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16 Thinking about overdiagnosis in a setting of significant health inequalities – a perspective from central australia
  1. Katrina Lloyd
  1. Central Australian Aboriginal Congress, Alice Springs, Australia


Central Australia is the desert heart of Australia. The main town is Alice Springs which has a population of around 28,000, of which approximately 20% are Aboriginal (First Nations) people.

Aboriginal and Torres Strait Islander people in Australia still experience a significantly poorer standard of health than non-Indigenous Australians. Nationally, the gap between Indigenous and non-Indigenous life expectancy is 10.8 years for males and 10.6 years for females. The national ‘Close the Gap’ campaign has been working for 10 years to address this inequality, but as of 2019 the Gap was widening, rather than closing.

Primary care practitioners working with Aboriginal people in Central Australia operate in a unique environment. There is a background of:

  • High levels of economic disadvantage

  • Significant geographic remoteness

  • A long history in Australia of institutional racism against Aboriginal people

  • Social determinants of health have an ongoing significant impact on health outcomes.

Aboriginal people in Central Australia experience:

  • A higher prevalence of some health conditions (eg. communicable diseases such as diabetes/metabolic syndrome and communicable diseases such as syphilis and Hepatitis B.

  • The occurrence of conditions that are rare in non-indigenous Australians (eg. rheumatic heart disease)

  • A significant burden of disease that can be attributed to the social determinants of health (eg. childhood anaemia)

  • Lower rates of cancer survival. This difference is greater for those living remotely.

There are gaps in the information that is available to primary care practitioners who care for Aboriginal people. It does need to be acknowledged that there are significant ongoing attempts to address these gaps.

Some examples of information gaps are:

  • Reference ranges/expected normal values: eg. there are currently no validated spirometry reference values for Aboriginal people.

  • There is currently no Aboriginal and Torres Strait Islander population–specific risk prediction equations for CVD risk. It is thought that using current tools such as the Framingham Risk Equation underestimates risk, especially for Aboriginal people living remotely.

Regular Indigenous specific screening health checks are embedded in the practice of primary health care for Aboriginal people. These checks are designed to address areas of Aboriginal health disadvantage.

A very reasonable concern about underdiagnosis drives much clinical practice in Central Australia.

How can a primary health care practitioner balance a concern about underdiagnosis and service inequality while thinking critically about overdiagnosis ?

Could disadvantage be perpeptuated by overdiagnosis?

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