This report primarily draws on research looking at disparities between Aboriginal and non-Aboriginal Western Australians in cardiovascular health and health care, conducted with funding from three research grants, the most recent known as the Bettering Aboriginal Heart Health in WA project.
The methods used have included interviews, reviews of hospital records, analyses of linked hospital and mortality data, and literature reviews. Part I of the report primarily comprises summaries of the studies along with Key Findings and Recommendations arising from the research, while Part II details ‘Strategies for Action’ incorporating input from stakeholders and other strategic documents.
The research initially centred on coronary heart disease, with statistical analysis of state-wide WA data, to determine the occurrence, comorbidities and outcomes for Aboriginal people, including age, sex, and geographic distributions. The team is now also studying other heart conditions such as heart failure and abnormalities of heart rhythm (dysrhythmias). Key heart conditions covered in this report are briefly explained in boxes in the relevant sections.
Qualitative research was undertaken on the experiences of both the Aboriginal people affected by these illnesses and the health professionals involved in their care. This research aimed to understand the barriers and enablers of quality care provision and to promote optimal models of care. These original research projects were supplemented with critical reviews of published literature, resulting in stand-alone publications on the topics of interest.
The BAHHWA project has had significant input from a number of key partnerships, including with the Heart Foundation, and the Cardiovascular Health Network and Aboriginal Health Division of the WA Department of Health.
How this report should be cited:
Katzenellenbogen JM*, Haynes E*, Woods JA, Bessarab D, Durey A, Dimer L, Maiorana A, Thompson SC.Information for Action: Improving the Heart Health Story for Aboriginal People in Western Australia (BAHHWA
Report). Perth: Western Australian Centre for Rural Health, University of Western Australia; 2015.
*these authors contributed equally to this work
Aboriginal people experience both illness and death from heart disease at higher rates and at a much earlier average age than non-Aboriginal people. Many are further disadvantaged by living in rural and remote areas distant from centres of health service provision. The data underscore the urgency to direct efforts ‘upstream’ towards primary prevention and earlier, community-based detection and intervention. There is a need for more holistic and culturally appropriate approaches to health service delivery. Access to high quality primary health care, incorporating improved integration (e.g., multidisciplinary teams) and continuity (linkages between primary and specialist/hospital care) is vital.
In addition to in-patient clinical excellence, the hospital system must address the need for augmented discharge processes for Aboriginal patients, strengthened Aboriginal Health Liaison Officer programs and up-to-date information technology solutions to ensure continuity of care and optimal outcomes.
We have high quality information to inform progress in this context. Knowledge translation is paramount, and we must consciously regard data as the basis for directing our efforts for improvement in the health of Aboriginal people. To deliver the best possible outcomes, efforts need to be sustainable and founded on partnerships incorporating the broader Aboriginal community as well as linking organisations. We hope that the strategies proposed in this Information for Action Report will serve to inspire actions to make a difference to the health of Aboriginal Western Australians.
We acknowledge the traditional custodians of the land across Western Australia and their Elders past and present. Members of the Heart Foundation in WA, in particular Lyn Dimer, Trevor Shilton and Julie Smith, have been an integral part of the BAHHWA project since its inception. We appreciate the constructive advice provided by the Cardiovascular Health Network of the WA Health Department, in particular Kim Goodman, Jacquie Garton-Smith, and Tony Mylius. Many thanks to the BAHHWA workshop participants and knowledge translation Reference Group, including:
Tina Bertilone, Andy Brown, Ted Dowling, Laura Elkin, Michelle Elwell, Kim Goodman, Carol de Groot, Greg Levin,
Cheryl Hayward, Derrick Lopez, Suzanne McEvoy, Helen Mclean, Lesley Nelson, Kathy Ride, Melanie Robinson,
Frank Sanfilippo, Shaouli Shahid, Val Swift-Otero, Trevor Shilton, Tiew-Hwa Teng, Maureen Unsworth, Nicholas
Wells, Liz Wilkes, Marianne Wood.
We appreciate the contribution of Christine Jeffries-Stokes, Julie Owen, Ben Scalley, Shaouli Shahid, Leslee Warrior, the South Metropolitan Population Health Unit, the Aboriginal Health Improvement Unit and other unnamed contributors to the compilation of the case studies used in the report.
Lennie Smith’s contribution of artwork has substantially enhanced the visual presentation of the report. We appreciate Veronique Thomas-Smith’s input in her role as the design consultant. A special thanks to Rosalie Thackrah who edited a late version of the report. The many Aboriginal community members who participated in the research reported here have also made an essential contribution. Lastly this Report would not have been possible without the academics and clinicians who have supported this project at critical points or have contributed directly to the research.