Australia's health 2002:

Aboriginal and Torres Strait Islander
Australians

This section reproduced with kind permission of the Australian Institute of Health and Welfare, originally published in Australia's health 2002

Aboriginal and Torres Strait Islander peoples suffer a greater burden of ill health than other Australians. Indigenous people are more likely to experience disability and reduced quality of life due to ill health, and die at younger ages (see ABS & AIHW 2001 for a detailed report). Census data indicate that the Indigenous population is disadvantaged across a range of socioeconomic factors that have an impact on healthoutcomes. In 1996, Aboriginal and Torres Strait Islander peoples reported lower incomes than other Australians, higher rates of unemployment, poorer education outcomes and lower rates of home ownership (ABS 1998a). However, socioeconomic status alone does not explain the variations in health status that exist between Indigenous and other Australians. Health risk behaviours (e.g. smoking, alcohol misuse) and other health risk factors (e.g. poor housing, exposure to violence) are also important determinants of health, but even these do not fully explain the differential burden of disease between population groups. Research suggests that the social environment partially explains health outcomes, including the immediate local or neighbourhood environment, social connections with friends, family and the community, the extent of control and perceptions of mastery in the workplace and wider society (ABS & AIHW 2001). A recent qualitative analysis of the health of the Yolgnu Indigenous people of north-east Arnhem Land identified the loss of control as leading to hopelessness, the loss of the will to live and, ultimately, to high levels of sickness and mortality (Trudgen 2000). Although the incomplete recording of Indigenous status in administrative records and the experimental nature of Indigenous population estimates remain barriers to the production of a true picture of Indigenous health in Australia, an increased emphasis on the inclusion of an Indigenous identifier in a range of surveys and administrative data sets is a key strategy in providing good-quality information about the health of Indigenous Australians in the future (ATSIHWIU 1997). Even though a comprehensive picture of Indigenous health is not yet available, this section provides information on Aboriginal and Torres Strait Islander peoples where data are of adequate reliability.

Coverage of the Indigenous status of people in birth and death registration is improving in Australia, but the data collected from deaths registrations is not yet of high enough quality in all States and Territories, and cannot provide national estimates. Thus, data from Queensland, Western Australia, South Australia and the Northern Territory are used to provide indicative information.

Records of hospital use or general practice encounters cannot provide an understanding of the prevalence of particular diseases in the Indigenous population, and the extent of undercounting of Indigenous people in these data sources is not known. However, information from hospitals and general practitioners provides broad indications of the burden of chronic conditions and acute illnesses in comparison to the rest of the Australian population. At present, there is no national data source for conditions treated by primary healthcare providers such as Aboriginal health workers or nurses. Other sources of data have the ability to identify Indigenous peoples such as the Aboriginal Medical Services, disease registers and national household surveys with supplementary Aboriginal and Torres Strait Islander samples. Such data sources provide detailed information on specific diseases, risk factors and living conditions.

The Indigenous population

The Indigenous population in Australia is estimated at 386,049, based on 1996 Census figures, representing 2.1% of the total Australian population. Approximately 11% of Indigenous people counted in the Census reported that they were of Torres Strait Islander origin. More than half of all Indigenous people live in New South Wales and Queensland, with the majority residing in urban areas. New South Wales has the greatest number of Indigenous people (110,000) and the Northern Territory has the highest proportion of Indigenous people, at approximately 28% of all residents. Almost 20% of the total Indigenous population live in areas that are classified as very remote, compared with only 1% of the other Australian population.

The Indigenous population is much younger than the general population. In 1996, the median age for Indigenous people was 20 years, compared with a median age of 34 years for the total Australian population. Fertility is higher for the Aboriginal and Torres Strait Islander populations and Indigenous women give birth at younger ages than other Australian women. In the period 1996-1998, over 80% of Indigenous mothers had babies before the age of 30. The comparable figure for other Australian mothers was 54%. The estimated life expectancy at birth for Aboriginal and Torres Strait Islander males and females is 19-20 years lower than for other Australians. In the period 1997-1999, the life expectancy at birth for the Indigenous population was estimated to be 56 years for males and 63 years for females. In contrast, the life expectancy at birth for all Australians was 76 years for males and 82 years for females. The 1997-1999 Indigenous life expectancies are similar to life expectancy for the total male population in the period 1901-1910, and for the total female population in the period 1920-1922 (ABS 2000c).

