Overview
Nutrition, alcohol consumption, smoking and use of other drugs and substances, are some of the key health risk factors that contribute to the greater burden of ill health experienced by Aboriginal and Torres Strait Islander peoples when compared with non-Indigenous Australians.
Health risk factors impact on the onset, maintenance and prognosis of a variety of chronic diseases. Understanding risk factors facilitates early intervention and management strategies to prevent or ameliorate disease and to achieve health gains for individuals and populations (NPHP 2001). Non-communicable diseases are 'to a great extent preventable through interventions against the major risk factors and their environmental, economic, social and behavioural determinants in the population" (WHO 2000). The health risk factors presented in this section focus on behavioural risk factors including smoking, alcohol and other drug use and nutrition, all of which impact on the health and quality of life of Indigenous Australians. These risk factors are responsible for a large proportion of the total burden of disease in Australia (Mathers et al. 1999; AIHW 2002) and are an important component of the greater burden of ill health experienced by Aboriginal and Torres Strait Islander peoples when compared with non-Indigenous Australians.
On this page
Alcohol consumption
The hazardous use of alcohol is related to conditions such as alcohol dependence syndrome, alcoholic liver disease, high blood pressure, stroke and some cancers. Alcohol is frequently a contributing factor to injuries from traffic accidents, assault and self-harm, and may contribute to social problems such as family breakdown, domestic violence, and financial and legal problems.
While several surveys have shown that Indigenous Australians are less likely than other Australians to drink alcohol (ABS 2002; AIHW 2003), those who do so are more likely to consume it at hazardous levels. The 2004-05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) showed that 48% of Indigenous people aged 18 years and over had consumed alcohol in the week prior to interview; the 2004-05 National Health Survey showed that a higher proportion (62%) of all respondents consumed alcohol in the week prior to interview.
The 2004-05 NATSIHS found that, of the Indigenous Australians surveyed who had consumed alcohol in the week prior to interview, 16% had consumed alcohol at a high risk level. Although only 36% of Indigenous people living in remote areas consumed alcohol in the week prior to interview compared to 54% of Indigenous people living in non-remote areas, the proportion who drank at high risk levels was similar. Indigenous males (19%) were more likely to consume alcohol at high risk levels than Indigenous females (14%). International data indicate that drinking at hazardous levels is more common among the Indigenous populations of New Zealand and Canada. In the 1996-97 New Zealand Health Survey, Maori adults were twice as likely as non-Maori adults to report that they had not drunk any alcohol in the previous year but one in three Maori drinkers were consuming alcohol at hazardous levels compared with one in five non-Maori drinkers (Ministry of Health 1999). Canadian data indicate that Aboriginal youths are two to six times more at risk than non-Aboriginal youths for every alcohol-related problem examined (Health Canada 1999).
For more information, go to Alcohol and other drug treatment services.
Smoking
While the effects of excess alcohol consumption on individuals, families and communities can be clearly identified, the effects of smoking, a major cause of preventable ill health and death, may take many years to appear (Unwin et al. 1994). As a single risk factor, smoking causes the greatest burden of disease (approximately 10%) for the total Australian population (Mathers et al. 1999).
Cigarette smoking is associated with the increased incidence of, and mortality from, various types of cancer, including lung, cervical, bladder and pancreatic cancers, coronary heart disease, stroke, chronic respiratory tract diseases, and pregnancy-related conditions (English et al. 1995). The effects of passive smoking are also associated with higher rates of lung cancer and heart disease in adults, asthma and lower respiratory tract illness such as bronchitis and pneumonia in children (NHMRC 1997), and higher rates of sudden infant death syndrome (Scragg et al. 1993, Mitchell et al. 1997). In addition, smoking is a risk factor for low birthweight (Sayers & Powers 1997), which, as noted above, is a risk factor for both childhood and long-term diseases.
Surveys have revealed a high prevalence of smoking among Aboriginal and Torres Strait Islander people. The 2004-05 NATSIHS found that 51% of Indigenous males and 49% of Indigenous females were current smokers. After adjusting for differences in age structure, Indigenous Australians were more than twice as likely to be current daily smokers as non-Indigenous Australians.
High rates of smoking have also been found among other Indigenous groups. In New Zealand, the proportion of Maori people who smoke has decreased over the last 15 years but remains high, with almost half of all Maori adults aged 15 and over reporting that they were smokers in the 1996-97 National Health Survey, compared with 23% of non-Maori adults (Ministry of Health 1999). Over 60% of Canada's Aboriginal population over the age of 15 reported that they were smokers in 1997, more than twice the rate of the general Canadian population (Health Canada 1999).
