3. How Indigenous Australians are faring
In 2018, the burden of disease among Aboriginal and Torres Strait Islander people was 2.3 times that of non-Indigenous Australians. The leading contributors to burden for Indigenous Australians were: mental and substance use disorders, injuries and chronic diseases such as cardiovascular disease, cancer, musculoskeletal conditions and respiratory disease. In general, people living in rural and remote areas are more likely to live with, and die prematurely from, a disease or injury. This is particularly relevant to Indigenous Australians as the proportion of Indigenous population increases with remoteness, from 1.8% in Major cities to 32% in Remote and very remote areas based on estimated Indigenous population projections for 2021.
A large part of the disparity in health outcomes between Indigenous Australians and non-Indigenous Australians is explained by disparities in social determinants, in particular income, employment and education. In many cases, Indigenous Australians also have lower access to health services than non-Indigenous Australians, for a range of reasons including barriers such as cost and a lack of accessible or culturally appropriate health services. For Indigenous Australians to have better health outcomes, improvements in the health system and determinants beyond the health sector are required.
Measures of Indigenous Australians’ health status and outcomes drawn from the HPF show mixed results over the most recent decade of data. Key selected findings are shown in below Figures, and described in the sections that follow.
It is often difficult to establish the reasons behind improving or worsening health in a population, for several reasons:
- The factors that affect health are complex and are often inter-related.
- The relationship between health and health determinants can work in both directions – while education and employment can affect people’s health, health can also affect people’s ability to participate in schooling and work
- Health is shaped throughout life – an adult’s health is shaped by their life history, daily living conditions and health behaviours (Osborne et al. 2013).
However, measures across the HPF tiers can provide insights into changing health outcomes – for example, deaths from cardiovascular disease have decreased along with a decreased rate of smoking and increased rates of hospital procedures related to coronary heart disease.
Some key changes in health outcomes, determinants of health, and health system performance are shown in Figures 3.1, 3.2 and 3.3, respectively. Note that changes over time cannot be assessed for all measures, as trend data are not available in all cases. When assessing change over time, information from all data points in the series has been considered, rather than just the first and last points in the time trend. Linear regression (based on ‘least squares’ method) was used when assessing change over time for all trends shown in Figure 3.1 with more than 5 data points.
Figure 3.1: Key changes in health status and outcomes for Indigenous Australians over time
Figure 3.2: Key changes in determinants of health for Indigenous Australians over time
Figure 3.3: Key changes in health system performance for Indigenous Australians over time
Outcomes improved for a number of measures
Cardiovascular disease is the second leading cause of death among Aboriginal and Torres Strait Islander people. The age-standardised death rate due to cardiovascular disease decreased by 18% over the decade from 2010 to 2019. The decline in deaths from cardiovascular disease coincided with reductions in smoking rates and an increase in hospitalisations for cardiovascular-related procedures.
Over the decade from 2010 to 2019, the age-standardised rate of death due to kidney disease declined by 36%.
Over the period from 2012 to 2021, the proportion of Indigenous Year 3 students meeting the national minimum standards for reading increased by 11% and the gap with non-Indigenous students narrowed by 33%. Over the same period the proportion of Indigenous students in Year 5 meeting the national minimum standards for numeracy increased by 13%.
Levels of educational attainment have improved over the decade. The proportion of Indigenous Australians aged 20–24 who had a Year 12 or equivalent qualification increased from 45% in 2008 to 66% in 2018–19. The rate at which Indigenous adults completed higher education courses increased from 38 to 67 per 10,000 between 2001 and 2018–19.
Between 2011–12 and 2020–21, the rate of youth justice supervision for Indigenous young people (aged 10–17) declined from 186 to 117 per 10,000 population, a reduction of 29%.
In the decade from 2011–12 to 2020–21, the rate of Indigenous young people aged 10–17 in detention declined from 34 to 23 per 10,000 population, while the rate for non-Indigenous young people remained similar (from 1.6 to 1.3 per 10,000) and the gap declined from 32 to 22 per 10,000). Based on linear regression, the rate of Indigenous young people aged 10–17 in detention declined by 25% nationally between 2011–12 to 2020–21.
In 2018–19, 31% of Indigenous adults lived in household that were owned or being purchased – an increase from 27% in 2002. The proportion of Indigenous Australians who lived in overcrowded households fell from 27% in 2004–2005 to 18% in 2018–19.
Household incomes of Indigenous adults increased in real terms (that is, after adjusting for inflation) from $544 to $802 per week between 1996 and 2016. Other Australian adults experienced a weekly increase in household income of $801 to $1,096 over the same period.
The proportion of Indigenous Australians aged 15 and over who smoked daily fell from 45% in 2008 to 37% in 2018–19. The proportion of Indigenous Australians aged 15–17 who smoked fell from 22% to 13% between 2008 and 2018–19 and the proportion who had never smoked increased from 72% to 85% over the same period. The proportion of Indigenous women who smoked during pregnancy fell from 52% in 2009 to 44% in 2019.
In 2019, almost all (99.3%) Indigenous mothers attended antenatal care services at least once during pregnancy. Between 2012 and 2019, the proportion of Indigenous mothers who attended antenatal care in the first trimester of pregnancy increased by 18 percentage points from 50% in 2012 to 68% in 2019.
Between 2008 and 2018, the proportion of Indigenous children aged 5 who were fully immunised increased by 20 percentage points from 77% in 2008 to 97% in 2018, which was higher than the non-Indigenous rate of 95% in 2018.
The rate of health assessments for Indigenous Australians increased fourfold between 2009–10 and 2018–19 from 68 checks per 1,000 population to 297 checks per 1,000.
