Primary Prevention of Type 2 Diabetes — Palm Island, Australia.

Part 2 of 4 on Palm Island, Queensland, Australia

This chapter will focus on the prevention of type 2 diabetes on Palm Island, Queensland, Australia. The slides were written by Sophie Horlock.

Introduction

Now, I am sure we have all walked up castle hill as the sun is rising of a morning and looked out at the breathtaking view to see a number of islands surrounding our city. If we look towards the horizon we may be able to catch a glimpse of Palm Island. It may only be 65km from Townsville but the discrepancies between the two places are far further apart. The Island faces a number of health issues but today I will be focusing on the primary prevention of type II diabetes.

Situated 65 kilometres north-west of Townsville on the east coast of Queensland, Palm Island is classified as Remote Australia with an RA 4 and an MMM class 7.

It was established in 1918 as a mission. Many of today’s Palm Islanders are descendants of Aboriginal and Torres Strait Islander people who were forcibly removed from areas throughout Queensland. The Manburra people are thought to be the original occupants of; however, the contemporary name for Palm Islanders is “Bwgcolman people’ which means ‘many tribes one people.’

Here we can see the Historical timeline of the Island. Palm’s traumatic past plays a major role in its present disadvantage. The impact Palm Islands history has had on fostering distrust in the healthcare system. During the colonial days Palm Islanders were forbidden from walking down Mango Avenue, one of the roads surrounding where the hospital is now located.

100 years after Palm Island was established, its current population is at 2446 with Aboriginals making up 75.2% and Torres Strait Islanders 12.8%

Putting the population into a pyramid we can better appreciate the decline in population with an increase in age. Palm Island has a very young age profile with its median age being 24 and only 3.3% of the population being aged 65 or over.

Comparing Palm Islands population pyramid to that of Queensland and Australia’s average we see a stark difference in shapes due to significant differences in life expectancy and fertility rates.

Palm Island is currently ranked as the 10th most disadvantaged socio-economic area in Australia. Its unemployment rate in 2018 was almost 7 times higher than that of Queensland and Australia's, sitting at 46.3%. Education is also a major issue on the island with high truancy rates and low attainment rates.

Diabetes is a complex and chronic condition that can lead to morbidity, disability, reduced quality of life and premature death.

Data published by the Government on the island both highlight the significance of this health issue throughout the Palm Island community.

Aboriginal and Torres Strait Islander people are 3 times more likely to have type II diabetes than non-Indigenous Australians and this number is even higher for those Aboriginal and Torres Strait Islanders living in remote areas. On Palm Island, type II diabetes is the 4th leading contributor to the Island’s burden of disease.

Currently 320 diabetics are under care plans but an estimated total of 600 are living with type II diabetes, a significant 24% of their population.

Palm Island residents are hospitalized at a rate of 35.3 per 1000 population for type II diabetes, a number considerably higher than other locations as evident in this graph.

Dr Vicki Stonehouse, one of the Islands GP’s, says she has seen Palm Islanders in their teens and twenties with type II diabetes – 20 years younger than it typically develops among non-Indigenous Australians.

Type 2 diabetes is directly related to lifestyle factors such as smoking, poor nutrition and low levels of physical activity. As well as Aboriginal and Torres Strait Islander ethnicity being a major risk factor.

From analysing the 2016 Palm Island Health Snapshot we can see the elevated risk factors for type II diabetes in the Palm Island population. Obesity and smoking are both prevalent above state average and physical activity and fruit and vegetable intake are both below state average. A lack of services on the island make it difficult for these risk factors to be minimized.

Here you can see an outline of the health services available to the Palm Island Community, specifically for the prevention, treatment and management of diabetes. The Joyce Palmer Hospital is the largest health facility on the island with a 15-bed inpatient facility, emergency department and Ambulance Service. It also provides an outpatient clinic where a permanent chronic wound care nurse is based and provides services for diabetic foot care. Other diabetes specific services such as dieticians, podiatrists and endocrinologists visit the island however, only on a monthly basis

Primary Prevention is defined as preventing the onset of disease. Diabetes Queensland states that up to 60 per cent of type 2 diabetes can be prevented through healthier living choices however, rurality challenges the success of primary prevention due to limited access to services.

Rurality not only impacts access to health services, but it particularly results in poorer social determinants of health which have a direct effect on the health of a population and especially on preventing health issues. Populations with low health literacy have poorer health outcomes and are less empowered to exercise their health care rights. Poor health literacy, combined with low income, high prices of food and limited access to healthy food, all result in a struggle to prevent type II diabetes simply because of a rural location.

As stated earlier, diabetes can be prevented through a healthy diet and active lifestyle. Limited availability of fresh fruit and vegetables and the high prices associated with fresh food on the island make this difficult to achieve. Prices at the community retail store are grossly inflated with islanders paying $7 for a head of broccoli on Palm Island, compared to $1 in Townsville.

