Major Findings

The health of Aboriginal and Torres Strait Islander peoples is improving for a number of measures, although there remain many issues for which there have been no improvements. This suggests some progress against the commitments made by COAG to closing the gap and the goals of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH). This chapter summarises those areas where there have been improvements and highlights areas where further concerted effort will be needed to close the gap in Indigenous disadvantage. The areas of success can be used to guide this renewed effort. The key messages also show the role of the determinants of health in understanding health status and outcomes throughout different stages of life, from childhood into older age.

The analysis of HPF measures of the health status of Aboriginal and Torres Strait Islander peoples is viewed in the context of determinants of health and the performance of the health system to address disparities. Measures such as community functioning (1.14) show that Aboriginal and Torres Strait Islander peoples draw strength from a range of health determinants such as connectedness to family, land, culture and identity. While the HPF presents a national picture of health status, analysis of the measures show that issues of concern are experienced differently according to social and environmental contexts which vary according to remoteness and life stages. The report encourages readers to consider the complexity of issues and the diverse experiences of Aboriginal and Torres Strait Islander peoples when considering the impact and implications of health inequity and how to achieve improved health outcomes in partnership with a diverse and culturally distinct population group.

COAG Target: Close the gap in life expectancy

According to the latest data available (for the period 2005–07), the gap in life expectancy at birth between Aboriginal and Torres Strait Islander people and other Australians is estimated at 11.5 years for males and 9.7 years for females. Assuming current improvements in total Australian life expectancy continue, an annual increase in life expectancy of 0.8 years for Indigenous males and 0.6 years for females is needed to close the gap in life expectancy within a generation.

As improving life expectancy is dependent on initiatives across the determinants of health, it is still too early for the data to demonstrate progress for this target. The next five years will provide a clearer picture of how the mortality gap is changing and the progress to meeting the life expectancy target by 2031.

In the absence of trend data for Indigenous life expectancy, mortality rates provide an indication of progress. While there has been a decline in Indigenous mortality over the last two decades, there has also been a decline in non-Indigenous death rates and although the mortality gap has narrowed it has not closed.

COAG Target: Halve the gap in mortality rates for children under five

In 2008, the child mortality rate for NSW, Qld, WA, SA, and NT combined was 221 per 100,000 compared with 100 per 100,000 for non-Indigenous children. This makes the baseline gap 121 per 100,000. To achieve the target, the national gap in child mortality rates needs to fall to 60 per 100,000. This would require 18 fewer Indigenous deaths of children aged under five years over the decade. Based on historical data, if current trends continue, it is likely that Indigenous child mortality rates will fall within the range of the target by 2018.

Commitments made by the Council of Australian Governments

Closing the life expectancy gap within a generation.

Halving the gap in mortality rates for Indigenous children under five within decade.

Halving the gap for Indigenous students in reading, writing and numeracy within a decade.

Ensuring all Indigenous 4 year olds living in remote communities have access to early childhood educationwithin five years.

Halving the gap for Indigenous people aged 20–24 in Year 12 or equivalent attainment rates by 2020.

Halving the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade.


Reasons for optimism

The progress of recent years demonstrates that with sustained effort, more can be achieved in the future so that Aboriginal and Torres Strait Islander Australians experience equitable health and wellbeing.

Between 1991 and 2008, there has been a downward trend in all-cause mortality (measure 1.22) for Aboriginal and Torres Strait Island peoples living in WA, SA and NT, although in the most recent years there have been no significant changes. There has been a 22% decline in Indigenous deaths due to avoidable causes and a significant closing of the gap during the period 1997 to 2008. There have been greater declines in mortality rates in these jurisdictions for Indigenous women compared with Indigenous men. When data from NSW and Qld are included, it appears Indigenous mortality rates did not change significantly across the years 2001 to 2008. These trends are impacted by identification of Indigenous Australians in deaths data, which has been improving in more recent years. Overall, the evidence suggests that while the gap has narrowed by 24% in the longer-term there has been a slowing of improvement in recent years.