 

Measures of health status

Mortality

In the four jurisdictions where mortality data are reliable, the 1997-1999 age-specific death rates for Aboriginal and Torres Strait Islander peoples were higher than the all-Australian rates in every age group (Figure 4.12). The largest relative differences in age-specific death rates occurred for ages 35-54, where Indigenous rates were 5-6 times higher than all-Australian rates. There were also substantial differences between the 25-34 and 55-64 age groups, where the Indigenous age-specific death rates were 3-5 times higher than the all-Australian rates.

After adjusting for age difference, death rates were higher for Indigenous people than for Australians as a whole for almost all causes of death. Diseases of the circulatory system, deaths resulting from external causes (predominantly accidents, self-harm and assault), neoplasm (cancers), respiratory diseases, and endocrine/metabolic diseases accounted for the greatest numbers of deaths among Indigenous people in the period 1997-1999 (Table 4.10). These were also the leading causes of death among the Australian population as a whole, accounting for about 75% of all deaths. However, both Indigenous males and Indigenous females had higher death rates, and were more likely to die at younger ages from these causes, than the general population.

Infant mortality rates reported here are produced from data provided by all States and Territories for the 3-year period 1996-1998 (ABS & AIHW 2001). During that period, babies of Indigenous mothers were twice as likely to die at birth and during the early post-natal phase than babies born to other Australian mothers (Figure 4.13). Although it is difficult to assess trends due to uncertainties about the extent to which women are identified as Indigenous in the perinatal collections, the overall infant mortality rate for this period is similar to that for 1994-1996.

The infant mortality rate for babies born to Torres Strait Islander mothers in Queensland (21.8 per 1,000 births) was similar to that for babies born to Aboriginal mothers (22.6 per 1,000 births), but twice as high as the rate for babies born to other Australian mothers (10.6 per 1,000 births) (Perinatal Data Collection, Queensland Health). A study that examined 10 years of Queensland perinatal data showed a higher rate of neonatal mortality (death before 28 days) for babies of Torres Strait Islander mothers, and suggested that this outcome for the babies may be related to the high prevalence of diabetes among the mothers (Coory 2000).

Common diseases

In 1998-99, Indigenous people in every age group were more likely than other people to be hospitalised for most diseases and conditions, indicating a higher occurrence of illness at more acute levels (Figure 4.14). Excluding hospital episodes for dialysis, which is the highest frequency treatment in hospital for Indigenous people, the main reasons for Indigenous males to be hospitalised during this period were injuries and poisoning (13% of Indigenous male hospital stays), respiratory disease (12%), digestive diseases (7%) and mental and behavioural disorders (6%). For Indigenous females, pregnancy and childbirth were common reasons for hospitalisation (17% of all hospital stays for Indigenous women), followed by respiratory diseases (9%), injury and poisoning (8%) and digestive diseases (5%).

The six most frequent problems managed by GPs for Indigenous patients between April 1998 and December 2000 were upper respiratory infection, diabetes, hypertension, asthma, acute bronchitis/broncholitis and acute otitis media/myringitis. This compares with the six most common problems, hypertension, upper respiratory infection, immunisation, depression, asthma and acute bronchitis/bronchiolitis managed for other Australian patients (AIHW General Practice Statistics and Classification Unit, unpublished).

Kidney disease is more prevalent among Indigenous people than among other Australians. Deaths from kidney failure are eight times greater for Indigenous males and five times greater for Indigenous females than for the general population. The most common principal diagnosis in Australian hospitals in the period 1998-99 for both Indigenous males and females was for 'care involving dialysis', haemodialysis being the most common procedure. Patients with end-stage renal disease may be admitted to hospital several times a week for treatment. When compared with all patients receiving haemodialysis, there were over six times as many procedures for Indigenous males and eleven times as many for Indigenous females (ABS & AIHW 2001).

