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Disability

The most recent data relating to disability in Indigenous children comes from the WAACHS. An estimated 2% of children aged 4-17 years in Western Australia needed help with activities of daily living such as eating, dressing, bathing and going to the toilet. Limitations in vigorous activity were experienced by 4% of children of the same age. Approximately 8% of Indigenous children did not have normal vision in both eyes, and 7% did not have normal hearing in both ears.

Social and emotional wellbeing

A variety of health conditions, social circumstances and behaviours experienced by individuals, their carers and families may have an impact on the social and emotional wellbeing of Aboriginal children (Zubrick et al. 2005). Information on the social and emotional wellbeing of Aboriginal children living in Western Australia is available from the WAACHS.

Approximately 24% of Indigenous children aged 4-17 years were assessed from questionnaires completed by their carers (a version of the Strengths and Difficulties Questionnaire) as being at high risk of clinically significant emotional or behavioural difficulties, compared with 15% of other children (Zubrick et al. 2005). Indigenous boys were twice as likely as Indigenous girls to be at high risk of clinically significant emotional or behavioural difficulties, and those living in areas of extreme isolation were less at risk than those living in urban areas.

Family and household factors

A number of family and household factors were found to be associated with high risk of clinically significant emotional or behavioural difficulties in children. These include: the number of stress events experienced by the family in the 12 months before the survey, quality of parenting, family functioning, and family care arrangements. Household occupancy level, the physical health of the child (speech, hearing and vision problems), the physical health of the carer and the carer’s use of mental health services were also associated with increased risk of clinically significant emotional or behavioural difficulties in children.

For example, around 22% of children aged 4-17 years in Western Australia were living in families where seven or more life stress events (e.g. illness, hospitalisation, death of a close family member, family break-up, arrests, job loss, financial difficulties) had occurred over the preceding 12 months. These children were more than five times as likely to be at high risk of clinically significant emotional or behavioural difficulties as children in families where two or fewer life stress events had occurred. Children in the primary care of a person with a long-term health condition were more than three times as likely to be at high risk of emotional and behavioural difficulties as children whose primary carer had no long-term medical condition (Zubrick et al. 2005).

The children of Aboriginal carers who had been forcibly separated from their natural family by the government, welfare or a mission were twice as likely to be at high risk of clinically significant emotional or behavioural difficulties as children whose primary carer had not been forcibly separated from their natural family. These children also had higher rates of conduct and hyperactivity problems.

Health risk factors

A number of health risk factors were also found to be associated with a high risk of clinically significant emotional and behavioural difficulties. An estimated 18% of Western Australian Aboriginal young people aged 12-17 years who smoked regularly were at high risk of emotional and behavioural difficulties compared with 7% of non-smokers. Around one in three (29%) of young people who used marijuana daily were at risk of clinically significant emotional or behavioural difficulties compared with 9% of young people who had never used marijuana. Young people who did not participate in organised sport were twice as likely to be at high risk of emotional and behaviour difficulties compared with young people who did participate in sport (16% and 8% respectively). Those who had been subjected to racism in the past six months were more than twice as likely to be at high risk of emotional and behavioural difficulties as those who had not experienced racism.

Suicidal behaviour

An additional survey was administered to Aboriginal young people aged 12-17 years to measure rates of suicidal thoughts and suicide attempts. Around one in six (16%) of Western Australian Aboriginal young people reported having had suicidal thoughts in the 12 months prior to the survey. A higher proportion of Aboriginal girls (20%) reported that they had seriously thought about ending their own life than Aboriginal boys (12%). Of those who reported having had suicidal thoughts in the 12 months prior to the survey, 39% also reported having attempted suicide in the same period. Aboriginal young people who had been exposed to family violence were more than twice as likely to have thought about ending their own life (22%) as those who had not been exposed to family violence (9%). A much higher proportion of Aboriginal boys with low self-esteem (21%) had thought about ending their own life than those with high self-esteem (5%).

Other health conditions

Of the health conditions reported in the WAACHS, respiratory conditions (e.g. asthma) and recurring infections (e.g. ear infections) were the most prevalent.

The prevalence of asthma reported in the 2001 NHS was 15% for Aboriginal and Torres Strait Islander children aged 0-14 years and 13% for non-Indigenous children of the same age. In the WAACHS, the occurrence of asthma was reported to be 23% for Aboriginal children aged 0-17 years in Western Australia. The prevalence of asthma varied by level of relative isolation, with asthma being four times as common among Aboriginal children aged 0-17 years living in Perth metropolitan areas as among those living in extremely isolated areas of the state.

