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Summary of Australian Indigenous health ©

2008

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• Introduction
• What is known about the Indigenous population?
• What is known about Indigenous births?
• What is known about Indigenous deaths?
• Specific health conditions
  • What is known about cardiovascular disease (CVD) in the Indigenous population?
  • What is known about cancer in the Indigenous population?
  • What is known about diabetes in the Indigenous population?
  • What is known about kidney disease in the Indigenous population?
  • What is known about injury in the Indigenous population?
  • What is known about respiratory disease in the Indigenous population?
  • What is known about communicable diseases in the Indigenous population?
  • What is known about eye health in the Indigenous population?
  • What is known about ear conditions in the Indigenous population?
  • What is known about oral health in the Indigenous population?
  • What is known about skin infections and infestations in the Indigenous population?
• What is known about factors contributing to ill-health in the Indigenous population?
• Summary
• References

Introduction

This summary includes facts about common health problems and risk factors among Australian Indigenous peoples. More detailed information about the health of Indigenous peoples, associated social and economic circumstances, and risk factors, is available from the HealthInfoNet's website (www.healthinfonet.ecu.edu.au).

What is known about the Indigenous population?

There were almost 517,200 Indigenous people living in Australia in 2006 (around 463,900 Aboriginal people, 33,100 Torres Strait Islanders, and 20,200 people of both Aboriginal and Torres Strait Islander descent) [1]. Indigenous people comprise 2.5% of the total Australian population. More than one-quarter of Indigenous people live in each of New South Wales (NSW) and Queensland (Qld), more than one-seventh in Western Australia (WA), and around one-eighth in the Northern Territory (NT). The NT has the highest percentage of Indigenous people among its population and Victoria (Vic) the lowest. Most Torres Strait Islander people live in Queensland , with NSW the only other state with a large number of Torres Strait Islanders.

Almost 32 out of 100 Indigenous people live in major cities, 21 out of 100 in inner regional areas, 22 out of 100 in outer regional areas, 10 out of 100 in remote areas, and 16 out of 100 in very remote areas [1] .

The Indigenous population is much younger overall than the non-Indigenous population [1] . According to the 2006 Australian census, about 37 out of 100 Indigenous people were aged less than 15 years, compared with 19 out of 100 non-Indigenous people. About 3 out of 100 Indigenous people were aged 65 years or over, compared with 13 out of 100 non-Indigenous people.

These figures are preliminary estimates of the Indigenous estimated resident populations based on the 2006 census counts. It is anticipated that the final estimates will be available in mid 2008, along with projections for 2007 and later years.

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What is known about Indigenous births?

In 2006, there were 12,496 births registered in Australia where one or both parents were Indigenous (five out of every one hundred births) [2]. Overall, Indigenous women had more children and had them at younger ages than did non-Indigenous women.

Based on the pattern of births in recent years, Indigenous women would have, on average, around 2.1 births in their lifetime, compared with 1.8 births for non-Indigenous women [2]. Almost 52 out of 100 Indigenous mothers were 24 years or younger when they had their babies, compared with 18 out of 100 non-Indigenous mothers. Almost 21 in 100 Indigenous mothers were teenagers, compared with four in 100 non-Indigenous mothers.

In 2005, babies born to Indigenous women on average weighed 217 grams less than those born to non-Indigenous women [3]. Babies born to Indigenous women were more than twice as likely to be of low birthweight (less than 2,500 grams) than were those born to non-Indigenous women. (Low birthweight can increase the risk of health problems.)

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What is known about Indigenous deaths?

Indigenous people are much more likely to die before they are old than people in the rest of the Australian population [4] . Estimates from the Australian Bureau of Statistics (ABS) indicate that an Indigenous male born in the period 1996-2001 could be expected to live to 59 years, which is around 17 years less than a male in the total population at that time (who could expect to live 76.5 years). In the same period, an Indigenous female could be expected to live to 65 years, which is around 17 years less than a woman in the total population (82 years).

In 2006, there were 2,279 people who died and were identified as Indigenous [4] . Many Indigenous deaths are incorrectly identified as non-Indigenous — the actual number of Indigenous deaths is likely to be more than 4,100.

