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Durey A, Naylor N, Slack-Smith L. Inequalities between Aboriginal and non-Aboriginal Australians seen through the lens of oral health: time to change focus. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220294. [PMID: 37381845 PMCID: PMC10291420 DOI: 10.1098/rstb.2022.0294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/21/2023] [Indexed: 06/30/2023] Open
Abstract
Inequitable social environments can illustrate changes needed in the social structure to generate more equitable social relations and behaviour. In Australia, British colonization left an intergenerational legacy of racism against Aboriginal people, who are disadvantaged across various social indicators including oral health. Aboriginal Australian children have poorer health outcomes with twice the rate of dental caries as non-Aboriginal children. Our research suggests structural factors outside individual control, including access to and cost of dental services and discrimination from service providers, prevent many Aboriginal families from making optimum oral health decisions, including returning to services. Nader's concept of 'studying up' redirects the lens onto powerful institutions and governing bodies to account for their role in undermining good health outcomes, indicating changes needed in the social structure to improve equality. Policymakers and health providers can critically reflect on structural advantages accorded to whiteness in a colonized country, where power and privilege that often go unnoticed and unexamined by those who benefit incur disadvantages to Aboriginal Australians, as reflected in inequitable oral health outcomes. This approach disrupts the discourse placing Aboriginal people at the centre of the problem. Instead, refocusing the lens onto structural factors will show how those factors can compromise rather than improve health outcomes. This article is part of the theme issue 'Evolutionary ecology of inequality'.
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Affiliation(s)
- Angela Durey
- School of Population and Global Health, University of Western Australia, Perth, Western Australia 6009, Australia
| | - Nola Naylor
- Aboriginal Health Strategy, Clinical Service Planning & Population Health, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
| | - Linda Slack-Smith
- School of Population and Global Health, University of Western Australia, Perth, Western Australia 6009, Australia
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Devlin S, Ross W, Widders R, McAvoy G, Browne K, Lawrence K, MacLaren D, Massey PD, Judd JA. Tuberculosis care designed with barramarrany (family): Participatory action research that prioritised partnership, healthy housing and nutrition. Health Promot J Austr 2021; 33:724-735. [PMID: 34743380 PMCID: PMC9542773 DOI: 10.1002/hpja.554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 10/04/2021] [Accepted: 11/02/2021] [Indexed: 01/13/2023] Open
Abstract
Issue addressed. Ongoing tuberculosis (TB) transmission in Aboriginal communities in Australia is unfair and unacceptable. Redressing the inequity in TB affecting Aboriginal peoples is a priority in Australia's Strategic Plan for Tuberculosis Control. Improving TB care needs not to just identify barriers but do something about them. Privileging the voices of Aboriginal people affected by TB is essential to identify effective and enabling strategies.
