Differences Between Indigenous and Non-Indigenous Population Groups (VCE SSCE Health and Human Development): Revision Notes

Differences Between Indigenous and Non-Indigenous Population Groups

Introduction

Indigenous Australians represent 3.3 per cent of Australia's population and experience significantly poorer health outcomes compared to non-Indigenous Australians across nearly all health indicators. Understanding these disparities requires examining the complex interplay of biological, sociocultural and environmental factors that influence health status.

While Australia's overall life expectancy has increased dramatically from approximately 57 years in 1901 to around 82 years in 2019, these improvements have not been equally shared across the population. Indigenous Australians, along with males, people of low socioeconomic status, and those living outside major cities, continue to experience substantially lower life expectancy than the national average.

Key differences in health status

Life expectancy and mortality

The gap in life expectancy between Indigenous and non-Indigenous Australians remains substantial. In 2017, Indigenous Australians had a life expectancy of 71.6 years for males and 74.6 years for females. This represents a difference of approximately 10.5 years for males and 10.2 years for females when compared with the rest of the population.

Comprehensive health status variations

Indigenous Australians experience poorer health outcomes across multiple measures:

Mortality and life expectancy:

• Overall mortality rate almost two times higher than other Australians
• Mortality rate four times higher among Indigenous people aged 35-44
• Infant mortality rates two times higher than the rest of the population

Self-rated health:

• Half as likely to report health status as excellent or very good
• Twice as likely to report health status as fair or poor

Disease burden and chronic conditions:

• Burden of disease 2.3 times the rate of other Australians
• Cardiovascular disease incidence and mortality rates 1.5 times greater
• Cancer mortality rates 1.3 times higher, with significantly higher rates for lung, cervical and liver cancers
• Diabetes and high blood glucose levels more than three times higher, with mortality rates from diabetes five times higher
• Chronic kidney disease rates nearly four times higher
• Respiratory disease burden (including COPD) 2.5 times higher
• Almost twice as likely to report having asthma

Injuries and hospitalisation:

• Hospitalisation and death from injury two times higher
• Higher rates of sexually transmissible infections, with burden from unsafe sexual practices nearly four times higher

Mental health and disability:

• Nearly twice as likely to have a disability or restrictive long-term health condition
• High or very high psychological distress experienced at nearly three times the rate of non-Indigenous population
• Suicide rates four times higher
• Hospitalisation for mental health issues twice as high

Other health conditions:

• Higher rates of dental decay and gum disease
• Indigenous Australians more likely to develop diabetes at a younger age and die from it earlier

Factors contributing to variations in health status

The poorer health status of Indigenous Australians results from a complex interaction of biological, sociocultural and environmental factors. No single factor acts in isolation; rather, these factors work together to create cumulative disadvantage.

Biological factors

Body weight

Aboriginal and Torres Strait Islander peoples experience higher rates of high body mass index across all ages. The obesity rate among Indigenous adults is one and a half times higher than in the non-Indigenous population. Obesity increases the risk of chronic conditions including cardiovascular disease, type 2 diabetes and osteoarthritis.

Being obese is strongly linked to Syndrome X (also called metabolic syndrome), which represents a major health challenge for Indigenous populations.

Syndrome X involves the simultaneous occurrence of several unhealthy conditions:

• Abdominal fat accumulation
• Low levels of good cholesterol (high-density lipoprotein or HDL)
• High levels of triglycerides (harmful blood fats)
• High blood pressure
• High blood sugar with high insulin levels, indicating insulin resistance

While Syndrome X is not a disease itself, this collection of conditions dramatically increases the risk of serious health problems.

Blood pressure

Indigenous Australians are 1.3 times more likely to report hypertension compared to non-Indigenous Australians. High blood pressure is a significant risk factor for stroke and heart disease.

Glucose regulation

Higher rates of impaired glucose regulation among Indigenous Australians contribute to the elevated rates of diabetes and kidney disease experienced by this population. The body's inability to properly regulate blood sugar levels creates a cascade of health problems.

