Where the dreaming changed shape the Aboriginal and Torres Strait Islander adult health check in a remote Aboriginal community
Creators: name: Burgess, Christopher Paul
Publisher: name: Charles Darwin University
Year: 2011

description: The gap in health outcomes between Australia’s Aboriginal and Torres Strait Islander peoples and the general population is now the subject of a national campaign for health equity. To help close the gap, primary health care (PHC) practitioners are encouraged to detect and intervene earlier for the common causes of morbidity and mortality through an Indigenous-specific Adult Health Check (AHC). To date there have been no evaluations of the AHC in remote settings, where the health disadvantages are greatest. The Aboriginal community participating in my research comprises a large remote township and a surrounding network of homelands in north central Arnhem Land in Australia’s Northern Territory (NT). My evaluation of the AHC in this setting featured two complementary objectives. First, I determined what the AHC contributed to: (i) the recorded delivery of preventive clinical services, (ii) the identification of chronic conditions (iii) the initiation of preventive interventions and (iv) improving preventive care for cardiovascular disease (CVD). Second, at the request of Aboriginal community members, I used the AHC findings to test associations between population health outcomes and an Aboriginal asserted health promoting activity: caring for country. To address the first objective, in collaboration with the PHC service, I systematically delivered an outreach AHC program for township and homeland residents. Then, through a medical record audit over time periods before and after AHC participation, I: (i) compared the recorded delivery of preventive clinical services during PHC prior to the AHC to those performed during the AHC, (ii) compared the identification of chronic conditions during PHC prior to the AHC with the identification of chronic conditions during the AHC, (iii) compared the recorded delivery of preventive interventions during PHC prior to the AHC to the recorded delivery of preventive interventions during and following the AHC and (iv) used an interrupted time series study design to determine if there were any changes in the recorded delivery of preventive care for CVD for those identified with elevated CVD risk during the AHC. To address the second objective I: (i) undertook a literature review to theoretically explore caring for country as a health promotion activity, (ii) contextualised caring for country in the research setting through a key informant interview, (iii) developed and validated a measure of caring for country and (iv) used the AHC findings to determine the associations between caring for country participation and health outcomes relevant to Aboriginal morbidity and mortality. Systematic delivery of the AHC in this remote PHC service was associated with significant improvements in: (i) the recorded delivery of preventive clinical services, (ii) the identification of chronic conditions (iii) the recorded delivery of preventive interventions, (iv) preventive care for CVD and (v) an improvement in the CVD risk profile among AHC participants identified with elevated CVD risk. However, constraints in the PHC workforce and PHC systems were also identified. In this community, participation in caring for country: (i) is associated with a distinct construct of health and wellbeing, (ii) is measurable, (iii) is associated with better health outcomes compared to those who don’t participate in caring for country and (iv) may be a significant opportunity for economic development on Aboriginal lands in remote Australia. The AHC can make an important contribution to closing the health gap for Indigenous Australians in remote areas. For the participating community, the preliminary validation of caring for country as a policy-relevant Aboriginal health promotion strategy is arguably as important as the demonstrated improvements in preventive health care delivery. Regarding the latter, further research is required on how best to re-orientate remote PHC services to the care of chronic conditions, particularly the development of an appropriate workforce. Otherwise, the potential benefits of the AHC will not be fully realised for Australia’s most marginalised and disadvantaged peoples.