Indigenous health in Australia examines health and wellbeing indicators of
Indigenous Australians
Indigenous Australians or Australian First Nations are people with familial heritage from, and membership in, the ethnic groups that lived in Australia before British colonisation. They consist of two distinct groups: the Aboriginal peoples ...
compared with the rest of the population. Statistics indicate that
Aboriginal Australians
Aboriginal Australians are the various Indigenous peoples of the Australian mainland and many of its islands, such as Tasmania, Fraser Island, Hinchinbrook Island, the Tiwi Islands, and Groote Eylandt, but excluding the Torres Strait Islands ...
and
Torres Strait Islanders
Torres Strait Islanders () are the Indigenous Melanesian people of the Torres Strait Islands, which are part of the state of Queensland, Australia. Ethnically distinct from the Aboriginal people of the rest of Australia, they are often grouped ...
are much less healthy than other Australians. Various government strategies have been put into place to try to remediate the problem; there has been some improvement in several areas, but statistics between Indigenous Australians and the rest of the Australian population still show unacceptable levels of difference.
Colonisation and ongoing disadvantage
Prior to
European colonisation, it is likely that the health Indigenous Australians was better than poorer sections of Europe. Colonisation impacted the health of Indigenous Australians via land dispossession,
social marginalisation,
political oppression
Political repression is the act of a state entity controlling a citizenry by force for political reasons, particularly for the purpose of restricting or preventing the citizenry's ability to take part in the political life of a society, thereb ...
,
incarceration
Imprisonment is the restraint of a person's liberty, for any cause whatsoever, whether by authority of the government, or by a person acting without such authority. In the latter case it is "false imprisonment". Imprisonment does not necessari ...
,
acculturation
Acculturation is a process of social, psychological, and cultural change that stems from the balancing of two cultures while adapting to the prevailing culture of the society. Acculturation is a process in which an individual adopts, acquires and ...
and
population decline
A population decline (also sometimes called underpopulation, depopulation, or population collapse) in humans is a reduction in a human population size. Over the long term, stretching from prehistory to the present, Earth's total human population ...
.
The process of colonisation began with the arrival of the
First Fleet
The First Fleet was a fleet of 11 ships that brought the first European and African settlers to Australia. It was made up of two Royal Navy vessels, three store ships and six convict transports. On 13 May 1787 the fleet under the command ...
in 1788.
In the following decades, foreign diseases, dispossession, exploitation, warfare and violence proved devastating for the Indigenous population, and the immediate effect was a widespread increase in mortality and disease.
By the end of the 19th century, Indigenous Australians were greatly reduced in numbers and the survivors were largely confined to remote reserves and missions. They were associated in the public mind with disease, which led to exclusion from institutions and isolation from non-Indigenous society for fear of contamination. These colonial policies resulted in segregated oppression and a lack of access to adequate medical care, leading to further disease and mortality.
The Australian government proceeded to deny the Indigenous people of their
civil rights
Civil and political rights are a class of rights that protect individuals' freedom from infringement by governments, social organizations, and private individuals. They ensure one's entitlement to participate in the civil and political life of ...
, including property rights; the ability to work and receive wages; and access to medical care and educational institutions. Legislation also allowed for the
separation of Indigenous families, with guardianship being awarded to government officials called
Protectors of Aborigines
The role of Protector of Aborigines was first established in South Australia in 1836.
The role became established in other parts of Australia pursuant to a recommendation contained in the ''Report of the Parliamentary Select Committee on Abori ...
. Indigenous children forcibly removed from their families under Protection legislation in the first half of the 20th century are referred to as the
Stolen Generations
The Stolen Generations (also known as Stolen Children) were the children of Australian Aboriginal and Torres Strait Islander descent who were removed from their families by the Australian federal and state government agencies and church miss ...
. Many of these children were neglected, abused, and denied of an education.
The Australian government forced the Indigenous populations to assimilate into the colonisers’ culture through schools and programs, where Indigenous languages were banned and any resistance to these practices could result in imprisonment or death. This process of acculturation has led to trauma, including historical, inter-generational, and social trauma. Issues such as anxiety, stress, grief, and sadness are produced from this trauma, which have led to higher suicide rates, violence, substance abuse and incarceration of Indigenous peoples today.
Social, political and economic factors that result from colonisation present barriers to quality healthcare, health education, and health behaviours. Acculturation has produced xenophobia, which has socially marginalized Indigenous people and excluded them from society. Social inclusion is a social determinant of health, and social marginalisation allows for injustices against Indigenous people to persist. Political disempowerment prevented them from accessing social services, sickness benefits, and from voting until the 1960s. Socio-economic inequality has resulted in poor employment opportunities, housing, education and healthcare. One in seven Indigenous Australians reported difficulty in accessing healthcare for their children, which include transportation costs and prescription costs. Displacement and disenfranchisement prevents access to healthcare resources such as screening programs, and results in delayed or inadequate treatment. An example of this can be seen in the high rates of cervical cancer, where a meta-analysis of Indigenous women from Australia,
New Zealand
New Zealand ( mi, Aotearoa ) is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and over 700 smaller islands. It is the sixth-largest island count ...
,
Canada
Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tot ...
and the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
attributed these rates to “socio-economic disenfranchisement resulting from colonialism”, rather than genetics.
The displacement of Indigenous Australians to reserves and the isolation from society led to generations suffering from
starvation
Starvation is a severe deficiency in caloric energy intake, below the level needed to maintain an organism's life. It is the most extreme form of malnutrition. In humans, prolonged starvation can cause permanent organ damage and eventually, dea ...
and
malnutrition
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues a ...
. This has had profound effects on physical and intellectual development; Indigenous communities today in remote locations continue to suffer from malnutrition and chronic health problems, as well as lower levels of education.
