1.19 Life expectancy at birth

Key facts

Why is it important?

Life expectancy is a useful integrated summary measure of population health (Barnes et al. 2008) and reflects performance against every measure in the Aboriginal and Torres Strait Islander Health Performance Framework. It is one of the most frequently used indicators to assess mortality risks and average longevity for a population group. Life expectancy is a synthetic measure of mortality that has the advantage of allowing for comparisons between different groups (Alameda County Public Health Department 2017; Egidi & Spizzichino 2008). While life expectancy at birth measures how long, on average, a group of people might expect to live, it is not an exact measure of how long individuals will live or how healthy and happy they will be throughout their life (ABS 2018). Cultural wellbeing, for example, is central to the health of Indigenous Australians (AHRC 2015).

Life expectancy reflects the combined effects of socioeconomic factors, health risk behaviours and access to high-quality health care services. Variations in life expectancy not only express the expected differences in population longevity but also are indicators of socioeconomic equity and justice.

In Australia, the life expectancy gap between Indigenous and non-Indigenous Australians represents ‘arguably the most important, and certainly most symbolic, indicator of Indigenous disadvantage’ (Banks 2009). In 2008, the Council of Australian Governments committed to closing the gap in life expectancy between Indigenous and non-Indigenous Australians within a generation (by 2031) (COAG 2008).

The recently established National Agreement on Closing the Gap has identified the importance of ensuring Indigenous Australians enjoy long and healthy lives. The target to close the Gap in life expectancy within a generation, by 2031 remains. A range of indicators will be used to support this target including: all-cause mortality; leading causes of death; and potentially avoidable mortality among others. Reporting arrangements for the new agreement are being established. The data presented in this report predates the establishment of the Agreement.

Findings

What does the data tell us?

In 2015–2017, after adjusting for age structure between the two populations, the gap between Indigenous and non-Indigenous Australians life expectancy was 8.6 years for males and 7.8 years for females. The life expectancy at birth was estimated to be 71.6 years for Indigenous males and 75.6 years for Indigenous females (Table D1.19.1, Figure 1.19.1).

Caution is required in comparing Indigenous life expectancy estimates over time, because of changing Indigenous identification rates across data collections, including the Census. These changes do not occur at the same rate across states and territories and socio-economic groups (PM&C 2020). A higher propensity to identify, especially among Indigenous Australians living in Major cities (where life expectancy is longer), may have influenced overall Indigenous life expectancy results (ABS 2018a).

The 2015–17 life expectancy data is not comparable to previous periods due to changes in the identification of Indigenous status in successive censuses. As such, no time series data has been provided in this measure.

Figure 1.19.1: Life expectancy at birth, by Indigenous status and sex, 2015–2017

Source: Table D1.19.1. Australian Bureau of Statistics 2018. Life tables for Aboriginal and Torres Strait Islander Australians, 2015–2017. ABS Cat no. 3302.0.55.003. Canberra: ABS.

Life expectancy by jurisdiction

Life expectancy for Indigenous Australians varied according to where they were living. Data are available for four jurisdictions that have populations of sufficient size to calculate life expectancy estimates for Indigenous Australians (New South Wales, Queensland, Western Australia and the Northern Territory). In 2015–2017, life expectancy of Indigenous Australians was estimated to be highest in Queensland and lowest in the Northern Territory. Life expectancy was 72.0 years for Indigenous males living in Queensland compared with 66.6 years in the Northern Territory (a difference of 5.4 years). For Indigenous females, life expectancy was 76.4 years in Queensland compared with 69.9 years in the Northern Territory (a difference of 6.5 years) (Table D1.19.1, Figure 1.19.2). Jurisdictional life expectancy estimates are based on linked census and deaths samples that, unlike national estimates presented above, were too small for age adjustment and should be interpreted with caution.

