Nursing: Community Health and Diversity - Term Paper Example

 NURSING: COMMUNITY HEALTH AND DIVERSITY Table of Contents Introduction………………………………………………………….3 The main health issue……………………………………………..4 Community support………………………………………………...7 Conclusion…………………………………………………………..9 Sources……………………………………………………………..11 NURSING: COMMUNITY HEALTH AND DIVERSITY Introduction The government is spending money to provide good health to the indigenous aborigines in Australia. The Australian government spends 50 billion dollars annually on health care for its citizens. However, there is concern that the program to make a difference in the lives of the aborigines is not working to the desired satisfaction (A statistical overview of Aboriginal and Torres Strait Islander peoples in Australia). According to the 2001 census, there were about 458,000 aborigines which make about 2.4% of the total population in Australia. This is an increase of 16% in the population of the aborigines between 1996 and 2001 (A statistical overview of Aboriginal and Torres Strait Islander peoples in Australia). Good health and intellect of the aborigines is important to the polity and culture of Australia which is lagging in terms of health welfare of its indigenous population behind Canada, the United States and New Zealand and even some developing economies. Allocation of funds and portfolios is not enough to raise the health standards of a community. The discipline must percolate to the ground level where the major amount of action lies. There is severe shortage of health personnel in Australia to attend the need of its indigenous population (Ring, Ian T & Brown). Efforts are also required to raise health workers from among the indigenous community. There must be attempts at the highest levels in the government to oversee efforts in the indigenous community so that doctors and nurses come from this community in sufficient numbers to bring the entire indigenous population into the national health mainstream (Office of Aboriginal Health). Nationally, Australia’s health statistics provide encouraging figures. But compared to the national standards, the indigenous’ health figures are rather grim and pathetic. This purpose of this paper is aimed at closing the gap between the health statistics of the nation and its indigenous community. The main health issue The Aborigines in Australia continue to suffer in almost every sphere of health aspects. The dismal condition of the Aborigines is apparent for the simple reason that their health concern has not evoked sufficient concern at appropriate levels. 80% of the Aborigines babies die under one year of age. Their health conditions do not improve upon their survival. They are subject to diverse illnesses and diseases that continue to ravage their lives decades after they have been noticed (Aboriginal Health Overview). The life expectancy of an indigenous Australian is 16 to 19 years lower than that of the non-indigenous Australian. Mortality rates are more than three times the expected rate and death rates between 25-54 years of age are 5-8 times that seen in non-indigenous Australians. Higher levels of disadvantage lead to higher prevalence of risk factors, greater disease burden and worse experience of illnesses among the indigenous Australians. Yet, despite the huge disparity in health outcomes, indigenous Australians receive an additional 8% in per capita health spending only, most of which is spent in the hospital sector (Preventable Chronic Disease Strategies in Aborigines and Torres Strait Islander Peoples). The collection of statistics paints a picture of morbid misery. Year after year one only sees the problem get more acute. There is little action to show for the money spent and the programs made. There appears to be a dire need for the problem to be addressed in more holistic way than is being done. It does seem that the adage “prevention is greater than the cure” needs to be amplified so that it is applied in the required measure in the lives of the indigenous population of Australia Preventable Chronic Disease Strategies in Aborigines and Torres Strait Islander Peoples). Of all diseases, heart ailments and pulmonary infections make their presence felt in the Aborigines lives. Indigenous Australians are 1.5 times as likely to die after a major coronary event as compared to other Australians (Aboriginal and Torres Strait Islander Cardiovascular Health). Aborigines suffer pulmonary disease at more than three times the rate of indigenous peoples in Canada and more than twice the rate of indigenous peoples in the USA (Pulmonary Disease, p1). Heart ailments and pulmonary diseases are among the health issues that not only immobilize a person for a certain period of time but continue to harass that person for longer duration and even the entire lifetime if not treated with medical care. The heart and lungs are the major internal organs besides the digestive tract whose good condition at all times are important for survival in normal lives. Cardiovascular disease claimed more than 47,000 lives and affected 3.5 million Australians in 2004. A greater share of this burden has been borne by the indigenous Australian (Aboriginal and Torres Strait Islander Cardiovascular Health). The health condition of the aborigines warrants attention to their social life. Physically, indigenous Australians tend to be more inactive than their non-indigenous counterparts. They were twice as much more likely to smoke than their non-indigenous counterparts, and they consumed alcohol at higher risk level than the non-indigenous Australians (Aboriginal and Torres Strait Islander peoples). Smoking and alcohol damage internal organs. The average non-indigenous Australian is aware of the damaging effects of these two addictions. The awareness level among the aborigines may not be enough to exercise caution and control (A statistical overview of Aboriginal and Torres Strait Islander peoples in Australia). The choice of heart and pulmonary diseases is not perfunctory. It is a conscious and deliberate decision because of all diseases the damages done to these two organs are so widespread that it becomes necessary to shortlist these two. By highlighting these two organs, it also becomes possible to go into all the ramifications governmentally and socially, research and specify issues that contribute to their debilitation, and suggest ways to find remedies (Pulmonary Disease). Their level of education also does not match those of the non-indigenous Australians. In fact, the indigenous population appears to be resigned to their fate of abjection and misery. Reports by governmental agencies portray positive features of alleviation of the overall conditions of the aborigines. These include health, employment, housing, and education (A statistical overview of Aboriginal and Torres Strait Islander peoples in Australia). Governmental statistics stick close to the policies and programs outlined by the commonwealth. They do not disclose relative figures as compared to the indigenous populations in Canada and the USA. These two countries have sizable indigenous population. The fact is that such comparison will not project the achievements of the Australian government in a commendable light. Nonetheless, such comparison is essential in order to achieve and sustain momentum. First of all, it is necessary to raise the social standards of the aborigines so that they do not fall easy prey to heart and pulmonary diseases. It is necessary to ensure their living and hygienic conditions encourage decent living styles. Diseases and infections strike at a community when there is less resistance and situations that increase the number of casualties (Mateo et al). does appear the attitude of the non-indigenous Australians for their indigenous counterpart needs sea change so that governmental efforts get a boost. There is the need for reaching out clearly and specifically not only to address health issues but also to cover up for centuries of neglect and lack of concern. On the bright side, traditional medicines of the aborigines can find their way to recognized laboratories and highlight availability of cheaper medicines. The indigenous Australians have lived in the continent for thousands of years and naturally must possess access to herbal medicines hitherto unknown to the average non-indigenous Australian (Mateo et al). Community support There is dire need for the indigenous Australian to address health concerns as a community. The aborigines may be socially and educationally backward. However, there has to be capable men and women in the community who are inclined to take responsibilities and provide results. It is neither possible nor advisable for the non-indigenous Australian to take up the full responsibility of the aborigines’ health factors. Even the government can only provide men, material and money on a limited scale. The rest is up to the community (Aboriginal and Torres Strait Islander peoples). The government needs to support research and forge a time bound plan of action that will bring about positive results. It is necessary to have a positive approach to the whole issue. A routine approach will not do. There may be feelings that doing the best is no good. However, careful planning and sustained follow up have yielded positive results elsewhere. There is no reason why such a strategy will not work in Australia. After all, the aborigines are human beings and by and large will favorably respond to regenerative activities. They have to be activated to rise and seek remedial measures for their own good. Action must be initiated at the community level so that they develop on their own by choosing their own leaders and engaging in profitable ventures that help to raise their standard of living (Aboriginal Health Overview). It is necessary to help them form their own cooperatives so that they rise up as a community. It is essential to work on time bound programs that will help them set their own social, economical and educational targets. They may be engaged in economical activities that benefit the overall society (Pathways of Cultural Awareness). It is perceived that the approach to the question of indigenous population’s growth socially, economically and in the area of health has been inadequate and inappropriate. Sensing the long, unfruitful period of ineffective handling, the government has chosen to merely highlight the few statistics where there were some improvements and rhetorically gloss over the rest (Aboriginal Health Overview). Nonetheless, it is never too late to begin anew and afresh. There are ways to zestfully change the community by engaging people who show concern and interest in bringing about the change (Aboriginal Health Overview). In the health environment, it is first of all necessary to engage doctors, nurses and paramedics who are sensitive to the cultural needs of the aborigines. The world is becoming divergent in population. Hospitals and health institutions are increasingly seeing people from different background and ethnicity. In such situation, it is necessary that doctors, nurses and paramedics are trained suitably to adapt to cultural needs (Aboriginal and Torres Strait Islander peoples). The aborigines are a distinct culture. They have their own opinion and beliefs. Their health issues must be addressed in the language and method they understand (Aboriginal Health Overview). The western culture is open and progressive. However, not all cultures are the same. A culture has social, traditional, religious, ethnic and economic ethos and these have to be understood so that health improvement can be quickly achieved through proper understanding of the patient and his or her concerns (Cultural Competence). Conclusion The dismal record of the Australian aborigines on the issue of health is largely due to their social structure. Compared to the non-indigenous Australian the aborigine is backward and poor. The aborigines’ status as a backward community is responsible for much of their diseases and ailments. Be that as it may, the aborigine may be backward. His community may not be in position to allow him the care and concern that are available to his non-indigenous counterpart. However, it is the government’s responsibility to recognize this backwardness and implement measures to raise the economic and educational levels of the community. If the government has taken measures and they do not appear to be working, it can only mean two things. The government has formed policies and programs but has abdicated responsibility in their implementation. Or else, the government has simply stopped trying to effect the change (Aboriginal Health Overview). Australia is a developed nation and continent. It has the best economy which ranks as equal among those of other western nations like Canada, the United States and the United Kingdom. It cannot be so difficult for such a nation to undertake projects to oversee the progress of their own community. Unfortunately, it has allowed this little affair of the aborigines to tar its