The persistence of inequality in educational attainment among contemporary Indigenous communities is viewed as a product of historical, political and social factors.
European colonisers believed that Indigenous people were intellectually inferior, and education was thus denied as it was considered pointless.
Low levels of education increase the likelihood of engaging in high risk health behaviours, as well as lower rates of participation in health screening and treatment. However, poor health behaviours and low utilisation of healthcare resources can be due to a combination of many factors. Racial discrimination towards Indigenous peoples that stems from processes of colonialism leads to a cumulative exposure to
racism
Racism is the belief that groups of humans possess different behavioral traits corresponding to inherited attributes and can be divided based on the superiority of one race over another. It may also mean prejudice, discrimination, or antagonism ...
, and this is related to negative health outcomes. It produces feelings of anger and shame, which limits active participation in the mainstream healthcare system and society at large.
The
outstation movement
An outstation, homeland or homeland community is a very small, often remote, permanent community of Aboriginal Australian people connected by kinship, on land that often, but not always, has social, cultural or economic significance to them, as ...
of the 1970s and 1980s, when Aboriginal people moved to tiny remote settlements on traditional land, brought health benefits, but funding them proved expensive, training and employment opportunities were not provided in many cases, and support from governments dwindled in the 2000s, particularly in the era of the
Howard government.
Health issues cannot be separated from social and cultural factors such as
racism
Racism is the belief that groups of humans possess different behavioral traits corresponding to inherited attributes and can be divided based on the superiority of one race over another. It may also mean prejudice, discrimination, or antagonism ...
, discrimination, cultural disconnection and lack of employment and educational opportunities. Colonisation has had an ongoing impact. Overcrowding and poor housing contributes to poor health and family dysfunction and
violence
Violence is the use of physical force so as to injure, abuse, damage, or destroy. Other definitions are also used, such as the World Health Organization's definition of violence as "the intentional use of physical force or Power (social and p ...
. High rates of incarceration of adults and youth
contribute to early death and poor
mental health
Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health ...
.
Hospitalisation rate
Indigenous Australians go to hospital at a higher rate than non-Indigenous Australians.
[
] In 2010–11, Indigenous Australians used hospitals 2.5 times more frequently than non-Indigenous people.
This rate comes from an age-standardised separation rate (hospital check-out) of 911 per 1,000 for Indigenous people.
The 2010–11 age-standardised separation rate for Indigenous people living in the NT was 1,704 per 1,000, 7.9 times the rate for non-Indigenous people. About 80% of the difference between these rates was due to higher separations for Indigenous people admitted for
dialysis.
Life expectancy
From 1996 to 2001, the Australian Bureau of Statistics (ABS) used indirect methods for its calculations, because census results were deemed to be unreliable, and figures published in 2005 (59.4 years for males and 64.8 years for females) indicated a widely quoted gap of 17 years between indigenous and non-indigenous life expectancy, though the ABS does not now consider the 2005 figures to be reliable.
The ''Social Justice Report: 2005'' by the
Australian Human Rights Commission
The Australian Human Rights Commission is the national human rights institution of Australia, established in 1986 as the Human Rights and Equal Opportunity Commission (HREOC) and renamed in 2008. It is a statutory body funded by, but opera ...
reported a seventeen-year gap between the
life expectancy
Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of its birth, current age, and other demographic factors like sex. The most commonly used measure is life expectancy at birth ...
of Indigenous Australians and non-Indigenous Australians. This prompted health and human rights activists to establish the "
Close the Gap
Close the Gap (CTG) is a social justice campaign focused on Indigenous Australians' health, in which peak Aboriginal and Torres Strait Islander and non-Indigenous health bodies, NGOs and human rights organisations work together to achieve heal ...
" campaign, which focused on health equality for Indigenous Australians, including increasing life expectancy, and associated factors such as housing.
In 2009, after previous methods of comparing life expectancy rates proved unreliable, a new method was developed by the ABS, based on tracing the deaths of people identified as Indigenous at the 2006 census. In 2009 the ABS estimated life expectancy at 67.2 years for Indigenous men (11.5 years fewer than for non-Indigenous) and 72.9 years for Indigenous women (9.7 years fewer than for non-Indigenous). Estimated life expectancy of Indigenous men ranged from 61.5 years for those living in the Northern Territory to a high of 69.9 years for those living in New South Wales, and for Indigenous women, 69.2 years for those living in the Northern Territory to a high of 75.0 years for those living in New South Wales.
As of 2010, life expectancy for Aboriginal and
Torres Strait Islander
Torres Strait Islanders () are the Indigenous Melanesian people of the Torres Strait Islands, which are part of the state of Queensland, Australia. Ethnically distinct from the Aboriginal people of the rest of Australia, they are often grouped ...
men was estimated to be 11.5 years less than that of non-Indigenous men – 67.2 years and 78.7 years respectively.
[
] For Aboriginal and Torres Strait Islander women, the 2010 figures show a difference of 9.7 years – 72.9 years for Aboriginal and Torres Strait Islander women and 82.6 years for non-Indigenous women.
Indigenous Australians are more likely to die at a younger age than their non-indigenous counterparts due to being unhealthy.
A 2013 study, referring to the national Indigenous reform policy launched in 2008,
Closing the Gap
The Closing the Gap framework is an Australian government strategy that aims to reduce disadvantage among Aboriginal and Torres Strait Islander people, based on seven targets. From adoption in 2008, after meetings with the Close the Gap social ...
(see below), looked at the difficulties in interpreting the extent of the gap because of differing methods of estimating life expectancy between 2007 and 2012. It concluded:
The 2019 report by the Close the Gap campaign reported that the gap in life expectancy was "widening rather than closing".
Government initiatives
In 1989, the National Aboriginal Health Strategy was created.
