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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 collects information about the prevalence of disability and also data about individual’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 is collected in surveys such as the 2012-2013 AATSIHS [6]. Being based on self-reported information, each of these sources has limitations in capturing precise estimates of disability. This is particularly true for Aboriginal and Torres Strait Islander people, whose level of participation in surveys and censuses is lower than that of non-Indigenous people. Also some Aboriginal and Torres Strait Islander people may perceive the concept of disability differently [7].

The greater burden of disability experienced by Aboriginal and Torres Strait Islander people is associated with poorer physical and mental health, increased exposure to risk factors, and higher levels of socio-economic disadvantage [8][7].

Extent of disability among Aboriginal and Torres Strait Islander people

In the 2011 Census, around 29,560 Aboriginal and Torres Strait Islander people (5.7%) needed assistance with core activities (self-care, mobility or communication) some or all of the time [9][5]. The need for assistance increased with age among both Indigenous and non-Indigenous people, with the proportions requiring assistance higher among Aboriginal and Torres Strait Islander people than among their non-Indigenous counterparts for all age-groups. The proportion of Aboriginal and Torres Strait Islander males needing assistance with core activities was higher than for Aboriginal and Torres Strait Islander females up to the 35-39 year age-group (4.8% and 3.8% respectively), and both were higher than their non-Indigenous males and females counterparts (1.8% and 1.7% respectively). Beyond that age, proportions were higher for Aboriginal and Torres Strait Islander males than females up to 75+ years (37% and 46% respectively) and both were higher than their non-Indigenous counterparts (25% and 35% respectively).

In the 2012-2013 AATSIHS, 36% of Aboriginal and Torres Strait Islander people reported that they had a disability or restrictive long-term health condition [9]. The prevalence of disability increased with age ranging from 19% for those aged 0-14 years, to 67% for those aged 55 years and over.

For those with a disability:

Table 30. Aboriginal and Torres Strait Islander people reporting a disability/restrictive long-term health condition, by remoteness, age, sex, and state/territory, 2012-13

Remoteness

 

Non-remote

Remote

Australia

Overall population

distribution

 

Number

Rate(1)

Number

Rate(1)

Number

Rate(1)

 Per cent(2)

Age-group (years)3       

0-14

36,204

20

8,137

18

44,341

19

35

15-24

32,841

32

6,223

24

39,064

31

20

25-34

23,976

36

7,013

34

30,989

36

14

35-44

30,260

51

8,538

48

38,798

50

12

45-54

28,830

62

8,367

62

37,197

62

9.4

55+

29,291

67

8,489

66

37,780

67

8.9

Sex

             

Males

90,402

36

22,585

33

112,987

36

50

Females

91,001

36

24,181

35

115,182

36

50

State/territory       

NSW

72,331

38

4,203

46

76,534

38

32

Vic

20,156

44

..

..

20,156

44

7.2

Qld

46,561

32

10,416

30

56,977

32

28

SA

11,782

40

2,147

36

13,930

39

5.6

WA

14,317

29

14,284

44

28,602

35

13

Tas

9,110

40…

464…

60…

9,573

40

3.7

NT

4,427

39

15,252

29

19,687

31

10

ACT

2,718

46

..

..

2,718

46

0.9

Total per cent

..

36

..

34

..

36

100

Total number

181,403

..

46,766

..

228,169

..

638,324

Notes: † Estimate has a relative standard error between 25% and 50% and should be used with caution

  1. Rates per 100
  2. Distribution of total Indigenous population. Percentages add within columns
  3. Data for specific age-groups are not age-standardised, only the totals
  4. Data excludes not stated responses

Source: AIHW, 2015 [9]

The 2012 SDAC reported that for Aboriginal and Torres Strait Islander people the crude disability rate was 23% in 2012, a slight increase from 21% in 2009 [10]. The overall disability rates for Aboriginal and Torres Strait Islander males and females were similar (25% and 22% respectively). Aboriginal and Torres Strait Islander children aged 0-14 years were more than twice as likely as non-Indigenous children to have a disability (15% compared with 6.6%). The proportion for Aboriginal and Torres Strait Islander boys (21%) was 2.5 times higher than for Aboriginal and Torres Strait Islander girls (8.5%). Aboriginal and Torres Strait Islander people had higher rates of disabilities than non-Indigenous people across all age-groups and for both males and females. Aboriginal and Torres Strait Islander people aged 35-54 years old were 2.7 times more likely as non-Indigenous people of the same age to have a disability (38% compared with 14%). After age-adjustment, Aboriginal and Torres Strait Islander people were 1.7 times as likely as non-Indigenous people to be living with disability. After age-adjustment, Aboriginal and Torres Strait Islander people living in non-remote areas were 1.6 times more likely than their non-Indigenous counterparts to be living with a disability.

