NATIONAL ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH SURVEY: QUEENSLAND, 2004-05


INTRODUCTION
POPULATION CONTEXT
HEALTH STATUS
HEALTH RELATED ACTIONS
HEALTH RISK FACTORS
WOMEN'S HEALTH
FURTHER INFORMATION


INTRODUCTION

In recognition that Aboriginal and Torres Strait Islander peoples suffer greater ill health than other Australians, the ABS conducted the first National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) in 2004-05. This was the largest health survey of Indigenous Australians and collected health information from over 10,000 Aboriginal and Torres Strait Islander peoples in Australia.

The general health status of Aboriginal and Torres Strait Islander peoples is considerably poorer than for non-Indigenous Australians. On average, Indigenous peoples experience a higher burden of disease than non-Indigenous Australians and as a result experience higher rates of mortality. Life expectancy for Indigenous Australians is estimated to be about 17 years shorter than the measured life expectancy for all Australians.

Key findings of the 2004-05 NATSIHS identified that the relative socioeconomic disadvantage experienced by Aboriginal and Torres Strait Islander peoples, compared with non-Indigenous Australian people, placed them at greater risk of exposure to behavioural and environmental health risk factors, and that the health of Aboriginal and Torres Strait Islander peoples in rural and remote areas is generally worse than for those living in major cities.

Consistent with national patterns, Queensland Aboriginal and Torres Strait Islander peoples do not enjoy the same levels of health as their non-Indigenous counterparts.

Statistics in this article are taken from the National Aboriginal and Torres Strait Islander Health Survey: Queensland, 2004-05 (cat. no 4715.3.55.005) and provide relevant data to assist in understanding the disparities and challenges in health outcomes for Aboriginal and Torres Strait Islander peoples.

For a comprehensive definition of terms used in this article, refer to the glossary of the following ABS publication: National Aboriginal and Torres Strait Islander Health Survey, 2004-05 (cat. no. 4715.0).

POPULATION CONTEXT

Queensland has the second largest Aboriginal and Torres Strait Islander population (28% of the total indigenous population) to New South Wales (29%). The Indigenous population of Queensland at 30 June 2001 was estimated at 125,900 or 3.5% of the total Queensland population. Of the Indigenous population, 77% were identified as being of Aboriginal origin, 15% were identified as being of Torres Strait Islander origin and 8% were identified as being of both Aboriginal and Torres Strait Islander origin.

Queensland has a rich diversity of Aboriginal and Torres Strait Islander cultures and community languages, and Aboriginal and Torres Strait Islander peoples are ethnically and culturally distinct. The majority of Indigenous people live in regional Queensland (51%) with a further 25% living in major cities. Around one in four indigenous people (24%) were living in remote areas compared with only 3% of the non-Indigenous population.

The Aboriginal and Torres Strait Islander population in Queensland is relatively young, with a medium age of 20.1 years compared to 35.6 years for the non-Indigenous population. To account for differences in the age structure, comparisons between Indigenous and non-Indigenous people are presented by age group or by using age standardised rates as appropriate.
HEALTH STATUS

SELF ASSESSED HEALTH

Self assessed health status provides an indicator of overall health; it reflects an individual's perception of his or her own health. This measure is dependent on an individual's awareness and expectations regarding their health and may be influenced by factors such as access to health services and health information.

In 2004-05, the self assessed health status recorded for Aboriginal and Torres Strait Islander peoples in Queensland was similar to the national results, with 77% of the Queensland Indigenous population reporting their health status as either good, very good, or excellent compared with 78% nationally. The 2004-05 Queensland result is also similar to that recorded for Indigenous Queenslanders in 2002 (76%).

Self assessed health status is shown to vary with age. The proportion of Indigenous people aged 15 -24 reporting fair or poor health was 9%, compared with 54% aged 55 years and over. After adjusting for differences in the age structure between the Indigenous and non-Indigenous populations, Indigenous people overall were almost twice as likely as non-Indigenous people to report their health as fair or poor.