Another attempt by the federal government to address health issues was via the creation of the
Office of Aboriginal and Torres Strait Islander Health
The Office of Aboriginal and Torres Strait Islander Health, often known by its acronym OATSIH, was a division of the Australian Government's Department of Health and Ageing. It was set up in 1994 in the then Department of Human Services and Heal ...
(OATSIH) in 1994, but this is no longer in existence.
In 2007/08, the Australian government focused mainly on decreasing "overcrowding" within remote indigenous communities in endeavours to improve health in rural populations. The Implementation of Australian Rural Accommodation (ARIA) Programme was granted over four years to induce a significant level of housing reform.
In 2010–2011, health expenditure for Aboriginal and Torres Strait Islander people was estimated at , or 3.7% of Australia's total recurrent health expenditure.
[
] The Aboriginal and Torres Strait Islander population comprised 2.5% of the Australian population at this time.
Expenditure equated to per Indigenous person, which was 1.47 times greater than the spent per non-Indigenous Australian in the same year.
In 2010–2011, Governments funded 91.4% of health expenditure for Indigenous people, compared with 68.1% for non-Indigenous people.
In July 2018, Health Minister
Greg Hunt
Gregory Andrew Hunt (born 18 November 1965) is a former Australian politician who was the Minister for Health between January 2017 and May 2022. He was a Liberal Party member of the House of Representatives between November 2001 and 2022, repre ...
and
Ken Wyatt
Kenneth George Wyatt (born 4 August 1952) is a former Australian politician who was a member of the House of Representatives from 2010 to 2022, representing the Division of Hasluck for the Liberal Party. He is the first Indigenous Australian el ...
, then Minister for Indigenous Health, announced in funding for 28 new health initiatives through the
National Health and Medical Research Council
The National Health and Medical Research Council (NHMRC) is the main statutory authority of the Australian Government responsible for medical research. It was the eighth largest research funding body in the world in 2016, and NHMRC-funded rese ...
(NHMRC), including expanding renal health units in remote parts so that patients could stay on country with their families. The NHMRC also launched a plan to help direct Indigenous health and research investment for the next ten years.
Closing the Gap
The
Council of Australian Governments
The Council of Australian Governments (COAG) was the primary intergovernmental forum in Australia from 1992 to 2020. Comprising the federal government, the governments of the six states and two mainland territories and the Australian Local Go ...
initiated the first multi-sector approach in regards to initiating strategies to overcome the large discrepancy between Indigenous and European health statistics. The strategy, named Closing the Gap, was launched in 2008. The plan's success was dependent on the level of collaboration between all levels of the Australian Government, Indigenous leaders/communities and the health sector.
Although there was some improvement in some areas, only two out of its seven targets were met.
In July 2019, at the end of the first 10-year phase of Closing the Gap, the
National Indigenous Australians Agency
The National Indigenous Australians Agency (NIAA) is an Australian Government agency responsible for whole-of-government coordination of policy development, program design, and service delivery for Aboriginal Australians and Torres Strait Isla ...
was established in July 2019, under the
Minister for Indigenous Australians
The Minister for Indigenous Australians in the Government of Australia is a position which holds responsibility for affairs affecting Indigenous Australians. Previous ministers have held various other titles since the position was created in 196 ...
,
Ken Wyatt
Kenneth George Wyatt (born 4 August 1952) is a former Australian politician who was a member of the House of Representatives from 2010 to 2022, representing the Division of Hasluck for the Liberal Party. He is the first Indigenous Australian el ...
,
and this agency is now responsible for "lead
ngand coordinat
ngthe development and implementation of Australia’s Closing the Gap targets in partnership with Indigenous Australians".
Health status
Overall
In 2009, 26% of Indigenous Australians living in remote areas experienced 40% of the health gap of Indigenous Australians overall.
[
]
The most common cause of hospital admissions for Indigenous Australians is for
kidney dialysis
Kidney dialysis (from Greek , , 'dissolution'; from , , 'through', and , , 'loosening or splitting') is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions natura ...
treatment, .
End-stage kidney (or renal) disease (ESKD or ESRD) and
hospitalisation for the is much higher among Indigenous than non-Indigenous Australians, in particular those living in remote areas, who are 70 times more likely to be hospitalised.
A 2007 study by the
University of Queensland
, mottoeng = By means of knowledge and hard work
, established =
, endowment = A$224.3 million
, budget = A$2.1 billion
, type = Public research university
, chancellor = Peter Varghese
, vice_chancellor = Deborah Terry
, city = B ...
found that the 11 largest preventable contributions to the Indigenous
burden of disease
Disease burden is the impact of a health problem as measured by financial cost, mortality, morbidity, or other indicators. It is often quantified in terms of quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). Both ...
in Queensland were from the joint contribution of 11 risk factors, with the top three being
high body mass (12.1%),
tobacco
Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ...
(11.6%), and
inadequate physical activity (7.9%).
high cholesterol
Hypercholesterolemia, also called high cholesterol, is the presence of high levels of cholesterol in the blood. It is a form of hyperlipidemia (high levels of lipids in the blood), hyperlipoproteinemia (high levels of lipoproteins in the blood), ...
,
alcohol
Alcohol most commonly refers to:
* Alcohol (chemistry), an organic compound in which a hydroxyl group is bound to a carbon atom
* Alcohol (drug), an intoxicant found in alcoholic drinks
Alcohol may also refer to:
Chemicals
* Ethanol, one of sev ...
,
high blood pressure
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
,
low intake of fruit and vegetables,
intimate partner violence
Intimate partner violence (IPV) is domestic violence by a current or former spouse or partner in an intimate relationship against the other spouse or partner. IPV can take a number of forms, including physical, verbal, emotional, economic and sex ...
