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

Tier 3—Responsive—3.12 Aboriginal and Torres Strait Islander people in the health workforce

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Why is it important?:

Aboriginal and Torres Strait Islander peoples are significantly under-represented in the health workforce. This potentially contributes to reduced access to health services. International studies suggest that people prefer seeing health professionals from the same ethnic background (Powe et al. 2004). The Indigenous Australian workforce is integral to ensuring that the health system has the capacity to address the needs of Aboriginal and Torres Strait Islander peoples. Indigenous health professionals can align their unique technical and sociocultural skills to improve patient care, improve access to services and ensure culturally appropriate care in the services that they and their non-Indigenous colleagues deliver (West et al. 2010; Anderson et al. 2009). An Australian patient satisfaction survey found that the presence of an Aboriginal and Torres Strait Islander doctor at a community health centre was a key reason that Indigenous Australians attended the clinic. Patients reported that an Indigenous doctor was ‘more understanding of their needs’. Numbers of Aboriginal and Torres Strait Islander patients attending the clinic increased markedly following the arrival of the Aboriginal and Torres Strait Islander doctor and in response to other changes in the service designed to make it more welcoming (Hayman 1999).

Findings:

In 2006, there were 5,536 Aboriginal and Torres Strait Islander people employed in health-related occupations. Between 1996 and 2006, the number of Indigenous Australians employed in the health workforce increased by 2,165 (64%). In 2006, 1.2% of the Indigenous population was employed in health-related occupations. However, this is below the proportion of the non-Indigenous population employed in the health workforce (approximately 3%). While the Indigenous health workforce has grown between 1996 and 2006, the non-Indigenous health workforce has grown at a faster rate and there has been a 20% increase in the gap.

In 2006, the health occupations with the largest number of Indigenous employees were nursing (1,449), followed by nursing support and personal care workers (974), and Aboriginal and Torres Strait Islander Health Workers (966). The health occupations with the largest gap between numbers of Indigenous and non-Indigenous employees were nurses, medical practitioners and allied health professionals.

Victoria had the highest proportion of its Indigenous population employed in the health workforce (2.4%) and NT had the lowest (1.2%).

The 35–44 year age group has the largest number of Indigenous Australians in the health workforce. The largest gaps are in the 25–34 and 55–64 year age groups. Females accounted for 74% of the Indigenous health workforce. Aboriginal and Torres Strait Islander peoples made up 62% of the workforce in Aboriginal and Torres Strait Islander primary health care services as at June 2006.

Implications:

Increasing the size of the Aboriginal and Torres Strait Islander health workforce is fundamental to closing the gap in Indigenous life expectancy. The Australian Health Ministers’ Advisory Council has developed the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework (2011–2015). The Framework now underpins state and territory and Aboriginal community controlled health sector workforce strategic plans across all health disciplines. The Framework has been informed by health workforce elements within National Partnership Agreements, such as Closing the Gap in Indigenous Health Outcomes, Indigenous Early Childhood Development and Indigenous Economic Participation. The Framework also embraces the aspirational target of Indigenous Australians comprising at least 2.6% of all employees across the public sector by 2015 (equal to the proportion of Indigenous Australians in the working age population).

The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes aims to increase the capacity of the primary care workforce to deliver health care to Indigenous Australians. Governments are introducing a range of initiatives. For example, the Australian government is providing funding for over 700 new positions over four years, along with communication and marketing activities to encourage more Indigenous people to take up a career in health, and education and training to build the skills and capacity of the existing health workforce.

The Pathways into the health workforce for Aboriginal and Torres Strait Islander people: a blueprint for action is designed to maximise Aboriginal and Torres Strait Islander participation in the health workforce through promoting and improving pathways between school, vocational education, training and higher education; and retaining and building the capacity of the existing workforce (NATSIHC 2008).

Under the National Registration and Accreditation Scheme, Aboriginal and Torres Strait Islander Health Practitioners commenced registration on 1 July 2012. As at 30 June 2012 there were 270 Practitioners registered with the majority of those being in the Northern Territory.Top of Page

The Australian Government is currently implementing a number of Aboriginal and Torres Strait Islander specific employment and workforce development programs in aged and community care services. These programs are funded under the National Partnership on Indigenous Economic Participation and include funding for the employment and training of Aboriginal and Torres Strait Islander people in aged and community care services throughout Australia, largely in rural and remote locations. Since 2007, more than 700 permanent part time jobs have been created for Aboriginal and Torres Strait Islander people in aged care services nationally and accredited training has been delivered to more than 1200 Aboriginal and Torres Strait Islander people in rural and remote communities. Training programs are culturally appropriate, accredited and delivered on-site in communities. The training available under these programs includes delivery of identified skill sets and units of competency under the Home and Community Care, aged care, community and disability services training packages.

Improving the representation of Indigenous Australians in the health workforce will require collaboration between the health and education sectors and success across a range of fronts. Educational disadvantages faced by Aboriginal and Torres Strait Islander children can reduce options for further training (see measures 2.04 and 2.05). Strategies to address barriers to entry into health professional training, and strengthen support while in training, need to be implemented (see measure 3.20). Improved opportunities for employment, advancement, and retention also require attention.

Aboriginal and Torres Strait Islander health professionals should have access to employment in a broad range of settings within the health sector and attention to the type of occupation is required to avoid under-representation in better remunerated, more skilled and managerial positions.

