Last updated: 02/07/20

 Disparities in health care for Aboriginal and/or Torres Strait Islander Australians compared to non-indigenous Australians are a key concern for public health. The incidences and severity of many systemic diseases are higher in Australia's Aboriginal and/or Torres Strait Islander population, and the overall life expectancy of these citizens is also lower (due to both health and socio-economic factors). There are 7 objectives that Australia is aiming to meet in order to close the gap on this health disparity.

7 key objectives, according to Closing the Gap 2020 Report [1]:
  • Halve the gap in child mortality rates by 2018 - improvements in child/maternal health, but not meeting the target.
  • Halve the gap for Indigenous children in reading, writing and numeracy by 2018 - improvements, but more progress is needed.
  • Close the gap between Indigenous and non-Indigenous school attendance by 2018 - no improvements in non-attendance.
  • Halve the gap in employment outcomes between Indigenous and non-Indigenous Australians by 2018 - employment rates remain stable, needs progress.
  • Have  95 per cent of Indigenous four year-olds enrolled in early childhood education by 2025 - on track.
  • Halve the gap for Indigenous Australians aged 20–24 in Year 12 attainment or equivalent by 2020 - on track.
  • Close the gap in life expectancy by 2031 - not on track.

 Overall findings (healthcare):
  • Life expectancy is increasing for both indigenous and non-indigenous Australians.
  • The severity of circulatory diseases (heart disease, stroke, hypertension) is reducing in Indigenous patients.
  • However, rate of mortality in the Aboriginal community due to cancer is increasing.
    • "Later diagnoses of cancer, comorbidities and the types of cancer affecting Indigenous Australians are likely to be contributing to lower cancer survival"

 Main health concerns:
  • Cardiovascular disease e.g. high blood pressure, cholesterol, hypertension.
  • Diabetes, exacerbated by coexisting heart diseases which weaken the integrity of blood vessels.
  • Smoking, rate of smoking has increased.
    • Rate of lung diseases has increased.
  • Severity and incidence of cancer.

 Role of optometry
  • Prevention and treatment of vision loss - research suggests that around 30% of Aboriginal and Torres Strait Islander people have a long term eye condition, and 6x the rates of blindness and 3x the rates of vision loss compared to non-indigenous Australians [2]
  • Detection and monitoring of signs associated with systemic disease (I.e. hypertension, high blood pressure/cholesterol, diabetes, etc.).
  • Recognise that the severity and incidence of cardiovascular disease is often much higher in Indigenous populations.
  • Careful counselling and advice regarding diet, exercise, stopping smoking, the need for regular ocular/general health checkups.
  • Detection of metastasised tumours or ocular signs associated with tumours.
    • e.g. choroidal melanoma, Horner's syndrome due to pancoast tumour.
      • The uvea, and in particular the choroid, is a common location for metastasis of breast cancer and lung cancer. [3] [4]
      • Aboriginal people have a higher incidence of preventable cancers (liver, cervical), and they are more likely to be fatal (e.g. lung, liver). [5]
  • Explaining medical conditions in plain language.
  • Ensuring patient care is culturally appropriate to the Indigenous community.

Impact of COVID-19 on remote indigenous communities
There is heightened government response for remote indigenous communities to control infectious diseases worsened by already existing systemic issues e.g. COVID-19. [6]
  • Even with social distancing in place, ocular emergencies can still continue to happen.
  • The use of Telehealth may be one of many ways that optometrists can triage patients and monitor for symptoms of serious ocular health issues, as well as screen patients for symptoms of COVID-19.

Extra resources:

 References:
1. Australian Government. (2020). Closing The Gap Report 2020. Available: https://ctgreport.niaa.gov.au/. Last accessed: 02/05/20
2. Optometry Australia. (2020). Eye Health and Indigenous Australians. Available: https://www.optometry.org.au/advocacy/issues-at-a-glance/indigenous-eye-health/. Last accessed 02/05/2020.
3. Arepalli, S., Kaliki, S. and Shields, C.L., 2015. Choroidal metastases: origin, features, and therapy. Indian journal of ophthalmology, 63(2), p.122.
4. Bornfeld, N. and Singh, A.D., 2019. Uveal metastatic tumors. In Clinical Ophthalmic Oncology (pp. 403-421). Springer, Cham.
5. Chynoweth, J., McCambridge, M.M., Zorbas, H.M., Elston, J.K., Thomas, R.J., Glasson, W.J., Coutts, J.M., Daveson, B.A. and Whitfield, K.M., 2020. Optimal Cancer Care for Aboriginal and Torres Strait Islander People: A Shared Approach to System Level Change. JCO Global Oncology, 6, pp.108-114.
6. The Hon Greg Hunt MP. (2020). World first rapid COVID-19 testing to protect Aboriginal and Torres Strait Islander communities. Available: https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/world-first-rapid-covid-19-testing-to-protect-aboriginal-and-torres-strait-islander-communities. Last accessed 02/05/2020.
7. Simon Atkinson. (2020). Coronavirus: Why are Australia's remote Aboriginal communities at risk?. Available: https://www.bbc.com/news/world-australia-51971891. Last accessed 02/05/20.