to their lower socioeconomic status.
Studies have shown a relationship between behavioral risk factors and socioeconomic position
such as smoking (Lucero et al., 2014). Unemployed and poorly educated Indigenous Australians
have poor health because it affects their capacity to use available health information. Moreover,
their low income reduces their access to health care services and early treatment of CVD (Price,
& Rogers, 2019). As a result, the CVD becomes acute making treatment difficult.
Health Inequalities
Low socioeconomic status of Indigenous Australians is a risk factor for health
inequalities because the community can not afford quality healthcare services like the non-
Indigenous population. For example, the study by Markwick et al. (2014) on the health
inequalities among the Australian Indigenous populations found out that the Aboriginal
Australians were less likely to go for routine medical check-ups such as blood pressure checks
and to seek medical advice for mental health cases. Furthermore,
Social Gradient

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The social-economic gradient is observable in the early years of the Indigenous children.
Non-Indigenous children from households with higher income display better health than the
Indigenous Australians. The Indigenous mothers in 2013 were twice (12.2%) likely to give birth
to low birthweight babies compared to non-Indigenous mothers (6.1%) (AIHW 2015b). Low
socioeconomic gradient among Indigenous populations was attributable to poor infant diet which
is linked to poverty and acute heart diseases in their teenage or adult lives (AIHW 2015c).
SECTION TWO
An Intervention to Address Social Determinants of Cardiovascular Disease among
Indigenous Australians
The Medical specialist outreach assistance program (MSOAP)
The MSOAP was initiated in 2000 to enhance access to healthcare services in areas
outside the cities. The program also increases accessibility to a variety of maternity services for
Indigenous expectant women and their families during the whole antenatal and postnatal periods
(MSOAP, 2010).
The specific objectives of the program include:
 Improve hospital visits for specialized services
 Support healthcare workers to provide healthcare services to outside the cities
 Facilitate visiting experts and local nurses to provide outreach medical services in the
rural community:
 Catering for travel expenses such as flights, accommodation costs and any other
associated costs incurred by visiting healthcare providers

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 Increase the range of healthcare services provided by visiting health experts to effectively
improve the health of Indigenous Australians.
 Support the growth and development of skills of healthcare experts in rural and remote
areas based on the community needs.
(National Aboriginal Community Controlled Health Organisation, 2012).
The MSOAP is an effective program that could prevent cardiovascular heart disease
among Indigenous Australians by addressing the significant social determinants of the disease.
The increase in the accessibility to quality healthcare services for the Indigenous community in
the remote and rural areas through the facilitation of the healthcare specialist will help prevent
CVD (Joyce, & McGrail, 2014). This is because the Poor Indigenous population will easily
access the same quality of healthcare services that their non-Indigenous counterparts’ access at
no fee
The intervention also supports the continuous advancement of healthcare skills to enable
them to provide a range of services. This implies that the Indigenous community will be able to
obtain basic education on healthful practices, thus reducing the risk of developing CVD.
Additionally, expectant mothers will be provided with basic information on infant diet to help
build their immune system and prevent the development of acute heart diseases in their
adulthood (McMahon, Wycherley, O'Dea, & Brimblecombe, 2017).
Since the healthcare providers are fully facilitated to the rural and remote areas, the
intervention will have catered for the problem of transportation which is a hindrance to the
accessibility of healthcare services among the Indigenous community. Moreover, the
intervention ensures the availability of a range of healthcare services in addition to the increase

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in the number of hospital visits by the community. This will ensure that CVD is detected early
and treated early.
Other Sector Aside from the Health Sector
The Education sector apart from the health sector could be incorporated into the
intervention
Education Sector
The Education sector can be included in the MSOAP intervention to provide education
services on basic preventive health. Additionally, the Education sector can play a significant role
in promoting education among the Indigenous community as a way of preventing and
minimizing the effect and prevalence of CVD.
Studies have shown that education is directly related to the health status of individuals
(Sun et al., 2013; Reisi et al., 2012). For instance, the study by Berkman et al. (2011) attributed
poor health status to poor education and literacy. This is because poor education and literacy
reduces accessibility to health information and high incidences of risky behaviors. This is true
for Indigenous Australians, who have high incidences of tobacco smoking, excessive
consumption of alcohol and poor diet (DiGiacomo et al., 2011; Calabria et al., 2010) The AIHW
(2015a) reported that 42% of Indigenous adults smoked compared to non-Indigenous Australians
(16%) and were much more likely to develop blood pressure (25% and 21% respectively).
Conclusion
Cardiovascular disease among Indigenous Australians is much more prevalent than non-
Indigenous Australians across all age groups and also a major cause of death. Statistically, the

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Indigenous Australians are twice more likely to die of CVD than non-Indigenous counterparts.
Such a trend is attributable to the existing social determinants such as low social economic
status, health inequalities, and distinct social gradient. The Medical specialist outreach assistance
program (MSOAP) is an appropriate intervention to help prevent the prevalence and effect of
CVD among Indigenous Australians. It addresses the major social determinants such as health
inequalities, accessibility to healthcare services and education. The education sector could be an
important sector to be incorporated into the intervention.

