Food for Thought

The devastating effects of diabetes on Indigenous health in Australia.  
“It has become obvious that the situation is urgent and is an area of national neglect” says Dr Neale Cohen, General Manager Diabetes Services, BakerIDI Heart and Diabetes Institute. Diabetes rates in Australia are high but its prevalence in the Indigenous population is between three and four times higher than the rest of the population. There are many reasons, including genetics, poverty and lack of education and resources, particularly in remote communities. Dr Cohen says we need to act decisively. And now.

Dr Neale Cohen
Dr Neale Cohen.

“In the past few years I have been fortunate enough to be involved in a clinical diabetes services in outreach communities in the Northern Territory, says Dr Cohen. “As an Australian and experienced physician, I am shocked and alarmed. It has become obvious that the situation is urgent and is an area of national neglect. There’s a tsunami of kidney failure and other complications heading our way with many people having signs of early kidney damage, eye damage and heart disease. All these are associated with very poor control of their diabetes. Complication rates in the indigenous population are among the highest in the world and about 10 times non-indigenous rates.

In my travels to remote settlements, I have seen children as young as 12 with type 2 diabetes. More worrying is the age of patients developing early kidney complications. I know of one young man aged 16 who already has signs of significant kidney disease and will no doubt head towards dialysis and death in the next 10 to 15 years. Many of my patients continuously live with blood glucose levels in the 20 to 30 range (compared to a normal range of 4 to 6).

There are many challenges in managing Indigenous diabetes. Its nature appears to be more aggressive and less responsive to conventional therapies. We have now reached a crisis point for the devastating effects of diabetes on Indigenous health. And while treatment of chronic disease in remote communities is challenging and complex, we must not be deterred. The loss of a great Australian, M. Yunupingu, should serve as a reminder that more needs to be done. Tiny clinics in remote towns need staff devoted to the prevention and treatment of diabetes and its complications. And communities need assistance at every level with the day-to-day management of this very complex disease.

Education and health promotion are critical in the long term but their health benefits may take decades. Clearly, we don’t have that sort of time. An emphatic response, firmly grounded in equity, compassion and human rights is needed to turn the tide of what will soon become a national disaster. If we do not act decisively, we will look back in 10 years and wonder why we didn’t.”
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Credit: Paul Williams - Photographer

Where soft drink is cheaper than water. Short films deliver health messages in remote Indigenous communities. Skinnyfish, a Darwin-based record company, is using its connections with Indigenous musicians to spread health messages in remote communities. Co-founder Mark Grose says they will launch 30 short films devised and written by people from seven communities from Western Arnhem Land to Croker Island (with help from the record label and filmmaker Paul Williams). Comedy, music and traditional knowledge are used to tackle serious health issues, including excess consumption of soft drinks. “So it’s really Aboriginal people speaking to Aboriginal people about a modern issue.” The overall message is “get active, eat bush tucker and live longer”. Nigel Yunupingu stars in Sugar Man, which addresses excess sugar consumption in his community of Galiwin’ku on Elcho Island, off the coast of Arnhem Land. WATCH.