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FEATURE ARTICLE: INDIGENOUS DISADVANTAGE AND SELECTED MEASURES OF WELLBEING

Australia’s Aboriginal and Torres Strait Islander peoples are disadvantaged across many areas of social concern. The disparity in outcomes between Indigenous and non-Indigenous Australians has been well-documented in recent reports, including the 2009 Overcoming Indigenous Disadvantage (OID) report, commissioned by the Council of Australian Governments (COAG). The 2009 OID report framework comprises six targets (as outlined below) which will need to be addressed in order to improve Indigenous well-being. In addition to the six COAG targets, there are six headline indicators and seven ‘strategic areas for action’. Each strategic area for action includes a set of indicators, designed to show whether actions are making a difference, and to identify areas where more attention is needed.

This article adopts a similar structure to the 2009 OID report framework, providing information on the COAG targets, headline indicators and selected indicators relevant to the strategic areas for action. This article includes published data from the 2009 OID report and more recent information from the 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) and the ABS causes of death collection.


Indigenous estimated resident population

The ABS final estimated resident Indigenous population of Australia at 30 June 2006 was 517,000 people or 2.5% of the total population. This Indigenous population estimate was 14% higher than the 2006 unadjusted Census count (455,000). The adjusted population estimates take into account Indigenous people not counted in the Census, using the results of the ABS Post Enumeration Survey (PES).


COAG TARGETS

The six COAG targets are outlined below. The current status of selected performance indicators against these targets is presented in Table S9.1.


Life expectancy at birth

Life expectancy is an indicator of the long-term health and wellbeing of a population. The COAG target for life expectancy is to close the gap in life expectancy at birth between Indigenous and non-Indigenous people within a generation. Based on 2005-2007 data, the life expectancy at birth of Indigenous people was estimated to be 67.2 years for males and 72.9 years for females. This represents a gap between Indigenous and non-Indigenous life expectancy at birth of 11.5 years for males and 9.7 years for females. Note that these figures cannot be compared with previous data due to changes in the methodology for estimating life expectancy.


Young child mortality

The COAG target for young child mortality is to halve the gap in mortality rates between Indigenous and non-Indigenous children (under five years of age) within a decade. The majority of childhood deaths are of infants under 12 months of age. For the period 2003-2007, the Indigenous infant mortality rate was 9.7 deaths per 1,000 live births. This represented an improvement from 1997-1999, but still remained more than twice the non-Indigenous infant mortality rate.


Early childhood education

Access to, and participation in, good quality early childhood education provides children with a head start at school. The COAG target for early childhood education is to provide "access to quality early childhood education, within five years, for all Indigenous four year olds, including those in remote communities". In 2006, one-third (33%) of Indigenous children aged three to five years were enrolled in preschool, compared with 43% of non-Indigenous children. However, since the term “pre-school” was left to the respondent to interpret, these data should be interpreted with caution.


Reading, writing and numeracy

The COAG target is to halve the gap between Indigenous and non-Indigenous children in reading, writing and numeracy within a decade. Data from the Ministerial Council on Education, Employment, Training and Youth Affairs (MCEETYA) show that in 2008, a smaller proportion of Indigenous students met the national minimum standards for reading, writing and numeracy compared to non-Indigenous students. Between 2001 and 2007, the proportion of Indigenous Year 7 students meeting national minimum standards remained unchanged at around 65% for reading, 74% for writing and 49% for numeracy. The gaps between Indigenous and non-Indigenous students achieving Year 7 benchmarks in 2008 were 23 percentage points for reading, 25 percentage points for writing and 18 percentage points for numeracy.


Year 12 Attainment

Young people who complete Year 12 (or equivalent) are likely to have better employment options than those who do not. This COAG target is to halve the gap between Indigenous and non-Indigenous people in Year 12 attainment or equivalent attainment rates by 2020. In 2006, the proportion of Indigenous 19 year olds who had completed Year 12 (or equivalent) was half that of non-Indigenous 19 year olds (36% compared with 74%).


Employment

Participation in employment is associated with increased income levels, better health outcomes, improved educational attainment and enhanced self esteem. The COAG target for employment is to "halve the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade". Expressed as a proportion of people aged 15-64 years in the labour force (employed plus unemployed), the Indigenous unemployment rate decreased from 20% in 2001 to 16% in 2006. During the same period, the non-Indigenous unemployment rate for people aged 15-64 years also decreased, from 7% to 5%. In these data, known participants in CDEP (Community Development Employment Projects) were counted as being employed.

