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Tier 1 - Health status and outcomes

1.14 Disability

Key facts

Why is it important?

A disability may be an impairment of body structure or function, a limitation in activities and/or a restriction in a person’s participation in specific activities. A person’s functioning involves an interaction between health conditions, environmental and personal factors. Aboriginal and Torres Strait Islander people are at greater risk of disability due to increased exposure to factors such as low birth weight, chronic disease, preventable disease and illness (for example, otitis media and acute rheumatic fever), injury and substance use. Along with limited access to early treatment and rehabilitation services, these factors increase a person’s risk of acquiring a disability. Such factors tend to be more prevalent in populations in which there is a higher unemployment rate, lower levels of income, poorer diet and living conditions, and poorer access to adequate health care.

Findings

What does the data tell us?

Findings from ABS survey data

The 2018–19 National Aboriginal and Torres Strait Islander Health Survey collected data for those aged 15 and over on a broad definition of disability (that is, those reporting a limitation, restriction, impairment, disease or disorder that has lasted, or is expected to last, for six months or more that restricts everyday activities) (ABS 2019). Results are self-reported and, therefore, could be understated.

In 2018–19, of Indigenous Australians aged 15 and over, 46% (248,100) reported they had a disability or restrictive long‑term health condition, similar to the proportion reported in the 2014–15 National Aboriginal and Torres Strait Islander Social Survey (45%) (Table D1.14.18). The rate of having a disability or restrictive long-term health condition was the same for Indigenous males and females aged 15 and over (both 46%) (Table D1.14.4).

The four most common self-reported disability types for Indigenous Australians were physical disabilities (63%; 156,500), sight/hearing/speech disabilities (47%; 116,500), psychological disabilities (23%; 56,400) and intellectual disabilities (18%; 45,000) (Table D1.14.4, Table D1.14-1).

Table 1.14-1: Disability type, by age group for those aged 15 and over, Indigenous Australians, 2018–19

Disability type

15–24

25–34

35–44

45–54

55–64

65+

Total

Sight/hearing/speech

39.4%

30.3%

39.5%

57.9%

56.8%

61.1%

47.0%

Physical

40.6%

57.0%

70.1%

69.9%

74.3%

73.9%

63.1%

Intellectual

29.8%

22.5%

16.9%

15.2%

12.9%

6.7%

18.1%

Psychological

23.5%

23.7%

26.5%

28.0%

20.4%

8.6%

22.7%

Head injury, stroke or brain damage

2.3%†

2.3%†

4.7%†

4.4%†

5.3%†

3.8%†

3.4%

Other

18.1%

20.2%

27.5%

37.1%

41.5%

44.6%

30.2%

Total with a disability or long-term health condition(a)

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

† Proportion has a relative standard error between 25% and 50% and should be used with caution.
(a) Note that more than one disability type may be reported and thus the sum of the components may add to more than the total.
Source: Table D1.14.4. AIHW and ABS analysis of National Aboriginal and Torres Strait Islander Health Survey 2018–19.

Around 9% (47,500) of Indigenous Australians aged 15 and over had a profound or severe core activity limitation with at least one activity of everyday living (self-care, mobility or communication) and 17% (93,300) reported a moderate or mild core activity limitation. A further 7% (38,100) reported they had a disability or restrictive long-term health condition that only restricted their engagement with school and/or employment activities (Table D1.14.4, Figure 1.14.1).

Figure 1.14.1: Disability status of Indigenous Australians aged 15 and over, 2018–19

The bar chart shows that overall, 46% of Indigenous Australians aged 15 and over had a disability or restrictive long-term health condition. The breakdown was 9% had a profound or severe core activity limitation, 17% had a moderate or mild core activity limitation, 7% had a disability or restrictive long-term health condition which only restricted their engagement with school and/or employment activities and 13% had an impairment but with no specific limitation or restriction.

Note: 'No limitation or specific restriction' includes persons living with an impairment but having no limitation or specific restriction with everyday activities of mobility, self-care and communication or schooling/employment.
Source: Table D1.14.4. AIHW and ABS analysis of National Aboriginal and Torres Strait Islander Health Survey 2018–19.