,
illicit drugs
The prohibition of drugs through sumptuary legislation or religious law is a common means of attempting to prevent the recreational use of certain intoxicating substances.
While some drugs are illegal to possess, many governments regulate the ...
,
child sexual abuse
Child sexual abuse (CSA), also called child molestation, is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. Forms of child sexual abuse include engaging in sexual activities with a child (whet ...
and
unsafe sex completed the list.
A 2014 follow-up report concluded that the "leading causes of disease and injury burden in the Aboriginal and Torres Strait Islander population were largely the same as in the non-Indigenous population: mental disorders, cardiovascular disease, diabetes, chronic respiratory disease and cancers" in the 2007 study. However, the rate and age distribution between the two populations are very different. Mental disorders and cardiovascular disease account for almost a third of the burden, with diabetes, chronic respiratory disease and cancers the next three leading causes. Also, Indigenous people carried a disproportionate share of the total disease burden for the state, increasing as remoteness increased. The study also highlighted the lack of data on epidemiology of many of the conditions suffered by the Indigenous population.
[
]
Summary table (2003)
Health problems with the highest disparity (compared with the non-Indigenous population) in incidence as of 2003 are outlined in the table below:
Each of these indicators is expected to underestimate the true prevalence of disease in the population due to reduced levels of diagnosis.[
In addition, the following factors have been at least partially implicated in the inequality in life expectancy:][
* poverty
* insufficient education
* substance abuse
* for remote communities, poor access to health services
* for urbanised Indigenous Australians, cultural pressures which prevent access to health services
* cultural differences resulting in poor communication between Indigenous Australians and health workers
]
Diabetes
In some areas of Australia, particular the Torres Strait Islands
The Torres Strait Islands are a group of at least 274 small islands in the Torres Strait, a waterway separating far northern continental Australia's Cape York Peninsula and the island of New Guinea. They span an area of , but their total land ...
, the prevalence of type 2 diabetes among Indigenous Australians is between 25 and 30%.[
] In Central Australia
Central Australia, also sometimes referred to as the Red Centre, is an inexactly defined region associated with the geographic centre of Australia. In its narrowest sense it describes a region that is limited to the town of Alice Springs and i ...
high incidences of type-2 diabetes has led to high chronic kidney disease rates amongst Aboriginals.[
] The most common cause of hospital admissions for Indigenous Australians in mainland Australia was for dialysis treatment.[
] Indigenous women experience twice the adjusted-age risk of gestational diabetes, thus leading to Indigenous women having a higher risk of developing type 2 diabetes after pregnancy and birth. Compared with the general Australian population, Indigenous Australians develop type 2 diabetes at a younger age.
Cancers
The incidence rate of cancer in Indigenous Australians compared with non-Indigenous Australians has varied between 2009 and 2017 and by state, but mostly showing a higher rate at between 1.1% and 1.4% for all cancers. Lung and breast
The breast is one of two prominences located on the upper ventral region of a primate's torso. Both females and males develop breasts from the same embryological tissues.
In females, it serves as the mammary gland, which produces and secret ...
cancers were the most common in the Indigenous population, and both lung
The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...
and liver cancer
Liver cancer (also known as hepatic cancer, primary hepatic cancer, or primary hepatic malignancy) is cancer that starts in the liver. Liver cancer can be primary (starts in liver) or secondary (meaning cancer which has spread from elsewhere to th ...
s were more common in the Indigenous than non-Indigenous population. Overall mortality rate from cancer was higher in New South Wales, Victoria, Queensland, WA, and the NT 2007–2014 (50% vs 65%, or 1.3 times as likely to die); this may be because they are less likely to receive the necessary treatments in time, or because the cancers that they tend to develop are often more lethal than other cancers.[
]
Human T-lymphotropic virus 1
In central Australia, Indigenous Australians have human T-lymphotropic virus 1 at a rate thousands of times higher than non-Indigenous Australians.
Smoking
In 2008, 45% of Aboriginal and Torres Strait Islander adults were current daily smokers. Smoking is one of the main factors contributing to chronic disease. Amongst Indigenous Australians 1 in 5 mortalities are caused by smoking. If the number of smoking Indigenous Australians is reduced to equal the number of non-smoking non-Indigenous individuals there is a potential decrease of 420 mortalities among Aboriginal and Torres Strait Islanders. In 2010 the Australian Government have put in place a 10-year program aimed at improving the health of Indigenous and Torres Strait Island.[
] Specific types of cancer including lung and cervical cancer occurs to 52% of indigenous women due to their smoking habit.[
]
Mental health
In 2010, the rate of high or very high levels of psychological distress for Aboriginal and Torres Strait Islander adults was more than twice that of non-Indigenous Australians. A 2007 study in ''The Lancet
''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823.
The journal publishes original research articles, ...
'' found that the four greatest preventable contributions to the Indigenous mental health burden of disease were: alcohol consumption, illicit drugs, child sexual abuse and intimate partner violence
Intimate partner violence (IPV) is domestic violence by a current or former spouse or partner in an intimate relationship against the other spouse or partner. IPV can take a number of forms, including physical, verbal, emotional, economic and sex ...
. Up to 15% of the 10 year life expectancy gap compared to non-Indigenous Australians has been attributed to mental health disorders. Mental health should be taken into consideration in the Aboriginal concept of health and well being. In the incidence of children and the elderly many problems tend to be hidden. Some of the behavioural problems encountered tend to be linked to neurodevelopment delay and a failing education system.
Mental health
Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health ...
, suicide
Suicide is the act of intentionally causing one's own death. Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and s ...
and self-harm
Self-harm is intentional behavior that is considered harmful to oneself. This is most commonly regarded as direct injury of one's own skin tissues usually without a suicidal intention. Other terms such as cutting, self-injury and self-mutilatio ...
remain major concerns, with the suicide rate being double that of the non-Indigenous population in 2015, and young people experiencing rising mental health rates.
