Crikey

The recent death of an Aboriginal man who had tested positive to swine flu has raised concerns of the vulnerability of Indigenous Australians to disease pandemics. As AM reported this morning, doctors working in remote Indigenous communities are calling for greater access to the anti-viral medication used to treat swine flu.

Dr Sophie Couzos, Public Health Officer with the National Aboriginal Community Controlled Health Organisation (NACCHO) has been calling for a pandemic plan designed specifically for Aboriginal peoples and Torres Strait Islanders for the last four years.

In December 2006 Dr Couzos delivered a presentation entitled Australian Flu Pandemic: Preparedness and the Aboriginal Population at a national workshop hosted by the Department of Health and Ageing.

Presented in the shadow of Avian Influenza, Dr Couzos told Crikey that the information is relevant to Swine Flu but that “nothing came out of” the 2006 workshop.

At the time, Dr Couzos believed the share of morbidity/mortality amongst Aboriginal peoples in the event of a pandemic. She found that indigenous people would make up a significant proportion – much more than 2% share of the number of people affected.

This was based on the fact that indigenous Australians have five times higher hospitalisation rates for respiratory diseases overall and pneumonia/influenza hospitalisation (1999-2001) and 12-15 times higher death rates for pneumonia/influenza (1999-2001).

So why are Aboriginal people more vulnerable to a pandemic?

According to the presentation by Dr Couzos:

• The population profile is younger.
• Higher prevalence of chronic disease (diabetes, chronic renal failure, chronic cardiac, bronchiectasis, COPD)
• Suboptimal Influenza vaccine coverage
• Poorer access to medication (based on PBS utilisation) and health services
• Mobility of the population
• Social and economic disadvantage (overcrowded housing, ineffective health hardware, etc).

Personal and household infection control strategies such as washing hands and cough etiquette are more likely to fail because of the following factors:

• 70% of the Aboriginal population lives outside major cities
• Majority of the Aboriginal population are renters (twice the non-Indigenous population)
• Aboriginal people are more likely to live in overcrowded housing.
• In remote Indigenous communities, the average occupancy ratio was 5.8 people per dwelling, compared to a national average of about half that size
• In 1999, 13% of all the dwellings in remote communities were temporary dwellings such as caravans, tin sheds or humpies, housing a population of over 7,000 Aboriginal people (Aust Housing Survey, 1999)
• Water restrictions were experienced in 36% of remote Indigenous communities of 50 people or more (over 12 months). The most common reason for having water restricted was the breakdown of equipment (CHIN survey,1999).

In 1999, the majority (58%) of the 145,532 Indigenous households in Australia were renting their home, most commonly from a private landlord or a State or Territory housing authority landlord (27% and 22% respectively). In comparison, only 27% of non-Indigenous households were renting, and the majority of these rented from a private landlord.

13% of Indigenous households required one or more bedrooms additional to what they currently had, compared to only 4% of non-Indigenous households.

Unique challenges are presented by remote communities, such as:

• The Australian Plan for pandemic flu states that a GP will swab clients with flu-like symptoms/rapid testing and the “patient will be advised to stay home”. But how readily accessible is testing in remote areas? (plus it takes at least four days for result)
• Home is an overcrowded environment — so is this still considered ”containment”?
• If the patient is suffering from a severe form of the illness they will need to  transported to hospital, but very often this involves aeromedical evacuation
• The telephone “Hotline” for information won’t be accessible for many Aboriginal peoples. Existing communications need to be supported (e.g. “word of mouth”, trusted sources, local radio, Aboriginal Health Workers, etc)
• Notified cases will be investigated through ‘seek and contain’ activities for each case — but who will conduct these?

Dr Couzos’ recommendations included:

A significant proportion of the Federal Pandemic Planning Budget should be quarantined to address Aboriginal peoples planning issues.

This funding should include:

• the modelling of the impact of pandemic flu on the Aboriginal and Torres Strait Islander population
• communications strategy including information sharing between Aboriginal Community Controlled Health services (ACCHS) so as to facilitate the development of planning across Australia
• the goal should require that every ACCHSs in Australia should be part of a local containment plan for pandemic flu. (Have unique expertise in dealing with the myriad of cultural and social factors that could result in excess Aboriginal deaths).
• State Health Department regional planning should incorporate the specific issues for remote Aboriginal communities. E.g. timely medicines supply; evacuations; containment, etc
• Focus communication efforts on AHWs as they are the main workforce of services especially if GPs leave
• ACCHSs have high GP turnover, so planning needs to involve the Board/Council and management and not rely on GPs
• Health delivery is not the only responsibility of ACCHSs. Transport services, funeral, aged care planning, etc — thus local planning for non-health services must also involve ACCHSs.

Dr Couzo told Crikey that “many of these actions have only now been started to be implemented through State and Territory Departmental discussions with NACCHO Affiliates and ACCHSs across Australia.”

The NACCHO has also recommended planning start as soon as possible regarding the roll-out of a H1N1 vaccine, and how it might be administered to Aboriginal peoples through ACCHSs.