Aboriginal and Torres Strait Islander Peoples

Major inequalities exist in the health status of Aboriginal and Torres Strait Islander peoples. Indigenous people experience a much poorer level of health compared with that of non-Indigenous people, they die at a younger age and are more likely to have a reduced quality of life.

Nature and extent of health inequities

Aboriginal and Torres Strait Islander people have:

• lower life expectancy rates at birth for both males and females. Life expectancy for Indigenous people is almost 10 years lower than the life expectancy of non-Indigenous people.

• higher mortality rates at all ages compared with the rates for non-Indigenous people. In the five states/territories with the largest Indigenous populations, 62 per cent of Indigenous males and 54 per cent of Indigenous females who died were younger than 65 years (2016). This compares with the 21 per cent of non-Indigenous males and 13 per cent of non-Indigenous females who dies younger than 65 years (2016).

• higher mortality rates from preventable causes compared with Australia as a whole. Death rates were almost three times as high for the Indigenous population and they were for non-Indigenous people.

• high death rates from cancer, diseases of the circulatory system (including heart disease and stroke), injuries (motor vehicle crashes homicide and suicide), respiratory diseases (including pneumonia), endocrine, metabolic and nutritional disorders (specifically diabetes), and digestive disorders.

• an infant mortality rate that is twice that for non-Indigenous people.

Trends in the health status of ATSI peoples include:

• a decline in death rates from all causes for Indigenous males (reflecting a similar reduction for all Australian males)

• a similar decline in death rates for Indigenous females

Determinants of Indigenous Health

There are multiple determinants of this gap in health outcomes between ATSI and other Australians. Australia’s Health 2014 report states:

“Many factors contribute to the gap between Indigenous and non-Indigenous health. Social disadvantage, such as lower education and employment rates, is a factor, as well as higher smoking rates, poor nutrition, physical inactivity and poor access to health services.”[1]

Health reports confirm that Aboriginal and Torres Strait Islander people are disadvantaged, compared with other Australians. These indicators are linked to higher health risk factors such as smoking, alcohol abuse, poor housing and exposure to violence. Other determinants of health also play a part in the likelihood of higher health risk factors, such as the neighbourhood in which they live and the quality of social connections with family, friends and community. In some studies of Indigenous communities, people who felt a lack of control over aspects of their lives, or had experienced removal from their natural family, were likely to self-assess their health as ‘fair or poor’.

The sociocultural determinants of health for ATSI include: family, peers, religion, culture and media. Epidemiological data reveals ATSI families are less educated and have less money, which contribute to the family upbringing. There are also higher rates of domestic violence. One in 5 Indigenous adults reported being a victim of violence in the 12 months prior to the NATSISS. In 2008–09, the rate of substantiated child protection notifications for Indigenous children was close to 8 times the rate for other children. Indigenous Australians comprised more than one-quarter of all prisoners as at June 2010. Between 2000 and 2010, the Indigenous imprisonment rate rose by 52%. In 2006, nearly half (47%) of Indigenous families with dependent children were one‑parent families, accounting for 45% of dependent children. About 1 in 9 Indigenous adults spoke an Aboriginal or Torres Strait Islander language as their main language at home in 2008. About 2 in 5 Indigenous adults spoke at least some words of an Indigenous language. Almost two-thirds (62%) of Indigenous adults identified with a clan, tribal or language group – an increase from 54% in 2002.

Together these statistics show the affects of sociocultural determinants on ATSI health. As ATSI are brought up in these communities and are greatly influenced by this culture. This also creates poor access to health services with language barriers existing in some instances and poor examples being set by adults.

Another major barrier within the culture of ATSI people is the disempowerment they feel as a result of many years of oppression and discrimination from non-indigenous Australians. This ranges from the invasion of the first fleet to our white Australia policy, the stolen generation and general caricatures of the ATSI people today. Although the Rudd Government and their Apology in 2008 went a long way towards beginning the healing process, much work is yet to be done. Tara Raven in the Australian 29 August 2008 reports that the Rudd governments intervention into child protection further disempowered the ATSI people group and causes mistrust between ATSI people and the government.

The socioeconomic determinants of health include: education, employment and income. With less than two-thirds (65%) of working-age ATSI were in the labour force in 2008, compared with nearly 4 out of 5 (79%) non-Indigenous Australians. In 2008, ATSI households were nearly 2.5 times as likely to be in the lowest income bracket and 4 times less likely to be in the top income bracket as non-Indigenous households. Nearly half of all Indigenous children were living in jobless families in 2006—3 times the proportion of all children. Socioeconomic determinants, such as: unemployment and poorer levels of education lead to poor behavioural choices causing higher prevalence of risk factors. This lower health literacy leads to increased rates of risk behaviours such as smoking and physical inactivity.

Household income, level of education, and employment status has very large impacts on health outcomes and contribute to the health gap. As do behavioural factors such as smoking, BMI, and drinking.

Environmental determinants include geographical location and access to health services and technology. Amongst ATSI people access to health services is poorer than other Australians, contributing to the gap in health outcomes. ATSI people reported having difficulty accessing health services such as dentists and GPs in 2008 due to long waiting times or the services being unavailable. ATSI have higher rates of renting compared to owning a house, higher rates of homelessness and are more likely to live in rural or remote locations because of their culture. (source PDHPE.NET)

The roles of individuals, communities and governments in addressing the health inequities

Individuals are empowered by a number of interventions to make informed choices about their own behaviour and encouraged to reduce risk behaviours and increase protective behaviours. Each individual is responsible to promote their own health and the health of others

Communities and leaders of ATSI people were and are still involved in the design and implementation of many of the closing the gap programs and interventions. This includes many community groups such as Australian indigenous Doctors Association, National Aboriginal Community Controlled Health organisation, Aboriginal Community Controlled Health Services and Aboriginal Medical Services.

The Australian Government’s main role is larger health promotion and funding. The $805 million Indigenous Chronic Disease Package, is an example, and aims to improve the way the health-care system prevents, treats and manages the chronic diseases that affect many Indigenous Australians. The goal is to reduce key risk factors for chronic disease in the Indigenous community (such as smoking), improve chronic disease management and follow-up, and increase the capacity of the primary care workforce to deliver effective care to Indigenous Australians with chronic diseases (Department of Health 2013a).

The Close the Gap initiative is a statement of intent signed by Australia’s governments (state, territory & commonwealth). This statement aims to achieve equality in health status by reducing infant mortality, and increasing life expectancy in ATSI people. The statement also includes closing the gap in education, and employment outcomes; along with improving accessibility of health care to ATSI people living in remote areas. And includes specifically designed and implemented programs to address risk taking behaviours of individuals. Close the gap includes a housing strategy to improve their environmental determinant of health. Some other initiatives include: Office of Aboriginal and Torres Strait Islander Health and Aboriginal Health & medical Research Council.