Disadvantaged Health Status of Indigenous People

Why are indigenous people in Australia still disadvantaged with regard to health and community services?

Despite decades of policy reform and increased federal spending, the ongoing health gap between Indigenous and non-Indigenous Australians remains one of the most pressing public health challenges in the country, rooted in intersecting historical, cultural, and socio-economic forces that continue to shape access to care. As scholars and students researching Indigenous health disadvantage in Australia will find, this gap is neither accidental nor inevitable; rather, it reflects systemic inequities that have accumulated across generations. “The status of Indigenous health in contemporary Australia is a result of historic factors as well as contemporary socio-economic issues” (Markwick et al., 2019, p. 1).

The deficient health stature of Indigenous Australians is a contemporary consequence of their historical treatment as Australia’s traditional owners and as of a result of cultural issues that impact on the acceptance of health and community services. Students studying social determinants of health will recognise that the barriers faced by Aboriginal and Torres Strait Islander peoples are not simply matters of individual behaviour but are structured by centuries of dispossession, forced relocation, and institutional racism. This historical treatment and cultural issues has led to Indigenous Australians experiencing social disadvantages, significantly low socio-economic status, dispossession, poverty and powerlessness within contemporary Australian society. Research published by the Australian Institute of Health and Welfare (AIHW, 2022) confirms that Indigenous Australians remain significantly more likely to experience food insecurity, overcrowded housing, and limited access to primary care services compared to the non-Indigenous population.

Previous to the invasion and colonisation by the British on January 26, 1788, the indigenous people were the carers of Australia and the Torres Strait for a period of over 60,000 years. During this time, it is suggested that Indigenous Australians lived relatively prosperous lives and enjoyed generally better health than most people living in Europe (Hampton & Toombs, Indigenous Australian concepts of health and well-being, 2013). Archaeological and anthropological evidence suggests that pre-colonial Aboriginal populations maintained sophisticated ecological knowledge systems that supported nutritional balance and physical wellbeing far more effectively than European observers acknowledged at the time. Indigenous Australians mortality was greatly affected by the considerable loss of lives caused by the direct conflict with the British and by the arrival of introduced diseases, especially smallpox. The impact of this loss extended far beyond the immediate victims of disease, affecting the very fabric of Indigenous societies through depopulation and social disruption (Dudgeon et al., 2022).

Traditionally, Indigenous Australians had complete freedom over all parts of their lives such as, ceremonies, spiritual practices, medicine, social relationships, management of land and law and economic affairs (Saggers & Gray, 1991). Along with the impacts of introduced diseases and conflict, Indigenous Australians also experienced harmful effects related to disconnection from Country due to the spread of colonists and their subsequent political policies. For students examining Indigenous health through a cultural lens, this severing of the connection to Country is not a peripheral concern but a central driver of the psychological and physical ill-health observed in Aboriginal communities today. For an Indigenous Australian, Country is not just physical territory but the central aspect of their identity (Hampton & Toombs, Racism, colonisation/colonialism and impacts on indigenous people, 2013). Occupation and colonialism impacted far beyond the physical, as Indigenous Australians had their culture devalued, traditional food sources destroyed, and were separated from their families and in some cases entire communities were expelled. This caused separation or loss of languages, beliefs and social structures which form the fundamental basis of Indigenous cultures.

The current condition of Indigenous health has been impacted negatively by the stolen generations and other past government practises and for many Indigenous Australians, the ongoing effects have created other social, emotional and physical disadvantages. These disadvantages are evident through the social determinants of health, including; economic opportunity, physical infrastructure, and social conditions that influence the health of individuals, communities, and societies as a whole. Inequalities in these are especially evident in education, employment, income, housing, access to services, social networks, connection with land, racism, and incarceration rates. Research from Closing the Gap progress reports indicates that, while some indicators such as child mortality have improved incrementally, disparities in educational attainment, employment rates, and chronic disease burden remain persistent across most jurisdictions (Commonwealth of Australia, 2023).

In all of these factors, Indigenous Australians experience considerably lower rates than non-Indigenous Australians, with the most disturbing being that Indigenous Australians have a drastically lower life expectancy rate and overall health status, than non-Indigenous Australians. For indigenous people, the rate of chronic disease is still 2.5 times higher than that of other Australians and they die 15 to 20 years younger than those in mainstream Australia (AIHW, 2022). More than half of these figures are caused by chronic diseases such as heart disease, stroke, diabetes, chronic respiratory disease and kidney disease. The majority of these chronic diseases are preventable and while research is continuing to find ways to reduce the risk factors, issues such as smoking, alcohol and substance abuse, diabetes, chronic kidney disease, and promoting healthy eating and active lifestyles are still major challenges in Indigenous communities throughout Australia. According to Zhao et al. (2021), cardiovascular disease alone accounts for approximately one-quarter of the mortality gap between Indigenous and non-Indigenous Australians, underscoring the critical need for targeted, culturally appropriate prevention strategies.