image. It has all the resources it needs to oversee the progress of the aborigines. It appears that there is only the lack of will to speed up the well being of the aborigines (Aboriginal Health Overview). One can only hope that the government cracks the whip to make the right people stand and be accountable for their actions. Sources: A statistical overview of Aboriginal and Torres Strait Islander peoples in Australia, Australian Human Rights Commission, August 2006, http://www.hreoc.gov.au/Social_Justice/statistics/index.html Aboriginal and Torres Strait Islander Cardiovascular Health, http://www.healthinsite.gov.au/topics/Aboriginal_and_Torres_Strait_Islander_Cardiovascular_Health Aboriginal and Torres Strait Islander peoples, Australian Institute of Health and Welfare, http://www.aihw.gov.au/publications/cvd/hsvd01/hsvd01-c06.pdf Aboriginal Health Overview, http://www.creativespirits.info/aboriginalculture/health/ Baker, P et al; HTA of treating renal disease in Australian Aborigines, NLM Gateway, http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102271688.html Cultural Competence, Transcultural Nursing, http://culturediversity.org/cultcomp.htm Flowers, Deborah L; Culturally Competent Nursing Care, http://ccn.aacnjournals.org/cgi/content/full/24/4/48 Grumbach, Kevin; Central Valley Nursing Work Force Diversity Initiative Project Evaluation, http://www.fresno.ucsf.edu/latinocenter/research/central%20valley%20nursing.pdf Indigenous Health, Australian Government, Medicare Australia, http://www.medicareaustralia.gov.au/provider/patients/indigenous.jsp Krzyzanek, Jessica Ann; Nurses' wrists as carriers of transient, pathogenic bacteria, Gonzaga University, http://proquest.umi.com.libraryproxy.griffith.edu.au/pqdlink?Ver=1&Exp=05-17-2014&FMT=7&DID=766509541&RQT=309&attempt=1 Lobo, Maria; Cultural Awareness of Nurses in Practice, http://findarticles.com/p/articles/mi_qa4036/is_200602/ai_n17177761/ Mateo et al, Workforce diversity: Challenges and strategies, Health Care Industry, http://findarticles.com/p/articles/mi_qa3919/is_200107/ai_n8980883/ Midwifery care for Australian Aboriginal women, Australian College of Midwives Incorporated Journal, Volume 12, Issue 3, September 1999, Pages 7-11, http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B82YM-4JKB6S1-5&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=27ff0bb9144d5cbb3baae104a01e71f0 Office of Aboriginal Health, Government of Western Australia, Department of Health, http://www.aboriginal.health.wa.gov.au/publications/index.cfm Pathways of Cultural Awareness, http://www.contemporarynurse.com/archives/vol/28/issue/1-2/article/2317/pathways-of-cultural-awareness Preventable Chronic Disease Strategies in Aborigines and Torres Strait Islander Peoples, www.ama.com.au/system/files/node/518/healths_gd_ps_prev+chron+dis+strat+abor+%2526+tsi+people.doc Pulmonary Disease (Diseases of the Lung and Respiratory Tract), http://www.naccho.org.au/Files/Documents/International_Comparative_Health_Data_Diseases_Lung_&_Respiratory_Tract.pdf Publications showing detailed statistics on coronary heart disease, Australian Institute of Heart and Welfare, http://www.aihw.gov.au/cvd/coronary_pubs.cfm Ring, Ian T & Brown, Ngaire; Indigenous health: chronically inadequate response to damning statistics, The Medical Journal of Australia, http://www.mja.com.au/public/issues/177_11_021202/rin10435_fm.html Using Australian Aboriginal Records to Trace Your Family History, Explore Genealogy, http://www.exploregenealogy.co.uk/AustralianAboriginalRecords.html Welcome to the Aboriginal Health Council of Western Australia (AHCWA) website, Aboriginal Health Council of Western Australia, http://www.ahcwa.org.au/ Young, Judith Anne; Nurses’ work satisfaction, University of Toronto (Canada), http://proquest.umi.com.libraryproxy.griffith.edu.au/pqdlink?Ver=1&Exp=05-17-2014&FMT=7&DID=744671121&RQT=309&attempt=1 A statistical overview of Aboriginal and Torres Strait Islander peoples in Australia August 2006 Introduction Population figures Indigenous households and families Language and culture Health Income Employment Education Housing and homelessness Indigenous peoples and criminal justice systems Child protection Endnotes Introduction This collection of statistics has been chosen to highlight the current situation of Aboriginal and Torres Strait Islander peoples in Australia, (hereon Indigenous peoples)[1] across a range of indicators including: health; education; employment; housing; and contact with criminal justice and welfare systems. Where possible, data is also provided that identifies: absolute change in the situation of Indigenous peoples over the past five and ten years; relative change in relation to the non-Indigenous population over the past five to ten years; and the position of Indigenous peoples in relation to other indigenous peoples, notably those in New Zealand, Canada and the United States, and population groups around the world. While reducing peoples and their experiences to percentages and numbers is problematic, statistics are useful as indicators of trends over time and disparities, as well of similarities, between Indigenous peoples and the non-Indigenous population. It should also be noted that the statistics reproduced here are not exhaustive of data available on Indigenous peoples in Australia. Census and other data collections The main source of information used here is the national censuses, various surveys and data collection projects undertaken by the Australian Bureau of Statistics (ABS). Another source of information is the Steering Committee for the Review of Government Service Provision’s reports Overcoming Indigenous Disadvantage: Key Indicators. These draw together data collected by Australian governments. The first was published in November 2003 and a second in July 2005[2]. Statistics on Indigenous peoples are subject to a range of data quality issues. In addition to cultural considerations in relation to statistical matters (such as concepts, definitions, collection practices), data quality issues arise from the relatively small size of the Indigenous population in comparison with the total population, the dispersion of the Indigenous population, particularly across remote areas of Australia, and the way in which Indigenous persons are identified in statistical collections[3]. Aboriginal people were first counted as citizens in the 1971 Census. Since then, censuses have shown a significant increase in people identifying as Aborigines and/or Torres Strait Islanders: Between the 1991 and 1996 Census there was a 33% increase recorded in the numbers of Indigenous peoples. Between the 1996 and 2001 Census there was a 16% increase. In contrast, the total population in Australia increased by five per cent between 1991 and 1996 and four per cent from 1996 - 2001. The increases in the Indigenous population cannot be accounted for by the birth rate alone. The ABS attributes the increase to a growing propensity of people to identify as Aboriginal and/or Torres Strait Islander, and the greater efforts made to record Indigenous status in the censuses[4]. Because of the recorded increases in the number of Indigenous peoples, the ABS has warned that comparisons made between two censuses must be made with caution. They recommend comparing percentages from two censuses, rather than directly comparing counts or numbers.[5] Despite the increases in people identifying as Indigenous in censuses, however, there are still believed to be significant undercounts occurring. Identifying as Aboriginal and/or Torres Strait Islander, or any other group, in censuses is voluntary. In the 2001 Census, Indigenous status is unknown for 767,757 people who completed the census questionnaire: that is 4.1% of the total population[6]. Because some of these people will be Indigenous, the ABS calculates what it calls 'experimental estimates' to give a figure for the 'true' size of the number of Indigenous peoples[7]. It is important to distinguish actual counts from censuses from the experimental estimates. Indigenous social surveys This collection of statistics also includes comparisons made across the ABS's National Aboriginal and Torres Strait Islander Survey (1994) (NATSIS 1994)[8] and the National Aboriginal and Torres Strait Islander Social Survey (2002) (NATSISS 2002).[9] These are the most comprehensive Indigenous-specific surveys in Australia. In the latter, the survey sample was 9,400 Indigenous people.[10] The results across the social surveys allow for some broad measures of change to be made for those indicators which are comparable. These comparisons are set out in the report based on the NATSISS 2002[11]. Please note that to account for the high growth in the recorded numbers of Indigenous peoples between the 1991 and the 1996 Census, the NATSIS 1994 data file has been re-benchmarked by the ABS (from using the 1991 to the 1996 Census-based population estimates), and survey data revised accordingly.[12] 1. Population figures (a) Size of the Indigenous population Table 1 below shows that 410,000 people identified as of Aboriginal and/or Torres Strait Islander origin in the 2001 Census.[13] There were approximately 409,729 people of Aboriginal origin and 29,239 of Torres Strait Islander origin. A further 19,552 people identified as of both Aboriginal and Torres Strait Islander origin[14]. There are slightly more women (230,994) than men (227,562); a similar distribution to the non-Indigenous population.[15] Table 1: Census count of the numbers of Indigenous peoples, 1991-2001[16] 1991 1996 2001 Recorded by the Census 265,500 353,000 410,000 Increase on previous census (per cent) 17.0 33.0 16.0 % of the total population (per cent) 1.6 2.0 2.2 Due to the undercount believed to occur in the Census, the ABS has estimated that the number of Indigenous peoples in 2001 was 458,500 people or 2.4% of the total Australian population[17]. (b) Growth of the Indigenous population While an overall decline in the Indigenous fertility rate has been reported since the 1960s, in 2001, the fertility rate of Indigenous women remained higher than that of non-Indigenous women: 2.1 babies per Indigenous woman compared to 1.7 babies per non-Indigenous woman[18]. The ABS notes that the fertility of Indigenous women may be underestimated because of the incomplete identification of Indigenous status of the mother in birth registrations. Further, because Indigenous babies are born to non-Indigenous women, estimates of population growth based exclusively on the fertility of Indigenous women results in an underestimate of the actual growth of the Indigenous population. High fertility at younger ages contributes to the relatively high fertility of Indigenous women. Teenage births are more common among Indigenous women than among other women. In 2003, the teenage (15–19 years) birth rate among Indigenous women was more than four times the overall Australian teenage birth rate. Teenage pregnancies are associated with low birth weight[19]. The ABS publishes experimental projections of the Indigenous population until 2009, based on the 2001 Census. There are 2 projections available depending upon alternative assumptions about the unexplained growth in the Census counts for the Indigenous population since the 1996 Census (as discussed above) which cannot be attributed to births alone: The first projection assumes no further unexplained growth in the Indigenous census counts and provides an estimated Indigenous population of 528,600 in 2009. The second assumes further unexplained growth and results in an estimated Indigenous population of 600,200 in 2009. The projected average annual growth rate under the assumption of no further unexplained growth is 1.8%. This compares with 3.4% for annual growth rate assuming the continuing unexplained growth continues[20]. The Australian Government has estimated the annual rate of growth of the Indigenous population at 2.3% per annum compared with 1.2% growth per annum for the non-Indigenous population in 2003.[21] (c) Age structure of the Indigenous population and the cohort of young Indigenous people Indigenous peoples have a different population age structure to the rest of the Australian population. In common with many other 'western' nations, the non-Indigenous population of Australia is rapidly ageing, whereas Indigenous peoples are facing increased growth in young age groups. Graph 1 below, extracted from the ABS publication Population Characteristics, Aboriginal and Torres Strait Islander Australians 2001, demonstrates the different age structures of Indigenous peoples and the non-Indigenous population and the young population cohort. The much younger age structure of the Indigenous population is largely a product of high levels of fertility and mortality compared with the non-Indigenous population. The average age in the Indigenous population is considerably younger than that in the non-Indigenous population. The median age is 20 years, whereas it is 35 years for non-Indigenous Australians. There are also relatively fewer Indigenous people aged 65 or over. In 2001, the proportion of Indigenous people under 15 years of age was 39% compared with 20% of non-Indigenous people. Persons aged 65 years and over comprised 3% of the Indigenous population and 13% of the non-Indigenous population.