Australian Indigenous

Overview of Indigenous health 2004

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The context of Indigenous health

• Indigenous population
• The socioeconomic context

Indigenous population

In the 2001 Census of Housing and Population, 410,003 Aboriginal and Torres Strait Islander people were counted [3]. Based on this figure, the ABS has estimated that there were 458,520 Indigenous people living in Australia at 30 June 2001 [4]. New South Wales (NSW) had the largest Indigenous population with 134,888, followed by Queensland (125,910), WA (65,931), and the NT (56,875) (Table 1). The NT had the highest proportion of Indigenous people among its population (28.8%) and Victoria the lowest (0.6%).

Table 1 Estimated Indigenous population, Australia , by jurisdiction, 30 June 2001

Source: Australian Bureau of Statistics, 2003 [4]

Notes:

1. The estimates of the resident Indigenous population, based on the 2001 Census counts, make allowances for unknown Indigenous status and for net under-enumeration and make a back adjustment for natural increases between 30 June 2001 and 7 August 2001 (the date of the census).

2. Australian population includes Jervis Bay Territory , the Cocos (Keeling) Islands , and Christmas Island .

The census counts for Indigenous people were 16% higher in 2001 than in 1996 (the counts for the total Australian population were 6% higher) [5]. The difference between births and deaths contributed to 12% of the overall increase among Indigenous people, with much of the remaining 4% being attributed by the ABS to 'an increasing propensity for persons to be identified as Indigenous on census forms'. The increase of 16% between 1996 and 2001 followed an increase of 33% between 1991 and 1996.

The majority of Indigenous people live in cities and towns, but the Indigenous population is much more widely dispersed across Australia than is the non-Indigenous population. Slightly more than one-half of the Indigenous population lives in areas classified as 'major cities' or 'inner regional' areas, compared with almost nine-tenths of the non-Indigenous population [6]. (As well as these two classifications of 'remoteness' in terms of access to goods and services and opportunities for social interaction , the Australian Standard Geographical Classification (ASGC) has four other categories: 'outer regional', 'remote', 'very remote' and 'migratory' [7].) Around one-quarter of Indigenous people live in areas classified as 'remote' or 'very remote' in relation to having ' very little or very restricted access to goods and services and opportunities for social interaction' [6, 8]. Only 2% of non-Indigenous people live in remote or very remote areas.

In terms of specific geographical areas, more than one-half of all Indigenous people live in nine of the 36 ATSIC regions: Sydney; Brisbane; Coffs Harbour; Wagga Wagga; Perth; Cairns; Townsville; Hobart; and Adelaide [5].

Of the estimated Indigenous population of 458,520 people, around 409,800 identified as Aboriginal, around 29,120 as Torres Strait Islander, and around 19,600 as both Aboriginal and Torres Strait Islander (the census question on Indigenous status enabled people to identify as Aboriginal, Torres Strait Islander or Aboriginal and Torres Strait Islander.) [4, 5]. A total of 429,392 people identified as Aboriginal (including those who were identified as Aboriginal and Torres Strait Islander) and 48,730 as Torres Strait Islander (including those who were identified as Aboriginal and Torres Strait Islander) (Table 2). As expected, most Torres Strait Islander people live in Queensland , with NSW the only other State with a substantial number of Torres Strait Islanders.

Table 2 Estimated resident Indigenous population by Aboriginal/Torres Strait Islander status and jurisdiction, 30 June 2001

Source: Derived from ABS, 2002 [5] and ABS, 2003 [4]

Notes:

1. The estimates of the resident Indigenous populations, based on the 2001 Census counts, make allowances for unknown Indigenous status and for net under-enumeration and make a back adjustment for natural increases between 30 June 2001 and 7 August 2001 (the date of the Census).

2. People who identified as being both Aboriginal and Torres Strait Islander are included in the figures for each sub-population. As a result, the combined figure for this table is around 19,600 higher than the estimated resident population of 458,520.

3. Australian populations include Jervis Bay Territory , the Cocos (Keeling) Islands , and Christmas Island .

The Indigenous population is markedly younger than the non-Indigenous population - in 2001, 40% of Indigenous people were aged less than 15 years, compared with 21% of non-Indigenous people. Only 2.6% of the Indigenous population was aged 65 years or over, compared with 12% of the non-Indigenous population (see Figure).

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The socioeconomic context

The current health status of Indigenous people is only explicable in terms of their extreme social disadvantage [9]. This social disadvantage, directly related to dispossession and characterised by poverty and powerlessness, is reflected in measures of their education, employment, income and housing. Before summarising key indicators of Indigenous health status, the current sections provide information about the context within which these indicators should be considered.

