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Research on housing and health shows a relationship between inadequate housing and housing related infrastructure and poor health outcomes (Howden-Chapman & Wilson 2000, Waters 2001). Overcrowding, poor dwelling condition and inadequate basic utilities such as facilities for washing clothes, sewerage systems or safe drinking water have all been associated with higher rates of infectious and parasitic diseases. These include skin infections and infestations, respiratory infections, eye and ear infections, diarrhoeal diseases and rheumatic fever (Menzies School of Health Research 2000).

In May 2001, housing ministers endorsed a 10-year statement on directions for Indigenous housing reform to provide better housing for Indigenous Australians (HMC 2001). This statement addressed the 1997 ministers’ reform agenda the focus of which was to:

• identify and address outstanding need
• improve the viability of Indigenous community housing organisations
• establish safe, healthy and sustainable housing for Indigenous Australians, especially in rural and remote communities
• establish a national framework for the development and delivery of improved housing outcomes for Indigenous Australians by state, territory and community housing providers.

The framework states that houses should be designed, constructed and maintained to support healthy living practices that were identified as being essential for good health. One of these principles relates to reducing overcrowding and the potential for the spread of infectious diseases. Some principles specify that houses must have the facilities required for washing people, washing clothes and bedding, storing and preparing food. In addition dwellings must be in good physical condition and connected to basic services to support healthy living.

Overcrowding

A higher proportion of Aboriginal and Torres Strait Islanders live in overcrowded conditions than other Australians and this can adversely affect their health. Overcrowding can put stress on bathroom, kitchen and laundry facilities as well as on sewerage systems such as septic tanks. It can lead to the spread of infectious diseases such as meningococcal, tuberculosis, rheumatic fever and respiratory diseases and skin infections (Howden-Chapman & Wilson 2000). It has also been associated with poorer self-reported physical and mental health, and higher rates of smoking and hazardous drinking (Waters 2001).

Various measures can be used to assess the extent of overcrowding in dwellings. The nationally accepted definition of overcrowding used in relation to housing assistance is the Proxy Occupancy Standard, which is a measure of the appropriateness of housing related to the household size and composition (AIHW 2004k). The standard specifies the following bedroom requirements for different household types:

• single adult - 1 bedroom
• single adult group - 1 bedroom per adult
• couple with no children - 2 bedrooms
• sole parent or couple with 1 child - 2 bedrooms
• sole parent or couple with 2 or 3 children - 3 bedrooms
• sole parent or couple with 4 or more children - 4 bedrooms.

In 2001, some 10% of Indigenous households in Australia (13,380 dwellings) were overcrowded according to the Proxy Occupancy Standard. In other words, 22% of Indigenous people living in private dwellings (80,370 people) were living in overcrowded accommodation. Overcrowding varied significantly by tenure type, with the lowest rates among owner/purchaser households and the highest among households in Indigenous or mainstream community housing. About one-third (34%) of Indigenous households and over one-half of Indigenous people (57%) renting from Indigenous or mainstream community housing organisations were living in overcrowded conditions (table 4.11).

4.11 Indigenous households and Indigenous persons in overcrowded conditions, by tenure type - 2001
	Persons(a)		Households(a)
	no.	%	no.	%
Home owner/purchaser	8 110	8.3	2 160	4.7
Renter state/territory housing authority	14 500	17.5	2 660	9.1
Renter Indigenous/mainstream community housing	44 040	57.3	5 320	34.0
Private and other renter	11 330	11.6	2 840	6.1
Total(b)	80 370	22.2	13 380	9.5
(a) Excludes dwellings where the number of bedrooms was not stated.
(b) Includes other tenure types and not stated tenure type.
ABS, 2001 Census of Population and Housing

Overcrowding varied by state and territory. The very high proportion of overcowded households in the Northern Territory (32%) reflects the high number of Indigenous households in Indigenous or mainstream community housing, and the large proportion of these (55%) that were overcrowded (table 4.12).

4.12 Overcrowded Indigenous households, by state and territory - 2001
	NSW	Vic.	Qld	SA	WA	Tas.	NT	ACT	Australia
Number (no.)
Home owner/purchaser	810	190	580	110	250	100	110	20	2 160
Renter state/territory housing authority	660	160	690	210	630	50	240	30	2 660
Renter Indigenous/mainstream community housing	380	30	1 260	240	870	-	2 530	-	5 320
Private and other renter	890	180	1 110	110	270	60	190	20	2 840
Total(a)	2 810	580	3 740	690	2 110	220	3 160	60	13 380
Proportion(b) (%)
Home owner/purchaser	4.8	4.0	5.2	4.1	5.2	2.5	7.0	2.6	4.7
Renter state/territory housing authority	6.4	7.0	11.3	7.9	13.1	4.4	14.5	6.2	9.1
Renter Indigenous/mainstream community housing	12.5	8.5	27.7	31.2	39.4	-	55.2	-	34.0
Private and other renter	5.5	4.9	7.1	4.8	6.1	3.3	11.6	3.4	6.1
Total(a)	5.9	5.1	9.8	8.2	12.6	3.1	32.4	4.0	9.5
- nil or rounded to zero (including null cells)
(a) Includes other tenure type and tenure type not stated.
(b) Excludes dwellings with number of bedrooms not stated.
ABS, 2001 Census of Population and Housing.
Overcrowding was measured according to the Proxy Occupancy Standard.

