In 1910 Australia appointed a government official as the legal guardian of every indigenous child on the continent.
The Protector of Aborigines – a truly Orwellian title – then launched a campaign to systematically remove Aboriginal children from their families, under the guise of “civilizing” them. Many were crammed into “training houses”, where they were forced to adapt white standards for a future of menial work. Sexual abuse was endemic. The abduction of what would be called the Stolen Generations continued into the early 1970s. Between 10 and 33 percent of Aboriginal children born during those years were abducted. It was the last injustice in a long history.
The collective trauma of Australia’s indigenous population has led to perhaps one of the highest rates of dementia in the world.
A new study, published this month in Neurology, found that the prevalence of dementia in a group of Indigenous Australians living in urban areas was twice that of non-Indigenous Australians. The findings echo those of a growing body of research.
Several health conditions and unfortunate life circumstances increase the risk of dementia, and many of them disproportionately affect marginalized and persecuted groups.
To examine dementia among the First Nations population of Australia is to see how the effects of colonialism, racism and inequality accumulate in the brain over a lifetime. The implications go far beyond Australia.
Context – Indigenous Australians, collectively known as Aboriginal and Torres Strait Islander peoples, are ethnic groups whose presence on the continent predates British colonization.
Like Indigenous peoples around the world, they encompass divergent cultures and peoples who have come to share a broad identity through a common history.
Currently, there are approximately 760,000 people of Aboriginal descent in Australia, or 3.3% of the population.
With the arrival of the British in 1788, large swathes of Aboriginal people were massacred or died of diseases transmitted by Europeans. They faced centuries of segregation, land theft and apartheid economies where they were paid a fraction of the wages of white workers. Some were conscripted into slave labor systems. According to some sources, their number rose from 750,000 before colonization to 117,000 in 1901.
As part of the Stolen Generations policies, the government attempted to force the children of Indigenous peoples to deny their culture and then spread it to the white population, ultimately wiping out the First Nations. The children were stolen by federal and local welfare agencies and the parents searched for them for decades.
“The story they created devastated our lives,” said Terry Donovan, an Indigenous Liaison Officer for Neuroscience Research Australia, the medical research institute behind the new study. Reverse.
“We always feel like we’ve been invisible here over the years,” he adds. “We had no access to health care. They retained our cultural knowledge. Everyone here is treated better than us.
What’s new – The recently published study includes only participants living in urban areas. Neuroscience Research Australia maintains the Koori Growing Old Well Study, an ongoing longitudinal study of Aboriginal volunteers in New South Wales, to draw from.
For this study, participation was limited to people aged 60 and over. They underwent cognitive assessments for dementia, reviewed by a panel of three clinicians.
Eighty-two percent of Indigenous citizens live in the networks of cities and towns where most of Australia’s population is clustered away from the country’s vast wilderness. However, previous research has included – and even focused on – people living in remote First Nations communities.
The first research on the subject was the “Kimberley study” in which a team of researchers, working with local leaders, interviewed residents of Kimberley, a remote region of Western Australia.
“People lived a very traditional lifestyle,” said Leon Flicker of the University of Western Australia and one of the study’s researchers. Reverse. To overcome cultural barriers, the researchers created their own cognitive assessment test for Aboriginal people.
Their findings, published in 2008, showed a rate of dementia five times higher than the Australian average. It was a shocking number and unprecedented in studies of dementia in any population. One question lingered: how affected was he by the isolation conditions at Kimberley?
The state of the brain in old age is an accumulation of how you lived all your years and even your health in utero.
At the same time, Neuroscience Research Australia has started recruiting people of Aboriginal descent, living in several types of contexts, to track their health outcomes over the years.
In 2015, she published her first study, with 336 participants. They had an age-adjusted dementia rate of 21%.
Dementia rates are never exact and sometimes difficult to compare to each other, but a government statistic indicates that one in 15 Austrians over the age of 65 have dementia. This is about 6.6%, which puts the rate for the Aboriginal group in this study at about three times the national norm. Australia’s rate is comparable to averages for other affluent regions, such as Western Europe and North America.
The new study from Neuroscience Research Australia includes data from 155 Indigenous people, aged 60 to 86, who live in urban areas, mostly around Sydney. In the six years since researchers first assessed them, 16 have developed dementia.
[T]These rates are significantly higher than estimates for the general Australian population and many populations around the world,” the report states, “but are consistent with incidence rates for Aboriginal people in remote areas.”
Even in urban areas, Aboriginal people seem to have a much higher risk of dementia.
“We think of remote populations [as] having so much less access to educational opportunities, work opportunities, access to health care,” says Kylie Radford, a clinical neuropsychologist at the University of New South Wales in Sydney and lead author of the new study. Reverse. “Always, [the urban subjects] have very high rates of dementia.
Why is it important – Scientists still don’t fully understand how Alzheimer’s disease and other types of dementia develop in the brain, robbing people of their mental faculties as they age. Neurologists agree that anyone, regardless of lifestyle, can develop dementia.
However, there are risk factors that increase its chances. These include unfortunate life circumstances, such as low education, traumatic brain injury, and social isolation. Risk factors also include health problems often linked to distress, such as hypertension, diabetes, obesity, depression and high alcohol consumption.
Indigenous people have worse health outcomes from birth to death than non-Indigenous Australians. According to government statistics, indigenous children have 70% higher rates of malnutrition. Hospitalization rates for Indigenous Australians are higher, twice as high for circulatory disease and 11 times higher for kidney failure. Among those aged 15 and over, 45% of Aboriginal people consider themselves disabled, compared to 18.5% of Australians in general. Their suicide rate is double and their life expectancy is about 10 years lower than the national average.
Researchers believe that poor living conditions, health complications and psychological distress – which get worse and worse – lead to higher rates of dementia in indigenous populations.
From the new study:
[O]The ongoing effects of colonization, systemic racism, and the resulting widespread social and health disparities in various Australian Aboriginal communities likely contribute to these higher rates, with multifactorial disadvantage from early in life.
Flicker, who was not involved in the new study, says the results don’t surprise him. “All these [Indigenous] groups share a common history of early trauma. … The state of the brain in old age is an accumulation of how you have lived all your years and even your health in utero. That’s what you see with aboriginal people.
Disadvantaged groups in the United States also have higher rates of dementia. According to the Alzheimer’s Association, African Americans are twice as likely to develop it, Latinos 50% more likely, and Native Americans are more likely than whites, although exact rates are uncertain.
Radford says studies of indigenous Australians are reminiscent of a 2008 paper on Arabs living in Israel’s northern triangle of Arab villages. Researchers from Tel Aviv University found that 20.5% of Arabs living in Israel showed signs of dementia, compared to about 6% for the same age group in all of Israel.
She says that as science develops a better understanding of dementia, it is important to seek information from marginalized populations. Otherwise, the role of historical trauma and social emancipation risks being overlooked. “If we only understand the mechanisms of its development in some people, how will it be treatable for everyone?” she asks.
As the world’s population ages, dementia will become more common and more costly, in healthcare dollars and in the unpaid work of family caregivers. According to a model by researchers at Johns Hopkins University, the global prevalence of Alzheimer’s disease alone will quadruple, from 2006 to 2050, when 1 in 85 people worldwide will be living with the disease, and 43% will have need for home nursing care or equivalent. “We face an impending global epidemic of Alzheimer’s disease,” the report said.
The burden may fall unequally on groups that have historically been treated unequally.
And after – Radford says Neuroscience Research Australia works with health service agencies that cater to Indigenous populations to create early detection programs, using knowledge gained from their research.