Upstream health care in remote communities

Health outcomes for Aboriginal and Torres Strait Islander peoples are very poor and considerably worse in remote regions. The East Pilbara in Western Australia, where the Indigenous communities of the Martu and Nyiyaparli peoples reside, is one such remote region. To alter the trajectory of poor health outcomes for the Martu and Nyiyaparli, the Puntukurnu Aboriginal Medical Service (PAMS) has identified the need to move from the ‘repair shop’ model of health care that addresses disease to an upstream preventive model that concentrates on the wider determinants of health.

To achieve this goal, PAMS initiated the first phase of a multi-phase project with a request to Curtin Medical School’s Rural Health Campus to undertake a grey literature review of the health services and health outcomes of the Martu and Nyiyaparli peoples. As subsequent phases of the project will involve in-depth community consultation undertaken by permanent members of the project team, this review was limited by its role as an initial enquiry.

The review found that health data rarely distinguish between the language groups that constitute Australia’s diverse Aboriginal and Torres Strait Islander populations. There were no means, using currently available data, by which to identify the distinct cultural, social, health and environmental needs of specific language groups such as the Martu and Nyiyaparli peoples. There were sparse data available in the public domain that did specifically identify the Martu and Nyiyaparli peoples. This highlights the need for locally driven, place-based solutions.

However, there was sufficient data to identify poor health outcomes for the Aboriginal and Torres Strait Islander peoples of the East Pilbara, with health indicators that were trending negative. For example, the median age of death (43.5 years) was the lowest in Western Australia and had deteriorated in the five years leading to 2021.

The review also found that the healthcare workforce shortage common to very remote areas across Australia was particularly problematic in the East Pilbara. Of 22 health workforce categories tracked by the National Rural Health Alliance, the 2020 workforce FTE per 100,000 population in the East Pilbara local government area fell below the benchmark in 19 categories and below the average in 15 categories compared to very remote (MM7) areas Australia-wide.

In 2008, the Australian Government stated its intent to close the gap in health outcomes between Aboriginal and Torres Strait Islander and non-Indigenous people. As a result, Australia’s healthcare budget increased 100 per cent in the decade to 2019. However, this review confirmed that the remote communities of the Martu and Nyiyaparli peoples, like so many other Aboriginal and Torres Strait Islander communities in remote Australia, have not benefited from this increase in healthcare budgeting.

These findings demonstrate that the current healthcare system has not met the needs of the Martu and Nyiyaparli peoples, in common with many remote Aboriginal and Torres Strait Islander communities. Importantly, evidence continues to mount that the preventive health approach is less expensive and produces better outcomes than the repair shop model. Yet Australia’s health system remains fundamentally focused on the treatment of illness and disease.

The need to move to a preventive healthcare model, such as the upstream healthcare model proposed by PAMS for the Martu and Nyiyaparli peoples, is acknowledged in the National Preventive Health Strategy 2021–2030. It is now a matter of providing sufficient funding in the next federal budget to translate strategy into practice.