Friday, 25 January 2008

Aboriginal health stats and other misinformation

I have been looking at a number of reports into Aborginal health, or a lack of it, and trying to make some sense of the numbers.

According to the Human Rights Commission, Aborginals made up 2.2% of the population at the last census. That's 410,000 people out of say 19 million.

One of the reasons given for poor health outcomes is that 26% of Aboriginals live in remote or very remote areas, as opposed to 2% for the rest of the population.

Now when you read a stat like that, you go, "Wow, that's a big difference in percentages - that must be a root cause of bad health outcomes".

However, do the maths.

26% of 410,000 people is about 100,000 Aboriginals living in remote areas.

2% of the remaining 18,600,000 non-Aboriginal population is 372,000.

Right. So whitefellas outnumber Aboriginals in remote areas by over 3:1. But are the health outcomes for the whitefellas in remote areas as bad as for the Aborginal population in that area?

I doubt it. If it was, I'm sure we'd know about it.

So let's forget about the "remote" argument for a minute. It looks like a crock of shit. If white people can live in the same location without horrible health problems, then remoteness is not a causal factor.

But if it is a factor, then we should immediately close down all the remote townships and ship everyone off to places that are less remote. If you can't get good services to the people, move the people to the services. The WA government closed the town of Wittenoom because of asbsestos. If remote townships are as "toxic" as asbestos, then they should be abandoned. Is it worth staying where you are if it's killing you?

How about another statistic - that of low birth weight.

According to the Department of Health:

Low birthweight infants (weighing less than 2,500 grams at birth) are more at risk of developing conditions such as coronary heart disease and stroke when older. In 2000-02, live-born babies of Indigenous mothers were twice as likely to be of low birthweight as babies born to non-Indigenous mothers (12.9% compared to 6.1%)

Indigenous infant and child health is significantly poorer than that of non-Indigenous infants and children. A 'low birth weight baby' weighs less than 2500 grams at birth
[41] indicating, among other things, foetal malnutrition. There is a growing body of evidence that suggests a malnourished foetus will program its body in a way that will incline it to chronic diseases later in life.[42] Beyond infancy, normal growth is considered vital for good health in adulthood. Significant numbers of Indigenous children demonstrate failure to thrive

OK then, why are so many Aboriginal babies low birth weight?

High fertility at younger ages contributes to the relatively high fertility of Indigenous women. Teenage births are more common among Indigenous women than among other women. In 2003, the teenage (15–19 years) birth rate among Indigenous women was more than four times the overall Australian teenage birth rate. Teenage pregnancies are associated with low birth weight.

So what they are saying really is that some Aboriginal kids are fucking each other silly and popping out kids at an amazing rate.

So what is the government to do about that? Say sorry and issue a chastity belt? How about they take the kids away and put them in a boarding house where they can be supervised and controlled and taught a few morals?

Oops, can't do that anymore. Strike that thought.

But why are Aboriginal teenagers getting pregnant so often?

I thought about this last night. It must be boredom.

When I was a teenager, I was as randy as the next kid. I spent most of my teenage years trying to get laid, mainly without result. It was the same for most of my friends. The reason we were unsuccesful is that the girls we knew were remarkably reticent about opening their legs. It's as simple as that - unless a girl consents, there is no sex, so the chances of getting pregnant are pretty low. I'd say they are zero, but then I'm a stickler for the facts.

What kept their legs closed?

I'd say the main factors were these:

  • a strong moral upbringing by their parents
  • a lack of loosening agents, like drugs and alcohol
  • few opportunities to slip away unnoticed
Hell, we certainly tried to overcome all three barriers. We tried to talk them out of it (overcome the moral objections), but that rarely worked. So we then held parties and plied them with beer, wine and vodka (wine coolers were a favourite), but most passed out or vomited before they lost their inhibitions. Even then, the opportunities for having parties were limited, because our parents kept us on a tight leash, and they kept us busy. We played organised sport almost every weekend, trained before or after school several times per week and played disorganised sport on every free day. In between, we studied.

