Australian Indigenous HealthInfoNet
http://www.healthinfonet.ecu.edu.au

 

The context of Aboriginal and Torres Strait Islander health

  • Home
    • » Health facts
      • » Overview of Australian Aboriginal and Torres Strait Islander health status 2015
        • » The context of Aboriginal and Torres Strait Islander health

The context of Aboriginal and Torres Strait Islander health

Historical context and social determinants of Aboriginal and Torres Strait Islander health

Aboriginal and Torres Strait Islander people are the original first peoples of the country. Aboriginal people are distinctively different ethnically and culturally from Torres Strait Islander people [1].

Aboriginal people in Australia are recognised among the oldest living cultures in the world with estimates ranging from 50,000 to 120,000 years [2]. They occupied the mainland and some surrounding islands of what is now Australia. They enjoyed a semi-nomadic lifestyle in family or community groups. Around 260 language groups coexisted each with their own customs and cultural practices.

Torres Strait Islander people have lived on the 270 or so islands in the straits between Australia and Papua New Guinea for approximately 2,500 years [2]. Today in addition to living in other parts of Australia, they continue to live on 17 of the islands with two communities on the far northern Queensland coast. Community life was based on hunting, fishing, gardening and trading. Being located in the Torres Strait they have traditionally had close contact with Papuan New Guinean communities and Australian Aboriginal communities.

Despite their differences, Aboriginal and Torres Strait Islander people have had many shared experiences since colonisation including dispossession, marginalisation and racism, and the Stolen Generations, that have had a significant impact on health outcomes to the present day.

The historical context of Aboriginal and Torres Strait Islander health

There is an indisputable relationship between the enduring impact of colonisation and current health status of Aboriginal and Torres Strait Islander people [2][3][4][5][6]. This relationship has also been defined as the historical determinants of health [7]. Social disadvantages, directly related to dispossession and characterised by poverty and powerlessness, are reflected in measures of education, employment, income and incarceration. Aboriginal and Torres Strait Islander people generally enjoyed better health in 17881 than most people living in Europe at that time [8][9][10][11][12]. They did not suffer from smallpox, measles, influenza, tuberculosis, scarlet fever, venereal syphilis and gonorrhoea; diseases that were common in 18th century Europe. Indigenous people probably suffered from hepatitis B, some bacterial infections (including a non-venereal form of syphilis and yaws2 and some intestinal parasites. Trauma is likely to have been a major cause of death, and anaemia, arthritis, periodontal disease, and tooth attrition are known to have occurred. The impact of these diseases at a population level was relatively small compared with the effects of the diseases that affected 18th century Europe.

All of this changed after 1788 with the arrival of introduced illness from non-Indigenous people, initially smallpox and sexually transmissible infections (gonorrhoea and venereal syphilis), and later tuberculosis, influenza, measles, scarlet fever, and whooping cough [9][10][13][14]. These diseases, particularly smallpox, caused considerable loss of life among Aboriginal and Torres Strait Islander populations, but the impacts were not restricted to the immediate victims. The epidemic also affected the fabric of Aboriginal and Torres Strait Islander societies through depopulation and social disruption.

The impact of introduced diseases was almost certainly the major cause of death for Aboriginal and Torres Strait Islander people, but direct conflict and occupation of Indigenous homelands by non-Indigenous people also contributed substantially to Aboriginal and Torres Strait Islander people’s mortality [13][15][16][17]. The initial responses of Aboriginal and Torres Strait Islander people to the arrival of the First Fleet were apparently quite peaceful. It didn't take long, however, before conflict started to occur - initially over access to fish stocks and then over access to other resources as non-Indigenous people started to plant crops and introduce livestock. This pattern of conflict was almost certainly widespread as non-Indigenous people spread across the country.

A number of identifiable periods define the process of colonisation since settlement all of which have had profound implications for the health and wellbeing of Aboriginal and Torres Strait Islander people [4]. Sherwood describes the early but enduring experiences of dispossession, conflict, protectionism, removal of children and assimilation and the more contemporary impacts of self-determination, the intervention, and the apology by former Prime Minister, Kevin Rudd in 2008 ([4], pp.31-36). These issues continue to impact on the health outcomes and prospects for Aboriginal and Torres Strait Islander people, in both policy and practice.

