Topic 16: The historical and contemporary impacts of policy

Introduction

Both historical and contemporary policies continue to affect the health outcomes and circumstances of Aboriginal and Torres Strait Islander individuals and communities.  This topic attempts to raise awareness of these past and current policies with consideration of the impacts which have been and continue to be felt by Aboriginal and Torres Strait Islander Peoples. 

The impact of policy on critical illness

In the context of critical illness, a number of studies have examined the characteristics and outcomes of Indigenous Australians admitted to ICU and how this might be impacted by policy decisions. Critically ill Indigenous Australians are significantly younger and have higher rates of invasive mechanical ventilation, emergency admissions and inter-hospital transfers than their non-Indigenous counterparts, but the overall ICU and hospital mortality are similar between the two groups. Indigenous Australians have higher rates of admission with sepsis, trauma and respiratory illness and higher rates of ICU readmission. Long-term follow-up suggests that there is a higher rate of long-term mortality, with one study demonstrating a 68% mortality at five years post-ICU admission at a median age of 53 years. The same study revealed severe ongoing functional limitation at five years, with higher rates of healthcare utilisation than comparable international studies. This has profound implications for healthcare planners and may suggest a need for increased primary healthcare resources to pre-emptively manage chronic disease and reduce the burden of healthcare utilisation at acute care facilities. The impact of healthcare policies around alcohol pricing has also been studied; over 25% of admissions to the Alice Springs Hospital ICU have been linked to alcohol misuse; however, following the introduction of a minimum alcohol price (floor price) in the Northern Territory the number of ICU admissions associated with alcohol misuse significantly declined.

The impact of policy on the health and well-being outcomes for children

Colonisation, government policy and racism have resulted in poor health outcomes for Aboriginal and Torres Strait Islander children (Queensland Family and Child Commission, 2022b). Aboriginal and Torres Strait Islander children often experience multiple vulnerabilities and are consistently and significantly overrepresented in the child protection system and child mortality statistics (Queensland Family and Child Commission, 2022-b). The mortality rate for Indigenous children was 69.6 deaths per 100,000 Indigenous children aged 0–17 years, compared to 29.6 deaths per 100,000 non-Indigenous children (3-year average), indicating the Indigenous mortality rate was 2.3 times the rate for non-Indigenous children for all causes (Queensland Family and Child Commission, 2022-b). The Aboriginal and Torres Strait Islander infant mortality rate was 6.5 deaths per 1,000 Indigenous births, compared to 3.5 deaths per 1,000 non-Indigenous births (3-year average) (Queensland Family and Child Commission, 2022-b). The other associated outcomes are increased unnatural deaths in young people and suicides – Indigenous infants, children and youth are over-represented (Queensland Family and Child Commission, 2022-b).

	Activities to facilitate learning

The following activities will enhance your learning on this topic.

	Watch

1. Watch the Boyer lecture: Noel Pearson

2. Watch the Boyer lecture: Rachel Perkins 

Text transcript

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	Additional recommended resources

You are encouraged to source other information about this topic independently. Additional recommended resources for optional further learning are:  

Discover the lived experiences of children, families and young people in contact with the youth justice system in Yarning for change

• Pages 8-15: contacts with the system
• Pages 16-17: the impact of child protection
• Pages 18-19: what is needed by children in contact with the youth justice system

1. Read the article on alcohol floor price and critical care admissions by Secombe et al. (2020)
2. Read the article on the impact of alcohol-related admissions on resource use in critically ill patients by Secombe and Stewart (2018) (ANZCA link)
3. Read the article on long-term morbidity and mortality in survivors of critical illness by Secombe and Stewart (2017)
4. Review the article on incident haemodialysis and outcomes in the Top End of Australia by Hughes et al. (2020)
5. Read the article on trauma‐related admissions to intensive care units in Australia by Magee et al. (2019)
6. Review the article on mortality after admission for acute myocardial infarction in Aboriginal and non-Aboriginal people by (Randall et al. 2012) (ANZCA link)
7. Read the article on Aboriginal and Torres Strait Islander patients requiring critical care by Secombe et al. (2019) (ANZCA link)
8. Read the article on characteristics and outcomes of critically ill Aboriginal and/or Torres Strait Islander patients in North Queensland by Trout et al. (2015) (ANZCA link)
9. Explore the results of the National Aboriginal and Torres Strait Islander Health Survey

Reflect on your learning Select the image to answer the reflection question for this topic.