Indigenous health in Australia examines health and wellbeing indicators of Indigenous Australians compared with the rest of the population. Statistics indicate that Aboriginal Australians and Torres Strait Islanders 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 of Indigenous Australians was better than that of the inhabitants of poorer sections of Europe. Colonisation impacted the health of Indigenous Australians via land dispossession, social marginalisation, political oppression, incarceration, acculturation and population decline. The process of colonisation began with the arrival of the First Fleet 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, 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. 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. 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, Canada and the United States 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 and malnutrition. 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, 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 of the 1970s and 1980s, when Aboriginal people moved to tiny remote settlements on traditional land, brought health benefits, AIATSIS summary 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, 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. High rates of incarceration of adults and youth contribute to early death and poor 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. The 2020 AIHW reported that Indigenous children are more likely to get hospitalized and experience tooth decay. Lack of access to the right diet, dental services, and other social disadvantages are reported as contributing factors to such poor health.
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 reported a seventeen-year gap between the life expectancy of Indigenous Australians and non-Indigenous Australians. (PDF) This prompted health and human rights activists to establish the "Close the Gap" 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 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 (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". The 2022 AIHW report showed that the cancer death rate rose from 205 to 235 per 100,000.
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 (OATSIH) in 1994, but this is no longer in existence.Note: Closed before Closing the Gap, or earlier?
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 2008, Aspen Medical established the Remote Area Health Corps (RAHC) as a non-profit subsidiary which was funded by the Australian Government through the Indigenous Australians' Health Programme: Stronger Futures Northern Territory initiative. Its primary objective is to alleviate persistent and chronic shortages in healthcare personnel within remote Aboriginal communities situated in the Northern Territory (NT).
RAHC operates by facilitating short-term placements, ranging from three to 12 weeks, while concurrently augmenting the pool of professionals equipped with the requisite skills and competencies to administer culturally sensitive care within these communities. The initiative particularly targets urban-based professionals who have previously lacked experience in remote healthcare settings. In 2021-2022, RAHC received A$6.4 million in funding, spending A$5.4 million due to less placements than anticipated during the pandemic.
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.