” On the final day of the Uluru convention on a referendum for Indigenous constitutional recognition, former prime minister Kevin Rudd spoke to the ABC about Indigenous disadvantage since his National Apology to the Stolen Generations in 2008.
Mr Rudd told Radio National on May 26: “One of the programs that we established back then was to eliminate trachoma amongst Indigenous young people. Twenty thousand kids were suffering from trachoma back then at about a 20, 25 per cent rate. We’re now down to about four per cent.”
Is Mr Rudd correct about the incidence and decline of trachoma among Indigenous young people? RMIT ABC Fact Check investigates
” The Roadmap to Close the Gap for Vision has played a part in prompting actions that contribute to this improvement. The Roadmap outlines a whole of system approach to improving Indigenous eye health, and achieving equity between Aboriginal and non-Aboriginal eye health outcomes.
There is however still work to be done on Closing the Gap for Vision. For example, half of Indigenous participants with diabetes had not had the recommended retinal examination.
NACCHO has been involved with the Roadmap from its inception, and had a long relationship with Indigenous Eye Health at the University of Melbourne, and with RANZCO. We’re pleased with the great work and good progress being made.”
Ms Patricia Turner, Chief Executive Officer, of the National Aboriginal Community Controlled Health Organisation (NACCHO) launching The 2016 Annual Update on the Implementation of the Roadmap to Close the Gap for Vision November 2016
Mr Rudd’s claim is overstated.
In saying that 20,000 kids were suffering from trachoma, Mr Rudd appears to have used data for the number of children living in communities judged to be at risk of having endemic trachoma. The number of children estimated to have trachoma in 2009 was about 3,000.
His rate of 20 to 25 per cent “back then” is supported by a prevalence figure of 21 per cent contained in a 2008 report. However, the rates for 2007 and 2009 were each 14 per cent, and the report for 2009 cautions about the reliability of the 2008 data.
Rates of trachoma among Indigenous children in at-risk communities have declined steadily since 2009. The claim that rates have fallen to about four per cent is supported by recent reliable data.
What is trachoma?
Trachoma is a contagious infection of the eye that, with repeated long-term infections, can result in the eyelashes turning inwards and scratching the cornea, leading to blindness.
Trachoma affects children and preschool-aged children in particular. It is commonly spread through nose and eye secretions, occurs in areas with poor community and personal hygiene, and is associated with overcrowding and reduced access to water.
Australia is the only developed country where trachoma is still endemic, and it occurs primarily in remote Aboriginal communities in Central Australia.
What program did the Rudd government establish?
Professor Hugh Taylor is the Harold Mitchell Professor of Indigenous Eye Health at Melbourne University and when Mr Rudd announced the policy in 2009 he was head of the National Trachoma Surveillance and Reporting Unit, which receives funding from the Federal Department of Health.
Professor Taylor told Fact Check that “after years of either inaction or ineffective action, in 2009 Kevin Rudd committed to eliminate trachoma in Australia by the year 2020”.
Australia adopted a trachoma eradication strategy in line with the World Health Organisation’s 1998 global strategy and based on its SAFE guidelines. SAFE stands for [S]urgery to repair inward eye lashes, [A]ntibiotics, promotion of [F]acial cleanliness, and [E]nvironmental improvements in hygiene and water access.
Mr Rudd’s office told Fact Check the policy he was referring to was a $58 million commitment made in February 2009 to “help tackle eye and ear diseases in Indigenous communities”, with a major focus on trachoma eradication.
The funding was to be allocated over four years, and according to a press release at the time, included “a major increase in services to address trachoma, which will enable at least 10 regional teams to treat and help prevent the disease in NT, WA, SA and other states where trachoma is identified”.
The 2009-10 federal budget papers spell out $58.4 million in funding over four years for “improving eye and ear health services for Indigenous Australians”.
According to the National Trachoma Surveillance and Reporting Unit, in 2009 the Government committed $16 million over four years towards eliminating trachoma in Australia, and in 2013 committed a further $16.5 million.
The source of the claim
When contacted by Fact Check, Mr Rudd’s spokeswoman said reports for 2008 and 2015 by the National Trachoma Surveillance and Reporting Unit were the source of his claim.
Fact Check was unable to find another consistent, national source of data on the prevalence of trachoma in Indigenous communities. Experts confirmed that there was not any other reliable source.
In the unit’s data collection process, communities are classified as being at risk or not at risk of trachoma and screening of the disease focuses on the at-risk communities.
Screening is administered by local health officials who report the data back to the surveillance and reporting unit for collation and analysis.
Coverage of trachoma screening of at-risk communities has increased over time, due to the increasing level of resourcing of the trachoma eradication program.
20,000 kids with trachoma?
Mr Rudd’s February 2009 media release contains the sentence: “Approximately 20,000 Indigenous children suffer from trachoma in Australia.”
Mr Rudd’s office told Fact Check that “in 2009, it would appear the material provided by the Health Department to the Government referred to 20,000 kids suffering from trachoma”.
His spokeswoman pointed to a May 2009 media release from the then Indigenous affairs minister Jenny Macklin which contained the same sentence and a July 2009 speech by the then parliamentary secretary for social inclusion Ursula Stephens who said: “Trachoma affects approximately 20,000 Indigenous children — a stunning statistic and one that is confronting to government.”