After adjusting for differences in the age structure between the two populations, Indigenous Australians were 1.5 times as likely as non‑Indigenous Australians to have a disability or restrictive long-term health condition (51% and 34%, respectively) and 2.6 times as likely to have a profound/severe core activity limitation (10% and 4%, respectively) (Table D1.14.3).

The rate of having a disability or restrictive long-term health condition for Indigenous Australians increased with age, ranging from 33% of those aged 15–24 to 79% of those aged 65 and over. The rate of having a disability or restrictive long-term health condition was significantly higher for Indigenous Australians in all age groups compared with that of non-Indigenous Australians, particularly those aged 25–44 (Table D1.14.3, Figure 1.14.2).

Figure 1.14.2: Disability status of people aged 15 and over, by Indigenous status and age, 2018–19

This bar chart shows that the presence of disability or restrictive long-term health condition was higher for Indigenous than non-Indigenous Australians and rates increased with age for both populations. The proportion increased from 33% for Indigenous Australians aged 15-24 to 79% for Indigenous Australians aged 65 and over, while these proportions were 20% and 63% for non-Indigenous Australians, respectively. For Indigenous Australians with a profound/severe core activity limitation, the proportion increased from 5% for those aged 15-24 to 18% for those aged 65 and over, and for non-Indigenous Australians these proportions were 2% and 10%, respectively.

Note: Totals are age-standardised.
Source: Table D1.14.3. AIHW and ABS analysis of National Aboriginal and Torres Strait Islander Health Survey 2018–19 and National Health Survey 2017–18.

Of Indigenous Australians aged 15–64 who were studying and had a disability or restrictive long-term health condition, 41% (14,300) reported they had difficulty pursuing their education. Employment difficulties were reported by 50% (107,800) of Indigenous Australians aged 15–64 with a disability or restrictive long-term health condition (Table D1.14.5).

More than half (54%) of Indigenous Australians aged 15 and over who reported having a disability or restrictive long-term health condition were not in the labour force, compared with 35% of those who did not report having a disability. Indigenous Australians with a disability or restrictive long-term health condition were more likely than those without a disability to be living in households in the lowest income quintile (46% compared with 33%, respectively), and to have had problems accessing services (53% and 33%, respectively) (Table D1.14.28).

The self-reported rate of having a disability or restrictive long-term health condition was the lowest for Indigenous Australians in Western Australia (42%) and highest in Tasmania (58%). The rate was similar across remoteness areas (47% in Non-remote areas and 45% in Remote areas) (Table D1.14.2, Figure 1.14.3).

Figure 1.14.3: Indigenous people aged 15 and over reporting a disability/restrictive long-term health condition, by jurisdiction and remoteness, 2018–19

This bar chart shows that by jurisdiction, the proportion of Indigenous Australians aged 15 and over reporting a disability/restrictive long-term health condition was lowest in WA (42%) and highest in SA (59%). By remoteness, the rate was 47% in Non-remote areas and 45% in Remote areas. Nationally, the rate was 46%.

Source: Table D1.14.2. AIHW and ABS analysis of National Aboriginal and Torres Strait Islander Health Survey 2018–19.

Assistance with core activities

The 2016 Census collected data on one element of disability (that is, those reporting the need for assistance with core activities). In 2016, 7.2% (43,750) of the total Indigenous population were identified as needing assistance with a core activity (self-care, mobility or communication) some or all the time. The proportions were similar for Indigenous males (7.7%) and Indigenous females (6.7%) (Table D1.14.10).

The proportion of Indigenous Australians who needed assistance with a core activity was higher in all age groups when compared with non-Indigenous Australians. Rates increased with age for both populations; however, this began earlier for Indigenous Australians (from around age 40) than for non-Indigenous Australians (from around age 60) (Table D1.14.10, Figure 1.14.4).