The importance of contemporary social determinants and cultural concepts of Aboriginal and Torres Strait Islander health

The international literature unequivocally attests to the impact of what have become known as the social determinants of health on health outcomes [5][6][7][18]. The social (and cultural) determinants of Aboriginal and Torres Strait Islander health include socioeconomic status, employment, poverty, housing, education, racism, trauma, stressful life events and access to community resources [7]. Gee et al [7]note that these factors are concurrent and cumulative and cannot be considered in isolation. It is also crucial to direct a reflective gaze on the persisting impact of colonisation on contemporary health care practices and to ensure that invoking the social determinants of health does not obscure the important culturally bound understanding of these determinants [4]. It is also important to understand that for Aboriginal and Torres Strait Islander people health is a holistic concept. There was no separate term in Indigenous languages for health as it is understood in western society [19]. It encompasses everything important in a person's life, including land, environment, physical body, community, relationships, and law. Health is the social, emotional, and cultural wellbeing of the whole community and the concept is therefore linked to the sense of identity and being.

The shift to strengths based approaches

In recent years there has been a marked shift in the rhetoric and the use of language to describe the experiences of Aboriginal and Torres Strait Islander people in a range of areas including health. It is now widely recognised that there is a need to shift from ‘deficit’ thinking to more strengths-based approaches. In response to calls from the community many authoritative institutions and organisations have made public commitments to promote strengths based approaches in the public discourse on Aboriginal and Torres Strait Islander issues [20][21]. For example the National Aboriginal and Torres Strait Islander health plan 2013-2023 defines a strengths based approach:

A strengths based approach views situations realistically and looks for opportunities to complement and support existing strengths and capacities as opposed to a deficit-based approach which focusses on the problem or concern. ([22], p.50-51)

Similarly the Overcoming Indigenous disadvantage report (2014) declares a ‘greater focus on strengths-based reporting with a reframing from ‘overcoming disadvantage’ to ‘improving wellbeing’ ([21], p.94). The report also offers some relatively simple actions that have the capacity to shift the narrative in published materials from a deficit focus to a strengths focus including:

Shifting from a deficit to a strengths based approach has the capacity to:

In relation to Aboriginal and Torres Strait Islander health there is increased recognition of the importance of a number of culturally determined ‘health protecting factors’ including connection to land, culture, spirituality and ancestry; kinship and; self-determination, community governance and cultural continuity ([6], pp.104-105). Strengths based approaches embrace and endorse strategies, programs and policies that embody these health protective factors. It is also very important for strengths based approaches to adopt a decolonising agenda; ‘why it is important that we all employ a more open and decolonising gaze’ ([4], p. 29).

Indicators of Aboriginal and Torres Strait Islander social disadvantage

The key measures in these areas for Aboriginal and Torres Strait Islander people nationally include:

Education

According to the 2011 Australian Census [24]:

An ABS school report [25] revealed, in 2013:

The 2015 national report on schooling in Australia [26] showed:

Employment

According to the 2011 Australian Census [24]:

Income

The median real equivalised4 gross weekly household income for Aboriginal and Torres Strait Islander households in 2011-13 was $465 compared with $869 for non-Indigenous households [21].

Aboriginal and Torres Strait Islander population

Based on information from the 2011 Australian Census, the ABS has estimated the Aboriginal and Torres Strait Islander population at 729,048 on 30 June 2015 [27](Table 1). The Aboriginal and Torres Strait Islander population accounted for 3.0% of Australia’s total population of 24 million [27][28]. The estimation for the Aboriginal and Torres Strait Islander population in NSW is the highest (225,349 people), followed by Qld (208,026), WA (95,707), and the NT (73,396) (Table 1). The NT has the highest proportion of Aboriginal and Torres Strait Islander people among its population (29.7%) and Vic the lowest (0.9%).

Table 1: Estimated Indigenous population, by jurisdiction, Australia, 30 June 2015

Jurisdiction

Indigenous population (number)

Proportion of Australian Indigenous population (%)

Proportion of jurisdiction population (%)

NSW

225,349

31

3.0

Vic

52,299

7.2

0.9

Qld

208,026

29

4.3

WA

95,707

13

3.5

SA

40,646

5.6

2.4

Tas

26,440

3.6

5.1

ACT

6,902

0.9

1.7

NT

73,396

10

30

Australia

729,048

100.0

3.0

Note: Australian population includes Jervis Bay Territory, the Cocos (Keeling) Islands, and Christmas Island
Source: Derived from ABS, 2014 [27], ABS, 2013 [28]