Birth weight

Aboriginal and Torres Strait Islander mothers are almost twice as likely to give birth to a baby with low birth weight compared with other Australians. In 2018, 11.7 per cent of live births to Indigenous mothers were classified as low birth weight, compared with 6.4 per cent for non-Indigenous mothers.

Several factors contribute to this disparity:

• Maternal tobacco use
• Poor maternal nutrition
• Limited access to healthcare during pregnancy

Additionally, babies of Indigenous mothers were more likely to be premature, with 14 per cent born prematurely compared to 8.5 per cent for non-Indigenous mothers. Low birth weight and prematurity contribute to higher under-five mortality rates and can affect health throughout life.

Sociocultural factors

Socioeconomic status

Indigenous Australians are more likely to experience lower socioeconomic status than non-Indigenous Australians. On average, Aboriginal and Torres Strait Islander peoples have:

• Lower incomes
• Poorer educational achievements
• Lower rates of home ownership

Lower educational outcomes contribute to reduced levels of health literacy (the ability to understand and use health information). This places Indigenous Australians at greater risk of engaging in harmful behaviours such as smoking, poor dietary choices and sedentary lifestyles. These behaviours further contribute to obesity, type 2 diabetes, cardiovascular disease and lung cancer.

Unemployment

In 2019, Indigenous Australians were four times as likely to be unemployed as other Australians, with unemployment rates of 19 per cent compared to 5 per cent. Unemployment is even more pronounced for those living outside Australia's major cities, where rates for Aboriginal and Torres Strait Islander peoples range from 20-28 per cent.

Unemployment is strongly associated with various risk factors and poor health outcomes:

The relationship between unemployment and health includes:

• Increased rates of smoking and alcohol abuse
• Reduced overall feelings of wellbeing
• Higher rates of cardiovascular disease
• Elevated rates of mental health problems
• Increased risk of lung cancer

Social exclusion

Social exclusion manifests in several damaging ways for Aboriginal and Torres Strait Islander peoples.

Discrimination and racism:

Discrimination and racism have been directly associated with poorer health status for Aboriginal and Torres Strait Islander peoples, particularly affecting mental health. According to health surveys, 32 per cent of Aboriginal and Torres Strait Islander adults reported avoiding healthcare due to cultural factors including:

• Language barriers
• Lack of trust in health providers
• Experiences of discrimination

This avoidance of healthcare can increase disease duration and severity, contributing to higher morbidity and mortality.

Forced removal from family:

The effects of forced removal continue to impact Indigenous health:

• 17.5 per cent of Aboriginal and Torres Strait Islander adults reported having been removed from their natural family by welfare authorities, government, or by being taken to a mission
• 36 per cent reported that relatives had been removed from their natural family
• In total, more than half (53.5 per cent) reported that either they or their relatives had been removed from their natural family

Homelessness:

In 2016, an estimated 23,437 Aboriginal and Torres Strait Islander people were experiencing homelessness in Australia—a rate nearly 10 times that of other Australians. Of all homeless people who provided information on their Indigenous status, 20 per cent were Indigenous.

Homelessness increases the risk of:

• Psychological distress
• Risk-taking behaviours including tobacco and alcohol abuse
• Mental health disorders
• Obesity
• Type 2 diabetes
• Cardiovascular disease
• Some cancers

Food insecurity

Aboriginal and Torres Strait Islander peoples are significantly more likely to report food insecurity compared with the general population. Several factors contribute to this disparity:

• Lower incomes
• Poorer quality and overcrowded housing
• Higher cost of fresh foods in areas outside major cities
• Lack of transport
• Lower levels of nutritional knowledge

Food insecurity contributes to higher rates of obesity and associated conditions such as type 2 diabetes, kidney disease and cardiovascular disease.

Early life experiences

Maternal substance use during pregnancy has significant impacts on Indigenous health status.

Tobacco use: 44 per cent of Aboriginal and Torres Strait Islander women smoked while pregnant, compared to 10 per cent of other women.

