There is a substantial body of evidence that the experience of the child in utero, at the time of birth and in infancy and childhood has the potential to impact on health throughout life (Eades 2004; Barker 1993; Power et al. 2000). Therefore a life course approach is critical for building a platform for a long and healthy life (Griew et al. 2007; Weeramanthri et al. 1999). Providing children with a positive sense of themselves as Aboriginal and Torres Strait Islander children, and building on their knowledge of Aboriginal language and culture provides a strong foundation in lifelong learning and resilience (Eades 2004). Close contact with the extended family is viewed as essential for developing a strong sense of identity (Williamson et al. 2010). Strong cultural attachment is associated with positive outcomes on a range of socioeconomic indicators including health status, education and employment (Dockery 2011).
Contemporary thinking about chronic disease management has moved beyond the concept of individual episodes of care for a patient, to the development of long term relationships with them, their family, and their community (Zwar et al. 2006). A number of reports identify the importance of family and carers to Aboriginal and Torres Strait Islander patients, and their involvement in decision-making, including in the areas of population health, primary health care, cardiac rehabilitation and secondary prevention, diabetes prevention and management, and palliative care (NHMRC 2005; Griew et al. 2007; Broomhead et al. 2008; McGrath 2008). Working collaboratively with and learning from Aboriginal and Torres Strait Islander patients, families, interpreters, cultural mentors, Aboriginal Health Workers and other co-workers has also been identified as critical (NHMRC 2005).
Family-centred primary health care approaches move beyond providing care to the individual patient, to seeing them as embedded in a family and taking a life course approach (Griew et al. 2007). Studies have identified that Aboriginal and Torres Strait Islander concepts of family are important to consider (Walker et al. 2008) and that engaging with Aboriginal and Torres Strait Islander patients and families in a respectful and culturally competent way is a key success factor for preventative health and health care service delivery (Griew et al. 2007). These approaches aim to support people to proactively manage their health across the life course.
Maternal healthMaternal health is one of the priority areas of reform identified by COAG. Antenatal care provides opportunities to address health risks and support healthy behaviours throughout pregnancy and into the early years of childhood. Access to antenatal care (see measure 3.01) is high for Indigenous women, and similar to that for non-Indigenous women, but often occurs later in the pregnancy and less frequently. Indigenous mothers who attended at least one session of antenatal care were less likely to have low birthweight babies (11%) than those who did not attend (40%). The likelihood of a mother having a low birthweight baby decreases in line with an increase in the number of antenatal visits. Low birthweight babies are also associated with later commencement of antenatal care. Similar relationships are evident with pre-term births and perinatal mortality.
Smoking increases the risk of adverse events in pregnancy (such as miscarriage, ectopic pregnancy, preterm labour and antepartum haemorrhage), and is also associated with poor perinatal outcomes (such as low birthweight), and respiratory illnesses (such as bronchitis or pneumonia) during the child's first year of life (see measure 2.21). In 2009, Aboriginal and Torres Strait Islander mothers were 3.7 times as likely to smoke during pregnancy as non-Indigenous mothers, and unlike other Australian mothers, the high rates persist across geographic areas and age groups. Smoking during pregnancy for both Indigenous and non-Indigenous mothers is associated with higher prevalence of pre-term birth and a higher proportion of low birthweight babies. Smoking is also associated with a higher rate of perinatal deaths, which occur for Indigenous mothers at 1.5 times the rate of non-Indigenous mothers (see measure 1.21). Reducing smoking continues to be a priority, now being addressed through the Indigenous Tobacco Control Initiative and the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (see measure 2.15).
For Aboriginal and Torres Strait Islander mothers, teenage pregnancies were not associated with an increased risk of giving birth to a low birthweight baby.
Childhood (0–14 years)Most data are currently only available for the combined age group of 0–14 years.
Improving the health, social, and environmental factors of babies and young children is likely to have positive flow-on effects for the remainder of the life cycle. International studies have found that programs that intervene in the first six to eight years of life are more successful at improving developmental outcomes than later interventions (Griew et al. 2007)
Research has found a strong link between attachment to traditional culture and positive effects on both wellbeing and socioeconomic outcomes (Dockery 2011). The measure of community functioning (see measure 1.13) finds that in 2008 the majority of Indigenous children aged 0–14 years attended a cultural event in the last 12 months (70%), 47% recognised their homelands, 42% spent time with an Indigenous elder, 76% slept well and 74% of children aged 4–14 years spent at least 60 minutes every day being physically active. Informal learning activities were undertaken with most children aged 0–14 years (94%). Most children in this age group (71%) also cleaned their teeth once or twice per day.