Household facilities

Across Australia, a high proportion of Indigenous households were living in dwellings with the facilities required to support healthy living practices. In 2002, some 99% of Indigenous households reported having working facilities for washing people, 98% had working facilities for washing clothes and bedding, and 95% had working facilities for storing and preparing food.

There were, however, a number of households which did not have these working facilities. For example, 1,700 Indigenous households reported that they did not have working facilities for washing people, 3,500 did not have working facilities for washing clothes or bedding, 8,300 did not have working facilities for storing or preparing food and 1,900 did not have working sewerage facilities.

Renters of Indigenous or community housing were less likely to have working sewerage facilities, working facilities for washing people or working facilities for food preparation and storage, than those with other kinds of housing tenure. For example, 85% of households renting Indigenous or community housing had working facilities for storing and preparing food compared with 99% of owner/purchaser households.

4.13 Functionality of basic facilities, Indigenous households by tenure type - 2002
	Home owner/ purchaser	Renter State or Territory housing authority	Renter Indigenous/ mainstream community housing	Private and other renter	Other tenure	Total
Number (no.)
Has working facilities for washing people	50 300	37 400	24 000	46 500	5 700	164 000
Has working facilities for washing clothes/bedding	50 100	36 900	24 000	45 500	5 600	162 200
Has working facilities for storing/preparing food	49 700	36 100	20 800	45 300	5 300	157 300
Has a working telephone	48 000	27 400	11 800	37 100	4 200	128 500
Total households	50 400	37 700	24 500	46 700	6 200	165 700
Proportion (%)
Has working facilities for washing people	99.8	99.2	98.0	99.3	91.7	99.0
Has working facilities for washing clothes/bedding	99.2	98.0	97.9	97.2	91.7	97.9
Has working facilities for storing/preparing food	98.6	95.9	85.1	96.7	85.3	95.0
Has a working telephone	95.2	72.7	48.0	79.2	67.8	77.6
Total	100.0	100.0	100.0	100.0	100.0	100.0
ABS, 2002 NATSISS
Numbers are rounded to the nearest hundred.

Some 78% of all Indigenous households had a working telephone but this proportion varied significantly by tenure type, ranging from 48% for renters of Indigenous/ community housing to 95% of home owners.

Dwelling condition

The physical condition of a dwelling is important for reducing the negative impact of dust, controlling the temperature of the living environment and reducing the potential for trauma (or minor injury) around the house and living environment. The 2002 NATSISS asked households whether the dwelling in which they lived had structural problems. This included rising damp, major cracks in floors or walls, sinking or moving foundations, sagging floors, walls and windows out of plumb, wood rot/termite damage, major electrical problems, major plumbing problems, and major roof defects.

There were 58,100 Indigenous households, or 35%, that reported that their dwelling had structural problems of some kind in 2002 (table 4.14). The highest proportion of households that lived in dwellings with structural problems were renters of Indigenous or mainstream community housing (55%), followed by renters of state or territory housing (42%).

4.14 Dwelling condition, by tenure type - 2002
	Home owner/ purchaser	Renter State or Territory housing authority	Renter Indigenous/ mainstream community housing	Private and other renter	Other tenure	Total
Number (no.)
Has structural problems	11 300	15 700	13 400	15 600	2 000	58 100
Repairs and maintenance have been carried out	34 800	24 300	14 100	28 700	3 200	105 100
Total households	50 400	37 700	24 500	46 800	6 200	165 700
Proportion (%)
Has structural problems	22.0	42.0	55.0	33.0	33.0	35.0
Repairs and maintenance have been carried out	69.0	65.0	58.0	61.0	52.0	63.0
Total	100.0	100.0	100.0	100.0	100.0	100.0
ABS, 2002 NATSISS
Numbers rounded to the nearest hundred.

Repairs and maintenance had been carried out in the last 12 months in the dwellings of 63% of households overall. Home owners (69%) were the most likely to have had repairs and maintenance carried out, followed by renters in state or territory housing (65%).

Indigenous community housing

The 2001 Community Housing and Infrastructure Needs Survey (CHINS) collected data on dwelling condition for permanent dwellings in discrete Indigenous communities that were managed by Indigenous housing organisations. The majority of these dwellings were located in the Northern Territory (6,498), Queensland (3,740) and Western Australia (2,725). The data on dwelling condition were categorised according to the cost of repairs required to the dwelling.

