Disability

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Disability

At some point in their lives, most people in a population will experience a disability, defined by the ABS as a limitation, restriction or impairment which has lasted, or is likely to last, for at least six months and restricts everyday activities [1]. A disability can be considered in terms of the nature of the impairment (such as sight and hearing impairments, difficulties with mobility, or brain damage) or the interaction between the individual's health condition and their environment [2][3].

The main source of information about the level of disability at a population level is the ABS's periodic Survey of Disability, Ageing and Carers (SDAC), which also collects information about a person's need for assistance with core activities. Information about disability among Indigenous people has also been collected in the 2002 and 2008 NATSISSs [4][5]. Some information about disability at a population level is also collected in Australia's five-yearly censuses. Being based on self-reported information, each of these sources has limitations in capturing precise estimates of disability. This is particularly true for Indigenous people, whose level of participation in surveys and censuses is lower than that of non-Indigenous people [6]. The level of response among Indigenous people in the 2006 Census to the questions related to disability was lower than that for non-Indigenous people. Also, some Indigenous people 'find the concept of disability hard to understand or irrelevant' ([6], p.532).20

Despite these limitations, it is clear that disability is a serious issue for Indigenous people: about 50% of Indigenous adults reported a disability in 2008 [7]. The greater burden of disability experienced by Indigenous people is due to higher levels of morbidity in a range of areas (including mental health, diabetes, CVD, injuries, and respiratory diseases), as well as higher levels of socio-economic disadvantage [2][6].

Extent of disability among Indigenous people

According to information collected by the ABS in the 2006 Census21, around 19,600 Indigenous people (4.3%) needed assistance with core activities some or all of the time [8].

The need for assistance with core activities generally increased with age for both Indigenous and non-Indigenous people in 2006 (Table 23) [9]. The proportion of Indigenous males needing assistance with core activities was higher than that of Indigenous females up to 70 years of age, but the reverse was true beyond that age [8].

The need for assistance with core activities among Indigenous people varied with the remoteness of residence in 2006 [8]. The highest proportions of Indigenous people requiring assistance with core activities were in major cities and inner regional areas (both around 5%), with proportions decreasing slightly with increasing remoteness (around 4% in both outer regional and remote areas, and 3% in very remote areas).

Table 23: Proportions of people aged 18 years or older needing assistance with core activities, by Indigenous status and age-group, Australia, 2006

Age-group (years)	Proportion of Indigenous people (%)	Proportion of non-Indigenous people (%)	Ratio
Source: ABS, AIHW 2008 [9]
Notes: Proportions are expressed as percentages; proportions for 'All ages' have been standardised using the 2001 Australian standard population Ratio is Indigenous proportion divided by the non-Indigenous proportion ABS notes that 'needing assistance with core activities' is conceptually related to the 'presence of a profound/core activity restriction'
18-24	2.5	1.3	2.0
25-34	2.8	1.2	2.3
35-44	4.9	1.7	2.8
45-54	8.2	2.7	3.1
55-64	13.2	4.8	2.8
65+	20.2	13.4	1.5
All ages	8.4	4.1	2.1

More recent information – from the 2008 NATSISS – found overall levels of profound/core activity restriction were similar to those reported in the 2006 Census, but the levels for the younger age-groups were higher for both Indigenous and non-Indigenous people (Table 24) [10]. After age-adjustment, Indigenous people were more than twice as likely as their non-Indigenous counterparts to have a need for assistance with core activities some or all of the time (that is, have a profound/core activity restriction). The proportions of Indigenous people needing assistance with core activities were higher than those of non-Indigenous people for all age-groups. Higher proportions of Indigenous people required assistance with a core activity from a younger age (45 years and older) than did non-Indigenous people (55 years and older).

Table 24: Proportions of persons 18 years or older with profound/core activity restriction, persons, by Indigenous status and age-group, and Indigenous:non-Indigenous ratios, non-remote areas of Australia, 2008

Jurisdiction	Indigenous population (number)	Proportion of Australian Indigenous population (%)	Proportion of jurisdiction population (%)
Source: Steering Committee for the Review of Government Service Provision, 2011 [10]
Notes: Ratio is the Indigenous percentage divided by the non-Indigenous percentage Proportions for 'All ages' is age-standardised ABS notes that 'needing assistance with core activities' is conceptually related to the presence of a 'profound/core activity restriction'
18-24	6.3	3.0	2.1
25-34	6.2	2.4	2.6
35-44	6.2	3.0	2.1
45-54	10.2	4.1	2.5
55+	17.7	8.5	2.1
All ages	10.3	4.7	2.2

The proportions of profound or severe core activity restrictions among Indigenous people were similar in 2008 for remote and non-remote areas (8.1% and 7.9% respectively) [10].22 The proportions of Indigenous people with a profound or severe core activity restriction living in non-remote areas varied slightly across the states and territories, ranging from 8.0% in Qld to 13.0% in SA.