Death rates relate the numbers of deaths to the total numbers of people. After taking account of the fact that the Indigenous population is much younger overall than the non-Indigenous population and that many Indigenous deaths are not identified as such, the death rates for Indigenous males and females are likely to be around four times higher than those of their non-Indigenous counterparts [5].

Indigenous babies are more likely to die in their first year than non-Indigenous babies [4]. In 2004-2006, the infant mortality rate for Indigenous babies was highest in the NT (almost 17 babies died out of 1,000 births) and WA (12 babies died out of 1,000 births) and lowest in NSW (8 babies died out of 1,000 births). (The rate for the total Australian population was 5 deaths per 1,000 births.)

The leading causes of death in 2000-2004 for Indigenous people living in Qld, WA, SA and the NT were: cardiovascular disease (including heart disease and strokes); injuries (including transport accidents, self-harm and assault) and cancer [6]. (More information about these causes of death is provided below).

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Specific health conditions

What is known about cardiovascular disease (CVD) in the Indigenous population?

In the 2004-2005 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), almost one-in-eight Indigenous people reported having a long-term heart or related condition [7]. Heart and related conditions are around 1.3 times more common for Indigenous than for non-Indigenous people, with high blood pressure, the most commonly reported condition being 1.5 times more common.

CVD was the leading cause of death for Indigenous people living in Queensland, WA, SA and the NT in 2000-2004, with deaths from CVD being around three times more common for Indigenous people than for non-Indigenous people [8]. Indigenous people are much more likely to die from CVD than other Australians at any age, but particularly in younger age groups.

Heart attacks and closely related conditions caused more than three-fifths of the deaths from CVD of Indigenous males and around one-half of those of Indigenous females [8]. Strokes caused almost one-in-six of the deaths from CVD of Indigenous males and around one-in-five of those of Indigenous females.

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What is known about cancer in the Indigenous population?

It is not known just how many Indigenous people develop cancer, but notifications of new cases have been less common for Indigenous people than for non-Indigenous people in recent years [9]. It is likely, however, that much of this difference is because some notifications do not correctly identify the person as Indigenous [9].

In contrast to the relative frequency of cancer notifications, deaths from cancer are generally more common for Indigenous people living in Qld, WA, SA and the NT people than for non-Indigenous people living in those states [9].

In 1999-2003, the greatest differences in death rates from cancer in Qld, WA, SA and the NT were in the older age groups 35-64 years, where deaths from cancer were up to twice as common for Indigenous people than for non-Indigenous people [9].

The leading causes of Indigenous cancer deaths include cancers of the digestive organs and lung cancer [9, 10]. Smoking-related cancers are more common among Indigenous people than among non-Indigenous people. Cervical cancer is more common among Indigenous women than among non-Indigenous women, but breast cancer is less common.

The fact that Indigenous people are more likely than non-Indigenous people to die from cancer could be because the cancers they develop (such as cancers of the lung and liver) are more likely to be fatal, or that the stage of cancer may be more advanced by the time it is recognised [5, 9, 11].

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What is known about diabetes in the Indigenous population?

Diabetes is a major health problem among Indigenous people, but it is difficult to know just how many Indigenous people have the disease. Diabetes was reported by 6% of Indigenous people in the 2004-2005 NATSIHS, with the condition being more common among people living in remote areas (95) than among those living in non-remote areas (5%) [7]. Overall, diabetes is around three-and-a-half times more common among Indigenous people than among other Australians.

Only around one-half of people with diabetes know they have the condition, so the levels reported in the 2004-2005 NATSIHS are similar to the estimate made in a major review of evidence from a variety of studies that concluded that the overall prevalence among Indigenous people was between 10% and 30% [12].

Deaths from diabetes were seven to 10 times more common for Indigenous people than for non-Indigenous people living in Qld, WA, SA and the NT in 1999-2003 [9]. For people aged 35-54 years, deaths from diabetes were 23 times more common for Indigenous males than for non-Indigenous males, and 37 times more common for Indigenous females than for non-Indigenous females.

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What is known about kidney disease in the Indigenous population?

Kidney disease is a very serious health problem for many Indigenous people. End-stage renal disease (ESRD), which occurs when the kidneys are no longer able to function, is much more common for Indigenous people than for non-Indigenous people across most of the country [13].