Between 2006–2007 and 2010–2011, participation rates in BreastScreen Australia among Indigenous women aged 40 and above remained at around 18%. In the subsequent decade between 2010–2011 and 2018–2019, participation rates among Indigenous women aged 40 and above increased from 18% to 27%, before decreasing to 25% in 2019–2020, most likely due to the impact of the COVID-19 pandemic.
Between 2009–10 and 2017–18, the age-standardised rate of Medicare Benefit Schedule (MBS) claims for Indigenous Australians for chronic diseases management plans increased – from 55 to 125 per 1,000 for Team Care Arrangements (TCAs) and from 69 to 142 per 1,000 for GP Management Plans (GPMPs). In 2018, the rate for TCAs and GPMPs combined was 1.4 times the rate for non-Indigenous Australians (267 per 1,000 compared with 185 per 1,000).
The number of Commonwealth-funded Indigenous-specific primary health-care organisations increased from 108 in 1999–00 to 198 in 2017–18. Episodes of care delivered by these organisations increased from 1.2 million to 3.6 million and the number of health care workers in these organisations more than tripled from 2,300 to 8,215 over the same period.
In 2018–19, 92% of Indigenous Australians reported they had a usual place to go for health problems and advice. Those with a usual general practitioner or medical service reported higher rates of satisfaction with their health care experience than those without one.
The rate of general practitioner Medicare Items claimed by Aboriginal and Torres Strait Islander people increased by 42% between 2003–04 and 2017–18. Aboriginal and Torres Strait Islander people used GP services at rates that were slightly higher than those for non-Indigenous Australians (1.2 times) but do not reflect the higher level of need among Indigenous Australians.
Over the decade from 2009–10 to 2018–19, there was a 14% increase in the age-standardised proportion of hospitalisations for Indigenous Australians that included a hospital procedure.
Over the decade from 2009–10 to 2018–19, the age-standardised hospitalisations for Indigenous Australians where the patient was discharged from hospital at their own risk decreased from 4.4% to 3.8%. Similarly, the proportion of emergency department presentations where the patient left at their own risk or did not wait to be seen decreased from 9.1% to 8.5% for Indigenous Australians between 2011–12 and 2018–19.
However, there has been little recent change for some measures
The proportion of Indigenous babies born with a low birthweight did not change significantly over the period from 2013 to 2019. However, despite this the absolute gap in low birthweight between Indigenous and non-Indigenous babies generally decreased over this period, from 5.2 percentage points in 2013 to 4.4 percentage points in 2019.
Over the decade from 2010 to 2019, the age-standardised rate of avoidable deaths among Indigenous Australians did not change significantly, nor was there a significant change in the absolute gap between Indigenous and non-Indigenous Australians.
From 2010 to 2019, there was no significant change in the age-standardised all-cause death rate for Indigenous Australians. However, the rate for non-Indigenous Australians declined by 8.6% and as a result the gap widened by 18% over this period.
Between 2010 and 2019, there was no significant changes in the death rates of perinatal, neonatal or stillbirth babies born to Indigenous women nor where there any significant reduction in the gap with babies born to non-Indigenous women.
In 2018–19, 31% of Indigenous adults reported high/very high levels of psychological distress, not significantly different from 2014–15 (33%). Those who had been removed from families or had relatives removed from families had a higher proportion of high/very high level of psychological distress (38%) compared with those who were not removed from their families (26%).
The employment rate for Indigenous Australians remained unchanged between 2008 and 2018–19 (48% and 49%, respectively).
MBS claim rates for Indigenous patients accessing specialist providers were almost half the rate of non-Indigenous patients (598 per 1,000 and 1,070 per 1,000 population, respectively) in 2017–18. Over the period from 2009–10 to 2017–18 there was no significant change in the age-standardised rate of Medicare claims for specialist care among Indigenous Australians.
Some measures have worsened
Cancer is currently the leading cause of death (accounting for 23.4% of all deaths of Indigenous Australians) among Indigenous Australians. Between 2010 and 2019, the death rate for Indigenous Australians increased by 12% while the non-Indigenous rate decreased by 10%. This results in a widening of the absolute gap between Indigenous and non-Indigenous Australians. Indigenous Australians have lower cancer screening rates and are more likely to be diagnosed with cancer at more advanced stages resulting in lower cancer survival rates.
In 2015–2019, the suicide rate for Indigenous Australians was 24 per 100,000 deaths and accounted for 5.5% of all Indigenous deaths. Over the decade from 2010 to 2019, the age-standardised rate of death due to suicide increased by 30% for Indigenous Australians. Similarly, over the period from 2009–10 to 2018–19 the hospitalisation rate of Indigenous Australians for Intentional self-harm increased by 63%.
Over the decade from 2009–10 to 2018–19, the age-standardised rate of hospitalisations due to assault for Indigenous Australians increased by 7.9%. This increase was driven by the 11% increase in hospitalisation rates due to assault for Indigenous females as the rate for Indigenous males remained unchanged over this period.
From 2012 to 2021, there was a 40% increase in the age-standardised imprisonment rate among Indigenous adults compared with an increase of 28% among non-Indigenous adults. As a result, the absolute gap between Indigenous and non-Indigenous Australians widened over this period.
In the two-year period July 2017 to June 2019, 15% of all hospitalisations (excluding dialysis) of Indigenous Australians were potentially preventable. Over the decade from 2010–11 to 2018–19 the potentially preventable hospitalisation rates for both acute and chronic conditions for Indigenous Australians increased by 23% and 37%, respectively. Similarly, the rate of vaccine preventable conditions increased by 67% in the period in which data were available (2013–14 to 2018–19).