People with end-stage renal disease may also require a kidney transplant for survival, but Indigenous people are less likely than other people to receive a transplant. In 1999, 46% of all patients registered with the Australian and New Zealand Dialysis and Transplant Registry had a functioning kidney transplant, but for Indigenous people

identified on this registry only 18% had functioning transplants. Some of the reasons Indigenous patients are less likely to receive a transplant include having multiple illnesses, being less likely to receive a suitable donor, or being too ill to undergo the surgery required (ABS & AIHW 2001).

Diabetes is a significant health problem for Aboriginal and Torres Strait Islander peoples. Indigenous people who have Type 2 diabetes often develop the disease earlier than other Australians and often die at younger ages. In 1995, the reported rate of diabetes was four times higher among Indigenous people aged 15 years and over living in metropolitan and rural areas than for the general population (Figure 4.15) (ABS 1999c). In 1998-99, there were 10-15 times more hospital separations for Indigenous patients with Type 2 diabetes than occurred for other patients (ABS & AIHW 2001).

Diabetes can cause serious complications such as cardiovascular disease, kidney disease, nerve damage, eye damage, ulceration and gangrene. There are a number of health risk factors associated with diabetes, including obesity, poor nutrition, lack of physical activity and, as yet, unspecified genetic factors. Type 1 diabetes (early onset and insulin-dependent) is relatively rare in the Indigenous population, but there is a very high prevalence of Type 2 diabetes (late onset, non-insulin-dependent). In 1998-99 about 75% of Aboriginal and Torres Strait Islander peoples who received hospital treatment for diabetes had Type 2 diabetes.

The number of deaths associated with diabetes provides an indication of the differential burden of the disease in the Indigenous population. Age-specific death rates for 1997-1999, where diabetes was recorded as an underlying cause in those jurisdictions where Indigenous identification in mortality data is reliable, show that, from age 25 onwards, the death rate for diabetes in the Indigenous population is higher than that for the total population (Figure 4.16). This rejects the earlier onset of diabetes in this population group. Causes of death where diabetes was an underlying cause included ischaemic heart disease (41% of Indigenous deaths where diabetes was an underlying cause), other forms of heart disease (26%) and renal disease (38%). The earlier onset of Type 2 diabetes among Indigenous people has serious implications for diabetic complications (O'Dea 1992).

Mental health

At present, there are no national data sources which provide information about the incidence or prevalence of mental disorder for Aboriginal and Torres Strait Islander peoples in the community. Data on hospitalisation and mortality due to serious mental disorders and illnesses are the main sources of information that can provide an indication of mental health conditions in the Indigenous population.

In 1998-99, Aboriginal and Torres Strait Islander peoples were hospitalised for conditions classified as 'mental and behavioural disorder's at a higher rate than that experienced by the general population. The rate of hospitalisation for Indigenous people diagnosed with mental disorders due to psychoactive substance use and organic disorders such as dementia was three times higher than the rate for the all-Australian population. The rate for psychotic disorders was twice as high (ABS & AIHW 2001). Mortality data for 1997-1999, from Queensland, Western Australia, South Australia and the Northern Territory combined, show that there were over twice as many deaths associated with mental disorders among Indigenous people than for other Australians. The majority of these deaths in the Indigenous population (78%) were attributed to mental disorders due to psychoactive substance use. There were five times more deaths from assault for Indigenous males, and ten times as many for Indigenous females, than for males and females in the general population.

Rates of intentional injury, whether self-inflicted or caused by assault, may be an indicator of psychological illness and distress in the community. The rate of hospitalisation for Indigenous males due to assault was six times higher than the general population, and for Indigenous females almost 19 times higher. The rate of hospitalisation due to self- harm for both Indigenous males and Indigenous females was twice as high as that for the general population.

Suicide accounted for almost three times as many deaths for Indigenous males and twice as many deaths for Indigenous females than for the general population. The highest age-specific death rate from suicide was 108 per 100,000 Indigenous males in the 15-24 age group compared with 27 per 100,000 for males in the same age group in the general population. In the 25-34 age group, deaths by suicide occurred at a rate of 96 per 100,000 Indigenous males compared with 38 per 100,000 for all males. For Indigenous females, the highest rate was 18 per 100,000 in the 15-24 age group compared with 6 per 100,000 for all females.