There have been improvements in several measures of child health for Aboriginal and Torres Strait Islander peoples in recent years. Since the 1990s, perinatal and infant mortality rates have declined. Although these rates remain considerably higher than for other Australians, the gap has closed significantly. Indigenous infant mortality (measure 1.19) declined by 55% between 1991 and 2008 for WA, SA and NT combined, and by 32% between 2001 and 2008 for NSW, Qld, WA, SA and NT combined. Perinatal mortality (measure 1.20) decreased by 34% between 1999 and 2008 (for NSW, Qld, WA, SA and NT combined). Indigenous infant and perinatal mortality declined at a faster rate than for other infants and the gap has narrowed. It may be that the improvement in the perinatal mortality rate for Aboriginal and Torres Strait Islander babies is predominantly due to improved acute care, which has reduced deaths during late pregnancy and following birth, rather than improvements in the health of mothers during pregnancy and improvements in the growth and development of babies in-utero.

Hospitalisation is becoming more common for Aboriginal and Torres Strait Islander peoples (measure 1.02). This does not necessarily indicate deterioration in health status. Changes in the level of accuracy of Indigenous identification in hospital records will potentially result in an increase in the number of reported hospital separations for Indigenous Australians. Changes in access, primary care delivery, hospital policies and practices all impact on the level of hospitalisation over time. An increase in hospitalisation rates may also reflect better health care access rather than a worsening of health.

Areas of concern

Although the health status of Aboriginal and Torres Strait Islander peoples is improving, very large disparities between Indigenous and other Australians remain. In 2008, an estimated 50% of Aboriginal and Torres Strait Islander people reported having a disability or long-term health condition.

The gap between the two populations for conditions such as cancer is widening because the rate of improvement in cancer deaths has been greater for other Australians than for Aboriginal and Torres Strait Islander peoples over recent years.

Indigenous mortality rates for kidney disease are increasing and at a faster rate than for non-Indigenous Australians, widening the gap. The incidence of Aboriginal and Torres Strait Islander people with end stage renal disease commencing renal replacement therapy (measure 1.09) has more than tripled over the last decade, and is 8 times higher than for other Australians.

Determinants of health—such as contact with the criminal justice system (measure 2.14) and health behaviours—such as tobacco use (measures 2.18 and 2.19) continue to represent significant challenges to achieving health equity for Aboriginal and Torres Strait Islander peoples, families and communities.

The origins of health behaviours are located in a complex range of environmental socioeconomic and community factors. Evidence from general population studies shows that these particular modifiable health behaviours act, in various combinations, to increase the risks for adverse health outcomes such as ischaemic heart disease, stroke, diabetes and some cancers. Health behaviours also affect biological risk factors such as high body mass, high cholesterol levels and hypertension. Other health behaviours such as infant breastfeeding, adequate diet and physical exercise have a protective impact on health. The key findings of the HPF are best considered in the context of the determinants of health.

Table 3 presents a summary of how four key socio-economic factors are associated with health behaviours. The factors are household income (measure 2.08), education (measure 2.06), employment (measure 2.07) and housing tenure type (measure 2.09), in association with smoking (measure 2.18), risky alcohol use (measure 2.20), physical activity, diet and overweight/obesity (measures 2.22, 2.23 and 2.26). There are strong associations across most of these measures, which highlights how important addressing underlying socio-economic disadvantage will be in increasing the uptake of healthy behaviours by Indigenous Australians.