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Affiliation(s)
- Sue Devlin
- North Coast Public Health Unit, New South Wales, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Wayne Ross
- Traditional Knowledge Custodian of the Gumanyggirr Nation, New South Wales, Australia
| | | | - Gregory McAvoy
- North Coast Public Health Unit, New South Wales, Australia
| | - Kirsty Browne
- North Coast Public Health Unit, New South Wales, Australia
| | | | - David MacLaren
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Peter D Massey
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Jenni A Judd
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Centre of Indigenous Health Equity Research, Central Queensland University, Bundaberg, Queensland, Australia
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Meumann EM, Horan K, Ralph AP, Farmer B, Globan M, Stephenson E, Popple T, Boyd R, Kaestli M, Seemann T, Vandelannoote K, Lowbridge C, Baird RW, Stinear TP, Williamson DA, Currie BJ, Krause VL. Tuberculosis in Australia's tropical north: a population-based genomic epidemiological study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 15:100229. [PMID: 34528010 PMCID: PMC8350059 DOI: 10.1016/j.lanwpc.2021.100229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/03/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Northern Territory (NT) has the highest tuberculosis (TB) rate of all Australian jurisdictions. We combined TB public health surveillance data with genomic sequencing of Mycobacterium tuberculosis isolates in the tropical 'Top End' of the NT to investigate trends in TB incidence and transmission. METHODS This retrospective observational study included all 741 culture-confirmed cases of TB in the Top End over three decades from 1989-2020. All 497 available M. tuberculosis isolates were sequenced. We used contact tracing data to define a threshold pairwise SNP distance for hierarchical single linkage clustering, and examined putative transmission clusters in the context of epidemiologic information. FINDINGS There were 359 (48%) cases born overseas, 329 (44%) cases among Australian First Nations peoples, and 52 (7%) cases were Australian-born and non-Indigenous. The annual incidence in First Nations peoples from 1989-2019 fell from average 50.4 to 11.0 per 100,000 (P<0·001). First Nations cases were more likely to die from TB (41/329, 12·5%) than overseas-born cases (11/359, 3·1%; P<0·001). Using a threshold of ≤12 SNPs, 28 clusters of between 2-64 individuals were identified, totalling 250 cases; 214 (86%) were First Nations cases and 189 (76%) were from a remote region. The time between cases and past epidemiologically- and genomically-linked contacts ranged from 4·5 months to 24 years. INTERPRETATION Our findings support prioritisation of timely case detection, contact tracing augmented by genomic sequencing, and latent TB treatment to break transmission chains in Top End remote hotspot regions.
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Affiliation(s)
- Ella M Meumann
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
- Territory Pathology, Royal Darwin Hospital, Darwin, Australia
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Kristy Horan
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Anna P Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Belinda Farmer
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Maria Globan
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Elizabeth Stephenson
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Tracy Popple
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Rowena Boyd
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Mirjam Kaestli
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Torsten Seemann
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Koen Vandelannoote
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Christopher Lowbridge
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Robert W. Baird
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
- Territory Pathology, Royal Darwin Hospital, Darwin, Australia
| | - Timothy P. Stinear
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Deborah A. Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Bart J. Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Vicki L. Krause
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
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Polanco-Pasaje JE, Rodríguez-Márquez I, Tello-Hoyos KY, Torres-Pereda P, Guzmán-Salazar BL, Pérez F. Tuberculosis care cascade for the indigenous population in Colombia: an operational research study. Rev Panam Salud Publica 2021; 45:e20. [PMID: 33643402 PMCID: PMC7901045 DOI: 10.26633/rpsp.2021.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/15/2020] [Indexed: 12/23/2022] Open
Abstract
Objective. Construct and evaluate the care cascade for pulmonary tuberculosis in the indigenous population of the department of Cauca (Colombia) and identify existing gaps. Methods. Mixed-methods sequential explanatory design. In the first phase, the pulmonary tuberculosis care cascade for the indigenous population of Cauca was evaluated. Data were obtained from secondary sources and all cases diagnosed from 1 January 2016 to 31 December 2017 were included. In the second phase, semi-structured interviews were done with nine program coordinators and 11 nursing auxiliaries to explain identified gaps. Absolute and percentage values were estimated for each of the steps and gaps in the care cascade. Quantitative and qualitative results were triangulated. Results. In 2016 and 2017, an estimated 202 patients with respiratory symptoms were expected to be positive and 106 cases of pulmonary tuberculosis were reported among the indigenous population of the department of Cauca. A gap of 47.5% was found for diagnosis, since only 52.5% of subjects were diagnosed in health services. This gap was explained by poor quality of samples and flawed smear techniques; flaws in correct identification of patients with respiratory symptoms; limited access to diagnostic methods, such as culture and molecular tests; and limited training and high turnover of personnel in health service provider institutions. Conclusions. The tuberculosis control program should focus actions on bridging the gap in case detection in the indigenous population.
