Faculty/Presenter Disclosure

Jane Freemantle has no relevant financial relationships with the manufacturer(s) of commercial services discussed in this CME activity

Jane Freemantle does not intend to discuss any unapproved/investigational uses of commercial products/services in this presentation.

Social Determinants of Health: Aboriginal and Torres Strait

Islander Peoples7th International Meeting on Indigenous

Child Health March 2017 Associate Professor Jane Freemantle

Melbourne School of Population and Global Health

The First Peoples of AustraliaThe Aboriginal and Torres Strait Islander people-one of the oldest surviving cultures in the world.They have inhabited the continent of Australia for at least 60,000 years.They established ways of managing land and their society that were sustainable and ensured good health.Connectedness to family and community, land and sea, culture and identity are integral to 'health' from an Aboriginal perspective (NAHASWG 1989).

Health of Australian And Torres Strait Islander* PeoplesThe gap in health status between Aboriginal and non-Aboriginal Australians remains unacceptably wide. Successive Australian Governments have identified the imperative of improving the health status of Aboriginal Peoples in Australia.United Nations committees and Australian governments have identified the disparities in health as a human rights concern

*respectfully Aboriginal

The Colonisation of AustraliaCaptain Arthur PhillipThe first fleet - 11 ships and around 1,350 people

The First Australians

January 1788

Social Determinants of Health…..are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources, and systems in place to address the circumstances at global, national and local levels (WHO, 2013)

Social justice….social determinants

“…….. It is awakening in a house with adequate water supply, cooking facilities and sanitation. It is the ability to nourish your children and send them to school where their education not only equips them for employment but reinforces their knowledge and understanding of their cultural inheritance. It is the prospect of genuine employment and good health: a life of choices and opportunity, free from discrimination."Professor Michael Dodson AM, First Report of the Aboriginal and Torres Strait Islander Social Justice Commissioner, 1993

Facts

Australian Government. Department of Prime Minster and Cabinet, Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report

The Australian Institute of Health Welfare reported that selected social determinants such as education, employment status, overcrowding and household income together with risk factors explained up to 46% of the health gap between Aboriginal and non-Aboriginal Australians (AIHW 2014d).

In 2014-15In 2014, Aboriginal and Torres Strait Islander population estimated at 713,600 people (3%); 6% of births are to mothers &/or fathers who identify as Aboriginal and Torres Strait Islander .1

Mortality rate (AS): 1.9 higher; perinatal mortality rate twice as high.1

The national rate of hospitalisation of Aboriginal children aged 0-4 years was higher than the rate for non-Aboriginal children (161 per 1,000 compared with 100 per 1,000 respectively).2

The rate of hospitalisation of Aboriginal children was almost twice as high in remote areas (306 per 1,000)2

Main causes potentially preventable diseases and injuries;2

Facts: health

1. Australian Indigenous HealthInfoNet (2015) Overview of Australian Indigenous health status, 2014. Retrieved [access 24th March 2017e] from http://www.healthinfonet.ecu.edu.au/health‐facts/overviews2. Australian Indigenous HealthInfoNet (2017). Overview of Aboriginal and Torres Strait Islander health status 2016. Retrieved [access 24th March 2017] from http://www.healthinfonet.ecu.edu.au/health‐facts/overviews

Aboriginal children are eight times more likely to develop type 2 diabetes3

The 2012–13 Aboriginal and Torres Strait Islander Health Survey found that 7% of Aboriginal children aged 0–14 across Australia had ear or hearing problems5.

Aboriginal children has one of the highest recorded rates of middle ear disease in the world 5

Facts: Health

3. Australian Institute of Health and Welfare (2014) Type 2 diabetes in Australia’s children and young people: a working paper. (AIHW Catalogue no CVD 64, diabetes series no 21) Canberra: Australian Institute of Health and Welfare5 AIHW Close the Gap Clearing House  Resource sheet no. 35 produced by the Closing the Gap Clearinghouse November 2014 availableathttp://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Our_publications/2014/ctgc‐rs35.pdf accessed March 2017

Facts: EducationThe target of 95% of Aboriginal four-year-olds attending preschool in remote communities by 2013 was not met, with 85% enrolled8.

Literacy and Numeracy (NAPLAN) scores for Aboriginal students across all learning areas in Years 3, 5, 7 and 9 were substantially lower than those for non-Aboriginal students in 2013 (ACARA 2013)9.

In 2011, almost half (49%) of Year 7/8 Aboriginal students stayed at school until Year 12, compared with 81% of non-Aboriginal students9.

8. AIHW 2014. Australia's health 2014. Australia's health series no. 14. Cat. no. AUS 178. Canberra: AIHW Chapter 7 Sction 7.59.. The Conversatiponhttp://theconversation.com/closing‐the‐gap‐in‐education‐report‐card‐needs‐improvement‐37455 accessed 24th March 2017 

Facts: Income & employment

Half of all Aboriginal people aged 15 and over had a personal weekly income of $362 or less in 2011 compared with $582 or less for non-Aboriginal people8. In 2011, 42% of Aboriginal Australians aged 15 and over were employed compared with 61% of non-Aboriginal people 8. Unemployment rates were 17% for Aboriginal Australians and 5% for non-Aboriginal Australians (ABS 2012a)8.