There was a 21% increase in the number of Aboriginal and Torres Strait Islander people counted in the 2011 Census compared with the 2006 Census [29].5 The largest increases were in the ACT (34%), Vic (26%), NSW (25%) and Qld (22%) [30]. For all jurisdictions, the 55 years and over age-group showed the largest relative increase (i.e. the Indigenous population is ageing) [31]. There are a number of 'structural' reasons contributing to the growth of the Indigenous population:

Three other factors are considered likely to have contributed to the increase in the Indigenous population in the 2011 Census [31]:

In 2015, around 35% of Aboriginal and Torres Strait Islander people (256,056 people) lived in major cities, 45% (324,886 people) lived in inner and outer regional areas, and 20% (148,106) lived in remote and very remote areas [27].

In terms of specific geographical areas, more than one-half (53%) of all Aboriginal and Torres Strait Islander people counted in the 2011 Census lived in nine of the 57 Indigenous regions6 [32]. In 2015, the largest projected populations were in three regions in eastern Australia (Brisbane, NSW Central and the North Coast, and Sydney-Wollongong), which accounted for 29% of the total Aboriginal and Torres Strait Islander population [27].

According to the 2011 Census, around 90% of Indigenous people are Aboriginal, 6% are Torres Strait Islanders, and 4% people identified as being of both Aboriginal and Torres Strait Islander descent [32]. Around 63% of Torres Strait Islander people 7 lived in Qld; NSW was the only other state with a large number of Torres Strait Islander people.

The Aboriginal and Torres Strait Islander population is much younger overall than the non-Indigenous population (Figure 1) [33]. According to estimates from the 2011 Census, at 30 June 2011 about 36% of Aboriginal and Torres Strait Islander people were aged less than 15 years, compared with 18% of non-Indigenous people. About 3.4% of Aboriginal and Torres Strait Islander people were aged 65 years or over, compared with 14% of non-Indigenous people.

Figure 1. Population pyramid of Aboriginal and Torres Strait Islander and non-Indigenous populations, 30 June 2011

Population pyramid of Indigenous and non-Indigenous populations, 30 June 2011

Source: ABS, 2012 [33]