Oral health

Information on the oral health of Indigenous adults has been limited to data from the Commonwealth Dental Health Program which ceased in 1996, and data from a small sample of Indigenous people in the 1994-1996 National Dental Telephone Interview Surveys (AIHW DSRU 1995; AIHW: Brennan & Carter 1998). While indicative only, these data suggested that dental problems, tooth extraction and edentulism are more common among Indigenous people than other Australians. A more recent study of oral health in the Anangu Pitjantjatjara lands of South Australia found that the children had a high and increasing prevalence of dental caries in their deciduous teeth, and that edentulism among adults had increased over the last decade, from no recorded cases in 1987, to ten cases by the year 2000 (Endean et al. forthcoming). There is an association between periodontal disease and diabetes (Taylor et al. 1996) and all of the edentulous adults on the Anangu Pitjantjatjara lands also had a diagnosis of diabetes (Endean et al. forthcoming).

The oral health of Indigenous children is poorer than that of other children. Comparative data from the 1998 Child Dental Health Survey for children in the Northern Territory show that Indigenous children are more likely than other children to have decayed, missing or filled deciduous teeth ('baby' teeth). Between the ages of 6 and 13, there is a decline in the proportion of all children with healthy permanent teeth, but this decline is more pronounced among Indigenous children than other children. Data for New South Wales, although based on small numbers of Indigenous children, show a similar though less marked pattern (AIHW Dental Statistics and Research Unit, unpublished data).

Health risk factors

Low birthweight

In the period 1996-1998, babies of Indigenous mothers were nearly twice as likely as babies of other Australian mothers to be of low birthweight (i.e. a weight of less than 2,500 grams at birth). Low birthweight may be a result of premature birth, foetal growth retardation, or a combination of the two (Alberman 1994). Factors influencing a baby's birthweight may include socioeconomic disadvantage, the size and age of the mother, the number of babies previously carried, the mother's nutritional status, smoking and other risk behaviours, illness during pregnancy, and the duration of pregnancy. Low-birthweight babies are more prone to ill health during childhood, and may be more vulnerable to illness, such as kidney disease, in adulthood (Alberman 1994; Barker & Clark 1997).

Obesity

There is a greater level of obesity among Aboriginal and Torres Strait Islander adults than in the general Australian population, based on body mass index, putting this population group at greater risk for kidney disease, Type 2 diabetes and cardiovascular disease. Results of two national surveys, the 1994 National Aboriginal and Torres Strait Islander Survey and the 1995 National Nutrition Survey, provide comparative data on obesity for Indigenous and other Australian adults (Figure 4.17). Approximately 25% of adult Indigenous males and 29% of adult Indigenous females were classified as obese compared to about 19% of both other Australian adult males and adult females.

Poor nutrition

Many Aboriginal and Torres Strait Islander peoples do not have access to a healthy diet. Indigenous people who live in remote areas do not have the same opportunities as people living in metropolitan and regional centres to obtain affordable, healthy food. In areas where healthy food is available, factors such as competing priorities for limited family incomes, restricted access to traditional foods, lack of knowledge of the nutritional value of certain foods and lack of culturally appropriate information on healthy food can lead to inadequate nutrition (Public Health Services 2001).

The diet of many Aboriginal and Torres Strait Islander peoples has undergone rapid change, from a fibre-rich, high protein, low saturated fat 'traditional' diet to one which is high in refined carbohydrates and saturated fats. This kind of diet creates a predisposition to obesity, Type 2 diabetes, cardiovascular disease and renal disease (NHMRC 2000; O'Dea 1992), conditions which, as noted above, are prevalent in the Indigenous population. Maternal undernutrition is a factor linked to low birthweight and a risk factor for infant death and ill health in childhood, and may also predispose babies to cardiovascular diseases and Type 2 diabetes in later life (Barker & Clark 1997).

Alcohol and other drug use

Several surveys have shown that Indigenous people are less likely than other people to drink alcohol, but those who do so are more likely to consume it at hazardous levels (ABS & AIHW 2001). The hazardous use of alcohol is related to conditions such as alcohol-dependence syndrome, alcoholic liver disease, high blood pressure, stroke and some cancers (Anderson 1996). Alcohol is frequently a contributing factor to injuries, accidents, assault and self-harm (Unwin et al. 1994), and may contribute to social problems such as family breakdown, domestic violence, and financial and legal problems (Davis 1998).