Immunisation is highly effective in reducing illness and death caused by vaccine-preventable diseases. Immunisation coverage is high for Aboriginal and Torres Strait Islander children, and by 2 years of age, the immunisation coverage (92.3%) was similar to other Australian children (92.6%) (see measure 3.02). Gaps in immunisation still exist in younger and older children. Top of page
Although the prevalence of ear disease is significantly higher for Aboriginal and Torres Strait Islander children (approximately 3 times the rate for other children), levels of access to treatment are similar to those of other Australian children. Hospitalisations for ear disease—specifically, the rate of myringotomy procedures in hospital (incision in eardrum to relieve pressure caused by excessive build-up of fluid)—for Indigenous children was lower than for non-Indigenous children (1.4 per 1,000 compared with 1.7 per 1,000). General practitioners managed ear problems at a similar rate for both populations in data collected between April 2006 and March 2011.
The National Indigenous Eye Health Survey found that approximately 1.5% of Aboriginal and Torres Strait Islander children had low vision and 0.2% blindness. Trachoma rates are very high in some Indigenous communities. Data on trachoma in children in 240 at-risk communities in NT, SA, and WA found a prevalence of 12% for those aged 1–4 years, 13% for those aged 5–9 years and 11% for those aged 10–14 years.
Data on dental health show that a lower proportion of Indigenous children had no decayed, missing or filled teeth compared with non-Indigenous children in each age group 5 to 15 years (see measure 1.11). Dental disease in childhood is readily treated but Aboriginal and Torres Strait Islander children do not have ready access to dental care with cost and geography being significant barriers.
Hospitalisation rates for respiratory disease (see measure 1.04) for Indigenous children aged 0–4 years were around twice those for non-Indigenous children. Between 1998–99 and 2009–10 there has been a significant decline (25%) in hospitalisation rates for Indigenous children for respiratory disease and a narrowing of the gap.
A much higher proportion of Aboriginal and Torres Strait Islander children aged 0–14 years live in households with a regular smoker compared to other Australian children, particularly households where smoking occurs indoors. The proportions have fallen slightly over time, but at a slower rate than for other Australian children, and therefore, the disparities remain.
A study of school students aged 12–15 years in 2008 found that 23% of Indigenous students reported smoking in the last 12 months and 12% were current smokers. Approximately 5% of total students were current smokers. Around 27% of Indigenous students had never consumed alcohol while 23% had consumed alcohol in the past week. Around 23% of Indigenous students reported they had used illicit substances with cannabis being the most common (20%) (White et al. 2009).
The proportion of Aboriginal and Torres Strait Islander students achieving the reading, writing and numeracy benchmarks in Years 3, 5, 7 and 9 remain below the corresponding proportions of non-Indigenous students. There have been improvements in the gap for reading and for numeracy (except Year 7), however other measures have not shown significant progress.
Youth (15–24 years)Young people in this age group do not use primary health care services frequently, however the lifestyle factors leading to chronic diseases in later life are often established in this age group. Studies have found that empowering families and communities to work with youth on preventative health and to develop a positive sense of themselves are important in providing a strong foundation for long and healthy lives (Eades 2004; Williamson et al. 2010).
The measure of community functioning (see measure 1.13) finds that in 2008 two thirds (66%) of Aboriginal and Torres Strait Islander youth recognised their homelands, 63% had attended a cultural event in the last 12 months, 78% had family or friends they could confide in, 89% felt able to have a say with family and friends most or all the time, and 96% had contact with family or friends outside of the household at least once per week. The majority of Indigenous young people had participated in sport or social activities in the preceding 3 months (90%). Most young people felt safe at home during the day (93%) and after dark (77%). Sixty-two per cent had no disability or long-term health condition.
Education is a key factor in improving health and wellbeing. The pathways between education and health are complex and are interrelated with employment, income, psycho-social resources such as a sense of control, and practical skills which allow individuals to better manage their health (Griew et al. 2007).