Table 43—Aboriginal and Torres Strait Islander people employed in selected health-related occupations, 1996, 2001 and 2006

Total health occupations

Occupation	1996	2001	2006	Period linear % change	Rate per 10,000 2006—Indigenous	Rate per 10,000 2006—Non-Indigenous	Rate difference (per 10,000)
Total health occupations	3371	4004	5536	64.2*	123.3	297.8	174.6

* represents results that are statistically significant
Source: NIHEC (2010)

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Aboriginal and Torres Strait Islander Health Worker

Occupation	1996	2001	2006	Period linear % change	Rate per 10,000 2006—Indigenous	Rate per 10,000 2006—Non-Indigenous	Rate difference (per 10,000)
Aboriginal and Torres Strait Islander Health Worker	667	853	966	44.8*	21.5	n.a.	n.a.

* represents results that are statistically significant
n.a. represents results that are not applicable
Source: NIHEC (2010)

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Nurses, midwives, nurse educators and researchers

Occupation	1996	2001	2006	Period linear % change	Rate per 10,000 2006—Indigenous	Rate per 10,000 2006—Non-Indigenous	Rate difference (per 10,000)
Nurses	1258	1123	1449	15.2*	32.3	121.1	88.8
Registered Nurses	640	832	1111	73.6*	24.7	94.5	69.8
Nurse Managers and Nursing Clinical Directors	20	38	56	180.0*	1.2	7.2	6
Midwives	27	40	50	85.2*	1.1	6.7	5.6
Enrolled and mothercraft nurses	564	202	215	-61.9*	4.8	10.5	5.7
Nurse Educators and Researchers	7	11	17	142.9*	0.4	2.1	1.7

* represents results that are statistically significant
Source: NIHEC (2010)

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Medical practitioners

Occupation	1996	2001	2006	Period linear % change	Rate per 10,000 2006—Indigenous	Rate per 10,000 2006—Non-Indigenous	Rate difference (per 10,000)
Medical practitioners	61	90	101	65.6*	2.2	30.2	28
Generalist medical practitioners	41	57	82	100*	1.8	19.7	17.9
General medical practitioner	29	47	61	110.3*	1.4	16.4	15
Resident medical officer	12	10	21	75.0*	0.5	3.3	2.8
Other medical practitioners	20	33	19	-0.5	0.4	10.5	10.1

* represents results that are statistically significant
Source: NIHEC (2010)

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Allied health professionals

Occupation	1996	2001	2006	Period linear % change	Rate per 10,000 2006—Indigenous	Rate per 10,000 2006—Non-Indigenous	Rate difference (per 10,000)
Allied health professionals	179	274	441	146.4*	9.8	36	26.2
Dietitians	n.p.	18	7	75.0*	0.2	1.4	1.3
Optometrists	n.p.	n.p.	8	166.7*	0.2	1.7	1.5
Psychologists	13	19	43	230.8*	1	7.4	6.4
Physiotherapist	16	29	54	237.5*	1.2	6.7	5.5
Podiatrist	6	8	6	0	0.1	1.1	1
Speech professionals and audiologists	7	10	17	142.9*	0.4	2.7	2.3
Occupational therapist	n.p.	n.p.	13	160.0*	0.3	3.8	3.5
Social Worker	113	166	269	138.1*	6	6.7	0.7
Other health therapy professionals	12	12	24	143.4*	0.5	4.6	4

* represents results that are statistically significant
n.p. represents results that are not published
Source: NIHEC (2010)

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Dental and dental-allied workforce

Occupation	1996	2001	2006	Period linear % change	Rate per 10,000 2006—Indigenous	Rate per 10,000 2006—Non-Indigenous	Rate difference (per 10,000)
Dental and dental-allied workforce	147	155	205	39.5*	4.6	16.1	11.6
Dental practitioner	12	13	15	25.0*	0.3	4.5	4.2
Dental hygienists, technicians and therapists	18	17	19	5.6	0.4	3.3	2.9
Dental assistant	117	125	171	46.2*	3.8	8.3	4.5

* represents results that are statistically significant
Source: NIHEC (2010)

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Health diagnostic and promotion professionals

Occupation	1996	2001	2006	Period linear % change	Rate per 10,000 2006—Indigenous	Rate per 10,000 2006—Non-Indigenous	Rate difference (per 10,000)
Health diagnostic and promotion professionals	164	185	638	289.0*	14.2	22.4	8.2
Medical Imaging Professionals	7	14	19	171.4*	0.4	5.6	5.2
Pharmacists	6	10	9	50.0*	0.2	8.4	8.2
Occupational Health and Safety Adviser	22	25	50	127.3*	1.1	3.7	2.6
Health promotion officers(g)	n.a.	n.a.	438	n.a.	9.8	1.9	-7.9
Environmental health officer	122	114	98	-19.7*	2.2	2.1	-0.1
Other health diagnostic and promotion professionals	7	22	24	242.9*	0.5	0.7	0.2

* represents results that are statistically significant
n.a. represents results that are not applicable
Source: NIHEC (2010)

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Health diagnostic and promotion professionals

Occupation	1996	2001	2006	Period linear % change	Rate per 10,000 2006—Indigenous	Rate per 10,000 2006—Non-Indigenous	Rate difference (per 10,000)
Other	895	1324	1736	94.0*	38.7	71.9	33.3
Health service managers	21	n.p.	17	19.0*	2.9	4.6	1.6
Nursing support worker and personal care workers	579	808	974	68.2*	21.7	31	9.3
Ambulance officers and paramedics	49	83	153	212.2*	3.4	4.6	1.2
Drug and alcohol counsellor	80	96	117	46.3*	2.6	0.7	-1.9
Other	166	276	475	186.1*	8	31	23
Total health occupations	3371	4004	5536	64.2*	123.3	297.8	174.6

* represents results that are statistically significant
n.p. represents results that are not published
Source: NIHEC (2010)

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