Indigenous Health in Australia

Overview Indigenous Health in Australia

Few Australians are aware of the extent of the ongoing crisis in Indigenous health or realise that the health of Indigenous Australians is on a par with, or worse than the populations of many developing countries.
The following information is a summary of key facts provided in a series of 10 information sheets which form a kit titled Indigenous Health in Australia, prepared by The Fred Hollows Foundation in 2004.

Why is Indigenous health so poor?

The social determinants of health

(see information sheet 4)

The underlying causes of poor health are called the social determinants of health. These do not only affect Indigenous people. All people who are disadvantaged are likely to have poorer health, and few of the factors that cause groups of people to be disadvantaged can be controlled by individuals. A recent report by the Productivity Commission says that Indigenous Australians continue to experience marked and widespread disadvantage1. About 30% of Indigenous households (some 120,000 people) are in income poverty In 2001, 20% of Indigenous people were unemployed, about three times the rate for non-Indigenous people 60% of Indigenous people work in low skill occupations. 18% are on work for the dole schemes; it is estimated that the true rate of Indigenous unemployment is more than 43% The average Indigenous household income is about 62% of average nonIndigenous household income Only about 31% of Indigenous Australians own or are buying their own homes, compared with 70% for other Australians See Figure 1: Interactions of social and physiological determinants of health on the last page of this overview.

How does it affect children?

(see information sheet 4)

Infant mortality rate twice as high Low birth weight twice as high In remote areas, children are three times as likely to die before the age of one; the main cause of illness is preventable infection 30 80% of Indigenous school aged children suffer significant hearing loss as a result of preventable chronic ear infections Low birth weight is an important indicator of chronic health problems in later life and a possible causal factor in illnesses such as kidney failure, diabetes and heart disease.

What is the health emergency?

(see information sheet 1)

As a whole, Aboriginal and Torres Strait Islander populations throughout Australia have much poorer health than nonIndigenous Australians. Compared with non-Indigenous Australians, Indigenous people have: Life expectancy 20 years less Median age at death of 53 years 25 years less than for the population as a whole Hospitalisation rate about twice as high Only 24% of Aboriginal men are expected to live to 65 years of age, compared with 87% for the nonIndigenous population Life expectancy in most developing countries has increased significantly over the past 20 years, yet similar gains for Indigenous Australians have not yet been achieved. Indeed, the figures appear to have worsened in recent times. Life expectancy in countries like Nigeria, Nepal, Bangladesh, India and Thailand is much greater than for Indigenous Australians.

What are the levels of illness?

(see information sheet 2)

As a group, Indigenous people have much higher rates of chronic disease. This burden of illness takes a huge toll on individuals, families and communities. Rheumatic heart disease 6-8 times higher Diseases of the circulatory system 3 times higher Diabetes 4 times higher Kidney disease 9 times the nonIndigenous rate, and in some regions 30 times as high Diseases such as heart disease, kidney disease and diabetes are linked, and many Indigenous people, especially those in remote regions, may suffer from two or more of these serious illnesses or co-morbidities.

Environmental health
(see information sheet 5)

In addition to these social determinants, Indigenous people in Australia are affected by particular factors like poor housing, lack of community infrastructure (such as water, sewerage, roads), high levels of poverty

Twenty years is just short of the standard measure of a generation. It represents a tragic loss and a waste, for Indigenous people and for Australia as a whole.
Gary Banks, Chairman, Productivity Commission, 2003

The Fred Hollows Foundation 4 Mitchell Street Enfield NSW 2136 Australia

Telephone +61 2 8741 1900 Facsimile + 61 2 8741 1999 24hr donation line 1800 352 352

Email fhf@hollows.org Website www.hollows.org

and the high cost of food in remote areas where many Indigenous people live. In 2001 a national survey of Indigenous communities found that 31% of houses needed major repair or replacement Many Indigenous communities still do not have a reliable water supply and do not have electric power A survey of 4,000 Indigenous homes in the Northern Territory in 1998-99 found that only 13% had functioning water, waste, cooking and cleaning facilities See Figure 2: Socio-economic disadvantage across ATSIC regions map on the last page of this overview.

