HEALTH INEQUITIES - ATSI

Mortality: Health Conditions: ATSI suffer larger death rates and are 5x more likely to die from circulatory diseases, endocrine,
metabolic and nutritional disorders (diabetes). More likely to suffer from long-term health conditions (asthma, 3x rate
diabetes, arthritis, 7x rate kidney diseases). 2011 census show that ATSI people require a increase in assistance for
daily activities
Mortality Rate: 1.7x non-ATSI rate,
↓ in deaths male + female

Child Mortality: Child Mortality: 2x non-ATSI rate.

There has been a significant decline in child mortality rates (aged 0–4), from 217 deaths per 100,000 Indigenous children
in 1998 to 146 deaths per 100,000 in 2016.
2.1 times as likely to die before their fifth birthday
● 1.9 times as likely to be born with low birthweight

Mental Health: Mental Health: ↑ rates depression, anxiety, self-harm, ATSI suicide rate= 1.9x non-ATSI rate
● 2.7 times as likely to experience high or very high levels of psychological distress

Life expectancy: Life Expectancy: 10yrs below non-ATSI,

Between 2005–2007 and 2010–2012, the gap in life expectancy at birth between Indigenous and non-Indigenous
Australians decreased from 11.4 to 10.6 years for males, and from 9.6 to 9.5 years for females.
● 1.7 times as likely to have a disability or restrictive long-term health condition

Risk Factors: Nature: Extent:

Diet: Inadequate vegetable and fruit intake
increases risk of developing health conditions
such as obesity, coronary heart disease,
stroke, forms of cancer, type-2 diabetes and a
higher blood pressure than other Australians.
ATSI communities in rural, remote or
socioeconomically disadvantaged areas have
decreased access to healthy food resulting in a
poor diet.
Physical Activity: Lack of sufficient exercise
of ATSI contributes to a decrease in a healthy
maintained weight. This factor is a key
contributor to disease burden in Australia.
Aspects that contributed to this decrease
include social structure, education, and quality
relationships.
Obesity: Excessive weight poses a major risk
factor for diseases such as cardiovascular
disease, type-2 diabetes, some
musculoskeletal conditions and cancers. There
are differences in weight between ATSI and
non-ATSI Australians. Many habits that
contribute to obesity in ATSI begin in childhood
due to the lack of education across ATSI
communities in a variety of locations that are
disadvantaged.
Alcohol Consumption: Surveys show a
relatively low rate of risky drinking behaviours
in rural and remote ATSI communities.
Smoking: Leading preventable cause of poor
health and death in Australia for both ATSI and
non-ATSI peoples. Smoking contributes to
respiratory diseases, cancer, cardiovascular
diseases, infections and endocrine disorders. ↓
smoking rates & risking drinking (still 2x
non-ATSI rate)
Diet: 97% of ATSI people over the age of 15 have inadequate fruit
and vegetable consumption, males having a lower rate of
consumption (99%) to females (96%). Rural (98%) and
non-remote locations (97%), ATSI children aged 2-14 (94%).
Overall ATSI (97.2%) to other Australians (94.8%).
Physical Activity: Increase in amount of physical activity
performed by ATSI peoples between the ages of 18-24
(50min/day) and declined with age of those aged 55 and over
(29min/day) → in 2012-13, 4 in 10 (38%) of ATSI peoples in
non-remote locations met physical activity guidelines.
Obesity: →2018-19, 3.5% of ATSI people reported to be
underweight, 22% in a normal weight range, 29% overweight and
45% obese. →ATSI females aged 15-17 are reported to be 4x
more likely to be underweight than males of the same age (14%
female, 3.1% male)
Alcohol Consumption: → 37% of ATSI people over the age of
18 in remote locations reported to have not consumed alcohol in
the past year or have never consumed alcohol, and ATSI in
non-remote locations (23%). →In 2019-20, 17% of clients seeking
alcohol and other drug treatment services aged 10 and over were
ATSI.→ Data from the Australian Burden of Disease Study 2018
show that alcohol use = 2nd largest contributor to burden & was
responsible for 10.5% of the total burden of disease. Alcohol use
was the major contributor to non-fatal burden (9.2%).→
Abstinence among ATSI have increased from 25% in 2010 to 29%
in 2019→ ATSI aged 15 and over participating in lifetime risk
alcohol consumption increased between 2014-15 and 2018-19.
Although there has been a decrease in rates from 19.2% in 2008
to 18.4% in 2019→ Lifetime risky drinking of ATSI aged 15 is
18.7% compared to non-ATSI (15.2%) ATSI alcohol related deaths
= 23.8 per 100k compared to non-ATSI= 4.7 per 100k
Smoking: 2.7 times as likely to smoke→ Responsible for 11.9% of
burden of disease amongst ATSI and the major contributor to fatal
burden (23%/ over 800 deaths). Leading risk factor for both males
and females ATSI.→ An overall decline in current smokers of ATSI
peoples, 43.4% in 2018-19. Majority of decline occurred in
non-remote locations and a slight increase in remote and rural
locations→ No change in gap between current smokers of ATSI
and non-ATSI peoples→ In 2018-19 Males were more likely to be
smokers (45.6%) than females (41.2%)→ 1 in 2 ATSI peoples with
mental illness were daily smokers (46%)
Smoking rates among Indigenous Australians have declined from
51% in 2002 to 42% in 2014–15. This decline was concentrated in
 non-remote areas.Fewer young Indigenous people aged 15–17 are
smoking now than in the past—30% in 1994 compared with 17% in
2014–15.In 2014–15, 15% of Indigenous people aged 15 and over
reported that they drank alcohol at lifetime risky levels— a decrease
from 19% in 2008.

