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SOCIAL AND ECONOMIC WELLBEING OF ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE WITH DISABILITY ACKNOWLEDGEMENT The Australian Bureau of Statistics (ABS) acknowledges and thanks the First Peoples Disability Network Australia (FPDN) for their review of this feature article. This paper is an outcome of ongoing discussions with FPDN over several years and its release coincides with a joint presentation given recently at the Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) National Indigenous Research Conference 2017. Using the rich stream of data from the National Aboriginal and Torres Strait Islander Social Survey (NATSISS), the paper helps fill a gap in information about the extent and nature of disability experienced by Aboriginal and Torres Strait Islander Australians. While the NATSISS can be investigated to provide the statistics, the ABS has partnered with FPDN to help bring these stories to life. FPDN's research program takes a narrative research approach to investigate the intersection between the cultural inclusion of Aboriginal and Torres Strait Islander people and the social inclusion of a person with disability. The ABS agrees that the context and narratives provided by FPDN enhances understanding of the lived experience of Aboriginal and Torres Strait Islander people with disability. "The lived experience of Australia's First Peoples with disability has historically been neglected in research and policy due to a number of factors, including limited data that genuinely reflects the prevalence and nature of disability among Aboriginal and Torres Strait Islander People. Disaggregated information on Aboriginal and Torres Strait Islander disability has not been available in this space and we welcome its publication. The opportunity to enhance the data available by connecting quantitative data generated through the NATSISS and other ABS instruments, with the narrative data on the lived experiences of disability gathered through FPDN’s ‘Living our ways’ research program, enables a new level of understanding of the scope and prevalence of disability in Aboriginal and Torres Strait Islander communities and its impact across a person’s life trajectory." Scott Avery, First Peoples Disability Network INTRODUCTION The lived experiences of each Aboriginal and/or Torres Strait Islander person with disability are unique. In a society that seeks to be fair and inclusive, their contributions to contemporary life should be respected and valued. This includes recognising their individual and collective histories and connection to culture, and more broadly, their human rights. A social model of disability recognises that for people with impairments, barriers to equality and full participation in society are a root cause of disability. [1] The 2014–15 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) provides a range of information about the social and economic circumstances of Aboriginal and Torres Strait Islander people aged 15 years and over living with disability or a restrictive long-term health condition. Results presented in this article are for Aboriginal and Torres Strait Islander people aged 15 years and over unless stated otherwise. "Social justice is what faces you in the morning. It is awakening in a house with adequate water supply, cooking facilities and sanitation. It is the ability to nourish your children and send them to school where their education not only equips them for employment but reinforces their knowledge and understanding of their cultural inheritance. It is the prospect of genuine employment and good health: a life of choices and opportunity, free from discrimination." Mick Dodson, Annual Report of the Aboriginal and Torres Strait Islander Social Justice Commissioner, 1993. [2] Aboriginal and Torres Strait Islander people are more likely than other Australians to experience various forms of disadvantage, including higher unemployment rates, poverty, isolation, trauma, discrimination, exposure to violence, trouble with the law and alcohol and substance abuse. For some people, this disadvantage is coupled with impairments that result in disability. In this article, people with disability or a restrictive long-term health condition are collectively referred to as 'people with disability', and those with a profound or severe core activity limitation are referred to as 'people with profound/severe disability'. It should be noted that survey information used to determine disability, and levels of disability, is self-reported and not independently verified. For more information on how disability is determined and defined in the NATSISS, see the Disability module in the Questionnaire and Disability Status entry in the Glossary. Living with disability Almost half (45%) of Aboriginal and Torres Strait Islander people aged 15 years and over were living with disability or a restrictive long-term health condition in 2014-15. Disability was more prevalent among females than males (47% compared with 43%) however overall rates were similar in non-remote and remote areas (45% and 44%, respectively). Reflecting general population trends, the likelihood of disability increased with age. For example, the proportion of Aboriginal and Torres Strait Islander 15-24 year olds with disability was 32%, around half the rate for those aged 55 years and over (66%) (Table 11.1). Profound or severe disability People with a profound or severe core activity limitation are at the high needs end of the disability spectrum; always or sometimes needing assistance with self care, mobility and/or communication. In 2014-15, one in thirteen (8%) Aboriginal and Torres Strait Islander people aged 15 years and over experienced profound or severe disability. Rates were similar for males and females and for people in non-remote and remote areas. Nationally, people with profound/severe disability accounted for one in six (17%) of all Aboriginal and Torres Strait Islander people with disability (Table 11.1).