[22] Graph 1: Estimated resident population, comparing Indigenous and non-Indigenous age structures, 2001[23] Using both population growth forecasts (one according to the birth rate, the other with unexplained growth factored in, as discussed above) the ABS estimates the proportion of the total Indigenous population aged less than 15 years is projected to fall from 39% at June 2001 to 35% in 2009. Indigenous persons aged 65 years and over comprised 3% of the total Indigenous population in 2001. This proportion would remain unchanged in 2009 in both growth forecasts.[24] (d) Where Indigenous peoples live Almost 53% of Indigenous peoples lived in two states in 2001: New South Wales and Queensland. Despite this, they make up a small minority of the total population of these States (2.1% and 3.5% respectively). In contrast, while there total numbers are relatively small, as a proportion of the total population Indigenous peoples constitute 28.8% of the total population of the Northern Territory.[25] Table 3 below details the percentage of the total number of Indigenous peoples that lives in each State and Territory, and the proportion of each State and Territory's population that is Indigenous. Table 3: Location of Indigenous peoples - by State and Territory [26] Percentage of the total Indigenous population living in a State or Territory Percentage of the State or Territory's total population that is Indigenous NSW 29.4 2.1 Vic 6.1 0.6 Qld 27.5 3.5 SA 5.6 1.7 WA 14.4 3.5 Tas 3.8 3.7 NT 12.4 28.8 ACT 0.9 1.2 Most Torres Strait Islanders (86.2%) live on mainland Australia, with 13.8% living in the Torres Strait region. 63.4% of the Torres Strait Islander population live in the state of Queensland and a further 16.3% in NSW.[27] (e) Remoteness While the majority of Indigenous people live in either major cities, inner or outer regional areas of Australia, the proportion of people that live in remote or very remote areas is much higher than for the non-Indigenous population. Table 4 below illustrates that 30.2% of Indigenous peoples live in major cities, as opposed to 67.2% of the non-Indigenous population; with 26.5% of Indigenous peoples living in remote or very remote areas, which compares to just 2% of the non-Indigenous population.[28] Table 4: Location of Indigenous peoples by remoteness Indigenous peoples Non-Indigenous population Major cities 30.2% 67.2% Inner regional 20.3% 20.7% Outer regional 23.1% 10.1% Remote 8.8% 1.5% Very remote 17.7% 0.5% There was a decline in the number of people who lived in homelands and traditional country over the period of the social surveys (29% to 22%).[29] Top 2. Indigenous households and families An Indigenous household is defined by the ABS as being one in which an Indigenous person was resident and present on census night. These are further classified as family, group or lone person households.[30] There were approximately 145,000 Indigenous households recorded in the 2001 Census. Of these, the vast majority (78%) contained one family. Of the remaining 22%, approximately five per cent were multi-family households and five per cent were group households. Approximately 13% of Indigenous peoples live in lone person households.[31] Couples with dependent children comprise 40% of Indigenous families, whereas 31% were one parent families (as opposed to 10% of non-Indigenous families) and 30% were couples without children (compared with 50% of non-Indigenous couples). Indigenous peoples are more likely to live in one or multi-family households than non-Indigenous peoples (82% compared with 70%) and less likely to live in lone person households (13% compared with 24%). Living arrangements vary according to remoteness. For example, multi-family households increase with remoteness whereas one parent families tend to live in major cities.[32] Top 3. Language and culture Census data Indigenous cultures today reflect both traditional elements and the influence of non-Indigenous cultures. The 2001 Census reported: 80% of Indigenous peoples reported speaking only English at home, which is about the same as the non-Indigenous population. 12% of Indigenous peoples reported speaking an Indigenous language at home; with three quarters of those recording they were also fluent in English. Many Indigenous people are bilingual; however, the pattern varies with geographical location. 55% of those living in remote areas reported speaking an Indigenous language, compared with one per cent in urban centres. Older Indigenous people (over 45 years) are more likely to speak a language than younger Indigenous people. Indigenous languages are more likely to be spoken in the centre and north of Australia than in the south.[33] Social surveys The NATSIS 1994 survey reported approximately 60% of Indigenous respondents identified with a clan, tribal or language group.[34] The NATSISS 2002 shows a similar proportion (just over half) of Indigenous respondents continued to identify with a clan, tribal or language group despite there being a decline in the proportion (29% to 22%) of people who lived in homelands and traditional country over the period of the social surveys. Almost 7 out of 10 Indigenous respondents aged 15 years or over had attended cultural events in the previous 12 months, similar to the situation in 1994. In 2002, use of an Aboriginal or Torres Strait Islander language as the main language spoken at home remained at 1994 levels (about one in eight Indigenous people).[35] Top 4. Health Over the twentieth century in Australia, for the general population life expectancy is estimated for women to have increased 26.7 years[36]; while for males, 28.7 years.[37] The median age at death in 2004 was 76.6 years for males and 82.6 years for females, an increase of 6.0 years and 5.3 years respectively on the median age of death for both males and females in 1984.[38] Other statistics show remarkable reductions in the impact of diseases in the general population. These statistics demonstrate that significant improvements in the health and life expectation of population groups can occur within decades. For example, in the general population: death rates from cardiovascular disease have fallen 30% in Australia since 1991, and 70% in the last 35-years. The infant mortality rate of 4.7 infant deaths per 1,000 live births in 2004 was 20.3% lower than in 1994 and 48.9% lower than 1984.[39] Because of these rapid gains in the general population, despite some significant health gains being made by Indigenous peoples in the 1970s and 1980s, health inequality with the non-Indigenous population appears to have remained static or continued to grow across a number of indicators. It is also significant that Indigenous peoples' self-assessed health status shows they believe little improvement has occurred over the past decade. Over the NATSIS 1994 - NATSISS 2002, the percentage of Indigenous respondents assessing their health as 'fair/poor' rose from 17.5% to 23.3%. Correspondingly, there was no statistically significant increase in the number who assessed their health as 'excellent/very good' or reported reductions in smoking; or alcohol consumption.[40] (a) Infant and child health Low birth weight infants Indigenous infant and child health is significantly poorer than that of non-Indigenous infants and children. A 'low birth weight baby' weighs less than 2500 grams at birth[41] indicating, among other things, foetal malnutrition. There is a growing body of evidence that suggests a malnourished foetus will program its body in a way that will incline it to chronic diseases later in life.[42] Beyond infancy, normal growth is considered vital for good health in adulthood. Significant numbers of Indigenous children demonstrate failure to thrive.[43] Approximately twice as many low birth weight infants were born to Indigenous women compared to those born to non-Indigenous women over 1998 - 2000.[44] In the period 2000-2002, babies of Indigenous mothers continued to be twice as likely to be of low birth weight as babies born to non-Indigenous mothers (13% compared to 6%).The ABS reported in 2005 that since 1991 there appears to be no change in both the rates of low birth-weight infants being born to Indigenous women and the mean birth weights of those infants.[45] Infant mortality After significant reductions to the Indigenous infant mortality rate in the 1970s and 1980s, there was a levelling out of the rate in the mid 1990s. The decline is believed to have halted because of the generally poor health of Indigenous mothers; their exposure to risk factors; and the poor state of health infrastructure in which infants were raised[46]. The infant mortality rate is expressed as the number of deaths in the first year per 1000 births in a population. The ABS concluded in 2001 that no reliable Indigenous infant mortality rate national trend (either for better or worse) was identifiable, largely because of the poor quality of data.[47] Since 2003, only certain State and Territory infant mortality rates (those where data is considered reliable) have been published by the ABS[48]. In these jurisdictions, from 1999 – 2004, around twice as many Indigenous infants died before their first birthday as non-Indigenous infants.[49] In the Northern Territory the Indigenous infant mortality rate was three - four times the national rate in 2004 (15.4 deaths per 1000 to 4.69 deaths per 1000 nationally).[50] (b) Chronic diseases Chronic diseases, in particular cardiovascular disease, are the biggest single killers of Indigenous people. A comparison of rates of death from the five main groups of chronic diseases over 2000 - 2002 is set out in table 5. Table 5: Indigenous peoples' rates of death from chronic diseases expressed as a multiple of the rates in the non-Indigenous population (2000 - 2002) [51] Chronic disease group Indigenous women Indigenous men Cardiovascular diseases (heart diseases, strokes 2.2 times the rate of non-Indigenous women 3.0 times the rate of non-Indigenous men Neoplasms (inc. cancers) 1.6 times the rate of non-Indigenous women 1.3 times the rate of non-Indigenous men Diseases of respiratory system 3.6 times the rate of non-Indigenous women 3.9 times the rate of non-Indigenous men Endocrine, nutritional and metabolic diseases (inc. diabetes) 10.1 times the rate of non-Indigenous women 7.3 times the rate of non-Indigenous men Diseases of the digestive system 3.4 times the rate of non-Indigenous women 4.6 times the rate of non-Indigenous men (c) Communicable diseases Data on the rates of communicable diseases is gathered from two sources: hospital separations data (records of admission to, and discharge from, hospitals because of a particular disease); and the National Notifiable Diseases Surveillance System. Both sources indicate that rates of a wide range of communicable diseases are at much higher rates in Indigenous peoples than in the non-Indigenous population. Table 6 sets out hospital separations data. Table 6: Indigenous peoples' rates of hospitalisation for communicable diseases as multiples of the rates in the non-Indigenous population (2003- 2004)[52] Communicable disease Indigenous women Indigenous men Infectious intestinal diseases 1.9 times the rate of non-Indigenous women 2.0 times the rate of non-Indigenous men Tuberculosis 4.4 times the rate of non-Indigenous women 5.1 times the rate of non-Indigenous men Pneumonia 3 times the rate of non-Indigenous women 3.8 times the rate of non-Indigenous men Viral infections 1.5 times the rate of non-Indigenous women 1.3 times the rate of non-Indigenous men Infections, sexual transmission 6.5 times the rate of non-Indigenous women 4.3 times the rate of non-Indigenous women Data from the National Notifiable Diseases Surveillance System is set out in Table 7. Table 7: Rates of communicable diseases in Indigenous peoples reported to the National Notifiable Diseases Surveillance System as multiples of the rates in the non-Indigenous population (2003)[53] Communicable disease Detected in Indigenous peoples Hepatitis A 8 times the rate detected in the non-Indigenous population Hepatitis B 3 times the rate detected in the non-Indigenous population Meningococcal infection 3 times the rate in the non-Indigenous population Salmonellosis 4 times the rate in the non-Indigenous population Chlamydia Infection 7 times the rate detected in the non-Indigenous population Tuberculosis 7 times the rate in the non-Indigenous population. (d) Life expectancy There are long-standing issues pertaining to the identification of an Aboriginal and/or Torres Strait Islander person as the deceased on death certificates that prevent definitive statements being made about Indigenous peoples' life expectation: over 2000-04, only 57% of the deaths of Indigenous people were believed to have been correctly identified as either Aboriginal and/or Torres Strait Islander on death certificates nationally [54]. Under the new life expectation formula adopted by the ABS in 2003, Indigenous males' life expectation was estimated to be 59.4 years over 1996-2001, while female life expectation was estimated to be 64.8 years. A life expectation inequality gap of approximately 18 years was identified, a reduction of approximately three years on estimates produced in 2001 under a now superseded formula. This is well below the 82.0 years and 76.6 years for total females and males respectively, for the 1998-2000 period[55]. The next estimate will be calculated over 2001 - 2006 using data from the Census 2006. Indigenous peoples’ life expectation appears to be similar to that of people in low development states. Although international comparisons should be made with some caution because of the different formulae with which life expectation is calculated between jurisdictions, with reference to the 2005 United Nation's Human Development Index, Indigenous peoples appear to have a life expectation approximating that of the people of Turkmenistan (62.4 years).