Health Assessment in Aboriginal and Torres Strait Islander People

Life Style:
Alcohol Consumption - Hazardous ingestion of alcohol is more prevalent among indigenous Australian males and females aged 35–44 years than among the general population.

• Strongly advise pregnant women and those likely to conceive to abstain from alcohol.
• Base assessment of problem drinking follow by brief interventional counselling commencing at a young age (14–15 years). Repeat opportunistically at least annually, but care is needed to avoid jeopardising the client’s ongoing relationship with the health care provider.
• Simple advice about safe drinking
• Referral to specialist service or therapist
  

Smoking - Indigenous Australian adults from age 18 years are approximately twice as likely to be current smokers than non-Indigenous adults.

• Advise smokers at a higher risk of developing smoking related complications and those with smoking related disease about the benefits of quitting.
• Offer smokers support including self help health promotion materials.

Immunisation:
Influenza - Influenza and secondary pneumonia contribute to the much higher rates of hospitalisation for respiratory diseases among Indigenous Australians.

• Offer annual influenza vaccination from age 50 years.
• Offer annual influenza vaccination to clients with chronic illness from age 6 months.

Pneumococcal - The rate of invasive pneumococcal disease in the Aboriginal and Torres Strait Islander population far exceeds that in the non-Indigenous population. Some reported rates have been the highest ever recorded in the world.

• The 7vPCV is recommended for all Aboriginal and Torres Strait Islander children as part of the Australian Standard Childhood Vaccination Schedule.
• Offer 23vPPV with a single repeat vaccination 5 years after the initial dose from age 50 years.
• The 23vPPV is specifically recommended for Aboriginal and Torres Strait Islander clients aged 15–49 years who smoke or who have chronic illnesses (eg. chronic cardiac, renal and pulmonary disease, diabetes and/or alcohol related problems). Re-vaccination is required after 5 years, and again 10 years later or at 50 years, whichever is later.

Screening:
Pap smear - Cervical cancer is the most common cause of death due to cancer among Aboriginal women. There is an overall mortality rate that is more than nine times greater than that of non-Aboriginal women.

• Screen women who have no symptoms or history suggestive of cervical pathology with Pap tests every 2 years.
• Commence Pap tests for all women who have ever been sexually active at 18–20 years or 2 years after their first sexual intercourse, whichever is later.

Mammogram - Aboriginal and Torres Strait Islander women may be less likely than other women to be diagnosed with breast cancer. However, the incidence of breast cancer may be increasing.

• Screen women aged 50–69 years using mammography every 2 years.
• Advise women aged 40–49 years that there may be a small benefit in mammography screening when weighed against factors such as their age (the benefits of screening may increase through the decade), family history, possible risk factors, personal concerns, levels of anxiety, inconvenience, cost, and discomfort.
• Clinical breast examination is not recommended for breast cancer screening alone or in place of mammography.

Eye:
Visual Acuity - The Aboriginal and Torres Strait Islander population has a higher risk of developing cataracts than the general Australian population.

• Screen adults (from age 40 years) for reduced visual acuity at least every 2 years. The need for cataract surgery and/or correction of any refractive errors should be identified.

Active trachoma - Active trachoma is endemic in the Aboriginal populations of northern and
central Australia, and predominantly affects children.

• Perform an opportunistic eye examination as part of any child health assessment where trachoma affects a community.
• Single dose azithromycin is the treatment of choice for active trachoma.

Trichiasis - Trichiasis affects a significant proportion of the elderly Aboriginal population (defined as aged >50 years) in remote areas of northern and central Australia.

• Screen for trichiasis as part of the routine annual examination from age 40 years if the region is or has been endemic for trichiasis.
• Refer for surgery when trichiasis is present.

Vascular Health:
Blood Pressure -

• Measure BP of adults (>18 years) at every visit (ensuring BP has been measured at least annually).
• Screening may commence earlier (from 15 years) in regions known to have a high prevalence of hypertension from this age.
• Screen 6-monthly for those with diabetes or target organ damage.

Physical activity -

• Recommend moderate intensity physical activity (such as brisk walking) of 30 minutes or more on most, if not all, days of the week. The total 30 minutes may be accumulated in shorter bouts, such as three 10-minute walks.

Cholesterol and lipids -

• Commence lipid screening at age 18 years and continue annually thereafter.
• Those whose cholesterol levels are raised but who are at low to moderate absolute risk of CVD should be given dietary and other lifestyle advice and monitored more closely over the next year.