(a) Aboriginal and Torres Strait Islander people aged 15 years and over. (b) Core activity restrictions involving a limitation in the performance of one or more core activities such as self-care (eating, washing, dressing, toileting), mobility or communication. Source(s): ABS 2014–15, National Aboriginal and Torres Strait Islander Social Survey, cat.no. 4714.0.
(a) Aboriginal and Torres Strait Islander people aged 15 years and over. (b) Sum of components will exceed total as some people have reported more than one type of disability. (c) Core activity restrictions involving a limitation in the performance of one or more core activities such as self-care (eating, washing, dressing, toileting), mobility or communication. Source(s): ABS 2014–15, National Aboriginal and Torres Strait Islander Social Survey, cat.no. 4714.0.
Factors which can enable the full participation of Aboriginal and Torres Strait Islander people with disability include paid employment, and access to education, social networks, affordable and secure housing, and culturally safe services and support. However, in some instances, people with disability may be less able than others to participate in the labour force, effectively interact in the community or access appropriate services due to the nature of their disability and/or lack of adequate support. The remainder of this article focuses on outcomes for Aboriginal and Torres Strait Islander people with profound/severe disability, compared with those who had no disability. However, it is worth noting that the poorer outcomes experienced by Aboriginal and Torres Islander people with profound/severe disability are generally consistent with results for all those with disability (including lower levels of disability). Cultural identity Connection to country, family and community can be significant factors for Aboriginal and Torres Strait Islander people. In 2014–15, similar proportions of Aboriginal and Torres Strait Islander people, with and without disability, recognised an area as homelands/traditional country, identified with a clan, tribal or language group and/or spoke an Indigenous language. Participation rates for cultural events, ceremonies or organisations in the last 12 months — such as NAIDOC week activities and art, craft, music or sporting festivals — were also similar (Table 28). Family and community connections At least 90% of Aboriginal and Torres Strait Islander people received support in times of crisis from people living outside their household, however those with profound/severe disability were less likely to have received support from a family member (78%) or friend (55%), than were people with no disability (85% and 64%, respectively). They were instead, almost twice as likely to have received crisis support from more formal sources such as a community, charity or religious organisation (20% compared with 12%) and/or health, legal or financial professional (15% compared with 8%) (Table 28). In 2014-15, Aboriginal and Torres Strait Islander people with profound/severe disability were less likely than people with no disability to be living in couple families (40% compared with 46%); and were instead more likely to live alone (14% compared 8%). Those with profound/severe disability were also less likely to have had daily face-to-face contact with family or friends outside their household (35%) than were people with no disability (45%) or to have accessed the internet at home (58% compared with 78%) (Table 27 and 28). Smaller proportions of Aboriginal and Torres Strait Islander people with profound/severe disability had exceeded the 2009 NHMRC alcohol consumption guidelines[3] for lifetime risk (11% and 14%) and single occasion risk (18% compared with 32%) in 2014–15, compared to those with no disability. However, the difference between rates for lifetime risk was not statistically significant (Table 28). Aboriginal and Torres Strait Islander people with profound/severe disability were more likely than those with no disability to be a daily smoker (42% compared with 36%), but were less likely to report both smoking and exceeding the alcohol guidelines for single occasion risk (12% compared with 17%). Aboriginal and Torres Strait Islander people with profound/severe disability reported higher rates of illicit substance use (33%) than those with no disability (28%), however the difference in rates was not statistically significant (Figure 11.1 and Table 28). Figure 11.1. Smoking and substance use(a), by disability status — 2014–15 Footnote(s): (a) Aboriginal and Torres Strait Islander people aged 15 years and over. (b) Proportions are calculated on persons who completed the substance use module. (c) Differences between rates for profound/severe disability and no disability are not statistically significant. Source(s): 2014–15 National Aboriginal and Torres Strait Islander Social Survey In 2014–15, most (83%) Aboriginal and Torres Strait Islander people with profound/severe disability had experienced one or more stressors in the last 12 months, compared with 63% of those with no disability. People with disability were significantly more likely than those without disability to have experienced multiple stressors. For example, one in eight (12%) of those with disability (and 19% of people with profound/severe disability) reported four or more stressors, compared with one in twenty (5%) people with no disability (Table 28).