CLOSE THE STATS GENERAL INFO

GAP - In 2007, COAG (Council of Australian Close the Gap campaign aims to close the health and life
CAMPAIGN Governments) set targets to track and expectancy gap between Aboriginal and Torres Strait Islander
assess developments in the health and people and non-Indiginous Australians within a generation.
→ info to wellbeing of ATSI people. These targets - The 10 year review of the campaign posted in February
summarise being closing the gap and halving the 2018 examines how Australian governments have not yet
mortality rate gap for children under 5 succeeded in closing the gap and why continuing on the
https://www.clo within a decade current course of action will not achieve the Close the Gap
singthegap.gov - In March of 2008, Kevin Rudd and campaigns goal by 2030.
.au/ Brendan Nelson signed the Close the
Gap statement of intent. Their belief:
https://humanri - Since the first meeting of the committee When ATSI people have a say in the design and delivery of policies,
ghts.gov.au/ou in March 2006, almost 200,000 programs and services that impact them, they achieve better life
r-work/aborigin Australians have formally pledged their outcomes.
al-and-torres-st support
rait-islander-so
cial-justice/pub
lications/close-
gap-2020?_ga= From the video (Close the Gap 2017) THEIR OBJECTIVES
2.206249683.13 - There needs to be more aboriginal and - How: implementing a human rights based approach to
75374949.1647 torres strait islander health workers ATSI health
417667-438055 - VAHS ● Close the Gap statement of intent includes a committee to:
176.164602970 - Develop a comprehensive, long-term plan of
5 action, that is targeted to need, is evidence-based
and capable of addressing the existing
https://humanri inequalities in health services, in order to achieve
ghts.gov.au/ou equality of health status and life expectancy
r-work/aborigin between ATSI peoples and non- ATSI Australians
al-and-torres-st by 2030.
rait-islander-so - Ensures the full participation of ATSI peoples and
cial-justice/pub their representative bodies in all aspects of
lications/close- addressing their health needs.
gap-report-our
- Statement of intent: A fundamental feature of the
https://humanri campaign that when signed by the Australian government
ghts.gov.au/ou they committed to a evidenced-based path to achieving
r-work/aborigin equity of health. This is a path supported by the entirety of
al-and-torres-st the ATSI health sector.
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DETERMINANTS - ATSI
Socioeconomic
Education
ATSI people experience an overall lower
level of education than non-ATSI people,
however between 2004-19 there has been
an increase with 47% aged 20-24 completing
Yr 12 in 2016, compared with 37% in 2011.
The rate of qualifiers had increased from
59% to 66% in 2018-19. Higher levels of
education can promote and lead to better
overall health, 54% of Yr 12 qualifiers
reported being in good health compared to
38% with a Yr 10 or lower level of education.
71% who completed Yr 12 did not smoke
and had higher levels of physical activity to
those with a Yr 10 or below education level
(15% to 9.1%). Education accounts for 8.7%
of the total health gap between ATSI and
non-ATSI people.
Employment
ATSI people unemployed are more likely to
participate in health risk behaviours such as
smoking and inactivity, this leads to an
overall decline in their health. In 2018-19,
66.1% employed did not smoke and had
physical activity levels 6.6% higher than
those unemployed.Unemployment can lead
to psychosocial stress impacting an
individual's physical and mental health and
wellbeing. Participating in work assists in
protecting health, improves self-esteem and
positive sense of identity. ATSI people
experience lower levels of employment
compared to non-ATSI Australians. 2007-08
and 2018-19 showed a drop in overall
employment for ATSI people from 54% to
49% and the rate for non-ATSI remained
unchanged at 76%. During this period, the
gap in employment rates between ATSI and
non-ATSI was 27 points. Between 2018-19
the 5 most common occupation groups of
working ATSI were labourers (18%),
community and personal service workers
(18%), professionals (15%), trade workers
(14%) and administrative workers (11%)
Income
