Overviews
The Health and Welfare of Australia's Aboriginal and Torres Strait
Islander Peoples
ABS Catalogue No. 4704.0
AIHW Catalogue No. IHW2
Summary
Introduction
This is a new report which is going to be published every two years by the Australian Bureau of Statistics (ABS) and the Australian Institute of Health and Welfare (AIHW). The aim of the report is to provide the most up-to-date statistics about Indigenous health and welfare. It will also provide a good opportunity to see whether things are changing with time.
The information comes mainly from national surveys and from the Census and from data collections of various State and Territory agencies. Most of the information presented talks about health and welfare on a national level but where possible information has been included about differences between the States and regions.
What you should know about the data
Some of the information in the report is not complete. This is because health information about Australia's Indigenous population is not nearly as available or as good as it is for the whole Australian population. The reason for this is that the data are limited by incomplete identification of Indigenous people in national data collections.
By identification we mean for example when people go to hospital because they are sick or are going to have a baby, they need to be asked "Are you of Aboriginal or Torres Strait Islander origin?". If the question is not asked, things like how many Indigenous people are going to hospital and for what reasons can't be worked out. If this can't be worked out, no-one knows exactly how many Indigenous people are sick and dying and what the causes are and whether things are getting better or worse.
A lot of people from government and Indigenous organisations around Australia are working to improve the identification of Indigenous people so that better information can be obtained. More needs still to be done.
The following sections talk about the main points described in the report:
Population
In 1991, Indigenous people made up about 1.6% of the Australian population (Census figures). Approximately 1 in 3 Indigenous people live in areas outside the cities and major towns while only about 1 in 7 non-Indigenous people live in these areas.
Most Indigenous people live in the south-east of Australia. This surprises many people because they think of most Indigenous people as living in northern and central Australia. The Northern Territory in fact has the highest proportion of Indigenous people making up its population (23%, 46,040 Indigenous people), but New South Wales has the biggest Indigenous population (only 1.2% of NSW's population but 80,440 Indigenous people).
The Indigenous population is younger than the Australian population as a whole and is expected to grow at a faster rate in the future. The graphs below - called 'population pyramids' - show that there are many more Indigenous people in the younger age groups compared to non-Indigenous people. Comparing the two populations when the age structures are so different can be difficult so a technique called age-standardisation or age-adjustment is used.
Housing and environmental health infrastructure This section of the report recognises the important link between health and living conditions. Infections, and parasitic diseases are more common when people live in poor housing and don't have access to clean water and proper waste removal. These diseases can then lead to malnutrition, and serious conditions such as rheumatic heart disease and kidney disease.
In the 1994 NATSIS (National Aboriginal and Torres Strait Islander Survey), the first survey of Australia's Indigenous people, people were asked whether their water, toilet or electricity had broken down in the previous four weeks. The results showed that this had happened to about 1 in 10 Indigenous people. In some areas, mainly remote areas of Australia, about 1 in 5 people had experienced these problems.
The HCINS (Housing and Community Infrastructure Needs Survey) was another survey, carried out in 1992. It looked in a lot of detail at the living conditions of communities. Nearly 1 in 5 Indigenous people in the communities surveyed did not have access to water that was fit for drinking. A study carried out in the Torres Strait showed that water supply systems were in poor condition and water supplies during the dry season were very bad. This led to a very high incidence of hepatitis A in the area.
Other studies also show what many Indigenous people know only too well, that many households are overcrowded. Overcrowding makes it easier for diseases to be spread. It also means that appliances and facilities in the house are working harder which makes them more likely to break down.
Health risk factors
Risk factors are behavioural factors that can have an effect on a person's health either for better or for worse. For example, if you smoke, this increases the risks of suffering lung cancer and heart disease. However, If you eat good food, you have a better chance of staying healthy.
Indigenous people are more likely to get sick than non-Indigenous people due to higher rates of smoking, 'unsafe' levels of alcohol consumption, being overweight or obese, and because of injuries from violence.
On the other hand,-a high proportion of Indigenous mothers breastfeed their babies and this is expected to be good for the health of their children.
A special chapter has been devoted to smoking in the report because it is so important. Smoking can be the cause of many diseases such as lung and other cancers, chronic bronchitis, heart disease, and stroke. Mothers who smoke are more likely to have low birth weight babies.
Indigenous people are twice as likely as non-Indigenous people to smoke and Indigenous people have higher rates of illness and death from causes linked to smoking. Yet smoking isn't thought of as an important problem by many Indigenous Australians. One study showed that about 2 out of 3 Indigenous people thought that alcohol causes the most deaths of Indigenous people. However only about 3 in 100 said tobacco was the biggest killer, even though smoking causes many more deaths than alcohol or other substances. People tend to live longer if they stop smoking or never start.
There is a belief in our society that Indigenous Australians are more
likely to drink alcohol than non-Indigenous Australians. However it's
actually the other way around. In the NATSIS, a large proportion of
Indigenous people across Australia reported that they had never drunk
alcohol.
The problem with alcohol is that the Indigenous people who do drink are more likely to be heavy drinkers. Drinking more than 4 drinks per day for females and 6 drinks per day for males is considered harmful to health. In one study, 4 out of 10 Indigenous male drinkers said they usually had more than 13 drinks whenever they had a drinking session. Heavy drinking can affect the health of non-drinkers too, because drinking can be linked to violence.