Healthy living choices are not easy for people living in remote communities which results in a high incidence of preventable chronic disease. In remote and very remote areas, the cost of fresh fruit and vegetables can be up to three times higher than in metropolitan centres, making nutritional equity practically unattainable for many families on low fixed incomes. Good nutrition is fundamental to the maintenance of general well-being and the prevention of sickness and disease. It plays an imperative role in pregnancy and early childhood, prevents obesity and type 2 Diabetes and can lower the risk of recurrent heart disease by up to 70%. However, remote communities face many barriers to healthy eating, including isolation, the high cost of food, the variable supply of fresh food, lack of community town infrastructure and inadequate health promotion support, are just a few of these barriers that prevent community people from being able to make healthy living choices.

All of these inequalities, combined with the social attitudes towards Indigenous Australians and their health in contemporary Australian society, contribute to the difficulties Indigenous Australians have accessing satisfactory healthcare. The provision of adequate healthcare for Indigenous Australians can be difficult as many service providers do not understand how Indigenous Australians view or understand health and many health services are not as user-friendly or culturally appropriate for Indigenous people as they are for non-Indigenous people. This adds to higher levels of disadvantage and a greater hesitance to utilise these services. Health literacy programs that embed community-controlled Aboriginal health organisations as key delivery partners have shown measurably better uptake and patient retention compared to top-down, government-administered services in several Australian states (Dudgeon et al., 2022). The traditional Indigenous outlook on health is holistic. It integrates everything significant in a person’s life, including land, environment, physical body, community, relationships, and law. Health is the social, emotional, and cultural well being of the whole community and the concept is therefore linked to the sense of being an Indigenous Australian.

Specific issues such as reducing the incidence of chronic disease requires a significantly greater effort in coordinating collective strengths, creating and delivering preventative programs and primary health care for Indigenous communities and while great work is being done, more efforts are required to reduce the high incidence of chronic disease on Indigenous people and communities. When designing and developing services to meet the needs of our Indigenous people, close collaboration and consultation with the people for whom the service will be provided is vital.

It is important to remember that policies and practises of the past have had major adverse impacts on the health of contemporary Indigenous Australians, and these impacts have contributed significantly to the inequalities present in Indigenous and non-Indigenous health status. However, whilst health disadvantages experienced by Indigenous Australians are considered to be historical in origin, the perpetuation of the disadvantages relies heavily on contemporary structural and social factors.

As a result of our history and because of the continuing disadvantage, our people have needs that differ from those of mainstream Australians. Therefore, it is also imperative that we acknowledge and respect the impact of events and issues in Indigenous people’s history when designing and delivering these services.

The role of cultural safety in improving Indigenous health outcomes has gained increasing attention in Australian healthcare policy over the past decade. Cultural safety goes beyond cultural awareness or sensitivity training; it requires health systems to actively examine and address the power imbalances embedded in clinical encounters, administrative structures, and institutional practices that have historically excluded Aboriginal and Torres Strait Islander voices from decision-making. Emerging evidence suggests that community-controlled health organisations (CCHOs) — services designed, governed, and delivered by Indigenous communities — may produce significantly better health outcomes and higher patient satisfaction than mainstream services, particularly for chronic disease management, maternal health, and mental health care (Markwick et al., 2019). The Australian Government’s National Agreement on Closing the Gap (2020) now formally recognises community control as a core mechanism for achieving health equity, yet funding shortfalls and workforce shortages in remote areas continue to limit the reach of these services. Addressing Indigenous health disadvantage therefore requires not only more resources but a genuine structural shift toward self-determination, whereby Aboriginal and Torres Strait Islander communities are empowered to lead, shape, and evaluate the health services that serve them.

References

Australian Institute of Health and Welfare (AIHW). (2022). Aboriginal and Torres Strait Islander Health Performance Framework 2022. Australian Government.

Commonwealth of Australia. (2023). Closing the Gap Annual Data Compilation Report July 2023. Department of Prime Minister and Cabinet. https://www.closingthegap.gov.au

Dudgeon, P., Milroy, H., & Walker, R. (Eds.). (2022). Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice (3rd ed.). Commonwealth of Australia. https://www.telethonkids.org.au/working-together

Markwick, A., Ansari, Z., Sullivan, M., & McNeil, J. (2019). Inequalities in the social determinants of health of Aboriginal and Torres Strait Islander people. Australian and New Zealand Journal of Public Health, 43(3), 207–213. https://doi.org/10.1111/1753-6405.12861

Zhao, Y., Dempsey, K., Longman, J., & Pit, S. (2021). Cardiovascular disease among Aboriginal and Torres Strait Islander peoples in Australia. The Lancet Regional Health – Western Pacific, 9, 100320. https://doi.org/10.1016/j.lanwpc.2021.100320