Other drugs and substances
Indigenous Australians are also at risk of ill health through the use of substances such as marijuana, heroin, amphetamines and inhalants (e.g. petrol, glue, aerosols). The 2001 National Drug Strategy and Household Survey (NDSHS) indicates that illicit drug use among Aboriginal and Torres Strait Islander peoples was higher than that for non-Indigenous Australians. Over half (57%) of Indigenous respondents aged 14 years and over indicated that they had tried an illicit drug compared to 37% of non-Indigenous respondents.
Data for 2004-05 from the Alcohol and Other Drug Treatment Services National Minimum Data Set indicates that Indigenous people made up about 10% of clients using treatment services, a small increase from 2000-01. Indigenous clients were more likely than non-Indigenous clients to be receiving treatment for problems related to alcohol, cannabis or solvents, but less likely to be receiving treatment for opiates, amphetamines or benzodiazepines. As this data collection does not cover some Indigenous specific substance use services, the number of Indigenous clients is underestimated.
Injecting drugs is a risk factor for blood-borne diseases such as hepatitis B and C, and HIV. A study of the prevalence of hepatitis C among injecting drug users using needle exchanges in 1995-96 found that about 70% of Indigenous and non-Indigenous injecting drug users were infected with the virus (ANCARD 1997). Over the period 1992-99, 140 cases of HIV among the Indigenous population were notified to the National HIV Surveillance Centre. Eight of these cases were reported in conjunction with injecting drug use, while a further 14 cases were reported in conjunction with exposure to both injecting drug use and male homosexual contact.
Petrol sniffing continues to be a major problem in some Indigenous communities, and particularly affects young people. Petrol sniffing can cause confusion, aggression, lack of coordination, hallucinations, respiratory problems, and chronic disability including mental impairment (see D'Abbs & MacLean 2000).
For more information, go to Alcohol and other drug treatment services.
Nutrition
The importance of the roles played by diet and nutrition in health is universally acknowledged. Less well understood are the complex interrelationships between nutrition and health risk factors. For example, diet-related diseases may be associated with environmental, behavioural, biological and genetic factors, making it difficult to determine the extent to which diet contributes to disease.
Many Aboriginal and Torres Strait Islander people live in remote areas of Australia and do not have the same opportunities as other Australians to obtain affordable, healthy food. For example, the 2000 Healthy Food Access Basket survey in Queensland confirmed that the cost of basic food was considerably higher in rural and remote communities than in metropolitan and regional centres, and noted that 'the food supply and delivery system is structured to favour metropolitan areas' (Public Health Services, Queensland Health 2001, p.38).
Even when healthy food is available, factors such as competing priorities for limited family incomes, restricted access to traditional foods, lack of knowledge of the nutritional value of certain foods, and lack of culturally appropriate nutritional information can lead to inadequate or inappropriate nutrition. A healthy living environment is also important and reduces the chances of gastrointestinal infection and diarrhoeal diseases, which may cause or exacerbate malnutrition in infants.
The diet of many Aboriginal and Torres Strait Islander people has undergone rapid change, from a fibre-rich, high protein, low saturated fat 'traditional' diet, to one in which refined carbohydrates and saturated fats predominate (O'Dea 1992). As has been found in other indigenous populations undergoing a similar change in diet and lifestyle, Australia's Indigenous people are prone to a group of conditions known collectively as Syndrome X, or the 'insulin resistance syndrome'. This syndrome includes obesity, Type 2 diabetes, cardiovascular disease and renal disease. All these conditions are more common in Indigenous Australians than in non-Indigenous Australians.
For more information on some of these conditions, go to Ill-health conditions.
Diet and nutrition during pregnancy and the child's early life may have life-long effects. Breastfeeding is associated with reduced infant and child mortality. Maternal under-nutrition is one factor linked to low birthweight, which is about twice as common among babies born to Indigenous mothers as it is among babies born to non-Indigenous mothers, and is a risk factor for infant death and ill health in childhood. In addition, Barker (1999a, 1999b) proposes that under-nourishment of the foetus may predispose the person to diseases such as heart disease, stroke, high blood pressure and Type 2 diabetes in later life. More research is necessary to confirm these findings.
For more information, go to Mothers and babies.
Further information
For more general information on health risk factors, go to risk factors.