Renal disease as a metaphor: Towards a more integrated view of Aboriginal health

Authors
Citation
We. Hoy, Renal disease as a metaphor: Towards a more integrated view of Aboriginal health, CLIN EXP PH, 25(12), 1998, pp. 1038-1042
Citations number
29
Categorie Soggetti
Pharmacology & Toxicology
Journal title
CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY
ISSN journal
03051870 → ACNP
Volume
25
Issue
12
Year of publication
1998
Pages
1038 - 1042
Database
ISI
SICI code
0305-1870(199812)25:12<1038:RDAAMT>2.0.ZU;2-J
Abstract
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.