How does healthcare differ among aborigines and non-Indigenous people?

HOW CAN WE IMPROVE THE HEALTH OF ABORIGINES
Improving the Health of Indigenous people is not a simple proposition. The fact is that theirs is an ancient culture very different from the European. This is made more complicated by their mixing with the white community both socially and by breeding. To put it simply the Indigenous Community is not just one homogenous entity. 

A major health problem among Aboriginal and Torres Strait Islander people is that they have the fourth highest rate of Type II diabetes in the world. It is thought that between 10 and 30 per cent of Aboriginal and Torres Strait Islanders have this type of diabetes
Aboriginal health issues - diabetes - Better Health Channel.

This is especially relevant because of the complications that can result from diabetes (Diabetes in Aboriginal Australians).
Diabetes shows up earlier in life among Aborigines and therefore there is more chances of complications developing (Odea, Rowley and Brown).

Complications that arise out of diabetes include a higher risk of heart attack or stroke, eye disease, mental problems, kidney disease and nerve damage, possibly leading to limb amputation.

Added to this, the incidence of gestational diabetes is also two to three times higher among Indigenous women than in the general Australian population. Since many women who suffer from gestational diabetes go on to develop Type 11 diabetes in later years (Beat It), this adds to the problem. The death rate from diabetes and associated problems among Aborigines and Torres Strait Islanders is believed to be up to 17 times that of non-indigenous Australians, mainly due to high levels of cardiovascular and kidney disease (Diabetes in Aboriginal Australians).

Causes of the problem
Many explanations have been suggested for the high incidence of diabetes among Indigenous Australians. Extreme social disadvantage in the form of high unemployment, welfare dependency, poor education and overcrowded living conditions have all been cited as contributing causes (O’Dea). Added to this the Indigenous community appears to have developed a different Genotype to the rest of the population.

Thrifty Genome Theory
Some Researchers have claimed that during several millennia of living as hunter gatherers where food availability was associated with physical activity, the Aborigine has developed a “thrifty genotype” (Neel). As a result of this, the Aboriginal community appears to get by on less food than European Australians. While this could be helpful when food is in short supply it would cause them to easily gain excess adiposity when food is plentiful. This has been compounded by the social factors mentioned earlier. A community which belongs to the lower socio-economic bracket and therefore lacks educational opportunities also find that foods that promote obesity are readily available and also cheaper than a healthier diet. It is therefore natural for them to gravitate towards this type of food. When Indigenous people lived a traditional lifestyle, they generally had a low body mass compared with what is considered normal for European Australians, and their weight did not tend to increase with age. Watching their weight is therefore not in their culture.

Some Aboriginal and Torres Strait Islander populations have mild glucose intolerance and relatively high cholesterol levels without suffering any ill effects (Gault et al). There is no evidence to show that Aboriginal people had diabetes, or other conditions affected by lifestyle such as heart and blood vessel disease, obesity or high blood pressure, when they lived a traditional lifestyle (Hales,Desai and Ozanne 1997). Early studies of Indigenous people before the adoption of Western lifestyles showed no evidence of diabetes, Research has shown that Aboriginal people who live a Westernised lifestyle have high rates of obesity, impaired glucose tolerance, high blood pressure, high levels of triglycerides (fats) in the blood, and excessively high insulin levels in the blood combined with Central Obesity (O”Dea). The Westernised Lifestyle is not confined to diet and physical activity alone but must take into consideration the part that psychological stress has to play in central adiposity.

Stress and Central Obesity
The Westernised Lifestyle has also introduced psychological stress into Aboriginal life in a variety of ways. This is mostly because they have been uprooted from a way of life in which they were comfortable and planted in an environment that is foreign to their philosophy and culture. It has been shown that stress results in higher cortisol levels which makes the fat receptors in the Omentum more active and in turn results in accumulation of central adiposity. This is especially true when the diet is at fault and alcohol is consumed in excess. A fatty Omentum is a known cause of higher insulin resistance, diabetes and a variety of chronic disease (Bluher et al).

Low Birth Weight
A lighter than average birth weight also has a loose correlation with visceral fat in adulthood. Aboriginal parents being smaller than the average European Australian will tend to have smaller children but when the low birth weight is due to fetal underdevelopment, it is more likely to be associated with increased risk of developing central adiposity in later life. The mother's nutritional status, illness during pregnancy and the duration of the pregnancy are all relevant  (Curhan et al). A mother's alcohol consumption and use of tobacco and other drugs during pregnancy can also impact on the size of her baby. Tobacco, in particular, has a major impact on birth weight. The mean birth weight of live babies born in 2001-2004 to Indigenous women who smoked was 3,037 grams, that is more than 250 grams lighter than those born to Indigenous women who did not smoke (3,290 grams) (McNeeley et al).

Can the situation be reversed?
The situation is reversible but like all long standing problems the solution is by no means simple. It calls for social changes, and education both of the Indigenous community and the rest of us. There are problems which the Indigenous community can handle and others which must be faced by the community at large. We must realise that whereas a dichotomy is not sustainable, the answer is not just to make them like us, there is much that we can learn from the Indigenous community.

It is also important that we treat Indigenous people as human beings and on an equal footing to us. Consult them about their future instead of talking down to them telling them what is good for them. I would not suggest that they go back to living in the bush and return to being hunter gatherers, it is Lifestyle modification that is desirable. This would mean a shift away from the so called western lifestyle which initially caused the problem and this could include smoking, alcohol and maybe even medication, except in extreme cases. In a study comparing Metformin with a change in Lifestyle, Metformin reduced blood sugar levels by 31% while changes in Lifestyle resulted in a 58% improvement (New England Journal of Medicine 2002).

I would therefore recommend a diet which conforms to their genotype and metabolic needs and an exercise program to increase muscle mass, even if neither is exactly what their ancestors were used to. This could be a diet including lean meats like Kangaroo and Emu, Fish and even Rabbit which tends to be lean, rather than the fatty farmed meats which are part of the average Australian diet. Although the vegetables and fruit we now eat is not exactly what they consumed in their hunter gatherer days, eating fruit with a low GI might still be a move in the right direction. On the other hand they should increase muscle mass which will increase their metabolic rate and insulin sensitivity. We must also realise that mixed blooded Aborigines must be considered separately as they would have a different metabolism not necessarily the complete thrifty genotype. Many of them are Urban dwellers and would not live the physical lifestyle of their ancestors.