Relationships between socioeconomic factors, health behaviours and health status

‘Inequities in health, avoidable health inequalities, arise because of the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces.’
Commission on Social Determinants of Health 2008


Current smoker status:

Higher proportions of Aboriginal and Torres Strait Islander people than other Australians are current smokers (see measure 2.18). These proportions vary across socioeconomic status groups, based on associations observed from survey data. The proportion of Indigenous Australians in the lowest quintile of equivalised household income who are current smokers is 1.7 times the proportion of those in the two highest quintiles (see Table 3). Ratios of a similar order are observed between Indigenous adults whose highest level of schooling was Year 9 or below, relative to those who had completed Year 12 (a ratio of 2.0), between Indigenous adults who are unemployed relative to those who are employed (a ratio of 1.8) and between those who are renters relative to those who own their dwelling (1.5).

Where comparative data are available to calculate ratios for the non-Indigenous population, they are observed to be similar for the two populations (Table 3). This suggests that, as well as the higher prevalence of current smoking in the Indigenous Australian population in general, a higher propensity to be a current smoker is associated with greater socioeconomic disadvantage in a manner that is similar to the patterns evident in the non-Indigenous population.

Alcohol consumption:

As reported for measure 2.20, long-term risky or high risk alcohol consumption is similar to that for non-Indigenous persons, but for short-term risky or high risk alcohol consumption, the prevalence for Indigenous Australians is about twice that of non-Indigenous persons. Differences between different socioeconomic status groups in prevalence of risky and high risk alcohol consumption are only evident in the national data on education and housing tenure. Indigenous adults whose highest level of schooling was Year 9 or below, were 1.5 times as likely to report short-term risky/high risk drinking at least once per week in the last 12 months relative to those who had completed Year 12.

Physical inactivity:

A higher proportion of Indigenous Australians whose highest level of schooling was Year 9 or below reported low levels of physical activity (1.8 times) relative to those who had completed Year 12.

Dietary behaviours:

Indigenous Australians are twice as likely to report no usual daily fruit intake and 7 times as likely to report no daily vegetable intake as non-Indigenous Australians (see measure 2.23). Associations with socioeconomic status are also evident. Indigenous Australians reporting no usual daily vegetable intake are more likely to be in the lowest quintile of equivalised income (a ratio of 10.1 compared with the highest quintiles) and to have a housing tenure type of renter (a ratio of 15 compared with people with a tenure type of owner).

Overweight or obesity:

Aboriginal and Torres Strait Islander males are 1.6 times as likely as other Australian males to be obese, while Aboriginal and Torres Strait Islander females are twice as likely as other Australian females to be obese (measure 2.26). The prevalence rates for Indigenous Australians do not appear to be associated with socioeconomic status (as indicated by ratios close to 1 in Table 3).

Table 3 – Relationship between selected socioeconomic factors and selected health behaviours and overweight and obesity, by Indigenous status (c), 2004–05

Alcohol risk levelDietary behaviours
Current smokerLong-term risk (a)Short term risk in last 12 months (b)Short term risk at least once a week in past 12 months (b)Physical inactivityBaby never breastfedNo usual daily vegetable intakeNo usual daily fruit intakeOverweight or obese
Indig. Non-Indig. Indig. Indig. Indig. Indig. Indig. Indig. Indig. Indig.
Household income
1st quintile (lowest) (%) 55.3* 32.4* 15.0 49.0 20.0 51.6 29.3 7.8 16.859.1
4th and 5th quintile (highest) (%) 33.1* 20.5* 20.0 63.0 15.0 43.6 8.1 0.8 8.8 61.5
Ratio lowest/highest 1.7* 1.6* 0.8 0.8* 1.3 1.2 3.6* 10.1* 1.9* 1.0
Highest year of school completed
Year 9 or below (%) 57.9* 37.5* 17.5 46.4 20.9 60.8 n.a. 7.7 16.9 56.8
Year 12 (%) 28.6* 17.0* 12.2 59.4 13.5 34.4 n.a. 3.8 9.4 63.7
Ratio Year 9 or below/Year 12 2.0* 2.2* 1.4 0.8* 1.5* 1.8* n.a. 2.0* 1.8* 0 .9
Employment
Unemployed (%) 75.9* 41.5* 20.0 67.0 23.0 38.0 n.a. 4 14.459.3
Employed (%) 41.5* 23.0* 19.0 61.0 21.0 45.1 n.a. 5 14.360.6
Not in the labour force (%) 53.7* 26.0* 12.0 43.0 16.0 51.8 n.a. 6.8 15.6 59.6
Ratio unemployed/employed 1.8* 1.8* 1 .1 1.1 1.1 0.8 n.a. 0.8 1.01.0
Housing tenure type
Renter (%)57.4 n.a. 15.0 54.0 21.0 49.0 24.3 7.4 16.4 48.5
Owner (%) 37.4 n.a. 19.0 55.0 14.0 45.0 11.5 0.5 11.1 59.0
Ratio renter/owner 1.5* n.a. 0.8 1.0 1.5* 1.1 2.1 14.8* 1.5* 0.8*

