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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 . 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 . 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)’ .
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 also collects details about a person's need for assistance with core activities . Information about disability at a population level is also collected in Australia's five-yearly censuses  and information about disability among Indigenous people was collected in the 2008 NATSISS . Being based on self-reported information, each of these sources has limitations in capturing precise estimates of disability. This is particularly true for Indigenous people, whose level of participation in surveys and censuses is lower than that of non-Indigenous people . The level of response among Indigenous people in the 2006 Census to the questions related to disability was lower than that for non-Indigenous people. Also, some Indigenous people 'find the concept of disability hard to understand or irrelevant' (, p.532).38 Despite these limitations, it is clear that disability is a serious issue for Indigenous people: about 50% of Indigenous people aged 15 years and over reported a disability or a long-term health condition in 2008 . The greater burden of disability experienced by Indigenous people is associated with poorer physical and mental health, increased exposure to risk factors, and higher levels of socio-economic disadvantage .
The 2012 SDAC reported that for Indigenous people the crude disability rate was 23% in 2012, a slight increase on 21% in 2009 . The overall disability rates for Indigenous males and females were not significantly different (25% and 22% respectively). The disability rate for Indigenous boys aged 0-14 years old (21%) was 2.5 times higher than the comparable rate for girls (8.5%).
Indigenous people had higher rates of disabilities than non-Indigenous people across all age groups and for both males and females. Indigenous children aged 0-14 years were more than twice as likely as non-Indigenous children to have a disability (15% compared with 6.6%) . Indigenous people aged 35-54 years old were 2.7 times as likely as non-Indigenous people of the same age to have a disability (38% compared with 14%). After age-adjustment, Indigenous people were 1.7 times as likely as non-Indigenous people to be living with disability.
According to counts collected by the ABS as part of the 2011 Census, around 29,559 Indigenous people (5.4%) needed assistance with core activities (i.e. had a profound/core activity restriction) . The need for assistance with core activities generally increased with age among both Indigenous and non-Indigenous people, with the proportions requiring assistance higher among Indigenous people than among their non-Indigenous counterparts for all age-groups (Table 30). The proportion of Indigenous males needing assistance with core activities was higher than for Indigenous females up to the 65 years and older age-group, but the reverse was true beyond that age.
|Source: Derived from ABS, 2013 , ABS, 2001 |
The 2012 SDAC reported that Indigenous people had a significantly higher overall need for assistance compared with non-Indigenous people (63% compared with 60%) . Indigenous people were almost twice as likely to require assistance with communication compared with non-Indigenous people (11.3% compared with 6.6%) and they were more likely to need assistance with cognitive or emotional tasks (29% compared with 22%). The proportions of Indigenous people with profound/severe core activity limitation were 1.7 times higher than for non-Indigenous people for all age-groups; 7.8% of Indigenous 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. Higher proportions of Indigenous people required assistance with a core activity from a younger age (45 years and older) than non-Indigenous people (55 years and older). After age-adjustment, Indigenous people living in non-remote areas were more than twice as likely as their non-Indigenous counterparts to have a need for assistance with core activities.39
In 2008, the proportion of profound/core activity restriction among Indigenous people varied slightly with the remoteness of residence . The highest proportions of Indigenous people with a profound/severe core activity restriction were in major cities (9.0%) and very remote areas (8.9%); the lowest proportion was in remote areas (6.7%).
There were differences in the proportions by state and territory of Indigenous people living in non-remote areas with profound/core activity restrictions in 2008 .40 After age-adjustment, the proportions were highest among Indigenous people living in Tas (16%) and SA (13%); the lowest proportion was in Qld (7.5%). Proportions among non-Indigenous people were consistently between 4.5% to 5.0% in all states and territories, with Indigenous:non-Indigenous ratios ranging from 3.3 in Tas to 1.6 in WA.
The 2008 NATSISS provided information on broad categories of types of disability: sight/hearing/speech; physical; intellectual; psychological; type not specified . Among Indigenous people aged 15 years and over, 33% reported a physical disability, 17% reported a disability affecting sight/hearing/speech, and 7.7% reported an intellectual disability . In 2012-13, physical disability was the most common disability type for Indigenous adults living in non-remote areas (32%) followed by ‘sight, hearing, speech’ (20%) .
Increasing the access to disability services for the Indigenous 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 Indigenous people with disability . The National Indigenous access framework forms part of the NDA and aims to ensure that the needs of Indigenous people with disability are addressed through accessible and appropriate service delivery . NDA services include accommodation support, community support, community access, respite and employment services .
Some Indigenous people face significant barriers to access disability support services, due to social marginalisation, concern about approaching government agencies, differences in cultural attitudes towards disability and services that are culturally aware .
In 2010-11, around 41% of the Indigenous potential population41 aged 0-64 years used NDA disability support services provided by the states and territories (Table 31) . The highest proportions of disability support service use by the Indigenous potential population were in SA (66%), followed by the ACT (65%). The proportion of the Indigenous potential population requiring support services has increased steadily since 2008-09.
|Source: Steering Committee for the Review of Government Service Provision, 2013 |
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 Indigenous 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' (, p.14-18).
The NDA specialist disability support service most commonly used by Indigenous people in 2010-11 was community support services (36% of the potential population) (Table 32) . A higher proportion of Indigenous people than non-Indigenous people used community support services.
|Type of specialist service||Indigenous||Non-Indigenous||Ratio|
|Source: Steering Committee for the Review of Government Service Provision, 2013 |
After age-adjustment, Indigenous 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 . Indigenous 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). In 2012, Indigenous 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 Indigenous people with a disability was nearly three times as high as the comparable rate for non-Indigenous people with a disability (25.3% compared with 9.0%).