Access to health services In 2014–15, Aboriginal and Torres Strait Islander people with profound/severe disability were more likely to have experienced problems accessing one or more health services (27%) than were people with no disability (11%) however, people with profound/severe disability were also more likely to have sought access to health services. The relative disparity in access was apparent across the majority of health services, including doctors, dentists and hospitals (Figure 11.2 and Table 28). Figure 11.2. Difficulty accessing selected health services(a), by disability status — 2014–15 Footnote(s): (a) Aboriginal and Torres Strait Islander people aged 15 years and over. (b) Also includes Medicare, Aboriginal and Torres Strait Islander health workers, disability, mental health and alcohol/drug services. Source(s): 2014–15 National Aboriginal and Torres Strait Islander Social Survey Trust in own doctor was lower for Aboriginal and Torres Strait Islander people with profound/severe disability (76%) than for people with no disability (82%), with a more pronounced difference for trust in hospitals (54% compared with 70%) (Table 28). Educational attainment Footnote(s): (a) Aboriginal and Torres Strait Islander people aged 15–64 years. (b) Unemployed persons as a proportion of all persons in the labour force. (c) Differences between rates for disability and no disability are not statistically significant. Source(s): 2014–15 National Aboriginal and Torres Strait Islander Social Survey Household and personal income Equivalised gross household income provides an indication of how much money is likely to be available to each person in a given household, assuming that income is shared, and taking into account the combined income, size and composition of the household in which they live. In 2014–15, Aboriginal and Torres Strait Islander people with profound/severe disability were more likely than those with no disability to be living in households in the lowest income quintile (47% compared with 32%), and were twice as likely to be reliant on government pensions or allowances as their main source of personal income (73% compared with 37%) (Table 27).
In addition, Aboriginal and Torres Strait Islander people with profound/severe disability were almost twice as likely as those with no disability to have ever experienced homelessness (41% compared with 22%) (Table 27). For more information about how homelessness is defined in the NATSISS, see the Glossary. Overall life satisfaction Overall life satisfaction is a summary measure of wellbeing, based on self-reported ratings on a scale from 0 'not at all satisfied' to 10 'completely satisfied'. In 2014–15, around one in five (18%) Aboriginal and Torres Strait Islander people with profound/severe disability reported an overall life satisfaction rating at the lower end of the scale (0–4), compared with 5% of people with no disability. Conversely, those with no disability were significantly more likely to have said they were completely satisfied with their life (20% compared with 12%) (Figure 11.4 and Table 27). Figure 11.4. Overall life satisfaction rating(a)(b), by disability status — 2014–15 Footnote(s): (a) From zero 'not at all satisfied' to 10 'completely satisfied'. (b) Aboriginal and Torres Strait Islander people aged 15 years and over. (c) Differences between rates for profound/severe disability and no disability are not statistically significant. (d) Differences between rates for disability and no disability are not statistically significant. Source(s): 2014–15 National Aboriginal and Torres Strait Islander Social Survey Summary There are significant differences between the experiences of persons with and without disability across many areas as indicated in this article. The lower rates of educational attainment, coupled with poor employment outcomes contribute to lower life satisfaction. These factors along with a lack of adequate support impact on Aboriginal and Torres Strait Islander people with profound/severe disability and curtail their capacity to effectively interact in the community or access appropriate services. On the other hand, an Aboriginal and Torres Strait Islander person’s cultural connections cannot be underestimated and appears to provide a levelling factor in one’s lived experiences where very little difference exists between peoples’ experiences regardless of their level of disability or activity restriction. These connections to culture, family and the community alongside active participation in cultural activities can help lessen feelings of isolation and provide people with supportive networks. Understanding the benefits of connection to culture and giving it due consideration can only assist in improving the services provided to Aboriginal and Torres Strait Islander peoples with disability and their access to and trust in such services. 2 http://nationalcongress.com.au/wp-content/uploads/2016/10/The-Redfern-Statement-9-June-2016.pdf; last accessed 08/02/2017; <http://fpdn.org.au/>
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