Key indicators in these areas for Indigenous people nationally include:

Educational attainment

According to the 2001 Census:

• 3.0% of Indigenous people aged 15 years or older had never attended school, compared with only 1.0% of non-Indigenous people;

• 17% of Indigenous people and 38% of non-Indigenous people reported having completed year 12 or equivalent (people aged 15 years or older);

• less than 2% of the Indigenous population reported attending a university or other tertiary institution, compared with almost 4% of the non-Indigenous population; and

• among those who had left school, 35% of the non-Indigenous population had some form of post-secondary school qualification (including degrees, diplomas, and trade or basic qualifications), compared with less than 15% of Indigenous people [derived from 10].

Employment status

From information collected by the 2001 Census (which uses different procedures to those used in the compilation of the standard employment indicators):

• almost 22% of Indigenous males aged 15 years or over were unemployed, as were almost 18% of Indigenous females - the levels for non-Indigenous people were 7.7% for males and 6.5% for females;

• excluding people employed under the Community Development Employment Projects (CDEP) scheme, the overall Indigenous unemployment rate would have been around 34% - almost five times the rate of 7.2% for non-Indigenous people³;

• just under a quarter of employed Indigenous Australians worked as 'labourers and related workers' (Australian Standard Classification of Occupations (ASCO)), as did around 8% of employed non-Indigenous people;

• around 15% of employed Indigenous Australians were classified as managers or professionals (ASCO 'managers and administrators' and 'professionals'), as were 28% of employed non-Indigenous people [derived from 10].

Income

Key indicators include:

• the median family income for Indigenous people ($630) in 2001 was slightly more than one-half of that for non-Indigenous people ($1,188) [derived from 10] ; and

• CDEP payments were the main source of income for 11% of Indigenous people (30% in remote areas and 4% in non-remote areas), and other government pensions and allowances for 52% [11]. The reliance on government payments is more than twice that of non-Indigenous people.

Housing and the physical environment

The level and standard of current housing is a clear expression of Indigenous disadvantage, not only in remote areas, but also in long-settled parts of Australia . The sub-standard living conditions are generally characterised by overcrowding, inadequate water and washing facilities, poor sanitation and sewage disposal, limited food storage and sub-optimal food preparation facilities.⁴

Key indicators include:

• the average size of an Indigenous household was 3.5 persons compared with 2.6 persons per non-Indigenous household [12]. The average size of Indigenous households increased with remoteness of residence, ranging from 3.2 persons per household in the major cities to 5.3 in very remote areas. Across Australia, four-fifths of 2 or 3 bedroom households with 10 or more residents were Indigenous households [derived from 13];

• 15% of Indigenous households required at least one additional bedroom, compared with around 4% of other households [12]. The proportions of Indigenous households requiring additional bedrooms ranged from 11% in major cities to 42% in very remote areas;

• 19% of Indigenous households in non-remote areas reported their accommodation to be in high need of repairs, compared with 7% of non-Indigenous households [14]. In remote and very remote areas, 19% needed major repairs and 10% needed replacement [15].

For Indigenous people living on discrete Indigenous communities:⁵

• bore water was the main source of drinking water for 62% of the total number of discrete Indigenous communities included in the 2001 CHINS [15];

• water restrictions were significant in 2001, with 35% of Indigenous communities (with a usual population of 50 or more) having experienced water restrictions within the previous year [15];

• 20% of 213 discrete Indigenous communities with 50 or more residents who were not connected to town water had not have their water tested within the previous year [15]; 26% of the communities had drinking water of poor quality that had failed testing at least once within the previous year;

• 7% of communities had no organised sewerage system [15];

• 48% of 327 discrete Indigenous communities with 50 or more residents reported a sewage overflow or leakage within the year previous to the 2001 CHINS [15];

• 94% of discrete Indigenous communities with a usual population of 50 had organised rubbish collections in place, but rubbish was disposed of in an unfenced tip in 53% of communities (this may allow rubbish to be spread by dogs and other vectors or blown from the tip) [15];

• 7% of discrete Indigenous communities with populations under 100 people had no organised electricity supply [15];

• generators were the main source of organised electricity for 66,451 people living in 647 discrete Indigenous communities;

• 82% of the 327 discrete Indigenous communities with 50 or more residents experienced electricity interruptions in the previous year;

• 31% of the discrete Indigenous communities with 50 or more residents had experienced some flooding in the previous year [15];

• 42% of discrete Indigenous communities with 50 or more residents had experienced ponding - the formation of 'pools of still water that remain stagnant for a period of one week or more and cover an area of at least 10 square metres' [16, p.22] - in the year prior to the 2001 CHINS [15].