ESRD occurs at younger ages among Indigenous people than among non-Indigenous people - almost three-fifths of the Indigenous people diagnosed with the disease in 2003-2006 were aged less than 55 years compared with less than the one-third of non-Indigenous people diagnosed in that period [Derived from 13]. After taking account of the fact that the Indigenous population is younger overall than the non-Indigenous population (see ‘What is known about the Indigenous population?’), notifications of ESRD were almost nine times more common for Indigenous people than for non-Indigenous people in 2003-2006 [Derived from 13] . The highest rates were for Indigenous people living in the NT (2,431 per 1,000,000), WA (1,097), SA (927) and Qld (890). Notifications were 25 times more common for Indigenous people living the NT and 11 times more common for those living in WA than for non-Indigenous people Australia-wide.

Dialysis (a treatment for ESRD, in which the work of the kidneys is done artificially) accounted for more than one-third of all hospital admissions among Indigenous people in 2005-06 (many of these involved repeat admissions for the same people, some on an almost daily basis) [14]. Indigenous people were more than 12 times more likely to be hospitalised for dialysis than non-Indigenous people.

In recent years, almost one-half of all Indigenous ESRD patients come from regions without dialysis or transplant facilities, and around one-in-six from regions with only satellite dialysis facilities [15].

For the period 1999-2003, deaths from chronic kidney disease were up to 10 times more common for Indigenous people than for non-Indigenous people living in Qld, WA, SA and the NT [9]. The greatest differences between Indigenous and non-Indigenous people occurred in the 25-34 and 45-54 age groups, for which groups deaths from chronic kidney disease were between 30 and 40 times more common for Indigenous males than for non-Indigenous males and around 50-60 times more common for Indigenous females than for non-Indigenous females.

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What is known about injury in the Indigenous population?

Indigenous people are more likely to die from transport accidents, intentional self-harm and assault than other Australians [9]. For Indigenous people living in Qld, WA, SA and the NT in 1999-2003, the leading causes of death from injuries for males were intentional self-harm (34%), transport accidents (27%), and assault (11%), and for females they were transport accidents (31%), assault (19%) and intentional self-harm (17%). Injury was the second most common cause of death for Indigenous males and the fourth most common cause of death for Indigenous females – rates were around three times those of the total Australian populations (the actual difference is likely to be up to 30% greater).

Almost 13% of all admissions to hospital of Indigenous people living in Qld, WA, SA and the NT in 2005-06 were as a result of an injury of some sort (excluding those for renal dialysis) [14]. Admissions to hospital for injury were more than twice as common for Indigenous people than for non-Indigenous people. The most frequent causes of admission to hospital of Indigenous people for injury were those resulting from assault, accidental falls, and road crashes.

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What is known about respiratory disease in the Indigenous population?

Disease of the respiratory system was reported by 27% of Indigenous people who participated in the 2004-2005 NATSIHS [7]. These problems were reported more frequently by Indigenous people living in non-remote areas (30%) than by those living in remote areas (17%). The proportions represent a slight decrease from those reported to the 2001 NHS.

The overall levels of respiratory disease were similar for Indigenous and non-Indigenous people, but asthma, the condition most often reported by Indigenous people, was 1.6 times more common for Indigenous people than for non-Indigenous people [7].

More than 11% of all admissions to hospital of Indigenous people living in Qld, WA, SA and the NT in 2005-06 were as a result of a respiratory condition (excluding those for renal dialysis) [14]. Admissions to hospital for a respiratory condition were over three times more common for Indigenous people than for non-Indigenous people.

Respiratory disease was responsible for almost one-tenth of all deaths of Indigenous people living in Qld, WA, SA and the NT in 2000-2004, with death from a respiratory cause being around four times more common for Indigenous people than for non-Indigenous people [8].

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What is known about communicable diseases in the Indigenous population?

It is compulsory for some communicable diseases to be notified. The State and Territories collect the information, which is then collated and published by the National Notifiable Disease Surveillance System. Indigenous status is often not reported in notifications, and only the information from WA, SA and the NT is believed to be complete enough for publication by Indigenous status [16]. Information for Australian HIV/AIDS cases relates to all States and Territories and is collated and published by the National Centre in HIV Epidemiology and Clinical Research [17].

