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Indigenous health: a worldwide focus
Editorial
Lowitja Institute
Indigenous health: a worldwide focus
Aunty Di See World Report page e1 See Comment page 105 See Articles page 131
If you are a member of the Baka, an Indigenous tribe in Cameroon, you can expect to live until you are aged about 35 years, which is about 12 years less than for the non-Indigenous people there. In Greenland you would be better off, at 73 years, but nonetheless this figure is 9 years less than that for the Danish population. Such discrepancies are recognised, but now we have such data for all regions of the world. Melbourne, Australia, saw the launch on April 20 of a collaborative paper, published online in The Lancet, that examined indices of health of Indigenous and tribal people globally. Aunty Di, an elder of the Wurundjeri tribe, gave a traditional welcome. This paper and an accompanying Comment are published in today’s Lancet. The collaborators, led by Ian Anderson of Melbourne University, have gathered data from, most notably, some parts of China and India where almost two-thirds of the world’s Indigenous and tribal people live, and from the other parts of the world. They show us that it makes no difference where you live if you are Indigenous—you will be worse off health-wise, regardless of the economic status of that country.
Why do such large differences exist between populations living in the same country? The answer is related to poverty, poor education levels, employment status, and access to health services, and whether Indigenous people are actually counted, which they are not in some countries. So, what can be done to improve the lot of Indigenous and tribal peoples worldwide? The collaboration calls upon the UN Sustainable Development Goals to take specific account of Indigenous people, especially the goals directed at ending poverty, improving health and education, and reducing inequalities. Policy makers should follow Australia’s lead and make Indigenous disadvantage a national policy priority. Without that, the situation will remain unchanged, with 300 million people continuing to die much earlier than they should and women dying unnecessarily in childbirth. The next steps for the group will be to revisit these data in a few years, to see what governments have done now that the health inequalities have been brought clearly into focus. The Lancet
Ian Hooton/Science Photo Library
Harnessing primary care to reduce avoidable mortality
For Avoidable mortality in England and Wales: 2014 see https://www.ons.gov.uk/people populationandcommunity/health andsocialcare/causesofdeath/ bulletins/avoidablemortality inenglandandwales/2014 For Suspected cancer see https:// www.nice.org.uk/guidance/ qs124/resources/suspectedcancer-75545358576325
104
In 2014, almost a quarter of the 500 000 deaths among people aged less than 74 years in England and Wales could have been avoided, according to figures released by the Office for National Statistics on June 29. The report used a new definition of avoidable mortality that combined preventable deaths (mainly neoplasms) and deaths from conditions that were amenable to treatment (mainly cardiovascular disease) and was standardised to the European population. Premature mortality resulted in an average loss of 23 years of life for adults and 72 years for children, in whom accidental injury was the leading cause of death. 60% of the avoidable mortality was in males. The value of such data is the ability to identify areas for improvement, such as men’s health, and to monitor future performance. Avoidable mortality shows strong regional disparities. A point also emphasised in a quality standard on Suspected cancer published by the National Institute for Health and Care Excellence (NICE) on June 30, which found variation in referral rates for cancer that could not
be explained by epidemiological differences. To reduce premature mortality, NICE recommends that general practitioners and practice nurses have rapid, direct access to endoscopy and imaging for patients with suspected cancer. By reducing the time to investigation and by providing a written, culturally sensitive explanation of why the referral has been made and its importance, NICE hopes that patients will have a better experience, care will be safer, and treatment more effective. Taken together, these reports show the importance of primary care grounded in a strong tradition of clinical acumen and patient communication: precious skills that have been under-recognised in previous health service reforms. However, in a health system pressed to capacity on all sides, general practitioners and their staff will need appropriate support for the extended responsibilities and deeper integration of services that the changes entail. Above all, the new pathways must be shown to benefit patients, most of whom will not have cancer and may yet require specialist referral for differential diagnoses. The Lancet www.thelancet.com Vol 388 July 9, 2016
Lowitja Institute
Indigenous health: a worldwide focus
Aunty Di See World Report page e1 See Comment page 105 See Articles page 131
If you are a member of the Baka, an Indigenous tribe in Cameroon, you can expect to live until you are aged about 35 years, which is about 12 years less than for the non-Indigenous people there. In Greenland you would be better off, at 73 years, but nonetheless this figure is 9 years less than that for the Danish population. Such discrepancies are recognised, but now we have such data for all regions of the world. Melbourne, Australia, saw the launch on April 20 of a collaborative paper, published online in The Lancet, that examined indices of health of Indigenous and tribal people globally. Aunty Di, an elder of the Wurundjeri tribe, gave a traditional welcome. This paper and an accompanying Comment are published in today’s Lancet. The collaborators, led by Ian Anderson of Melbourne University, have gathered data from, most notably, some parts of China and India where almost two-thirds of the world’s Indigenous and tribal people live, and from the other parts of the world. They show us that it makes no difference where you live if you are Indigenous—you will be worse off health-wise, regardless of the economic status of that country.