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References
AHMAC (Australian Health Ministers’ Advisory Council). (2015a). Aboriginal and Torres Strait
Islander Health Performance Framework: 2014 report. Canberra: AHMAC.
Australian Institute of Health and Welfare (AIHW). (2015). Cardiovascular disease, diabetes and
chronic kidney disease—Australian facts: Aboriginal and Torres Strait Islander people.
Cat. no: CDK 5. Canberra: AIHW. Retrieved from
https://www.aihw.gov.au/reports/heart-stroke-vascular-disease/cardiovascular-diabetes-
chronic-kidney-indigenous/contents/summary
Australian Institute of Health and Welfare (AIHW). (2015b). Aboriginal and Torres Strait
Islander Health Performance Framework 2014 report: detailed analyses. Cat. no. IHW
167. Canberra: AIHW.
Australian Institute of Health and Welfare (AIHW). (2015c). Australia’s mothers and babies
2013—in brief. Perinatal statistics series no. 31. Cat. no. PER 72. Canberra: AIHW.
Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low
health literacy and health outcomes: an updated systematic review. Annals of internal
medicine, 155(2), 97-107.
Calabria, B., Doran, C. M., Vos, T., Shakeshaft, A. P., & Hall, W. (2010). Epidemiology of
alcohol‐related burden of disease among Indigenous Australians. Australian and New
Zealand journal of public health, 34, S47-S51.
Commission on Social Determinants of Health. (2015). Closing the gap in a generation: health

Cardiovascular Disease
10
equity through action on the social determinants of health. 2008. World Health
Organization: Geneva.
DiGiacomo, M., Davidson, P. M., Abbott, P. A., Davison, J., Moore, L., & Thompson, S. C.
(2011). Smoking cessation in indigenous populations of Australia, New Zealand, Canada,
and the United States: elements of effective interventions. International journal of
environmental research and public health, 8(2), 388-410.
Gray, C., Brown, A., & Thomson, N. (2012). Review of cardiovascular health among Indigenous
Australians. Australian Indigenous HealthInfoNet. Retrieved from
http://www.healthinfonet.ecu.edu.au/heart_review
Joyce, C. M., & McGrail, M. R. (2014). Adoption, implementation and prioritization of specialist
outreach policy in Australia: a national perspective. Bulletin of the World Health
Organization, 92, 512-519.
Lucero, A. A., Lambrick, D. M., Faulkner, J. A., Fryer, S., Tarrant, M. A., Poudevigne, M., ... &
Stoner, L. (2014). Modifiable cardiovascular disease risk factors among indigenous
populations. Advances in preventive medicine, 2014.
Markwick, A., Ansari, Z., Sullivan, M., Parsons, L., & McNeil, J. (2014). Inequalities in the
social determinants of health of Aboriginal and Torres Strait Islander People: a cross-
sectional population-based study in the Australian state of Victoria. International journal
for equity in health, 13(1), 91.

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11
Marmot, M. (2011). Social determinants and the health of Indigenous Australians. Med J
Aust, 194(10), 512-3.
McMahon, E., Wycherley, T., O'Dea, K., & Brimblecombe, J. (2017). A comparison of dietary
estimates from the National Aboriginal and Torres Strait Islander Health Survey to food
and beverage purchase data. Australian and New Zealand journal of public health, 41(6),
598-603.
Medical Specialist Outreach Assistance Program (MSOAP). (2010). Guidelines.
http://www.ruralhealthwest.com.au/docs/outreach-in-the-outback-docs/msoap---
specialist-services.pdf?sfvrsn=0
National Aboriginal Community Controlled Health Organisation, Royal Australian College of
General Practitioners. (2012). National guide to a preventive health assessment for
Aboriginal and Torres Strait Islander people ( 2nd ed.). South Melbourne: Royal
Australian College of General Practitioners.
Price, K., & Rogers, J. (Eds.). (2019). Aboriginal and Torres Strait Islander education (2nd ed.).
Cambridge University Press.
Reisi, M., Javadzade, S. H., Mostafavi, F., Sharifirad, G., Radjati, F., & Hasanzade, A. (2012).
Relationship between health literacy, health status, and healthy behaviors among older
adults in Isfahan, Iran. Journal of education and health promotion, 1(1), 31.
Sun, X., Shi, Y., Zeng, Q., Wang, Y., Du, W., Wei, N., ... & Chang, C. (2013). Determinants of

Cardiovascular Disease
12
health literacy and health behavior regarding infectious respiratory diseases: a pathway
model. BMC public health, 13(1), 261.