Introduction
The disease burden is greatest among indigenous Australians compared with other groups in the population. Although genetic makeup is reported to contribute towards the disease aetiology, there are also other factors unique to this group that are attributed to high prevalence of Type 2 Diabetes among the Aboriginal Australians. Indigenous Australians are the victims of urbanization, with nearly 76% of the Australian population living in urban areas (Pink & Albon, 2008). As a result, indigenous Australians, along with the rest of the population, have adopted sedentary lifestyles, and reduced their involvement in physical activities (Magliano et al., 2008). Consequently, the prevalence of lifestyle disease among this group has increased tremendously, including Type 2 Diabetes Mellitus. Indigenous Australians is a term used in reference to individuals who are regarded as indigenous to Australia, in that the identity of their ancestry is linked to people who resided in Australia prior to colonization. Examples of indigenous Australians include the Aboriginal and Torres Strait Islander people.
Diabetes remains a leading contributor to the disease burden of the Australian healthcare system. The overall prevalence of diabetes in Australia stood at 7.4% in 2002 (Dunstan et al., 2002; Marmot et al., 2008; McDermott, Li & Campbell, 2010). Among the Torres Strait Islanders, prevalence and incidence of type 2 diabetes mellitus is 6 times higher than the rest of the population (Trewin, 2006). This is indicative of systematic differences in the Australian healthcare system that may be potentially avoided. Only a limited number of studies have endeavored to assess Type 2 Diabetes Mellitus trends in urban areas. The most comprehensive national study to have been conducted on this population is the 2002 AusDiab Study (Dunstan et al., 2002). In order to succinctly assess the disease burden of Type 2 Diabetes Mellitus among the Aboriginal and Torres Strait Islander people, it is important to undertake more comprehensive studies on their poor state of health. Nonetheless, Type 2 Diabetes Mellitus remaining a significant health issue in Australia.
Description of the health issue
Type 2 Diabetes Mellitus is among the leading causes of noncommunicable disease. Its fundamental causes are usually poor diet and physical inactivity, although genetics also plays a minor role in its causation. Studies show that the Australian Indigenous population has a curiously high prevalence and incidence of Type 2 diabetes Mellitus. Type 2 Diabetes Mellitus is characterized by increased blood glucose. This increase is primarily due to relative insulin deficiency and/or insulin resistance
(Dunstan et al., 2000; Feskens et al., 1994). Increase in body fat due to overnutrition and lack of exercise decreases sensitivity of body cells to insulin (Dunstan et al., 2000; Feskens et al., 1994). As a result, the liver improves the rate at which it releases glucose. On the other hand, there is decreased uptake of glucose by the skeletal muscle since insulin normally regulates these functions (Dunstan et al., 2000; Feskens et al., 1994). Consequently, pancreatic beta cells en d up producing elevated levels of insulin, and this may cause pancreatic death (McDermott et al., 2000).
Ultimately, Type 2 Diabetes Mellitus may result in the development of various diseases and is a leading factor in the development of renal disease, coronary heart disease, and retinopathy, among other debilitating conditions.
Why is Type 2 Diabetes Mellitus a significant health issue in Australia?
Studies show that Type 2 Diabetes Mellitus has already attained epidemic proportions in various parts of the world, including Australia (Dunstan et al., 2000). However, both the Torres Strait Islanders and the Aboriginal people of Australia are reported to have an earlier age onset and higher prevalence of Type 2 Diabetes mellitus relative to other groups in Australia. For example, the Torres Strait Islander and Aboriginal people are five to ten times more likely to be diagnosed with Type 2 Diabetes Mellitus compared with the general population (Burke et al., 2007). Some communities have even reported a prevalence of between 21% and 35% (McDermett et al., 2000; Burke et al., 2007), in comparison with a prevalence of about 8% reported in the general Australian population.