Recurring infections (infections which repeatedly return after remission), are associated with the occurrence of other acute and chronic illnesses and are a particular problem for Aboriginal and Torres Strait Islander children. Results from the WAACHS indicate that an estimated 18% of Aboriginal children had a recurring ear infection, 12% had a recurring chest infection, 9% had a recurring skin infection and 6% had a recurring gastrointestinal infection. The prevalence of these infections was less at older ages (table 6.11).

6.11 Recurring infections among Aboriginal children, by age group, Western Australia - 2001-02
		Age (years)
		0-3 years	4-11 years	12-17 years	Total
Chest infection	%	19.4	11.5	8.0	12.3
Gastrointestinal infection	%	7.2	6.1	3.5	5.6
Skin infection	%	8.0	10.3	6.1	8.5
Ear infection	%	20.4	19.9	13.6	18.1
Children(a)	no.	6 900	13 800	9 100	29 800
(a) Data are weighted estimates and have been derived by weighting the survey sample to reflect the Western Australian Aboriginal population.
Zubrick et al. 2004

Around two-thirds of children (69%) reported none of the four types of recurring infections in table 6.11, with 22% reporting one type and 10% reporting more than one type of recurring infection.

Infant and child hospitalisations

In 2003-04, Aboriginal and Torres Strait Islander infants (aged less than one year) were hospitalised at a rate 1.3 times that of other infants. Diseases of the respiratory system were the leading cause of hospitalisation of Indigenous children, followed by conditions originating in the perinatal period, and infectious and parasitic diseases. For skin diseases, diseases of the respiratory system and infectious and parasitic diseases, Aboriginal and Torres Strait Islander infants were hospitalised at around three times the rate of other infants (table 6.12).

6.12 Reasons for hospitalisation of infants, by Indigenous status - 2003-04
	Indigenous		Other(a)
	no.	rate(b)	no.	rate(b)	Rate ratio(c)
Diseases of the respiratory system (J00-J99)	2 902	238.0	16 902	71.1	3.3
Conditions originating in the perinatal period (P00-P96)	2 341	192.0	48 957	206.1	0.9
Infectious and parasitic diseases (A00-B99)	1 208	99.1	8 146	34.3	2.9
Contact with health services (Z00-Z99)	714	58.5	17 333	73.0	0.8
Symptoms not elsewhere classified (R00-R99)	511	41.9	11 961	50.3	0.8
Congenital malformations (Q00-Q99)	355	29.1	8 394	35.3	0.8
Injury and poisoning (S00-T98)	224	18.4	2 470	10.4	1.8
Diseases of the skin (L00-L99)	175	14.4	1 200	5.1	2.8
Subtotal	8 430	691.3	115 363	485.6	1.4
All other causes	610	50.0	18 413	77.5	0.6
Total(d)	9 056	742.6	133 875	563.5	1.3
(a) Includes infants whose Indigenous status was not stated.
(b) Per 1,000 population aged less than one year.
(c) Rate for Indigenous Australians divided by the rate for other Australians.
(d) Includes hospitalisations for which no principal diagnosis was recorded.
AIHW, National Hospital Morbidity Database.

In 2003-04, Aboriginal and Torres Strait Islander children aged 1-14 years were hospitalised at similar rates to other children of the same age for most conditions. Aboriginal and Torres Strait Islander children were hospitalised for skin diseases, diseases of the respiratory system, and infectious and parasitic diseases at higher rates than for other children (table 6.13).

6.13 Reasons for hospitalisation of children aged 1-14 years, by Indigenous status - 2003-04
	Indigenous		Other(a)
	no.	rate(b)	no.	rate(b)	Rate ratio(c)
Diseases of the respiratory system (J00-J99)	4 748	28.0	73 250	20.6	1.4
Injury and poisoning (S00-T98)	3 479	20.5	61 090	17.2	1.2
Infectious and parasitic diseases (A00-B99)	2 078	12.3	29 070	8.2	1.5
Diseases of the digestive system (K00-K93)	1 787	10.5	46 156	13.0	0.8
Diseases of the skin (L00-L99)	1 359	8.0	9 845	2.8	2.9
Diseases of the ear and mastoid process (H60-H95)	1 292	7.6	27 978	7.9	1.0
Symptoms n.e.c. (R00-R99)	1 276	7.5	23 344	6.6	1.1
Contact with health services (Z00-Z99)	958	5.7	23 087	6.5	0.9
Subtotal	16 977	100.2	293 820	82.5	1.2
All other causes	4 570	27.0	109 926	30.9	0.9
Total(d)	20 610	121.7	380 812	106.9	1.1
(a) Includes children whose Indigenous status was not stated.
(b) Per 1,000 population aged 1-14 years.
(c) Rate for Indigenous Australians divided by the rate for other Australians.
(d) Includes hospitalisations for which no principal diagnosis was recorded.
AIHW, National Hospital Morbidity Database.

