A majority, 59 per cent, of Aboriginal and Torres Strait Islander adults are at an elevated risk of developing severe illness from COVID-19 due to ongoing health inequities, a major study led by The Australian National University (ANU) has found.
The study examined the prevalence of health factors like cardiovascular disease, diabetes, cancer and smoking among Aboriginal and Torres Strait Islander adults, which all increase the risk of severe illness if an unvaccinated person gets COVID-19.
It found more than half of Aboriginal and Torres Strait Islander adults have these and other existing conditions that could increase the risk of needing intensive care admission, mechanical ventilation or death if they contract COVID-19 and are not vaccinated.
The study was undertaken by researchers and health practitioners at ANU, the National Aboriginal Community Controlled Health Organisation (NACCHO), the Royal Australian College of General Practitioners (RACGP) and the Lowitja Institute.
According to the researchers, their findings reinforce that Aboriginal and Torres Strait Islander Australians "must remain a priority group" for the nation's COVID-19 vaccine roll-out and broader pandemic response, rather than being simply labelled "vulnerable".
"The root cause of Aboriginal and Torres Strait Islander peoples' elevated risk of severe COVID-19 illness is health inequity, stemming from colonisation and racism," lead researcher Dr Katie Thurber, from ANU, said.
"Aboriginal and Torres Strait Islander adults who have high household income, live in advantaged areas, are food secure, do not experience discrimination, were not forcibly removed from family, and have access to healthcare are at significantly lower risk of severe illness if they contract COVID-19.
"If all Aboriginal and Torres Strait Islander peoples had access to these key determinants of health, it is likely that risk of severe illness from COVID-19 would be much lower in the population.
"Our study makes it very clear; because of these long-term inequities, Aboriginal and Torres Strait Islander peoples must continue to be treated as one of the highest priority groups in our pandemic response."
Dr Jason Agostino from ANU, and a medical advisor to NACCHO, said: "We found that three-in-five Aboriginal and Torres Strait Islander adults have at least one of these risk factors.
"This means there are almost 300,000 Aboriginal and Torres Strait Islander adults who are at higher risk of getting very sick if they are not vaccinated and get COVID-19.
"This is why getting the vaccine is so important for Aboriginal and Torres Strait Islander peoples. It lowers your own risk of severe COVID-19 and decreases your chance of spreading COVID-19 to people at high risk in your community and your family.
"The results also stress the importance of early testing. If you have any symptoms, seek help and testing as soon as you can. Isolating early will help reduce the spread of disease. In addition, getting medical help early means that you may be able to access early treatment to reduce the impacts if you do have COVID-19."
Professor Catherine Chamberlain from La Trobe University and the Lowitja Institute said that labelling Aboriginal and Torres Strait Islander Australians as "vulnerable" in responses to the pandemic, rather than as a "priority" group, does not reflect the resilience and strengths within communities to address challenges like COVID-19.
"It can lead to policy responses that ignore the root causes of inequities, missing opportunities for prevention and limiting the effectiveness of interventions and recovery from this disaster," Professor Chamberlain said.
"Aboriginal communities are resilient and strong, and in turn, communities having an active role in any disaster response can really help foster resilience and support recovery from the disaster. So it is important that these capacities are recognised and utilised.
"Another risk is that if Aboriginal and Torres Strait Islander communities do experience the worst impacts of outbreaks over the next year, constructs which ignore the root causes could lead to communities feeling blamed for these outcomes, risking a compounding of discrimination and trauma."
The researchers are calling for policymakers to address the long-term health inequities driving the elevated risk of severe illness from COVID-19 among Aboriginal and Torres Strait Islander Australians.
"Our study shows that we must address the inequities that underlie this elevated risk of severe illness from COVID-19 among Aboriginal and Torres Strait Islander Australians as a matter of priority," senior author Dr Tanya Schramm, from RACGP, said.
"Improving access to social determinants such as housing and healthcare will reduce the risk of severe illness from COVID-19 among Aboriginal and Torres Strait Islander peoples, and improve health within the context of the pandemic and beyond. This must occur alongside ongoing care and management of chronic conditions and efforts to increase vaccination coverage."
Dr Janine Mohamed, CEO of the Lowitja Institute, said: "Our communities are strong and resilient and have responded rapidly and effectively to the pandemic when they have been trusted, enabled and resourced by governments to lead the way.
"We need governments to work together with Aboriginal Community Controlled Health Organisations to support culturally safe delivery of vaccines and improve data collection to increase vaccination coverage as quickly as we can."
The study is published in Australian and New Zealand Journal of Public Health.