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Concluding comments

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Concluding comments

It is clear from this Overview that Indigenous people remain the least healthy sub-population in Australia. Being a 'snapshot' of the most recent indicators of health status – with limited attention to trends – the Overview doesn't, however, fully reflect the evidence that the health status of Australia's Indigenous people continues to improve slowly.

For a start, there is evidence of reductions in mortality in recent years in a number of jurisdictions.1 Age-standardised death rates for Indigenous people living in WA, SA and the NT, the only jurisdictions with adequate data quality for long-term analysis, declined by around 33% over the 20-year period 1991-2010 [1]. The gap in death rates between Indigenous and non-Indigenous people declined significantly both absolutely and relatively over that period. Much of the decline appears to have been in the first half of the 20-year period, however, as the pattern in WA, SA and the NT in 2001-2010 has been very similar to that documented for NSW, Qld, WA, SA and the NT combined, for which jurisdictions the rates declined by only 5%.

The most recent estimates of life expectancy at birth for Indigenous people – 69.1 years for males and 73.7 years for females in 2010-2012 – are higher than previous estimates, but, as the ABS warns, the apparent improvements are likely to be due largely to revised statistical methods [2].2

Indigenous infant mortality rates for WA, SA and the NT declined significantly over the 20-year period 1991-2010 [1]. The Indigenous rate declined by 62% over that period, slightly more than the 43% decline of the rate for non-Indigenous infants. The gap between Indigenous and other infants closed significantly, both absolutely (67%) and relatively (35%).

The long-term declines in infant mortality rates have occurred despite the lack of parallel changes in the birthweights of babies born to Indigenous mothers – the mean weight of babies born in 2011 to Indigenous mothers was still around 190 grams less than the weights of babies born to non-Indigenous mothers [3].

In terms of specific health conditions, substantial improvements have occurred in the overall impact of many infectious diseases (partly due to immunisation programs) including:

There have also been improvements in a number of areas contributing to health status:

There is no doubt other evidence of improvement in some measures of health status and of deterioration in others. But, clearly, the gap between the health status of Indigenous people and that of other Australians is still very wide.

Despite the important advances that have been made in recent years in both the extent and quality of information about the health of Indigenous people, it will be very obvious to readers of this version of the Overview that there is substantial scope for further improvement. Such information is crucial for both policy and strategy development and for monitoring progress towards the various targets set recently as a part of the COAG commitments to 'closing the gap' in health between Indigenous and other Australians (see below) [18].

In view of the commitments made in December 2007 by all Australian governments, through the COAG,3 to 'closing the gap' in disadvantage between Indigenous and other Australians [19], the need for reliable, up-to-date, comprehensive information about the health of Indigenous people is more important than ever. The 'closing the gap' commitments were stimulated by the Social justice report 2005, which highlighted the vast gap between the health of Indigenous and other Australians and called on Australian governments to commit to achieving Indigenous health equality within 25 years [20].4

Following the release of the report, 40 of Australia's leading Indigenous and non-Indigenous health peak bodies and human rights organisations joined forces to launch a campaign to 'close the gap' on health inequality [21]. In December 2006, the Coalition published an open letter to the Prime Minister, the State Premiers and Territory Chief Ministers, parliamentarians and the Australian public calling for an end to Indigenous health inequality. The Closing the gap campaign was launched in April 2007.

The Indigenous Health Summit, held in March 2008, concluded with the Prime Minister issuing, on behalf of the Australian Government and the Indigenous peoples of Australia, a statement of intent 'to work together to achieve equality in health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by the year 2030' ([22], p.1).

In March 2008, the Prime Minister also announced establishment of the National Indigenous Health Equality Council,5 which 'advises the [Australian Government's] Minister for Health and Ageing… on the achievement of equitable and sustainable health outcomes for Aboriginal and Torres Strait Islander peoples' ([23], p.546).

Reflecting the increased attention directed to Indigenous reform, it is now a standing item on all COAG meetings. As a part of its deliberations about Closing the gap, COAG has agreed on a number of specific targets for reducing Indigenous disadvantage in the areas of education, early childhood development, health and employment. The targets are to [24]:

In addressing these targets, COAG, through the Australian and state and territory governments, allocated $4.6 billion over four years across early childhood development, health, housing, economic participation, and remote service delivery. COAG also achieved a number of supportive commitments by the corporate and community sectors [24]. This is the first time that such a high level of commitment has been made by the Australian, state and territory governments and others, raising the possibility of substantial reductions in the health and other disadvantages experienced by Indigenous people.

As encouraging as these commitments are, achievement of substantial improvements in the health and wellbeing of Indigenous people will depend largely on the effective implementation of comprehensive strategies and policies that address the complexity of the factors underlying the disadvantages experienced by Indigenous people.

Importantly, effective, integrated comprehensive strategies and policies will need to be sustained for a long period of time, as improvements to the extent set in the various targets will not occur in the short-term. The timeframes for the Closing the gap targets suggest there is some awareness by governments of the enormity of the challenge, but the real test will be to sustain the commitments through changing political and economic cycles.


  1. Reflecting the uncertainty and probable variation in the levels of under-identification of Indigenous status, some caution should be exercised in assessing trends in death rates.
  2. A variety of techniques has been developed by demographers to estimate life expectancy in instances where registration of deaths is incomplete. This is effectively the case with Indigenous deaths: even though very few Indigenous deaths will not be registered, many Indigenous deaths are not correctly identified as such.
  3. COAG is 'the peak intergovernmental forum in Australia, comprising the Prime Minister, State Premiers, Territory Chief Ministers and the President of the Australian Local Government Association (ALGA)'.
  4. The Social justice report is an annual report of the Australian Human Rights Commission's Aboriginal and Torres Strait Islander Social Justice Commissioner.
  5. The Council was re-named National Aboriginal and Torres Strait Islander Health Equality Council in August 2011.
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