SOCIAL AND EMOTIONAL WELLBEING

The 2004-05 NATSIHS collected information on the social and emotional wellbeing of Indigenous adults (aged 18 years and over) using selected questions from the Medical Outcome Short Form (SF-36) and the Kessler Psychological Distress Scale. Questions were also asked regarding feelings of anger, the impact of psychological distress, stressors, and cultural identification.

In response to questions from the SF–36 about feelings of happiness and energy levels, almost three-quarters of adult Aboriginal and Torres Strait Islander Queenslanders reported being happy (74%), and more than half reported feeling calm and peaceful (58%) and/or full of life (56%) all or most of the time, while just under half (49%) said they had a lot of energy all or most of the time. Indigenous people living in remote areas were more likely to report having had these positive feelings all or most of the time than were indigenous people living in non-remote areas.

Responses to questions from the Kessler Psychological Distress Scale showed that in Queensland 7% of Aboriginal and Torres Strait Islander persons aged 18 years and over reported feeling nervous all or most of the time, almost 8% felt without hope all or most of the time and 6% felt so sad that nothing could cheer them up all or most of the time. Higher proportions of the adult Aboriginal and Torres Strait Islander population in Queensland reported feeling restless (11%) and/or that everything was an effort all or most of the time (19%). These results were similar to the national proportions (12% and 17% respectively).


LONG TERM HEALTH CONDITIONS

Around two-thirds (63%) of Indigenous people in Queensland reported at least one long term health condition. Indigenous people living in remote areas were less likely to report a long term health condition than those living in non-remote areas (61% compared with 64%).

Results from the 2004-05 NATSIHS showed the most commonly reported long term health conditions among Aboriginal and Torres Strait Islander Queenslanders were eye/sight problems (30%), asthma (15%), back and disc disorders (13%), ear/hearing problems (11%), and heart and circulatory problems/diseases (10%).


High proportions of Aboriginal and Torres Strait Islander adults in Queensland who reported a long term condition also reported that stressors (such as death of a family member or close friend, divorce or separation, alcohol and drug problems, and discrimination/racism) were experienced by themselves, family or friends. For example, 82% of those with arthritis, 80% of those with diabetes and 79% of those with asthma reported a stressor (other than serious illness or disability). Of Aboriginal and Torres Strait Islander adult Queenslanders who did not report a long term condition, 63% had experienced a stressor (other than serious illness or disability).

Asthma

Consistent with the national Aboriginal and Torres Strait Islander average, asthma was reported by around one in seven Indigenous Queenslanders (15%) in 2004-05. After adjusting for age differences between the two populations, Indigenous people were 1.4 times more likely to report asthma as a long term health condition than were non-Indigenous people. A higher proportion of Indigenous females reported asthma as a long term health condition (18%) compared to Indigenous males (11%).

Diabetes

After adjusting for age differences, Indigenous people in Queensland were 3.7 times more likely to report diabetes/high sugar levels than were non-Indigenous people. Aboriginal and Torres Strait Islander females reported a higher incidence than males (13% compared to 11%) and Indigenous people in remote areas were more likely to report diabetes as a long term health condition than those living in non-remote areas (11% compared to 5%).

Heart and circulatory problems/diseases

In 2004-05, one in ten Indigenous Queenslanders (10%) reported a long term health condition associated with the heart and circulatory system. These long term conditions were more prevalent in remote (15%) than non-remote (9%) areas. Hypertensive disease (high blood pressure) was the most commonly reported heart and circulatory condition among Aboriginal and Torres Strait Islander people.

Kidney disease

After adjusting for age differences, rates of kidney disease were higher in the Queensland Indigenous population (3%) than in the non-Indigenous population (less than 1%).

HEALTH RELATED ACTIONS

An individuals health related actions, and access to health professionals and services are important factors in the successful prevention and management of health conditions. Apart from visits to the dentist, Aboriginal and Torres Strait Islander peoples in Queensland were more likely than other Queenslanders to have taken at least one of the surveyed health related actions in 2004-05.

HOSPITAL ADMISSIONS

Nearly one in six Indigenous people living in Queensland (15%) had been admitted to hospital in the 12 months prior to the 2004-05 survey. After adjusting for age differences between the two populations, Indigenous people were 1.3 times more likely than non-Indigenous people to have been hospitalised in the 12 months prior to interview. Within the Indigenous population, unemployed people were more likely to have been admitted to hospital than those in employment (19% compared to 15%).