[56] (e) Life expectancy - Comparison with other indigenous peoples Approximately thirty years ago, life expectancy rates for indigenous peoples in Canada, New Zealand and the United States of America were similar to the rates for Indigenous peoples in Australia. However, significant gains in life expectancy have been made in the past two decades in the indigenous populations in Canada, New Zealand and the United States of America. Comparable mortality rates for Aborigines and Torres Strait Islanders in 1990-1994 were at or above the rates observed 20 years ago in Maori and Native Americans, being 1.9 times the rate in Maori, 2.4 times the rate in Native Americans, and 3.2 times the rate for all Australians. Australia has fallen significantly behind in improving the life expectancy of its Indigenous peoples. Although comparisons should be made with caution (because of the way different countries calculate life expectation) data suggests Indigenous males in Australia live between 8.8 and 13.5 years less than indigenous males in Canada, New Zealand and the USA. Indigenous females in Australia live between 10.9 and 12.6 years less than indigenous females in these countries[57]. (f) Health risk factors Health surveys Diseases and conditions associated with obesity fall into two categories, those associated with the metabolic consequences of obesity such as type two diabetes, gall bladder disease, hypertension and coronary heart disease; and those associated with excess weight such as sleep apnoea, asthma and osteoarthritis.[58] In 2001, the ABS National Health Survey (2001) classified 61% of Indigenous respondents over 15 years of age as overweight or obese compared with 48% of non-Indigenous respondents. The proportion of both Indigenous and non-Indigenous respondents aged 18 years and classified as obese has increased since the previous survey in 1995.[59] Smoking is a risk factor for coronary heart disease, stroke and cancers. The National Health Survey also reported 49% of Indigenous respondents aged 18 years and over were smokers, compared with 24% in the general population.[60] The National Health Survey reported that 58% of Indigenous respondents did not drink alcohol, compared with 38% of non-Indigenous respondents. 12% of Indigenous respondents were likely to consume alcohol at risky/high risk levels, compared with 11% of non-Indigenous respondents.[61] The rate of risky/high risk consumption was higher for Indigenous male than for female respondents and peaked amongst those aged 35-44 years (20%).[62] This finding contrasts with the Australian Institute of Heath and Welfare National Drug Strategy Household Survey (2001) that reported Indigenous respondents consumed alcohol at risk levels twice (20%) that of the non-Indigenous respondents[63]. Social surveys The results of the health surveys are supported by the social surveys. The NATSISS 2002 reported just over half (51%) of Indigenous respondents aged 15 years or over were cigarette smokers, similar to the rate in 1994 (52%). Similar rates of men and women respondents were current daily (or regular) smokers (51% and 47%). For both men and women, the highest rates were reported for those aged 25-44 years.[64] The NATSISS 2002 reported around one-sixth (15%) of Indigenous respondents aged 15 years or over reported risky/high risk alcohol consumption in the last 12 months. The rate was higher for Indigenous male than female respondents (17% compared with 13%) and peaked for males aged 45-54 years (22%) and for females aged 35-44 years (19%). The level of risky/high risk alcohol consumption in the last 12 months was similar for Indigenous respondents in non-remote and remote areas. Respondents with a non-school qualification reported risky/high risk alcohol consumption at a lower rate (14%) than did people whose highest educational attainment was Year 9 or below (18%).[65] (g) Disability as reported by the social surveys Among Indigenous respondent aged 15 years or over, the NATSISS 2002 reported just over one-third had a disability or long-term health condition. Such people were less likely to have participated in social activities (86% compared with 92%), more likely to have experienced at least one stressor in the last 12 months (86% compared with 80%), and also more likely to have had transport difficulties. In 2002, 16% of Indigenous people with a disability or long-term health condition said they could not get to, or often had difficulty getting to, the places needed, compared with the 9% of Indigenous people who did not have a disability[66]. Due to differences in the way disability data were collected in remote and non-remote areas, comparisons with the non-Indigenous population are limited to those Indigenous respondents living in non-remote areas. When the effects of age differences were removed, the disability rate among Indigenous respondents was 1.4 times higher than among the non-Indigenous population (57% compared with 40%).[67] (h) Mental health While data collections are largely inadequate to the task of definitively assessing the state of mental health among Indigenous peoples, there have been several reports over the past decade and several indicators that suggest Indigenous peoples suffer higher rates of poor mental health than non-Indigenous Australians. The 1996 national consultancy on Indigenous mental health, Ways Forward, reported that mental health problems significantly affected at least 30% of Indigenous communities.[68] Urban studies in the 1990s reported that 54% of Indigenous people attending Aboriginal medical services had a mental health disorder. Women tended to present earlier, while men's first presentation was often following involuntary admission into acute psychiatric care.[69] Self harm and suicide In 2003-04, Indigenous males had a hospitalisation separation rate 2.1 times higher than non-Indigenous males, and Indigenous females had a hospitalisation separation rate 1.5 times higher than non-Indigenous females for mental and behavioural disorders.[70] Hospitalisation and mortality rates from intentional injury or self harm may be indicative of mental illness and distress. In 2003-04, Indigenous Australians also had a higher rate of hospitalisation for intentional self harm than the non-Indigenous population: 2.4 higher for Indigenous males and 1.9 times higher for Indigenous females.[71] Violence Violence is an important determinant of the poorer health of Indigenous peoples when compared to the non-Indigenous population. Reported physical, or threatened physical, violence, appear to have doubled over the period of social surveys: 13% of respondents in 1994 identifying as victims, compared to 25% of respondents in 2002. This may, however, reflect under-reporting by respondents in the 1994 NATSIS.[72] The ABS reports that in 2003-04, as in previous years, the most commonly recorded external causes for injury resulting in hospitalisation was assault (females 28%; males 20%). Hospitalisations recorded for injury due to assault were seven and 31 times higher for Indigenous males and females respectively.[73] Assault is a significant cause of death for both Indigenous males and females. Over the period 1999-2003, the Indigenous male age-specific death rates for assault for ten-year age groups from 25 to 54 were between 10 and 18 times the corresponding age-specific rates for non-Indigenous males, while for females the rates ranged between 6 and 16 times the equivalent age-specific rates for non-Indigenous females.[74] (i) Social determinants of health and psychosocial stress Research has demonstrated associations between an individual's social and economic status and their health. Poverty is clearly associated with poor health[75]. For example: Poor education and literacy are linked to poor health status, and affect the capacity of people to use health information;[76] Poorer income reduces the accessibility of health care services and medicines; Overcrowded and run-down housing is associated with poverty and contributes to the spread of communicable disease[77]; Poor infant diet is associated with poverty and chronic diseases later in life; [78] and Smoking and high-risk behaviour is associated with lower socio-economic status.[79] Research has also demonstrated that poorer people also have less financial and other forms of control over their lives. This can contribute to a greater burden of unhealthy stress[80] where 'prolonged exposure to psychological demands where possibilities to control the situation are perceived to be limited and the chances of reward are small.'[81] Chronic stress can impact on the body's immune system, circulatory system, and metabolic functions through a variety of hormonal pathways and is associated with a range of health problems from diseases of the circulatory system (notably heart disease) [82]and mental health problems[83] through to men's violence against women and other forms of community dysfunction.[84] The perception of control, or lack of control, can be influenced by: Factors like racism, and other forms of discrimination.[85] Addiction in the community: this undermines resilience and social support and communities. It has been mostly closely observed in relation to alcoholism.[86] Particular traumas: accidents, violence, natural disasters etc. Variables that help mitigate stress include social support and social cohesion. Studies show that people in long-term, familial relationships and close-knit communities are better able to deal with stress and will live longer than those who do not.[87] Set out below is an extract from the NATSISS 2002 report summary highlighting stressors and factors that mitigate stress that are measured in the social surveys: The overwhelming majority of Indigenous respondents (90%) reported that, in a time of crisis, they could get support from outside their household. Those in the two highest income quintiles were more likely (96%) than those in the lowest quintile (89%) to report that they could get support. Availability of support was higher for Indigenous respondents living in non-remote areas (92%) than those in remote areas (87%). Overall, 82% of Indigenous respondents reported that they had experienced at least one stressor in the last 12 months. The most frequently reported stressors were the death of a family member or close friend (46%), serious illness or disability (31%) and inability to get a job (27%). However, for those living in remote areas, the most frequently reported stressors, after death of a family member or close friend (55%), were overcrowding at home (42%) and alcohol and drug-related problems (37%). Indigenous respondents in remote areas were slightly more likely than those living in non-remote areas to report experiencing a stressor (85% compared with 81%). Among those aged 18 years or over, Indigenous respondents were almost one-and-a-half times more likely than non-Indigenous population to report experiencing at least one stressor (83% compared with 57%). To measure the number of Indigenous people potentially impacted by the removal of children from their families, the 2002 NATSISS asked Indigenous respondents aged 15 years or over whether they or any of their relatives had been removed from their natural families. Thirty-eight percent (38%) reported that they had either been removed themselves and/or had relatives who, as a child, had been removed from their natural family. About 8% of Indigenous respondents reported that they themselves had been removed from their natural family. The most frequently reported relatives removed were grandparents (15%), aunts or uncles (11%), and parents (9%).[88] Top 5. Income (a) Household income Estimates of household income are adjusted by the ABS according to 'equivalence factors' in order to recognise the impact of different household compositions and different household sizes.