ATSI people experience lower average
incomes from employment and private
sources than non-ATSI Australians, and are
more likely to be living on low incomes. This
acts as a contributing factor to lower levels of
health and wellbeing outcomes as well as
increased reliance on government assisted
income.In 2018-19, the average household
income per week for ATSI aged 18 and over
was $553, 4.5% lower than in 2014-15
($579). Between 2014-15 and 2018-19, ATSI
people's personal income decreased by
5.6% from $518 to $489. In 2018-19 ATSI
Sociocultural
Family
An individual’s family can influence
physical and mental health through
providing access to services, products
and activities, and through creating a
safe and supportive emotional and
learning environment. In 2008-9, the
rate of ATSI child protection was 8
times the rate for other children, and
ATSI accounted for over one-quarter of
all prisoners in 2010 with rates of
imprisonment rising to 52% between
2000-10. 47% of ATSI families with
dependent children were single
parents.Child abuse and neglect
increases the risk of anxiety and
depressive disorders alongside suicide
or self-inflicted injuries. In 2016, 1 in 6
women (17%) and 1 in 16 men (6.1%)
had experienced physical or sexual
violence by a current or previous
partner since the age of 15.
Peers/friends
Social connectedness and an
individual's ability to form close bonds
with others outside of family
relationships have been linked to lower
morbidity and increased life
expectancy. Physical and mental health
can be improved through strong social
networks that provide practical and
emotional support, alongside
assistance in economic and material
hardship.
Media
Social inequalities and disadvantages
are the main reason for avoidable and
unfair differences in health outcomes
and life expectancy across groups in
society. Bringing attention to the
inequities of health experienced by the
ATSI population can support the
implications of improved health
initiatives produced by the government.
It can also encourage change within
ATSI communities to make positive
decisions in regards to their health to
Environmental
Technology
For ATSI communities in rural or remote areas,
access to medical services and technology is
limited when compared to services of major cities.
Medical technology such as cancer screening
programs require people suffering with certain
diseases to travel long distances on a regular
basis, leading to relocation and decrease in rural
or remote ATSI population. In 2011, 80% of all
Australians had access to the internet while only
6% of ATSI people reported having a computer,
and 64% with access to internet within their
household.
Access
ATSI people experience a decreased level of
access to health services than non-ATSI people,
increasing participation in risk factors that leads to
higher rates of disease and death. In 2008 ATSI
people reported having difficulty accessing
services such as dentists and GP’s due to long
waiting times or service unavailability. GP
employment rates in rural and remote areas are
improving with a 23% increase between 2010-14,
but remain significantly lower than rates of major
cities. This limits access to general medical
service. Additionally, with a decrease in access to
healthcare facilities in rural or remote locations,
there is an increasing prevalence of risk factors.
Location
ATSI people populate across all of Australia, 38%
(329,100 people) live in Major cities, 44%
(381,300) live in Inner and outer regional areas
and 18% (153,700) live in Remote and very
remote areas combined. The Northern Territory
has the highest proportion of ATSI residents, 31%
(78,600 people) in 2020. As remoteness increases
employment and income rates decrease. Death
rates and rates of disease for diabetes, cancer
and circulatory diseases are higher for rural or
remote locations being 4 times the rate of major
cities.
peoples main source of income relied on a further address the health
government pension or allowance (45%), indifferences.
employment income (44%), other main
sources (5.7%), and no source of income
(5.6%). Government pension or allowance
peaked for ATSI people in 2018-19 of outer
regional areas and was lowest in major
cities, this was equal for non-ATSI people
during this period.