Education involves more than the formal schooling system. Aboriginal and Torres Strait Islander culture depends for its continued existence on social practices, which are themselves educational (Educational Determinants of Aboriginal Health Group 2004; Bell et al. 2007). Aboriginal land management is an example where scientific learning combines with intergenerational transmission of Aboriginal knowledge (Davies et al. 2010).
When determining the impact of education on Aboriginal and Torres Strait Islander health outcomes, the quality and cultural appropriateness of mainstream education also needs to be considered (Dunbar et al. 2007). Over time there have been improvements in the proportion of Indigenous students remaining in school to Year 10 and Year 12, although Indigenous retention rates remain lower than for other students (see measure 2.05). The Vocational Education and Training (VET) sector also provides large numbers of Aboriginal and Torres Strait Islander peoples with non-school education training opportunities. During 2010, there were approximately 13,900 course completions in the VET sector by Indigenous Australians aged 15 years and over. This constitutes 3.8% of the Indigenous population aged 15 years and over compared with 2.1% of the non-Indigenous population aged 15 years and over.
Aboriginal and Torres Strait Islander youth experience a number of challenges compared to non-Indigenous Australian youth including higher rates of poor health (see measure 1.17). They are also three times as likely to report high or very high levels of psychological distress (comparisons are for 18–24 year olds) (see measure 1.18), less likely to be employed (see measure 2.07), more likely to be sedentary (see measure 2.18), and more likely to be a current smoker (see measure 2.15). Aboriginal and Torres Strait Islander youth have higher rates of contact with the criminal justice system (see measure 2.11). In 2009–10, an average of 201 Indigenous youth aged 10–18 years were on remand each day compared with 232 non-Indigenous youth. Disproportionate representation of Indigenous youth in contact with the criminal justice system impacts on a range of areas including physical health and the social and emotional well-being of families and communities (see measure 1.18).
In this age group, males made up 70% of deaths during the period 2006–10. Deaths due to external causes such as suicide and transport accidents were the leading cause of death in this age group. A study of suicide in British Columbia between 1987 and 2000 found that First Nation communities that succeed in taking steps to preserve their heritage and culture, and work to control their futures are more successful in insulating their youth against suicide risk (Chandler et al. 2008).
Adults (25–54 years)Premature mortality from chronic diseases, such as circulatory disease, cancer, diabetes and respiratory diseases is a major concern in this age group. In the 25–34 year age group, deaths due to external causes (including suicide and transport accidents) were the leading cause of death. In the 35–54 age groups chronic diseases were the leading causes of death. Top of page
In 2008, 72% of Aboriginal and Torres Strait Islander peoples aged 15 years and over recognised their homelands, 62% identified with a clan or language group, 89% felt able to have a say with family and friends some, most or all or the time and 94% had contact with family or friends outside the household at least once per week.
The proportion of Indigenous Australians aged 15–64 years who were employed increased from 44% in 2001 to 54% in 2008 (see measure 2.07). However unemployment rates remain higher than the corresponding rates for non-Indigenous Australians (about 4 times as high). Many adults are seeking to improve their knowledge, skills and qualifications, with 33% intending to study in the future.
54 years and olderLeadership is a theme within the measure of community functioning (see measure 1.13) used to describe strong vision and direction from Elders (both male and female) in family and community and strong role-models who have time to listen and advise. Statistics included in the 2008 NATSISS to describe this theme were limited to data on children: 42% of children aged 3–14 years had spent time with an Indigenous leader or Elder in the week prior to being surveyed. The role of Elders in providing leadership to support healthy families and communities is vital and better measurement of this is needed.
Home ownership increases with age, from 22% in the 18–34 year age group to 36% in the 55 year and over age group. These rates are below those for non-Indigenous home ownership (65% of adults).
Aboriginal and Torres Strait Islander peoples are less likely than non-Indigenous Australians to report 'very good' or 'excellent' health (see measure 1.17), this difference between the two populations was greatest in the older age groups. Self-assessed health status correlates with a range of other measures, such as reported long-term health conditions, recent health related actions, and the presence of a disability.
Older people with a reduced degree of functional capacity require a range of services. Aged care is frequently provided in combination with basic medical services, prevention, rehabilitation or palliative care services. The age for accessing home and community care programs has been adjusted to take account of the younger age at which Aboriginal and Torres Strait Islander peoples may begin to suffer from serious chronic illness.
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