* Statistically significant difference between Indigenous and non-Indigenous rate (a) Includes long-term ‘risky’ and ‘high risk’ drinking, i.e., average consumption in excess of (i) for males: 4 standard drinks per day amounting to 29 or more standard drinks per week; (ii) for females 2 standard drinks per day amounting to 15 or more standard drinks per week (b) Includes short-term ‘risky’ and ‘high risk’ drinking, i.e., consumption in excess of (i) for males: 6 standard drinks or more on any one day; (ii) for females: 4 standard drinks or more on any one day. (c) Data for smoking, alcohol and overweight and obesity are for persons aged 18 years and over. Data for physical inactivity and dietary behaviours are for persons aged 15 years plus.

Source: ABS & AIHW analysis of 2004–05 National Health Survey

Table 4 presents associations between selected socio-economic factors and reported heart/circulatory conditions, diabetes and self-reported health status. Table 5 presents associations between key health behaviours and these three health status measures.

Diabetes:

There was a statistically significant difference in prevalence of diabetes when comparing the proportion of Indigenous Australians who are renters with home owners (ratio of 1.7). The associations for employment and income were not statistically significant. Those who are overweight/obese were twice as likely to have diabetes as those who are not.

Self-assessed health status:

Aboriginal and Torres Strait Islander Australians who reported their health status as fair or poor, were more likely to live in households with an equivalised income in the lowest quintile (2.1 times as likely as those in the two highest quintiles), have left school at Year 9 or earlier (1.4 times as likely as those who attended school to Year 12) and be a renter (1.4 times as likely as those who were home owners). Those who smoke, those who reported low levels of physical activity and those who reported poor diet are also more likely to report fair/poor health status.

In 2008, poorer perceived health status (measure 1.15) is associated with a range of determinants of health. In 2008, 34% of Indigenous Australians in the lowest household income quintile reported fair or poor health status, compared with 19% of those in the highest quintile. Twenty per cent of Indigenous Australians who had completed Year 12 at secondary school reported fair or poor health status, compared with 33% of Indigenous Australians who had completed Year 9 or below.

Heart/Circulatory conditions:

These data show an association between higher prevalence of heart/ circulatory conditions and higher levels of socio-economic disadvantage. A higher proportion of Indigenous Australians not in the labour force reported heart/circulatory problems than those who are employed. Those with reported physical activity levels categorised as low or sedentary are 2.5 times more likely to have heart/circulatory problems than those with high physical activity levels. Those who are overweight/obese are 1.4 times as likely to have heart/circulatory problems as those who are not.

