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Australian Indigenous HealthBulletin
 

Disability

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Disability

Disability can be defined as a limitation, restriction or impairment which has lasted, or is likely to last, for at least six months and restricts everyday activities [1]. It can be considered in terms of the nature of the impairment in body structure or function, a limitation in activities (such as mobility and communication), a restriction in participation (involvement in life situations, such as work, education and social interaction), and the affected person’s physical and social environment [2][3]. A profound or severe core-activity limitation refers to ‘a specified condition for which the person requires help or supervision in one or more core activities (e.g. self-care, mobility or communication)’ [4].

The main source of information about the level of disability at a population level is the ABS' periodic Survey of disability, ageing and carers (SDAC), which also collects details about a person's need for assistance with core activities [1]. Information about disability at a population level is also collected in Australia's five-yearly censuses [5] and information about disability among Indigenous people was collected in the 2008 NATSISS [6]. 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 [7]. 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' ([7], p.532).38 Despite these limitations, it is clear that disability is a serious issue for Indigenous people: about 50% of Indigenous people aged 15 years and over reported a disability or a long-term health condition in 2008 [8]. The greater burden of disability experienced by Indigenous people is associated with poorer physical and mental health, increased exposure to risk factors, and higher levels of socio-economic disadvantage [9][7].

Extent of disability among Indigenous people

The 2012 SDAC reported that for Indigenous people the crude disability rate was 23% in 2012, a slight increase on 21% in 2009 [10]. The overall disability rates for Indigenous males and females were not significantly different (25% and 22% respectively). The disability rate for Indigenous boys aged 0-14 years old (21%) was 2.5 times higher than the comparable rate for girls (8.5%).

Indigenous people had higher rates of disabilities than non-Indigenous people across all age groups and for both males and females. Indigenous children aged 0-14 years were more than twice as likely as non-Indigenous children to have a disability (15% compared with 6.6%) [10]. Indigenous people aged 35-54 years old were 2.7 times as likely as non-Indigenous people of the same age to have a disability (38% compared with 14%). After age-adjustment, Indigenous people were 1.7 times as likely as non-Indigenous people to be living with disability.

According to counts collected by the ABS as part of the 2011 Census, around 29,559 Indigenous people (5.4%) needed assistance with core activities (i.e. had a profound/core activity restriction) [11]. The need for assistance with core activities generally increased with age among both Indigenous and non-Indigenous people, with the proportions requiring assistance higher among Indigenous people than among their non-Indigenous counterparts for all age-groups (Table 30). The proportion of Indigenous males needing assistance with core activities was higher than for Indigenous females up to the 65 years and older age-group, but the reverse was true beyond that age.

Table 30: Prevalence (%) of people needing assistance with core activities, by sex, Indigenous status age-group, and Indigenous:non-Indigenous ratios, Australia, 2011
Age-group (years)MalesFemalesPersons
IndigenousNon-IndigenousRatioIndigenousNon-IndigenousRatioIndigenousNon-IndigenousRatio
Source: Derived from ABS, 2013 [11], ABS, 2001 [12]
Notes:
  1. Prevalences are expressed as percentages
  2. Ratio is Indigenous proportion divided by the non-Indigenous proportion
  3. Ratios for ‘All ages’ have been standardised using the 2001 Australian estimated resident population
  4. ABS notes that ‘needing assistance with core activities’ is conceptually related to the ‘presence of a profound/core activity restriction’
  5. The information in this table is based on counts from the 2011 Census
0-4 1.7 1.2 1.4 1.1 0.7 1.5 1.4 1.0 1.4
5-14 4.8 3.3 1.5 2.6 1.6 1.6 3.7 2.5 1.5
15-19 3.8 2.3 1.7 2.6 1.4 1.8 3.2 1.9 1.7
20-24 3.4 1.5 2.2 2.1 1.1 1.9 2.8 1.3 2.1
25-34 3.4 1.4 2.4 2.7 1.2 2.3 3.0 1.3 2.3
35-44 5.2 1.9 2.7 4.8 1.9 2.6 5.0 1.9 2.6
45-54 8.8 3.0 2.9 8.8 3.2 2.8 8.8 3.1 2.8
55-64 15 5.5 2.7 14 5.1 2.8 15 5.3 2.7
65+ 25 15 1.7 29 20 1.4 27 18 1.5
All ages 5.7 4.3 2.0 5.1 5.0 1.9 5.4 4.6 1.9

