Dementia rates of Indigenous Australians show the lifelong impact of racism

In 1910, Australia appointed one public 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 Indigenous children from their families, under the pretense of “civilizing” them. Many were crowded into “training homes,” where they were coerced into adapting white norms for a future of menial labor. Sexual abuse was rampant. The abduction of what would be known as the Stolen Generations continued through the early 1970s. Between 10 and 33 percent of Indigenous children born in those years were taken. It was the latest injustice in a long history.

The collective trauma of Australia’s Indigenous population may have begat one of the highest dementia rates 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 double that of non-Indigenous Australians. The findings echo those of a growing body of research.

Several health problems and unfortunate life circumstances increase one’s risk of dementia, and many of them are heaped disproportionately onto marginalized and persecuted groups.

To look at dementia among Australia’s First Nations population is to look at how the effects of colonialism, racism, and inequity pile up in the brain over a lifetime. The implications go far beyond Australia.

Background — Indigenous Australians, collectively called the 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 that came to share a broad identity through a shared history.

Currently, there are about 760,000 people of Indigenous descent in Australia, making up 3.3 percent of the population.

With the arrival of the British in 1788, swaths of Indigenous people were massacred or died from European-carried diseases. They faced centuries of segregation, land theft, and apartheid economies where they were paid a fraction of the salaries of white workers. Some were conscripted into labor systems akin to slavery. According to some sources, their numbers dropped from 750,000 pre-colonization to 117,000 by 1901.

Under the Stolen Generations policies, the government tried to force the children of Indigenous people to disavow their culture and then propagate with the white population, finally eliminating the First Nations. Children were swiped by federal and local welfare agencies and parents searched for them for decades.

“The history they created devastated our lives,” Terry Donovan, an Aboriginal liaison for Neuroscience Research Australia, the medical research institute behind the new study, tells Inverse.

“We still feel like we are invisible here through the years,” he adds. “We weren’t being given access to healthcare. They withheld our cultural knowledge. Everyone here is treated better than us.”

What’s New — The newly published study only includes participants living in urban areas. Neuroscience Research Australia maintains the Koori Growing Old Well Study, an ongoing longitudinal study of Indigenous volunteers across New South Wales, from which to draw.

For this study, participation was limited to people 60 and older. 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 wildernesses. However, past research included — and even focused on — people living in remote First Nations communities.

The first research into the subject was the “Kimberley study” in which a team of researchers, working with local leaders, surveyed people in Kimberley, a remote region of Western Australia.

“People were living a very traditional lifestyle,” Leon Flicker of the University of Western Australia and one of the researchers on that study, told Inverse. To overcome cultural barriers, the researchers created their own cognitive assessment test for Indigenous people.

Their findings, published in 2008, showed a dementia rate five times higher than the Australian average. It was a shocking number and was unprecedented in studies of dementia in any population. A question lingered: To what degree was it affected by the isolated conditions of Kimberley?

The brain’s condition 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 began recruiting people of Indigenous descent, living in several types of settings, to track their health outcomes over years.

In 2015, it published its first study, with 336 participants. They had an age-adjusted dementia rate of 21 percent.

Dementia rates are never exact and sometimes hard to compare to one another, but one government statistic states that one out of 15 Austrians over 65 are afflicted with dementia. That’s about 6.6 percent, putting the rate of the group of Indigenous people in that study at about three times the country’s norm. Australia’s rate is comparable to averages from other wealthy regions, like Western Europe and North America.

The new Neuroscience Research Australia study 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 evaluated them, 16 had developed dementia.

[T]hese rates are substantially higher than estimates for the general Australian population and many populations globally,” the report states, “yet are consistent with incidence rates for Aboriginal people in remote areas.”

Even in urban areas, Indigenous people seem to have a much higher risk of dementia.

“We think of remote populations [as] having so much less access to educational opportunities, to work opportunities, to healthcare access” Kylie Radford, a clinical neuropsychologist at the University of New South Wales in Sydney and the lead author of the new study tells Inverse. “Still, [the urban subjects] have very high rates of dementia.”

Why It Matters — Scientists still don’t fully understand how Alzheimer’s disease and other kinds of dementia develop in the brain, robbing people of their mental faculties as they age. Neurologists agree that anyone, with any kind of lifestyle, can develop dementia.

However, there are risk factors that increase one’s chance. These include some unfortunate life circumstances, like low educational attainment, traumatic brain injury, and social isolation. Also among the risk factors are health conditions often related to distress, like 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 percent higher rates of malnutrition. Hospitalization rates of Indigenous Australians are higher, twice as high for circulatory disease and 11 times higher for kidney failure. Of those 15 and older, 45 percent of Indigenous people consider themselves disabled, compared to 18.5 percent of Australians generally. They have double the suicide rate, and their life expectancy is about 10 years less than the country’s average.

Researchers think that poor living conditions, health complications, and psychological distress — all of which compound and increase one another — are leading to higher dementia rates in Indigenous populations.

From the new study:

[O]ngoing effects of colonisation, systemic racism, and resultant widespread social and health disparities across diverse Aboriginal Australian communities likely contribute to these higher rates, with multifactorial disadvantage from early life.

Flicker, who was not involved in the new study, says the results do not surprise him. “All these [Indigenous] groups share the common history of early life trauma. … The brain’s condition in old age is an accumulation of how you lived all your years and even your health in utero. That’s what you see in Aboriginal people.”

Disadvantaged groups in the U.S. also have higher rates of dementia. According to the Alzheimer’s Association, African-Americans are twice as likely to develop it, Latinos 50 percent more likely, and Native Americans are more likely than whites, though the exact rates are uncertain.

Radford says the studies on Indigenous Australians recall a 2008 paper on Arabs living in Israel’s Northern Triangle of Arab villages. Researchers at Tel Aviv University found 20.5 percent of Arabs living in Israel showed signs of dementia compared to about 6 percent for the same age cohort across 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 enfranchisement may be overlooked. “If we only understand the mechanisms of how it develops from some people, how will it be treatable for everyone?” she asks.

As the world population ages, dementia will become more common and more costly, in healthcare dollars and unpaid labor of family caregivers. According to one model from researchers at John Hopkins University, the worldwide prevalence of Alzheimer’s disease alone will quadruple, from 2006 to 2050, by which time 1 in 85 persons worldwide will be living with the disease, and 43 percent will need nursing home care or an equivalent. “We face a looming global epidemic of Alzheimer’s disease,” the report states.

The burden may unequally fall on groups that have always been treated unequally.

What’s Next — Radford says Neuroscience Research Australia is working with health service agencies that cater to Indigenous populations to create early detection programs, using insights gained from their research.