So what the hell is happening in Aboriginal communities? Well, I think we know that in some cases, the parents are getting drunk or stoned and don't give a fuck what their kids do, the kids aren't going to school or doing any sport so they are just BORED. Perfectly respectable friends of mine did a bit of burglary when they were teenagers because they were BORED. Committing crime is quite exciting, you know. I've committed the odd criminal act, and thinking about some of the more extreme things that I got away with still gets the heart racing.

But do you know how much input the government had into keeping me active as a kid?

Nil. Not one iota. It was all down to my parents, the parents of my friends, and some dedicated teachers. Government and government agencies had nothing to do with it. They are not the answer.

If kids are stuck in some bumhole and they're bored, yank them out of there and send them to a boarding school in the city. By force if necessary. I went to boarding school with kids that came from some pretty remote sheep and cattle stations from the boondocks of WA, and they were pretty wild when they arrived. Being out in the sticks your entire life can mess with your head.

Stuffing kids into boarding school was of course the sort of thing that we did up until about 1970, until some people started having "issues" with it. They complained about things like kids being caned for being naughty. Well I got caned for being naughty - got six of the best across the arse from a nasty ex-Rhodesian teacher who was notorious for being the hardest caner in school, and let me tell you this - I never fucked up again. It was humiliating and it hurt like hell and yes, I cried. Everyone did. It was supposed to make you cry - the idea being that if it hurt that much, you'd never forget it, and you might think twice about doing something naughty next time you got a stupid idea into your head.

Got that? It was supposed to hurt. You remember painful lessons really, really well. Unless you are a complete and utter blockhead.

Another statistic - the death rate.

According to NT Health:

The overall death rate for the Indigenous population is more than twice that for the total Australian population. The greatest differences occur in the middle age group of 25 to 54 years. In 2000 the leading causes of death among the Indigenous population were diseases of the circulatory system, external causes of injuries and poisoning and malignant neoplasms. These accounted for 26%, 14% and 14% of Indigenous death respectively.

It is premature adult death and not excess infant death that accounts for the reduced life expectancy of Indigenous people.

So what's the cause of all these people dropping off in middle age?

  • Half the adult Indigenous population aged 18 and over were current daily smokers, about twice the (age-standardised) rate for non-Indigenous adults.
  • 16% of Indigenous adults aged 18 and over drank alcohol at risky or high risk levels, a similar (age-standardised) rate to non-Indigenous adults.
  • Three quarters of Indigenous people aged 15 and over were sedentary or exercised at low levels.
  • 57% of Indigenous people aged 15 and over were self-reported as overweight or obese, which (when adjusted for age differences between the two populations and for survey non-response) was 1.2 times higher than for non-Indigenous Australians.
  • 14% of Indigenous people (20% in remote areas) aged 12 and over had no usual daily fruit intake, twice the rate for non-Indigenous people.
  • 5% of Indigenous people (15% in remote areas) aged 12 and over had no usual daily vegetable intake, over six times the rate for non-Indigenous people.
Let me get this right. They smoke heaps, drink a fair bit, eat shit, avoid fruit and sit around like a bunch of lard arses. And who is to blame for that? The individuals concerned? The fat turds that lack the willpower to give up the fags, can't be arsed exercising or don't bother to eat a healthy meal? Nooooo - someone else is always to blame. Especially the government.

After reading some of this stuff, I am starting to think that we should just say: "Sorry. Yep, we're sorry for stuff that happened a long time ago. But that's over - now sort your sorry fucking lives out and pull up your socks and get on with it. You've gotten your apology - you've got no excuses left now."

So, how do we solve these diet, smoking, drinking and exercise problems - particulary amongst those under 18?

Grab the little fuckers and send them to a boarding school where they are kept active, closely supervised and mixing with a peer group that provides positive images.

Actually, I'd scrap the last item. The kids that we looked up to where those that could get laid on a regular basis, were good at sculling beer and tops at fighting Catholics when we played sport agains the Micks. Clean living swats like me where not the preferred role model.

I'm starting to see a repeating pattern here - something about kids and boarding schools..... hmm, wonder if that's been tried before?

