The current state of Indigenous health
Three percent of Australia’s population – or more than 700,000 people – are Indigenous. Indigenous people live in all parts of the country, but most live in major cities. Delivering culturally sensitive health services to Aboriginal and Torres Strait Islander communities is crucial to improving outcomes.
Aboriginal and Torres Strait Islander patients carry a larger burden of grief, losses and traumatic events in their lives, and that’s reflected by the anxiety and depression that you see every day.Dr Lisa Fraser, GPTQ Registrar
Indigenous communities are all vastly different
Indigenous groups speak many diverse languages and descend from hundreds of distinct groups. This can present some unique challenges for providing health care.
Recognising these and other challenges, the government committed to ‘closing the gap’ in health equality between Indigenous and non-Indigenous people in 2006. After much consultation, the campaign launched with the targets to:
- Close the gap in life expectancy within a generation (by 2031)
- Halve the gap in mortality rates for Indigenous children under five within a decade (by 2018)
- Ensure all Indigenous children aged four in remote communities have access to early childhood education within five years (by 2013)
- Halve the gap in reading, writing and numeracy achievements for Indigenous students within a decade (by 2018)
- Halve the gap for Indigenous people aged 20–24 in Year 12 or equivalent attainment rates by 2020
- Halve the gap in employment outcomes between Indigenous and non-Indigenous people within a decade (by 2018)
Health care and hospital visits
Delivering culturally sensitive health services to Aboriginal and Torres Strait Islander communities is crucial to improving outcomes. Some Indigenous patients may be reluctant to access health services due to cultural barriers. Delays in treating Indigenous patients can worsen conditions and require more complex interventions.
There has been some encouraging news on this front. Indigenous health checks increased significantly between 2006 and 2014. The rate of attendance to a GP for a standard health check rose by 25 percent (for those aged 15 to 54).
The hospitalisation rate in 2012–2013 was 2.3 times higher for Indigenous people than non-Indigenous people living in Australia. Eighty-four percent of this difference was attributable to Indigenous people requiring dialysis treatment. Excluding these presentations, the hospitalisation rate for Indigenous people was still 1.2 times higher than non-Indigenous people.
How much progress has been made?
Current data shows these targets are unlikely to be met, but significant gains have been achieved in some areas over the past decade.
There have been positive outcomes in adult and child mortality rates and disease prevalence, including:
- A 33 per cent decline in Indigenous child mortality rate between 1998 and 2014
- A 34 per cent reduction in the gap between Indigenous and non-Indigenous child mortality rate
- A 16 per cent decline in Indigenous adult mortality rate between 1998 and 2012
- A 17 per cent reduction in the mortality gap between Indigenous and non-Indigenous people between 1998 and 2012
- A 41 per cent reduction in Indigenous mortality rate from circulatory disease and 27 per cent reduction for respiratory disease from 1998 to 2013
- A 38 per cent decline in Indigenous kidney disease mortality rate from 2006 to 2013
Even with these gains, Australia is still not on track to achieve the government’s target of ‘closing the gap in life expectancy by 2031’. There are still areas that need focus and attention to ensure inequalities are addressed. For instance, according to the Closing the Gap report:
- Chronic disease accounts for almost three-quarters of the gap in mortality rates between Indigenous and non-Indigenous people.
- Cancer mortality rates are rising. Between 2006 and 2013, cancer death rates for Indigenous patients increased by 10 per cent, but declined by 6 per cent for non-Indigenous people living in Australia.
Inter-generational trauma is prevalent in many Indigenous communities. This is mainly due to forced removal from family, substance misuse, family breakdown and disadvantage due to racism and discrimination. Many community members struggle with mental health issues as a result. Current statistics show:
- Mental health-related problems accounted for 11 percent of all problems managed by GPs for Indigenous patients from 2008 to 2013. This is 1.3 times higher than the rate for non-Indigenous people living in Australia.
- The suicide rate for Indigenous people was almost twice the rate for non-Indigenous people during the same period. For 15–19 year-olds, the rate was five times higher than the non-Indigenous rate.
- Thirty percent of Indigenous adults were assessed as having high or very high levels of psychological distress during 2012–13. They were 2.7 times more likely than non-Indigenous adults to have these levels of psychological distress.
- In 2012–13, almost half (48 percent) of Indigenous adults reported that either they or their relatives had been removed from their natural family.
Antenatal care, birth and early childhood
Proper ante- and post-natal care is crucial to the long-term health of a child. Early interventions in maternal care are paramount to future childhood health and welfare. The current state of Indigenous health in this area shows:
- From 2010 to 2013, Indigenous mothers attending antenatal care in the first trimester of pregnancy increased slightly (52 percent compared to 60 percent for non-Indigenous mothers).
- Vaccination rates remain high in the Indigenous community. In 2013, approximately 90 percent of children were fully vaccinated by age five in both Indigenous and non-Indigenous populations.
- Low birth weight in Indigenous communities remains an issue. Twelve percent of Indigenous babies born between 2003 and 2013 were in this category. Smoking during pregnancy appears to be a large factor.
Chronic conditions and addictions
Many factors are at play in chronic conditions and/or addictions. They are often deep-seated, multi-faceted and difficult to treat. Unfortunately, our Indigenous communities suffer with high rates of chronic conditions. For example, in 2012–13:
- 31 percent of Indigenous people reported some form of long-term respiratory disease
- 18 percent had indicators of chronic kidney disease
- 10.2 percent of Indigenous children aged 2 to 14 were obese (1.6 times more likely than non-Indigenous children)
- 37 percent of Indigenous people aged 15 and older were obese
- 11 percent of Indigenous adults had diabetes and were 3.3 times more likely to have diabetes than non-Indigenous adults
- 42 percent of Indigenous people aged 15 and older smoked daily
You can help by choosing to undertake an Aboriginal and Torres Strait Islander training post at an Aboriginal Medical Service.
These statistics show there is still much work to be done to balance health outcomes between Indigenous and non-Indigenous people living in Australia. Understanding the unique medical and cultural needs when treating Indigenous patients will make you a better doctor. Your work will contribute to a better future for Indigenous communities and our nation at large. It will also equip you with the clinical skills to both prevent and manage complex cases and illnesses.
To find out more about Indigenous training with GPTQ, visit our Indigenous health page.
Working together to improve health outcomes
Learn how George Couchy collaborated with medical professionals to improve accessibility to health services in his community.