National Aboriginal and Torres Strait Islander Health Plan 2013–2023

Priorities—Whole of Life

Page last updated: 27 June 2013

Whole of life

“The strength of using a whole-of-life structure is that it encourages attention to the broader factors affecting health as people move through the stages.” 35

Goal

Aboriginal and Torres Strait Islander people are as healthy as non-Indigenous people and enjoy the same life expectancy by 2031 (one of the six Closing the Gap targets).

Context

Aboriginal and Torres Strait Islander people are three per cent of the total Australian population, which has increased by 30 per cent from June 2006, with a birth rate which is 25 per cent higher than for non-Indigenous Australians. Sixty two per cent of Aboriginal and Torres Strait Islander people are less than 30 years of age and just three per cent are aged 65 years and over, compared to 14 per cent of non-Indigenous Australians.36

The younger age profile of the Aboriginal and Torres Strait Islander population requires a focus on well-designed and implemented antenatal care and early childhood programs, along with effective interventions to support young adults to adopt healthy lives.37

However there will also be increases in the number of older Aboriginal and Torres Strait Islander people over the coming decade. The key challenge here will be to deliver person-centred, culturally appropriate health care for older people that maximises their function and independence through access to a flexible range of general and specialist health services.

Applying a whole-of-life perspective recognises the different stages in life, highlights key transition periods for individuals and provides strategic points of intersection between health and mental health and social and emotional wellbeing. Addressing health risks earlier in the life span, through prevention and early intervention during developmentally sensitive periods, provides greater returns for the resources invested. A life course approach is necessary in order to address the inter-generational mechanisms that impact on health inequalities. For example, delays in child development impact on education progress which in later life can impact on employment and opportunities, and consequently reinforces the social inequalities that produce health inequalities in subsequent generations.

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Health Impacts Across the Life Course

There are a number of health conditions that significantly contribute to the disparity in the health status between Aboriginal and Torres Strait Islander people and the non-Indigenous population. Interventions on these issues need to recognise the importance of a multi-layered approach to risk factor modification including system-level and community responses alongside programs targeted at individuals.

Risk factors contributing to the health gap between Aboriginal and Torres Strait Islander and non-Indigenous people. 38

Risk factors contributing to the health gap between Aboriginal and Torres Strait Islander and non-Indigenous people.D
The top seven risk factors that require a continued focus are illustrated above. Smoking leads to higher incidence of a number of diseases, including chronic lung disease, cardiovascular disease and many forms of cancer. Obesity, which can result from the combination of poor nutrition and physical inactivity, increases the risk of cardiovascular diseases and type 2 diabetes.

The nutritional status of Aboriginal and Torres Strait Islander people is influenced by socio-economic disadvantage and geographical, environmental and social factors. While food supply can be more limited in rural and remote areas, including quality, variety and cost of fresh fruit and vegetables,39 food supply problems are also evident in urban poor communities.

Violence and hospitalisations for injuries arising from assault are higher for Aboriginal and Torres Strait Islander people. They also have three times the rate of road death and injury than other Australian’s, a result of lower seatbelt use and, driving on lower-standard roads in vehicles with a lower safety standard. Alcohol is also often a factor in road crashes.

Aboriginal and Torres Strait Islander people are also at greater risk of disability due to increased exposure to factors such as low birth weight, chronic disease, infectious diseases, accidents and violence, mental health problems, substance use and limited access to treatment and rehabilitation services. Such factors tend to be more prevalent where there are higher rates of unemployment, lower levels of income, poorer diet and living conditions, and poorer access to adequate healthcare.

In addition to these risk factors, governments also need to focus on the greatest disparity where quality of life is significantly reduced. This includes fundamental issues such as eye, ear and oral hygiene and care, and safe sexual health practices.Top of page

The gap in potential years of life lost before age 65 years per 1,000 population between Aboriginal and Torres Strait Islander people and non-Indigenous Australians, by age for 2007-11

(source: ABS mortality database (unpublished). Data refers to NSW, QLD, WA, ST and NT combined).