This is just a lovely set of numbers:

In the NT, Indigenous infant mortality has declined substantially since the early 1980s. In 1981 to 1983 there were 31.3 infant deaths per 1 000 live births and in 1997 to 2000 the rate reduced to 16.9. There are many reasons for this fall in Indigenous infant mortality rates. The main reason is increased access and better resourcing of primary health care services. There is, however, still great disparity between the rates for Indigenous and non Indigenous infants with the Indigenous infant mortality rate almost 4 times the non Indigenous rate. The 35 Indigenous infant deaths recorded in the NT in 2000 comprised 81% of total infant deaths

Infant mortality 4 times the whitefella rate! Hells bells. That number just kicks you in the balls.

It must be a lack of money. Something must be done....

Per capita expenditure for Aboriginal and Torres Strait Islander people was estimated $4 936 per person compared with $1 433 per person for the rest of the population.

Ok then, I got that wrong. It's not a lack of money. We are spending just under 3.5 times as much on blackfellas health as whitefellas. Maybe too much money is the problem?

Language barriers? Maybe language barriers prevent them from talking to doctors etc?

  • 80% of Indigenous peoples reported speaking only English at home, which is about the same as the non-Indigenous population.
  • 12% of Indigenous peoples reported speaking an Indigenous language at home; with three quarters of those recording they were also fluent in English.
Those numbers tell me that nearly 90% of Aboriginals are fluent in English. So we don't have huge numbers of Aboriginals running around that can't communicate with a doctor.

My in-laws arrived in this country without a word of English between them. Somehow, they figured it out and raised three healthy kids. I went to school with a lot of kids whose parents came out from Italy, Yugoslavia, Hungary, Greece and all those places without a word of English between them, and somehow they turned out fit, healthy and morally centred kids. All the parents also became pretty fluent in English, even though many of them started learning it at the age of 25 or 30 - and that's a hard time to learn a language. I have never seen a lack of English as an impediment. If half the planet can learn enough English to do business with us and the rest of the planet, then I don't see why it is so hard for people who are born in an English speaking country to learn a bit of English.

I could rant on about learning English all day, but think about it. You can travel to just about any country on the planet and find that all your needs will be serviced by someone that speaks English. I've sat in a restaurant in Italy with people from Japan, Germany, Holland, South America, South Korea and numerous other countries where they speak something else at home and everyone conversed in English. Maybe not very well, but well enough that we could all understand each other.

Hell, in a job I had a few years ago, about half my team where from a non-English speaking background. And by that, I mean they arrived from Cambodia about 10 years before with no English at all. Some had utterly rotten spoken English - but they could understand me, and I could understand them. I had guys that grew up in Vietnam, China, Yugoslavia and other places like that where they didn't start learning English until they arrived in Australia as adults. Not only were they functioning pretty well, they were all earning at least $60,000 per year doing fairly skilled work.

What is the best way to ensure that kids are fluent in English?

Get them out of the remote communities where it is not spoken regularly and immerse them in a 100% English speaking environment. That sounds remarkably like a boarding school to me.

Crummy housing is also given as a reason for poor Aboriginal health, with overcrowding being cited as a big problem.

But is overcrowding really a cause of poor health?

When I lived in London in the early 1990's, 8 friends of mine lived in a 3 bedroom flat - a very small 3 bedroom flat. They had bunk beds in each room, and 2 of them shared a single bed as one worked nightshift and the other dayshift. Now that was overcrowding!

Did any of them get horribly sick?

Only when they drank too much Newcastle Brown Ale. Overcrowding did not seem to affect their health.

My parents grew up during the Depression, and they had a stack of siblings - and they both grew up in small houses. The house that Mum spent her childhood in was a dirt floored shack made of hessian on a farm out on the far edge of the WA wheatbelt. All the kids slept on the verandah, which was enclosed with fly screens, and they slept on pretty horrible beds made of bush poles and the like. Mum likes to tell the story of how her Mum was cooking one day, found the kitchen to be oppresively hot and cut a window in the kitchen wall with a pair of scissors.

In short, she grew up in housing conditions that today would be considered..... unbelievable.

As for poverty, well, my in-laws arrived from the former Yugoslavia with the shoes and clothes that they were wearing and not much else. You can imagine the kind of conditions Mum grew up in - her family walked off the farm during the Depression because they went broke. I guess they were homeless for a while. Some of your ancestors probably walked off a ship in leg irons. They started with nothing but the convicts clothing on their backs.