Access and use of services
Because Indigenous people are more likely than non-Indigenous people to live in rural and remote areas, they are more likely to live further away from health facilities and health professionals.
Distance is not the only thing which makes it difficult for Indigenous people to receive the health care they need, but there are few statistics available about other factors.
One factor which is likely to affect access to and use of health services is the number of Indigenous people working in the health area. 1991 Census figures show that the proportion of Indigenous people working in the health field was only half that for non-Indigenous Australians. Although more Indigenous people are enrolling in universities and TAFEs to do health-related courses, the proportion of Indigenous people actually finishing these courses has not increased over the last few years.
Welfare services
This section of the report presents information about child care, child protection, adoption, aged care, disability, housing assistance, income support and educational attainment, as well as the employment and training of Indigenous people in welfare-related fields.
Welfare statistics show that Indigenous Australians are disadvantaged compared to non-Indigenous Australians. Indigenous people are more likely to need housing assistance and income support than non-Indigenous people. A higher proportion of Indigenous people have incomes of less than $12,000 per year.
Indigenous children are more likely to be reported as abused or neglected and are more likely to be under 'care and protection' orders than non-Indigenous children.
Information on other aspects of welfare, such as disability and aged care, is limited by the incomplete identification of Indigenous people in national collections.
Mothers and babies
Poor health starts early for Indigenous people. On average, Indigenous mothers give birth at a younger age than non-Indigenous mothers. They are also more likely to have a medical condition complicating the pregnancy. In most States and Territories, Indigenous babies are about 2 - times more likely to be of low birth weight (under 2.5 kg). They are also 2 - times more likely to die at birth than babies born to non-Indigenous mothers.
Sickness
Indigenous people are about 2 - times more likely to be hospitalised than Australian people in general.
Hospital separations are records of the times when people 'separate' from (leave) hospital, that is, they either go home, are transferred to another hospital or they die. The records include information about the person's age and sex, what was wrong with them, what happened while they were in hospital and how long they stayed. The records should also include information about whether a person is Indigenous or not. The graphs below show the number of hospitalisations per 100,000 people for all causes combined. They do not include NSW, Tasmania or Victoria because in those States, the hospital records didn't have good enough information about whether people were Indigenous.
The graphs show that for both males and females, Indigenous people in every age group are more likely to go to hospital than non-Indigenous people.
Now for some statistics on individual health conditions:
Respiratory diseases and injury:Respiratory disease and injury are among the most common causes of hospitalisation for both Indigenous males and Indigenous females, occurring at 3-4 times the numbers expected.
Infectious diseases: Indigenous people also suffer higher rates of infectious diseases, including tuberculosis and sexually transmitted diseases. There were 4-5 times more hospitalisations from infectious diseases than for the non-Indigenous population.
Mental illness:There is very little statistical information on mental illness. However Indigenous people seem to be more likely to be diagnosed with some conditions that might indicate mental illness such as self-harm, suicidal behaviour, alcohol abuse and violence. The graph below shows the much higher rates of hospitalisation due to injuries from 'interpersonal violence' (that is, injuries inflicted by another person or people) that Indigenous people suffer.
Cancer: Information' on the incidence of cancer in Indigenous people is limited. It appears that in some areas such as the Northern Territory the rates of getting most cancers may not be much different for Indigenous and non-Indigenous people. However, Indigenous people who get cancer are more likely to die from it than are non-Indigenous people who get cancer.
Mortality
National statistics on deaths of Indigenous people are not available because of incomplete recording of Indigenous status in the death records of some States and Territories. The identification and recording of whether someone is Indigenous is good enough in Western Australia, South Australia and the Northern Territory to report information on death. This gives us only part of the national picture because only one third of Indigenous people live in these areas. We can't be sure if the information from these areas gives us an accurate picture about what happened elsewhere.
For all causes of death combined in WA, SA and the NT there were 3.5 times more deaths than expected among Indigenous males and 4 times more deaths than expected among Indigenous females in 1992 - 94.
Indigenous people experienced a higher death rate than non-Indigenous people in every age group, but the largest gap between Indigenous and non-Indigenous death rates was among adults aged 25-54 years, when death rates were about 6-8 times higher.
The graphs compare causes of death for Indigenous and non-Indigenous people. They clearly show the much higher death rates experienced by Indigenous people for almost every group of conditions. Little improvement in death rates was observed between 1985 and 1994.
Summary
Indigenous Australians are more likely to be sick and die at a younger age than non-Indigenous Australians, and this is true for almost every type of disease or condition for which information is available. One way of summarising what this all means is to look at life expectancy.
Life expectancy at birth represents the average number of years a newborn baby could expect to live if the death rates of today were to continue throughout that baby's life.
In the period 1992 - 94, life expectancy at birth among non-Indigenous people was 74.9 years for males and 80.6 years for females. As the graph below shows, life expectancy at birth was 15 to 20 years lower for Indigenous people in Western Australia, South Australia and the Northern Territory.
As at 1993, Aboriginal and Torres Strait Islander life expectancy was lower than those for most countries of the world with the exception of some central African countries and India.
There has been little improvement in the last 10 years.
For more information and/or to obtain a copy of the publication, contact the National Centre for aboriginal and Torres Strait Islander Statistics (NCATSIS) in Darwin on 1 800 633 216. The price of the publication is $31.00 and copies can be purchased from the nearest ABS office (in all capital cities). Statistics are also available from NCATSIS on many other topics of interest to Aboriginal and Torres Strait Islander people.
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