Figure 1.19.2: Life expectancy at birth for Indigenous Australians, by sex and jurisdiction, 2015–2017

Source: Table D1.19.1. Australian Bureau of Statistics 2018. Life tables for Aboriginal and Torres Strait Islander Australians, 2015–2017. ABS Cat no. 3302.0.55.003. Canberra: ABS.

Life expectancy by remoteness

Life expectancy for Indigenous males living in Remote and Very remote areas combined was estimated to be 6.2 years lower than that of Indigenous males living in Major cities (65.9 years compared with 72.1 years) and 6.9 years lower for Indigenous females (69.6 compared with 76.5 years).

While life expectancy for Indigenous Australians decreased with increasing remoteness, life expectancy for non-Indigenous Australians was similar across all remoteness categories. This resulted in an increased life expectancy gap between Indigenous and non-Indigenous Australians as remoteness increased (Table D1.19.3, Figure 1.19.3). Life expectancy estimates by remoteness are based on linked census and deaths samples that, unlike national estimates presented above, were too small for age adjustment and should be interpreted with caution.

Figure 1.19.3: Life expectancy by Indigenous status, sex and remoteness, 2015–2017

Source: Table D1.19.3. Australian Bureau of Statistics 2018. Life tables for Aboriginal and Torres Strait Islander Australians, 2015–2017. ABS Cat no. 3302.0.55.003. Canberra: ABS; ABS unpublished data.

Life expectancy by socioeconomic status

In line with many other measures of health, Indigenous life expectancy varied by socioeconomic status, with those living in the least disadvantaged geographic areas (in this case, the 40% least relatively disadvantaged areas) usually faring better than those living in relatively more disadvantaged areas. Socioeconomic status is measured using the Index of Relative Socio-Economic Disadvantage from the Socio-Economic Indexes for Areas (SEIFA), a set of indexes that rank geographic areas in Australia according to relative socioeconomic advantage and disadvantage (ABS 2018b).

In 2015–2017, life expectancy for Indigenous Australians living in the least socioeconomically disadvantaged areas was estimated to be 72.4 years for males and 76.6 years for females. Life expectancy decreased progressively with decreasing socioeconomic status and was estimated to be 68.2 years for Indigenous males and 72.8 years for Indigenous females living in the most disadvantaged areas. Life expectancy for Indigenous Australians was lower than for non-Indigenous Australians across all SEIFA quintiles. Indigenous life expectancy in the least disadvantaged SEIFA group (top two quintiles) was lower than non-Indigenous life expectancy in the most disadvantaged SEIFA group (Table D1.19.4, Figure 1.19.4).

Figure 1.19.4: Life expectancy, by Indigenous status, sex and Socio-Economic Index for Areas (SEIFA) quintile, 2015–2017

Source: Table D1.19.4. Australian Bureau of Statistics 2018. Life tables for Aboriginal and Torres Strait Islander Australians, 2015–2017. ABS Cat no. 3302.0.55.003. Canberra: ABS.

International comparisons of life expectancy

Internationally, life expectancy has increased greatly over the past few decades. In 2015, the average life expectancy for Organisation for Economic Co-operation and Development (OECD) member countries was 80.6 years, and emerging countries such as India, Indonesia, Brazil and China have also achieved large gains in longevity (OECD 2017). Methods of calculating life expectancy vary internationally, so caution is needed in making comparisons. Higher income per capita is generally associated with higher life expectancy, although there are some variations across countries, for example, the United States had lower life expectancy than other countries with similar incomes. Life expectancy at birth for Indigenous Australians was close to that of the general populations in Latvia and Russia. In New Zealand, there was a life expectancy gap between the Māori and non-Māori populations of 7.3 years for males and 6.8 years for females (Statistics New Zealand 2015).

Figure 1.19.5: Life expectancy at birth, selected countries, 2017

Source: Table D1.19.1. Australian Bureau of Statistics 2018. Life tables for Aboriginal and Torres Strait Islander Australians, 2015–2017. ABS Cat no. 3302.0.55.003. Canberra: ABS. | OECD (2020), Life expectancy at birth (indicator). doi: 10.1787/27e0fc9d-en

Globally, over the period 1950–55 to 2002, average life expectancy at birth increased by almost 20 years (from 46.5 to 65.2 years), representing a global average increase of approximately 0.33 years per year (WHO 2003). Recently, the gains in life expectancy have slowed down in the European Union and some high-income OECD countries.