A 2017 article in ''The Lancet
''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823.
The journal publishes original research articles, ...
'' described the suicide
Suicide is the act of intentionally causing one's own death. Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and s ...
rate among Indigenous Australians as a "catastrophic crisis":
The report advocates Indigenous-led national response to the crisis, asserting that suicide prevention programmes have failed this segment of the population. The ex-prisoner population of Australian Aboriginal people is particularly at risk of committing suicide; organisations such as Ngalla Maya
Ngalla Maya was a Western Australian non-profit organisation benefiting Aboriginal Australians and Torres Strait Islanders newly released from prison. The organisation mentored and trained newly released prisoners and helped them find employment. T ...
have been set up to offer assistance.
There are high incidences of anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
, depression, PTSD
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a ...
and suicide amongst the Stolen Generations
The Stolen Generations (also known as Stolen Children) were the children of Australian Aboriginal and Torres Strait Islander descent who were removed from their families by the Australian federal and state government agencies and church miss ...
, with this resulting in unstable parenting and family situations.
Some mental health problems are attributed to the inter-generational trauma brought about by the Stolen Generations
The Stolen Generations (also known as Stolen Children) were the children of Australian Aboriginal and Torres Strait Islander descent who were removed from their families by the Australian federal and state government agencies and church miss ...
.
There are known links between mental health and substance abuse
Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, ...
.
Substance abuse
Many Indigenous communities suffer from a range of health, social and legal problems associated with substance abuse
Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, ...
of both legal and illegal drugs, including but not limited to alcohol abuse
Alcohol abuse encompasses a spectrum of unhealthy alcohol drinking behaviors, ranging from binge drinking to alcohol dependence, in extreme cases resulting in health problems for individuals and large scale social problems such as alcohol-relat ...
, petrol sniffing
Inhalants are a broad range of household and industrial chemicals whose volatile vapors or pressurized gases can be concentrated and breathed in via the nose or mouth to produce intoxication, in a manner not intended by the manufacturer. They ...
, the use illegal drugs such as methamphetamines
Methamphetamine (contracted from ) is a potent central nervous system (CNS) stimulant that is mainly used as a recreational drug and less commonly as a second-line treatment for attention deficit hyperactivity disorder and obesity. Methamph ...
and cannabis
''Cannabis'' () is a genus of flowering plants in the family Cannabaceae. The number of species within the genus is disputed. Three species may be recognized: ''Cannabis sativa'', '' C. indica'', and '' C. ruderalis''. Alternatively ...
and smoking tobacco.[
Tobacco use has been estimated to be the "greatest contributor (23%) to the gap in the disease burden between Indigenous and non-Indigenous Australians", with Indigenous people more than 2.5% likely to smoke daily than non-Indigenous Australians.] The 2004–05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) by the ABS found that, after adjusting for age differences between the two populations, Indigenous adults were more than twice as likely as non-Indigenous adults to be current daily smokers of tobacco.[
NATSIHS 2004/5 found that the proportion of the Indigenous adult population engaged in "risky" and "high-risk" alcohol consumption (15%) was comparable with that of the non-Indigenous population (14%), based on age-standardised data.] The definition of "risky" and "high-risk" consumption used is four or more standard drinks per day average for males, two or more for females. The 2007 National Drug Strategy Household Survey reported that Indigenous peoples were "more likely than other Australians to abstain from alcohol consumption (23.4% versus 16.8%) and also more likely to consume alcohol at risky or high-risk levels for harm in the short term (27.4% versus 20.1%)". These NDSHS comparisons are non-age-standardised; the paper notes that Indigenous figures are based on a sample of 372 people and care should be exercised when using Indigenous figures.
A 2016 study reported that in the Northern Territory
The Northern Territory (commonly abbreviated as NT; formally the Northern Territory of Australia) is an states and territories of Australia, Australian territory in the central and central northern regions of Australia. The Northern Territory ...
(which has the greatest proportion of Indigenous Australians than any other state or territory, at 32%), per capita alcohol consumption for adults was 1.5 times the national average. In addition to the health risks associated with alcohol use, there is a relationship among alcohol abuse, violence and trauma. There has been increasing media attention to this problem, but it defies simple analysis or solutions as the issues are complex and intertwined. The study attempted to collate existing data on the problems and attempts to address them, concluding that more funding is needed to investigate the feasibility and suitability of the various interventional approaches in the Northern Territory.
Indigenous Australians were 1.6 times as likely abstain completely from alcohol than non-Indigenous people in 2012–3. Twice as many men as women drink alcohol, and more likely to drink to risky levels. Foetal alcohol syndrome has been a problem, but the rate of pregnant women drinking had dropped from 20% in 2008 to 10% in 2015. To combat the problem, a number of programs to prevent or mitigate alcohol abuse have been attempted in different regions, many initiated from within the communities themselves. These strategies include such actions as the declaration of " dry zones" within Indigenous communities, prohibition and restriction on point-of-sale access, and community policing and licensing. In the 1980s, the psychoactive
A psychoactive drug, psychopharmaceutical, psychoactive agent or psychotropic drug is a chemical substance, that changes functions of the nervous system, and results in alterations in perception, mood, consciousness, cognition or behavior.
