Review of Australian Government Health Workforce Programs

5.1 Context

Page last updated: 24 May 2013

Overview of Aboriginal and Torres Strait Islander health

In the 2011 Census, approximately 550,000 people identified as being of Aboriginal and/or Torres Strait Islander descent, equating to around 2.5% of the Australian population,102 Up to 75% of Aboriginal and Torres Strait Islander people are located in major cities and regional areas, with the remaining 25% located in remote areas.103 In understanding the health needs of Aboriginal and Torres Strait Islander Australians it is therefore important to bear in mind the needs of urbanised populations as well as the (often quite different) needs of regional and remote Aboriginal and Torres Strait Islander communities.

In comparison with the broader Australian population, Aboriginal and Torres Strait Islander people on average die younger, have significantly higher rates of ill health and are more likely to have a disability. The majority of health concerns experienced by Aboriginal and Torres Strait Islander people are those of a chronic nature, such as cardiovascular disease, cancer, respiratory disease, diabetes, mental illness and oral health. The health issues experienced by Aboriginal and Torres Strait Islander people are affected by high levels of socioeconomic disadvantage.104

In 2008, 26% of Aboriginal and Torres Strait Islander people aged 15 years and over reported problems with accessing health services. Access issues were higher in remote areas (36%) than non-remote areas (23%). Of the people reporting problems accessing services, close to 20% reported problems accessing dentists, followed by doctors (10%), hospitals (7%) and Aboriginal and Torres Strait Islander health workers (6%). Key barriers identified to accessing health services included:

  • waiting time too long/not available at time requested (52%);
  • not enough services in area (42%);
  • no services in area (40%);
  • transport/distance (34%);
  • cost of service (32%);
  • don’t trust services (10%); and
  • services not culturally appropriate (7%).105

Chronic disease is identified in the Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report (Performance Framework) as a key area of concern. DoHA was advised that during the development of the National Aboriginal and Torres Strait Islander Health Plan, many health experts and Aboriginal and Torres Strait Islander community members suggested that barriers to early detection of chronic disease include lack of awareness of the role of primary health care services, how welcoming the services are to Aboriginal and Torres Strait Islander people, the relationship with the health care providers as well as trust in the providers, and communication issues.106

Overview of the Aboriginal and Torres Strait Islander health workforce

2011 ABS Census data indicates an increase in the total number of Aboriginal and Torres Strait Islander people in the health workforce since the last census in 1996. Table 5.1 below shows an increase in the workforce from 1996 to 2011 in selected health-related occupations. The table highlights that the number of Aboriginal and Torres Strait Islanders working in the majority of health professions increased between 2006 and 2011.

There has also been a significant increase in the number of Aboriginal and Torres Strait Islander people studying health-related disciplines since 2006. While there have been efforts from both Commonwealth and state/territory governments to increase the size of the Aboriginal and Torres Strait Islander health workforce in recent years, there has also been an increase in the number of people identifying as Aboriginal and Torres Strait Islanders in the 2011 Census.

Despite the increase in numbers in the workforce, Aboriginal and Torres Strait Islander people remain under-represented in the health workforce (as a proportion of the population) when compared with the non–Aboriginal and Torres Strait Islander health workforce. ABS data shows that approximately 1.8% of Australia’s health workforce consists of Aboriginal and Torres Strait Islander people.107

The Performance Framework identifies that increasing the proportion of Aboriginal and Torres Strait Islander people currently in the health workforce is essential to closing the gap in Aboriginal and Torres Strait Islander life expectancy. It also supports the aspirational target of Aboriginal and Torres Strait Islander people comprising at least 2.6% of employees in the public health sector by 2015 (this target has recently been increased to 2.7%).108

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Table 5.1: Aboriginal and Torres Strait Islander people employed in selected health-related occupations, 1996, 2001, 2006 and 2011
Occupations1996200120062011Difference
(2011-2006)
Percentage change
2006-2011

Source: ABS 2011 Census: Employment, Income and Unpaid Work - accessed by DoHA through Table Builder January 2013