What do research and evaluations tell us?

Research has found that life expectancy is affected by several factors, including health risk behaviours, socioeconomic factors and environmental factors (such as overcrowded housing and sanitation) (AIHW 2018a; SCRGSP 2016; Zhao et al. 2013). It has been found that:

• Health risk behaviours accounted for half (51%) of the gap in disease burden between Indigenous and non-Indigenous Australians, according to the 2011 Australian Burden of Disease study.
  • Tobacco use was the leading risk factor, accounting for almost one-quarter (23%) of the overall gap in life expectancy between Indigenous and non-Indigenous Australians (AIHW 2016).
• Social determinants account for approximately one-third of the health gap according to estimates based on analysis of the 2011–13 Australian Health Survey data.
  • Education, employment status, overcrowding and household income accounted for around one-third (34%) of the gap in health outcomes between Indigenous and non-Indigenous adults aged 15 to 64 years (AIHW 2018b).

Studies have noted the link between improvements in health services access and chronic disease management and gains in life expectancy among Indigenous Australians:

• Recent life expectancy increases among Indigenous Australians in the Northern Territory, across all adult age groups, were consistent with improved health service access and chronic disease management (Georges et al. 2017).
• In Queensland, 36% of the Indigenous male life expectancy increase and 48% of the Indigenous female life expectancy increase, between 2010–12 and 2015–17, can be attributed to the reduced mortality rate from cardiovascular disease (primarily coronary heart disease and stroke) (State of Queensland 2019).
• In Queensland, reduction in diabetes mortality contributed 0.5 and 0.3 years to the increased life expectancy of Indigenous males and Indigenous females, respectively (State of Queensland 2019).

Over time, life expectancy improvements for Indigenous Australians living in the Northern Territory have shifted from younger to older age groups. Between 1967–1971 and 1980–1984, there were rapid rises in life expectancy through reduced infant mortality. More recently, from 1994–1998 to 2008–2012, there were modest gains in older age groups. The higher mortality of Indigenous Australians living in the Northern Territory aged 35–74 now accounts for 73% of the gap in life expectancy between them and all Australians (Georges et al. 2017).

In recent decades, the predominant causes of death of Indigenous Australians shifted from maternal, perinatal and infectious diseases to chronic diseases (Condon et al. 2004; Zhang & Dempsey 2006). A transition in nutrition from childhood malnourishment and stunting to overeating—often of food high in calories but of poor nutritional quality—is likely to have contributed to the increased prevalence of chronic diseases (Gracey & King 2009). Concurrently, socioeconomic disadvantage, a major factor of the life expectancy gap in the Northern Territory, is contributing as much as half of the difference between Indigenous and non-Indigenous populations (Georges et al. 2017).

This suggests that targeted health care can improve life expectancy, but it will have a limited effect on the life expectancy gap unless socioeconomic disadvantage and its associated risks are also reduced (Georges et al. 2017).

Implications

Successive reports on the target to close the gap in life expectancy by 2031 have shown the target is not on track. Caution is required interpreting trends in this measure due to changes in Indigenous status identification in the datasets required for calculating life expectancy estimates for Indigenous Australians. However, analysis showing the differences in life expectancy within the Indigenous Australian population by remoteness and by socioeconomic status is highly useful for identifying sub-populations with the greatest need.

All the measures within the Health Performance Framework in some way relate to life expectancy as a global measure of health. Continued efforts by governments and Indigenous Australians are needed to address health outcomes and improve life expectancy through actions targeting the antecedents of disease, health risk factors, the social and cultural determinants as well as the performance of the health system to meet the needs of Indigenous Australians.