Figure 1.14.4: People needing assistance with core activities, by Indigenous status and age group, 2016

This bar chart presents the proportion of Indigenous and non-Indigenous Australians with a core-activity need for assistance by age. The rate for Indigenous Australians is lowest in those aged 0-4 at 2% and increased to 43% for those aged 75 and over. For non-Indigeous Australians, the pattern is the same, however the rates are lower, with 1% of those aged 0-4 needing assistance with core activities, increasing to 31% for those aged 75 and over.

Source: Table D1.14.10. AIHW and ABS analysis of Census of Population and Housing 2016.

In 2016, variations in self-reported rates by jurisdiction and remoteness that are presented should be treated with caution. The proportion of Indigenous Australians needing assistance with a core activity ranged from 5.2% in the Northern Territory to 8.6% in Victoria (Table D1.14.12). For Indigenous Australians, the proportion with a core activity need for assistance was lowest in Very remote areas (4.2%) and highest in Inner regional areas (8.3%) (Table D1.14.11).

Indigenous Australians were twice as likely as non-Indigenous Australians to need assistance with a core activity (10% compared with 5%) after adjusting for differences in the age structure between the two populations. The gap between Indigenous and non-Indigenous Australians was the largest in South Australia (a gap of 5.9 percentage points), followed by Victoria (a gap of 5.8 percentage points) (Table D1.14.12).

Social and cultural connections

A feature article from the 2014–15 National Aboriginal and Torres Strait Islander Social Survey presented findings on the lived experiences of Indigenous Australians who had a disability or long-term restrictive condition. Indigenous Australians with a disability experience difference across many areas related to family and community connections, compared with those with no disability. Connections to culture, family and the community, along with engagement in cultural activities, are important in reducing isolation and improving access to supportive networks (ABS 2016).

In 2014–15, the proportion of Indigenous Australians who reported they recognised their homelands or traditional Country, identified with a clan, tribal group or language group and/or spoke an Indigenous language was similar for those who had a disability and those who did not. Reporting participation in cultural events was also similar, regardless of disability status.

Indigenous Australians with a severe or profound disability were less likely to have had daily face-to-face contact with family or friends outside their household, compared with those with no disability (35% compared with 45%).

In 2014–15, Indigenous Australians with a severe or profound disability were less likely to have received support in a time of crisis from a family member (78%) or friend (55%) from outside their household, compared with those who did not have a disability (85% and 64%, respectively). However, they were more likely to have received crisis support from community, charity or religious organisations (20%) or health, legal or financial professional (15%) than those with no disability (12% and 8%, respectively) (ABS 2016).

Carers

The ABS Census of Population and Housing 2016 collected data on those who provided care for family members or others. After adjusting for differences in the age structure between the two populations, 13% (58,500) of Indigenous Australians aged 15 and over provided unpaid assistance to a person with a disability, long-term illness or problems related to old age. This was 1.3 times the proportion for non-Indigenous Australians (9%) (Table D1.14.15).

Of Indigenous Australians who provided unpaid assistance to a person with a disability, long-term illness or problems related to old age, 41% (24,100) were employed, 12% (6,800) were unemployed, and 47% (27,200) were not in the labour force. Indigenous Australians providing unpaid assistance were less likely to be in the labour force than those who did not provide unpaid care (53% compared with 57%) (Table D1.14.26). From 2011 to 2016, the median weekly income of Indigenous carers providing unpaid assistance to a person with a disability, long-term illness or problems related to old age increased from $359 to $439 (Table D1.14.27).

Disability support services

While the National Disability Insurance Scheme (NDIS) has mostly replaced the provision of services to people with disabilities under the National Disability Agreement (NDA), many people were still receiving support under the NDA in 2017–18. Over the year, 2,524 Indigenous NDA service users transitioned to the NDIS (out of a total of 40,018 who transitioned that year) (AIHW 2019).

The Disability Services National Minimum Dataset (DS NMDS) provides data on users receiving disability support services under the NDA. Varying jurisdictional transitions to the NDIS have influenced service user representation in DS NMDS data in recent years. Additionally, people might not appear in the DS NMDS as having transitioned to the NDIS. More information on the change in service use is available in the People with disability in Australia web report. In 2017–18, the DS NMDS showed that 6% (15,771) of disability support service users under the NDA were Indigenous Australians (Table D1.14.20).