[89] In the Census 2001, the mean (average) equivalised gross household income for Indigenous persons was $364 per week, or 62% of the rate for non-Indigenous persons ($585 per week). The ABS has stated that 'this disparity reflects the lower household incomes received by households with Indigenous person(s), and the tendency for such households to be larger than Other households and hence for the equivalised gross household income to be lower'.[90] For Indigenous persons, income levels generally decline with increased geographic remoteness. In major cities and regional areas, average equivalised incomes for Indigenous persons were approximately 70% of the corresponding income for non-Indigenous persons. This declines to approximately 60% in remote areas, and just 40% in very remote areas.[91] Between the 1996 and 2001 Census, the average equivalised gross household income for Indigenous persons rose by 11% (after adjustment for inflation using the Consumer Price Index) compared with 13% for non-Indigenous persons. As a consequence, the relative income disparity between Indigenous and non-Indigenous persons increased slightly. Overall, the average equivalised income for Indigenous persons declined from 64% of the corresponding non-Indigenous rate in 1996, to 62% in 2001.[92] The social surveys found that mean equivalised gross household income for Indigenous persons 15 years or over has risen from $345 per week in 1994 to $387 per week in 2002. When 2002 data are recalculated for the population aged 18 years or over this is 59% of the relevant income level for non-Indigenous persons ($665 per week). The surveys support the income data from the 2001 and 1996 Population Censuses confirms that while Indigenous mean equivalised gross household income has increased, the gap between Indigenous and non-Indigenous incomes has not narrowed.[93] (b) Individual income The median weekly gross individual income for Indigenous peoples in 2001 was $226 (a $36 or 19% increase from the 1996 rate). This compares to $380 for the non-Indigenous population in 2001 (an increase of 28.4% from the 1996 figure of $296).[94] The disparity between Indigenous peoples and the non-Indigenous population increased noticeably in relation to individual income over the decade 1991 - 2001. The Centre for Aboriginal Economic Policy Research have estimated that median individual income for Indigenous adults, expressed as a ratio to non-Indigenous adult income, fell from 0.70 in 1991 to 0.65 in 1996 to 0.59 in 2001 (where 1.0 indicates a situation of equality or parity).[95] Much of the difference is due to the significant numbers of Indigenous people who derive their income from unemployment benefits or who are engaged in Community Development Employment Projects. There are also a larger number of Indigenous peoples in lower-skilled jobs. Of indigenous persons aged 15 and over who indicated their labour force status in the 2001 Census, one third (34%) were engaged in mainstream employment, 7% participated in CDEP’s, 10% were unemployed and 48% were not in the labour force.[96] The ABS has also noted that Indigenous persons tend to earn less money than non-Indigenous persons within the same occupational categories. For example, in 2001 the median income of Indigenous managers was 81% of the non-Indigenous median, for professionals it was 73% and among labourers just 56%.[97] (c) Income source from the social surveys Data on income source in the NATSISS 2002 echo the changes in employment status of the Indigenous population. CDEP and non-CDEP wages and salaries combined accounted for a larger proportion of Indigenous respondents main income source in 2002 (39% compared to 33% in 1994). Government pensions and allowances was the main income source for 50% of Indigenous respondents in 2002 (compared to 55% in 1994).[98] (d) Financial stress in the social surveys In the NATSISS 2002, just over half (54%) of all respondents aged 15 years or over were living in households in which the household spokesperson reported that they could not raise $2,000 within a week in a time of crisis. Around one-third (37%) of respondents were living in households with Indigenous children under five years of age, and almost two-thirds (64%) were living in households with Indigenous children under 15 years of age. A higher proportion of respondents in remote areas reported that, in a time of crisis, they could not raise $2,000 within a week (73% compared with 47% in non-remote areas). In remote areas, 77% of respondents were living in households with Indigenous children under 15 years of age. Among people aged 18 years or over, Indigenous respondents were about four times as likely to report that they were unable to raise $2,000 within a week, in a time of crisis as in the non-Indigenous population.[99] Top 6. Employment (a) Participation in the labour force Census data In the 2001 Census, 52% of Indigenous people aged 15 years and over reported that they were participating in the labour force (meaning that they were engaged in mainstream employment, participating in CDEP or unemployed). This compares to 53% in 1996. The participation rate was higher for Indigenous men (60%) than Indigenous women (45%).[100] The labour force participation rate for the non-Indigenous population was 63% in 2001 (i.e. 11% higher than for Indigenous peoples). When adjusted to include only people aged 15-64 years, the disparity in labour force participation widens further with 54% of Indigenous people in this age group in the labour force compared with 73% of the non-Indigenous population.[101] Table 8 shows that labour force participation rates for Indigenous peoples declines with remoteness, with a 57% participation rate in major cities compared with 46% in very remote areas.[102] Table 8: Labour force participation, by remoteness, 2001 Indigenous persons Non-Indigenous persons Major cities 57.3 64.3 Inner Regional 52.0 59.9 Outer regional 50.7 63.3 Remote 50.5 71.8 Very remote 46.2 78.1 Nationally, 46% of all Indigenous people aged 15-64 years were not in the labour force in 2001. This indicates that they were not actively engaged in the labour market, for reasons including carer responsibilities, illness, disability or lack of market opportunities. By comparison, 27% of the non-Indigenous population in the same age group were not participating in the labour force.[104] The social surveys The social surveys support the Census data, in the NATSISS 2002, 60 per cent of respondents aged 15 years and over reported that they were participating in the labour force (meaning that they were engaged in mainstream employment, participating in CDEP or unemployed).The surveys indicate marked changes over 1994 – 2002 in employment status, with the proportion of employed respondents increasing from 36% to 46%. The CDEP accounted for one in four jobs held by respondents in 2002, and the proportion of respondents employed in mainstream (non-CDEP) jobs also increased (from 28% to 34%).[105] Nationally, 48 per cent of all Indigenous respondents aged 18 years or over, once the effects of age differences between Indigenous peoples and the non-Indigenous population have been removed, were not in the labour force in 2002. This indicates that they were not actively engaged in the labour market, for reasons including carer responsibilities, illness, disability or lack of market opportunities. By comparison, 33 per cent of non-Indigenous population in the same age group were not participating in the labour force.[106] (b) Unemployment The unemployment rate is the number of people unemployed expressed as a proportion of the total labour force. The ABS does not classify participation in the CDEP scheme as unemployed. In the Census 2001, the unemployment rate for Indigenous peoples was 20%. The rate in 1996 was 23%. This is approximately three times higher than the rate for the non-Indigenous population.[107] Table - 9 shows the unemployment rate for Indigenous peoples and the non-Indigenous population by remoteness. It shows that Indigenous people living in inner and outer regional areas have the highest unemployment rate. The low rate of unemployment in very remote areas relates to low levels of labour force participation, combined with high levels of CDEP participation ad limited mainstream labour market opportunities[108]. Table 9: Unemployment rates by remoteness, 2001[109] Indigenous peoples Non-Indigenous population Major cities 20.1 6.9 Inner Regional 25.0 8.1 Outer regional 23.1 7.4 Remote 19.2 4.9 Very remote 8.3 3.5 Table 10 shows that unemployment rates were highest for Indigenous people aged 15-17 years (31.8%), and 18-24 years (27.3%). These rates were approximately double the non-Indigenous rate. Table 10: Unemployment rates by age group, 2001 [110] Indigenous persons Non-Indigenous persons 15-17 Years 31.8 16.3 18-24 Years 27.3 12.8 25-34 Years 20.7 7.1 35-44 Years 16.0 5.7 45-54 years 11.7 4.9 55-64 Years 10.4 5.7 (c) Employment and CDEP Participation Indigenous people employed in 2001 had the following characteristics: 93% were employees, with four per cent self-employed and two per cent employers; 55% worked in the private sector and 23% in government; 18% participated in CDEP; 52% were full time and 38% part time; 60% worked in low skill occupations, 21% in medium skill occupations and 15% in high skill occupations; 29% reported having a non-school qualification.[111] In 2001, 18% of all Indigenous people who were classified as employed were engaged in Community Development Employment Projects (CDEP). The CDEP Scheme enables participants to exchange unemployment benefits for opportunities to undertake work and training in activities managed by local Indigenous community organisations. Compared with all Indigenous people who were employed, Indigenous people identified as CDEP participants were: twice as likely to work part time (74% compared with 38%); more likely to report working in a low skilled occupation (79% compared with 60%); and one third as likely to report having a non-school qualification (nine per cent compared with 29%).[112] Top 7. Education (a) Secondary education Table 11 compares the highest level of secondary schooling completed for those Indigenous and non-Indigenous people, 18 years or over, who do not have a non-school qualification. It shows that 49.9 per cent of non-Indigenous Australians had no non-school qualification compared with 71 per cent of Indigenous Australians. Table 11: Highest level of schooling completed, 2002[113] Level completed Indigenous (%) Non-Indigenous (%) Year 9 or below 33.4 15.8 Year 10 or 11 26.9 18.8 Year 12 10.7 15.3 No non-school qualification 71.0 49.9 Table 12 below shows the difference between Indigenous and non-Indigenous students' transition to non-compulsory Year 11 schooling. The retention rate for Indigenous students fell from nearly 90% in year 10 to 67% in year 11. By comparison, the rate for non-Indigenous students falls less dramatically from year 10 to year 11 from 99% to 87%. Table 12: Grade progression rates, 2003[114] Year level Indigenous students (%) Non Indigenous students (%) 8 to 9 95.1 100 9 to 10 89.2 99 10 to 11 71.0 90.9 11 to 12 66.3 86.3 Table 13 below indicates that retention rates from years nine to 12 for Indigenous students has increased over the five year period between 1998 and 2002. However, the retention rate for Indigenous students remains substantially lower than non-Indigenous students. As at 2002, the apparent retention rate for Indigenous year 12 students was 38 per cent compared to 76.3 per cent for their non-Indigenous counter-parts. Table 13: Apparent Retention Rates - Indigenous and non-Indigenous students, 2000-2004[115] 2000 2001 2002 2003 2004 Year 9 Indigenous Non-Indigenous 95.5 99.8 96.5 99.9 97.8 99.8 96.8 99.9 97.2 99.9 Year 10 Indigenous Non-Indigenous 83.0 98.0 85.7 98.4 86.4 98.5 87.2 98.9 85.8 98.5 Year 11 Indigenous Non-Indigenous 53.6 86.2 56.1 87.6 58.9 88.7 61.4 89.5 61.0 88.9 Year 12 Indigenous Non-Indigenous 36.4 73.3 35.7 74.5 38.0 76.3 39.1 76.5 39.5 76.8 (b) Post-secondary education The NATSISS 2002 identified people aged over 18 years who had a non-school qualification such as a bachelor degree, certificate or diploma. The ABS has reported that Indigenous peoples participate at a similar rate to non-Indigenous population in post-secondary education, although this varies across age groups, type of institution attended and across geographic regions. Table 14 below shows that Indigenous peoples are also less likely to have a post-graduate degree, bachelor degree, advanced diploma or diploma than the non-Indigenous population. Table 14: Highest non-school qualification, Percentage of persons aged 18 years and over, 2002 Level obtained Indigenous peoples (%) Non-Indigenous population (%) Bachelor degree 3.7 16.9 Certificate or Diploma 24.1 32.7 Total with non-school qualification 29.0 50.1 The proportion of Indigenous peoples reporting a non-school qualification of Bachelor degree or above, while small at just over 3%, has progressed significantly since 1994 (just over 1%). Significant gains also occurred in the number of people reporting other non-school qualifications such as certificates and diplomas. The proportion of Indigenous peoples with a non-school qualification increased from around 12% in 1994 to 26% in 2002, although this level still remained well below that for the non-Indigenous population.