Registered Nurses
640
832
1104
1709
605
54.80%
Enrolled and mothercraft nurses
564
202
216
287
71
32.87%
Nursing support worker and personal care workers
579
808
984
1438
454
46.14%
Midwives
27
40
50
70
20
40.00%
Nurse Managers and Nursing Clinical Directors
20
38
54
81
27
50.00%
Nurse Educators and Researchers
7
11
17
21
4
23.53%
Indigenous Health Workers
667
853
965
1255
290
30.05%
Generalist medical practitioners
41
57
80
129
49
61.25%
Pharmacists
6
10
11
28
17
154.55%
Medical Imaging Professionals
7
14
20
20
0
0.00%
Ambulance officers and paramedics
49
83
153
216
63
41.18%
Psychologists
13
19
43
85
42
97.67%
Social Workers
113
166
269
462
193
71.75%
Physiotherapists
16
29
54
78
24
44.44%
Dietitians
n.p.
18
7
25
18
257.14%
Occupational therapists
n.p.
n.p.
13
23
10
76.92%
Dental practitioners
12
13
18
23
5
27.78%
Dental hygienists, technicians and therapists
18
17
15
30
15
100.00%
Dental assistants
117
125
171
266
95
55.56%
Speech professionals and audiologists
7
10
17
18
1
5.88%
Podiatrists
6
8
7
5
-2
-28.57%
Optometrists
n.p.
n.p.
8
5
-3
-37.50%
Totals
4276
6274
1998
46.73%

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Aboriginal and Torres Strait Islander people are clearly under-represented in nursing, medical practice and allied health professions. Interestingly, though, the most common health-related course for Aboriginal and Torres Strait Islander undergraduate students in 2010 was nursing. Of all the health‑related professions, the participation rates in rehabilitation therapies, dental, pharmacy, radiology and optical studies were the lowest.109 Table 5.2 below shows a comparison of Aboriginal and Torres Strait Islander people working in each health profession compared with non–Aboriginal and Torres Strait Islander people.110

DoHA has indicated that while there has been significant improvement in Aboriginal and Torres Strait Islander data collection, data quality limitations are still prevalent and should be recognised when interpreting results. It is important to take this into account when evaluating Aboriginal and Torres Strait Islander health and the health workforce.111

Table 5.2: 2011 ABS Census data – health professions
OccupationsIndigenous health professionalsTotal number of health professionalsIndigenous as a percentage of total health professionals

Source: ABS 2011 Census: Employment, Income and Unpaid Work - accessed by DoHA through Table Builder January 2013.

Health Diagnostic and Promotion Professionals
5
156
3.21%
Dietitians
25
3707
0.67%
Medical Imaging Professionals
20
13244
0.15%
Occupational and Environmental Health Professionals
298
18925
1.57%
Optometrists and Orthoptists
5
4303
0.12%
Pharmacists
28
19935
0.14%
Other Health Diagnostic and Promotion Professionals
569
5595
10.17%
Health Therapy Professionals
0
169
0.00%
Chiropractors and Osteopaths
10
4348
0.23%
Complementary Health Therapists
19
5949
0.32%
Dental Practitioners
23
10988
0.21%
Occupational Therapists
23
9248
0.25%
Physiotherapists
78
15929
0.49%
Podiatrists
5
2801
0.18%
Speech Professionals and Audiologists
18
6799
0.26%
Medical Practitioners
3
1432
0.21%
Generalist Medical Practitioners
129
43430
0.30%
Anaesthetists
3
3764
0.08%
Specialist Physicians
3
5472
0.05%
Psychiatrists
8
2584
0.31%
Surgeons
11
4926
0.22%
Other Medical Practitioners
18
8620
0.21%
Midwifery and Nursing Professionals
3
354
0.85%
Midwives
70
14103
0.50%
Nurse Educators and Researchers
21
5288
0.40%
Nurse Managers
81
12631
0.64%
Registered Nurses
1709
206916
0.83%
Health Professionals
61
2115
2.88%
Health and Welfare Support Workers
68
777
8.75%
Ambulance Officers and Paramedics
216
11939
1.81%
Dental Hygienists, Technicians and Therapists
30
6332
0.47%
Diversional Therapists
43
4257
1.01%
Enrolled and Mothercraft Nurses
287
17893
1.60%
Indigenous Health Workers
1255
1372
91.47%
Massage Therapists
75
10604
0.71%
Psychologists
85
18604
0.46%
Social Workers
462
16917
2.73%
Welfare Support Workers
3575
50206
7.12%
Personal Carers and Assistants
61
1422
4.29%
Aged and Disabled Carers
2669
108215
2.47%
Dental Assistants
266
18824
1.41%
Nursing Support and Personal Care Workers
1438
70503
2.04%
Special Care Workers
246
2794
8.80%
Total
14022
774390
1.81%

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Addressing Aboriginal and Torres Strait Islander health outcomes

A range of issues affect efforts to strengthen the capacity of the health workforce to address Aboriginal and Torres Strait Islander health outcomes. Many of these were identified through the Aboriginal and Torres Strait Islander Health Workforce Roundtable consultation undertaken as part of this review.

