1.14 Community Functioning

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Tier 2: Determinants of Health

Tier 3: Health System Performance

Why is it important?:

A functioning is a state of being or doing that people have reason to value. Measuring functionings is an important supplement to the more traditional approach to the measurement of health and wellbeing. This measure seeks to describe, both in aggregate and as single measures, the level of key functionings Aboriginal and Torres Strait Islander people have described as important to the quality of, and equality in, life. Life is multidimensional and it cannot easily or accurately be measured by reference to just one facet. Measures of functionings add value to health analyses by helping to frame more traditional, single issue measures in a quality of life construct defined by Aboriginal and Torres Strait Islander peoples. Health providers, planners and health and social policy interests need to know more than the level of sickness in a community if they are to work with communities and families to achieve a healthy life.

This measure can play a vital role in evaluating programs, initiatives and progress more generally. Single-issue measures are effective and appropriate in evalu-ating single issues. But for more complete analyses of life, single-issue measures may not be sufficient. For example, measures of morbidity alone can tell us about the level and perhaps type of disease in a population but they do not describe the very real and substantial difficulties that Aboriginal and Torres Strait Islander families and communities experience in trying to deal with ill health; they do not describe the context or ability of Aboriginal and Torres Strait Islander peoples to change the circumstances that have contributed to it. An Indigenous person might seek and obtain health care from a GP but if their power to control choices and options in respect of household income is low or if there is no appropriate storage for medications then treatment may be only a temporary fix. More complete measures are required based on the factors that impact on the lives of Aboriginal and Torres Strait Islander peoples.

As an example, while it is possible to estimate life expectancy at birth (measure 1.17), this provides a prospective measure of longevity rather than quality of life—it does not describe how relatively hard or easy that life will be. Will the individual be free or able to choose a career, be educated or adequately housed, or participate freely in cultural events? Will the individual be free or able to achieve the things in life that they believed were demonstrative of a fulfilling life? Measurement of functionings assists in understanding the quality of life.

Indigenous Australians have long sought health outcomes encompassing the physical, social, cultural and emotional elements of life. The cultural elements relate to Aboriginal and Torres Strait Islander peoples’ ability to live proudly and freely as Aboriginal and Torres Strait Islander peoples, to achieve a state of being that is commensurate with their view of a culturally fulfilling life. Similarly, Aboriginal and Torres Strait Islander peoples have sought a quality of life where racism ceases to be a barrier. Racism can reduce access to adequate shelter; it can deter people from being able to go out in public without shame or fear and from accessing or deriving an equal benefit from a health service.

To develop a picture of quality of life from Aboriginal and Torres Strait Islander peoples’ perspectives, workshops drawing together participants from across Australia were held in 2008 and 2010. Aboriginal and Torres Strait Islander participants at the workshops described the various achievements and objectives that they believed were necessary if Aboriginal and Torres Strait Islander peoples’ lives were to be fulfilling. The workshops identified a number of key themes and weighed these functionings according to their relative value. In 2010 there were six functionings identified by Aboriginal and Torres Strait Islander participants and these have been used to present available data. Each of these functionings is relevant to the ability of Aboriginal and Torres Strait Islander families and communities to achieve greater levels of family and individual development. If these functionings were improved then the potential for Aboriginal and Torres Strait Islander people and families to achieve better health and wellbeing would be improved. They would have greater capacity and freedom to be well.

Aboriginal and Torres Strait Islander participants at the workshops indicated that the functionings used in this measure are important to the quality of Aboriginal and Torres Strait Islander family and community life. Participants were drawn from a number of jurisdictions and settings so the themes they identified appear to reflect widely held views among Aboriginal and Torres Strait Islander peoples. Independently of these workshops a review of relevant research has supported the association between the functionings identified by the workshops and the achievement of health and wellbeing.

Findings:

Connectedness to country, land, and history; culture and identity is a theme involving 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 Australians and Torres Strait Islander Australians. Data items drawn from the 2002 and 2008 NATSISS show that the proportion of Aboriginal and Torres Strait Islander people who recognise their homelands has remained constant (70% and 72% respectively). Over the same period, the proportion of people who identified with a clan or language group has increased significantly, from 54% to 62%. 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.