S9.1 SELECTED PERFORMANCE INDICATORS: INDIGENOUS AND NON-INDIGENOUS PERSONS
	Indigenous	Non-Indigenous	Gap	Rate Ratio(a)
Male life expectancy (2005-2007)	67.2 yrs	78.7 yrs	11.5 yrs	0.9
Female life expectancy (2005-2007)	72.9 yrs	82.6 yrs	9.7 yrs	0.9
Infant mortality rate (2003-2007)	9.7 per 1,000 live births	4.4 per 1,000 live births	5.3 per 1,000 live births	2.2
Pre-school participation rate (2006)	33%	43%	10%	0.8
Reading (Year 7, 2008)	72%	95%	23%	0.8
Writing (Year 7, 2008)	68%	93%	25%	0.7
Numeracy (Year 7, 2008)	79%	96%	18%	0.8
Year 12 attainment (19 yr olds, 2006)	36%	74%	38%	0.5
Unemployment (2006)	16%	5%	11%	3.1
(a) An Indigenous to non-Indigenous rate ratio of 1.0 indicates parity, while rate ratios other than 1.0 indicate relative Indigenous advantage/disadvantage, depending on the indicator. For positive indicators such as life expectancy, a rate ratio of less than 1.0 indicates relative indigenous disadvantage, whereas for negative indicators such as the infant mortality rate, a rate ratio greater than 1.0 indicates relative indigenous disadvantage.
Source: Overcoming Indigenous Disadvantage 2009; Infant mortality data from ABS (unpublished), Causes of Death collection.

HEADLINE INDICATORS

Post-secondary education - participation and attainment

Attaining a qualification from a formal course of study can have a major impact on the range of opportunities available to Indigenous people. In 2006, 5% of Indigenous people aged 20-24 years attended university, with a further 5% attending a Technical and Further Education institution (TAFE). Among Indigenous people aged 20-64 years, 12% had completed a Certificate III or IV (which provide a broader knowledge base and the skills necessary to perform a wider range of skilled tasks than a Certificate I or II). This was an increase from 8% in 2001 and represented a decrease in the gap between Indigenous and non-Indigenous levels of attainment. In contrast, completion rates for Bachelor degrees, and Advanced diplomas and Diplomas increased only marginally for Indigenous people (3% to 4% for both) (graph S9.2).

Disability and chronic disease

In 2006, after adjusting for age differences between the Indigenous and non-Indigenous populations, Indigenous people required assistance with one or more core activities (i.e. self-care, mobility and/or communication) at almost twice the rate of non-Indigenous people. In turn, Indigenous people aged 15 years or over were 1.2 times more likely than non-Indigenous people to provide unpaid care to a person with a disability, long-term illness or problems related to old age.


Household income

Household income reflects the economic resources available to household members and therefore their standard of living. In 2006, the median gross weekly equivalised (adjusted) household income for Indigenous households was $398. This represented an increase in real terms of 9% (or $33) since 2001 (graph S9.3). However, gross weekly equivalised household income for other households was still about one-and-a-half times as high as income for Indigenous households.

Substantiated child abuse and neglect

Results from the Australian Institute of Health and Welfare (AIHW) Child Protection Notifications, Investigations and Substantiations collection indicate that in 2007-08, approximately 35 per 1,000 Indigenous children aged 0-16 years were victims of substantiated child abuse and neglect. This was an increase from 16 per 1,000 children in 2000-01. During the same period, the rate of substantiated child abuse and neglect among non-Indigenous children aged 0-16 years remained relatively constant (increasing from 5 to 6 children per 1,000). Measurements obtained must be interpreted with caution, as data are only for incidents that were officially reported and investigated by authorities. In addition, it is possible that increased substantiations of abuse may be the result of reduced tolerance in Indigenous families and communities of the abuse or neglect of children. In these instances, an increased rate would signify increased awareness and identification of the problem of abuse or neglect.

Family and community violence

In the 2008 NATSISS, around one-quarter (23%) of Indigenous people aged 15 years or over reported having experienced physical or threatened violence in the past 12 months. There was no significant change in the reported rates of physical or threatened violence for males or females between 2002 and 2008.