Infant and child mortality

Infant mortality

Infant deaths are deaths of live-born children before the age of one. For the period 1999-2003, the mortality rate for Aboriginal and Torres Strait Islander infants living in Western Australia, South Australia, Queensland and the Northern Territory was almost three times that of non-Indigenous infants (table 6.14). The leading causes of death for Indigenous infants were conditions originating in the perinatal period (mainly foetus and newborn affected by complications of placenta, cord and membrane, and foetus and newborn affected by maternal complications of pregnancy), symptoms, signs and ill-defined conditions (mainly sudden infant death syndrome), congenital malformations (such as other congenital malformations of brain, congenital malformations of musculoskeletal system not elsewhere classified and congenital malformations of lung), respiratory diseases (mainly pneumonia), injury and poisoning (mainly accidental suffocation and strangulation in bed), and infectious and parasitic diseases (such as septicaemia, meningococcal infection and congenital syphilis).

Mortality rates for respiratory diseases and infectious and parasitic diseases were particularly high for Aboriginal and Torres Strait Islander infants, who died at ten and eight times the rates of non-Indigenous infants.

6.14 Causes of infant deaths, by Indigenous status - 1999-2003(a)
	Indigenous		Non-Indigenous
	no.	rate(b)	no.	rate(b)	Rate ratio(c)
Conditions originating in the perinatal period (P00-P96)	209	581.0	922	212.6	2.7
Symptoms, signs and ill-defined conditions (R00-R99)	89	247.0	221	51.0	4.9
Congenital malformations (Q00-Q99)	76	211.0	501	115.5	1.8
Diseases of the respiratory system (J00-J99)	29	81.0	35	8.1	10.0
External causes (V01-Y98)	22	61.0	76	17.5	3.5
Infectious and parasitic diseases (A00-B99)	19	53.0	29	6.7	7.9
All other causes	24	67.0	122	28.1	2.4
Total(d)	469	1 304.0	1 931	445.3	2.9
(a) Data from Queensland, South Australia, Western Australia and the Northern Territory. Based on state/territory of usual residence, year of occurrence of death for 1999-2002 and year of registration of death for 2003. Excludes a total of 48 deaths for which Indigenous status was not stated.
(b) Per 100,000 population aged less than one year.
(c) Rate for Indigenous persons divided by the rate for non-Indigenous persons.
(d) Includes deaths for which no cause of death was recorded.
AIHW, National Mortality Database

Child mortality

In the period 1999-2003, the death rate for Aboriginal and Torres Strait Islander children aged 1-14 years in Western Australia, South Australia, Queensland and the Northern Territory was more than twice that of non-Indigenous children in these jurisdictions (table 6.15).

External causes (such as transport accidents, assault and intentional self-harm) were the leading causes of death of Aboriginal and Torres Strait Islander children. Aboriginal and Torres Strait Islander children died from infectious and parasitic diseases, diseases of the respiratory system and circulatory diseases at around four to five times the rate of non-Indigenous children.

6.15 Causes of death for children aged 1-14 years, by Indigenous status - 1999-2003(a)
	Indigenous		Non-Indigenous
	no.	rate(b)	no.	rate(b)	Rate ratio(c)
External causes (V01-Y98)	91	18.5	481	7.3	2.5
Diseases of the nervous system (G00-G99)	20	4.1	106	1.6	2.5
Neoplasms (C00-D48)	14	2.8	185	2.8	1.0
Infectious and parasitic diseases (A00-B99)	13	2.6	35	0.5	5.0
Congenital malformations (Q00-Q99)	13	2.6	74	1.1	2.4
Diseases of the circulatory system (I00-I99)	12	2.4	42	0.6	3.8
Diseases of the respiratory system (J00-J99)	10	2.0	31	0.5	4.3
Symptoms, signs and abnormal findings (R00-R99)	10	2.0	38	0.6	3.5
All other causes	9	1.8	73	1.1	1.7
Total	192	39.0	1 065	16.1	2.4
(a) Data from Queensland, South Australia, Western Australia and the Northern Territory. Based on state/territory of usual residence, year of occurrence of death for 1999-2002 and year of registration of death for 2003. Excludes a total of 37 deaths for which Indigenous status was not stated.
(b) Per 100,000 population aged 1-14 years.
(c) Rate for Indigenous persons divided by the rate for non-Indigenous persons.
AIHW, National Mortality Database.