Out of sadness, hope : a cause of death validation study and public health audit of adult Aboriginal deaths in the Northern Territory

Abstract

The work presented in this thesis is a descriptive and critical study of the production and use of mortality statistics relating to adult Aboriginal people of the Northern Territory (NT). It is based on the belief that a death can be an opportunity for professional and community reflection on the best ways to prevent a similar death in the future. It utilises an intensive case-study approach to describe and interpret the deaths of 220 adult Aboriginal people who resided and died in the NT in 1992.

There are two main parts to the thesis: a medical cause-of—death validation study and a description of how a medical audit can be transformed into an audit with broad public health implications. The thesis attempts to 'make death meaningful’ through consideration of the links between Western and Aboriginal experiences. concerns. systems and worldviews. Improved understanding of the similarities and differences between these worldviews will enhance communication and respect between health professionals in the NT and the community they serve.

A number of new methods are applied in the cause-of—death validation study and public health audit: a method to delineate the types of misclassification that can affect underlying cause“ of death statistics; a method to identify death certification error with potential significance for underlying cause of death coding; a method to define an alcohol-related death directly; a method to classify deaths according to four broad underlying causes (Land, Body, Spirit and Smoking); and a preliminary method to identify medical, community and organisational issues around death.

Overall, the work makes two contributions to the literature on adult Aboriginal mortality. Firstly, it identifies certification of death by the physician, rather than diagnostic accuracy. as the key process requiring improvement, if the validity of mortality statistics is to be maximised. Secondly, the thesis identifies ways in which mortality information can be classified, reviewed and presented so as to maximise its impact on decision-making processes that affect the health status of Aboriginal people.

The thesis makes five broad recommendations and details the means of implementation. The recommendations concern the need for a quality assurance programme promoting excellence in death certification, the need to improve the system of feedback of coronial information to families of Aboriginal decedents, the need to develop best practice guidelines for health professionals dealing with death in Aboriginal communities, the need to make medical mortality review compulsory in all major NT hospitals, and the need for a broadly constituted Aboriginal Mortality Committee to report annually on the level and causes of Aboriginal mortality.