Family and community violence may be associated with a number of wider neighbourhood problems. Data from the NATSISS show that in 2008, 71% of Indigenous people aged 15 years or over reported problems in their neighbourhood. The most common of these were dangerous or noisy driving (46%), alcohol (41%), theft (41%) and illegal drugs (36%) (table S9.4).

S9.4 Neighbourhood problems by remoteness, Indigenous persons aged 15 years and over - 2008
	Non-remote	Remote	Total
	%	%	%
Dangerous or noisy driving(a)	47.0	43.2	46.1
Alcohol	37.1	53.9	41.3
Illegal drugs	34.4	42.5	36.4
Theft(a)(b)	42.1	38.3	41.1
Vandalism/graffiti/damage to property(a)	35.2	35.7	35.3
Problems involving youths(c)	32.8	39.1	34.4
Levels of personal safety day or night(a)	13.5	14.7	13.8
Family violence	20.8	36.9	24.8
Assault	18.2	36.1	22.7
Sexual assault	10.3	15.8	11.7
Prowlers/loiterers(a)	19.1	19.1	19.1
Problems with neighbours(a)	15.1	16.1	15.4
Levels of neighbourhood conflict	11.6	21.5	14.1
None of the above(a)	26.7	23.1	25.8
Persons aged 15 years and over ('000)(d)	245.6	81.5	327.1
(a) Difference between remote and non-remote data are not statistically significant.
(b) Includes burglaries, theft from homes, motor vehicle theft, other theft.
(c) Includes youth gangs, lack of youth activity.
(d) Includes 'type of neighbourhood problem' not stated.
Source: Data available on request, 2008 National Aboriginal and Torres Strait Islander Social Survey.

Imprisonment and juvenile detention

Indigenous people continue to be over-represented in the criminal justice system, as both young people and adults. Data from the ABS Prisoners in Australia collection show that in 2008, after adjusting for age differences between the Indigenous and non-Indigenous populations, Indigenous people aged 18 years and over (17 years and over in Queensland) were 13 times as likely as non-Indigenous people of the same age to be in prison. In 2007, Indigenous juveniles aged 10-17 years were 28 times as likely as non-Indigenous juveniles to have been detained (403 per 100,000), compared with 14 per 100,000 (Taylor 2009).
STRATEGIC AREAS FOR ACTION

Early child development

Development during the early years of childhood is influenced by a number of factors. One key factor is the wellbeing of women during and after pregnancy. The health and lifestyle of women during pregnancy can shape the future development of their children. In the 2008 NATSISS, 92% of Indigenous mothers of children aged 0-3 years, reported having attended check-ups while pregnant. Data on alcohol consumption and smoking during the mother's pregnancy was obtained from 79% of mothers with children aged 0-3 years. One in five (20%) of Indigenous mothers of children aged 0-3 years reported having consumed alcohol during pregnancy and 42% had smoked tobacco.

The teenage birth rate is also an important indicator for early child development. Data from the ABS Birth Registrations collection show that in 2007, the birth rate for Indigenous mothers aged 15-19 years was 70 per 1,000 births. This rate has remained relatively stable over time (71 per 1,000 births in 2004), but is still much higher than the birth rate for non-Indigenous teenage mothers (14 per 1,000 births in both 2004 and 2007). Another key measure for this strategic area is low birth weight (that is, babies with a birth weight of less than 2500g). Data from the AIHW National Perinatal Data Collection show that in 2004-2006, the proportion of Indigenous babies with low birth weight was 13%, compared with 6% of non-Indigenous babies.

A key health problem for young Indigenous children is hearing impediments (most commonly as a result of recurrent middle ear infections). In 2008, 9% of Indigenous children aged 0-14 years had ear or hearing problems. Results from the 2004-05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) and the 2008 NATSISS indicate that the prevalence of ear or hearing problems among Indigenous children did not change significantly over this period. However, for children in remote areas, the prevalence of ear or hearing problems decreased (from 13% in 2004-05 to 10% in 2008).


Education and Training

Access to high quality education has been linked to improved employment, income and health outcomes. One important measure of Indigenous education and training is the apparent retention rates of students progressing from Year 7 or 8, to Year 9. Data from the ABS Schools Australia collection show that in 2008, 99% of Indigenous students in Year 7 or 8 continued to Year 9, however, a smaller proportion (89%) continued to Year 10. In contrast, the retention rates for non-Indigenous students remained relatively unchanged (100% for both Year 9 and 10). These retention rates indicate that Indigenous students are less likely than non-Indigenous students to continue to the more senior levels of schooling.

