A pig of a health-care system

The first person to die after testing positive to swine flu in Australia was a 26-year-old Aboriginal man from a remote desert community. Health workers have said it is evidence of the significant gap between Indigenous and non-Indigenous health, and warn more deaths are likely.

The man was suffering pneumonia and had to be flown 700 kilometres from his community to a hospital in Alice Springs before being transferred to Royal Adelaide Hospital, where he died on June 19.

The death followed weeks of fear that the swine flu outbreak in Australia could become a pandemic.

Yet health authorities have tried to quell panic by discounting the likelihood that swine flu caused or contributed to his death.

South Australia's chief medical officer, Paddy Phillips, said the man already suffered a number of chronic conditions and that his condition had significantly deteriorated by the time he reached Adelaide, said ABC Online on June 19.

"At the moment this man had a number of serious illnesses that pre-existed this episode", he said.

Yet Aboriginal health services say it was no surprise.

"It's sad that there's no accident that the first death in Australia is from a target group of people who are known to be 17 years behind mainstream Australia", said Dr Brad Murphy from the Royal Australian College of General Practitioners, reported ABC Online on June 20.

The South Australian Aboriginal Health Council has warned Aboriginal people are at higher risk to pandemics because they have more underlying chronic problems.

The council's chief executive, Mary Buckskin, told the June 23 National Indigenous Times: "Because of the significantly higher rates of chronic diseases including diabetes, kidney disease and lung disease in our communities, we are concerned that we will have higher rates of severe and complicated flu, and possibly more deaths, than in the wider community."

The Australian Medical Association has warned there could be "many deaths", while the number of cases reported in the Northern Territory rose to 78 and six people were being treated in hospital, ABC Radio National's The World Today said on June 24.

The death of the Aboriginal man illustrates the chronic health problems suffered by many Aboriginal people, putting them more at risk from the influenza A(H1N1) virus.

Despite this, calls for Tamiflu, the anti-viral drug, to be distributed free to all Aboriginal people have been ignored by the government. Only those diagnosed would receive it, the June 24 Brisbane Times said.

"Aboriginal people will only get Tamiflu if they are in the same risk category as non-Aboriginal people", Dr John Boffa, from the Aboriginal Health Service in Alice Springs said, according to the article. "So the national response is the same for all Australian citizens. Some people might say, 'Well that is fair, that is how it should be', but the reality is that it is not equitable."

Meanwhile, the reasons for the appallingly low health standards of Aboriginal people have so far been ignored in all government management plans.

A study commissioned by the National Aboriginal Community Controlled Health Organisation (NACCHO) and Oxfam Australia in 2007, Close the Gap, said Australia was the worst First World country when it came to health standards for indigenous people.

"The burden of disease or level of sickness, in the Aboriginal population ... is three time higher than in the general population", NACCHO chairperson Dr Mick Adams said in a May 29 media release.

"There is a much higher rate of hospitalisation and death that occurs from seasonal flu in the Aboriginal and Torres Strait Islander population", NACCHO public health officer Dr Sophie Couzos told ABC Online on June 23.

According to Health Info Net, pneumonia and influenza are the most common conditions requiring hospitalisation, with the rate of hospitalisation for Aboriginal men and women 4.6 and 4.9 times respectively those for non-Aboriginal men and women. Death is 12-15 times more likely.

The National Centre for Immunisation Research and Surveillance said, in Vaccination for our Mob (2006), young Aboriginal adults were particularly at risk from influenza: hospitalisation was seven times higher than non-Aboriginal people, and death rates were 28 times higher.

The story is similar for chronic conditions, such as heart and kidney disease, arthritis, asthma, and diabetes.

Heart and circulatory problems develop over the course of a lifetime. The National Aboriginal and Torres Strait Islander Health Survey 2004-05 (NATSIHS) said Aboriginal people experience an increase in prevalence after 35 years of age, 10 years earlier than in the non-Aboriginal population. Hypertension (high blood pressure) was most common.

Similarly, the survey said diabetes is more than three times as likely to affect Aboriginal people, with a prevalence of 6%. It is more than twice as prevalent in remote areas as in non-remote areas.

Close the Gap said Aboriginal and Torres Strait Islanders die 17 years earlier than non-Indigenous Australians and that Aboriginal and Torres Strait Islander infant mortality is three times that of non-Indigenous Australians.

However, warning that swine flu will affect Indigenous communities more because of poor health conditions cannot be separated from the widespread poverty and ongoing denial of real Aboriginal self-determination.

Among the two-thirds of Aboriginal people with at least one long-term health condition, there were high levels of stress, anger, impacts of psychological distress and poverty, according to the NATSIHS.

Eighty-one per cent of those with kidney disease and 75% who suffered diabetes reported what the survey described as "stressors", often caused by negative conditions, such as unemployment, family breakdown, low socio-economic conditions and experiences of racism.

The disparity between access to health services and the ability to live healthy lives between Aboriginal and non-Aboriginal Australians is a product of the dispossession of both land and self-determination that Aboriginal people have experienced. It is also a crucial factor in economic and social equality.

Consecutive federal and state governments have consistently and severely underfunded Indigenous health. The fact that the man who died had no access to adequate health care in his community of Kiwirrkurra in remote Western Australia, and had to be flown 700 kilometres to the nearest hospital, is evidence of this.

When Prime Minister Kevin Rudd gave his apology to the Stolen Generations, he pledged to close this gap in health standards. While that pledge appears more important now than ever, Aboriginal people are yet to see any action to back up the government's words.