Mind the Gap

By Elia Petzierides 

While Australia celebrated Harmony Day on March 21, 2015, another day recently past almost unnoticed. It represents an inequity within Australia that is poorly understood and seldom discussed. 

Kumintji, an Indigenous Australian with numerous medical conditions died in custody aged 50-years. His life and death represent the gap between the health of Indigenous and non-Indigenous Australians. National Close the Gap Day was held on 19 March, 2015 in Australia to raise awareness of this inequality and take action in support of health equality by 2030. So how wide is the health gap between Indigenous and non-Indigenous Australians?

First, let’s get to know Kumintji. It is Indigenous cultural practice to avoid the use of the Christian name of a deceased Indigenous person. In light of this and out of respect to his family and culture the subject of this article will be referred to only as Kumintji. 

Kumintji was born 200km north west of Alice Springs at Napperby Station in Australia’s Northern Territory on July 1, 1963. He was the oldest of his four siblings and left school in year nine. He had worked as a labourer at a local council in his early years and later worked as a stockman at Mt Allan Station. In his later years as a result of his poor health and alcohol abuse he moved to Alice Springs where he was unemployed. In August 2013 he was sentenced to nine months imprisonment for driving whilst disqualified and restoration of an earlier suspended sentence. 

Kumintji suffered from numerous medical conditions including cardiovascular disease, previous myocardial infarction (heart attack), high blood pressure, type 2 diabetes, end stage renal failure requiring haemodialysis, liver cirrhosis, oesophageal varices and an umbilical hernia that was a source of constant aggravation.

On the evening of February 6, 2014 Kumintji fell ill and the following day when he arrived for his haemodialysis he was deemed to be too unwell and was sent to Alice Springs Hospital. He was found to have an incarcerated (trapped) and probably strangulated umbilical hernia which could not be returned to its normal position without emergency surgery. He was advised of the significant risks of the surgery given his previous medical history but insisted on having the operation. Shortly after the operation in the early hours of February 8 – one month prior to his scheduled release from prison – Kumintji died.

The forensic pathologist explained the reason Kuminji died in layman’s terms for the benefit of the Court and his family. The three reasons were:
1. “Really serious heart disease.”
2. “Serious (kidney) damage and disease.”
3. “Hernia at the front of his belly.” 

The incarcerated hernia was described as a serious problem in its own right. The heart and kidney disease only made a bad situation worse. 


Statistics 

The Close the Gap Campaign 2015 report lists the health inequalities between Indigenous and non-Indigenous Australians. These are summarised below. The term Indigenous Australian is used in this article to refer to people of Aboriginal and Torres Strait Islander descent. 

The first is life expectancy with Indigenous Australians falling ten years short of non-Indigenous. The good news is this gap is closing: 
  • Most notably with life expectancy increasing by 1.6 years for Indigenous males  (from 67.5 years in 2005-07 to 69.1 years in 2010-12) compared to 0.8 years for non-Indigenous males (from 78.9 years in 2005-07 to 79.7 years in 2010-12). 
  • Less impressively Indigenous females life expectancy increased by 0.6 years  (from 73.1 years in 2005-07 to 73.7 years in 2010-12) compared to 0.5 years  (from 82.6 years in 2005-07 to 83.1 years in 2010-12) for non-Indigenous. 

The report cautioned readers against underestimating these seemingly small gains and emphasised that this translated to valuable extra life for Indigenous Australians. It cited the valuable example of elders having more time to impart wisdom.


With 26% of Indigenous deaths attributed to cardiovascular disease it is the single biggest killer of Indigenous Australians (2007-2009). In 2009-11 the cardiovascular disease death rate was 1.3 times as high as that of non-Indigenous people. Slow progress is expected here with contributing factors such as smoking and high blood pressure (both also seen in higher rates in Indigenous Australians) requiring time to address and subsequently flow on to improve death rates from cardiovascular disease. 

Indigenous Australians are three times as likely to have diabetes than non-Indigenous. Indigenous Australians are also twice as likely to have signs of chronic kidney disease than non-Indigenous and more than four times as likely to be in the advanced stages of chronic kidney disease. 

More Indigenous Australians are engaging in daily binge drinking (more than seven standard alcoholic drinks per day) than non-Indigenous (men 8.1% versus 6.1%, women 4% versus 2.1%). The alcohol induced death rate for Indigenous Australians was five times higher than non-Indigenous (in jurisdictions where data is deemed reliable). The majority of Indigenous homicides each year involve alcohol. Foetal Alcohol Spectrum Disorders are highest for Indigenous people and high levels of alcohol misuse is associated with family violence in Indigenous communities. 

Forty-one percent of Indigenous people are recorded as obese compared to 27% of non-Indigenous. 

The mortality rate for Indigenous childrenunder five is 165 deaths per 100,000 population versus 77 deaths per 100,000 for non-Indigenous children. 

Indigenous newborns are twice as likely to have a low birth weight (<2,500 grams) than non-Indigenous – 12.6% for the former versus 6% for the latter. Low birth weight children are at least 20 times more likely to die within their first year of life than those who weigh at least 2,500 grams. 

The health gap between Indigenous and non-Indigenous Australians may be closing, however the momentum gained in recent years has some obstacles ahead. The Close the Gap Campaign 2015 report is littered with references to ceased government funding and the impact this will likely have on progress. This is an ominous sign and one that raises more questions. Why does this health gap still exist in a prosperous country like Australia and why isn’t this issue making more headlines across the nation? 

Until people start making noise about this inequality Australia’s politicians will continue to believe that the majority of Australians don’t mind the gap. 

Watch this short video or this longer video by Oxfam Australia. 
Like the Close The Gap Facebook page. 

The author Elia Petzierides is a Victorian based Advanced Life Support Paramedic and a Registered Nurse with a Graduate Diploma in Advanced Clinical Nursing.

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