Another important measure of education and training relates to the successful transition of Indigenous young people from school to work. In the 2008 NATSISS, around 41% of Indigenous people aged 15-24 years were studying, either full-time or part-time. In addition, 28% were working (full-time or part-time) but not studying. However, around one-third (31%) of Indigenous people aged 15-24 years were neither studying nor working. This rate was significantly higher in remote areas than in non-remote areas (39% compared with 29%). Young people who are not engaged in education or work are at a greater risk of long-term future disadvantage.


Healthy lives

Health is a fundamental quality of life indicator. In the 2008 NATSISS, 44% of Indigenous people aged 15 years or over rated their health as excellent or very good, 34% rated their health as good and 22% rated their health as fair or poor. These proportions have not changed significantly since 2002.

Being overweight or obese is a key health risk factor for all Australians. In the 2004-05 NATSIHS, self-reported height and weight data were used to calculate a Body Mass Index score for respondents. Results from the survey indicate that 29% of Indigenous adults were overweight and a further 31% were obese (graph S9.5).



In 2004-05, after adjusting for differences in the age structures between the Indigenous and non-Indigenous populations, similar proportions of Indigenous and non-Indigenous adults were overweight. However, Indigenous adults were almost twice as likely as non-Indigenous adults to be obese. Indigenous adults who were obese were more likely to have heart/circulatory problems, diabetes and asthma than those who were overweight (ABS 2008).

A key factor in reducing obesity rates in the Indigenous population in the longer term lies in establishing healthy eating patterns among children, for example, encouraging regular consumption of fruit and vegetables. In 2008, more than half (59%) of Indigenous children aged 1-14 years were reported to eat fruit every day. This rate was significantly lower in remote areas than in non-remote areas (52% and 61% respectively). In addition, 53% of Indigenous children were eating vegetables daily.This rate did not differ significantly between remote and non-remote areas (graph S9.6).

Tobacco smoking was the leading risk factor contributing to the burden of disease for Indigenous Australians in 2003 (Vos et al. 2007). In the 2008 NATSISS, 47% of Indigenous people aged 15 years and over were current smokers. The smoking rate for Indigenous people has decreased since 2002 when it was 51%. However, after adjusting for differences in the age structures between the Indigenous and non-Indigenous populations, Indigenous people were still twice as likely as non-Indigenous people to be current smokers.


Economic participation

The extent to which people participate in the economy is closely related to their living standards and broader wellbeing. It can also influence how individuals interact at the family and community levels. In 2006, 48% of Indigenous people aged 15-64 years were employed, compared with 43% in 2001. However, the proportion of non-Indigenous people aged 15-64 years who were employed also increased during this period (68% in 2001 compared with 72% in 2006). Of those who were employed in 2006, 41% of Indigenous people were working part-time (compared with 31% of non-Indigenous employed people).

Home ownership is an indicator of wealth and saving, and is usually associated with employment and the income this generates. The proportion of Indigenous people living in home owner/purchaser households increased from 26% in 2001 to 29% in 2006.


Home environment

Poor living conditions can have a substantial impact on people’s health and wellbeing. In particular, overcrowding in housing is a problem experienced by many Indigenous people. Overcrowding places pressure on existing household infrastructure and may encourage the spread of infection and disease. While overcrowding remains a problem within Indigenous communities, the proportion of Indigenous people living in overcrowded housing decreased between 2001 and 2006 (from 31% to 27%). During the same period, the proportion of non-Indigenous people living in overcrowded housing was relatively unchanged (at about 6%) (graph S9.7).

Other important aspects of environmental health include access to clean water, working sewerage systems and a reliable supply of electricity. While many Indigenous people living in cities and large towns have regular access to these utilities, problems with access are more prevalent for members of remote, discrete Indigenous communities. Data from the Community Housing and Infrastructure Needs Survey (CHINS) show that in 2006, there were about 82,300 Indigenous people living in 322 discrete Indigenous communities with a population of 50 people or more. In 2006, 59% of these people had experienced an interruption to their water supply in the previous 12 months. In addition, 40% of these people had experienced sewerage overflows or leakages and 81% had experienced an electricity interruption in the previous 12 months.