The 2012 SDAC reported that Indigenous people had a significantly higher overall need for assistance compared with non-Indigenous people (63% compared with 60%) [10]. Indigenous people were almost twice as likely to require assistance with communication compared with non-Indigenous people (11.3% compared with 6.6%) and they were more likely to need assistance with cognitive or emotional tasks (29% compared with 22%). The proportions of Indigenous people with profound/severe core activity limitation were 1.7 times higher than for non-Indigenous people for all age-groups; 7.8% of Indigenous people had a profound/severe core activity limitation (7.8% of males and 7.5% of females) with males 1.5 times as likely and females 1.9 times as likely as their non-Indigenous counterparts. Higher proportions of Indigenous people required assistance with a core activity from a younger age (45 years and older) than non-Indigenous people (55 years and older). After age-adjustment, Indigenous people living in non-remote areas were more than twice as likely as their non-Indigenous counterparts to have a need for assistance with core activities.39

In 2008, the proportion of profound/core activity restriction among Indigenous people varied slightly with the remoteness of residence [9]. The highest proportions of Indigenous people with a profound/severe core activity restriction were in major cities (9.0%) and very remote areas (8.9%); the lowest proportion was in remote areas (6.7%).

There were differences in the proportions by state and territory of Indigenous people living in non-remote areas with profound/core activity restrictions in 2008 [8].40 After age-adjustment, the proportions were highest among Indigenous people living in Tas (16%) and SA (13%); the lowest proportion was in Qld (7.5%). Proportions among non-Indigenous people were consistently between 4.5% to 5.0% in all states and territories, with Indigenous:non-Indigenous ratios ranging from 3.3 in Tas to 1.6 in WA.

The 2008 NATSISS provided information on broad categories of types of disability: sight/hearing/speech; physical; intellectual; psychological; type not specified [4]. Among Indigenous people aged 15 years and over, 33% reported a physical disability, 17% reported a disability affecting sight/hearing/speech, and 7.7% reported an intellectual disability [8]. In 2012-13, physical disability was the most common disability type for Indigenous adults living in non-remote areas (32%) followed by ‘sight, hearing, speech’ (20%) [13].

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 [14][15]. 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 [16]. NDA services include accommodation support, community support, community access, respite and employment services [17].

Some Indigenous people face significant barriers to access disability support services, due to social marginalisation, concern about approaching government agencies, differences in cultural attitudes towards disability and services that are culturally aware [13][18].

In 2010-11, around 41% of the Indigenous potential population41 aged 0-64 years used NDA disability support services provided by the states and territories (Table 31) [17]. The highest proportions of disability support service use by the Indigenous potential population were in SA (66%), followed by the ACT (65%). The proportion of the Indigenous potential population requiring support services has increased steadily since 2008-09.

Table 31: Proportions (%) of Indigenous potential population aged 0-64 years accessing NDA state/territory-delivered disability support services, by jurisdiction and year, Australia, 2008-2011
YearsNSWVicQldWASATasACTNTAustralia
Source: Steering Committee for the Review of Government Service Provision, 2013 [17]
2008-09 24 79 23 43 64 10 35 33 33
2009-10 31 79 24 49 61 16 56 22 36
2010-11 36 64 26 53 66 20 65 55 41
Box 6: Assessing the level of use of disability support services

As is the case with all health and related services, not all people who could benefit from the use of disability support services actually access them. To assess the level of use of disability services by Indigenous people (and other ‘special needs’ groups), attention is directed to the ‘potential population’ of users: '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' ([17], p.14-18).

The NDA specialist disability support service most commonly used by Indigenous people in 2010-11 was community support services (36% of the potential population) (Table 32) [17]. A higher proportion of Indigenous people than non-Indigenous people used community support services.