The gap in potential years of life lost before age 65 years per 1,000 population between Aboriginal and Torres Strait Islander people and non-Indigenous Australians, by age for 2007-11D
The gap in life expectancy reflects differences in the age profile of deaths between Aboriginal and Torres Strait Islander people and non-Indigenous Australians. A very high percentage of deaths occur before the age of 65 years. The graph above shows the largest gaps between the populations are in the 0-4 age group followed by the middle years (35-39 years). An understanding of the impact of age at death helps direct policy to the issues facing the age groups most affected.

If the life expectancy gap is to be closed, there has to be a strong focus on the chronic diseases that have a big impact on Aboriginal and Torres Strait Islander people in the middle age bracket.

Palliative care is provided in almost all settings where health care is provided including neonatal units, paediatric services, acute hospitals, general practices, residential and community aged care services, and generalist community services. Palliative care is also an intrinsic part of all health and human services in their overall responsibilities in providing comprehensive care to their clients. Appropriate, culturally sensitive palliative care needs to be available for Aboriginal and Torres Strait Islander people across Australia. Integration and collaboration between health services and specialist palliative care services can ensure capacity building and enhanced quality of care, with a particular focus on delivering culturally appropriate and safe palliative care.

The first signs of mental health illness may emerge in childhood, and often appear in adolescence or early adulthood. Some people recover unaided from or enter a long phase without another episode of their illness. While some need short-term interventions, others need intensive support and access to a range of services over their lifetimes.40

Key Strategies to Achieve this Goal

  • Continue to complement system-wide health service delivery with targeted activity to address key risk factors that contribute to the mortality gap or to lesser health outcomes for Aboriginal and Torres Strait Islander people.
  • Continue to identify change levers in policy design which will make the greatest impact on a given health condition or issue. This may include population health activity or targeted activity to address Aboriginal and Torres Strait Islander health disparity.
  • Implement the National Disability Strategy 2010-2020, which sets out a ten year national plan for improving life for Australians with disability, their families and carers.
  • Implement the National Disability Insurance Scheme through DisabilityCare Australia.
  • Implement strategies to enhance the health and wellbeing of Aboriginal and Torres Strait Islander people with disability.
  • Continue implementation of the National Carer Strategy - the Australian Government's long-term commitment to carers to encourage a cohesive and collaborative national approach to supporting carers.
  • Improve access to nutritious foods through a National Nutrition Policy which includes a focus on at-risk mothers, infants and children.
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Maternal Health and Parenting

“Birth weight is important—in a sense, it is the first outcome. It reflects the influence of a number of parental factors, is directly linked with foetal death and is the earliest indicator of proneness to ill health during childhood and to later adult diseases, such as high blood pressure.” 41

Goal

Aboriginal and Torres Strait Islander mothers and babies get the best possible care and support for a good start to life.

Context

National policies should guide positive reproductive, perinatal, antenatal and infancy health through best practice principles and approaches. This will build on significant reductions in post-neonatal mortality achieved through improved access to primary health care (including antibiotics for acute infection) and earlier evacuation to hospital for severe illness. 42

Promoting perinatal mental health wellness among Aboriginal and Torres Strait Islander mothers is critical to redress the negative impacts on their children, families and the community. This can be achieved through supporting interconnectedness of cultural practices, spirituality, identity, family and community, access to appropriate support services and economic security.43

The provision of culturally appropriate maternal health services as close to home as possible is supported through programs that provide home visits, birthing support and postnatal follow up, and a range of birthing options. Around 97% of Aboriginal and Torres Strait Islander mothers access antenatal services at least once during their pregnancy, but access is usually later and less frequent than other mothers.44 Fathers influence the behaviours of mothers during pregnancy, and should be positively encouraging mothers to access services, and earlier, throughout their pregnancies.

Cultural practices and societal roles affect the role that fathers and other male family members play in the development of a child. It is important for services to acknowledge and include men in the raising of children in a culturally appropriate way.45 Family and kinship define obligations and responsibilities for Aboriginal and Torres Strait Islander people and are important elements in child rearing.

