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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 (such as sight and hearing impairments, difficulties with mobility, or brain damage) and the interaction between the individual's health condition and their 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's 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 . Information about disability among Indigenous people was also 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).23
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 .
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 those among their non-Indigenous counterparts for all age-groups (Table 29). The proportion of Indigenous males needing assistance with core activities was higher than that of 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 |
According to the NATSISS, around 7.9% of all Indigenous people aged 15 years and older had a profound/core activity limitation in 2008 . 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 (Table 30).24 The proportions of Indigenous people with profound/severe core activity limitation were higher than those of non-Indigenous people for all age-groups. Higher proportions of Indigenous people required assistance with a core activity from a younger age (45 years and older) than did non-Indigenous people (55 years and older).
|Source: AIHW, 2013 |
The proportion of profound/core activity restriction among Indigenous people varied slightly with the remoteness of residence in 2008 . 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 .25 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 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 .
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 .
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).
In 2010-11, around 41% of the Indigenous potential population26 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: SCRGSP, 2013 |
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: SCRGSP, 2013 |