Table 4 – Relationship between selected socioeconomic factors and reported heart/circulatory disease, diabetes and fair/poor health status, by Indigenous status, persons aged 15 years and over 2004–05

Has heart/circulatory problemsHas diabetesSelf assessed health status: fair/poor
Indig. Non-Indig. Indig. Non-Indig. Indig. Non-Indig.
Household income
1st quintile (lowest) (%)
28.2
25.7
17.9*
6.0*
35.1*
28.6*
4th and 5th quintile (highest) (%)
22
17.5
11.5*
3.5*
16.5*
8.4*
Ratio lowest/highest
1.3
1.5
1.6
1.7*
2.1*
3.4*
Highest year of school completed
Year 9 or below (%)
30.0*
24.6*
17.3*
6.0*
34.0*
28.0*
Year 12 (%)
23.6
18.4
14.4*
3.8*
24.0*
11.0*
Ratio Year 9 or below/Year 12
1.3
1.3*
1.2
1.6*
1.4*
2.5*
Employment
Unemployed (%)
28.2
13.6
22.2*
3.7*
37
21.0*
Employed (%)
22.5*
17.0*
12.5*
3.2*
18.0*
9.0*
Not in the labour force (%)
30.3*
25.9*
17.3*
5.5*
38.0*
26.0*
Ratio unemployed/employed
1.3
1.8
1.8
1.2
2.1
2.3*
Housing tenure type
Renter (%)
18.4
n.a.
10.9
n.a.
23.6
n.a.
Owner (%)
17.3
n.a.
6.6
n.a.
17.3
n.a.
Ratio renter/owner
1.1
n.a.
1.7*
n.a.
1.4*
n.a.
* Statistically significant difference between Indigenous and non-Indigenous rate
Source: ABS & AIHW analysis of 2004–05 National Aboriginal and Torres Strait Islander Health Survey and 2004–05 National Health Survey

Table 5 – Relationship between selected health behaviours and overweight and obesity and reported heart/circulatory disease, diabetes and fair/poor health status, by Indigenous status(a), 2004–05

Has heart/circulatory Has diabetes Self assessed health status:
Indig. Non-Indig. Indig. Non-Indig. Indig. Non-Indig.
Smoker status
Current daily smoker (%) 29.0* 19.4* 12.7* 3.5* 34.9* 21.7*
Not current daily smoker (%) 27.7* 22.9* 18.5* 4.8* 26.0* 14.3*
Ratio current daily smoker/not current daily smoker 1.0 0.8* 0.7* 0.7 1.3* 1.5*
Risky/high risk alcohol consumption in last 12 months
Yes (%) 31.0* 20.5* 8.1* 2.9* 34.9* 13.6*
No (%) 28.1* 22.8* 17.4* 5.0* 29.7* 16.4*
Ratio yes/no1.1 0.9 0.5* 0.6* 1.2 0.8
Physical activity
Low–sedentary (%)27.5* 21.9* 13.6* 4.8* 32.4* 17.9*
Moderate (%)21.9 21.0 12.1* 4.0* 25.4* 10.3*
High (%) 11.0 15.4 11.2 2.6 19.3* 6.2*
Ratio low–sedentary/high 2.5* 1.4* 1.2 1.8* 1.7* 2.9*
Eats vegetables daily
Yes (%) 27.0* 21.4* 14.9* 4.5* 28.8* 15.4*
No (%) 24.5 27.0 23.7* 3.4* 34.5* 28.1*
Ratio yes/no 1.1 0.8 0.6 1.3 0.8* 0.5*
Eats fruit daily
Yes (%) 27.1* 21.5* 15.5* 4.5* 28.3* 15.0*
No (%)24.9 19.6 12.6* 3.5* 34.6* 22.6*
Ratio yes/no1.1 1.1 1.2 1.3 0.9* 0.7*
Overweight/obese
Yes (%) 29.3* 23.8* 17.7* 5.9* 29.8* 17.3*
No (%)20.6 18.5 8.7* 2.9* 26.7* 12.8*
Ratio yes/no1.4* 1.3* 2.0* 2.0* 1.1 1.3*
* Statistically significant difference between Indigenous and non-Indigenous rate (a) Data for smoking, alcohol and overweight and obesity are for persons aged 18 years and over. Data for physical inactivity and dietary behaviours are for persons aged 15 years and over.
Source: ABS & AIHW analysis of 2004–05 National Aboriginal and Torres Strait Islander Health Survey and 2004–05 National Health Survey

Maternal health

Maternal health is one of the priority areas of reform identified by COAG to effectively address improvements in child health. Antenatal care provides opportunities to address the various health risks faced by Aboriginal and Torres Strait Islander women and their children, and support healthy behaviours throughout pregnancy and into the early years of childhood.