At the individual level, health risk factors such as maternal smoking, alcohol and other drugs consumption by both parents, inadequate nutrition, stress, illness and infection can all disrupt the development of the child before birth and are associated (along with young maternal age) with low birth weight, which connects with long-term effects on learning and behaviour, and the development of chronic disease later in life. In particular, drinking alcohol while pregnant may result in a range of impairments and cognitive social and emotional dysfunction over the child’s lifetime, otherwise known as foetal alcohol spectrum disorder (FASD).46

Key Strategies to Achieve this Goal

  • Continue working across governments to achieve the Closing the Gap target to halve the gap in mortality rates for Aboriginal and Torres Strait Islander children under give within a decade.
  • Continue working across governments on efforts to address access to maternity services and birthing options through the National Maternity Services Plan.
  • Increase access to positive parenting programs and services in relation to early childhood development, family support, health and wellbeing, alcohol and other drugs.
  • Improve the quality and accessibility of primary health care screening and routine antenatal care for all Aboriginal and Torres Strait Islander women which would include focusing on the extent to which the first antenatal visit occurs in the first trimester.
  • Broaden antenatal care to include support for perinatal depression screening, evidence-based intervention strategies to reduce maternal stress, reduce smoking and alcohol consumption rates, and improve nutrition during pregnancy.
  • Support routine testing for and management of diabetes and sexually transmitted infections and urinary tract infections.
  • Implement strategies to increase rates and duration of breastfeeding.
  • Improve data systems and monitoring of maternal and foetal health.
  • Promote awareness of the National Immunisation Program to increase the uptake amongst Aboriginal and Torres Strait Islander families.
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Childhood Health and Development (birth–early teens)

“Early years of a child’s development lay the foundation for the healthy adult life. Preventative action on many of the health issues faced by Aboriginal and Torres Strait Islander people needs to begin in early childhood in order to be successful.” 47

Goal

Aboriginal and Torres Strait Islander children have long healthy lives, meeting key childhood developmental milestones.

Context

Early childhood is when children develop a range of essential capabilities including social, emotional, language, cognitive and communication skills that provide the foundations for formal learning and relationships in later life. During the middle childhood period (approximately 6-10 years) physical and mental development occurs and learning and social behaviours are established.

Health care in the early years (including good nutrition, immunisation and addressing threats to health such as tobacco smoke) are crucial for healthy physical and social development. Early engagement with parents, families and carers emphasises a whole of family responsibility for children’s health, including the elders and grandparents.

Positive role modelling by parents, families and carers encourages compassion, autonomy, self-reliance and early learning. Early childhood development programs that include access to early childhood education, family support and parenting are a highly effective means of reducing health inequalities and providing additional life-long health benefits and educational and economic achievement. In addition, initiatives that facilitate a strong sense of identity and pride in Aboriginal and Torres Strait Islander young people can play a role in developing positive health and wellbeing.

Negative role modelling around gambling, drinking and other substance misuse, as well as the absence of a mother or father due to incarceration, can contribute to child abuse and neglect. When developing national childhood development policy, coordination must occur among health, education, housing, families, and community services agencies, and the non-government sector to address these system-wide issues.

Environmental factors also impact on health and wellbeing. Programs to improve environmental health help prevent eye and ear health problems which are more prevalent in Aboriginal and Torres Strait Islander communities. Rheumatic heart disease (RHD), including acute rheumatic fever (ARF), is almost exclusively experienced by Aboriginal and Torres Strait Islander people and is also associated with environmental factors such as poverty, poor and overcrowded living conditions and poor hygiene.

Key Strategies to Achieve this Goal

  • Improve targeted programs for children including: New Directions: Mothers and Babies, Australian Nurse Family Partnership, Strong Fathers Strong Families and Healthy for Life.
  • Implement innovative programs that integrate services across sectors to improve Aboriginal and Torres Strait Islander children’s development outcomes.
  • Continue implementation of the National Early Childhood Development Strategy, including the strengthening of universal maternal, child and health services.
  • Promote awareness and use of the Australian Early Development Index to support the development of evidence-informed strategies, policies and programs, and support communities to consider what they can do to better support children and their families.
  • Continue implementation of the Closing the Gap - Improve Eye and Ear Health Services for Indigenous Australians measure.
  • Promote uptake of the Medicare Benefits Scheme health assessment for Aboriginal and Torres Strait Islander children aged 0-14 years and follow up care and services where needed.
  • Promote awareness of the National Immunisation Program to increase the uptake amongst Aboriginal and Torres Strait Islander families.
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Adolescent and Youth Health (early teens to mid 20s)