The most recent national data on alcohol consumption among Indigenous people come from the 2001 National Drug Strategy Household Survey (NDSHS). The survey found that 20% of Indigenous peoples drank at levels that were risky or high risk for long-term harm, compared with 10% of other Australians. Further, 49% of Indigenous people compared with 34% of other Australians had at least one drinking episode in the past year that was risky or high risk for short-term harm.

Cigarette smoking is associated with the increased incidence of and mortality from various types of cancer, including lung, cervical, bladder and pancreatic cancers, coronary heart disease, stroke, chronic respiratory tract diseases, and pregnancy-related conditions (English et al. 1995). Data from the 2001 NDSHS show that there is a high prevalence of smoking among Aboriginal and Torres Strait Islander peoples, with the rate being approximately twice that for other Australians, placing them at an increased risk for diseases and conditions described above.

Indigenous people are also at risk of ill health through the use of illicit substances such as marijuana, heroin, amphetamines and inhalants (petrol, glue, aerosols). The 2001 NDSHS found that the rates of recent illicit drug use among Indigenous people were higher than for other Australians: 32% of Aboriginal and Torres Strait Islander peoples aged 14 years and over had used an illicit drug in 2001 compared with 17% of other Australians. Most of this difference was associated with cannabis use (28% for Aboriginal and Torres Strait Islander peoples compared with 13% for other Australians), although recent use of any illicit drug other than cannabis was also significantly higher (13% compared with 8% for other Australians).

There are no reliable national data collected on petrol sniffing, but case studies indicate that the practice continues to be a major problem in some Indigenous communities. Petrol sniffing causes confusion, aggression, lack of coordination, hallucinations, respiratory problems and chronic disability including mental impairment. It is practised mainly by young people, but the problems associated with it extend to families and the wider community (d'Abbs& MacLean 2000).

Housing and living conditions

Housing has been identified as a major factor affecting the health of Aboriginal and Torres Strait Islander peoples. Many Indigenous people live in housing which does not satisfy the basic requirements of shelter, safe drinking water and adequate sewerage provisions-conditions which are considered unacceptable by general Australian standards (Neutze 1998).

Overcrowded living conditions increase the risk of the spread of infectious diseases such as meningococcal disease, rheumatic fever, tuberculosis and respiratory infections (Waters 2001). Aboriginal and Torres Strait Islander peoples experience overcrowded living conditions more commonly than other Australians. Results from the 1999 Australian Housing Survey showed that 13% of Indigenous households in urban areas and major regional centres did not have enough bedrooms to meet their needs,compared with 4% of other Australian households (Figure 4.18) (ABS 2001a).

Results from the 1999 Australian Housing Survey also indicated that Indigenous households in urban areas and major regional centres were almost three times more likely than other households to report their homes to be in high need of repair (19% compared with 7%). A higher proportion of other Australian households reported no need for repairs (44% compared with 34%) (Figure 4.19). The 1999 Community Housing and Infrastructure Needs Survey (CHINS) also investigated the number and condition of houses in discrete Indigenous communities in urban, rural and remote areas. Findings from the CHINS indicate that the housing conditions of Indigenous people are generally poorer in rural and remote communities than in urban areas, with a third of the 14,667 community-owned or managed permanent dwellings in these communities requiring major repairs (23%) or replacement (10%) (ABS 2000d).

 

Inadequate and poorly maintained infrastructure adversely affects many Indigenous communities, particularly those in remote and rural areas of Australia. It is recognised that improving basic environmental health conditions, such as access to clean water and adequate sanitation, are critical issues that need to be confronted if better health outcomes for Aboriginal and Torres Strait Islander peoples living in these communities are to be achieved.

Water is a basic necessity, and ready access to safe drinking water is an essential public health requirement. Regular water testing and treatment are necessary to ensure that water is free from microorganisms hazardous to human health (NHMRC 2001). The 1999 CHINS collected information on water treatment and testing from a sample of 233 discrete Indigenous communities that were not connected to a town water supply. Of these, 64 communities (representing a population of approximately 11,100 people) had not had their water tested in the 12 months before the survey. Of those tested, 58 communities (representing a population of approximately 25,300 people) had failed water testing at least once in the same period. Chlorination was the most common type of treatment reported.