Access to antenatal care (measure 3.01) is high for Indigenous women, and similar to that for non-Indigenous women, but occurs later (particularly in remote areas) and less frequently. Indigenous mothers who attended at least one session of antenatal care were less likely to have low birthweight babies (27%) than those who did not attend (36%). The likelihood of low birthweight decreases with an increase in the number of antenatal visits. Low birthweight babies are also associated with later commencement of antenatal care. Similar relationships are evident with pre-term births and perinatal mortality.

Smoking is a risk factor for adverse events in pregnancy (such as spontaneous abortion, ectopic pregnancy, preterm labour and antepartum haemorrhage), and is associated with poor perinatal outcomes (such as low birthweight), and respiratory illnesses (such as bronchitis or pneumonia) during the child’s first year of life (see measure 2.19). Aboriginal and Torres Strait Islander mothers are 3 times more likely to smoke as non-Indigenous mothers during pregnancy, and unlike other Australian mothers, the high rates persist across geographic areas and age groups. Smoking during pregnancy for both Indigenous and non-Indigenous mothers is associated with higher prevalence of pre-term birth and a higher proportion of low birthweight babies. Smoking by Indigenous mothers is also associated with a higher rate of perinatal deaths, which occur at around twice the rate of non-Indigenous births (measure 1.20). The high prevalence of Aboriginal and Torres Strait Islander mothers smoking during pregnancy suggests the need for culturally appropriate and effective health promotion and primary health care interventions specifically related to smoking during pregnancy. Reducing Indigenous smoking continues to be a priority for Australia, now being addressed through the Indigenous Tobacco Control Initiative (2008) and the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (see measure 2.18).

Childhood (0–14 years)

The report presents information on the determinants of health specifically relevant for children. Significant health and environmental challenges remain for Aboriginal and Torres Strait Islander children that affect their ability to get a good start in life. Improving the health, social, and environmental factors of babies and young children is likely to have positive flow-on effects for the remainder of the life cycle.

The measure of community functioning (1.14) finds that in 2008 the majority of Indigenous children aged 0–14 years did not have problems sleeping (76%) and 74% of children aged 4–14 years spent at least 60 minutes every day being physically active. Informal learning activities were undertaken with most children aged 0–14 years (94%). Most children in this age group (71%) also cleaned their teeth once or twice per day.

Immunisation is highly effective in reducing morbidity and mortality caused by vaccine-preventable diseases, and is effective in reducing the disease disparities between Indigenous and non-Indigenous populations, despite socioeconomic circumstances. Coverage is high for Aboriginal and Torres Strait Islander children, and by age 5, the immunisation coverage is very similar to other Australian children (measure 3.02). This measure demonstrates that primary health care services can deliver an effective health care intervention to almost all Aboriginal and Torres Strait Islander children when adequately resourced and organised.

The only national data available on ear disease in Indigenous Australian children are self-reported from parents/guardians in national surveys, and suggests that there has been little improvement in levels of ear disease for children aged 0–14 years. In 2008, 9% of Aboriginal and Torres Strait Islander children aged 0–14 years were reported as having ear or hearing problems. This was 3 times the rate for non-Indigenous children. Around 3% of these children were reported to have complete or partial deafness or hearing loss and the same proportion were reported to have otitis media. There are known limitations to these data, as they are based on parents reporting. Data from localised, population-based screening surveys suggests ear disease is a more significant problem than indicated here. Although the prevalence of ear disease is significantly higher for Aboriginal and Torres Strait Islander children, levels of access to treatment are similar to those of other Australian children. Hospitalisations for ear disease—specifically, the rate of myringotomy procedures in hospital (incision in eardrum to relieve pressure caused by excessive build up of fluid)—for Indigenous children was lower than for non-Indigenous children (1.0 per 1,000 compared with 1.6 per 1,000). General practice encounters for ear problems are similar in both populations, however Indigenous children were 5 times more likely to be diagnosed with severe otitis media than non-Indigenous children.