Th ...
drug kava
Kava or kava kava (''Piper methysticum'': Latin 'pepper' and Latinized Greek 'intoxicating') is a crop of the Pacific Islands. The name ''kava'' is from Tongan and Marquesan, meaning 'bitter'; other names for kava include ''ʻawa'' (Hawaiʻi), ...
was introduced into the NT by Pacific Islander
Pacific Islanders, Pasifika, Pasefika, or rarely Pacificers are the peoples of the list of islands in the Pacific Ocean, Pacific Islands. As an ethnic group, ethnic/race (human categorization), racial term, it is used to describe the original p ...
missionaries as an alternative to alcohol, as a safer alternative to alcohol. In 2007, commercial import of kava was banned, but Fiji
Fiji ( , ,; fj, Viti, ; Fiji Hindi: फ़िजी, ''Fijī''), officially the Republic of Fiji, is an island country in Melanesia, part of Oceania in the South Pacific Ocean. It lies about north-northeast of New Zealand. Fiji consists ...
and Vanuatu
Vanuatu ( or ; ), officially the Republic of Vanuatu (french: link=no, République de Vanuatu; bi, Ripablik blong Vanuatu), is an island country located in the South Pacific Ocean. The archipelago, which is of volcanic origin, is east of no ...
have asked the government to lift the ban.
Petrol sniffing
Inhalants are a broad range of household and industrial chemicals whose volatile vapors or pressurized gases can be concentrated and breathed in via the nose or mouth to produce intoxication, in a manner not intended by the manufacturer. They ...
has been a problem among some remote Indigenous communities. Petrol vapour produces euphoria and dulling effect in those who inhale it, and due to its widespread availability, became a popular drug. Proposed solutions to the problem became a topic of heated debate among politicians and the community at large. In 2005 this problem among remote Indigenous communities was considered so serious that a new, low aromatic petrol Opal
Opal is a hydrated amorphous form of silica (SiO2·''n''H2O); its water content may range from 3 to 21% by weight, but is usually between 6 and 10%. Due to its amorphous property, it is classified as a mineraloid, unlike crystalline forms ...
was distributed across the Northern Territory to combat it. A 2018 longitudinal study
A longitudinal study (or longitudinal survey, or panel study) is a research design that involves repeated observations of the same variables (e.g., people) over short or long periods of time (i.e., uses longitudinal data). It is often a type of obs ...
by the University of Queensland
, mottoeng = By means of knowledge and hard work
, established =
, endowment = A$224.3 million
, budget = A$2.1 billion
, type = Public research university
, chancellor = Peter Varghese
, vice_chancellor = Deborah Terry
, city = B ...
, commissioned by the National Indigenous Australians Agency
The National Indigenous Australians Agency (NIAA) is an Australian Government agency responsible for whole-of-government coordination of policy development, program design, and service delivery for Aboriginal Australians and Torres Strait Isla ...
, reported that the number of people sniffing petrol in the 25 communities studied had declined by 95.2%, from 453 to just 22. However volatile substance misuse (VSM) was found to continue to occur in several communities, mostly occasionally and opportunistically.
The 2018 UQ study also reported that alcohol and cannabis were the drugs causing most concern in many of the 25 communities studied. "Alcohol was reported as being in regular use in 22 communities, and occasionally present in two others. Cannabis was reported as being in regular use in all 25 communities, and a serious problem in 20 communities. Ice was reported to be present in 8 of the 25 communities" (although mostly only occasional use).
Violence and accidents
Aboriginal and Torres Strait Islander Australians, particularly males, are far more likely than the rest of the community to experience injury and death from accidents and violence.
Infant mortality
The Aboriginal and Torres Strait Islander infant mortality
Infant mortality is the death of young children under the age of 1. This death toll is measured by the infant mortality rate (IMR), which is the probability of deaths of children under one year of age per 1000 live births. The under-five morta ...
rate varies across Australia. In New South Wales, the rate was 7.7 deaths per 1,000 live births in 2006–2008, compared with the non-Indigenous infant mortality rate of 4.3 deaths per 1,000 live births. In the Northern Territory, the Aboriginal and Torres Strait Islander infant mortality rate was over three times as high as the non-Indigenous infant mortality rate (13.6 deaths per 1,000 live births compared with 3.8 deaths per 1,000 live births).
Male Aboriginal and Torres Strait Islander infant mortality in the Northern Territory was about 15 deaths per 1,000 live births, while female Aboriginal and Torres Strait Islander infant mortality was 12 deaths per 1,000. For non-Indigenous males the rate was 4.4 deaths per 1,000 births and for females it was 3.3 deaths per 1,000 (ABS 2009b).
Between 1998 and 2008 the Indigenous to non-Indigenous rate ratio (the Aboriginal and Torres Strait Islander rate divided by the rate for other Australians) for infant mortality declined in the Northern Territory an average of 1.7% per year, while the rate difference (the Aboriginal and Torres Strait Islander rate minus the rate for other Australians) almost halved from 18.1 to 9.8 deaths per 1,000 births, which suggests that the gap between Aboriginal and Torres Strait Islander and non-Indigenous infant mortality in the Northern Territory has reduced (ABS 2009b).
Pneumococcal disease
Indigenous Australians have a higher rate of Invasive pneumococcal disease
''Streptococcus pneumoniae'', or pneumococcus, is a Gram-positive, spherical bacteria, alpha-hemolytic (under aerobic conditions) or beta-hemolytic (under anaerobic conditions), aerotolerant anaerobic member of the genus Streptococcus. They ar ...
(IPD) than the wider Australian population.[
] In Western Australia between 1997–2007, the IPD incidence rate was 47 cases per 100,000 population per year among Aboriginal people and 7 cases per 100,000 population per year in non-Aboriginal people.
After the introduction of a pneumococcal conjugate vaccine (7vPCV), total IPD rates among Aboriginal children decreased by 46% for those less than 2 years of age and by 40% for those 2–4 years of age. Rates decreased by 64% and 51% in equivalent age groups for non-Aboriginal children.