Poverty is something that you can pull yourself out of. But only if you want to.

Then we have infant mortality rates. I have been Googling all over the interweb looking for stats on infant mortality. The good news is that it is way down. I had lots of trouble finding stats that I could understand, but have a look at these numbers.

In 1978, PNG had an infant mortality rate of 110 per 1000. That's enormous. But back in 1900, the rate in Australia was 103 per 1000. In 1950, that had been reduced to 25 per 1000. These days, Australia has an infant mortality rate of about 5 per 1000, except amongst Aboriginals, where it is around 20 per 1000. Cuba has an infant mortality rate of around 6 per 1000.

In Afghanistan, before us nasty people invaded and overturned the Taleban, it was around 165 per 1000. Yikes.

So, what do I make of all that?

If you have poor sanitation, bad hygenic practices, a poor diet, bad water and a lack of basic medical attention, you have a horrendous infant mortality rate. I have been trying to find numbers for Australia and the UK for before 1900, but I imagine that if you go back to say 1850, the infant mortality rate in inner-city Sydney was probably comparable to Afghanistan under the Taleban.

Lowering the infant mortality rate is pretty simple - so simple, they were able to do it in Tasmania 100 years ago, when they didn't have the medical sophistication that we have now, or the fabulous wealth that we now enjoy.

In 1908, the Chief Health Officer for Tasmania noted that Hobart had the second highest infant mortality rate to any other state capital. He attributed this high death rate (and an even higher rate in Launceston) to 'sheer ignorance on the part of mothers of the elementary principles of child-feeding and child-care' and recommended 'one carefully selected trained nurse' be employed for 'popular education of young wives and mothers in the health protection of thehome and the care of infants and children'.

At this time, Dr Truby King established the Karitane Mothercraft hospital in New Zealand to reduce the infant mortality rate through the education of mothers. In Dunedin, his statistics demonstrated a remarkable decline in infant mortality from diarrhoea:

  • 1907: 25 babies died per 1000 live births
  • 1913: 4 babies died per 1000 live births
  • 1918: there were no infant deaths from diarrhoea

In 1917, the Chief Health and Quarantine Officer (Tasmania) recommended the employment of a nurse to home visit mothers and provide instruction on infant feeding. He surmised that the infant mortality rate could be significantly reduced by minimising deaths from diarrhoea. This was to be achieved by educating women to improve breastfeeding and hygienic food preparation.

His simple words spell it out for even simpletons to understand. I will repeat the important ones:

'sheer ignorance on the part of mothers of the elementary principles of child-feeding and child-care'

What do those words really mean? What is "child feeding" and child care"?

I can comment on these as I am now a Dad. I had no idea what they meant a few years ago.

I'll summarise it as follows:

  • Wash your hands
  • Bathe your kids daily, or at most, every two days
  • Change their nappies when they have done a poo
  • Wash your dishes and the baby bottles
  • Change and wash your clothes on a daily basis
  • Keep your house clean and get rid of the more obvious risks to baby
  • Feed your baby regularly (preferably via mum's tit)
  • Mum is not to drink, smoke, do drugs or have a shitty diet
Is it that hard? Really? Wash your hands, stick the kid in the bath, run the washing machine every day or so.

Doing this does not require money. It does not require education. It doesn't require you to live in a major coastal city. It just requires commitment and discipline and effort. I don't like having to do three loads of washing every day - but it has to get done. It just has to. Your job as a parent is to ensure that it's done, because no one else is going to do it. I want to flop on the couch in front of the TV as much as the next person, but there is no getting away from doing some basic chores on a daily basis. Shopping for food. Cooking meals. Washing dishes. Changing nappies. Getting the kids out of bed in the morning, feeding them and taking them to school. Nagging them to do homework. Tidying up. Taking Monkey to the park/pool/playground etc for an hour a day.

Being poor is not an excuse for nothing doing the washing. When I was at Uni, I was poor. I stacked shelves at Coles for about $10 an hour between 10pm and 2am, I worked the late shift in a video hire shop and spent my holidays weighing wheat trucks in the middle of nowhere. At one point, our washing machine blew up, so me and my two flatmates chipped in and bought one from the Trading Post.