Safe and supportive communities

Community is a fundamental part of Indigenous culture, with group activities playing an important role in maintaining ties between community members. Participation in sporting activities brings people together and is associated with good physical and mental health. In the 2008 NATSISS, 95% of Indigenous people were living in households that had access to outdoor playing fields and play areas. In addition, 76% of Indigenous people lived in households with access to a swimming pool in their community and 72% had access to an indoor sports centre. Access to these sporting facilities was significantly higher in non-remote areas than in remote areas (graph S9.8). Almost half (47%) of Indigenous children aged 4-14 years, had been involved in organised sport in the last 12 months. This proportion was higher in non-remote areas (49%) than in remote areas (40%).

Many Indigenous people have strong connections to a particular area, commonly referred to as their traditional country or homelands. In 2008, 72% of Indigenous people aged 15 years or over recognised an area as their homelands and 25% were currently living there. The vast majority of those not living in their homelands reported being allowed to visit there.

Communities can play an important role in providing support during times of crisis. In 2008, 89% of Indigenous people aged 15 years or over were able to get support from outside their household during a time of crisis. The most common sources of support were family (90%), friends (72%) and neighbours (31%).
Despite the strong community ties that exist in many Indigenous communities, some continue to face problems related to the excessive consumption of alcohol and misuse of drugs. High levels of drug or alcohol consumption may lead to problems for individuals and their communities, such as violence, crime and long-term health effects. In 2008, 37% of Indigenous people aged 15 years or over reported short-term risky/high risk alcohol consumption (binge drinking) in the two weeks before interview. In addition, one in six (17%) Indigenous people reported long-term risky/high risk alcohol consumption. Neither of these proportions had changed significantly since 2002. Data from the Australian Institute of Criminology (AIC) National Homicide Monitoring Program (NHMP) show that in 70% of Indigenous homicides over the period 1999-2000 to 2006-07, both the offender and the victim had consumed alcohol.

Illicit drug use is another risk factor for Indigenous people and their communities. In 2008, around one-quarter (24%) of Indigenous people aged 15 years or over living in non-remote areas stated using illicit drugs within the last year, similar to the rate stated in 2002 (26%). Data from the AIC NHMP show that 24% of Indigenous homicides over the period 1999-2000 to 2006-07 were associated with the use of drugs at the time of offence, compared with 34% of non-Indigenous homicides.


Governance and Leadership

This strategic area of action focuses on both the leadership provided by governments in their engagement with Indigenous people and on the governance provided by Indigenous people and organisations to the communities they serve. The inclusion of this strategic area in the 2009 OID framework recognises that Indigenous people and organisations have a vital role to play in achieving measurable improvements in their economic, social and health outcomes.


References

Australian Bureau of Statistics 2008, Overweight and obesity - Aboriginal and Torres Strait Islander people: A snapshot, 2004-05 (4722.0.55.006).

Australian Bureau of Statistics 2009, Births, Australia, 2008 (3301.0).

Australian Bureau of Statistics 2009, National Aboriginal and Torres Strait Islander Social Survey, 2008 (4714.0).

Australian Institute of Criminology 2008, Responding to Substance Abuse and Offending in Indigenous Communities: Review of Diversion Programs, Research and Public Policy Series, no. 88, Canberra..

Australian Institute of Health and Welfare, Australia's Mothers and Babies 2006, AIHW cat. no. PER 46, National Perinatal Statistics Unit, Sydney.

Australian Institute of Health and Welfare, Child Protection Australia 2007-08, Child welfare series no. 45, AIHW cat. no. CWS 33, Canberra.

Ministerial Council on Education, Employment, Training and Youth Affairs (MCEETYA), National Report on Schooling in Australia (various years), Preliminary paper: National Benchmark results - Reading, writing and numeracy, Years 3, 5 and 7,Melbourne.

Steering Committee for the Review of Government Service Provision 2009, Overcoming Indigenous Disadvantage: Key Indicators 2009, Productivity Commission, Canberra.

Taylor, N. 2009, Juveniles in Detention in Australia, 1981-2007, Technical and Background Paper, Australian Institute of Criminology, Canberra.

Vos, T, Barker, B, Stanley, L and Lopez, A 2007, The Burden of Disease and Injury in Aboriginal and Torres Strait Islander Peoples, 2003, School of Population Health, Brisbane.