Only 38% of Indigenous students complete high school, compared with about 76% of non-Indigenous students Fewer Indigenous children attend preschool, and so are less school ready than other children who have attended pre-school

Other public health costs, such as ensuring clean food and water, environmental health, sewerage, roads and so on, are also the responsibility of Governments. The Aboriginal and Torres Strait Islander Commission (ATSIC/ATSIS) does not have any responsibility for health.

Lack of primary health care services

(see information sheet 7)

One of the most important components of an effective health system is access to affordable primary health care (doctors, pharmacists, health education, early detection and screening). Indigenous people have much less access to primary health care because of cost and lack of provision of health services in the areas where most Indigenous people live Approximately half the total national expenditure on Indigenous health is spent on hospital care this reflects not only poorer Indigenous health, but lack of access to primary health care

Nutrition
(see information sheet 8)

Health professionals regard poor nutrition as the main factor contributing to the majority of illnesses in remote Aboriginal communities. The cost of fresh food in remote communities averages between 150180% of capital city prices Maternal malnutrition, low birth weight, and poor nutrition in infancy and childhood are all implicated as possible causal factors in the development of chronic, life-threatening illness in later life

Many government inquiries have found that although all levels of government have responsibility for Indigenous health, none takes responsibility! A practice called cost shifting (claiming another level of government, department or agency has responsibility) lets governments and departments off the hook.
Commonwealth Grants Commission, Report on Indigenous Funding 2001, p.27

Dont we spend a lot of money on Indigenous health?

(see information sheets 3 and 7)

The overwhelming feeling among health professionals is that poor nutrition is the main factor contributing to the majority of illnesses in remote Aboriginal communities.
Australian Medical Association, 19972

An effective primary health care system must provide a range of services that match client needs, are available and accessible, and are delivered in such a way that the target group can make full use of them.
(Commonwealth Dept of Health and Aged Care, Better Health Care)

No! The Commonwealth spends more, per person, on non-Indigenous Australians through MBS and PBS than it does on Indigenous Australians. In 1998-99 it was estimated that for every $1.00 spent per person for the general population on MBS and PBS, only $0.37 was spent per Indigenous person Commonwealth spending on Indigenous people through programs it administers is about 18% less per person than for non-Indigenous people Hospital expenditure on Indigenous people is twice as high. This reflects a failure to deliver adequate primary health care that results in higher cost hospital treatment This is a critical national policy issue. The cost of hospital treatment, for conditions that could be prevented by timely detection and treatment in primary health services, is ultimately a much more costly use of resources.

Literacy, education and health

(see information sheet 6)

Who pays for Indigenous health?

(see information sheets 3 and 7)

Public costs of health care for all Australians are a shared responsibility of the Commonwealth and state and territory governments. The Commonwealth has the main responsibility for primary health care through the Medical Benefits Scheme (MBS Medicare) and the Pharmaceutical Benefits Scheme (PBS). State and territory governments provide public health services such as hospitals, and the Commonwealth pays for nearly half the cost of public hospitals under Australian Health Care Agreements.

Education is an important social determinant of health, and there are strong two-way links between health and education. People with low educational attainment have fewer life opportunities, poorer health, lower incomes and are more likely to be unemployed. In 2001, approximately 67% of Indigenous students met Year 5 reading benchmarks and about 63% met year 5 numeracy benchmarks (about 90% of all students met both)

 additional $50 million per year for training

How does Australia compare with other countries?

A recent study found that the quality of life of Aboriginal Australians was the second worst on earth. In countries comparable to Australia, Australia has the highest gap in educational attainment between its Indigenous and non-Indigenous population and this gap has widened in the past decade3. The health outcomes for other Indigenous populations have improved markedly over the past 30-40 years. Maoris in New Zealand, Native Americans and Aboriginal Canadians all enjoy significantly better health than Aboriginal and/or Torres Strait Islander Australians4. According to the current National Collaboration between the health system and outside agencies It has also been noted that in each of these countries certain Indigenous rights have been guaranteed as a result of historic or recent treaties and agreements between the Indigenous and non-Indigenous peoples. Significant investment in addressing infrastructure needs and hence better environmental health Provision of good quality comprehensive primary health care services, supported by adequate resources for a substantial period of time Strong community involvement in health services and issues A public health care approach, with a prominent role for health education and promotion Pro-active workforce strategies focussed on training Indigenous people