However, a spokeswoman for the Department of Health told Fact Check that “the number of children screened and found to have active trachoma was 997 in 2008 and 575 in 2009”, and “we can confirm that the figure of 20,000 children relates to the number of children resident in potentially at-risk communities (population data), not those screened and found to have trachoma”.
The National Trachoma Surveillance and Reporting Unit’s report for 2009 says there were “20,155 children aged one to nine years resident in the 232 at-risk communities”.
Of these children, 4,116, or 20 per cent, were screened and 575 children had trachoma.
“If those 4,116 children screened were a representative sample of all 20,155 children resident in all at-risk communities, the additional number of children estimated to have trachoma across the three jurisdictions lies between 2,045 and 2,448,” the report said.
It appears that all three ministers were referring to statistics available at the time about the number of children at risk of contracting trachoma, not the number who were suffering from trachoma.
Professor Taylor told Fact Check that “the estimate in 2008 was that there were 20,000 kids in remote communities considered to be at risk of trachoma”.
“This is a rubbery figure because not all the communities had been examined,” he added.
The prevalence of trachoma in 2008
The executive summary of the National Trachoma Surveillance and Reporting Unit’s 2008 report says that “the prevalence of active trachoma in those communities from which data were reported was 21 per cent”.
Of 287 remote Aboriginal communities, 235 were identified as at risk of trachoma in 2008, and 121 were screened and reported data.
The 2008 report focused on the prevalence of trachoma in Indigenous children aged one to nine years old.
The discussion section of the 2009 report says that “in 2008, there was an abrupt two-fold increase in trachoma prevalence in NT, and an equally abrupt seven-fold decrease in trachoma prevalence in SA, compared with past years. Both of these sudden changes were reversed in 2009”.
The report says the variation in the numbers “suggests that the data from 2008 might be problematic”.
Professor Taylor told Fact Check that “there is an inconsistency in the data and it’s appropriate to acknowledge it, but those are the data that we have, and those are the data that we must use”.
Carleigh Cowling, senior surveillance officer with the National Trachoma Surveillance and Reporting Unit, said the Northern Territory intervention had an impact on the collection of the data in 2008.
“During the intervention, the trachoma screening program was taken over by unusual bodies, whose training was questionable,” she said, adding that “data collected by those teams were not presented in the 2008 report, which does make the data presented problematic”.
The prevalence of trachoma today
The most recent report from the National Trachoma Surveillance and Reporting Unit, published in June 2016 and containing data for 2015, shows that 139 communities were identified as being at risk of trachoma, a decrease of 96 communities since 2008.
Of these 139 communities, 67 were screened and reported data.
The 2015 report focused on children aged five to nine, though reports prior to 2010 focused on children aged one to nine. “It’s an assumption that one to four-year-olds are similar,” Professor John Kaldor, the current head of the National Trachoma Surveillance and Reporting unit, now part of the Kirby Institute at the University of New South Wales, said.
Professor Taylor and Ms Cowling both told Fact Check that though the 2008 report focuses on children aged one to nine and the 2015 report on children aged five to nine, this will have little impact on the comparability of the data from those years.
The results, for children aged five to nine as against one to nine reported in 2008, reveal that the prevalence of trachoma in the communities that screened was 3.7 per cent. The prevalence “using the most recent data carried forward in all at-risk communities” was 4.6 per cent.
The 3.7 per cent is for at-risk communities that screened in 2015, and the 4.6 per cent is for all at-risk communities, meaning those that screened and those that didn’t screen that year but are considered at risk based on previous data.
Professor Kaldor said policy guidelines changed in 2014 so that if a community had high rates of trachoma several years in a row, resources were shifted towards treatment rather than screening.
He and Professor Taylor both agreed that the current prevalence of trachoma among children in affected communities was about 4 per cent.
Professor Kaldor said of hotspots that still exist in Central Australia: “While the drug azithromycin is a big part of combating the disease, there’s the whole issue of fulfilling the other parts of the SAFE strategy to sustainably improve facilities and living conditions.”
“If these are not addressed, the impact of treatment may be short-lived.”
Professor Taylor told Fact Check that “since 2008 we’ve made considerable progress”.
“If you look at closing the gap, it’s actually one area where you can say we’ve made considerable progress,” he said.
- Kevin Rudd, Radio National, May 26, 2017
- Budget Paper No. 2 May 2009
- Department of Health, National Guidelines for Public Health Units, December 5, 2014
- Department of Health, Surveillance report for active trachoma annual reports, June 30, 2016
- Department of Health, Trachoma Surveillance Reports, April 2017
- Department of Prime Minister and Cabinet, $58.3m boost for indigenous eye and ear health, February 26, 2009
- Minister for Families, Housing, Community Services and Indigenous Affairs, Over $200 million for Closing the Gap in Indigenous health, April 12, 2009
- National Trachoma Surveillance and Reporting Unit. Trachoma Surveillance report 2007, November 2008
- National Trachoma Surveillance and Reporting Unit, Trachoma Surveillance report 2008, August 2009
- National Trachoma Surveillance and Reporting Unit, Trachoma Surveillance report 2009, June 2010
- National Trachoma Surveillance and Reporting Unit, Trachoma Surveillance report 2015, June 2016
- Parliamentary Secretary for Social Inclusion/Parliamentary Secretary for the Voluntary Sector, Speech to the Vision 2020 Australia 6th National Member Forum, July 28, 2009
- World Health Organisation, World Health Assembly Resolution 51.11 on the Global Elimination of Blinding Trachoma, May 16, 1998