Why do such large differences exist between populations living in the same country? The answer is related to poverty, poor education levels, employment status, and access to health services, and whether Indigenous people are actually counted, which they are not in some countries. So, what can be done to improve the lot of Indigenous and tribal peoples worldwide? The collaboration calls upon the UN Sustainable Development Goals to take specific account of Indigenous people, especially the goals directed at ending poverty, improving health and education, and reducing inequalities. Policy makers should follow Australia’s lead and make Indigenous disadvantage a national policy priority. Without that, the situation will remain unchanged, with 300 million people continuing to die much earlier than they should and women dying unnecessarily in childbirth. The next steps for the group will be to revisit these data in a few years, to see what governments have done now that the health inequalities have been brought clearly into focus. The Lancet
Ian Hooton/Science Photo Library
Harnessing primary care to reduce avoidable mortality
For Avoidable mortality in England and Wales: 2014 see https://www.ons.gov.uk/people populationandcommunity/health andsocialcare/causesofdeath/ bulletins/avoidablemortality inenglandandwales/2014 For Suspected cancer see https:// www.nice.org.uk/guidance/ qs124/resources/suspectedcancer-75545358576325
104
In 2014, almost a quarter of the 500 000 deaths among people aged less than 74 years in England and Wales could have been avoided, according to figures released by the Office for National Statistics on June 29. The report used a new definition of avoidable mortality that combined preventable deaths (mainly neoplasms) and deaths from conditions that were amenable to treatment (mainly cardiovascular disease) and was standardised to the European population. Premature mortality resulted in an average loss of 23 years of life for adults and 72 years for children, in whom accidental injury was the leading cause of death. 60% of the avoidable mortality was in males. The value of such data is the ability to identify areas for improvement, such as men’s health, and to monitor future performance. Avoidable mortality shows strong regional disparities. A point also emphasised in a quality standard on Suspected cancer published by the National Institute for Health and Care Excellence (NICE) on June 30, which found variation in referral rates for cancer that could not
be explained by epidemiological differences. To reduce premature mortality, NICE recommends that general practitioners and practice nurses have rapid, direct access to endoscopy and imaging for patients with suspected cancer. By reducing the time to investigation and by providing a written, culturally sensitive explanation of why the referral has been made and its importance, NICE hopes that patients will have a better experience, care will be safer, and treatment more effective. Taken together, these reports show the importance of primary care grounded in a strong tradition of clinical acumen and patient communication: precious skills that have been under-recognised in previous health service reforms. However, in a health system pressed to capacity on all sides, general practitioners and their staff will need appropriate support for the extended responsibilities and deeper integration of services that the changes entail. Above all, the new pathways must be shown to benefit patients, most of whom will not have cancer and may yet require specialist referral for differential diagnoses. The Lancet www.thelancet.com Vol 388 July 9, 2016