A new report on Aboriginal heart health, the most comprehensive ever published in Western Australia, highlights the need for all sectors of government, health service providers, business and the community to work together to further narrow the gap between rates of Aboriginal and non-Aboriginal heart disease deaths, its authors say.
A joint project by The University of Western Australia and the Heart Foundation, the report brings together an eight-year long research effort into heart disease among Aboriginal Western Australians.
The research used multiple methods to look at the issue of heart disease in Aboriginal people, including extensive use of linked State-wide health data. It also undertook audits of health services and collected interviews with Aboriginal people and health care providers.
Recent reports (Prime Minister’s Closing the Gap Report and the Australian Institute of Health and Welfare, 2014) reveal a significant decline in the gap in Aboriginal mortality from chronic diseases including coronary heart disease deaths.
However despite these gains there is still much to be done. The researchers found that Aboriginal Western Australians experiencing their first heart attack or hospitalisation for heart failure or atrial fibrillation (a type of irregular heart beat) were on average 15 to 20 years younger than non-Aboriginal patients.
Report author Dr Judy Katzenellenbogen, an epidemiologist from the WA Centre for Rural Health at UWA, says the disparity is greatest in the younger age groups.
For example, Aboriginal men aged 25 to 34 were about 16 times more likely to have a heart attack than non-Aboriginal men in the same age group. This disproportion was even greater for Aboriginal women than men.
“The high levels of co-existing diabetes, kidney and lung disease found in many Aboriginal heart patients make prevention, treatment and recovery more difficult,” Dr Katzenellenbogen says.
“We need to change the game for Aboriginal heart health in Western Australia. The journey starts with preventing heart disease in the first place and this area needs much more attention. Next is to treat existing cases early and with the most effective treatments we have.”
Currently, Aboriginal people are not receiving the full benefits of treatment because of the lack of communication between services (such as poor discharge planning) and lack of attention to cultural needs, including appropriate health education, she said.
The WA Centre for Rural Health report draws on the experiences of Aboriginal and non-Aboriginal stakeholders, documenting successful initiatives and providing government, service providers, health workers and Aboriginal people with practical suggestions for improving heart health outcomes.
One exemplary initiative is a culturally appropriate cardiac rehabilitation program based at the Derbarl Yerrigan Aboriginal Health Service in Perth.
The Heart Foundation’s Lyn Dimer, who spearheaded the cardiac rehabilitation program with other health practitioners, says Aboriginal patients received professionally supervised monitoring of blood glucose levels, blood pressure and cholesterol. They were also supported to adhere to medication, exercise and healthy eating.
“Once community members attend the program and find it supportive and enabling, they tell their families and friends,” Ms Dimer says. “The Heart Foundation is currently developing a similar initiative in the West Pilbara supported by corporate funding.”
Co-author Professor Sandra Thompson, Director of WA Centre for Rural Health says the research suggests that a well-supported Aboriginal health workforce and improved systems to allow seamless communication and better integration between services were the two most important health system improvements required to address heart health inequities.
“A committed effort from government, business, health service providers and communities has the potential to greatly improve the life expectancy of our Aboriginal population,” Professor Thompson said.
“We must build on progress made and work smarter – we need determination and hope, knowing that much can be done.”
Report contributors (back row, L to R) Sandy Hamilton, Derrick Lopez, Dawn Bessarab, Sandra Thompson (all UWA), Lyn Dimer (Heart Foundation WA), Andrew Maiorana (Curtin); (front row) Judy Katzenellenbogen and Emma Haynes (UWA).