The CDEP scheme offers unemployed Indigenous Australians the opportunity of working in community-managed projects and enterprises if they forego unemployment-related social security benefits.

The information summarised here has been extracted and/or derived from two main sources: the five-yearly Australian Census of Housing and Population (ABS, 2002); the 2001 Community Housing and Infrastructure Needs Surveys (CHINS), which collected information about housing in discrete Indigenous communities throughout Australia (ABS, 2002)

Information about discrete Indigenous communities - defined as geographic locations, bounded by physical or legal boundaries, and inhabited or intended to be inhabited predominantly (i.e. > 50% of usual residents) by Indigenous people, with housing or infrastructure that is managed on a community basis - was collected by the 2001 CHINS.

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Births and pregnancy outcome

• Age of mothers
• Total fertility rates
• Birthweights

In 2003, there were 11,740 births registered in Australia with one or both parents identified as Indigenous (5% of all births registered), but this figure probably underestimates the true number considerably as it has been estimated that only 91% of Indigenous births in 1998-2003 were correctly identified [17]. Completeness of identification varies across the country, with only Queensland , WA, SA and the NT having levels above 90%. Both parents were identified as Indigenous in 31% of these births occurring in 2003, only the mother in 43% (including births where paternity was not acknowledged and those where the father's Indigenous status was unknown), and only the father in 27%.

Age of mothers

In 2003, Indigenous women tended to have more babies and to have them at younger ages than did non-Indigenous women [17]. The median age of Indigenous mothers was 24.6 years compared with 30.5 years for all women. The highest birth rates (known technically as fertility rates) were for the 20-24 years age group for Indigenous women and in the 30-34 years age group for non-Indigenous women (Table 3). Fertility of teenage Indigenous women (73 babies per 1000 women) was more than four times the fertility rate for all teenage women (16 babies per 1000).

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Total fertility rates

In 2003, total fertility rates were 2,145 births per 1,000 Indigenous women and 1,755 per 1,000 for all mothers (Table 4) [17] . The highest Indigenous fertility occurred in the NT (2,771 babies per 1,000), followed by Queensland (2,332 babies per 1,000) and SA (2,172 babies per 1,000).

Table 3 Age-specific fertility rates, by Indigenous status of mother, selected jurisdictions, Australia , 2003

Source: Derived from ABS, 2004 [17]

Notes:

1. Rates per 1,000 women in each age group

2. Caution should be exercised in the interpretation of the figures. This is because the identification of Indigenous births is less than 90% for all jurisdictions except Queensland , WA, SA and the NT.

3. Numbers of Indigenous births for the ACT were not available

Table 4 Total fertility rates, by Indigenous status of mother, selected jurisdictions, Australia , 2003

Source: Derived from ABS 2004 [17]

Notes:

1. Total fertility rate is the number of children born to 1,000 women at the current level and age pattern of fertility

2. Caution should be exercised in the interpretation of the figures. This is because the identification of Indigenous births is less than 90% for all jurisdictions except Queensland , WA, SA and the NT.

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Birthweights

The average birthweight of babies born to Indigenous mothers in 2001 was 3,166 grams, which is around 200 grams less than the average for babies born to non-Indigenous mothers, 3,382 grams (Table 5) [18]. Babies born to Indigenous women in 2001 were more than twice as likely to be of low birthweight (LBW) (12.9%) than were those born to non-Indigenous women (6.0%). (LBW, which is defined as a birthweight of less than 2,500 grams, increases the risk of death in infancy and other health problems.) The low-birthweight proportions for babies born to Indigenous women were highest for SA (16.5%), WA (15.7%) and the NT (12.7%).

Table 5 Mean birthweights and percentage of low birthweight for babies born to Indigenous and non-Indigenous mothers, selected jurisdictions, Australia , 2001

Source: Derived from Laws and Sullivan, 2004 [18]

Notes:

1. Low birthweight is defined as less than 2,500 grams

2. Mean birthweights for babies born to non-Indigenous mothers have been estimated from published figures for Indigenous and all mothers

Risk factors for LBW include socioeconomic disadvantage, the size and age of the mother, the number of babies previously born, the mother's nutritional status, illness during pregnancy and the duration of the pregnancy [19]. A mother's alcohol consumption and use of tobacco and other drugs during pregnancy can also impact on the size of her baby. According to the Western Australian Aboriginal Child Health Survey (WAACHS), infants born to mothers who used tobacco during pregnancy had a significantly lower average birth weight (3,110 grams) than did infants born to mothers who had not used tobacco during pregnancy (3,310 grams) [20]. Lowest average birthweights were for infants whose mothers used marijuana with tobacco (3,000 grams) or with both tobacco and alcohol (2,940 grams).

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Last updated: 12 January, 2005