There is one fast food store on the Island with its highly processed food being much more affordable for Palm Islanders to feed their family. The people purchase alcohol and cigarettes is prioritised over fresh food and diabetic patients who smoked 3 packets a day but did not believe that they could afford a fridge to store fresh food.

The island has a PCYC centre where sport can take place however, there is a lack of education surrounding the importance of physical activity and there is little community initiative to take action together. The lack of services available to prevent this disease results in more patients suffering from the disease which ultimately puts more pressure on the already limited health staff and services on the island to support these patients.

Through discussions with my e-mentor and using the Palm Island 2018-2028 Health Action Plan, I have developed some strategies that I believe would be effective and realistic to improving type II diabetes in the Palm Island Community. Primary prevention is the most effective means of decreasing rates of this disease and targeting 3 major risk factors is an important first step. Research shows that programs that are likely to have the greatest success in Aboriginal and Torres Strait Islander communities are multi-component and take a whole-of-community approach and I have taken this approach when developing my strategies.

1. Smoking is a socially and culturally patterned behaviour so strategies such as making community events smoke free is a great way to promote community initiative. Targeting the youth to prevent them from taking up smoking is an important means of breaking the cycle in families and using social media to promote the message is an effective way of connecting with the target audience.

2. Subsidising fruit and vegetables would help improve the poor diet of the palm island community. In 2005, a rural Aboriginal community-controlled health service initiated a program in the Clarence Valley in NSW for providing subsidised fruits and vegetables to improve nutrition among disadvantaged Aboriginal families and the results of this program showed an association between this and short-term health improvements.

3. Finally, to target the lack of physical activity of palm island residents sporting programs could be implanted in schools. Influential Aboriginal and Torres Strait Islander role models such as Johnathon Thurston and Matty Bowen could promote and be involved in these programs.

In conclusion it is evident that rurality has a major impact on the primary prevention of type 2 diabetes, and this is reflected by the high incidence of disease on the island. However, with some effective strategies this issue could be improved. Thank you everyone for joining me today.

Published 5th May 2019. Last reviewed 30th December 2021.

---

---

Reference

1. Palm Island Aboriginal Shire Council. About Palm Island. Palm Island Aboriginal Shire Council Website. http://www.palmcouncil.qld.gov.au/about-palm-island. Published date unknown. Accessed March 28, 2019.

2. Queensland Government. Palm Island. Queensland Government Website. https://www.qld.gov.au/atsi/cultural-awareness-heritage-arts/community-histories/community-histories-n-p/community-histories-palm-island. Updated March 21, 2018. Accessed March 28, 2019.

3. Australian Government Department of Health. Doctor Connect. Australian Government Department of Health Website. http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/locator. Updated 2019. Accessed March 23, 2019.

4. Australian Bureau of Statistics. 2016 Census QuickStats. Australian Bureau of Statistics Website. http://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/LGA35790. Updated October 23, 2017. Accessed March 19, 2019.

5. Burrow S, Ride K. Review of diabetes among Aboriginal and Torres Strait Islander people. Australian Indigenous HealthInfoNet. https://healthinfonet.ecu.edu.au/healthinfonet/getContent.php?linkid=590810&title=Review+of+diabetes+among+Aboriginal+and+Torres+Strait+Islander+people. Published March 17, 2016. Accessed April 3, 2019.

6. Baker IDI Heart & Diabetes Institute. Diabetes: the silent pandemic and its impact on Australia. Diabetes Australia. https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/e7282521-472b-4313-b18e-be84c3d5d907.pdf. Published 2012. Accessed April 3, 2018.

7. Palm Island Aboriginal Shire Council. Palm Island Health Action Plan 2010-2015. Queensland Health. https://www.health.qld.gov.au/__data/assets/pdf_file/0019/156223/palm_island_action.pdf. Published 2011. Accessed March 20, 2019.

8. Diabetes Victoria. Diabetes Type 2. Better Health Channel. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetes-type-2. Updated August 2017. Accessed April 8, 2019.

9. Australian Government. Health Snapshot Palm Island Aboriginal Shire 2016. PHN Northern Queensland. https://www.primaryhealth.com.au/wp-content/uploads/2015/09/Palm-Island-Aboriginal-Shire-Council.pdf. Published 2016. Accessed March 30, 2019.

10. Palm Island Aboriginal Shire Council. Palm Island Health Action Plan 2018-2028. Palm Island Aboriginal Shire Council Website. Queensland Health. https://www.health.qld.gov.au/__data/assets/pdf_file/0033/715785/palm-island-action-plan-2018-28.pdf. Published 2018. Accessed March 28, 2019.