Alcohol use: While national data are limited, some studies suggest that up to 50 per cent of babies born in some Aboriginal and Torres Strait Islander communities display effects of maternal alcohol use.

Drug use: Babies born to Aboriginal and Torres Strait Islander mothers were around 3.5 times more likely to display signs of exposure to drugs while in the uterus.

Cultural norms

Cultural norms contribute to lower rates at which many Aboriginal and Torres Strait Islander people access western medicine. Many feel western medicine is culturally inappropriate and associate hospitals with death. As a result, many conditions go unchecked for extended periods, which can increase morbidity and mortality rates and reduce life expectancy.

Environmental factors

Housing

Housing plays a major role in the health and wellbeing of Aboriginal and Torres Strait Islander peoples. The absence of affordable, secure and appropriate housing can result in homelessness, poor health and wellbeing, and lower rates of employment and education participation, all leading to social exclusion.

Housing quality issues:

Among Aboriginal and Torres Strait Islander households in 2018-19:

• One in three (33 per cent) reported living in a dwelling with one or more major structural problems, such as electrical or plumbing problems, major cracks in floors or walls, or roof defects
• Around one in ten (10 per cent) reported living in a dwelling lacking at least one working facility such as a fridge, cooking facilities, toilet, or bath or shower

These substandard dwellings pose many risks to health status, including increased risk of injury, disease and mental health problems.

Overcrowding:

17.9 per cent of Aboriginal and Torres Strait Islander people were living in overcrowded housing in 2019 compared to 4.9 per cent of other Australians. Overcrowded housing places strain on bathroom, kitchen and laundry facilities, leading to:

• Unhygienic living conditions
• Increased risk of injury
• Higher rates of disease transmission
• Mental health issues

Environmental tobacco smoke:

In 2018-19, Aboriginal and Torres Strait Islander children aged 0-14 were four times as likely as other children to live in households with a daily smoker who smoked indoors (9 per cent compared to 2.1 per cent). Exposure to environmental tobacco smoke:

• Increases risk of respiratory diseases such as asthma
• Can increase the likelihood of children becoming smokers when older
• Is associated with cardiovascular disease

Water and sanitation

While most Australians enjoy one of the cleanest and most reliable water supplies in the world, many Indigenous communities face significant challenges.

Water supply issues:

The 2006 Community housing and infrastructure needs survey found that:

• 48 of 148 Aboriginal and Torres Strait Islander communities tested (about 12,000 people) had drinking water supplies that failed testing at least once in the 12 months before the survey
• Of 82,300 people surveyed, 59 per cent (about 48,500 people) experienced an interruption to their water supply in the previous 12 months

Sewerage problems:

In 2006, 40 per cent of Aboriginal and Torres Strait Islander communities (about 30,000 people) experienced a sewage leak or overflow.

Access to health services

Indigenous Australians have lower levels of access to and use of health services and resources, including:

• Medicare-funded services
• Pharmaceutical Benefits Scheme (PBS), which subsidises medication
• Private general practitioners

Approximately 21 per cent of Aboriginal and Torres Strait Islander people live in remote areas, compared to 2 per cent of the rest of the population. This geographic isolation makes service delivery and access to services more difficult. As a result:

• Conditions may go undiagnosed or untreated
• Treatment options may be limited
• Morbidity and mortality rates increase

Infrastructure

Aboriginal and Torres Strait Islander people living outside Australia's major cities face additional environmental challenges:

• Unsealed roads
• Poorer lighting at night
• Increased risk of injuries and deaths from road crashes

Summary of contributing factors

The health disparities experienced by Indigenous Australians result from the complex interaction of multiple factors across biological, sociocultural and environmental domains. These factors do not operate independently but rather create cumulative disadvantage that compounds over time and across generations.

Understanding these interconnected factors is essential for developing effective strategies to address health inequalities and improve health outcomes for Aboriginal and Torres Strait Islander peoples.

Remember!