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Affiliation(s)
- Jhon Edwin Polanco-Pasaje
- Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia Medellín Colombia Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Iader Rodríguez-Márquez
- Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia Medellín Colombia Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Kelly Yoana Tello-Hoyos
- Secretaría de Salud Departamental, Gobernación del Cauca Colombia Secretaría de Salud Departamental, Gobernación del Cauca, Colombia
| | - Pilar Torres-Pereda
- Instituto Nacional de Salud Pública Cuernavaca Mexico Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Bertha Leonor Guzmán-Salazar
- Secretaría de Salud Departamental, Gobernación del Cauca Colombia Secretaría de Salud Departamental, Gobernación del Cauca, Colombia
| | - Freddy Pérez
- Department of Communicable Diseases and Environmental Determinants of Health Pan American Health Organization Washington D.C. United States of America Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington D.C., United States of America
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Hall NL, Barnes S, Canuto C, Nona F, Redmond AM. Climate change and infectious diseases in Australia's Torres Strait Islands. Aust N Z J Public Health 2021; 45:122-128. [PMID: 33522674 DOI: 10.1111/1753-6405.13073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/01/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE This research seeks to identify climate-sensitive infectious diseases of concern with a present and future likelihood of increased occurrence in the geographically vulnerable Torres Strait Islands, Australia. The objective is to contribute evidence to the need for adequate climate change responses. METHODS Case data of infectious diseases with proven, potential and speculative climate sensitivity were compiled. RESULTS Five climate-sensitive diseases in the Torres Strait and Cape York region were identified as of concern: tuberculosis, dengue, Ross River virus, melioidosis and nontuberculous mycobacterial infection. The region constitutes 0.52% of Queensland's population but has a disproportionately high proportion of the state's cases: 20.4% of melioidosis, 2.4% of tuberculosis and 2.1% of dengue. CONCLUSIONS The Indigenous Torres Strait Islander peoples intend to remain living on their traditional country long-term, yet climate change brings risks of both direct and indirect human health impacts. Implications for public health: Climate-sensitive infections pose a disproportionate burden and ongoing risk to Torres Strait Islander peoples. Addressing the causes of climate change is the responsibility of various agencies in parallel with direct action to minimise or prevent infections. All efforts should privilege Torres Strait Islander peoples' voices to self-determine response actions.
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Affiliation(s)
- Nina L Hall
- School of Public Health, The University of Queensland
| | - Samuel Barnes
- School of Public Health, The University of Queensland
| | - Condy Canuto
- School of Public Health, The University of Queensland
| | - Francis Nona
- School of Public Health, The University of Queensland
| | - Andrew M Redmond
- Faculty of Medicine, The University of Queensland.,Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Queensland
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Polanco-Pasaje JE, Rodríguez-Márquez I, Tello-Hoyos KY, Torres-Pereda P, Guzmán-Salazar BL, Pérez F. [Tuberculosis care cascade for the indigenous population in Colombia: an operational research studyCascata de atenção da tuberculose para os povos indígenas na Colômbia: pesquisa operacional]. Rev Panam Salud Publica 2020; 44:e150. [PMID: 33346246 PMCID: PMC7746001 DOI: 10.26633/rpsp.2020.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
Objetivo Construir y evaluar la cascada de atención de la tuberculosis pulmonar en la población indígena del departamento del Cauca (Colombia) e identificar las brechas existentes. Métodos Metodología mixta con diseño secuencial explicativo. En la primera fase se evaluó la cascada de atención de la tuberculosis pulmonar para la población indígena del Cauca. Se obtuvieron datos de fuentes secundarias y se incluyeron todos los casos diagnosticados entre el 1 de enero del 2016 y el 31 de diciembre de 2017. En la segunda fase, se aplicaron entrevistas semiestructuradas a nueve coordinadores de programa y 11 auxiliares de enfermería para explicar las brechas identificadas. Se estimaron los valores absolutos y porcentuales en cada uno de los pasos y las brechas de la cascada de atención. Se triangularon los resultados cuantitativos y cualitativos. Resultados Durante 2016 y 2017 se estimaron 202 sintomáticos respiratorios esperados positivos y se notificaron 106 casos de tuberculosis pulmonar en la población indígena del departamento del Cauca. Se encontró una brecha de 47,5% para el diagnóstico, ya que solo 52,5% de los sujetos recibieron el diagnóstico en los servicios de salud. Las explicaciones a esta brecha fueron la mala calidad de muestras y fallas en la técnica del extendido, fallas en la correcta identificación del sintomático respiratorio, acceso limitado a métodos diagnósticos como cultivo y pruebas moleculares, así como capacitación escasa y rotación alta de personal al interior de las instituciones prestadoras de servicios de salud. Conclusiones Las acciones del programa de control de tuberculosis deben enfocarse en reducir la brecha de detección de casos en la población indígena.