In addition, the Torres Strait Islander and Aboriginal people are more likely to be diagnosed with Type 2 Diabetes Mellitus compared with other groups in Australia. In one age group of between 25 and 34 years of age, prevalence of the disease was at 13%, while that of the general population was at 0.3% (Burke et al., 2007). This is a sign that the disease burden of Type 2 Diabetes Mellitus is greater among indigenous Australians than the rest of the population. Before embarking on an intervention strategy for Type 2 Diabetes Mellitus among the Indigenous population in Australia, it would be better to first understand the determining factors of the diseases.
Key determinants of Type 2 Diabetes Mellitus among the Indigenous Australian
Income and social status
There is a link between high prevalence of Type 2 Diabetes Mellitus among Indigenous Australians and their low income and social statuses. Both the Aboriginal and Torres Strait Islander peoples tend to be economically and socially underprivileged in comparison with the rest of the population (Australian Bureau of Statistics, 2006). Health status of a population improves with an increase in social and income hierarchy. Income affects the quality and quantity of food consumed. People with a higher income are more likely to access sufficient and healthy foods. In addition, higher social status and income enables people to have more discretion and control over life’s circumstances, including health. There is growing evidence to suggest that higher income and social status results in better health.
Several studies show than indigenous Australians are ranked in the lowest socioeconomic group (Trewin & Madden, 2005; Australian Bureau of Statistics, 2006; Rowley et al., 1997). As a result, they are more likely to purchase energy dense food because it is cheap. Based on their low socioeconomic status, indigenous Australians are also more likely to be affected by increased levels of psychological stress. Consequently, many of them may end up smoking or taking alcohol in a bid to relieve stress, in effect increasing their risks of getting Type 2 Diabetes Mellitus (Thompson, Gifford & Thorpe, 2000). Since indigenous Australians are generally characterized by low income and social statuses, it means that they are less likely to access proper nutrition and health services, and hence they are more predisposed to higher incidences of Type 2 Diabetes Mellitus in comparison with the rest of the population.
Education and literacy
There is a strong link between socioeconomic status and education. It is important to impart lifelong learning skills to both adults and children on the importance of adopting healthy lifestyles. Education imparts people with the necessary skills and knowledge to deal with health problems. It also enhances access to information on health (O’Dea, 2005). Compared with the rest of the Australian population, the Aboriginal and Torres Strait Islander people tend to have low levels of education and literacy. As such, they lack in the skills and knowledge necessary to deal with health issues such as Type 2 Diabetes Mellitus.
Social environment
The overall health and wellbeing of members of a society is determined by the social values and norms upheld by the society in question. A stable and cohesive society is also likely to work together towards realizing healthy lifestyles. In this case, a healthy lifestyle is indicative of the behavior of an individual and how he/she interacts with the social environment. Some of these social disadvantages shared by indigenous Australians include increased dependency on social welfare, overcrowded living conditions, high unemployment, poverty, poor community infrastructure, inferior housing, poor stands of hygienic and water supply (O’Dea, 2005). Since most of the Australian population does not experience the aforementioned socio-economic factors, it means that the indigenous people in Australia are more predisposed to developing poor health as a result of having to deal with these factors, including Type 2 Diabetes Mellitus.
Obesity
Several studies have linked obesity among indigenous Australians with Type 2 Diabetes Mellitus (Edwards & Madden, 2001; Guest & O’Dea, 1992). In addition, there is also a positive correlation between age and cases of Type 2 Diabetes Mellitus. As the population ages, so does the incidence of Type 2 Diabetes Mellitus (Edwards & Madden, 2001). For example, among persons below 25 years, the incidence rate of Type 2 Diabetes Mellitus is 2.2 for every 1000 person-years whereas for those between 45 and 54 years, the incidence rate is 39.9 for every 1000 person-years (Wang, Hoy & Si, 2010). There is need to appreciate the fact that obesity is due to a combination of factors like physical activity and dietary intake.
Physical activity
Urbanization, coupled with a shift from the traditional hunter-gatherer lifestyle in favor of the modern westernized lifestyle has seen the Torres Strait Islander and Aboriginal people of Australia reduce their involvement in physical activity (Burke et al., 2007; Guest & O’Dea, 1992). A report by the Australia Bureau of Statistics (2006) indicates that indigenous Australians are less likely to engage in physical activity in comparison with other Australians, thereby predisposing them to obesity and Type 2 Diabetes Mellitus.