I think we paid $100 for it. Washing machines were worth real money back then, back before China started making stuff. The classic thing is that we, the children of middle and upper-middle class parents, bought a washing machine from a bloke in a Housing Commission house. I guess the government had given him a new one, so he was selling the old one.

That washing machine represented a good night at the pub for the three of us, but we recognised where our priorities lay, and we spent our cash on a washing machine. Because we were still thirsty, we spent the small amount of money that we had left on a home brew kit, and that saw the start of a major exercise in brewing high strength rocket fuel. But that's another story. Being on the bones of your arse is no impediment to keeping clean.

All it really takes is a bit of selflessness. Kind of what the missionaries did when they gave up a comfortable life in suburbia and treked out to the back blocks of nowhere to start schools for the native kids. Apart from teaching lessons, I'm sure it involved an enormous amount of work in cooking meals (without a microwave or gas stove), doing laundry (without a washing machine), washing up without a dish washer etc etc etc. How is it that we have come to despise those people, rather than admiring them?

In the end though, is the simple explanation for the difference between black and white mortality rates explained by the proposition that some Aboriginal parents do not give a flying fuck about their kids? If they cared enough, they'd stop smoking, cut back on the drinking, cook a proper meal at least once a day and clean the fucking house. Is it really that hard to do a bit of washing and cleaning? Does it really come down to a lack of that?

I lived with a flatmate years ago that I called "Couchy", because she never left the couch. She had a job, which required her to turn up for 7.5 hours per day, but once home, she turned on the TV and lay on her couch with her cat on her lap.

In the year we shared a place, she never cleaned the house (as in ran a vaccuum cleaner around, dusted or scrubbed the bathroom and kitchen), never mowed the lawn, never took the rubbish out, never did the washing up. Her diet consisted mainly of fast food or fish fingers.

In essence, she was just fucking lazy. Nice, good fun to drink with on Friday night, but bone idle. Utterly disinterested in anything that took her away from her beloved TV and couch.

She had a job that put reasonable money into her pocket. Our house was dingy, but clean and spacious and liveable and close to Bondi. She could afford overseas travel and was certainly able to afford some binge drinking every Friday and Saturday night. She was educated to a diploma level, was kind of comfortably well off, but just bone fucking idle.

So if kids are dying because their parents are as bad as Couchy (or probably much worse), why are we leaving them in those circumstances? What would you prefer:

  1. Placed in a boarding school from age 10 to 17. Graduate with solid education, gain entrance into University, speak excellent English, have great job prospects and have a good social group. But spend 10 months of the year away from Mum.
  2. Stay in some dusty, crime ridden dump in the middle of nowhere with Mum, who is a drunk, and her current boyfriend, who changes every 3-4 months. Catch numerous infectious diseases each year. End up malnourished and filthy, attend school irregularly, start sniffing glue at 13, get into petty theft soon after, have no job prospects, get abused by "Uncle" Mike and barely speak English at 17. Spend more time in court than in school. But spend all the time with your Mum.
The answer seems pretty clear cut to me.

This is why I think the whole 'stolen generations' and the need to say sorry is a load of bollocks. We have nothing to apologise for, and there is an entire generation out there right now that should be whisked away from their parents and sent to boarding school as soon as possible. If that involves taking them away without their parents consent, then so be it. It's not as if they don't have telephones or a postal service in these remote towns. Mum can always ring up once a week to say hello.

If she's sober enough to remember.

The main causes of mortality among Aboriginal infants were infection (29%), SIDS (27%), prematurity (16%) and birth defects (15%). In the most recent years studied, the relative risk compared to non-Aboriginal infants of death due to infection was 9 times higher and the risk of SIDS was nearly 8 times higher. There are measures that can be taken in the current state of knowledge to reduce the number of deaths from SIDS or infection.

Overall, 51% of Aboriginal mothers smoked. In 60% of infant deaths, Aboriginal mothers smoked during pregnancy. The risk of SIDS for infants of Aboriginal mothers who smoked was nearly three times that of Aboriginal mothers who did not smoke.


Nilk said...

Well said, sir :) I think you'll find plenty agree with you on this festering mess.

Anonymous said...

Hear hear!

No matter how much money is thrown at the problem it'll still be there if people don't take care of themselves and their kids.