The 2012 SDAC reported that Aboriginal and Torres Strait Islander people had a higher overall need for assistance compared with non-Indigenous people (63% compared with 60%) [10]. Aboriginal and Torres Strait Islander people were almost twice as likely to require assistance with communication compared with non-Indigenous people (11% compared with 6.6%) and they were more likely to need assistance with cognitive or emotional tasks (29% compared with 22%). The proportions of Aboriginal and Torres Strait Islander people with profound/severe core activity limitation, were 1.7 times higher than for non-Indigenous people for all age-groups; 7.8% of Aboriginal and Torres Strait Islander 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.

Services

Increasing the access to disability services for the Aboriginal and Torres Strait Islander 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 Aboriginal and Torres Strait Islander people with disability [11][12]. The National Indigenous access framework forms part of the NDA and aims to ensure that the needs of Aboriginal and Torres Strait Islander people with disability are addressed through accessible and appropriate service delivery [13]. NDA services include accommodation support, community support, community access, respite and employment services [14]. In 2013-14, 5.8% of service users were Aboriginal and Torres Strait Islander people, with most of these aged under 50 [15] (Table 31). Forty per cent of Aboriginal service users lived in major cities, 27% lived in an inner regional area, 20% lived in an outer regional area and 13% lived in a remote or very remote area.

 Table 31. Numbers and proportions (%) of service users by Indigenous status, Australia, 2012-13 to 2013-14

 

Indigenous

Non-Indigenous

Not stated/ collected

Total

Year

Number

%

Number

%

Number

%

Number

%

2012-13

17,406

5.8

283,306

94

11,827

..

312,539

100

2013-14

18,021

5.8

291,631

94

11,879

..

321,531

100

Notes:

  1. Service user data are estimates after use of a statistical linkage key to account for individuals who received services from more than one service type outlet during the 12-month period
  2. Service user data were not collected for all NDA service types
  3. Percentages are of the total excluding service users for whom Indigenous status was ‘not stated/not collected’

Source: AIHW, 2015 [15]

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 Aboriginal and Torres Strait Islander 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' ([14], pp.14-18).

In 2012-13, around 29% of the Indigenous potential population aged 0-64 years used NDA disability support services provided by the states and territories (Table 32). The highest proportions of disability support service use by the Indigenous potential population were in ACT (52%), followed by the NT (45%). 

Table 32. Indigenous users of state/territory delivered NDA disability support services (aged 0-64 years) as a proportion (%) of the Indigenous estimated potential population, by jurisdiction and year, Australia, 2011-2013

Years

NSW

Vic

Qld

WA

SA

Tas

ACT

NT

Australia

2011-12

29

33

20

33

41

14

51

45

29

2012-13

30

27

21

29

40

16

52

45

29

Note: State/territory delivered disability support services comprise accommodation support, community support, community access and respite

Steering Committee for the Review of Government Service Provision, 2015 [16]

The NDA specialist disability support service most commonly used by Indigenous people in 2012-13 was community support services (25% of the potential population) (Table 33) [14]. A higher proportion of Indigenous people than non-Indigenous people used community support services.

Table 33. 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, 2012-13

Type of specialist service

Indigenous

Non-Indigenous

Ratio

Accommodation support

5.1

6.3

0.8

Community support

25

23

1.1

Community access

5.5

8.1

0.7

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

Source: Steering Committee for the Review of Government Service Provision, 2015 [16]

Some Aboriginal and Torres Strait Islander people face significant barriers to accessing disability support services, due to social marginalisation, concern about approaching government agencies, differences in cultural attitudes towards disability and services that are culturally inappropriate [17][18].

Education and employment

After age-adjustment, Aboriginal and Torres Strait Islander 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 in 2012 [10]. Aboriginal and Torres Strait Islander 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). Aboriginal and Torres Strait Islander 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 Aboriginal and Torres Strait Islander people with a disability was nearly three times as high as the comparable rate for non-Indigenous people with a disability (25% 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 (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13. Canberra: Australian Bureau of Statistics
  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 (2010) Australia's health 2010: the twelfth biennial report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare
  9. Australian Institute of Health and Welfare (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report: detailed analyses. 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. 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. Steering Committee for the Review of Government Service Provision (2013) Report on government services 2013: Indigenous compendium. Canberra: Productivity Commission
  15. Australian Institute of Health and Welfare (2015) Disability support services: services provided under the National Disability Agreement 2013-14. Canberra: Australian Institute of Health and Welfare
  16. Steering Committee for the Review of Government Service Provision (2015) Report on government services 2015: Indigenous compendium. Canberra: Productivity Commission
  17. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  18. Productivity Commission (2011) Disability care and support: Productivity Commission Inquiry report [vol 1 & 2]. Canberra: Productivity Commission
 

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    Last updated: 24 March 2016
     
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