The proportion of Torres Strait Islander people aged 15 years and over with a disability requiring assistance with core activities (7%) was similar to that for all Aboriginal and Torres Strait Islander people (8%) in 2008 [7].

Services

Increasing the access to disability services for the Indigenous population is one of the priority areas identified by the National Disability Agreement (NDA), developed by the Council of Australian Governments (COAG) to improve the outcomes for Indigenous people with disability [11][12]. The National Indigenous access framework forms part of the NDA and aims to ensure that the needs of Indigenous people with disability are addressed through accessible and appropriate service delivery [13]. Services include accommodation support, community support, community access, respite and employment services [14][15].

In 2009-10, around 28% of the Indigenous potential population23 used disability support services provided by the states and territories [14][16] (Table 25). The highest proportions of use of disability services by the Indigenous potential population was in Vic (62%), followed by SA (46%) [16] . The proportion of the Indigenous potential population requiring support services has increased steadily since 2007-08.

Table 25: Proportion (%) of Indigenous potential population aged 0-64 years accessing state/territory-delivered disability support services, by years and jurisdiction

Years	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Source: Steering Committee for the Review of Government Service Provision, 2012 [16]
2007-08	14	48	15	26	43	7.3	18	23	20
2008-09	19	63	18	32	49	8.1	27	24	25
2009-10	25	62	19	36	46	12	43	16	28

References

1. Australian Bureau of Statistics (2010) Disability, ageing and carers, Australia: summary of findings, 2009. Canberra: Australian Bureau of Statistics
2. Australian Institute of Health and Welfare (2010) Australia's health 2010: the twelfth biennial report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare
3. World Health Organization (2002) Towards a common language for functioning, disability and health: ICF, the international classification of functioning, disability and health. Geneva: World Health Organization
4. Australian Bureau of Statistics (2009) National Aboriginal and Torres Strait Islander social survey, 2008. Retrieved 11 April 2011 from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4714.0?OpenDocument
5. Australian Bureau of Statistics (2004) National Aboriginal and Torres Strait Islander Social Survey, 2002. Canberra: Australian Bureau of Statistics
6. Productivity Commission (2011) Disability within the Indigenous community. In: Disability care and support: Productivity Commission Inquiry report overview and recommendations. Canberra: Productivity Commission: 531-561
7. Australian Bureau of Statistics (2010) The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples, Oct 2010. Canberra: Australian Bureau of Statistics
8. Australian Institute of Health and Welfare (2011) Aboriginal and Torres Strait Islander health performance framework 2010: detailed analyses. Canberra: Australian Institute of Health and Welfare
9. Australian Bureau of Statistics, Australian Institute of Health and Welfare (2008) The health and welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008. Canberra: Australian Bureau of Statistics and Australian Institute of Health and Welfare
10. Steering Committee for the Review of Government Service Provision (2011) Overcoming Indigenous disadvantage: key indicators 2011. Canberra: Productivity Commission, Australia
11. National disability agreement (2009) Council of Australian Governments
12. National disability agreement: intergovernmental agreement on federal financial relations (2012) Council of Australian Governments
13. Disability Policy & Research Working Group (2012) National Indigenous access framework. Sydney: Disability Policy & Research Working Group
14. COAG Reform Council (2012) Disability 2010–11: comparing performance across Australia. Sydney: COAG Reform Council
15. Steering Committee for the Review of Government Service Provision (2012) Report on government services 2012: Indigenous compendium. Canberra: Productivity Commission
16. Steering Committee for the Review of Government Service Provision (2012) Report on government services 2012: attachment tables. Retrieved 31 January 2012 from http://www.pc.gov.au/gsp/rogs/2012

Endnote

20. In attempting to address these conceptual difficulties, there have been some methodological differences in collecting information about disability, particularly related to core activity restriction.

21. Information on disability collected as part of the 2011 Census is not yet available.

22. The proportions quoted here are based on a more limited set of criteria used to identify people with a disability, so are not comparable with the following estimates for the proportions of profound or severe core activity restriction in non-remote areas at a jurisdictional level.

23. The potential population refers to 'the number of people with the potential to require disability support services, including individuals who meet the service eligibility criteria but who do not demand these services' ([15], p.322).

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