8.1 Overview
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Two distinct Indigenous populations inhabit Australia. Initially, Aboriginal peoples lived throughout mainland Australia, Tasmania, and on many offshore islands, while Torres Strait Islanders inhabited the northernmost peak of the Australian mainland and the islands of the Torres Strait scattered between Cape York Peninsula and Papua New Guinea.1, 2 Both groups are now less clearly defined by geography, many Torres Strait Islanders having moved to mainland Australia for economic reasons,1 and the Torres Strait region now being home to a substantial population of individuals of both Torres Strait Islander and Aboriginal origin.2 Although the original languages, culture and customs of the Torres Strait Islander people have been less affected by European influence than those of Aboriginal peoples, over the years their geographical location has enabled contact with people from other world regions, such as south-east Asia, Japan, and the Pacific Islands.2
Combined, the Aboriginal and Torres Strait Islander populations make up 2.3% of the Australian population, numbering an estimated 455,031 in 2006.3 Those of Aboriginal origin account for 90% of the total Indigenous population, and Torres Strait Islanders comprise 6% of the total Indigenous population. The remaining 4% are of combined Aboriginal and Torres Strait Islander descent.4 The majority (70%) of the Aboriginal and Torres Strait Islander populations live outside major urban centres, with one in four members of these communities living in remote regions compared with one in 50 non-Indigenous Australians.4 More than half of all Indigenous people reside either in New South Wales or in Queensland (29% and 27% respectively). The Northern Territory is home to 12% of the Indigenous population, but has the highest proportion of residents of Aboriginal and Torres Strait Island origin (29%). In all other states and territories, the combined Indigenous population comprises less than 4% of the total resident population.4
Aboriginal peoples and Torres Strait Islanders are by far the most disadvantaged subgroup in the Australian population, according to a broad range of social indicators. Their median income is just more than half that (55%) of non-Indigenous persons.5 They are more likely to occupy overcrowded or otherwise substandard housing, to be unemployed, to attain lower levels of education and gain poorer access to facilities and services than other Australians.4, 5 Members of these populations are also more likely to meet with violence, and to come into contact with the criminal justice system as victims or offenders. Aboriginal peoples and Torres Strait Islanders are over-represented in the prison system.4 5 In general, level of disadvantage suffered increases with remoteness of dwelling.4 Contributing to and compounding these adverse outcomes are the ongoing traumas of dispossession, cultural dislocation, racism and separation of families experienced by many individuals and communities.1, 6, 7
Resulting in large part from these privations, Aboriginal peoples and Torres Strait Islanders suffer significantly worse health outcomes than the rest of the Australian population as a whole.4 Much of the burden of ill health is attributable to chronic diseases, including diabetes, heart and respiratory conditions. For the period 1996–2001, life expectancy at birth for members of Aboriginal and Torres Strait Islander communities was estimated to be 59 years for males and 65 years for females, compared to 77 years for males and 82 years for females for all Australians.4 More than half (54%) of Indigenous men and 41% of Indigenous women die before they reach the age of 50.8
Excess patterns of ill health are not unique to Australia's Indigenous peoples. Indigenous populations in New Zealand, North America and Canada have also experienced significantly higher mortality rates than the overall population in these countries. However the reductions in health inequality seen in these countries since the 1970s are not apparent in Australia. 9
Several possible obstacles contributing to the lack of progress in Indigenous health have been identified. Ongoing social and economic inequities remain clear barriers to improved health, which could be relieved by substantial progress in five major areas:10
- Infrastructure (including land, housing, water supply, education, income)
- Self-determination of health services
- Access to a network of community-controlled primary health care services delivering effective health services for priority issues
- The allocation of adequate resources
- Training and deployment of an appropriately skilled workforce.
Addressing macro or 'upstream' factors—the broader social, physical, economic and environmental influences which to a large extent determine health status11—is critical to improving the health of Australia's Aboriginal peoples and Torres Strait Islanders.12 Less tangible but nonetheless significant factors contributing to poor health status in the Aboriginal and Torres Strait Islander communities also include a loss of hope, sense of control and self-determination resulting from a history of colonial paternalism, dispossession, separation, assimilation, cultural loss and most fundamentally, the lack of formal recognition of traditional ownership of the land.9, 13-15 Without proper acknowledgement of this history, the cumulative effects of which are in great measure responsible for the poor health status of Australia's diverse Indigenous populations, sustainable solutions will not be found.16, 17
Addressing Indigenous inequalities in health is a national priority, and the role of licit and illicit substance use in affecting health and social welfare in Aboriginal and Torres Strait Islander peoples has been recognised by the National Drug Strategy,18 under which specific Action Plans have been developed to help support action against drugs in these diverse communities,2, 15, 19 and successive National Tobacco Strategies.20, 21
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