The Health and Welfare of Indigenous Australians

1
The Health and Welfare of Indigenous Australians

• Fadwa Al-Yaman
• Aboriginal and Torres Strait Islander Health and
  Welfare Unit

2
What do we know about the health of Indigenous
Australians?

• Some demographic information
• Main health conditions
• Health risk factors
• Evidence for improvement
• Remoteness and health

3
Age-sex structure
Different structure - different health needs to
the non-Indigenous Australian population
4
Fertility
More children (2.11 per woman compared with
1.77), at a younger age
Source ABS Births, 2004
5
Geographical distribution
Indigenous people are geographically distributed
differently to non-Indigenous people
6
Life expectancy

• Indigenous (1996-2001) 16 years
• 59 years for Indigenous males
• 77 years for non-Indigenous males
• All Australians (1998-2002) 17 years
• 65 years for Indigenous females
• 82 years for non-Indigenous females

7
Age at death 2000-2004
70 of Indigenous people die before age 65. 21
of non-Indigenous people die before age 65
8
What causes ill health

• Self reported prevalence
• - Respiratory 30 3rd, Circulatory 22 4th,
  Endocrine 18 5th
• Visits to GP
• - Respiratory 23/100 1st, Circulatory 13/100
  5th, Endocrine 13/100 6th
• Hospital stay
• -Injury 2nd, Respiratory 3rd, Circulatory 6th,
  Endocrine10th

9
What causes death among Indigenous Australians?

• The five main causes of deaths of Indigenous
  Australians compared with non-Indigenous
  population

1. Circulatory diseases 27 2.8 times
All other causes 24
5. Respiratory 9 diseases 3.9 times
2. Injury - accidental, assault, self
inflicted 16 2.9 times
4. Diabetes 9 8.8 times
3. Cancer 15 1.5 times
Proportion of all deaths, 2000-2004. Indigenous
versus non-Indigenous rates rate ratio.
10
Health risk factors

• Indigenous people are
• More likely to be current smokers
• 46 Indigenous vs. 21 non-Indigenous
• More like to be overweight or obese
• 62 vs. 51
• Less likely to drink alcohol
• Among those who drink more likely to drink at
  risky levels.
• 23 vs. 17

Source 2004-05 National Aboriginal and Torres
Strait Islander Health Survey and 2001 National
Health Survey unpublished data
11
Education
Highest level of schooling completed Persons
aged 18 years and over Indigenous vs.
non-Indigenous Year 9 or below (33 vs.
16) Year 10 or 11 (27 vs. 19) Year
12 (11 vs. 15) Non-school qualification (29
vs. 50)
Sources 2002 National Aboriginal and Torres
Strait Islander Social Survey
12
Trends in education

• Between 1996 and 2001, steady increases in
  Indigenous primary and secondary school
  enrolments and retention rates
• The proportion of Indigenous people aged 25-64
  years who had a non-school qualification rose
  from 20 in 1994 to 32 in 2002
• The proportion of Indigenous people aged 15 years
  and over who completed year 12 rose from 7 in
  1994 to 10 in 2002

Source ABS AIHW 2005. The Health and Welfare
of Australias Aboriginal and Torres Strait
Islander peoples
13
Employment 2002
100
Not in labour force
Per cent
80
Unemployed
60
Employed (other)
40
Community
Development
20
Employment Program
0
Indigenous
Non-Indigenous
Fewer Indigenous people (43) were employed than
non-Indigenous people (64).
Source 2002 National Aboriginal and Torres
Strait Islander Social Survey
14
Employment trends

• Between 1994 and 2002 the proportion of
  Indigenous people aged 18-64 years in mainstream
  employment rose from 31 to 38
• The Indigenous unemployment rate fell from 24 in
  1994 to 13 in 2002.

Source ABS AIHW 2005. The Health and Welfare
of Australias Aboriginal and Torres Strait
Islander peoples
15
Housing
Source ABS 2002 National Aboriginal and Torres
Strait Islander Social Survey
16
Housing trends

• The proportion of Indigenous households that were
  owners/purchasers increased from 26 in 1994 to
  30 in 2002

Source ABS AIHW 2005. The Health and Welfare
of Australias Aboriginal and Torres Strait
Islander peoples
17
Trends in mortality

• Infant mortality rates

• Rate per 1,000 live births

18
Mortality trends

• Between 1991 and 2003 there were significant
  declines in Indigenous mortality in Western
  Australia but not in Northern Territory or South
  Australia.

19
Mortality from circulatory disease

• Between 1991-1996 and 1997-2002, significant
  decline in mortality from circulatory disease in
  WA
• Between 1997 and 2002 significant decline in
  mortality from circulatory disease in SA NT.

Source ABS AIHW 2005. The Health and Welfare
of Australias Aboriginal and Torres Strait
Islander peoples, 2005
20
Remoteness as a cause of poor health and welfare

• In early May 2006, a public prosecutor in
  Northern Territory made a public statement about
  appalling social conditions in some remote
  Aboriginal communities.
• By the end of May, politicians, public servants,
  journalists, letter writers, radio shock-jocks
  and TV commentators, academics and indigenous
  leaders had all spoken or written about the
  problem.