[117] Top 8. Housing and homelessness (a) Housing tenure Census data The residents of households with Indigenous person(s)[118] were much more likely to be renting than purchasing a home than owning a home outright. Table 15 shows that 63% of households with Indigenous person(s) were renting (compared with approximately 27% of other households); 19% were purchasing their home (compared with 27% of other households); and 13% owned their home outright (compared with 40% of other households). Table 15: Housing Tenure, 2001[119] Households with Indigenous person(s) Other households Renting 63.5 26.6 Purchasing 19.4 27.0 Owner 12.6 40.5 Other / not known 4.5 5.9 Generally speaking, in remote areas, Indigenous peoples are less likely to own their home than in urban centres. This, in part, reflects the type of tenures available to people on traditional Indigenous lands[120]. The social surveys The NATSISS 2002 reported that 70% of Indigenous respondents lived in rented accommodation in 2002. This has not changed significantly since 1994 (71%). There has, however, been an apparent decline in the proportion of Indigenous respondents living in accommodation rented from state/territory housing authorities, from 33% in 1994 to 22% in 2002. Proportionally more respondents (about two-thirds in rental accommodation in 2002) are now living in accommodation rented through Indigenous Housing Organisations, community housing or other private rental providers (up from one-half in 1994). The NATSISS also 2002 reported 17% of respondents lived in dwellings that were being purchased and 10% lived in dwellings that were owned outright. In other words, 27% of respondents owned or part-owned their homes in 2002 up from 22% in 1994.[121] (b) Household size and overcrowding Households with Indigenous person(s) tend to have more residents than other households. At the 2001 Census, there was an average of 3.5 persons in households with Indigenous person(s), compared with 2.6 persons in other households. Both household size and the proportion of households requiring at least one additional bedroom rose with increased geographic remoteness. Average household with Indigenous person(s) size increased from 3.2 residents in major cities to 5.3 in very remote areas[122]. Although there is no universally accepted definition of what constitutes adequate accommodation, data presented below use the Canadian National Occupancy Standard. This standard specifies who should reasonably be expected to share bedrooms, dependent on age and sex. Based on this definition, 15% of households with Indigenous person(s) were considered to be living in dwellings requiring at least one additional bedroom, compared to 4% of other households. [123] The likelihood of needing additional bedrooms increased with the remoteness of households with Indigenous person(s). In major cities, 11% of all households with Indigenous person(s) require at least one extra bedroom, compared with 42% of households with Indigenous person(s) in very remote Australia. The likelihood of needing additional bedrooms for other households varied only slightly with the level of remoteness, fluctuating between 3% to 4%.[124] The Steering Committee for Government Service Provision has reported that Indigenous peoples were 5.6 times more likely to live in overcrowded houses than the non-Indigenous population. This rate rises to 18.8 times the non-Indigenous rate in very remote areas.[125] (c) Discrete Aboriginal or Torres Strait Islander communities 'Discrete' communities are those that comprise predominantly (i.e. over 50%) Aboriginal or Torres Strait Islander people[126]. They are located in both urban and remote areas. Conditions in these communities were until very recently far poorer than conditions in non-Indigenous communities. The Community Housing and Infrastructure Needs Surveys (CHINS) have been carried out every two years since 1997 by the ABS. They aim to provide a picture of life in discrete communities and allow government programs to improve conditions there to be monitored. A total of 1,216 discrete Aboriginal or Torres Strait Islander communities were covered in the 2001 CHINS, These communities had 16,966 permanent dwellings and a total reported population of 108,085.[127] While many problems with housing and infrastructure in discrete communities were reported, a number of improvements since the 1999 CHINS were observed. These include a reduction in the proportion of people living in temporary dwellings, an increase in the proportion of permanent dwellings connected to water, power and sewerage systems and a reduction in sewerage system overflows and leakages[128]. Selected findings in relation to discrete communities were that water quality was either not tested, or had failed testing in the 12 months prior to the survey, in 46% of the 213 communities which had a population of 50 or more and were not connected to a town water supply. This is a decrease from 52% of such communities in 1999. Further, overflows or leakages from sewerage systems in the 12 months prior to the survey occurred in 48% of Indigenous communities with a population of 50. [129] Top 9. Indigenous peoples and criminal justice systems (a) Indigenous adult prisoners The Royal Commission into Aboriginal Deaths in Custody (RCIADIC) reported in 1991. At that time, Aboriginal people made up 14% of the total prison population and were up to 15 times more likely to be in prison than non-Aboriginal people[130]. It made a large number of recommendations to address this issue[131] Despite this, the number of Indigenous prisoners increased over the last decade: Indigenous people represented 22% of the total prisoner population as at 30 June 2005.[132] The total number in prison increased by 12% over 2004 to 2005 (from 5,084 to 5,656)[133]. Age standardisation is a statistical method that adjusts crude rates to account for age differences between study populations. Age standardisation enables better comparisons between different populations. In the context of such a comparison, the key variable interests are the ratio of rates, rather than the age standardised rates alone.[134] As at December 2005 the highest aged standardised ratio[135] of imprisonment for Indigenous persons was recorded in Western Australia and South Australia with Indigenous people being 19 and 13 times more likely than non-Indigenous people to be in prison.[136].Tasmania had the lowest age standardised ratio of all states and territories with Indigenous people 4 times more likely to go to prison than non-Indigenous people.[137] The age profile for Indigenous prisoners is younger than the overall prison population. As at June 2005 the median age for Indigenous prisoners was 30 years, while the overall prison population was 32 years. Over one in twenty (6%) Indigenous men aged 25-29 years were in prison at 30 June 2004, compared with 0.6% of all males aged 25-29 years. [138] In the twelve months from 1 September 2004 to 1 September 2005 all States and Territories with the exception of the ACT recorded an increase in Indigenous imprisonment rates. The Northern Territory recorded the highest increase (13%) with Western Australia second (9%) and followed by Queensland (8%)[139]. A 2003 study demonstrates the extent of contact of Indigenous people with criminal justice processes in New South Wales. Between 1997 and 2001, a total of 25,000 Indigenous people appeared in a NSW Court charged with a criminal offence. This constitutes 28.6% of the total NSW Indigenous population. In the year 2001 alone, nearly one in five Indigenous males in NSW appeared in Court charged with a criminal offence. For Indigenous males aged 20-24 years, this rate increased to over 40%[140]. The increase in the rate of the incarceration of Indigenous people in Australia over 1991-2002 is shown in Graph 2 below. Graph 2: Indigenous prisoners in Australia 1992 - 2002 If you require this data in a more accessible format please email webfeedback@humanrights.gov.au (b) Indigenous women in corrections Indigenous women are currently the fastest growing prison population. Incarceration rates for women generally have increased more rapidly than for men and the increase in imprisonment of Indigenous women has been much greater over the period compared with non-Indigenous women.[141] The decade between 1993 and 2003 the general female prison population increased by 110 %, as compared with a 45 % increase in the general male prison population.[142] The Indigenous female prison population has increased from 111 women in 1993[143] to 467 in September 2005[144]. This suggests a 420% increase since 1993. As at March 2004, Indigenous women were imprisoned nationally at a rate 20.8 times that of non-Indigenous women.[145] The rate of over-representation by state and territory is set out in Table 16 below. Table 16: Indigenous women - rates of incarceration, September Quarter 2005 State / Territory Number of Indigenous females in corrections[146] Rate per 100,000 Indigenous females[147] NSW 171 420.1 Victoria 20 222.8 Queensland 98 239.5 South Australia 26 318.5 Western Australia 128 613.7 Tasmania 6 109.8 Northern Territory 18 98.5 ACT - - Total 467 323.3 There are many possible reasons for the increases in female Indigenous prison populations, with variations occurring in each State and Territory and again between regional and urban centres. In New South Wales, the Select Committee into the Increase in Prison Population found in 2001 that the most significant contributing factor was the increase in the remand population. There was no evidence to suggest that an in increase in actual crime accounted for the prison increase, although increases in police activity and changes in judicial attitudes to sentencing were also important.[148] (c) Indigenous juveniles and corrections The Australian Bureau of Statistics has noted that there is only limited national data on young people in the juvenile justice system and that a national data collection system is a work in progress[149]. It estimated that in 2002-03 Indigenous young people (that is, those 10 to 17 years of age) were detained at ten times the rate of all young people in Australia[150]. The Australian Institute of Criminology reports that at 30 June 2004, there were 306 young Indigenous persons detained in juvenile facilities throughout Australia[151] as compared with 258 non-Indigenous young people.[152] The Indigenous juvenile detention rate per is 312.9 young people per 100,000[153] compared to a rate of 12.2 young people per 100,000 for the non-Indigenous population.[154]. A study in Queensland has tracked the trajectory through the criminal justice system of young offenders who first appeared in the juvenile justice system from 1994-95 (through custodial and non-custodial orders) up to September 2002[155]. The study reported that by September 2002, 89% of Indigenous male juveniles on supervised orders had progressed to the adult system, with 71% having served at least one term of imprisonment. It also reported there was an increased likelihood that those juveniles who were subject to a supervised justice order and had been the subject of a care and protection order would proceed to the adult criminal justice system, with 91% of all such juveniles having some contact with the adult system, and 67% having served at least one term of imprisonment. The study concluded that 'over time, the probability of those juveniles on supervised orders in 1994-95 who are subject to multiple risk factors (e.g. male, Indigenous, care and protection order) progressing to the adult corrections system will approach 100 per cent.'[156] (d) Indigenous deaths in custody Over 1990-1999, 115 Indigenous people died in custody[157]. Indigenous deaths in custody throughout the 1990s represent a disproportionately high 18% of all deaths in custody[158]. In 2004, 14 Indigenous persons died in custody out of 67 total deaths in prison, police custody and custody-related operations[159]. The rate of Indigenous deaths in prison custody in 2004 was 1.4 prisoners per 1,000 Indigenous prisoners, while the rate of non-Indigenous deaths in prison custody was 1.6 per 1,000 non-Indigenous prisoners[160] The Australian Institute of Criminology reports that despite some fluctuations in rates of both Indigenous and non-indigenous deaths in custody since 1982, the rates of death per 1000 prisoners have become more similar since 1999 and both have begun to trend downward since 1999[161]. This indicates that the disproportionate number of Indigenous deaths in custody relative to the total Indigenous population must be understood in the broader context of the over-representation of Indigenous people in criminal justice processes. (e) Victims of crime There is no national data on the extent to which Indigenous peoples are victims of crime. A study in New South Wales in 2001 reported that Indigenous people are 5.5 times more likely (6.2 times for Indigenous females) than non-Indigenous people to be a victim of a domestic violence related assault; 3.4 times (rising to 5.2 times for Indigenous females) more likely to be the victim of assault; 2.8 times (2.9 for Indigenous females) more likely to be the victim of a sexual assault; 2.5 times (1.9 for Indigenous females) more likely to be the victim of murder; 1.4 times (same for Indigenous females) more likely to be the victim of a sexual assault against a child aged 0-15 years. Indigenous people were, however, less likely to be the victim of robbery. The study also reported that victimisation in violent crimes is also predominately the result of offending by other Aboriginal people.