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• Strength - based approaches vs deficit discourse

  defining strength -based approaches : focus on leveraging existing strengths and resources within individuals and communities to improve health

  contrast with deficit discourse : moves away from the traditional deficit model , which emphasises problems and deficiencies

  holistic health : emphasis on a comprehensive view of health that includes physical , mental , emotional and social well-being
• Key components of strength - based healthcare

  Assist-based approaches : utilising existing community strengths and resources to address health issues
• Key components of strength - based healthcare

  Cultural Appropriateness: Ensuring healthcare practices respect and integrate cultural values and practices of Indigenous communities
• Key components of strength - based healthcare

  • Empowerment: Encouraging self-determination and active participation in health decisions
• Improved health outcomes : shifting the focus to strengths and resilience can lead to better health and well-being
• Positive Self-Perception: Reduces stigma and negative stereotypes, promoting a positive cultural identity
• Community Engagement: Strength-based approaches often lead to greater community involvement and ownership of health initiatives Case Studies and Examples Deadly Kids
• Deadly Futures Framework: An Australian initiative aimed at improving child health through community and cultural strengths
• Ngangkari Program: Incorporates traditional healing practices in healthcare, showing respect for Indigenous knowledge and methods
• Aboriginal and Torres Strait Islander people in Australia carry a greater burden of ill-health than general population

  Experience barriers to receiving optimal health care:

  • mistrust of health system resulting from historic and current mistreatment, language and cultural differences

  Contextual factors:

  • Important for understanding the welfare of Indigenous Australians and history since colonisation

  • Stolen Generations - experienced adverse health, cultural and socioeconomic outcomes at a rate higher than the Indigenous population not removed
• mortality rate of Aborignial and Torres Strait Islander Children :

  
• Respiratory disease among aboriginal and Torres Strait islander people risk:

  • partially determined by genetic and prenatal factors

  • influenced by early life exposures

  • risk factors for a lower lung function: asthma/wheezing, lower respiratory tract infections, pre- and post-natal exposure to tobacco smoke, low birth weight, and low socioeconomic status
• risk of repsiratory disease among aboriginal and torres strait islander people:

  effects of multiple exposures and their potential interactions on early adult lung function remain poorly understood.

  • lower peak lung function associated with COPD in mid-late adult life

  • understanding how early life exposures influence early adult lung function would provide insights into respiratory disease and help guide preventive measures
• prevalence of repsiratory disease among aboriginal and torres strait islander people?


  1/3 aboriginal and Torres straight islander people have a respiratory condition :
• bronchiolitis :

  is broadly defined as a clinical syndrome of respiratory distress that occurs in children less than 2

  Clinical manifestations : upper respiratory symptoms , lower respiratory tract signs
• bronchiolitis : pathogenesis

  bronchiolitis cocue when viruses infect terminal bronchiolar epithelial cells , causing direct damage and inflammation in small bronchi and bronchioles . Oedema , excessive mucus , and sloughed epithelial cells lead to obstruction of small airways and atelectasis.
• Bronchiolitis :

  Viral aetiology : bronchiolitis is caused by viruses . Respiratory syncytial virus and rhinovirus

  less common: parainfluenza virus , human metapneumovirus

  epidemiology : in children less than 2 ( winter)
• bronchiolitis risk factors:

  Prematurity (gestational age ≤36 weeks),

  low birth weight, age <12 weeks, chronic pulmonary disease (e.g., bronchopulmonary dysplasia),

  immunodeficiency, anatomic defects of the airways (e.g., tracheoesophageal fistula) ,

  congenital heart disease, neurologic disease.

  Environmental and other risk factors contribute to more severe disease: passive smoking, crowded household, daycare attendance, concurrent birth siblings, older siblings, and outdoor air pollution
• chronic respiratory disease Aboriginal and torres strait islander people:

  Asthma and COPD most common

  • 29% self-reported having a long-term respiratory disease

  • 2.2 x as likely to report COPD • 1.6 x to report asthma as non-Indigenous Australians

  • Respiratory-related hospitalisation rate: 2.4 X non-Indigenous Australians

  • 2015–2019: 1,498 people died from respiratory diseases (10% of all deaths); most deaths from COPD, pneumonia, influenza and asthma

  • Those living in non-remote areas (32%) reported a higher rate of respiratory disease than in remote areas (15%)
• COPD

  pathologic features : chronic inflammation , increased numbers of goblet cells , mucus gland hyperplasia

  airways : collapse frequently occurs due to the loss of tethering caused by emphysematous destruction of alveolar walls

  Among patients with chronic bronchitis: have an increased number of goblet cells and enlarged submucosal glands Chronic airway inflammation: presence of CD8+ T-lymphocytes, neutrophils, and CD68+ monocytes/macrophages
• Lung parenchyma : emphysema affects structures distal to terminal bronchiole (respiratory bronchiole, alveolar ducts, alveolar sacs, and alveoli, known collectively as acinus).