Oral health
Until the 1980s Aboriginal children were recognised as having better oral health
Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions of ...
than non-Aboriginal children.[
][
] Today, average rates of tooth decay in Aboriginal children are twice as high as non-Aboriginal children. Between 1991 and 2001, the rate of tooth decay amongst Aboriginal children living in metropolitan areas fell, going against the increase in child tooth decay in remote areas. A study performed in 2001-2002 showed that Indigenous Australian patients showed a higher ratio of missing or decayed teeth than European patients, but a lower ratio of filled teeth.
A 2003 study found that complete loss of all natural teeth was higher for Aboriginal people of all age groups (16.2%) compared to non-Aboriginal people (10.2%). In remote communities, those with diabetes were found to have over three times the number of missing teeth than those without diabetes. Type 2 diabetes has been related to poor oral health.
Changes in the Australian Indigenous diet away from a traditional diet, which had originally contained high levels of protein and vitamins. High in fibre and sugar and low in saturated fats – to a diet high in sugar, saturated fats and refined carbohydrates has negatively affected the oral health of Indigenous Australians.
A 1999 study found that the water in rural and remote areas of Australia is less likely to be fluoridated than metropolitan areas, reducing access for many Aboriginal communities to fluoridated water. Fluoridated water has been shown to prevent dental decay.
Hearing loss
Aboriginals experience a high level of conductive hearing loss
Conductive hearing loss (CHL) occurs when there is a problem transferring sound waves anywhere along the pathway through the outer ear, tympanic membrane (eardrum), or middle ear ( ossicles). If a conductive hearing loss occurs in conjunction wi ...
largely due to the massive incidence of middle ear disease among the young in Aboriginal communities. Aboriginal children experience middle ear disease for two and a half years on average during childhood compared with three months for non indigenous children. If untreated it can leave a permanent legacy of hearing loss. The higher incidence of deafness in turn contributes to poor social, educational and emotional outcomes for the children concerned. Such children as they grow into adults are also more likely to experience employment difficulties and find themselves caught up in the criminal justice system. Research in 2012 revealed that nine out of ten Aboriginal prison inmates in the Northern Territory
The Northern Territory (commonly abbreviated as NT; formally the Northern Territory of Australia) is an states and territories of Australia, Australian territory in the central and central northern regions of Australia. The Northern Territory ...
suffer from significant hearing loss.
Health dynamics
A number of factors help to explain why Aboriginal and Torres Strait Islander people have poorer health than other Australians. In general, Aboriginal and Torres Strait Islander people are more likely to have lower levels of education, lower health education, higher unemployment, inadequate housing and access to infrastructure than other Australians.
In particular, crowded housing has been identified as contributing to the spread of infectious diseases
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
. Aboriginal and Torres Strait Islander Australians are also more likely to smoke, have poor diets and have high levels of obesity.
A 2007 study found that the 11 largest preventable contributions to the indigenous burden of disease
Disease burden is the impact of a health problem as measured by financial cost, mortality, morbidity, or other indicators. It is often quantified in terms of quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). Both ...
in Australia were tobacco, alcohol, illicit drugs, high body mass, inadequate physical activity, low intake of fruit and vegetables, high blood pressure, high cholesterol, unsafe sex, child sexual abuse and intimate partner violence. The 11 risk factors considered together explain 37% of the total burden of disease experienced by Indigenous Australians. The remaining 63% consists of a range of known and unknown risk factors, yet to be identified or quantified.
Contemporary diet
Poor-quality diet among the Indigenous population is a significant risk factor for three of the major causes of premature death in Indigenous Australians – cardiovascular disease, cancer and type 2 diabetes
Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, ...
. Much of this burden of disease is due to extremely poor nutrition throughout life.
A 2013 study of Indigenous dietary patterns in Northern Territory communities found there was a high expenditure on beverages and corresponding high intake of sugar-sweetened beverages coupled with low expenditure (and low intakes) of fruit and vegetables. Similarly high per capita consumption of sugar-sweetened beverages has also been reported among Aboriginal and Torres Strait Islander children at the national level.
Modern Aboriginal Australians living in rural areas tend to have nutritionally poor diets, where higher food costs drive people to consume cheaper, lower quality foods. The average diet is high in refined carbohydrates and salt, and low in fruit and vegetables. There are several challenges in improving diets for Aboriginal Australians, such as shorter shelf lives of fresh foods, resistance to changing existing consumption habits, and disagreements on how to implement changes. Some suggest the use of taxes on unhealthy foods and beverages to discourage their consumption, but this approach is questionable. Providing subsidies for healthy foods has proven effective in other countries, but has yet to be proven useful for Aboriginal Australians specifically.
Cross-cultural miscommunication
Among the factors that have been at least partially implicated in the inequality in life expectancy between Indigenous and non-Indigenous people in Australia are cultural differences resulting in poor communication between Indigenous Australians and health workers.
According to Michael Walsh and Ghil'ad Zuckermann
Ghil'ad Zuckermann ( he, גלעד צוקרמן, ; ) is an Israeli-born language revivalist and linguist who works in contact linguistics, lexicology and the study of language, culture and identity. Zuckermann is Professor of Linguistics and Ch ...
, Western conversational interaction is typically "dyadic", between two particular people, where eye contact is important and the speaker controls the interaction; and "contained" in a relatively short, defined time frame. However, traditional Aboriginal conversational interaction is "communal", broadcast to many people, eye contact is not important, the listener controls the interaction; and "continuous", spread over a longer, indefinite time frame.[
]
Hospital partnerships with traditional healers
The ngangkari are traditional healers of the Anangu Aboriginal people of the Western Desert cultural bloc
The Western Desert cultural bloc or just Western Desert is a cultural region in central Australia covering about , including the Gibson Desert, the Great Victoria Desert, the Great Sandy and Little Sandy Deserts in the Northern Territory, So ...