8. AIHW 2014. Australia's health 2014. Australia's health series no. 14. Cat. no. AUS 178. Canberra: AIHW Chapter 7 Section 7.5.

Facts: Housing

Aboriginal households were more than 3 times as likely as other households to be overcrowded

Remote areas (20%   ),Very remote areas (39%   ).7

In 2012–13, despite making up 3% of the population, Aboriginal people represented 22% of people accessing specialist homelessness services.8

7 AIHW 2014. Housing circumstances of Indigenous households: tenure and overcrowding. Cat. no. IHW 132. Canberra: AIHW. Viewed 30 March 2017 <http://www.aihw.gov.au/publication‐detail/?id=60129548060>.8. AIHW 2014. Australia's health 2014. Australia's health series no. 14. Cat. no. AUS 178. Canberra: AIHW Chapter 7 Sction 7.5. 

Aboriginal children were 11 times as likely as non-Indigenous children to be in out-of-home care4

24% of Western Australian Aboriginal children and young people aged 4-17 years were rated by their carers (parent or guardian) as being at high risk of clinically significant emotional or behavioural difficulties compared with 15% of those in the general WA population6

16% of 12-17yr olds had seriously considered ending their own life in the year; 39% of these had attempted suicide6

Facts: socioemotional

4. AIFC Child Family Community Australia https://aifs.gov.au/cfca/publications/child‐protection‐and‐aboriginal‐and‐torres‐strait‐islander‐children accessed 24th March 20176.Zubrick SR, Silburn SR, Lawrence DM, Mitrou FG, Dalby RB, Blair EM, Griffin J, Milroy H, De Maio JA, Cox A, Li J (2005) The social and emotional wellbeing of Aboriginal children and young people: vol 2. Perth: Telethon Institute for Child Health Research and Curtin University of Technology

The rate of Aboriginal infant deaths fell by 62% between 2001 and 2012 (Fig 1)

Aboriginal child death rates fell by 30% from 2001 to 2012 compared with 22% for non-Aboriginal children (Fig 1).8

Improvements infant & child mortality

Fig 1. Aboriginal and non-Indigenous Infant and child mortality, 2001-2012

8 AIHW 2014. Australia's health 2014. Australia's health series no. 14. Cat. no. AUS 178. Canberra: AIHW Chapter 7 Section 7.2.

In 2009, the prevalence of trachoma (in Aboriginal children) was 14%; in 2013, the prevalence was reduced to 4%.

Improvements: health

Trachoma, an eye infection affecting both eyes, is the world's leading cause of preventable blindness.

A significant rise in retention rates for Aboriginal students from Year 7/8 to Years 10, 11 and 12 between 1998 and 2011 (Fig 2)

Significant improvement in reading among Year 5 Aboriginal students, where the proportion who met or exceeded the national minimum standard increased from 65% in 2012, to 83% in 2013. 8

Improvements: educationFig 2. Retention rates of Indigenous schoolchildren, Australia, 1998–2011

Source AIHW 2013

8. AIHW 2014. Australia's health 2014. Australia's health series no. 14. Cat. no. AUS 178. Canberra: AIHW Chapter 7 Section 7.2

The proportion of Aboriginal people aged 20–24 with a Year 12 or equivalent qualification increased from 47% in 2006 to 54% in 2011 (COAG Reform Council 2013).

Improvements: educationFig 3. Aboriginal Year 12 completions, 

Source AIHW 2013

In 1991,it was estimated that there were 3,600 Aboriginal Australian graduates, and this number had risen to over 20,000 in 2006, 30,000 in 2015.10

In 1998 there were twenty Aboriginal medical graduates. At last count there are just over 300, and every year another dozen or so more Aboriginal people enrol in medical training. 10

Positive: education

10. Prof Sir Michael Marmot: 2017 Boyer lectures: Lecture 4 Social Justice and Health

There has been a gradual increase in the rate of home ownership among Aboriginal households: 32% owned their home in 2001, 34% in 2006, and 36% in 2011.11

The proportion of Aboriginal households that were overcrowded fell from 15.7% in 2001 to 12.9% in 2011.11

Substantial increase in Aboriginal employment over the period 1994 to 2008, especially in the private sector.12

Improvements :Home ownership

11. AIHW Indigenous Observatory Housing circumstances of Indigenous households: tenure and overcrowding. http://www.aihw.gov.au/indigenous-observatory/reports/housing-circumstances/ Accessed 24th March 201712. Issues paper no. 3 produced for the Closing the Gap Clearinghouse Matthew Gray, Boyd Hunter and Shaun Lohoar, March 2012 . http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2012/ctg‐ip03.pdf accessed March 2017

Acknowledging that the Aboriginal experience in Australia is one marked by strength and resilience as much as by inequity and disadvantage.Seeking advice from the Aboriginal people in determining what action to initiate, what collaborations to form, what silos must broken down and what directions should be taken in programs, policy and researchIncreasing number of Australian Aboriginal doctors, nurses and allied health professionals and Aboriginal Health workers graduatesShared partnerships and collaborations in research activities, program development and evaluationAboriginal health in Aboriginal hands

Developing the National Aboriginal and Torres Strait Islander Health PlanEmpowered Communities

Way forward

It is not enough to know, you must also use the knowledge; it is not enough to wish, you must also act... Thinking in order to

act, acting in order to think, that is the sum of all wisdom’

Goethe