Housing Religion/culture

Between 2006-16 there has been an overall
increase in ATSI household owners (34% to
38%). In 2017-18, 10.5% of the population
lived in low income households. This
contributes to 14% of the overall health gap.
Physical and mental health risks presented
by factors of homelessness and
overcrowding can be limited through access
to appropriate, affordable and secure
housing. People living with long-term health
conditions or a disability, unemployed or
underemployed are at greater risk of living in
poor-quality housing. In 2016, 50 per 10,000
of the population were estimated to be
homeless, a 10% increase from 2006. And in
2017-18, 43% of low income households
were in rental stress, allocating more than
30% of their income on housing costs. ATSI
housing experienced 14% higher levels of
overcrowding in 2018 compared to
non-ATSI. 1 in 3 ATSI adults are
homeowners and 2 in 3 are renting with 34%
living in social housing. Social housing rates
fell between 2008 and 2018-19, and private
renting increased to 33% in 2018-19.
Discrimination, cultural and historical
pressures, family structure and
intergeneration trauma create barriers in
housing market creating difficulty for quality
housing in the ATSI population. 16.4% of
ATSI households had no access to working
facilities such as food preparation, laundry
machines, and personal hygiene.
Due to higher rates of participation in
risk factors among ATSI communities,
there is a greater influence from this
culture on people brought up within
these environments. This contributes to
the poor evaluation to health services
with instances involving language
barriers and the bad health examples
set by adults. Barriers within the ATSI
culture due to disempowermant from
oppression and discrimination causes
mistrust between ATSI people and the
government. Within Indiginous
households 1 in 10 ATSI adults spoke
their native language as their main
language and 2 in 5 adults spoke at
least some words of their language.
62% of Indigenous adults identified
with a clan, tribal or language group,
showing an increase from 54% in
2002.

ROLES & RESPONSIBILITIES IN ADDRESSING THE HEALTH INEQUITIES- ATSI

Individuals Communities Governments

Individuals are responsible to promote their
own health and the health of others. Good
decision making and self responsibility can
assist in addressing the inequities faced by
ATSI people, this can be achieved through
reducing risk behaviours and increasing
protective ones as well as remaining in
school. An adequate level of education can
increase an individual's knowledge and
opportunities for employment that can assist
them later in life. Promoting health in their
family and friends, such as not smoking and
reducing alcohol intake can further address
the inequities of ATSI health.
Communities can begin to address the
health inequities of ATSI people by
providing relevant health care and
support services and programs, such
as the National Aboriginal Community
Controlled Health organisation.
Implementing government funding,
programs and policies can generate
positive change and empowerment
within the communities. It is important
residents fulfil their role in providing
services driven from local needs, this
can include delivery of health-based
information to everyone to encourage
positive change in regards to health
decisions.
Governments are responsible for creating
programs and policies that promote good health
alongside providing education, medical services
and employment opportunities. Influencing positive
health choices and funding education based
organisations can assist in addressing the health
inequities of the ATSI population. Government
organisations can provide health services such as
clinics and medical facilities for rural and remote
locations assisting the promotion of health for
people of certain geographic locations. The
services provided by governments to the ATSI
population can help reduce mortality and morbidity
rates alongside increasing their life expectancy.
HEALTH INEQUITIES - ELDERLY