References

  1. NSW Department of Health (2004) Communicating positively: a guide to appropriate Aboriginal terminology. Sydney: NSW Department of Health
  2. Dudgeon P, Wright M, Paradies Y, Garvey D, Walker I (2014) Aboriginal social, cultural and historical contexts. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed. Canberra: Department of The Prime Minister and Cabinet: 3-24
  3. Parker R, Milroy H (2014) Aboriginal and Torres Strait Islander mental health: an overview. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed. Canberra: Department of The Prime Minister and Cabinet: 25-38
  4. Sherwood J (2013) Colonisation - it's bad for your health: the context of Aboriginal health. Contemporary Nurse; 46(1): 28-40
  5. Zubrick SR, Holland C, Kelly K, Calma T, Walker R (2014) The evolving policy context in mental health and wellbeing. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd edition ed. Canberra: Department of The Prime Minister and Cabinet: 69-90 (chapter 5)
  6. Zubrick SR, Shepherd CCJ, Dudgeon P, Gee G, Paradies Y, Scrine C, Walker R (2014) Social determinants of social and emotional wellbeing. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd edition ed. Canberra: Department of The Prime Minister and Cabinet: 93-112 (chapter 6)
  7. Gee G, Dudgeon P, Schultz C, Hart A, Kelly K (2014) Aboriginal and Torres Strait Islander social and emotional wellbeing. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed. Canberra: Department of The Prime Minister and Cabinet: 55-68
  8. Jackson LR, Ward JE (1999) Aboriginal health: why is reconciliation necessary?. Medical Journal of Australia; 170(9): 437-440
  9. Butlin NG (1993) Economics and the dreamtime : a hypothetical history. Melbourne: Cambridge University Press
  10. Campbell J (2002) Invisible invaders: smallpox and other diseases in Aboriginal Australia 1780-1880. Melbourne: Melbourne University Press
  11. Webb S (2009) Palaeopathology of Aboriginal Australians: health and disease across a hunter-gatherer continent. Cambridge: Cambridge University Press
  12. Anderson W (2007) The colonial medicine of settler states: comparing histories of Indigenous health. Health and History; 9(2): 144-154
  13. Butlin NG (1983) Our original aggression : Aboriginal populations of southeastern Australia, 1788-1850. Sydney: Allen & Unwin
  14. Thomson N (1991) Tuberculosis among Aborigines. In: Proust AJ, ed. History of tuberculosis in Australia, New Zealand and Papua New Guinea. Canberra, ACT: Brolga Press: 61-67
  15. Reynolds H (1982) The other side of the frontier: Aboriginal resistance to the European invasion of Australia. Ringwood, Victoria: Penguin Books
  16. Elder B (2003) Blood on the wattle: massacres and maltreatment of Aboriginal Australians since 1788. 3rd ed. Frenchs Forest, N.S.W: New Holland
  17. Harrison B (1978) The Myall Creek massacre. In: McBryde I, ed. Records of times past : ethnohistorical essays on the culture and ecology of the New England tribes. Canberra: Australian Institute of Aboriginal Studies: 17-51
  18. Parker R, Milroy H (2014) Mental illness in Aboriginal and Torres Strait Islander peoples. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed. Canberra: Department of The Prime Minister and Cabinet: 113-124
  19. National Aboriginal Health Strategy Working Party (1989) A national Aboriginal health strategy. Canberra: Department of Aboriginal Affairs
  20. Haswell MR, Blignault I, Fitzpatrick S, Jackson Pulver L (2013) The social and emotional wellbeing of Indigenous youth: reviewing and extending the evidence and examining its implications for policy and practice. Sydney: Muru Marri, University of New South Wales
  21. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  22. Australian Department of Health and Ageing (2013) National Aboriginal and Torres Strait Islander Health Plan 2013-2023. Canberra: Australian Department of Health and Ageing
  23. Nakata M (2013) The rights and blights of the politics in Indigenous higher education. Anthropological Forum; 23(3): 289-303
  24. Australian Bureau of Statistics (2012) Census of population and housing: characteristics of Aboriginal and Torres Strait Islander Australians, 2011. Canberra: Australian Bureau of Statistics
  25. Australian Bureau of Statistics (2014) Schools, Australia, 2013. Canberra: Australian Bureau of Statistics
  26. Australian Curriculum Assessment and Reporting Authority (2015) National Assessment Program - Literacy and Numeracy achievement in reading, persuasive writing, language conventions and numeracy: national report for 2015. Sydney: Australian Curriculum, Assessment and Reporting Authority
  27. Australian Bureau of Statistics (2014) Estimates and projections, Aboriginal and Torres Strait Islander Australians, 2001 to 2026. Canberra: Australian Bureau of Statistics
  28. Australian Bureau of Statistics (2013) Population projections, Australia, 2012 (base) to 2101. Canberra: Australian Bureau of Statistics
  29. Biddle N (2012) CAEPR Indigenous population project 2011 census papers: population and age structure. Canberra: Centre for Aboriginal Economic Policy Research
  30. Yap M, Biddle N (2012) Indigenous fertility and family formation: CAEPR Indigenous population project: 2011 census papers. Canberra: Centre for Aboriginal Economic Policy Research
  31. Biddle N (2013) CAEPR Indigenous population project 2011 census papers: population projections. Canberra: Centre for Aboriginal Economic Policy Research
  32. Australian Bureau of Statistics (2012) Census of population and housing - counts of Aboriginal and Torres Strait Islander Australians, 2011. Canberra: Australian Bureau of Statistics
  33. Australian Bureau of Statistics (2012) Australian demographic statistics, March quarter 2012. Canberra: Australian Bureau of Statistics

Endnotes

1. The first Australian colony was formally proclaimed in 1788.

2. Yaws is a bacterial infection of the skin, bones and joints.

3. Factors that may account for retention rates exceeding 100% include international migration, students repeating a year of education, students changing between full-time and part-time study and age requirements for participation in education.

4. Equivalised household income adjusts the actual incomes of households to make households of different sizes and compositions comparable.

5. There is a difference between the census 'counts' and 'estimates'. The 'estimates' adjust for a number of factors and are more accurate.

6. Indigenous regions are large geographical units loosely based on the former Aboriginal and Torres Strait Islander Commission boundaries.

7. Includes people who identified as Torres Strait Islanders and those who identified as being of both Aboriginal and Torres Strait Islander descent.

 
© 2001-2016 Australian Indigenous HealthInfoNet