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Affiliation(s)
- Jhon Edwin Polanco-Pasaje
- Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia Medellín Colombia Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Iader Rodríguez-Márquez
- Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia Medellín Colombia Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Kelly Yoana Tello-Hoyos
- Secretaría de Salud Departamental Gobernación del Cauca Colombia Secretaría de Salud Departamental, Gobernación del Cauca, Colombia
| | - Pilar Torres-Pereda
- Instituto Nacional de Salud Pública Cuernavaca México Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Bertha Leonor Guzmán-Salazar
- Secretaría de Salud Departamental Gobernación del Cauca Colombia Secretaría de Salud Departamental, Gobernación del Cauca, Colombia
| | - Freddy Pérez
- Departamento de Enfermedades Transmisibles y Determinantes Ambientales de la Salud, Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Departamento de Enfermedades Transmisibles y Determinantes Ambientales de la Salud, Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América
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Haynes E, Mitchell A, Enkel S, Wyber R, Bessarab D. Voices behind the Statistics: A Systematic Literature Review of the Lived Experience of Rheumatic Heart Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041347. [PMID: 32093099 PMCID: PMC7068492 DOI: 10.3390/ijerph17041347] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 01/22/2023]
Abstract
In Australia, Aboriginal children almost entirely bear the burden of acute rheumatic fever (ARF) which often leads to rheumatic heart disease (RHD), a significant marker of inequity in Indigenous and non-Indigenous health experiences. Efforts to eradicate RHD have been unsuccessful partly due to lack of attention to voices, opinions and understandings of the people behind the statistics. This systematic review presents a critical, interpretive analysis of publications that include lived experiences of RHD. The review approach was strengths-based, informed by privileging Indigenous knowledges, perspectives and experiences, and drawing on Postcolonialism and Critical Race Theory. Fifteen publications were analysed. Nine themes were organised into three domains which interact synergistically: sociological, disease specific and health service factors. A secondary sociolinguistic analysis of quotes within the publications articulated the combined impact of these factors as ‘collective trauma’. Paucity of qualitative literature and a strong biomedical focus in the dominant narratives regarding RHD limited the findings from the reviewed publications. Noteworthy omissions included: experiences of children/adolescents; evidence of Indigenous priorities and perspectives for healthcare; discussions of power; recognition of the centrality of Indigenous knowledges and strengths; and lack of critical reflection on impacts of a dominant biomedical approach to healthcare. Privileging a biomedical approach alone is to continue colonising Indigenous healthcare.
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Affiliation(s)
- Emma Haynes
- School of Population and Global Health, The University of Western Australia, Perth 6000, Australia
- Telethon Kids Institute, Perth 6000, Australia; (S.E.); (R.W.)
- Correspondence:
| | - Alice Mitchell
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia;
| | - Stephanie Enkel
- Telethon Kids Institute, Perth 6000, Australia; (S.E.); (R.W.)
| | - Rosemary Wyber
- Telethon Kids Institute, Perth 6000, Australia; (S.E.); (R.W.)
- The George Institute for Global Health, University of New South Wales, Sydney 2000, Australia
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, The University of Western Australia, Perth 6000, Australia;
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