of Indigenous health workforce and community health education a minimum of $3.5 billion targeted over a reasonable time frame to address the backlog of housing and community infrastructure needs Planning and coordination between various levels of government between various departments that all share health-related responsibilities, including health, education, roads and transport, housing, community services, regional development Following the example of other countries If Canada, the United States and New Zealand can achieve significant improvements in Indigenous health, then so can Australia. The areas that must be targeted are: major investment in environmental health major investment in quality comprehensive primary health care services strong Aboriginal and Torres Strait Islander community involvement a public health care approach workforce strategies collaboration between the health system and outside agencies

Strategic Framework for Aboriginal and Torres Strait Islander Health: Context
2003, the major reasons for these comparatively much better health outcomes in comparison to Australia are:

References
1. Steering Committee for the Review of Government Service Provision, Overcoming Indigenous Disadvantage, Key Indicators 2003, Overview, p.1 2. AMA, Research into the cost, availability and preferences for fresh food compared with convenience food items in remote area Aboriginal communities, prepared by Roy Morgan Research, December 1997

What should we do?

The Commonwealth has the major responsibility for provision of primary health care to Indigenous Australians. A recent report by the Commonwealth House of Representatives Standing Committee on Family and Community Affairs urged the Commonwealth to play a leadership role in improving the health and well-being of Indigenous Australians5. All governments, however, must play a part, working with Indigenous representatives and communities to

overcome barriers that prevent Indigenous people accessing health services, and planning and coordinating services across all departments. Funding and resources A major commitment of funding and resources is needed to achieve significant improvement within a reasonable time frame. As a number of reports in recent years have identified, the resources needed include: additional $450 million6 per year for provision of primary health services

3. Jackson, A, Life of Aborigines second worst on earth, The Age, 28 April 2004 (researcher, Martin Cook, Western Ontario University, Canada) 4. see National Strategic Framework for Aboriginal and Torres Strait Islander Health: Context, NATSIHC, Canberra, 2003, pp 12-13 5. Health is Life Report on the Inquiry into Indigenous Health, Canberra, May 2000, pp xv-xvi 6. The AMA has updated its 2002-03 estimate of $250 million per year, AMA Indigenous Health Report calls for more Indigenous health workers and an extra $452.5 million a year in targeted funding, Press release 12 August 2004

Socio economic factors Low incomes Low employment Low education levels Poor nutrition

Lack of access to primary care Location issues Poor health linkages Cultural / social factors Lack of a public health focus Workforce issues Financial barriers

Environmental factors Poor living environments Sub-standard housing Poor sewerage / water quality Hot / dry and dusty Poor food storage and poor access to affordable healthy food

Poor health status

Figure 1: Interactions of social and physiological determinants of health

National Strategic Framework for Aboriginal and Torres Strait Islander Health: Context,
NATSIHC, Canberra, July 2003, p.10 Available from OATSIH website: http://www.health.gov.au/oatsih/pubs/pdf/ nsfatsihcont.pdf

High mortality rates High morbidity rates Lower life expectancy Multiple morbidities High injury / disability rates Higher hospital admissions Higher incarceration rates

Social and political factors Removal from land Separation of families Dislocation of communities Mistrust of mainstream services Culturally inappropriate services Poor cross cultural communication Relocation of women for child birth Specific health risk factors Poor nutrition Hazardous alcohol use High tobacco use Low physical activity

Figure 2: Socioeconomic disadvantage across ATSIC regions

Published in Commonwealth Grants Commission Report on Indigenous Funding

2001, Vol 1, page 33 http://www.cgc.gov.au/

Most Disadvantaged More Disadvantaged Less Disadvantaged Least Disadvantaged

The Fred Hollows Foundation 4 Mitchell Street Enfield NSW 2136 Australia

Telephone +61 2 8741 1900 Facsimile + 61 2 8741 1999 24hr donation line 1800 352 352

Email fhf@hollows.org Website www.hollows.org