“Indigenous youth are at the forefront of Aboriginal and Torres Strait Islander health. They represent more than half of the Indigenous population in Australia, are within the age bracket where death from diseases such as cardiovascular disease and diabetes is still avoidable, and importantly, have a passion for improving health outcomes.”48

Goal

Aboriginal and Torres Strait Islander youth get the services and support they need to thrive and grow into healthy young adults.

Context

Young people are the emerging leaders of the future and have a unique and valuable perspective to contribute to society. Young people should have opportunities to contribute to policies and programs that impact on them.

Adolescence and youth are key life stages with great personal change including physical development, the establishment of a sense of identity and values and emotional development including relationships and aspirations for the future. It is also the age where health enablers, such as positive role models and healthy behaviours, as well as factors negatively impacting on health and wellbeing such as racism, discrimination and limited access to education and social services, affects self-perception and behaviours.

Many Aboriginal and Torres Strait Islander young people grow up in difficult circumstances, including living with the impacts of intergenerational trauma and families and communities with lesser housing, education and employment opportunities. In some circumstances they may suffer from a disrupted home life and family disruption typified by alcohol and other substance abuse, welfare dependency, contact with the justice system and family violence.

Rates of mental illness and suicide are also higher amongst Aboriginal and Torres Strait Islander people compared to the broader Australian population. Developing resilience, strong support networks, strong connection to culture, a sense of belonging and problem solving skills from an early age can help to promote positive mental health and wellbeing and act as protective factors against mental illness and suicide.

Improved education about safe sex practices will also contribute to preventing sexually transmitted infections and unwanted pregnancies.

Sport, music and the arts can also play a key role in relation to promoting positive social and emotional wellbeing amongst young people. They can strengthen an individual’s self-esteem and dignity and can assist in connecting people to their local community.

Key Strategies to Achieve this Goal

  • Build strong communities through implementation of the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy.
  • Implement initiatives that promote the wellbeing of young Aboriginal and Torres Strait Islander people by strengthening pride in identity and culture.
  • Support initiatives that reduce systemic barriers and encourage young Aboriginal and Torres Strait Islander people to establish healthy lifestyle behaviours, reduce the risk of chronic disease, and empower young people to make informed choices about sexual health, mental health and risk taking behaviours.
  • Ensure young people can contribute to a range of national, state and territory, local and community platforms to ensure policies, programs and services reflect their needs and views.
  • Implement the National Partnership Agreement on Supporting Mental Health Reform and the renewed Aboriginal and Torres Strait Islander Social and Emotional Wellbeing Framework once finalised.
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Healthy Adults (mid 20s +)

“Aboriginal and Torres Strait Islander people accept that it is the norm to be suffering from chronic disease and be taking medication on a regular basis in their middle years. We need to challenge this.” 49

Goal

Aboriginal and Torres Strait Islander adults have the health care, support and resources to manage their health and have long, productive lives.

Context

Healthy adults are better able to positively contribute to communities and families and are more likely to ensure their families adopt healthy lifestyle behaviours.

Programs and services at the community level need to support and continue to encourage healthy lifestyle behaviours, chronic disease prevention and management, and social and emotional wellbeing. Responsive health systems as well as addressing system-wide determinants of health are critical.

The use of the health system is greatest in this and the older age group, with more than half of all potentially preventable hospitalisations from chronic conditions such as diabetes, asthma, angina, hypertension and congestive heart failure.50 It is important that the health system works and provides optimal clinical care.

Increased opportunities for education to improve health literacy will further enable Aboriginal and Torres Strait Islander adults to make informed health choices for themselves and their families.

Chronic diseases, such as cardiovascular disease, cancer, diabetes and kidney disease contribute to two-thirds of the health gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians.51 Premature mortality from chronic diseases is unacceptable in this age group and policies should target conditions that most contribute to this outcome. Additionally, rheumatic heart disease and poor eye and oral health are also highly prevalent in Aboriginal and Torres Strait Islander adults.