[162] This identifies the challenge to find solutions for Indigenous people being victims of crime, within the context of addressing the over-representation of Indigenous people in criminal justice processes. (f) The social surveys: crime, violence and the criminal justice system What follows is extracted from the NATSISS (2002) report summary: One-quarter of respondents in the NATSISS 2002 reported that they had been a victim of physical or threatened violence in the previous 12 months, nearly double the rate reported in 1994 (13%). Some of this increase may reflect under-reporting by respondents to the NATSIS 1994. The proportion of Indigenous respondents in 2002 who reported using legal services in the last 12 months had increased to 20%, up from 15% in 1994. Those who needed legal services but did not use them increased slightly to 3% from 2% in 1994. In 2002 about 75% of those who used legal services used an Aboriginal Legal Service or Legal Aid, down from 87% in 1994. The proportion of Indigenous respondents who reported having been arrested at least once in the previous five years declined by about one-fifth between 1994 (20%) and 2002 (16%). The proportion who reported being arrested once only in the previous five years was also down in 2002 (7% compared to 9% in 1994), contributing to the overall improved outcome. Between 1994 and 2002, the proportion of Indigenous respondents who reported that they had been arrested in the previous five years fell from 20% to 16%. In 2002, 7% of Indigenous respondents reported that they had been incarcerated in the last five years. Males, in comparison with females, were far more likely to report that they had been arrested (24% compared with 9%) and incarcerated (11% compared with 3%) in the last five years. Of those who had been arrested in the last five years, around seven out of ten were male, and of those who had been incarcerated, nearly eight out of ten were male. Of the 16% of Indigenous respondents aged 15 years or over who reported that they had been arrested by police in the last five years, 38% were living in households with Indigenous children under five years of age, and 63% were living in households with Indigenous children under 15 years of age. Indigenous respondents who had ever been charged by police (35%) were around twice as likely to be unemployed as the rest of the Indigenous population. In 2002, 21% of males and 19% of females who had ever been charged were unemployed compared with 12% of males and 9% of females in the remainder of the Indigenous population. Similarly, those ever charged were more likely to have ceased formal schooling before Year 10, although the difference primarily occurred among males. Of Indigenous male respondents aged 15 years or over, 42% of those who had ever been charged had ceased formal schooling before Year 10 compared with 32% of other Indigenous males. Of those Indigenous respondents who had ever been charged by police, those first charged before the age of 17 years were more likely to have been arrested and/or incarcerated in the last five years than those first charged when they were older. In 2002, over half (54%) of respondents first charged before the age of 17 years had been arrested by police in the last five years and 29% had been incarcerated in that period. Comparative figures for those first formally charged when they were 25 years or over were 31% and 14%[163]. Top 10. Child protection There are three areas of child protection services for which national data is compiled: Child protection notifications, investigations and substantiations; Children on care and protection orders; and Children in out-of-home care. Children who are perceived to be in need of protection can come into contact with community services departments or child protection agencies (in the states and territories) by someone expressing concern about the welfare of a child or making a report to the department. From the reporting stage, if it is decided that the child is prima facie under risk of harm (neglect or abuse) the report is classified as a notification. Most notifications are investigated and classified as substantiated or not substantiated according to the degree of risk to the child. A range of services are then provided to that child and the child's family. In extreme cases, state departments can apply to the court for a care and protection order. Children can also be placed in out-of-home care, either temporarily or more long term, by order of the court[164]. At the NATSIS (1994), 10% of Indigenous respondents aged 25 years or over reported that they had been taken away from their natural family. The same result (10%) was recorded for the closest equivalent age cohort group (35 years or over) in the NATSISS 2002. Both the 1994 and 2002 surveys recorded that 8% of Indigenous respondents aged 15 years or over at the time of the surveys, had been taken away from their natural family[165]. (a) Child protection notifications, investigations and substantiations The rates of Indigenous children entering the child protection system are higher than the rates for other children. Table 18 sets out the rates of Indigenous children per 1000 who were the subject of a substantiation orders in 2004-05. The highest rates recorded were in Victoria (63.0 Indigenous children per 1000). Table 18: Rate of children the subject of substantiations: By Indigenous status and state / territory, 2004-05[166] State/Territory Indigenous (rate per 1,000) Other children (rate per 1,000) Total NSW 27.1. 5.2 6.1 Vic 63.0 5.8 6.4 Qld 20.4 13.7 14.1 WA 12.2 1.6 2.3 SA 43.2 4.2 5.5 NT 13.7 3.9 7.9 Tas 4.8 5.8 5.8 A.C.T 56.0 10.9 12.0 The pattern of substantiated abuse and neglect for Indigenous children differs from the pattern for other children. Indigenous children were much more likely to be the subject of a substantiation of neglect. For example, in Queensland, 41% of substantiations for Indigenous children were of neglect (compared with 31% of other children)[167] (b) Children on care and protection orders Table 19 shows the rate of Indigenous children on care and protection orders across all States and Territories, and comparisons to the rate for other children. It shows that the rate per 1,000 Indigenous children is significantly higher than the rate for other children across all jurisdictions. Table 19: Rate of children on care and protection orders: By Indigenous status and state / territory, 30 June 2005[168] State/Territory Indigenous children (rate per 1,000) Other children (rate per 1,000) Total NSW 33.0 4.3 5.4 Vic 52.8 4.3 4.9 Qld 21.9 5.0 6.0 WA 21.6 2.5 3.7 SA 27.3 3.7 4.5 NT 11.4 3.8 7.0 Tas 11.5 5.7 6.1 A.C.T 37.4 5.3 6.1 (c) Children in out-of-home care Table 20 compares the rate per 1,000 Indigenous children and rate per 1000 other children in out-of-home care. It shows that the rate per 1,000 Indigenous children is significantly higher than the rate for other children across all jurisdictions. The national rate for Indigenous children was over six times the national rate for other children. Table 20: Rate of children in out-of-home care: By Indigenous status and state / territory, 30 June 2005 [169] State/Territory Indigenous children (rate per 1,000) Other children (rate per 1,000) Total NSW 39.7 4.4 5.8 Vic 40.7 3.4 3.8 Qld 20.8 4.8 5.8 WA 22.6 2.5 3.8 SA 24.3 3.1 3.9 NT 8.9 3.1 5.5 Tas 9.5 4.6 4.9 A.C.T 32.0 3.8 4.5 Total 26.4 3.9 4.9 At 30 June 2005, 69% of Indigenous children in out-of-home care across Australia were placed in accordance with the Aboriginal Child Placement Principle. This Principle outlines a preference for placing Indigenous children with an Indigenous family. It places a preference for placements first with their extended families, second with their Aboriginal or Torres Strait Islander community and third with Indigenous people before placing the child with a non-Indigenous family.[170] Top ENDNOTES [1] It is acknowledged that Aboriginal and Torres Strait Islander peoples are not a homogenous group. The term 'Indigenous peoples' is used to reflect this diversity. [2]Steering Committee for the Review of Government Service Provision, Overcoming Indigenous Disadvantage: Key Indicators 2005: Report, Productivity Commission, Canberra, 2005. [3] Australian Bureau of Statistics, Population Distribution, Aboriginal and Torres Strait Islander Australians 2001, ABS cat. no. 4705.0, Commonwealth of Australia, Canberra, 2002, pp7-15. [4] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2001, ABS cat. no. 4713.0, Commonwealth of Australia, Canberra, p12. [5] Australian Bureau of Statistics and Australian Institute of Health and Welfare, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, 2003, ABS cat. no. 4704.0 , Commonwealth of Australia, Canberra, 2003, p245. [6] Australian Bureau of Statistics, Population Characteristics, Aboriginal and Torres Strait Islander Peoples 2001, op.cit., p12. [7] ibid., p15. [8] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Survey 1994 – Detailed Findings, ABS cat. no. 4190.0, Commonwealth of Australia, Canberra, 1995. [9] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Social Survey 2002, ABS cat. no. 4714.0, Commonwealth of Australia, Canberra, 2004. [10] ibid., pv. [11] ibid., pp31-32. [12] ibid., p2. [13] Australian Bureau of Statistics, Population characteristics: Aboriginal and Torres Strait Islander Australians 2001, op.cit., p15. [14] ibid., p19, Table 2.2. [15] ibid., p20, Table 2.3. [16] ibid., p15; p25, Table 2.8. [17]ibid., p15. [18]Australian Bureau of Statistics, Year Book 2006, ABS cat. no. 1301.0, no. 88, Commonwealth of Australia, Canberra, 2006, p122. [19] Australian Bureau of Statistics and Australian Institute of Health and Welfare, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples 2005, ABS cat. no. 4704.0, Commonwealth of Australia, Canberra, 2005, p74. [20] Australian Bureau of Statistics, Year Book 2005, no. 87, ABS cat. no. 1301.0, Commonwealth of Australia, Canberra, 2005, p113. [21] Department of Immigration, Multiculturalism and Indigenous Affairs, Indigenous people in Australia (Fact sheet) DIMIA website: http://www.minister.immi.gov.au.atsia/facts/index.htm%20(Accessed%202 December 2003). [22] Australian Bureau of Statistics, Population characteristics: Aboriginal and Torres Strait Islander Australians 2001, op.cit., p18. [23] ibid., graph not numbered. [24] Australian Bureau of Statistics, Year Book 2005, op.cit., p113. [25] Australian Bureau of Statistics, Population characteristics: Aboriginal and Torres Strait Islander Australians 2001, op.cit., p19, Table 2.2. [26] ibid. [27] ibid., p19, Table 2.2. [28] ibid., p22, Table 2.5. [29] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Social Survey 2002, op cit., p2. [30] Australian Bureau of Statistics, Population characteristics: Aboriginal and Torres Strait Islander Australians 2001, op.cit., p27. [31] ibid., p28. [32] ibid., pp28-29. [33] ibid., pp35-36. [34] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Survey 1994, op.cit., p4. [35] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Survey 2002, op.cit. p2. [36] From 54.8 years to 81.5 years. Baum, F., The New Public Health, (2nd ed.), Oxford University Press, New York, 2002, p198. [37] From 47.2 years to 75.9 years. ibid. [38] Australian Bureau of Statistics, Deaths 2004, ABS cat. no. 3320.0, Commonwealth of Australia, Canberra, 2005, p10. [39] ibid., p14. [40] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Survey 2002, op.cit., p31, Table 6. [41] Australian Bureau of Statistics and Australian Institute of Health and Welfare, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, 2005, ABS cat. no. 4704.0, Commonwealth of Australia, Canberra, 2005, p79. [42] National Health and Medical Research Council, Nutrition in Aboriginal and Torres Strait Islander Peoples, an information paper, NHMRC, Canberra, 2000, p21. [43] Burn, J. and Irvine, J., ‘Nutrition and Growth’, Editor, Thomson, N., The Health of Indigenous Australians, Oxford University Press, Melbourne, 2003, pp81-84. [44] Australian Bureau of Statistics and Australian Institute of Health and Welfare, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, op.cit., p125. [45] Australian Bureau of Statistics and Australian Institute of Health and Welfare, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, 