Recent information about communicable diseases includes:

• tuberculosis – the rate of newly diagnosed cases for Indigenous people in 2001-2005 was more than 10 times the rate for Australian-born non-Indigenous people [18-22];
• Haemophilus influenzae type B – the notification rate in 2000-2002 for Indigenous children aged less than 5 years was 14 times that for the total Australian population in that age group [23];
• meningococcal infection – the notification rate for Indigenous people living in NSW, WA, SA and the NT in 2000-2002 was around twice that of the total population of those states [23];
• syphilis and gonorrhoea – notification rates for Indigenous people living in WA, SA, Vic and the NT in 2006 were 52 and 19 times higher, respectively, than those for non-Indigenous people [24]; and
• HIV/AIDS – compared with notification rates for the non-Indigenous population, the rate for HIV infection was slightly lower for the Indigenous population and the rate for AIDS diagnosis slightly higher in 2006 [24] .

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What is known about eye health in the Indigenous population?

Eye and/or sight problems were reported by 30% of Indigenous people who participated in the 2004-2005 NATSIHS [7]. These problems were reported slightly less frequently by Indigenous people living in remote areas (25%) than by those living in non-remote areas (32%). Eye and/or sight problems overall were slightly more common for non-Indigenous than for Indigenous people, but two serious problems – blindness and cataract – were around one-and-a-half times more common for Indigenous than for non-Indigenous people.

Eye conditions that affect the Indigenous population include refractive error (requiring glasses for correction), cataract (clouding of the lens), trachoma (a bacterial infection that can lead to blindness if untreated) and diabetic retinopathy (damage to the retina, at the back of the eye, caused by diabetes). There has been progress in the eye health of Indigenous people, but many people are still more likely than non-Indigenous people to suffer from preventable conditions [25].

Infectious trachoma among Indigenous children was still endemic across many remote parts of the country in 2006, particularly in central and north-western Australia [26]. The areas with the highest prevalence of active trachoma were the Pilbara, WA, 53%, and Katherine, NT, 30%, but the prevalence was also reported at around 20% for the Kimberley, Midwest and Goldfields regions of WA, the Barkley and Alice Springs Remote regions of the NT, and for the far north-west of SA and the area around Yalata in western SA.

The eye health of many Indigenous people is limited also by their difficulty in accessing specialised ophthalmological or optometrist services (because they are not available where they live, or are not culturally appropriate, or they are too expensive).

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What is known about ear conditions in the Indigenous population?

Disease of the middle ear can cause permanent hearing loss that limits life opportunities, particularly in education and in employment [27, 28].

Ear/hearing problems were reported by 12% of Indigenous people who participated in the 2004-2005 NATSIHS [7]. These problems were reported slightly more frequently by Indigenous people living in remote areas (13%) than by those living in non-remote areas (12%).

Complete or partial deafness was reported by 9% of Indigenous people living in both remote and non-remote areas, but the level of otitis media was higher for Indigenous people living in remote areas (4%) than for those living in non-remote areas (2%). Overall, otitis media was almost 3 times more common for Indigenous people than for non-Indigenous people [7]. An overall comparative figure for complete or partial deafness was not published, but the levels were higher for Indigenous than for non-Indigenous people for all age groups except people aged 55 years or older (for which group the levels were similar – 25% compared with 26%). The levels of complete or partial deafness among Indigenous people were around two times or more those among non-Indigenous people for age groups up to 34 years.

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What is known about oral health in the Indigenous population?

The oral health of Indigenous people generally is not as good as that of other Australians. In contrast to the situation for young non-Indigenous children, whose oral health has improved in recent years, that of young Indigenous children has generally declined [29]. In the Western Australian Aboriginal Child Survey about one in five Aboriginal children were reported to have holes in their teeth [30] . (There may be differences across the country, however, as Indigenous children in remote areas appear to have better oral health than those in urban areas.)

Partly because the overall level of dental care is lower for Indigenous people than for non-Indigenous people, their oral health deteriorates with age, contributing to higher frequencies of periodontal (gum) disease and tooth loss.

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What is known about skin infections and infestations in the Indigenous population?

