Issue 30 / 15 August 2011

IT is more than 3 years since Kevin Rudd’s historic apology to the Stolen Generations and the federal government has admitted progress in closing the gap has been slow. We still have the shame of terrible poverty and high premature illness and death in our Indigenous community.

Why do both the living and health status of our Indigenous community still fall many years behind that of the rest of the Australian community? A potent example is the very high rate of diabetes and its devastating complications in our Aboriginal and Torres Strait Islander peoples.

A recent systematic review, of which I was a coauthor, highlights the inadequate data available on the true magnitude of the diabetes epidemic among Indigenous populations in different parts of Australia.

The review confirmed rates of diabetes and prediabetes are high but there is considerable variation between different regions. This may be a methodological issue but the reasons certainly need to be established.

Many of the studies reviewed were either too small or used methodologies that do not allow adequate comparisons. It clearly emerges there is really no overall national picture.

Data on diabetes rates in urban Indigenous communities are sparse despite the fact they account for almost three-quarters of the total Indigenous population. Type 2 diabetes is increasing in Indigenous children, adolescents and young adults but, again, data are few.

Australia’s failure in Indigenous health is highlighted by the 2009 United Nations report “The state of the world’s indigenous peoples”, which lists our Indigenous people as having the worst ill health globally.

The prevalence of diabetes is one of the highest in the world, and its complications are major contributors to the huge gap in life expectancy in Indigenous adults, which is 17 years lower than for other Australians. Indigenous people are about 20 times more likely to die from chronic diseases such as diabetes, heart or kidney disease.

We are also faced with the appalling fact that Alice Springs is close to being the world’s “capital of diabetes” and, as a consequence, it has the largest kidney dialysis unit in the Southern Hemisphere. It also has one of the highest rates of leg amputations.

An article in the MJA highlighted the huge challenges we face in reversing this disastrous scenario. It emphasised the lifelong consequences of poor maternal nutrition resulting in a poor intrauterine environment in Indigenous mothers. It is increasingly recognised that this in-utero disadvantage predispose their children to obesity, type 2 diabetes, heart disease and even mental disorders in adult life.

Diabetes and obesity in the mother, malnutrition, smoking, alcohol and drug misuse all affect the baby’s genetic material. These changes are then passed on to the next generation creating a vicious intergenerational pattern of chronic disease susceptibility. What your grandmother ate may affect your adult disease susceptibility.

So, what are the strategies that may help turn the Titanic around?

First, it is during pregnancy and pre-pregnancy that interventions have a chance of helping to reverse the disastrous epidemic of type 2 diabetes among our Indigenous people.

Many children are born to young mothers who are malnourished, poorly educated, smoking and drinking, who develop diabetes during their pregnancy and are dwelling in squalid and dysfunctional circumstances.

Second, despite the billions of dollars that government has poured into a seeming bottomless pit in the Northern Territory and other regions, there is little to show, with housing through to progress in critical markers of health status still woefully inadequate.

Contributors to the chronic disease in Indigenous communities also include the trauma and grief associated with the erosion of the traditional Aboriginal way of life and poor maternal nutrition in pregnancy.

All of these issues need to be addressed for us to see a more robust community.

We must start from a new base, with a better understanding of the issues, wider consultation with the Indigenous community, enhancing their dignity and creating better opportunities for youth through education in all disciplines and employment opportunities. And we need to focus on maternal and child health — a sorely ignored component of this shameful scenario.

Diabetes is a disaster for our Indigenous peoples, from the womb to the tomb!

Professor Paul Zimmet is director emeritus of the Baker IDI Heart and Diabetes Institute.

