Lung health care for Aboriginal and Torres Strait Islander Queenslanders: breathing easy is not so easyKerry-Ann F. O’Grady A J , Amber Revell B , Graeme P. Maguire C D , Renate Millonig E , Michael A. Newman F , David W. Reid G , Deborah C. Hill H and Anne B. Chang A B I
A Queensland Children’s Medical Research Institute, Level 4, Foundation Building, Royal Children’s Hospital, Herston Road, Herston, QLD 4029, Australia.
C School of Medicine and Dentistry, Faculty of Medicine, Health and Molecular Sciences, James Cook University, Cairns Base Hospital, PO Box 902, Cairns, QLD 4870, Australia. Email: email@example.com
D Australian Lung Foundation, PO Box 847, Lutwyche, QLD 4030, Australia.
E Sunshine Coast Division of General Practice, PO Box 389, Cotton Tree, QLD 4558, Australia. Email: firstname.lastname@example.org
F Mt Isa Hospital, 30 Camooweal Street, Mt Isa, QLD 4825, Australia. Email: email@example.com
G Department of Thoracic Medicine, The Prince Charles Hospital, 672 Gympie Road, Chermside, QLD 4032, Australia. Email: firstname.lastname@example.org
H Patient Safety & Quality Improvement Service, Centre for Healthcare Improvement, Queensland Health, Royal Brisbane & Women’s Hospital, Herston Road, Herston, QLD 4029, Australia. Email: email@example.com
I Department of Respiratory Medicine, Royal Children’s Hospital, Herston Road, Herston QLD 4029, Australia.
J Corresponding author. Email: firstname.lastname@example.org
Australian Health Review 35(4) 512-519 http://dx.doi.org/10.1071/AH10973
Submitted: 20 October 2010 Accepted: 31 January 2011 Published: 30 September 2011
Objectives. In Aboriginal and Torres Strait Islander peoples in Queensland, to (a) determine the disease burden of common chronic lung diseases and (b) identify areas of need with respect to lung health services.
Methods. Literature reviews and analyses of hospitalisation and mortality data were used to describe disease epidemiology and available programs and services. Key stakeholder interviews and an online survey of health professionals were used to evaluate lung health services across the state and to identify services, needs and gaps.
Results. Morbidity and mortality from respiratory diseases in the Indigenous population is substantially higher than the non-Indigenous population across all age groups and regions. There are inadequate clinical services and resources to address disease prevention, detection, intervention and management in an evidence-based and culturally acceptable fashion. There is a lack of culturally appropriate educational resources and management programs, insufficient access to appropriately engaged Indigenous health professionals, a lack of multi-disciplinary specialist outreach teams, fragmented information systems and inadequate coordination of care.
Conclusions. Major initiatives are required at all levels of the healthcare system to adequately address service provision for Indigenous Queenslanders with lung diseases, including high quality research to investigate the causes for poor lung health, which are likely to be multifactorial.
What is known about the topic? Chronic diseases, including lung disease contribute to, and influence outcomes of, the well-known health and socioeconomic disadvantage among Aboriginal and Torres Strait Islander Australians. Nationwide, the most common reason for hospitalisation of Indigenous Australians is for lung diseases (after renal dialysis).
What does this paper add? There is currently no state- or nation-wide comprehensive review of chronic lung disease burden and the health services available to prevent, treat and manage lung disease. This review fills this gap in Queensland and has found that chronic lung disease burden is not homogenous. There are substantial gaps in, and barriers to, the provision of high quality, evidence based services and a paucity of well-designed research to inform policy and health service delivery.
What are the implications for practitioners? Evidence-based strategies are needed at the primary, secondary and tertiary levels of the healthcare system. Fourteen recommendations relevant to practitioners and policy makers were formulated.
Additional keywords: health policy, Indigenous, needs assessment.
References Aboriginal and Torres Strait Islander Health Performance Framework – Detailed Analyses. Canberra: Australian Government Department of Health and Ageing; 2008.
 A Picture of Australia’s Children 2009. Canberra: Australian Institute of Health and Welfare; 2009.
 Queensland Closing the Gap Report: 2008/09. Indicators and Initiatives for Aboriginal and Torres Strait Islander Peoples. Brisbane: Queensland Government; 2009.
 National Indigenous Reform Agreement (Closing the Gap). Canberra: Council of Australian Governments, 2008.
 The Health of Queenslanders: prevention of chronic disease. Brisbane: Queensland Health; 2008.
 Australasian Sleep Association, Australian Lung Foundation AL. Respiratory and Sleep Health in Indigenous Australians. Sydney: Thoracic Society of Australia and New Zealand; 2010.
 O’Grady KF, Revell A, Maguire G, Millonig R, Newman M, Reid D, et al. Lung Health Services for Aboriginal and Torres Strait Islander Peoples in Queensland. Brisbane: Queensland Health; 2010. Available at http://www.health.qld.gov.au/cpic/service_improve/clin_net_respiratory.asp [verified 1 September 2011].
 Population Distribution, Aboriginal and Torres Strait Islander Australians, 2006. Canberra: Australian Bureau of Statistics; 2007.
 Population Characteristics, Aboriginal and Torres Strait Islander Australians, 2006. Canberra: Australian Bureau of Statistics; 2008.
 Begg S, Bright M, Harper C. Queensland Burden of Disease and Injury. Brisbane: Queensland Health; 2006.
 National Health Survey: Summary of results, Queensland. Canberra: Australian Bureau of Statistics; 2004. Cat. No. 4362.0.