Skin infections, which are more common for Indigenous people than for non-Indigenous people, are often the result of poor living conditions. The most common skin infections affecting Indigenous people are scabies (caused by a mite) and streptococcal pyoderma (a bacterial infection) [31, 32] . Scabies, in particular, is a problem in many remote Indigenous communities where up to half the children may be infected.

Skin diseases cause very few deaths directly, but they can be linked with serious complications. They did, however, account for almost 1 out of every 20 hospital separations in 2005-06 for patients identified as Indigenous (excluding those for renal dialysis) , at a rate almost three times that of non-Indigenous people [14] .

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What is known about factors contributing to ill-health in the Indigenous population?

Indigenous people generally experience more risk factors for ill-health than do other Australians. Contributing generally to the poor health status of many Indigenous people are: social factors such as dispossession, dislocation and discrimination; disadvantages in education, housing, income and employment; and physical environmental factors. These social, economic and environmental disadvantages underlie specific health risk factors (such as smoking, obesity, physical inactivity and high blood pressure), and, often contribute to lack of access to good quality health care. Given the importance of these factors, substantial improvements in Indigenous health status are unlikely to be achieved without improvements in the overall circumstances of Indigenous people.

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Summary

Indigenous people remain the least healthy sub-population in Australia, even though there have been improvements in a number of areas in recent years and there appears to have been some slight reductions in mortality [5] .

The reasons why the health status of Indigenous people remains much worse than that of non-Indigenous people are complex, but represent a combination of general factors – such as education, employment, income and socioeconomic status – and factors more specific to the health sector. As the Australian health ministers noted in their introduction to the 2003 National Strategic Framework for Aboriginal and Torres Strait Islander Health , achievement of substantial improvements in Indigenous health will depend on long-term collaborative approaches involving Indigenous leaders and communities, the health and non-health sectors, and all levels of government [33] .

Within the health sector, there is a need for further improvement in: health advancement programs; identification of health conditions before they become serious; and substantial expansion of primary health care services. To achieve long term health benefits, funding needs to be directed to a wide range of preventive and clinical services. Funding should take account of the fact that mainstream services may not be accessible for many Indigenous people, who may also have difficulty in accessing Medicare and pharmaceutical benefits.

However, without substantial reductions in the overall disadvantages experienced by many Indigenous people, even fully committed approaches within the health sector will have a limited impact on achieving major improvements in Indigenous health status.