Data on the dental health of Aboriginal and Torres Strait Islander children are limited (measure 1.10). Available data demonstrate much greater levels of tooth decay and lower levels of dental care than for other Australian children. Dental disease in childhood is readily treated but Aboriginal and Torres Strait Islander children do not have ready access to dental care with cost and geography being significant barriers.

Hospitalisation for pneumonia (measure 1.04) for Indigenous children aged 0–4 years are around 4 times higher than for non-Indigenous children. Over the last 7 years there has been a significant decline in hospitalisation rates for Indigenous children for pneumonia and a narrowing of the gap.

The proportion of Indigenous students achieving the reading, writing and numeracy benchmarks in Years 3, 5, 7 and 9 remain below the corresponding proportions of non-Indigenous students. There have been significant improvements in Year 3 for reading and Year 5 for numeracy. However, numeracy rates have fallen for Years 3 and 7.

A major contributor to poor health in young children is exposure to tobacco smoke. A much higher proportion of Aboriginal and Torres Strait Islander children aged 0–14 years live in households with a regular smoker compared to other Australian children, particularly households where smoking occurrs indoors. The proportions have fallen slightly over time; however, at a slower rate than for other Australian children, therefore, the disparities remain.

While antenatal care and other primary health care are effective at improving pregnancy outcomes, improvements in the living conditions and economic and social circumstances of Aboriginal and Torres Strait Islander peoples, including housing and environment, education and employment, nutrition and substance use (particularly tobacco—measure 2.18) have a role to play in reducing the excess levels of child health problems.

Youth (15–24 years)

Education is a key factor in improving health and wellbeing. School retention and attainment represent issues which are supported through living in a healthy community and environment, incorporating values such as those described in the measure of community functioning (measure 1.14). Over time there have been improvements in the proportion of Indigenous students remaining in school to Year 10 and Year 12, although Indigenous retention rates remain lower than for other students (measure 2.05).

Aboriginal and Torres Strait Islander youth face many more social, emotional, physical and economic challenges than other Australian youth. They are twice as likely to suffer from disability or long-term conditions (comparisons are for non-remote locations) (measure 1.13), twice as likely to report poor health (measure 1.15), three times as likely to report high or very high levels of psychological distress (comparisons are for 18–24 year olds) (measure 1.16), less likely to be employed (measure 2.07), more likely to be sedentary (measure 2.22), and more likely to be a current smoker (measure 2.18).

Encouraging safe sexual practices remains a significant challenge for Indigenous and non-Indigenous Australians. For Aboriginal and Torres Strait Islander peoples, there are higher rates of several common sexually transmitted infections (measures 1.11 and 2.25) which occur more frequently in the young adult age groups.

Adults (25–54 years)

Connectedness to country, land, and history; culture and identity is a theme in the measure of community functioning (1.14) about being engaged and communicative with family, country and spirit, which gives Aboriginal and Torres Strait Islander peoples a strong sense of identity. This identity is connected to being part of a collective in which sharing, giving and receiving, trust, love and looking out for others, supports strong and positive social networks with other Aboriginal and Torres Strait Islander Australians. Data items drawn from the 2008 NATSISS to describe this theme show that 72% of Aboriginal and Torres Strait Islander Australians aged 15 years and over recognised homelands and 62% identified with a clan or language group. This is an increase from the 2002 NATSISS. Importantly, 89% of Aboriginal and Torres Strait Islander Australians ‘feel able to have a say with family and friends’ some, most or all or the time. Data from the 2008 NATSISS also show that 80% of Aboriginal and Torres Strait Islander Australians aged 15 years and over agree that their doctor can be trusted.