, who have been invited to partner with hospitals in South Australia to offer traditional healing services.
Studies relating to Aboriginal people only
The following studies are confined to Aboriginal peoples only, although not necessarily only true of those populations:
*A 2015 study showed that Aboriginal Australians have disproportionately high rates of severe physical disability
A physical disability is a limitation on a person's physical functioning, mobility, dexterity or stamina. Other physical disabilities include impairments which limit other facets of daily living, such as respiratory disorders, blindness, epileps ...
, as much as three times that of non-Aboriginal Australians, possibly due to higher rates of chronic diseases such as diabetes
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...
and kidney disease
Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can ...
. The study found that obesity
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...
and smoking rates were higher among Aboriginal people, which are contributing factors or causes of serious health issues. The study also showed that Aboriginal Australians were more likely to self-report their health as "excellent/very good" in spite of extant severe physical limitations.
*One study reports that Aboriginal Australians are significantly affected by infectious disease
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
s, particularly in rural areas. These diseases include strongyloidiasis
Strongyloidiasis is a human parasitic disease caused by the nematode called ''Strongyloides stercoralis'', or sometimes the closely related ''S. fülleborni''. These helminths belong to a group of nematodes called roundworms. These intestinal worm ...
, hookworm caused by ''Ancylostoma duodenale
''Ancylostoma'' is a genus of nematodes that includes some species of hookworms.
Species include:
: ''Ancylostoma braziliense'', commonly infects cats, popularly known in Brazil as ''bicho-geográfico''
: ''Ancylostoma caninum'', commonly infec ...
,'' scabies
Scabies (; also sometimes known as the seven-year itch) is a contagious skin infestation by the mite ''Sarcoptes scabiei''. The most common symptoms are severe itchiness and a pimple-like rash. Occasionally, tiny burrows may appear on the skin ...
, and streptococcal
''Streptococcus'' is a genus of gram-positive ' (plural ) or spherical bacteria that belongs to the family Streptococcaceae, within the order Lactobacillales (lactic acid bacteria), in the phylum Bacillota. Cell division in streptococci occur ...
infections. Because poverty is also prevalent in Aboriginal populations, the need for medical assistance is even greater in many Aboriginal Australian communities. The researchers suggested the use of mass drug administration
The administration of drugs to whole populations irrespective of disease status is referred to as mass drug administration (MDA).
This article describes the administration of antimalarial drugs to whole populations an intervention which has been u ...
(MDA) as a method of combating the diseases found commonly among Aboriginal peoples, while also highlighting the importance of "sanitation, access to clean water, good food, integrated vector control and management, childhood immunisations, and personal and family hygiene".
*A study examining the psychosocial
The psychosocial approach looks at individuals in the context of the combined influence that psychological factors and the surrounding social environment have on their physical and mental wellness and their ability to function. This approach is ...
functioning of high-risk-exposed and low-risk-exposed Aboriginal Australians aged 12–17 found that in high-risk youths, personal well-being was protected by a sense of solidarity and common low socioeconomic status. However, in low-risk youths, perceptions of racism caused poor psychosocial functioning. The researchers suggested that factors such as racism
Racism is the belief that groups of humans possess different behavioral traits corresponding to inherited attributes and can be divided based on the superiority of one race over another. It may also mean prejudice, discrimination, or antagonism ...
, discrimination and alienation contributed to physiological health risks in ethnic minority families. The study also mentioned the effect of poverty on Aboriginal populations: higher morbidity and mortality rates.
*Aboriginal Australians suffer from high rates of heart disease
Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, hea ...
. Cardiovascular diseases are the leading cause of death worldwide and among Aboriginal Australians. Aboriginal people develop atrial fibrillation, a condition that sharply increases the risk of stroke, much earlier than non-Aboriginal Australians on average. The life expectancy for Aboriginal Australians is 10 years lower than non-Aboriginal Australians. Technologies such as the Wireless ambulatory ECG
Wireless ambulatory electrocardiography (ECG) is a type of ambulatory electrocardiography with recording devices that use wireless technology, such as Bluetooth and smartphones, for at-home cardiac monitoring (monitoring of heart rhythms). These ...
are being developed to screen at-risk individuals, particularly rural Australians, for atrial fibrillation.
See also
* Animal Management in Rural and Remote Indigenous Communities
Animal Management in Rural and Remote Indigenous Communities (AMRRIC) is an Australian organisation that works alongside Aboriginal and Torres Strait Islander peoples to coordinate and facilitate sustainable, culturally-sensitive, professional an ...
(AMMRIC)
*Australian Indigenous HealthInfoNet
The Australian Indigenous Health''InfoNet'', formerly National Aboriginal and Torres Strait Islander Health Clearinghouse, is an internet resource that collects, collates, interprets, and presents evidence-derived knowledge on Aboriginal and Tor ...
- internet resource
* COVID-19 pandemic: impact on Indigenous Australians
* Health in Australia
Australia is a high income country, and this is reflected in the good status of health of the population overall. In 2011, Australia ranked 2nd on the United Nations Development Programme’s Human Development Index, indicating the level of develo ...
* New World Syndrome
New World Syndrome is a set of non-communicable diseases brought on by consumption of junk food and a sedentary lifestyle, especially common to indigenous peoples of the Americas, Oceania, and circumpolar peoples. It is characterized by obesity, h ...
* Race and health
Race and health refers to how being identified with a specific race influences health. Race is a complex concept that has changed across chronological eras and depends on both self-identification and social recognition. In the study of race and ...
References
Further reading
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* Contribution to the discussion about the next phase of the Closing the Gap Strategy.
{{Authority control
History of Indigenous Australians
Healthcare in Australia
Children's health in Australia
Mental health in Australia
Health policy in Australia
Aboriginal Australian health