Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 2—Community capacity—2.13 Transport

The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

Why is it important?:

Transport can have a beneficial impact on health by enabling access to goods and services and by helping people to build and maintain social networks. It is an enabling resource that communities require to achieve desired outcomes, including safety and health. Research into the social determinants of health has found that "lack of access to transport is experienced disproportionately by women, children, disabled people, people from minority ethnic groups, older people and people with low socioeconomic status—especially those living in remote rural areas" (Acheson 1998; Marmot 2010). The negative impacts of transport include motor vehicle accidents and reduced physical activity.

Aboriginal and Torres Strait Islander communities face various challenges related to transport. These challenges have a broader impact on social and economic circumstances, and specific impacts on access to health services. Limited or no public transport options significantly impact on the capacity to access health care, especially specialist services. Problems with access are particularly significant for patients with chronic illnesses where frequent attendance at specialist clinics may be required. Schemes to assist patients with travel and associated accommodation operate in the various jurisdictions. Other approaches have also been adopted, such as support for specialist services flying into remote localities.

Findings:

In 2008, Indigenous households in non remote areas were significantly less likely than other households to have access to a working motor vehicle (15% in 2006 compared with 50% in 2008 respectively). In remote areas 43% of Indigenous households had no access to motor vehicles.

In the 2008 NATSISS, an estimated 26% of Aboriginal and Torres Strait Islander adults had used public transport in the previous two weeks. Of the 215,400 adults who had not used public transport in the previous two weeks, 43% lived in an area in which there was no local public transport available. Use of public transport by Indigenous adults was lower in remote areas (13% in the last two weeks) than in non-remote areas (30%). One of the key contributing factors is the lack of availability of public transport in remote locations. Of the 65,000 Indigenous adults in remote areas who had not used public transport in the previous two weeks, 83% lived in an area where there was no public transport available.

In 2008, an estimated 8% of Indigenous people aged 18 years and over living in non-remote areas could not, or often had difficulty, getting to places needed, compared with 4% of non-Indigenous Australians in 2006. The proportion of Indigenous adults reporting these difficulties was higher in remote areas (18%) than in non remote areas (8%).

The proportion of Aboriginal and Torres Strait Islander adults with access to a working motor vehicle was 78% overall, ranging from 70% of those aged 18–24 years to 85% of those aged 35–44 years. The 2008 rates for Aboriginal and Torres Strait Islander peoples were significantly lower than those for non-Indigenous people (in 2006) for each age group. In 2008, a higher proportion of Aboriginal and Torres Strait Islander males than females reported having access to a motor vehicle whenever they needed it (74% compared with 69%).

In the 2008 NATSISS, 10% of Aboriginal and Torres Strait Islander peoples aged 15 years and over reported transport/distance as the reason they did not access services. Transport/distance was a bigger issue for those living in remote areas (19%) than those living in non remote areas (7%).Top of Page

Implications:

While public transportation may compensate for the lack of private transport in non remote areas, a higher proportion of Indigenous Australians in both remote and non-remote areas report having difficulty getting to places they need to go compared with non-Indigenous Australians.

The National Strategic Framework for Aboriginal and Torres Strait Islander Health’s (NSFATSIH) Key Result Area Six identifies wider strategies that impact on health. Actions related to transport include reviewing the effectiveness, eligibility criteria and payment levels of patient-assisted travel schemes to improve equitable access to services by Aboriginal and Torres Strait Islander peoples across Australia.

The National Healthcare Agreement (November 2008) commits states and territories to provide and fund patient assistance travel schemes (PATS) and to ensure that public patients are aware of how to access the schemes. The Department of Health and Ageing, through the Rural Health Standing Committee, worked with all jurisdictional health departments to draft policy principles and to undertake modelling to determine possible costs associated with nationally harmonised PATS. A paper presenting the policy principles and costings was considered by AHMAC at its meeting on 29&nbspSeptember 2011. AHMAC members noted the policy principles for the administration of PATS and that these principles will provide a basis for work should COAG identify a need for nationally consistent patient assisted travel schemes.

Patient transport services designed to assist patients with chronic illnesses to access health services on a regular basis are an important aspect of health service delivery. This is particularly the case for Indigenous households where private and public transport options are often restricted. Patient transport services are provided by a broad range of services including voluntary groups, Aboriginal controlled health services, hospitals and ambulance services. For example, the WA Department of Health has funded patient transport officers and patient journey officers in Aboriginal community controlled health services and area health services to ensure that Aboriginal patients have adequate transport to medical appointments at all levels of the health system (primary, secondary and tertiary). Unfortunately, the provision of these services varies significantly across Australia and access is not always assured.Top of Page
Figure 117—Proportion of households without access to a working motor vehicle, by Indigenous status and remoteness, 2008 (Indigenous) and 2006 (other)
Figure 117—Proportion of households without access to a working motor vehicle, by Indigenous status and remoteness, 2008 (Indigenous) and 2006 (other)
Source: ABS analysis of 2008 NATSISS. Non-Indigenous data are from the 2006 General Social Survey
Top of Page
Figure 118—Difficulty with transport, by Indigenous status and remoteness, persons aged 18 years and over, 2008 (Indigenous) and 2006 (non-Indigenous)
Figure 118—Difficulty with transport, by Indigenous status and remoteness, persons aged 18 years and over, 2008 (Indigenous) and 2006 (non-Indigenous)
Source: ABS analysis of 2008 NATSISS. Non-Indigenous data from the 2006 General Social Survey
Top of Page
Table 34—Use of public transport, by remoteness, Indigenous persons aged 18 years and over, 2008
Non-remote
Remote
Total
Used public transport in last 2 weeks
30
12.7
25.5
Used transport but not public transport in last 2 weeks
68.8
79.4
71.5
Did not use any transport in last 2 weeks
0.9
7
2.5
Total
100
100
100
Main reason did not use public transport(a)
Non-remote
Remote
Total
Prefer to use own transport or walk
57.9
12.7
44.2
Costs too much/takes too long
3.3
1.0*
2.6
No suitable services
7.4
2.3*
5.8
Personal reasons
2.6
0.3*
1.9
Other
3.1
0.9*
2.4
Total with access to public transport in local area
74.2
17.1
56.9
No public transport available in local area
25.8
82.9
43.1
Total
100
100
100
(a)Proportion calculation excludes "used public transport in last 2 weeks"
* Estimate has a relative standard error between 25% and 50% and should be used with caution.

Source: ABS analysis of 2008 NATSISS.

Top of Page