1. The health of Aboriginal people in the Northern Territory of Australia i
s among the worst in the world, with mortality rates increased in every 'di
sease-specific' category and averaging overall approximately five-fold thos
e of non-aboriginal Australians. Health services, which in most regions are
rudimentary, fragmented and underresourced, have been slow to recognize an
d meet this challenge. However, the cost implications of an epidemic of ren
al failure have stimulated concern that broader mortality statistics could
not.
2. In one high-risk Aboriginal community, we found that renal disease can b
e detected and its course chartered by a simple and reliable screening test
. Renal disease arises out of a broad menu of risk factors that reflect pov
erty, disadvantage and accelerated lifestyle changes and its expression is
progressively amplified with the simultaneous operation of more than one ri
sk factor It is intimately related to other 'diseases' through shared risk
factors and pathophysiology. We also found that people with established ren
al disease participated enthusiastically in a pharmacological treatment pro
gramme, with excellent clinical responses that predict a marked reduction i
n renal failure and cardiovascular morbidity and mortality over the interme
diate term.
3. It is likely that most other causes of excess mortality in Aboriginal pe
ople are, like renal disease, multideterminant, with a substantial base of
shared risk factors. They are probably equally susceptible to modification.
We must move away from 'single-cause' disease models, eliminate counterpro
ductive specialty barriers and rectify the unbalanced focus and resource co
mmitment to hospital-based, high technology treatments of people with advan
ced and irreversible disease. We must advocate for coherent, sustained, int
egrated public health and primary care programmes to improve the whole heal
th profile and for screening and treatment programmes to modify the course
of disease in people already afflicted.