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Monday 3 March 2008

RAPID ROUNDUP: Utopia model could point the way to improving Aboriginal health – Experts comment

In a finding which bucks the trend in Aboriginal health research, a study released in the Medical Journal of Australia today shows health outcomes at the Northern Territory community of Utopia are significantly better than  the average Territory Aboriginal community.

The cohort study of 296 residents over ten years showed a mortality rate 40% lower than the NT average for Aboriginal people. Earlier observations showed a drop in smoking, and successful prevention of obesity and diabetes.

Scientists and others involved in the study comment below.

If you would like a copy of this paper or you would like to speak to an expert about this research please don’t hesitate to contact us on (08) 8207 7415

Dr Lisa Jackson Pulver is a Senior Lecturer in Public Health and Community Medicine at the University of New South Wales

“This study proves a lot.  To see something coming from the NT where Aboriginal people’s lives are able to resume some kind of normality proves of course that outstation life is useful. These people have access to country and are caring for themselves.  It’s amazing that people are even surprised by this. Of course it has a positive effect. The key thing is that local people are able to guide the delivery of services according to what they believe are their needs.

I have no doubt that this study could be used to improve conditions in any other community , remote or urban, by focusing on listening to what the people in that community want and  having services provided in a way that they can direct them to meet their needs.”

Professor Ian Anderson is Research Director at the Cooperative Research Centre for Aboriginal Health at the University of Melbourne

“There are a range of possible reasons why Utopia has substantially better health outcomes than the average NT community, but  when we look at the standard macro indicators, employment, education and housing , there’s no difference between Utopia and the average community so the results have to be partly related to what’s happening in the social organisation of the community. This is a decentralised community with a long history of running its own affairs and a very well established primary health care service. So these things are very likely to be the contributing factors to explain the better outcomes.

There’s an assumption that all remote community outcomes are uniformly bad  and yet  here we have an example of a remote community where apparently things are much better and we need to understand why, because   it provide insights that might enable the development into  other communities. The decentralised model of outstation has benefits in physical activity, diet, and less access to alcohol.  The risk factors indicators show that obesity is more noticeable in communities near the store rather than in the remote outstations.

Cohort studies like this, following the health of a group of people, have been notoriously difficult to achieve but this study has a very representative sample,  over 90% and with 99% follow-up .There was a high degree of ownership of this study – it’s emblematic of what makes Utopia different.”

Ricky Tilmouth is Senior Health Worker at Urapuntja Health Service at Utopia

“This study gives hard evidence that community outstations and a community lifestyle do actually work if the primary healthcare is delivered properly. We’re very strong on our law and culture here, bush tucker and bush medicines too, and all that empowers our community.

With the health audits being done at present as part of the intervention, it’s an opportunity to try this model elsewhere, and also to extend these current mobile services to include hearing and dental health support services.”

Dr Karmananda Saraswati is a doctor with the Urapuntja Health Service at Utopia

“This study is important because it shows that if we deliver services in a culturally appropriate way we get much better health outcomes.   At Utopia people still have a traditional matrix, with food seeking, ceremonies and most importantly of all traditional land.  We’re providing primary health care in a mobile way and supporting them in that setting and the combination of those two means we’re getting better cardiac health outcomes.

If people are going to be visionary and say where are we going to go in Aboriginal health to get outcomes then I think this is important because he health outcomes here show the importance of land and traditional practices but also qualitatively what we observe is the more subtle thing of people being empowered and being in charge of their own lives.”