Mortality Nature
Mental Health → Elderly are considered people aged 65 years and over. In 2018, the elderly accounted for 16% of Australia's
Life expectancy population, and during 2019 the median age at death was 78 years for males and 84 years for females.
Risk Factors → As age increases, risk factors of a decline in health also increase, leading to a number of inequities in health. Older
people are most affected by chronic disease, with 78% suffering from either, type-2 diabetes, arthritis (49% of older
TRY TO FIND people suffering), depression and coronary heart disease (15%). Additionally, they experience higher rates of diabetes
MORE INFO (15%) and cancer (7%), with prevalence of diabetes being higher in men than women.
→ They experience the highest rates of injury-related hospitalisations.
→ Elderly experience higher rates of disability with more than 50% of older people have a disability
Extent
→ Australia’s population is ageing, from this the proportion of older Australians is increasing. The percentage of elderly in
Australia's population during 2018 (16%) is expected to increase to 21-23% by 2066. Additionally, there is an increased
population living with chronic disease and disability due to the higher prevalence among the elderly, from this there is a
higher healthcare expenditure and need for aged-care facilities.
→ In 2018, elderly accounted for 60% of registered deaths during 2019, with 59% for males and 73% for females. During
this time, the median age at death was 78 years for males and 84 years for females.
→ Australia’s elderly population face higher rates of chronic diseases than people aged 65 and below. In 2018, 86.5% of
people aged 65 years or above reported having one or more long-term health conditions, with 49% reporting having
arthritis. Survival rates for chronic disease are increasing.
→ 1 in 2 people aged 65 years or above had a disability compared with 1 in 9 for people aged 0-64 years. 93% of older
people suffer from dementia, and the prevalence of disease is increasing with 1.72 million people suffering in 2012, to
1.94 in 2018.
→ The Survival rate of cancer among the elderly is rising, due to this and Australia’s ageing population the recurrence of
cancer is also increasing.
→ Mortality due to coronary heart disease and stroke has decreased from 73% in 1980, to 69% in 2014.

DETERMINANTS - ELDERLY

Socioeconomic Sociocultural Environmental

Education Family Technology

Among the elderly population in Australia,
there is a diverse level of education and
study fields. 12% of elderly whose highest
qualification is a bachelor degree or higher,
studied in fields of education and health, with
an overall of 47% having a qualification of
year 12 or below. In 2016, less than 0.6% of
older Australians were enrolled in an
educational course. Of these, almost
one-third (some 6,600) were studying at
university or other tertiary institutions.
Within the elderly population there is
an increased reliance on family for
support, from this their health is often
subject to others availability, forcing or
straining important relationships.
Increased reliance can also come with
financial costs that may impact access
to certain health services such as GP
visits, or medical services.

Employment Peers/friends Access

The rate of participation among older
Australians is increasing. 619,000 of elderly
Australians were employed in the labour
force in April 2021, 61% being men and 39%
women. The workforce rate of participation
has doubled from 6.1% in 2001 to 15% in
2021, increasing 9% for men and 8% for
women and an unemployment rate of 3%. In
2018-19, the average retirement age was
55.4, during this period there were 3.9 million
people aged 45 and over retired due to
reaching retirement age or eligibility for
superannuation or pension, change in health
condition or made redundant. 49% of the
elderly population was employed full-time in
April 2021 and 51% part-time. As the
population ages the rate of older Australians
working full-time has decreased to 2 in 3
working aged 55-64 and 1 in 2 for those
aged 65 and over.
For the elderly population, it is
important that they maintain
relationships with friends to allow for
improvement in mental wellbeing. (7%
of older people living in households
had participated in social activities at
home. In 2018 9 in 10 older people
reported visiting relatives or friends
away from home and 3 in 4 reported
going out.
the majority of older people (aged 65
and over) who were living in
households had participated in social
activities at home (97%) or outside
their home (94%) in the previous 3
months.
Elderly people living in remote and very remote
locations experience poorer access to healthcare
services and facilities such as aged care services
than those living in Major cities. Access to services
such as dentists, GP’s and community services
can disadvantage the health outcomes of the
elderly living in remote areas. Additionally, as
remoteness increases the proportion of older
Australians using aged care services decreases.
Compared with 62% in metropolitan areas only
21% of permanent residential aged care facilities
are located in rural or remote areas.