Most discrete Indigenous communities had wastewater and sewerage systems, but a high proportion reported problems with these systems and a large number of communities reported unsafe ponding; 204 communities reported sewage overflows or leakage in the 12 months before the 1999 CHINS, some indicating chronic sewerage problems. Methods of wastewater disposal from bathrooms, laundries and kitchens were considered to be undesirable by Australian public health authorities in 41 communities. Ponding, where large pools of stagnant water collect and remain for more than a week, is commonly caused by rain, overflow from blocked drains; and sewage overflows and leakage. It is a major health risk associated with the increased risk of vectorborne diseases (diseases spread by insects such as mosquitoes). Fifty-six communities, representing a population of approximately 13,500 people, reported problems with ponding on five or more occasions during the 12 months before the 1999 survey.

Almost all (93%) discrete communities reported some form of organised rubbish disposal to the 1999 CHINS. Fenced or unfenced tips located on community land were the most commonly reported form of rubbish disposal (62% of communities). A further 18% used rubbish tips located outside community land, and 10% of communities incinerated their rubbish.

Health service provision, access and use

In 1998-99, an estimated $1,245 million was spent on health services by, and for, Aboriginal and Torres Strait Islander peoples (AIHW 2001c). This amount represents 2.6% of total health expenditure by Commonwealth, State and local governments as well as expenditure from private sources such as private health insurance and out-of-pocket expenses. Per capita, $3,065 was spent on each Indigenous person, compared with $2,518 for each other Australian.

Indigenous people experienced lower levels of access to health services than the general population, even though they were twice as likely to be hospitalised. Compared with the general population, Indigenous people are nearly twice as likely to live outside urban centres and are therefore more likely to live further from a range of health services and facilities. A considerable number of the Indigenous communities included in the 1999 CHINS did not receive visits from a wide range of health professionals. Other factors which were likely to influence the level at which Indigenous people accessed health services were the socioeconomic status of patients, the availability of transport, the ability to speak English, and cultural factors such as the availability of same-sex Indigenous health workers (ABS & AIHW 2001).

Box 4.4: Ratio of health expenditure for Indigenous and non-Indigenous Australians

Examining expenditure on health services is one way of understanding the way in which health services are delivered and used. Expenditure reflects not only differing client needs, but differing levels of access and modes of delivery that have developed in response to various policies and strategies. Most government expenditure on Indigenous health is administered through local and State governments.

In 1998–99, an estimated $1,245 million was spent on health services by, and for, Aboriginal and Torres Strait Islander peoples (AIHW 2001c). This amount represents 2.6% of health expenditure for all Australians, but is an estimate only, largely because of the incomplete identification of Indigenous people in many administrative data sets. However, patterns of expenditure from available data indicate clear differences between the Indigenous and other Australian populations in the way that health services are accessed. Greater amounts were spent on Aboriginal and Torres Strait Islander peoples in relation to community and public health services, patient transport, public hospital care (both admitted and non-admitted patient services), and mental health institutions. Lesser amounts were spent through Medicare, the Pharmaceutical Benefits Scheme, high-level residential aged care and private health services than for other Australians.

Overall, for each dollar spent on health services for other Australians, $1.22 was spent on health services for Aboriginal and Torres Strait Islander peoples. Per capita, $3,065 was spent on each Indigenous person, compared with $2,518 for each other Australian.

References

ABS 1998a. Census of housing and population: Aboriginal and Torres Strait Islander people, Australia, 1996. ABS Cat. No. 2034.0. Canberra: ABS.

ABS 1999c. National health survey: Aboriginal and Torres Strait Islander results 1995. ABS Cat. No. 4806.0. Canberra: ABS.

ABS 2000c. Deaths Australia, 1999. ABS Cat. No. 3302.0. Canberra: ABS.

ABS 2000d. Housing and infrastructure in Aboriginal and Torres Strait Islander communities, Australia, 1999. ABS Cat. No. 4710.0. Canberra: ABS.

ABS 2001a. Australian housing survey-Aboriginal and Torres Strait Islander people, 1999. ABS Cat. No. 4712.0. Canberra: ABS.