Health checks and follow up support at this stage of life can assist all people to make the necessary lifestyle changes to prevent or delay the onset of chronic disease.

Aboriginal men have the worst health outcomes of any group in Australia. Aboriginal men die earlier from chronic diseases, such as cardiovascular disease, injury, respiratory disease, cancer and endocrine disease. They have higher rates of suicide than non-Aboriginal men, and have similar death rates from assault to females. Aboriginal men often do not talk about their health and as a consequence, problems are often not acknowledged until they become too serious to ignore. All evidence shows that Aboriginal and Torres Strait Islander men use preventative health services less often than any other group. Aboriginal and Torres Strait Islander men must be empowered to prioritise their health needs and engaged to use health and other services.

Key Strategies to Achieve this Goal

  • Review and improve the implementation of the Indigenous Chronic Disease Package over the next decade – the Commonwealth’s contribution to the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, including regional tackling smoking and healthy lifestyle teams.
  • Promote uptake of the adult health check and associated follow up medical and allied health services available through the Medicare Benefits Scheme amongst adults at risk of chronic disease.
  • Improve access to high quality health care to enable better health outcomes for Aboriginal and Torres Strait Islander people.
  • Increase the participation of Aboriginal and Torres Strait Islander men in addressing physical, social and emotional health and wellbeing.
  • Ensure best practice, continuously improving, culturally appropriate primary health care services focussed on chronic disease prevention and treatment are provided through Aboriginal and Torres Strait Islander community controlled health organisations and mainstream services.
  • Implement strategies to improve access to high quality specialist and secondary services with priority on reducing differentials in access to appropriate diagnostic and treatment interventions and improving access to services, such as cardiac rehabilitation services with demonstrated efficacy in improving health outcomes.
  • Progress specific health interventions to address key areas of health disparity in Aboriginal and Torres Strait Islander adults.
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Healthy Ageing

“Elders and other senior community members should be engaged as key stakeholders to champion culturally appropriate choices and approaches to health and wellbeing.” 52

Goal

Older Aboriginal and Torres Strait Islander people are able to live out their lives as active, healthy, culturally secure and comfortably as possible.

Context

Aboriginal and Torres Strait Islander elders play a vital role in sustaining strong cultural practices and traditions within their communities with important roles and responsibilities such as passing on knowledge, languages and customs, participating in decision-making ceremonies, and ‘looking after country’. Older Aboriginal and Torres Strait Islander people also often still have caring responsibilities, sometimes of multiple generations.

Many older Aboriginal and Torres Strait Islander people will have been impacted by historical policies leading to the forcible removal of children. The consequences of these removal policies have long-term resonance, including social, physical and psychological devastation for Aboriginal and Torres Strait Islander people directly involved, as well as their families and communities.53 National policy needs to recognise this history and continue to provide social and emotional support for those who have been affected.

Older Aboriginal and Torres Strait Islander people should have the option to choose their environment where they feel most comfortable to age particularly if affected by ill-health and disability. Options for the increasing numbers of older Aboriginal and Torres Strait Islander people will be needed for those who will be seeking to age on country and may require access to appropriate services that maximise their independence.

Aged care facilities need to be culturally sensitive to the needs of Aboriginal and Torres Strait Islander elders and health care workers need to have the skills to meet this need. This includes palliative care services to ensure Aboriginal and Torres Strait Islander people receive culturally appropriate care for the end stages of life. Support is also important for the families who have caring responsibilities of older Aboriginal and Torres Strait Islander people with health problems or disabilities.

Key Strategies to Achieve this Goal

  • Adopt coordinated and innovative models of care that provide opportunities for older Aboriginal and Torres Strait Islander people to maintain social and cultural connections and age on country.
  • Engage elders and senior community members as key stakeholders and role models to champion culturally appropriate choices and approaches to health and wellbeing.
  • Build the capacity of the health and aged care workforce to be sensitive to the needs of older Aboriginal and Torres Strait Islander people.
  • Review and improve the implementation of the Indigenous Chronic Disease Package over the next decade – a Commonwealth contribution to the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes.
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