Coping skills and health practices
This refers to individual actions that enhance self-reliance, self-care, and ability to cope with challenges, and prevent diseases. Such coping skills and healthy practices are important because they help members of a community to improve their overall wellbeing. However, the prevailing socioeconomic factors in the community will have a huge influence on the choices made by members of such a community. This includes health choices as well. In their study, Braun et al. (1996) contend that indigenous people in Australia tend to consume energy dense food compared with the rest of the population. In addition, Torres Strait Islanders and Aboriginal people have limited access healthy foods such as fresh vegetables and fruits (Braun et al., 1996; Lee et al., 1994). In their study, Burke et. (2007) found a string link between the dietary habits of indigenous Australians and the prevalence of Type 2 Diabetes Mellitus. Separately, Braun et al. (1996) noted that when the Torres Strait Islander and Aboriginal people embrace healthy eating habits, such as increased consumption of bush meat, reduces intake of fat, and replaced processed meat with game meat, their risk of developing Type 2 Diabetes Mellitus reduced.
Addressing Type 2 Diabetes Mellitus in the Australian health system
We need to note that Type 2 Diabetes Mellitus can be prevented to a large extent. In addition, the health burden of Type 2 Diabetes Mellitus can be significantly reduced in the indigenous population. The most suitable prevention strategy is one that involves the input of the government and a multi-sectoral approach. At the same time, such a prevention strategy should be incorporated in consultation with indigenous organizations and leaders (Bailie et al., 2004). It is important to ensure that the most suitable and effective prevention strategies have been adopted.
Majority of the studies have designed intervention strategies at the community level. One of the studies encouraged a group of Torres Strait Islander and Aboriginal people to embrace their pre-colonization lifestyle (Edwards & Madden, 2001). This intervention strategy resulted in weight loss, reduced blood glucose, and psychosocial improvements (Edwards & Madden, 2001). In Victoria, there is a health center that is dedicated to providing primary healthcare to the Aboriginal population. The program pays special attention to the community’s cultural beliefs (Thompson & Gifford, 2000; Thompson et al., 2000; Rowley et al., 2001).
In addition, a prevention strategy for Type 2 Diabetes Mellitus among indigenous Australians should be geared towards early detection as well as primary intervention. This could involve the implementation of screening and healthy eating programs at school canteens and community centers. There should also be efforts to understand the indigenous culture in order to realize better therapeutic outcome. With regard to management, it is important that primary health practitioners try to explore methods of cooking family meals that will result in reduced fat levels, the need to replace processed foods with natural whole foods, methods by which the indigenous people can obtain fresh vegetables and fruits, and the identification of local sports that the indigenous population can engage in (O’Dea, 1992; Bailie et al., 2004). Past studies indicate that regular physical activity, coupled with healthy eating habits are effective measure in the prevention of Type 2 Diabetes Mellitus (World Health Organization Expert Consultation, 2004).
Conclusion
Type 2 Diabetes Mellitus is a huge challenge to the Australia healthcare system. The prevalence and incidence rates of Type 2 Diabetes Mellitus among the indigenous Australians are higher in comparison with the rest of the population. This could be due to the low income and social status of this group, coupled with such social disadvantages as poverty high unemployment and poor sanitation among the indigenous Australians. The low level of education of the indigenous community means that they are less likely to access quality health care. In addition, the group has been shown to have poor eating and lifestyle habits, and this further add to the disease burden of Type 2 Diabetes Mellitus among indigenous Australians. There is need for collective action from individuals, the community, and the government if at all we are to alleviate the disease burden and improve health outcomes. Governmental leadership and societal support are necessary in implementing prevention strategies. In addition, increased government funding will enable additional research studies to be conducted with a view to improving treatments for Type 2 Diabetes Mellitus and possibly, finding a cure. Nonetheless, individuals have to ensure that they embrace healthy lifestyle.