2005, op.cit., p80. [46] Thomson, N., ‘Responding to our ‘Spectacular Failure’, Editor, Thomson, N., The Health of Indigenous Australians, op.cit., p 490. [47] Australian Bureau of Statistics, Deaths 2001, ABS cat. no.3320.0. Commonwealth of Australia, Canberra, 2002, p 23. [48] Victoria, Tasmania and the Australian Capital Territory are excluded due to data quality issues. ibid., p77. [49] Australian Bureau of Statistics, Deaths 2004, ABS cat. no.3320.0. Commonwealth of Australia, Canberra, 2005, p69. [50] ibid., p69, Table 8.7. [51] Australian Institute of Health and Welfare, Australia’s Health 2004, AIHW cat. no. AUS 44, Commonwealth of Australia, Canberra, 2004, p197, Table 4.6. [52] ibid., p124, Table 7.37. [53] ibid., p121, Table 7.34. [54] Australian Bureau of Statistics, Deaths 2004, op.cit., p63, Table 8.1. [55] ibid., p 70. [56] United Nations Development Program, Human Development Report 2005, UNDP, Geneva, 2005, p220, Table 1. [57] Ring, I., and Firman, D., ‘Reducing indigenous mortality in Australia: lessons from other countries’, Medical Journal of Australia, 1998, Vol. 169, pp528-533. [58] National Health and Medical Research Council , Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults. Commonwealth of Australia, Canberra, 2003, p5. [59] Australian Bureau of Statistics, National Health Survey: Aboriginal and Torres Strait Islander Results, Australia, 2001. ABS cat. no. 4715.0, Commonwealth of Australia, Canberra, 2002, p10. [60] ibid., p7. [61] ibid., p8. [62] Australian Bureau of Statistics, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, 2005. op.cit., p136. [63] Australian Bureau of Statistics and the Australian Institute of Health and Welfare, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, 2003. op.cit., p174. [64] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Social Survey 2002, op. cit., p8. [65] ibid. [66] ibid., pp7-8. [67] ibid. [68] Swan, P., and Raphael, B., Ways Forward: National Consultancy Report on Aboriginal and Torres Strait Islander Health, National Mental Health Strategy, AGPS, Canberra, 1995, p42. [69] Hunter, E., ‘Mental Health’, Editors, Thomson, N., The Health of Indigenous Australians, Oxford University Press, Melbourne, 2003, p141. [70] Australian Bureau of Statistics and Australian Institute of Health and Welfare, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples 2005, op.cit., p131, Table 7.39. [71] ibid., p117, Table 7.30. [72] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Social Survey 2002, op.cit., p4. [73] Australian Bureau of Statistics and Australian Institute of Health and Welfare, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples 2005, op. cit., p116. [74] ibid., p160. [75] See generally Editors Marmot, M. and Wilkinson, R., Social Determinants of Health, Oxford University Press, New York, 1999. [76] Fred Hollows Foundation, Literacy for Life, Australian National University, Canberra, 2004, pp10-12, available online at http://www.hollows.org/content/TextOnly.aspx?s=244. See also the issues raised in: Malin, M, Is schooling good for Indigenous children's health?, Cooperative Research Centre for Aboriginal and Tropical Health & Northern Territory University, 2003, available online at: http://www.acer.edu.au/research/special_topics/ind_edu/report_papers.html [77] Australian Bureau of Statistics and Australian Institute of Health and Welfare, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples 2005, op.cit., p37. [78] Wadsworth, M., Early Life, Editors, Marmot, M. and Wilkinson, R., Social Determinants of Health, Oxford University Press, New York, 1999, p44. Chronic diseases that have poor diet as a determinant include cardiovascular disease, Type 2 diabetes and renal disease. Connections have been made between poor foetal nutrition and the presence of chronic diseases later in life: National Health and Medical Research Council, Nutrition in Aboriginal and Torres Strait Islander peoples - An information paper, Commonwealth of Australia, 2000, p15. [79] Jarvis, M. and Wardie, J., 'Social pattering of individual health behaviours; the case of cigarette smoking', Editors, Marmot, M. and Wilkinson, R., Social Determinants of Health, op.cit., pp241-244. [80] Shaw, M., Dorling, D. and Davey-Smith, G., 'Poverty, social exclusion, and minorities', Editors, Marmot, M. and Wilkinson, R.., Social Determinants of Health, op.cit., pp32-37. See also, ‘Financial stress in the social surveys’ below. [81] Brunner, E. and Marmot, M, 'Social Organization, stress and health', Editors, Marmot, M. and Wilkinson, R., Social Determinants of Health op.cit, p 17. [82] ibid., pp32-37. [83] Marmot, M., 'Health and the psychosocial environment at work', Editors, Marmot, M. and Wilkinson, R., Social Determinants of Health, op.cit., p124. [84] Wilkinson, R., 'Prosperity, redistribution, health and welfare', Editors, Marmot, M. and Wilkinson, R., Social Determinants of Health, op.cit., pp260-265. [85] Williams, R., Neighbours, H. and Jackson, J., 'Racial/Ethnic Discrimination and Health: Findings from Community Studies', (Feb 2003), 93(2) American Journal of Public Health 200, pp200-201. [86] Shaw, M., Dorling, D., and Davey Smith, G., ‘Poverty, social exclusion and minorities’, Editors, Marmot, M. and Wilkinson, R., Social Determinants of Health, op.cit., p220-221. [87] Stansfeld, S., ‘Social support and social cohesion’, Editors, Marmot, M. and Wilkinson, R., Social Determinants of Health, op.cit., p155. [88] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Social Survey 2002, op.cit., pp5-6. [89] Australian Bureau of Statistics, Population Characteristics: Aboriginal and Torres Strait Islander Australians 2001, op.cit., p81. [90] ibid. [91] ibid., p82. [92] ibid. [93] ibid., p81. [94] ibid., p88, Table 7.2. [95] Altman, J., and Hunter, B., Monitoring ‘practical’ reconciliation: Evidence from the reconciliation decade, 1991-2001, Discussion Paper No. 245/2003,Centre for Aboriginal Economic Policy Research, Australian National University, Canberra, pp6-8, Tables 1 and 2. [96] Australian Bureau of Statistics, Population characteristics: Aboriginal and Torres Strait Islander Australians 2001, op.cit., p84. [97] ibid., p85. [98] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Social Survey, 2002, op.cit., p3. [99] ibid, pp11-12. [100] Australian Bureau of Statistics, Population characteristics: Aboriginal and Torres Strait Islander Australians 2001, op.cit., p65. [101] ibid. [102] ibid., p66. [103] ibid., p71, Table 6.1. [104] ibid., p66. [105] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Social Survey 2002, op.cit., p3. [106] ibid., p10. [107] Australian Bureau of Statistics, Population characteristics: Aboriginal and Torres Strait Islander Australians, 2001, op.cit., p66. [108] ibid., p67. [109] ibid., p71, Table 6.1. [110] ibid., p73, Table 6.2. [111] ibid., p68. [112] ibid. [113] ibid.. p28, Table 4. [114] Department of Education, Science and Training, National Report to Parliament on Indigenous Education and Training 2003, Commonwealth of Australia, Canberra, 2005, p28, Table 3.4. [115] Australian Bureau of Statistics, Year Book Australia 2006, ABS series cat. no. 1301.0, Commonwealth of Australia, Canberra, 2006, p294, Table 10.9. [116] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Social Survey 2002, op.cit., p28, Table 4. [117] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Social Survey 2002, op.cit., p31, Table 6. [118] Defined by the ABS as a household in which at least one person identified as Aboriginal or Torres Strait Islander and was counted on the Census night. Australian Bureau of Statistics, Population Characteristics: Aboriginal and Torres Strait Islander Australians 2001, op.cit., p140. [119] ibid., pp93-94. [120] ibid., p93. [121] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Social Survey 2002, op.cit., p12. [122] Australian Bureau of Statistics and Australian Institute of Health and Welfare, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2003, op.cit., p38, Table 3.2. [123] ibid., p38. [124] Australian Bureau of Statistics, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2003, op.cit., p38 [125] Steering Committee for the Review of Government Service Provision, op.cit., pp10.24-10.25 [126] Australian Bureau of Statistics, Housing and Infrastructure in Aboriginal and Torres Strait Islander Communities 2001, op.cit., p87. [127] ibid., p1. [128] ibid., p4. [129] ibid. [130] Royal Commission into Aboriginal Deaths in Custody, National Report Volume 1, AGPS, Canberra, 1991, para. 9.3.1. Find the report online at: www.austlii.edu.au/au/other/IndgLRes/rciadic. [131] ibid. [132] Australian Bureau of Statistics, Prisoners in Australia 2005, ABS cat. no. 4517.0, Commonwealth of Australia, Canberra, 2005, p5 [133] ibid, p5. [134] ibid., p54. [135] There have been a number of changes to the way the Australian Bureau of Statistics (ABS) calculates Indigenous imprisonment rates. The ABS now employs an age-standardisation method to calculate rates and ratios of Indigenous and non-Indigenous prisoners. There are differences in the age distributions between Australia’s Indigenous and non-Indigenous populations. In 2001, the proportion of Indigenous people aged under 18 years and over was 54.6%, compared with 75.8% of the non-Indigenous people (and 75.3% of the total Australian population). Using crude rates to examine differences between Indigenous and non-Indigenous populations may lead to erroneous conclusions being drawn about variables that are correlated with age. For more information see ABS, Prisoners in Australia 2004. Series cat. no. 4517.0, Commonwealth of Australia, Canberra, 2004, p54, Appendix 2 [136] Australian Bureau of Statistics, Prisoners in Australia 2005, op.cit., p5. [137] ibid. [138] Australian Bureau of Statistics, Prisoners in Australia 2004, op.cit.., p6. [139] Australian Bureau of Statistics, Corrective Services, September Quarter 2005, ABS cat. no. 4512.0, Commonwealth of Australia, Canberra, 2005, p5. [140]Weatherburn, D., Lind, B. and Hua, J., ‘Contact with the New South Wales court and prison system: the influence of age, Indigenous status and gender’ 78 Crime and Justice Bulletin (NSW Bureau of Crime Statistics and Research) 1, 2003, pp4-5. Available online at: www.lawlink.nsw.gov.au/bocsar1.nsf/pages/cjb78text. [141] Cameron, M., ‘Women Prisoners and Correctional Programs’, Trends and Issues, no. 194, Australian Institute of Criminology, Feb 2001, p1. [142] ibid. [143] ibid. [144] Australian Bureau of Statistics, Corrective Services, September Quarter 2005, op.cit., p17, Table 10 [145] Australian Bureau of Statistics, Corrective Services, Australia, March Quarter 2004, op.cit., p22. [146] Australian Bureau of Statistics, Corrective Services, September Quarter 2005, op.cit., p17, Table 10. [147] ibid., p18, Table 11. [148] Cuneen, C. NSW Aboriginal Justice Plan – Discussion Paper, 2002, p26. [149] Australian Bureau of Statistics, Australian Institute of Heath and Welfare, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, op.cit., p215. [150] ibid. p217. [151] Veld, M. and Taylor, N., Statistics on juvenile detention in Australia: 1981-2004, Technical and Background paper No. 18, Australian Institute of Criminology, Canberra, 2005, p24. [152] ibid. p26. [153] ibid., p25. [154] ibid., p 27 [155] Lynch, M. Buckman, J. and Krenske, L. Youth Justice: Crime Trajectories, Australian Institute of Criminology and Queensland Crime and Misconduct Commission, AIC Trends and Issues in Crime and Criminal Justice, Issues paper 265, September 2003, AIC, Canberra, 2003 [156] ibid., p2. [157] Williams P, Deaths in Custody: 10 years on from the Royal Commission, Trends and issues in Criminal Justice – No. 203, Australian Institute of Criminology, Canberra, 2001, p2. [158] Collins, L. and Mouzos, J., Australian deaths in custody and custody related police operations 2000, Trends and Issues in Criminal Justice, no. 217, Australian Institute of Criminology, Canberra 2001, p2. [159] Joudo, J., Veld, M. Deaths in Custody in Australia: National Deaths in Custody Program Annual Report 2004, Australian Institute of Criminology, Technical and Background paper no. 19, Canberra, 2005, pix [160] ibid., p12, Table 4. [161] ibid., pix. [162] Fitzgerald, J. and Weatherburn, D. ‘Aboriginal Victims and Offenders: The Picture from Police Records’, NSW Bureau of Crime Statistics and Research, Sydney 2001, p1. Available online at: www.lawlink.nsw.gov.au/bocsar1.nsf/pages/pub_atoc#aboriginality. [163] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Social Survey 2002, op.cit., pp13-14 [164] For a detailed explanation of care and protection classifications and statistics see: Australian Institute of Health and Welfare, Child Protection 2001-02, AIHW, Canberra 2003, Chapter 1. [165] Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Social Survey 2002, op.cit., p2. [166] Australian Institute of Health and Welfare, Child Protection 2004-05, AIHW op.cit., p22, Table 2.8. [167] ibid., p23 [168] ibid., p39, Table 3.10. [169] ibid., p51, Table 4.8. [170] ibid., p53, Table 4.9. Read More