CONSULTATION WITH HEALTH PROFESSIONALS

In 2004-05, the rates of consultation by Queensland Indigenous people with health professionals were similar to the national Indigenous averages. Nearly one in five Queensland Aboriginal and Torres Strait Islander peoples (19%) reported having visited a doctor (GP or specialist) in the two weeks prior to interview, 16% had consulted an 'other' health professional (e.g. Aboriginal health worker or nurse), 6% had visited the casualty or outpatients department of a hospital and 5% (of people aged two years and over) had seen a dentist.

After adjusting for age differences between the two populations, Indigenous people were 1.3 times more likely than non-Indigenous people to have consulted an other health professional, and nearly three times more likely (2.9) to have visited the casualty or outpatients department of a hospital in the two weeks before the survey.


ORAL HEALTH

In 2004-05 NATSIHS, the ABS collected information for the first time about the oral health of Indigenous people, in addition to the information on recent visits to health professionals. Of Queensland Indigenous people aged 15 years and over, 5% had never visited a dentist or health professional about their teeth. This proportion was less than half the national Indigenous average (11%).

While more than three-quarters (78%) of Indigenous people aged 15 years and over living in Queensland had lost fewer than five adult teeth in their lifetime, the proportion who had lost five or more teeth varied with age. Over half (54%) of Indigenous people aged 45 years and over had lost five or more teeth. While Indigenous people aged 45 years or more in non-remote areas reported a higher level of tooth loss and greater use of dentures than those in remote areas, there was a higher proportion in remote areas (18% compared to 12% in non-remote areas) who reported they required dentures but did not have them.
HEALTH RISK FACTORS

SMOKING

In 2004-05, half the adult Queensland Indigenous population (50%) were current daily smokers, that is, people who smoked one or more cigarettes per day on average. Smoking was more prevalent among Indigenous than non-Indigenous people in every age group. For those people aged 55 years or more, 32% of Indigenous people and 44% of non-Indigenous people were ex-smokers.



After adjusting for age differences between the two populations, Indigenous adults were more than twice as likely as non-Indigenous adults to be current daily smokers.

ALCOHOL CONSUMPTION

In 2004-05, around half of Indigenous people living in Queensland (51%) reported having consumed alcohol in the week prior to interview, of whom over one-third (37%) reported drinking at risky/high risk levels. Across the age groups, patterns of risky/high risk alcohol consumption were different for men and women. Indigenous women reported their highest levels of risky/high risk consumption at an earlier age (24% of those aged 25-34 years) than Indigenous men (25% of those aged 35-44 years).


Substance use

Illicit substance use can be divided into two categories: use of substances, which are illegal to possess (e.g. heroin) and non-medical use of substances which are legally available (e.g. petrol inhalation and misuse of prescription drugs).

For Indigenous people aged 18 years and over who accepted the substance use form, 25% reported using illicit substances in the 12 months prior to the survey and a further 16% reported illicit substance use at least once in their lifetime. The substances most commonly used in the last 12 months were marijuana, hashish and cannabis resin (19%), amphetamines or speed (6%) and analgesics and sedatives for non-medical use (6%).

Diet and exercise

Many of the principal causes of ill-health among Aboriginal and Torres Strait Islander people are nutrition related diseases such as heart disease, Type II diabetes, and renal disease. While a diet high in saturated fats and refined carbohydrates increases the likelihood of developing these diseases, regular exercise and intake of fibre-rich foods, such as fruit and vegetables, can have a protective effect against disease. The National Health and Medical Research Council guidelines recommend a minimum of five serves of vegetables per day and two serves of fruit per day.

Fruit and Vegetables

The majority of Indigenous people aged 12 years and over reported eating vegetables (95%) and/or fruit (86%) daily in 2004-05. Fruit and vegetables may be less accessible to Indigenous people in remote areas, of whom one in five (20%) reported no usual daily fruit intake compared with one in eight (12%) in non-remote areas. The disparity was even greater for vegetables, where 15% of Indigenous people in remote areas reported no daily intake compared to 2% in non-remote areas. Of Indigenous people in non-remote areas, children aged 12 -14 had the highest proportions of meeting the recommended daily intake of fruit (57%) and vegetables (13%).