The new National Agreement on Closing the Gap was developed in partnership between all Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations. This new agreement outlines a better way of working, with governments working in genuine partnership with Aboriginal and Torres Strait Islander people to obtain better outcomes. The National Agreement sets out ambitious targets and new priority reforms that will change the way governments work to improve life outcomes experienced by Indigenous Australians. The National Agreement specifically outlines the following outcome and target to direct policy attention and monitor progress:

• Outcome 1—Aboriginal and Torres Strait Islander people enjoy long and healthy lives.
  • Target—Close the Gap in life expectancy within a generation, by 2031.

The policy context is at Policies and strategies.

References

• ABS (Australian Bureau of Statistics) 2018a. Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017. Canberra: Commonwealth of Australia.
• ABS 2018b. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2016. Cat. no. 2033.0.55.001. Canberra: ABS.
• AHRC (Australian Human Rights Commission) 2015. Close the Gap–Progress and Priorities Report 2017.
• AIHW (Australian Institute of Health and Welfare) 2016. Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Australian Burden of Disease Study series 6. Cat. no. BOD 7. Canberra: AIHW.
• AIHW 2018a. Closing the Gap targets: 2017 analysis of progress and key drivers of change. Canberra: AIHW.
• AIHW 2018b. Australia's Health 2018 (Cat. No. AUS 221; Australia's Health Series No. 16).
• Alameda County Public Health Department 2017. An Introduction to Measures of Mortality: Assessing Overall Health, Cause of Death Rankings, Health-Adjusted Life Expectancy, and Socioeconomic Conditions in Alameda County. Oakland, California.
• Banks G 2009. Are we overcoming Indigenous disadvantage. Reconciliation Australia’s 'Closing the Gap Conversation’ series, National Library, Canberra 7.
• Barnes T, Smith L, Zhao Y & Guthridge S 2008. A comparative analysis of indirect methodologies for estimating Indigenous life expectancy. Darwin: Charles Darwin University.
• COAG (Council of Australian Governments) 2008. Council of Australian Governments' Meeting, Communiqué, 2 October 2008. Council of Australian Governments Perth. 
• Condon J, Barnes T, Cunningham J & Smith L 2004. Demographic characteristics and trends of the Northern Territory Indigenous population, 1966 to 2001. Darwin: Cooperative Research Centre for Aboriginal Health.
• Egidi V & Spizzichino D 2008. Life expectancy: Complex measures of the length and the health related quality of life. Italian Journal of Public Health 5:91-5.
• Georges N, Guthridge SL, Li SQ, Condon JR, Barnes T & Zhao Y 2017. Progress in closing the gap in life expectancy at birth for Aboriginal people in the Northern Territory, 1967–2012. The Medical Journal of Australia 207:25-30.
• Gracey M & King M 2009. Indigenous health part 1: determinants and disease patterns. Lancet 374:65-75.
• OECD 2017. Health at a Glance 2017: OECD Indications. Paris: OECD Publishing.
• PM&C (Department of the Prime Minister and Cabinet) 2020. Closing the Gap Report 2020. February 2020.
• SCRGSP (Steering Committee for the Review of Government Service Provision) 2016. Overcoming Indigenous Disadvantage: Key Indicators 2016. Canberra: Productivity Commission.
• State of Queensland (Queensland Health) March 2019. Closing the gap performance report 2018. Brisbane.
• Statistics New Zealand 2015. New Zealand period life tables: 2012–14. New Zealand: New Zealand Government. 
• WHO (World Health Organization) 2003. The World health report: 2003: shaping the future.
• Zhang G & Dempsey K 2006. Causes of inequality in life expectancy between Indigenous and non-Indigenous people in the Northern Territory, 1981-2000: a decomposition analysis. . Medical Journal of Australia 184:490-4.
• Zhao Y, Wright J, Begg S & Guthridge S 2013. Decomposing Indigenous life expectancy gap by risk factors: a life table analysis. Population Health Metrics 11:1.