  Part of the acinus affected by permanent dilation or destruction determines the subtype of emphysema.
• Pulmonary vasculature: changes in the pulmonary vasculature include intimal hyperplasia and smooth muscle hypertrophy/hyperplasia due to chronic hypoxic vasoconstriction of small pulmonary arteries
• Asthma :

  Development of asthma and asthma severity are governed by complex interactions between genetic and environmental factors

  Key pathophysiological features:

  • lung inflammation

  • airway hyper-responsiveness

  • airway remodelling

  • mucous hypersecretion All contribute to variable airflow limitation
• asthma :

  
• Bronchiectasis :

  — chronic pulmonary condition characterised by a cycle of recurrent lower respiratory tract infections and airway inflammation giving ruse to frequent hospitalisations and reduced QoL
• Bronchiectasis :

  clinical manifestations -radiologically by dilatation of bronchial airways; clinically by chronic cough and sputum production
• Bronchiectasis :

  Prevalence: higher among Indigenous than non-Indigenous adults; in paediatric population, bronchiectasis incidence is one among the highest in the world; high disease burden in Central Australia and in the Northern Territory
• bronchiectasis factors :

  A lifelong disease; appears in early adulthood to middle-age in Aboriginal and Torres Strait Islander people. This younger age suggests that different factors, or similar factors acting at an earlier age, drive disease development

  Social and environmental disadvantages (e.g., household overcrowding), lower BMI, indoor air pollution compounded by remoteness, and repeated respiratory infections in childhood
• Circulatory system :

  • cardiovascular disease is more prevalent among indigenous people than non

  multifactorial : higher rates of modifiable and non modifiable risk factors :

  — tobacco smoking , Low levels of physical activity , overweight

  — age , sex , family history

  — socio-economic
• Hypertension :

  LEADING RISK factor for stroke, CHD , kidney. Disease

  — highly prevalent in Australian population

  — many undiagnosed

  
• ACUTE RHEUMATIC FEVER (ARF) and Rheumatic heart disease (RHD)

  ARF: an inflammatory illness caused by an autoimmune reaction to a throat or skin Group A Streptococcus bacterial infection e.g., impetigo and scabies
• Rheumatic heart disease is a complication of ARF.

  ARF and RHD is linked to socioeconomic disadvantage, such as household overcrowding and lack of access to working toilets, showers and taps

  RHD Endgame Strategy: end RHD in Australia by 2031 - identifies the critical role of housing and environmental health policies in addressing the disease, especially in remote First Nations communities
• Pathogenesis of RHD :

  — begins with streptococcal infection , typically sore throat

  ARF symptoms : arthritis , fever , swelling of the heart

  —> causes pancarditis , affecting the pericardium ( pericarditis) , epicardium , myocardium ( myocarditis , sometimes manifest as conduction system disease)
• Valvulitis : prominent manifestation of rheumatic carditis

  CHARACTERISED by scarring and deformity of heart valves , particularly affecting the mitral and aortic valves

  RESULTS IN progressive valvular disease in the years following one or more episodes of ARF ( manifests after initial infection)

  IF SUSPECTED / CONFIRMED must undergo echocardiography to determine abnormalities
• diabetes prevalence:

  Prevalence : 7.9% ( 64,100) live with diabetes

  indigenous Australians : 3X as likely to be living with diabetes as their non-indigenous
• Risk factors for diabetes occur earlier age and in higher frequency :

  Disproportionately affected by type 2 diabetes and associated complications.

  • Higher rates of comorbidities: Hypertension; dyslipidaemia; obesity; renal; cardiac; neurological; and ophthalmological

  • Intergenerational and epigenetic factors contributory factors in diabetes rates in young people
• As social determinants of health are key contributors - health, education and infrastructure changes can address obesity, diabetes and metabolic risks

  Good news: Wurli Wurlinjang Health Service Diabetes Day Program: improvement in social and emotional wellbeing and increase in number of people receiving medical check-ups
• As social determinants of health are key contributors - health, education and infrastructure changes can address obesity, diabetes and metabolic risks.

  School based health promotion program (Deadly Choices): improved knowledge, attitudes and self-efficacy regarding chronic disease and risk factors among young Aboriginal and Torres Strait people; increases in physical activity levels, breakfast frequency, fruit and vegetable consumption, uptake of health checks
• Chronic and end stage kidney disease:

  —> Leading cause of gap between indigenous and non

  Defintiion : person experiences kidney damage or reduced kidney function that lasts > 3 months
• kidney disease phases :

  OCCURS IN 5 STAGES :

  stage one : mildest form —> progressing through to stage 5 , which is END-STAGE kidney disease

  COMMON CAUSE : DIABETES

  OTHER CAUSES : HYPERTENSION , GLOMERULONEPHRITIS , POLYCYSTIC KIDNEY DISEAS