Table 32: Proportion (%) of Indigenous potential population aged 0-64 years accessing NDA specialist disability support services, by Indigenous status and type of specialist service and Indigenous:non-Indigenous ratios, Australia, 2010-11
Type of specialist serviceIndigenousNon-IndigenousRatio
Source: Steering Committee for the Review of Government Service Provision, 2013 [17]
Notes:
  1. ’Potential’ users are people aged 0-64 years with the ‘potential to require disability support services, including individuals who meet the service eligibility criteria but who do not demand these services’
  2. Ratio is the Indigenous proportion divided by the non-Indigenous proportion
  3. Information not available for respite services
Accommodation support 6.8 6.8 1.0
Community support 36 26 1.4
Community access 8.1 9.5 0.9
Education and employment

After age-adjustment, Indigenous people with a disability were 1.4 times more likely than non-Indigenous people with a disability to have obtained a Year 10 or below level of education, and less than half as likely to have a bachelor degree or higher [10]. Indigenous people generally had lower labour force participation than non-Indigenous people (65% compared with 79% respectively), however for those with disability, the gap was wider (35% and 54% respectively). In 2012, Indigenous people with a disability were significantly less likely than non-Indigenous people with a disability to be employed (26% compared with 49%); and the unemployment rate for Indigenous people with a disability was nearly three times as high as the comparable rate for non-Indigenous people with a disability (25.3% compared with 9.0%).

References

  1. Australian Bureau of Statistics (2013) Disability, ageing and carers, Australia: summary of findings, 2012. Canberra: Australian Bureau of Statistics
  2. Australian Institute of Health and Welfare (2014) Australia’s health 2014: the 14th biennial health report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare
  3. World Health Organization (2011) World report on disability. Geneva: World Health Organization
  4. Australian Bureau of Statistics (2010) National Aboriginal and Torres Strait Islander social survey: users' guide, 2008. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4720.0?OpenDocument
  5. Australian Bureau of Statistics (2012) Census of population and housing: characteristics of Aboriginal and Torres Strait Islander Australians, 2011. Canberra: Australian Bureau of Statistics
  6. 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
  7. Productivity Commission (2011) Disability care and support: Productivity Commission Inquiry report overview and recommendations. Canberra: Productivity Commission
  8. Australian Institute of Health and Welfare (2013) Aboriginal and Torres Strait Islander health performance framework 2012: detailed analyses. Canberra: Australian Institute of Health and Welfare
  9. 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
  10. Australian Bureau of Statistics (2014) Aboriginal and Torres Strait Islander people with a disability, 2012. Retrieved 1 December 2014 from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4433.0.55.005?OpenDocument
  11. Australian Bureau of Statistics (2013) Community profiles. Retrieved 2013 from http://www.abs.gov.au/websitedbs/censushome.nsf/home/communityprofiles?opendocument&navpos=230
  12. Australian Bureau of Statistics (2001) Australian demographic statistics: June quarter 2001. Canberra: Australian Bureau of Statistics
  13. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  14. National disability agreement (2009) Council of Australian Governments
  15. National disability agreement: intergovernmental agreement on federal financial relations (2012) Council of Australian Governments
  16. Disability Policy & Research Working Group (2012) National Indigenous access framework. Sydney: Disability Policy & Research Working Group
  17. Steering Committee for the Review of Government Service Provision (2013) Report on government services 2013: Indigenous compendium. Canberra: Productivity Commission
  18. Productivity Commission (2011) Disability care and support: Productivity Commission Inquiry report [vol 1 & 2]. Canberra: Productivity Commission

Endnotes

  1. In attempting to address these conceptual difficulties, there have been some methodological differences in collecting information about disability, particularly related to core activity restriction
  2. Data are not available for a comparison of the prevalences for all Indigenous and non-Indigenous people, including those living in remote areas
  3. Information was not available for the NT.
  4. 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' ([17], p.14-18).
 

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    Last updated: 16 April 2015
     
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