Resilience is a theme involving the ability to cope well with difference and optimising what one has through engaging in decision-making, coping strategies and the ability to control choices and options. Examples of such options are challenging injustice and racism and proceeding in the external world without shame. Data from NATSISS 2008 show that the majority (98%) of children aged 5–14 years were regularly attending school; 80% of those aged 15 years and over agreed that their doctor could be trusted; and 69% agreed that the local school could be trusted. In addition, 89% of adults felt they were able to find general support from outside the household and 89% of adults had participated in sport, social or community activities in the three months prior to the survey.

Leadership was a theme valued highly by participants at the workshops. Leadership is 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 NATSISS 2008 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 last week. For one in five children in secondary school (22%), encouragement from Elders and Council was considered to be a type of assistance that would help them complete Year 12. Additional data items which describe values of leadership would be useful in future social surveys.

Having a role, structure and routine is a theme encompassing being valued and acknowledged within family, community and society. This value is about knowing boundaries and culturally acceptable behaviours which support having a role for oneself and participating in paid and unpaid roles using capabilities and skills from non-formal education. In the 12 months prior to the 2008 survey, 78% of Aboriginal and Torres Strait Islander Australians had lived in one dwelling— suggesting stability in housing and routine. Informal learning activities were undertaken with most children aged 0–14 years (94%). Most children in this age group (71%) also cleaned their teeth at least once per day.

Feeling safe is a theme encompassing relationships that can sustain disagreement, cultural competency, emotional security, and safe places where there is no physical or lateral violence. Data from 2008 NATSISS show that 81% of Aboriginal and Torres Strait Islander children aged 2–14 years were not bullied or treated unfairly at school because of their Indigeneity. In addition, 75% of those aged 15 years and over had not experienced violence in the last 12 months. In the five years prior to the survey, 97% of Indigenous Australians had not been incarcerated (91% have never been incarcerated in their lifetime).

The final theme, Vitality covers community infrastructure, access to services, education, health, income and employment. NATSISS 2008 data show that half of Aboriginal and Torres Strait Islander adults had no disability or long-term health condition and 68% experienced low/moderate levels of psychological distress. There was no smoking inside the house in the majority of households (70%). The majority of 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. Many Aboriginal and Torres Strait Islander people are seeking to improve their knowledge, skills and qualifications, with 33% of those aged 15 years and over intending to study in the future. Education was the main purpose of Internet use for children (54%), while overall 30% reported using the Internet for education or study.

Implications:

Community functioning for Aboriginal and Torres Strait Islander peoples should be assessed within a framework that reflects the values of Indigenous Australians themselves. Community functioning scores present a national quantitative measure of functioning and suggest differences between remoteness, sex, age groups, and states and territories. Policy makers need to listen carefully to the voices of Aboriginal and Torres Strait Islander peoples themselves when assessing community functioning and the approaches that will enhance functioning.

Figure 37 – Community functioning score by remoteness, proportions, Indigenous Australians aged 0–14 years, Australia 2008

Source: ABS and AIHW analysis of NATSISS 2008
Text description of figure 37 (TXT 1KB)

Figure 38 – Community functioning score by remoteness, proportions, Indigenous Australians aged 15 years and over, Australia 2008

Source: ABS and AIHW analysis of NATSISS 2008
Text description of figure 38 (TXT 1KB)

Table 23 – Selected variables contributing to community functioning for Aboriginal and Torres Strait Islander peoples, Australia 2008 and 2002