4.15 Condition of permanent dwellings in discrete Indigenous communities, by state and territory - 2001
	Minor or no repair		Major repair		Replacement		Total
	no.	%	no.	%	no.	%	no.	%
New South Wales	865	69.9	336	27.2	36	2.9	1 237	100.0
Queensland	2 239	59.9	1 068	28.6	432	11.6	3 740	100.0
South Australia	680	70.2	180	18.6	109	11.2	969	100.0
Western Australia	1 790	65.7	552	20.3	383	14.1	2 725	100.0
Northern Territory	4 829	74.3	1 024	15.8	631	9.7	6 498	100.0
Australia	10 433	68.5	3 179	20.9	1 601	10.5	15 228	100.0
ABS, 2001 CHINS
Data only includes permanent dwellings managed by Indigenous Housing Organisations. Victoria and Tasmania included in Australia for confidentiality reasons.

Most permanent dwellings in discrete Indigenous communities required minor or no repairs or maintenance (69%), but there were 21% requiring major repairs and 11% requiring replacement. Dwellings in Queensland and Western Australia were in the poorest condition with 40% of permanent dwellings in Queensland and 34% in Western Australia requiring major repairs or replacement.

Connection to services

Most Indigenous households in Australia live in dwellings that are connected to water, sewerage and electricity. For example 99% of Indigenous households reported that they had working sewerage facilities (ABS 2002 NATSISS). Connection to services is primarily an issue for those households who live in Indigenous community housing where there are a number of dwellings not connected to an organised supply of water, sewerage or electricity.

Indigenous community housing

The CHINS data on main source of water, sewerage and electricity were collected at the community level for all discrete communities. While the data show services for all communities with permanent dwellings, and the number of permanent dwellings in these communities, some dwellings may not have had access to a service that was available at the community level. Data at the dwelling level can only be reported separately for each service so that the number of dwellings not connected to more than one service is unknown. However, of those communities that had permanent dwellings, 5 communities (with 13 dwellings) had no organised water supply; 35 communities (with 80 dwellings) had no organised electricity supply; and 51 communities (with 153 dwellings) had no organised sewerage system (table 4.16). There were 73 communities (with 208 dwellings) that had two organised services, and 9 communities (with 19 dwellings) that had only one organised service (ABS, 2001 CHINS).

Of the 16,966 permanent dwellings in discrete communities, the majority (10,429 or 61%) were in communities where the main source of drinking water was bore water. There were another 3,064 dwellings (18%) in communities connected to a town supply and 2,422 (14%) in communities where the main source of water was a river or reservoir. In addition, there were 214 permanent dwellings in communities where the main source of water was a well or spring and 13 permanent dwellings in communities that had no organised water supply (table 4.16).

In relation to sewerage, the majority of permanent dwellings (7,093 or 42%) were in communities with community water-borne systems. There were another 6,479 dwellings (38%) with some type of septic system and 2,580 dwellings (15%) connected to a town supply. In addition, there were 596 permanent dwellings in communities whose main type of sewerage system was pit toilets, and 15 dwellings in communities whose main type of sewerage system was pan toilets. There were also 153 permanent dwellings in communities with no organised sewerage supply (table 4.16).

The majority of permanent dwellings (9,790 or 58%) were in communities where the main source of electricity was community generators. There were also 5,954 dwellings (35%) in communities connected to the state grid, 727 dwellings (4%) with some form of solar supply and 296 dwellings (2%) where the main source of electricity was domestic generators. In addition, there were 80 permanent dwellings in communities with no organised electricity supply (table 4.16).

The NRF data collection includes data on connection to essential services. These data are still being developed but they will provide annual data on the number of dwellings connected to essential services.

4.16 Types of connection to water, sewerage and electricity in discrete Indigenous communities - 2001
		Number of communities with permanent dwelling(s)	Number of permanent dwellings(a)	Proportion of dwellings
		no.	no.	%
Main source of drinking water
	Connected to town supply	182	3 064	18.1
	Bore water	708	10 429	61.5
	Rain water tank(s)	50	794	4.7
	River or reservoir	71	2 422	14.3
	Well or spring	36	214	1.3
	Other organised water supply	11	30	0.2
	No organised water supply	5	13	0.1
	Total	1 063	16 966	100.0
Main type of sewerage system
	Connected to town system	87	2 580	15.2
	Community water-borne system	95	7 093	41.8
	Septic tanks with common effluent disposal	101	2 573	15.2
	Septic tanks with leach drain	551	3 906	23.0
	Pit toilets	171	596	3.5
	Pan toilets	2	15	0.1
	Other organised sewerage system	5	50	0.3
	No organised sewerage system	51	153	0.9
	Total	1 063	16 966	100.0
Main type of electricity supply
	State grid/transmitted supply	257	5 954	35.1
	Community generators	425	9 790	57.7
	Domestic generators	119	296	1.7
	Solar	88	290	1.7
	Solar hybrid	125	437	2.6
	Other organised electricity supply	14	119	0.7
	No organised electricity supply	35	80	0.5
	Total	1 063	16 966	100.0
(a) Data are collected at the community level and some permanent dwellings may not be connected to the type of service reported at the community level.
ABS, 2001 CHINS