After adjusting for differences in the age structure between the two populations, Indigenous Australians aged under 65 used disability support services at almost twice the rate of non-Indigenous Australians (22 and 12 per 1,000, respectively) (Table D1.14.17).

Psychiatric and intellectual disabilities were the most common primary disability groups for Indigenous service users aged under 65 (each representing 25%), followed by physical disability (21%) and autism (9%) (AIHW 2019).

Indigenous service users might need assistance to perform activities in different areas of their lives. In 2017–18, Indigenous service users always or sometimes needed assistance with:

  • activities of daily living (11 per 1,000)
  • activities of independent living (14 per 1,000)
  • activities of work, education and community living (14 per 1,000) (Table D1.14.23, Figure 1.14.5).
Figure 1.14.5: Age-standardised rate of Indigenous users of NDA disability support services, need for support in a life area by life area activity, 2017–18

This bar chart presents the rate of Indigenous users of NDA disability support services who needed support in a life area, by life area activity. There were 11 per 1,000 Indigenous Australians who always or sometimes needed help or supervision in activities of daily living; 14 per 1,000 needed help or supervision in activities of independent living; and 14 per 1,000 needed help or supervision in activities of work, educattion and community living.

Source: Table D1.14.23. AIHW analysis of the Disability Services National Minimum Data Set 2017–18.

For Indigenous service users aged under 65, the rate of disability support service use was lowest in the Australian Capital Territory and the Northern Territory (9 and 10 per 1,000, respectively) and highest in South Australia and Victoria (40 and 41 per 1,000, respectively) (Table D1.14.16). The rate also varied by remoteness, lowest in Remote areas (11 per 1,000) and highest in Non-remote areas (24 per 1,000) (Table D1.14.17).

The most common disability support services provided for Indigenous Australians aged under 65 were employment services (53%) and community support services (41%) (Table D1.14.21).

Of Indigenous disability support service users aged 15–64, 12% were employed, 54% were unemployed, and 21% were not in the labour force (Table D1.14.22). The main income source for Indigenous service users aged 16 and over was the disability support pension (44%) or another pension or benefit (46%). For non-Indigenous service users, 45% received a disability support pension as their main income source, and 42% received another pension or benefit (AIHW 2019).

National Disability Insurance Scheme

As of 30 June 2019, a total of 16,417 Indigenous Australians were participating in the NDIS—6% of all active participants. The most common primary disabilities for Indigenous participants were an intellectual disability (30%) and autism (28%). For non-Indigenous participants, these were also the two most common primary disabilities—27% and 31%, respectively.

The majority of Indigenous NDIS participants were aged under 25 (65%), compared with 54% of non-Indigenous participants.

Indigenous participants were less likely to be living in Major cities than non-Indigenous participants (43% compared with 68%, respectively) and more likely than non-Indigenous participants to live in Remote and Very remote areas (11% compared with 1%, respectively).

Supported Independent Living arrangements (help with and/or supervision of daily tasks) were included in the plans of 6% of Indigenous participants aged under 25 and 15% of those aged 25 and over, similar to the proportions for non-Indigenous Australians (7% and 15%, respectively).

Indigenous participants utilised less of the committed supports in their plans than non-Indigenous participants—60% compared with 67%, respectively (NDIA 2019).

What do research and evaluations tell us?

Survey and administrative data have shown a higher rate of disability across the life course for Indigenous Australians. Recent research highlights the characteristics, determinants and effects of disability and can provide insight into the experiences of disability across life stages. For example:

  • One study focused on family and cultural inclusion as essential components of healthy child development (Gilroy & Emerson 2016). The research analysed data collected in Wave 4 of Footprints in Time, the Australian Longitudinal Study of Indigenous Children, and found that Indigenous children with low cognitive ability are at a higher risk of social exclusion than their peers.
  • Another study found that frailty, or physiological decline in later life, is substantially higher in Indigenous Australians living in Remote areas than in other populations (Hyde et al. 2016).