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References

1 Australian Bureau of Statistics (2008) Population characteristics, Aboriginal and Torres Strait Islander Australians. (Catalogue no. 4713.0) Canberra: Australian Bureau of Statistics
2 Australian Bureau of Statistics (2007) Births Australia, 2006. (ABS catalogue no. 3301.0) Canberra: Australian Bureau of Statistics
3 Laws P, Abeywardana S, Walker J, Sullivan EA (2007) Australia's mothers and babies 2005. (AIHW catalogue no. PER 40) Canberra: National Perinatal Statistics Unit, Australian Institute of Health and Welfare
4 Australian Bureau of Statistics (2007) Deaths Australia, 2006. (ABS catalogue no. 3302.0) Canberra: Australian Bureau of Statistics
5 Thomson N, Burns J, Hardy A, Krom I, Stumpers S (2007) Overview of Indigenous health status, 2007. Retrieved 17 August 2007 from http://www.healthinfonet.ecu.edu.au/html/html_overviews/overviews_our_index.htm
6 Australian Bureau of Statistics (2005) Deaths Australia 2004. (Cat no. 3302.0) Canberra: Australian Bureau of Statistics
7 Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. (ABS catalogue no. 4715.0) Canberra: Australian Bureau of Statistics
8 Australian Institute of Health and Welfare (2006) Australia's health 2006: the tenth biennial health report of the Australian Institute of Health and Welfare. (AIHW catalogue no. AUS 73) Canberra: Australian Institute of Health and Welfare
9 Australian Bureau of Statistics, Australian Institute of Health and Welfare (2005) The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples 2005. (ABS catalogue no. 4704.0) Canberra: Australian Institute of Health and Welfare and the Australian Bureau of Statistics
10 Condon JR, Barnes T, Cunningham J, Armstrong BK (2004) Long-term trends in cancer mortality for Indigenous Australians in the Northern Territory. Medical Journal of Australia;180(10):504-511
11 Kirov E, Francis J, Thomson N (2003) Cancer. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press:207-223
12 de Courten M, Hodge A, Dowse G, King I, Vickery J, et al. (1998) Review of the epidemiology, aetiology, pathogenesis and preventability of diabetes in Aboriginal and Torres Strait Islander populations. Canberra: Commonwealth Department of Health and Family Services
13 McDonald S, Chang S, Excell L, eds.(2007) Australia and New Zealand Dialysis and Transplant Registry: the thirtieth report. Adelaide: Australia and New Zealand Dialysis and Transplant Registry
14 Australian Institute of Health and Welfare (2007) Australian hospital statistics 2005-06. (AIHW catalogue no. HSE 50) Canberra: Australian Institute of Health and Welfare
15 Cass A, Cunningham J, Wang Z, Hoy W (2001) Regional variation in the incidence of end-stage renal disease in Indigenous Australians. Medical Journal of Australia;175:24-27
16 Australian Bureau of Statistics, Australian Institute of Health and Welfare (2003) The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples 2003. (ABS Cat no.4704.0, AIHW Cat no. IHW11) Canberra: Australian Bureau of Statistics
17 National Centre in HIV Epidemiology and Clinical Research (2005) HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2005. (AIHW catalogue number PHE 64) Sydney: National Centre in HIV Epidemiology and Clinical Research
18 Li J, Roche P, Spencer J, National Tuberculosis Advisory Committee (2004) Tuberculosis notifications in Australia, 2003. Communicable Diseases Intelligence;28(4):464-473
19 Miller M, Lin M, Spencer J, National Tuberculosis Advisory Committee (2002) Tuberculosis notifications in Australia, 2001. Communicable Diseases Intelligence;26(4):525-536
20 Samaan G, Roche P, Spencer J, National Tuberculosis Advisory Committee (2003) Tuberculosis notifications in Australia, 2002. Communicable Diseases Intelligence;27(4):449-458
21 Roche PW, and the National Tuberculosis Advisory Committee (2006) Tuberculosis notifications in Australia, 2004. Communicable Diseases Intelligence;30(1):93-101
22 Roche PW, and the National Tuberculosis Advisory Committee (2007) Tuberculosis notifications in Australia, 2005. Communicable Diseases Intelligence;31(1):71-80
23 Menzies R, McIntyre P, Beard F (2004) Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia, 1999 to 2002. Communicable Diseases Intelligence;28(2):127-159
24 National Centre in HIV Epidemiology and Clinical Research (2007) HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2007. (AIHW catalogue number PHE 92) Sydney: National Centre in HIV Epidemiology and Clinical Research, Australian Institute of Health and Welfare
25 Burns J, Thomson N(2003) Eye health. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press:273-289
26 Tellis B, Keeffe JE, Taylor HR (2007) Surveillance report for active trachoma, 2006: National Trachoma Surveillance and Reporting Unit. Communicable Disease Intelligence;31(4):366-374
27 Couzos S, Metcalf S, Murray R(2007) Ear health. In: Couzos S, Murray R, eds. Aboriginal primary health care: an evidence-based approach. 3rd ed. South Melbourne: Oxford University Press:308-354
28 Burrow S, Thomson N(2003) Ear disease and hearing loss. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press:247-272
29 Jamieson LM, Armfield JM, Roberts-Thomson KF (2007) Oral health of Aboriginal and Torres Strait Islander children. (AIHW cat. no. DEN 167) Canberra: Australian Research Centre for Population Oral Health, Australian Institute of Health and Welfare
30 Zubrick SR, Lawrence DM, Silburn SR, Blair E, Milroy H, et al. (2004) The health of Aboriginal children and young people. (The Western Australian Aboriginal Child Health Survey, v. 1) Perth: Telethon Institute for Child Health Research
31 Currie BJ, Carapetis JR (2000) Skin infections and infestations in Aboriginal communities in northern Australia. Australasian Journal of Dermatology;41(3):139-145
32 Currie B, McGougan B(2003) Skin infections and infestations. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press:369-383
33 National Aboriginal and Torres Strait Islander Health Council (2003) National Strategic Framework for Aboriginal and Torres Strait Islander Health: framework for action by governments. Canberra: National Aboriginal and Torres Strait Islander Health Council

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