21
Views on remoteness

• Governments should close unviable, dysfunctional
  indigenous communities in remote Australia -
  Janet Albrechtsen, The Australian 31 May 2006.
• The West Australian Government says not all of
  the state's Aboriginal communities are
  sustainable in the long-term. - ABC PM 30 May
  2006.
• There is an alternative way forward for damaged
  Aboriginal communities in remote Australia
• - Professor Jon Altman, director of the Center
  for Aboriginal Economic Policy Research at the
  ANU. ABC Life Matters 24 May 2006

22
Is remoteness the cause of poor health and
welfare?

• The very strong impression was given in the media
  that remoteness is bad for Aboriginal people.
• What are the relationships between remoteness and
  health and welfare?

23

• Data sources two Aboriginal and Torres Strait
  Islander Surveys
• National Aboriginal and Torres Strait Islander
  Social Survey (2002).
• National Aboriginal and Torres Strait Islander
  Health Survey (2005).
• These surveys avoid many of the problems of
  differences in Indigenous identification in
  administrative data collections

24
The more remote an area, the higher the
proportion of the population is Aboriginal or
Torres Strait Islander.
47130.0 Population characteristics, Aboriginal
and Torres Strait Islander Australians, 2001.
Australian Bureau of Statistics
25
Education is disadvantaged by remoteness
Highest level of school completed
Indigenous people in non-remote areas are more
likely to complete a higher level of schooling or
a post secondary school qualification than
Indigenous people in remote areas
Source National Aboriginal and Torres Strait
Islander Social Survey 2002, 20
26
Employment is disadvantaged by remoteness
Indigenous people in remote areas are more likely
to employed through CDEP while Indigenous people
in non-remote areas are more likely to be
employed through other means or to be unemployed
Source National Aboriginal and Torres Strait
Islander Social Survey 2002, 20
27
Housing is disadvantaged by remoteness
The majority of Indigenous people living in
remote areas rent from Indigenous Housing
Organisations. Indigenous people in remote areas
are less likely to own their own house.
Source National Aboriginal and Torres Strait
Islander Social Survey 2002, 21
28
Remoteness does not influence self assessed
health status
Remoteness appears not to be associated with self
assessed health status. A smaller proportion of
very remote people report poor health.
29
Diabetes is associated with remoteness
A larger proportion of remote than non-remote
people report having diabetes.
Source National Aboriginal and Torres Strait
Islander Health Survey 2004-2005, 18
30
Circulatory problems are associated with
remoteness
A larger proportion of remote people report
having circulatory problems.
Source National Aboriginal and Torres Strait
Islander Health Survey 2004-2005, 18
31
Arthritis is not associated with remoteness
A lower proportion of remote people report having
arthritis.
Source National Aboriginal and Torres Strait
Islander Health Survey 2004-2005, 18
32
Asthma is not associated with remoteness
A lower proportion of remote people report having
asthma.
Source National Aboriginal and Torres Strait
Islander Health Survey 2004-2005, 18
33
In summary, arthritis, asthma, sight problems are
more prevalent in non-remote areas, diabetes and
circulatory problems are more prevalent in remote
areas
34
Proportion accessing services
A significantly larger proportion of remote
people reported having visited a health worker,
nurse or health professional, hospital or
casualty. These health workers are the first
point of contact for remote people in the health
service organization.
35
Proportion in need but not accessing services
A higher proportion of Indigenous people in
non-remote areas that indicated that they need
services but are not accessing them
36
Reasons why didnt go to a doctor
The costs/lack of transport are significant
constraints to seeking consultations with a
doctor in remote areas. The cost of the
consultation is a constraint in non-remote
areas. Similar reasons were given for not
visiting a dentist or a health professional
37
Why Indigenous people didnt visit a doctor,
dentist or health professional
Reasons more common in remote areas

• Transport/distance
• Waiting time too long Not available in the area

Reasons more common in non-remote areas

• Cost
• Waiting time too long
• Too busy

38
Risk/protective behaviours
Source ABS 2004-05 National Aboriginal and
Torres Strait Islander Survey
No daily vegetable or fruit intake are higher in
remote areas
39
Some stressors are more prevalent in remote areas
Source National Aboriginal and Torres Strait
Islander Social Survey 2002, 39
40
Other stressors are more prevalent in non-remote
areas
Source National Aboriginal and Torres Strait
Islander Social Survey 2002, 39
41
Neighborhood/community problems are more
prevalent in remote areas
42
Cultural attachment
43
It is apparent that the relationships between
remoteness and health and welfare are not simple
ones.Remoteness is a disadvantage in many ways.
But low incomes, poor education and some medical
conditions are similar or worse in non-remote
areas.The problems of Indigenous health cannot
all be explained by remoteness.
44
Summary

• Some improvements in health, education,
  employment and housing are evident but big
  disparities still exist
• Remoteness is an issue and it can tell us
  something about disadvantage but it does not
  explain all disparities