A recent study examined both peer-reviewed and grey literature focusing on access to services that increase the likelihood of Indigenous Australians with a disability to live independent and socially inclusive lives (Gilroy et al. 2017). The study aimed to identify methods to develop workforce capacity to better deliver National Disability Insurance Scheme (NDIS) services to Indigenous Australians with disabilities in rural and remote areas. The findings included:

  • the presence of significant access and equity barriers to culturally appropriate disability support services
  • the importance of strategies to attract, develop and retain Indigenous workers in the Indigenous disability workforce
  • the importance of culturally safe disability services and community-centred principles
  • identification of strategies such as cultural training for workforce development.

The study identified the importance of maximising the possible benefits of disability sector reforms for Indigenous Australians with disabilities.

Implications

Although disability prevalence varies across data sources, all show a higher disability rate experienced by Indigenous Australians than non-Indigenous Australians. The high levels of disability and earlier onset of core activity restrictions experienced by Indigenous Australians are consistent with the higher levels of disease and injury, socioeconomic and environmental factors, health risk factors and lower access to health services relative to need. There is a clear link between disability and socioeconomic disadvantage (Kavanagh et al. 2013; VicHealth 2012). Lower levels of educational attainment, lower participation in the workforce and lower income are likely to be both the cause and consequence of disability (Biddle 2013). High proportions of Indigenous Australians with a disability experiencing difficulties in pursuing education or employment is of concern.

The Second Implementation Plan for the National Disability Strategy 2010–20 includes actions for Australian Government agencies to improve life outcomes for Indigenous Australians with a disability. It includes areas for future focus across education, employment, health and the NDIS. The rollout of the NDIS will play an essential role in providing support for people with disability to participate in the workforce. However, since not all are eligible for NDIS support, mainstream support services and other systems also need to improve to reduce barriers for people with a disability in seeking, obtaining and retaining employment (DSS 2016).

The policy context is at Policies and strategies.

References

  • ABS (Australian Bureau of Statistics) 2016. National Aboriginal and Torres Strait Islander Social Survey 2014–15. Cat. no. 4714.0. Canberra: AIHW.
  • ABS 2019. National Aboriginal and Torres Strait Islander Health Survey, 2018–19. 4715.0. Canberra: ABS.
  • AIHW (Australian Institute of Health and Welfare) 2019. Disability support services: services provided under the National Disability Agreement 2017–18. Cat. no: DIS 73. Canberra: AIHW.
  • Biddle N 2013. CAEPR Indigenous Population Project 2011 Census Papers. Canberra: CAEPR.
  • DSS (Department of Social Services) 2016. National Disability Strategy Second Implementation Plan Driving Action 2015–2018. (ed., Services DoS). Canberra.
  • Gilroy J, Dew A, Lincoln M & Hines M 2017. Need for an Australian Indigenous disability workforce strategy: review of the literature. Disability and Rehabilitation 39:1664-73.
  • Gilroy J & Emerson E 2016. Australian indigenous children with low cognitive ability: Family and cultural participation. Research in developmental disabilities 56:117-27.
  • Hyde Z, Flicker L, Smith K, Atkinson D, Fenner S, Skeaf L et al. 2016. Prevalence and incidence of frailty in Aboriginal Australians, and associations with mortality and disability. Maturitas 87:89-94.
  • Kavanagh AM, Krnjacki L, Beer A, Lamontagne AD & Bentley R 2013. Time trends in socio-economic inequalities for women and men with disabilities in Australia: evidence of persisting inequalities. International Journal for Equity in Health 12:73.
  • NDIA (National Disabillity Insurance Scheme). 2019. NDIS Aboriginal and Torres Strait Islander participants 30 June 2019. NDIA.
  • VicHealth 2012. Disability and health inequalities in Australia: Addressing the social and economic determinants of mental and physical health. Melbourne: VicHealth.

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