 National Aboriginal and Torres Strait Islander Health Survey, 2004–2005. Canberra: Australian Bureau of Statistics; 2006.
 National Aboriginal and Torres Strait Islander Social Survey, 2008: QLD Stats, Dec 2009. Canberra: Australian Bureau of Statistics; 2009. Cat Number 1318.3.
 Kapur VK. Obstructive sleep apnoea: diagnosis, epidemiology, and economics. Respir Care 2010; 55 1155–67.
 Indigenous Information and Statistics Team. Health Service District Level Agreements. Brisbane: Queensland Health; 2009.
 A national profile of Australian Government funded Aboriginal and Torres Strait Islander Primary Health Care Services: Service Activity Reporting, 2007–2008 Key Results. Canberra: Australian Government Department of Health and Ageing, National Aboriginal Community Controlled Health Organisation; 2009.
 Aboriginal and Torres Strait Islander health labour force statistics and data quality assessment. Canberra: Australian Institute of Health and Welfare; 2009.
 Valery PC, Chang AB, Shibasaki S, Gibson O, Purdie DM, Shannon C, et al High prevalence of asthma in five remote indigenous communities in Australia. Eur Respir J 2001; 17 1089–96.
| High prevalence of asthma in five remote indigenous communities in Australia.CrossRef | 1:STN:280:DC%2BD3MvksFWnug%3D%3D&md5=4a6274d232f35e42c823d972942e504bCAS |
 Valery PC, Chang AB, Masters IB, Stirling J, Laifoo Y, Twist A. Stable prevalence of asthma symptoms in school-aged children in the Torres Strait region. Respirology 2008; 13 447–51.
| Stable prevalence of asthma symptoms in school-aged children in the Torres Strait region.CrossRef |
 Pink B, Allbon P. The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples: 2008. Canberra: Australian Bureau of Statistics and Australian Institute of Health and Welfare, 2008.
 Bremner PR, de Klerk NH, Ryan GF, James AL, Musk M, Murray C, et al Respiratory symptoms and lung function in aborigines from tropical Western Australia. Am J Respir Crit Care Med 1998; 158 1724–9.
| 1:STN:280:DyaK1M%2FmsFKntw%3D%3D&md5=c5d49945dbd490b4df56214dacf1775eCAS |
 Thompson JE, Sleigh AC, Passey ME, Barnes A, Streatfield RW. Ventilatory standards for clinically well aboriginal adults. Med J Aust 1992; 156 566–9.
| 1:STN:280:DyaK383islOquw%3D%3D&md5=150f2c0b811ef929b01b8cc77931f260CAS |
 Veale AJ, Peat JK, Salome CM, Woolcock AJ, Thompson JE. ‘Normal’ lung function in rural Australian aborigines. Aust N Z J Med 1997; 27 543–9.
| ‘Normal’ lung function in rural Australian aborigines.CrossRef | 1:STN:280:DyaK1c%2FmvVeqtA%3D%3D&md5=3ed1d6f4ce85b7d589bd6b7a134ffc9cCAS |
 Veale AJ, Peat JK, Tovey ER, Salome CM, Thompson JE, Woolcock AJ. Asthma and atopy in four rural Australian aboriginal communities. Med J Aust 1996; 165 192–6.
| 1:STN:280:DyaK28zmvFOjtQ%3D%3D&md5=70a8f4bc4d380befd28e6aed5c36fc3eCAS |
 Cunningham J, Rumbold AR, Zhang X, Condon JR. Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia. Lancet Oncol 2008; 9 585–95.
| Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia.CrossRef |
 Valery PC, Coory M, Stirling J, Green AC. Cancer diagnosis, treatment, and survival in Indigenous and non-Indigenous Australians: a matched cohort study. Lancet 2006; 367 1842–8.
| Cancer diagnosis, treatment, and survival in Indigenous and non-Indigenous Australians: a matched cohort study.CrossRef |
 Valery PC, Masters IB, Chang AB. Snoring and its association with asthma in Indigenous children living in the Torres Strait and Northern Peninsula Area. J Paediatr Child Health 2004; 40 461–5.
| Snoring and its association with asthma in Indigenous children living in the Torres Strait and Northern Peninsula Area.CrossRef | 1:STN:280:DC%2BD2cvhsV2qsw%3D%3D&md5=78e1aa0f4dbf087a5f35dfbe79935977CAS |
 Bailey EJ, Cates CJ, Kruske SG, Morris PS, Chang AB, Brown N. Culture-specific programs for children and adults from minority groups who have asthma. Cochrane Database Syst Rev 2009; CD006580
 Chang AB, Taylor B, Masters IB, Laifoo Y, Brown AD. Indigenous healthcare worker involvement for Indigenous adults and children with asthma. Cochrane Database Syst Rev 2007; CD006344
| 1:STN:280:DC%2BD2snhvFWnsA%3D%3D&md5=e580ab8af37d6d4213aa2855c68e6776CAS |
 La Roche MJ, Koinis-Mitchell D, Gualdron L. A culturally competent asthma management intervention: a randomized controlled pilot study. Ann Allergy Asthma Immunol 2006; 96 80–5.
| A culturally competent asthma management intervention: a randomized controlled pilot study.CrossRef |
 Centre for Palliative Care Research and Education Update of Program of Experience in the Palliative Approach (PEPA) for Aboriginal and Torres Strait Islander health workers in Queensland. Aborig Isl Health Work J 2008; 32 25–6.