Community functioning theme and associated variables		2008 Number	2008(a) %	2002(a) %
*Connectedness to family land and history, culture, identity*
	Recognises homelands	234,383	72	70
	Speaks an Aboriginal/Torres Strait Islander language	62,629	19	21
	Attended Aboriginal and Torres Strait Islander cultural event in last 12 months	205,674	63	68
	Identifies with clan group or language group	203,106	62	54
	Feels able to have a say with family and friends some, most or all of the time	292,375	89
	Feels able to have a say within community on important issues some, most and all of the time	157,312	48
	Contact with family or friends outside household at least once per week	307,515	94
	Has friends can confide in	246,649	75
	Able to get support in time of crisis from outside household - from family member	261,506	80
	Provides support to relatives outside household	166,892	51
*Resilience*
	Did not feel discriminated against in last 12 months	237,812	73
	Did not avoid situations due to past discrimination	225,507	69
	Can visit homelands	146,017	45	46
	Involvement with Aboriginal/Torres Strait Islander organisation	59,516	18	26
	Work allows for cultural responsibilities—can meet responsibilities	75,028	23	22
	Used strategies to meet living expenses	119,147	36	49
	No community problems reported	84,327	26	25
	Community problems reported, but less than three types	73,788	23	29
	No problems reported for theft	192,535	59	57
	No problems reported for alcohol	192,138	59	67
	No problems reported for illicit drugs	208,039	64	68
	No problems reported for family violence	245,938	75	79
	No problems reported for assault	253,009	77	80
	No problems reported for sexual assault	288,926	88	92
	Total persons who reported a community problem	232,592	71	74
	Agrees that most people can be trusted	118,975	36
	Agrees that their doctor can be trusted	260,777	80
	Agrees that the hospital can be trusted	204,189	62
	Agrees that police in the local area can be trusted	170,317	52
	Agrees that police outside the local area can be trusted	133,362	41
	Agrees that the local school can be trusted	224,734	69
	Knows someone in organisation/comfortable contacting	132,011	54
	Adult participated in sport/social/community activities in last 3 months eg:	289,381	89
	Recreational or cultural group	46,263	14
	Community or special interest group activities	42,274	13
	Church or religious activities	49,393	15	24
	Watched Indigenous TV	177,695	54
	Listened to Indigenous radio	85,682	26
*Leadership*
	Child spent time with an Indigenous leader or elder in last week (children aged 3-14 years)	65,035	42
	Encouragement from elders and council would help child in secondary school complete year 12	7,504	22
*Structure and routine/having a role*
	Can communicate with English speakers without difficulty	27,179	8
	(Indigenous language is main language spoken at home)
	In the last 12 months, has lived in only one dwelling	255,157	78	69
	Activities were undertaken with child doing informal learning activities	180,736	94
	in the last week (0-14 years) (e)
*Feeling Safe*
	Felt safe at home alone during the day	305,892	94
	Felt safe at home alone after dark	261,414	80
	Felt safe walking alone in local area after dark	172,047	53
	Not a victim of physical or threatened violence in the last 12 months:	246,372	75	76
	Indigenous culture taught at school	87,833	53
	Was taught Indigenous culture at school or as part of further studies	148,592	45
	Learnt about own Indigenous clan / language	55,947	17
	Child neither bullied nor treated unfairly at school because Indigenous	112,159	81
*Vitality*
	Self-assessed health status excellent or very good	143,004	44	44
	Has no disability or long term-health condition	164,157	50	64
	Does not have an education restriction due to disability	142,632	46
	Does not have an employment restriction due to disability	125,599	40
	Low/ moderate level of psychological distress (5-11 K5 score)	221,717	68
	Employed (persons aged 15-64 years in the labour force)	167,416	54
	Year 12 highest year of school completed	66,220	20	18
	Has a non-school qualification	83,257	40	32
	Living in a dwelling that has no major structural problems	370,606	71	60
	Household members used telephone(s) in last month	317,203	97
	Used computer in last 12 months	218,006	67	56
	Used Internet in last 12 months	192,852	59	41
	Has access to motor vehicles whenever needed	215,689	66	55
	Can easily get to places needed	241,481	74	70
	Equivalised gross household income is within the 3rd quintile or above	92,063	35	25
Total persons aged 15 years and over		327,001	100

(a) Unless otherwise indicated, percentages are of the estimated total Aboriginal and Torres Strait Islander population aged 15 years and over.
Source: ABS and AIHW analysis of NATSISS 2002 and 2008

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