Posted 15 August 2011

4 thoughts on “Paul Zimmet: Disaster from womb to tomb

  1. Tony Krins says:

    I believe that the enduring “Aboriginal problem” is not primarily a medical one but a psycho/socio/political one. Modern welfare has robbed Aboriginal communities of their economy. Without an economy, a community has no effective social hierarchy and so it falls apart and stays fallen apart (for 200 years) until such time as an economy and social hierarchy is somehow restored. This would require a paradigm shift in welfare strategies as well as a paradigm shift in Aboriginal culture from within.
    After working with Aboriginal people and after reading books by Noel Pearson and Richard Trudgen, I penned the following poem:


    What black shadows wander there?
    Across the dry red land?
    Gliding slowly, but still bound
    Together as a band.

    The shadows are of flesh and blood,
    They have their spirits too.
    Their souls are anchored in the earth.
    Their nation is not new.

    Their souls and spirits have been tied
    From thousands years before
    To the oldest land on earth
    But they’re alone no more.

    The Dreaming’s fine for the wanderer’s life,
    For millenia, fine and true.
    But now old Dreaming leads to strife,
    It’s made no rules for new.

    Older Dreaming did not know
    Of changes so unfair.
    How “welfare” can destroy the soul,
    Leave hearts in great despair.

    Older Dreaming did not see
    That ties to land must change.
    The place of living now must be
    Further from the range.

    To places where all succour’s found
    For body, soul and kin.
    All still can visit sacred ground
    Whilst all is right within.

    Till the Dreaming comes of age,
    Brings changes good for all,
    Despair will fill each history’s page,
    As progress hits the wall.

    Despair that’s eased with drugs and grog
    Till minds and bodies fail,
    Till nothing more will lift the fog
    And all the spirits wail.

    Whenever will the suffering end
    for the nation Black and sad?
    Whenever will the Dreaming bend
    For the Future to be had?

    Let First Australians sieze the day
    To steer their path from pain.
    We others only need make way
    To let them rise again.

    The shadows black and beautiful
    Forever may they glide
    Across this ancient sacred land
    “New Dreaming” on their side.

    Tony Krins 2009

  2. Amedstudent says:

    I’m a final year med student who did my GP and elective rotations in urban and regional Indigenous health. I have to agree with both Zimmet and the two other posters – the cycle of disadvantage needs to stop. Better education, better antenatal care, better nutrition for the whole community would help and is definitely possible. However, tackling the devastating culture of welfarism will be harder. The majority of Indigenous people between the ages of 18-45 that I have spoken to – people in the prime of their lives – didn’t expect to get or to cope with regular work. How do we change this? Imposition of values from above or outside the community doesn’t work. We need to work with community leaders – but many of those leaders have vested interests in keeping the government money rolling in. But all is not bleak – during my time on rotation to Indigenous health clinics I have met many Indigenous people – particularly young people – who want to work towards a community where there is greater stability and less welfare dependence. Young women, often the only employed people in their family, earning a crust and spreading it around their highly dysfunctional families. I think we need to identify, educate and support these people particularly.

  3. dr. anne glew says:

    Stop the cycle of destruction. Aboriginal children in each generation see their adult relatives destroy all their assets, with violence. Loss of assets breeds despair. Depair creates alcholism, hopelessness, with a determination to also destroy the next generation’s assets. Somebody somewhere in some generation needs to stop the destruction.
    Somebody needs to start accepting the hurt and practice forgiveness.

  4. lebistourie says:

    Your second last paragraph has been said pretty much since I was a medical student in the 1960s – though not as frequently or publicly.

    What are the possible solutions?
    1. Bring capital city health care institutions to multiple small communities?
    2Move the communities to capital cities

    3. Force all indiginous peoples to school and to pass?

    4. Give all indiginous peoples jobs as positive discrimination?

    5. Allow and insist on all the smaller communities to return to pre-inavasion lifestyle by eliminating all Western influences in vast tracts of the country?

    6. Accept that only cultural integration will work and that this will take another century or so and do our best to mitigate in the meantime the problems you describe.

    7. Education and positive lifestyle role models are needed but the provision of these and their acceptance is not going to occur without stronger sanctions and the availability of carrots that don’t reflect the wishful thinking groups that seem to dominate the discussion.

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