Reference List
Australian Bureau of Statistics. (2006). National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. Canberra: Australian Bureau of Statistics.
Bailie, R.S., Si, D., Robinson, G. W., Togni, S. J., & d’Abbs, P. H. (2004). A multifaceted health-service intervention in remote Aboriginal communities: 3-year follow-up of the impact on diabetes care. Med J Aust., 181,195-200.
Braun, B., Zimmermann, M. B., Kretchmer, N., Spargo, R. M., Smith, R. M., & Gracey, M. (1996). Risk factors for diabetes and cardiovascular disease in young Australian Aborigines. Diabetes Care, 19(5),472-9.
Burke, V., Zhao, Y., Lee, A. H., Hunter, E., Spargo, R. M., Gracey, M., Smith, R.M., Beilin, L. J., & Puddey, I. B. (2007). Predictors of type 2 diabetes and diabetesrelated hospitalisation in an Australian Aboriginal cohort. Diabetes Res Clin Pract., 78(3),360-8.
Dunstan, D. W., Zimmet, P. Z., Welborn, T. A., De Courten, M. P., Cameron, A. J., & Sicree, R. A. et al. (2002). The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care. 2002; 25(5), 829-34.
Edwards, R. W., & Madden, R. (2001). The health and welfare of Australia’s Aboriginal and TorresStrait Islander peoples. Canberra: ABS and AIHW.
Feskens, E. J., Loeber, J. G., & Kromhout, D. (1994). Diet and physical activity as determinants of hyperinsulinemia: the Zutphen Elderly Study. American Journal of Epidemiology, 140(4),350-60.
Lee, A. J, O’Dea, K., & Mathews, J. D. (1994). Apparent dietary intake in remote Aboriginal communities. Aust J Pub Health.,18(2),190-7.
Magliano, D. J., Barr, E. L. M., & Zimmet, P. Z., et al. (2008). Glucose indices, health behaviors, and incidence of diabetes in Australia. Diabetes Care, 31, 267-272.
Marmot, M., Friel, S., Bell, R., Houweling, T. A., &Taylor, S. (2008). Closing the gap in a in a generation: health equity through action on the social determinants of health The Lancet, 372, 1661-9.
McDermott, R., Rowley, K. G., Lee, A. J., Knight, S., & O’Dea, K. (2000). Increase in prevalence of obesity and diabetes and decrease in plasma cholesterol in a central Australian Aboriginal community. Med J Aust.,172(10),480-84.
McDermott, R. A., Li, M., & Campbell, S. K. (2010). Incidence of type 2 diabetes in two Indigenous Australian populations: a 6-year follow-up study. MJA, 192(10),562-565.
O’Dea, K. (2005). Preventable chronic diseases among indigenous Australians: the need for a comprehensive national approach. Heart Lung Circ.,14(3), 167-71.
Pink, B., & Albon, P. (2008). The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples 2008. Canberra: Australian Bureau of Statistics.
Rowley, K. G., Su, Q., Cincotta, M., Skinner, M., Skinner, K., Pindan, B., White, G. A., & O’Dea, K. (2001). Improvements in circulating cholesterol, antioxidants, and homocysteine after dietary intervention in an Australian Aboriginal community. Am J Clin Nutr., 74, 442-8.
Thompson, S. J., Gifford, S. M., & Thorpe, L. (2000). The social and cultural context of risk and prevention: food and physical activity in an urban Aboriginal community. Health Educ Behav., 27(6),725-43.
Thompson, S. J., & Gifford, S. M. (2000). Trying to keep a balance: the meaning of health and diabetes in an urban Aboriginal community. Soc Sci Med., 16;51(10),1457-72.
Trewin, D. (2006). National Aboriginal and Torres Strait Islander Health Survey 2004 05. Canberra: Australian Bureau of Statistics.
Wang, Z., Hoy, W. E., & Si, D. (2010). Incidence of type 2 diabetes in Aboriginal Australians: an 11-year prospective cohort study. BMC Public Health, 10(1),487-91.
World Health Organization Expert Consultation. (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The Lancet, 363, 157-163.