Income Media Location

For many older Australians, income levels For the elderly population living in rural and
can diminish during retirement, however, remote areas, they experience shorter lives,
there are a range of income sources that can higher death rates, higher levels of disease and
provide support and assistance during the injury, and decreased health outcomes. This is due
later years of life. The rate of reliance on to socioeconomic disadvantages, lifestyle risk
these sources are ever-changing. In 2018, factors and decreased access to health services.
57% of elderly had a government pension or Older people in remote areas have an increased
allowance (6% decrease from 2015), 21% prevalence of chronic conditions such as arthritis,
had superannuation, annuity or private asthma and COPD. Additionally, burden of disease
pension (3% increase from 2015) and 8% of rates increase as remoteness increases.
eldery relied on wages and salary as their
main source of income. In June 2020, 2 in 3
(67%) of elderly Australians received the age
pension, carer payment, disability support
payment or jobseeker payment. Due to the
increase in qualifying age for Age Pension,
the rate of elderly reliance on these payments
has increased by 2 million between 2016-20.

Housing Religion/culture

The rate of home ownership for elderly Culturally and linguistically diverse
Australians has decreased 5% between elderly may face barriers in accessing
2003-18, and during 2016, 1 in 4 older people essential supports and services that
lived alone in private dwellings. These lead to health improvements. 37% of
patterns of ownership can alter according to a elderly Australians were born outside
person's living arrangements. In 2016, 58% of Australia and 18% speak a different
all older Australians lived with a spouse or language at home.
partner and 92% of couples owned a home in
2017-18. Between 2017-18, 14% of elderly
people were renting, 64% from a private
landlord and 24% from a state or territory
housing authority. During the same period,
older lone people were 22% more likely to
rent than couple only households (6.2%).
Additionally, between 2019-20, 1 in 5
members of public housing households and
community households were elderly, with
women accounting for 59% of all older
occupants in both during 2019-20. The rate of
those at risk of homelessness increases with
age. In 2016, 1 in 6 of older Australians were
homeless.

ROLES & RESPONSIBILITIES IN ADDRESSING THE HEALTH INEQUITIES- ELDERLY

Individuals Communities Governments

The elderly can begin to address the health
inequities within their communities through
taking responsibility for their own health and
the health of others around them by making
and supporting healthier lifestyle choices.
Through participating in protective factors,
individuals can improve their health
outcomes and through increasing contact
with society such as family, volunteer
organisations and retirement villages
individuals can increase their physical and
mental wellbeing.
Communities can begin to address the
health inequities faced by the elderly
through providing local initiatives that
provide support and address their
specific needs. An example of this is
Meals on Wheels, an organisation that
delivers food to those with poorer
access to food services, such as those
in remote areas. Alongside rotary clubs
that provide free transport to services
and facilities for older people. Social
clubs and sporting associations can be
developed by communities to provide a
place for socialising, thus
strengthening older people's social
network through creating connections
and interacting with others.
Government's role in addressing the health
inequities faced by the elderly population is to
focus on and provide services that work towards
improving the health of older people. This can be
achieved through promoting good health and
encouraging protective lifestyle choices to reduce
the risk of chronic diseases. Governments can
improve the management of chronic conditions
through broader strategies and initiatives to enable
healthy ageing and increase one's quality of life.
They are also working towards enhancing
healthcare systems and their efficiency towards
improving the health and wellbeing of the elderly
population.