Opportunities and key areas for improvement

Stakeholders made considered and valuable contributions to improving Aboriginal and Torres Strait Islander health outcomes; these are reflected in this chapter. Key recommendations raised in this review’s consultation process included:

  • the maintenance of mentoring and support programs provided by Aboriginal and Torres Strait Islander peak organisations with the aim of increasing recruitment and retention;
  • developing pathways or pipelines from school, to the vocational education and training sector, to undergraduate studies and into the health workforce;
  • increasing the health education/training system capacity to deliver culturally safe health care; and
  • continuing support for Aboriginal and Torres Strait Islander leadership activities.

Aboriginal and Torres Strait Islander participation in the health workforce

The under-representation of Aboriginal and Torres Strait Islander people in the health workforce appears to be one of the factors contributing to the lower rates of Aboriginal and Torres Strait Islander people accessing health services compared with non–Aboriginal and Torres Strait Islander people.112 Increasing the rates of participation and completion of training by Aboriginal and Torres Strait Islander people in the Australian health workforce is fundamental to achieving better health outcomes.

Education

In relation to tertiary education, there is a need to increase participation of Aboriginal and Torres Strait Islander people in relevant health education and training courses, as well as incorporating Aboriginal and Torres Strait Islander health and cultural understanding into mainstream health workforce education and training. Improved education and training of health practitioners could assist in breaking down current barriers that impact on Aboriginal and Torres Strait Islander people accessing primary health care services.113

As the number of Aboriginal and Torres Strait Islander people studying health-related disciplines grows, it is important to provide appropriate support and mentoring within the educational pathway that leads into the workforce. For this to be achieved there needs to be greater collaboration in Aboriginal and Torres Strait Islander health workforce policy and program development, not only within DoHA but across government.

Recruitment and retention

Recruitment and retention of Aboriginal and Torres Strait Islanders in health-related disciplines is vital to achieve positive health outcomes, as is providing appropriate training and support to non–Aboriginal and Torres Strait Islander health practitioners.

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Box 5.1: The Indigenous Chronic Disease Package (ICDP) Sentinel Sites Evaluation (SSE)

The Sentinel Sites Evaluation (SSE) provides place-based monitoring and formative evaluation of the Indigenous Chronic Disease Package (ICDP). The Menzies School of Health Research has been contracted to undertake the Sentinel Sites Project (2010 to 2013). Twenty-four evaluation sites have been established across Australia covering urban, regional and remote areas. The SSE provides important information in relation to the ICDP at a local level and informs ongoing program refinement.

The SSE identified a range of “enablers” and “constraints” in the context of developing a workforce with the skills and capacity to improve access to and delivery of high quality services and programs for prevention and management of chronic disease.

The enablers include:

  • leadership commitment to workforce development;
  • structured and informed management;
  • clear articulation of vision and workforce requirements;
  • a tiered approach to dissemination of information to enable communications to be tailored to the needs of different organisations and individuals; and
  • practical support.

The constraints include:

  • highly variable workforce capacity;
  • limited availability of skilled workers;
  • limited service capacity for mentoring, supervising and developing staff; and
  • operational systems that are not well integrated.114

[end of box]

A key policy consideration identified by the ICDP SSE was the need to enhance the skills of the existing health workforce (for instance, nurses, who are well distributed in rural and regional areas of Australia), to provide more complex chronic disease management services and care.115 This highlights the importance of changing the focus towards preventative health care to address chronic disease in Aboriginal and Torres Strait Islander people, rather than continuing an approach based only on uncoordinated episodes of care to treat the symptoms of disease. This has important implications for training of the existing workforce, as well as the education of the future health workforce.