There are some signs of improvement in the proportion of Indigenous Australians able to gain work (measure 2.07). The proportion of Indigenous Australians aged 15–64 who were employed increased from 44% in 2001 to 54% in 2008. However unemployment rates remain higher than the corresponding rates for non-Indigenous Australians (about 4 times as high). Many adults are seeking to improve their knowledge, skills and qualifications, with 33% intending to study in the future.

Functional housing with utilities (measure 2.01) is one of the key requirements for good health outcomes. The most current data in relation to this comes from self- reports in the 2008 NATSISS. While working facilities for washing people, washing clothes/bedding, storing/ preparing food and working sewerage systems were reported by a high proportion of respondents, access to these utilities was still an issue for people living in very remote communities. Also, overcrowding (measure 2.02) continues to be a problem, with proportions well above those experienced by other Australians. The levels of overcrowding experienced by Indigenous Australians have not changed since 2002, and are particularly problematic in very remote areas.

Chronic diseases, such as circulatory disease, diabetes and other endocrine/metabolic/nutritional disorders, cancer, and respiratory diseases, continue to be the major contributors to mortality rates for Indigenous Australians. These conditions are also major reasons for the higher hospitalisation rates for Aboriginal and Torres Strait Islander peoples.

External causes were the third highest category of deaths amongst Aboriginal and Torres Strait Islander peoples, accounting for more than twice as many deaths as non-Indigenous Australians. The most common causes were intentional self-harm (suicide), transport accidents, accidental poisoning, and assault. The rates for intentional self-harm highlight the need to consider the implications of social and emotional wellbeing (see measure 1.16). Hospitalisation for injury and poisoning was also almost twice as common for Indigenous Australians compared with non-Indigenous Australians (measure 1.03). Assault is the most important injury prevention issue in relation to hospitalisations for Indigenous adults, followed by accidental falls.

Hospitalisation rates for Aboriginal and Torres Strait Islander peoples are 40% higher than for other Australians excluding dialysis. When including dialysis, the rates are 230% higher (measure 1.02). The main factors for hospitalisation rates are admissions for renal dialysis, endocrine system disorders (including diabetes) and respiratory system disorders. The higher rate of hospitalisation for Aboriginal and Torres Strait Islander peoples is less than expected given the much greater occurrence of disease and injury and much higher mortality rates (measure 1.22). Hospitalisation rates for Indigenous Australians are impacted by changes in access to primary health care and hospital policies and practices such as identification in hospital records. Reductions in hospitalisation will eventually occur through concerted action to reduce incidence and prevalence of the underlying conditions, and prevent or delay complications, through more comprehensive primary health care and addressing underlying determinants of health.

54 years and older

Leadership is a theme within the measure of community functioning (measure 1.14) used to describe strong vision and direction from Elders in family and community (both male and female) and strong role- models who have time to listen and advise. Data items from the 2008 NATSISS to describe this theme were limited to values for children: 42% of children aged 3–14 years had spent time with an Indigenous leader or Elder in the week prior to being surveyed. Encouragement from Elders and Council was considered to be a type of assistance that would help a child in secondary school complete Year 12 by 22% of Aboriginal and Torres Strait Islander people. The role of Elders in providing leadership to support healthy families and communities is vital and better measurement of this is needed.

Aboriginal and Torres Strait Islander people are less likely than non-Indigenous Australians to report very good or excellent health (measure 1.15), and the difference between the two populations was greatest in the older age groups. Self-assessed health status correlates with a range of other measures, such as reported long-term health conditions, recent health-related actions, and the presence of a disability.

Document download

This publication is available as a downloadable document.

Aboriginal and Torres Strait Islander Health Performance Framework - 2010(PDF 4380 KB)