ABS & AIHW 2001. The health and welfare of AustraliaÕs Aboriginal and Torres Strait Islander peoples, 2001. ABS Cat. No. 4704.0. AIHW Cat. No. IHW 6. Canberra: ABS.

AIHW 2001c. Expenditure on health services for Aboriginal and Torres Strait Islander people 1998-99. AIHW Cat. No. IHW 7. Canberra: AIHW.

AIHW DSRU (Dental Statistics Research Unit) 1995. Commonwealth Dental Health Program: research report 2. Adelaide: AIHW.

AIHW: Brennan DS & Carter KD 1998. Adult access to dental care-Indigenous Australians. AIHW Dental Statistics and Research Series No. 16. AIHW Cat. No. DEN 40. Adelaide: University of Adelaide.

Alberman E 1994. Low birthweight and prematurity. In: Pless IB (ed). The epidemiology of childhood disorders. New York: Oxford University Press.

Anderson P 1996. WHO working group on population levels of alcohol consumption. Addiction 91(2):275-83.

ATSIHWIU (Aboriginal and Torres Strait Islander Health and Welfare Information Unit) 1997. The Aboriginal and Torres Strait Islander health information plan... this time
let's make it happen. AIHW Cat. No. HWI 12. Canberra: AHMAC (Australian Health Ministers' Advisory Council), AIHW & ABS.

Barker DJP & Clark PM 1997. Fetal undernutrition and disease in later life. Reviews of reproduction 2:105-12.

Coory M 2000. Is birthweight an appropriate health-outcome measure for Torres Strait Islander babies? Australian and New Zealand Journal of Public Health 24(1):60-3.

d' Abbs P & MacLean S 2000. Petrol snifÞng in Aboriginal communities: a review of interventions. Darwin: Cooperative Research Centre for Aboriginal and Tropical Health.

Davis J 1998. Alcohol and Aboriginal society: is racism dead in the alcohol and drug Þeld? In: Hamilton M, Dellehear A & Rumbold G (eds). Drug use in Australia: a harm minimisation approach. Melbourne: Oxford University Press.

Endean C, Wooley S & Roberts-Thomson KF (forthcoming). Anangu oral health-the status of the Indigenous population of the Anangu Pitjantjatjara Lands. Proceedings of the 6th National Rural Health Conference, 4-7 March 2001.

English DCH, Milne E, Winter M, Hulse G & Codde J 1995. The quantiÞcation of drug caused morbidity and mortality in Australia 1995. Canberra: AGPS.

Neutze M 1998. Housing and infrastructure for Indigenous Australians. Working Paper No. 65, December. Canberra: Australian National University, Urban Research Program.

NHMRC 2000. Nutrition in Aboriginal and Torres Strait Islander peoples: an information paper. Canberra: NHMRC.

NHMRC 2001. Australian drinking water guidelines: summary. Updated September 2001. Cited 1 February 2002. www.health.gov.au/nhmrc/publications/synopses/eh19syn.htm

O'Dea K 1992. Diabetes in Australian Aborigines: impact of the western diet and lifestyle. Journal of Internal Medicine 232:103-17.

Public Health Services 2001. The 2000 healthy food access basket (HFAB) survey: full report. Queensland: Queensland Health.

Taylor GW, Burt BA, Becker MP et al. 1996. Severe periodontitis and risk for poor glycemic control in patients with non-insulin dependent diabetes mellitus. Journal of Periodontology, October Supplement 1085(92).

Trudgen R 2000. Why warriors lie down and die: towards an understanding of why the Aboriginal people of Arnhem Land face the greatest crisis in health and education since European contact. Darwin: Aboriginal Resource and Development Services Inc.

Unwin E, Thomson N & Gracey M 1994. The impact of tobacco smoking and alcohol consumption on Aboriginal mortality and hospitalisation in Western Australia, 1983-1991. Perth: Health Department of Western Australia.

Waters A 2001. Do housing conditions impact on health inequalities between Australia's rich and poor? Australian Housing and Urban Research Institute, Australian National University. Cited 3 April 2001. www.ahuri.edu.au/pubs/positioning/pp_ausrichpoor.pdf.

This section reproduced with kind permission of the Australian Institute of Health and Welfare, originally published in Australia's health 2002.
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Last updated: 1 August 2005