Background
The link between hygiene and infectious diseases has been known for centuries and there is indisputable evidence that poor environmental and living conditions promote the spread of infectious diseases.
In 1987, an environmental health review, Uwankara Palyanyku Kanyintjaku (UPK)2, was conducted in the Anangu Pitjantjatjara (APY) Lands in the north-west of South Australia. The review identified health problems that could be reduced by changes in the living environment for Indigenous communities in remote Australia. As a result, a prioritised list of nine ‘Healthy Living Practices’ that could help prevent the spread of infectious diseases was developed, see ‘How to use this guide’ and Part B ‘Health and housing’.
To achieve good health outcomes at a household level, individual living environments must be equipped with the health hardware that enables residents to carry out Healthy Living Practices. To maintain positive health outcomes at a community level, mosthouses in the community must have health hardware that works mostof the time, and community infrastructure, such as power, water and waste systems must be operating without interruption. Functioning health hardware and the capacity to perform Healthy Living Practices reduces the pool of infectious organisms and, therefore helps to reduce rates of diarrhoeal disease, skin infections, pneumonia, eye infections and other transmissible diseases.
The UPK study found that many houses in the APY Lands did not have functioning health hardware to enable Healthy Living Practices, and the community systems that provide water and remove waste from houses frequently broke down. The project also identified that communities did not have maintenance resources or systems to deal with these problems.
Environmental health and design consultants, Healthabitat, conducted a project at Pipalyatjara in the APYLands in 1992–933to improve the function of health hardware. Although there are many problems measuring health change in small communities, there were fewer clinic presentations for skin and eye infections following the project.
The project also refuted claims that Indigenous people do not use health hardware - residents involved in the project enthusiastically used these facilities when they were functioning and maintained. The myth that the primary cause of housing failure is due to Aboriginal people damaging their houses was also dispelled by this project - a comprehensive survey of the health hardware in houses showed that breakdown was caused by poor design and construction and lack of maintenance, rather than misuse or vandalism.
Similar surveys in communities around Australia over the past seven years continue to confirm that health hardware failed in 67 per cent of houses because of lack of routine maintenance; 25 per cent because of poor initial construction; and less than 8 per cent because of misuse, abuse or vandalism.
2Nganampa Health Council Inc., South Australian Health Commission and Aboriginal Health Organisation of South Australia 1987, Report of Uwankara Palyanyku Kanyintjaku, An Environmental and Public Health Review within the Anangu Pitjantjatjara Lands, Alice Springs.
3Pholeros, P, Rainow, S & Torzillo, P 1993, Housing for Health, Towards a Healthy Living Environment for Aboriginal Australia, Healthabitat, Newport Beach.