Salt and milk

In 2004-05, around seven in ten Indigenous people either sometimes (25%) or usually (47%) added salt after cooking. Indigenous people in remote areas (82%) were more likely than those in non-remote areas (69%) to report sometimes or usually adding salt after cooking.

Over four-fifths (82%) of indigenous people usually drank whole (full cream) milk in 2004-05, with 13% reporting reduced fat or skim milk. In non-remote areas, Indigenous people were much more likely to drink full cream milk than non-Indigenous people, regardless of age.

Exercise

The 2004-05 NATSIHS collected information relating to the frequency, intensity and duration of exercise undertaken by Indigenous Queenslanders living in non-remote areas. Nearly three-quarters (74%) of Indigenous people in non-remote areas were sedentary or engaged in low level exercise in the two weeks prior to interview.

Body Mass

The proportion of people that are overweight or obese within a given population can be determined by first calculating an individual's Body Mass Index (BMI) score (from reported information on height and weight) and then grouping people into BMI categories.

More than half (58%) of Indigenous people aged 15 years and over were recorded as being overweight or obese. Indigenous people in remote areas (68%) were more likely than those in non-remote areas (54%) to be overweight or obese. After adjusting for age differences between the two populations and non-response, Indigenous Queenslanders were 1.3 times more likely to be overweight/obese than non-Indigenous Queenslanders.

The 15-24 years age group for Indigenous Queenslanders recorded the lowest proportions of overweight/obesity for both males (37%) and females (27%) while the age group 45 years and over recorded the highest levels at 66% for males and 61% for females.


Breastfeeding

In 2004-05, the majority of Indigenous women aged 18-64 years who had had children reported having breastfed them (85%), consistent with the national Indigenous proportion (84%). The proportion of Queensland Indigenous women who breastfed their children was higher in remote areas (92%) than non-remote areas (82%). Of indigenous children under four years of age 79% had been breastfed for at least some period compared to 90% of non-Indigenous children under four years of age.

Immunisation

More than half (63%) of Queensland Indigenous people aged 50 years and over reported that they had been vaccinated for influenza in the 12 months before the survey and 40% for pneumonia in the last five years. The proportions for non-Indigenous Queenslanders were lower at 43% vaccinated for influenza and 18% vaccinated for pneumonia.

Older Indigenous people in remote areas (86%) were more likely than those in non-remote areas (54%) to have been recently vaccinated for influenza and nearly twice as likely to have been vaccinated against pneumonia in the last five years (60% compared with 32%).

WOMEN'S HEALTH

In 2004–05, a higher proportion (39%) of Queensland Indigenous women aged forty years or more reported having regular mammograms than the national Indigenous average (32%). Proportions for women living in remote and non-remote areas of Queensland are similar (38% compared with 39%).

The proportion of Queensland Indigenous women aged 18 years and over reporting having had regular pap smear tests is also slightly higher than the national Indigenous rate (56% and 52% respectively). Indigenous women living in remote areas of Queensland were more likely (62%) than those in non-remote areas (53%) to have regular pap smear tests.

CONTRACEPTION

Queensland Indigenous women aged 18-49 years reported that condoms (22%) were the most common form of contraception used, followed by the contraceptive pill (15%) and contraceptive injection (DepoProvera) (11%).
FURTHER INFORMATION

ABS SOURCES

National Aboriginal and Torres Strait Islander Health Survey, 2004-05 (cat. no 4715.0)
Deaths Australia, 2005 (cat. no 3302.0)
Population Characteristics, Aboriginal and Torres Strait Islander Australians, 2001 (cat. no 4713.0)
National Aboriginal and Torres Strait Islander Health Survey: Queensland, 2004-05 (cat. no 4715.3.55.005)
National Aboriginal and Torres Strait Islander Social Survey, Queensland, 2002 (cat. no 4714.3.55.001)