Distribution

Whilst there is a lot of effort focused on increasing the level of recruitment and retention of the health workforce in rural and remote areas, there are also challenges on building an appropriate health workforce in urban areas.

In addition to addressing geographical distribution of the health workforce, in its 2009 report, A Healthier Future for All Australians,116 the National Health and Hospitals Reform Commission recommended strengthening and expanding the organisational capacity and sustainability of the Aboriginal community‑controlled health sector to provide broader comprehensive primary health care services.

New workforce roles

The Aboriginal and Torres Strait Islander Health Worker Project – Growing Our Future, was released by Health Workforce Australia (HWA) in December 2012. Outcome 2.3 of this report proposes a more collaborative and strategic approach to planning the Aboriginal and Torres Strait Islander health workforce in response to local needs.117

Some key stakeholders consulted as part of this review’s consultation process identified that there should be a focus on incorporating additional competencies (training based) into current health workforce professions, including Aboriginal and Torres Strait Islander health workers, rather than creating new, specialised health workforce roles. Stakeholders raised this issue in the context of the creation of new workforce roles under the Indigenous Chronic Disease Package, where they argue that unintended consequences have arisen when existing health workers have left their current roles to take up these new positions.

The introduction of some Council of Australian Governments (COAG) workforce measures, including supporting new positions for Regional Tobacco Coordinators, Tobacco Action Workers, Healthy Lifestyle and Aboriginal and Torres Strait Islander Outreach Workers, has heightened the debate over pay inequity between different types of health workers providing services in these communities. In consultations as part of this review key stakeholders identified that these new workers are reportedly paid more than some existing Aboriginal and Torres Strait Islander Health Workers, without requiring the same level of qualification or having as broad a scope of practice. In consequence, Aboriginal and Torres Strait Islander health workers may be motivated to move out of clinical roles and into the new COAG-funded positions.

However, it should be noted that the ICDP SSE project could not find clear evidence of recruitment of Indigenous Health Outreach Workers or Aboriginal and Torres Strait Islander Outreach Workers in mainstream organisations having a negative impact on the Aboriginal and Torres Strait Islander workforce of other programs or sectors.118 This highlights the importance of enhancing collaboration in policy and program development to ensure new initiatives do not adversely affect the current health workforce (this is further discussed in Chapter 9 of this report). Linkages between clinical, community support and health promotion roles and their respective competencies also need to be considered in the mapping of workforce roles.


102 Australian Bureau of Statistics, 2075.0 – Census of Population and Housing – Counts of Aboriginal and Torres Strait Islander Australians, ABS, 2011

103 Community Services and Health Industry Skills Council, Environmental Scan, CS&HIC, 2012, p. 8

104 ibid.

105 Australian Health Ministers’ Advisory Council (AHMAC), Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report, AHMAC, Canberra, 2012

106 Department of Health and Ageing, Development of a National Aboriginal and Torres Strait Islander Health Plan – Discussion Paper, Commonwealth of Australia, 2012.

107 Australian Bureau of Statistics, 2011 Census: Employment, Income and Unpaid Work – accessed by DoHA through Table Builder, January 2013.

108 Australian Health Ministers’ Advisory Council (AHMAC), Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report, AHMAC, Canberra, 2012

109 ibid.

110 ibid.

111 Australian Health Ministers’ Advisory Council (AHMAC), Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report, AHMAC, Canberra, 2012

112 Australian Health Ministers’ Advisory Council (AHMAC), Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report, AHMAC, Canberra, 2012

113 Department of Health and Ageing, Development of a National Aboriginal and Torres Strait Islander Health Plan – Discussion Paper, Commonwealth of Australia, 2012.

114 Menzies School of Health Research, Indigenous Chronic Disease Package Sentinel Sites Evaluation Draft Report, 2013 (unpublished).

115 ibid.

116 National Health and Hospitals Reform Commission, A Healthier Future for All Australians: Final Report, 2009.

117 Health Workforce Australia, Growing Our Future: Final Report of the Aboriginal and Torres Strait Islander Health Worker Project, December 2011, accessed at http://www.hwa.gov.au/work-programs/workforce-innovation-and-reform/atsihw

118 Menzies School of Health Research, Indigenous Chronic Disease Package Sentinel Sites Evaluation Draft Report, 2013 (unpublished).