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2. Demographic and social context

Aboriginal and Torres Strait Islander Health Performance Framework - Summary report

2. Demographic and social context

According to national population estimates based on the 2016 Census, about 800,000 Australians identified as being Aboriginal and/or Torres Strait Islander in 2016 (ABS 2018a). Preliminary 2021 Census-based estimates indicate that there were 984,000 Aboriginal and Torres Strait Islander people in 2021 (ABS 2021). Final estimates for 2021 are expected to be released in August 2023, with time series data to be released in 2024.

Based on preliminary 2021 Census-based estimates, about 3 in 5 (62%) Indigenous Australians lived in New South Wales and Queensland.

New South Wales

339,546 (34.5 of the Indigenous population of Australia in 2021)

Queensland

273,224 (27.8%)

Western Australia

120,037 (12.2%)

Northern Territory

76,736 (7.8%)

Victorian

78,698 (8.0%)

South Australian

52,083 (5.3%)

Tasmanian

33,894 (3.4%)

Australian Capital Territory

9,544 (1.0%)

 

The information by remoteness that follows is based on 2016 Census-based estimates, as estimates based on the 2021 Census are not yet available. This will be updated in late 2023, once estimates based on the 2021 Census are available.

Most Aboriginal and Torres Strait Islander people (around 3 in 5) lived in Major cities and Inner regional areas in 2016, 1 in 5 lived in Outer regional areas, and nearly 1 in 5 lived in Remote or Very remote

Within remoteness areas, Indigenous Australians account for varying proportions of the total population, ranging from 2% in Major cities to 47% in Very remote areas in 2016 (Table 2.1).

Table 2.1: Indigenous population by remoteness area, 2016

Remoteness area

Number

Number as % of Indigenous population

Number as % of total population

Major cities

298,430

37.4

1.7

Inner regional

189,414

23.7

4.4

Outer regional

161,792

20.3

7.9

Remote

53,507

6.7

18.2

Very remote

95,222

11.9

47.2

Source: HPF Table D2 – AIHW analysis of Australian Bureau of Statistics (ABS) population estimates based on 2016 Census.

The Indigenous population is relatively young (Figure 2.1). In 2016, about 1 in 3 (34%) Indigenous Australians (274,300) were aged under 15, compared with fewer than 1 in 5 (18%) non-Indigenous Australians.  

Figure 2.1: Age structure of Indigenous and non-Indigenous populations, 2016

This figure shows the age structure of the Australian Indigenous and non-Indigenous populations in 2016 with 5-year age groups. The first bar chart shows that for Indigenous Australians, the population generally decreases with age. The second bar chart shows that for non-Indigenous Australians, the largest proportion of population is in the 25–29 and 30–34 age groups. Comparison of the two charts shows that the Indigenous population has a younger age profile than the non-Indigenous population. This figure shows the age structure of the Australian Indigenous and non-Indigenous populations in 2016 with 5-year age groups. The first bar chart shows that for Indigenous Australians, the population generally decreases with age. The second bar chart shows that for non-Indigenous Australians, the largest proportion of population is in the 25–29 and 30–34 age groups. Comparison of the two charts shows that the Indigenous population has a younger age profile than the non-Indigenous population.

Source: HPF Table D3 – AIHW analysis of ABS population estimates based on 2016 Census.

Cultural and social determinants

There is evidence that cultural factors – country and caring for country, knowledge and beliefs, language, self-determination, family and kinship, and cultural expression – can be protective, and positively influence Aboriginal and Torres Strait Islander people’s health and wellbeing (Bourke et al. 2018).

The Mayi Kuwayu Study of Aboriginal and Torres Strait Islander Wellbeing aims to provide more evidence of how culture is related to Aboriginal and Torres Strait Islander people’s health and wellbeing (Australian National University 2020; Thurber et al 2022).

In contrast to cultural protective factors, racism or racial discrimination are associated with poorer physical and mental health (see, for example, Paradies et al. 2014; Priest et al. 2011. Colonisation is recognised as having a fundamental impact on disadvantage and health among Indigenous peoples worldwide, through social systems that maintain disparities (see, for example, Paradies et al. 2016; Paradies Yin C & Cunningham 2012).

Racism can be interpersonal (such as through exclusion, abuse, or stereotyping), or systemic (through policies, conditions, and practices).

Experiences of racism can have an impact on health through:

  • reduced access to social resources, including employment, education, housing, health care, and other services
  • psychological distress and increased likelihood of engaging in risk behaviours, such as substance use
  • injury from assault (Paradies Yin C & Cunningham 2012).

In 2017, the Australian Government released My life my lead—opportunities for strengthening approaches to the social determinants and cultural determinants of Indigenous health: report on the national consultations. These consultations provided an opportunity for Indigenous communities and leaders, governments, the non-government and private sectors to inform the refreshed National Aboriginal and Torres Strait Islander Health Plan 2021-2031 (released December 2021).

My life my lead—report on the national consultations

In 2017, the Australian Government released My life my lead—opportunities for strengthening approaches to the social determinants and cultural determinants of Indigenous health: report on the national consultations. Four main themes emerged from the consultations:

  • Culture is central to the wellbeing of Aboriginal and Torres Strait Islander people, and needs to be an integral part of Aboriginal and Torres Strait Islander and mainstream services.
  • Racism within health and other systems must be addressed to remove barriers and achieve better outcomes in health, education, and employment.
  • The effects of trauma across generations of Aboriginal and Torres Strait Islander people must be acknowledged and addressed.
  • Governments need to support long-term, coordinated, placed-based approaches that honour community priorities and embed participation (Department of Health 2017).

Health is also influenced by social determinants – the circumstances in which people grow, live, work, and age (Commission on Social Determinants of Health 2008) – and individual health risk factors. Income, employment, and education are key social determinants of health that account for a large part of the disparity in Indigenous and non-Indigenous health outcomes. Obesity and smoking are key health risk factors. Section 5 looks at these and other social determinants of health and risk factors.

Recent events

During 2020, two major events with global effects occurred – the COVID-19 (coronavirus disease 2019) pandemic, and the Black Lives Matter protests that followed the death of George Floyd, a 46-year-old African American man, during a police arrest in the United States.

In Australia, there were concerns about the potential impact of COVID-19 on Aboriginal and Torres Strait Islander communities, particularly in remote areas. Black Lives Matter rallies in Australia protested against racism and deaths in police custody of Aboriginal and Torres Strait Islander people.

The pandemic and the protests have highlighted inequities in health and justice outcomes between Indigenous and non-Indigenous Australians. These events have also drawn attention to disparities in living conditions – including education, employment and housing – that are related to health and justice outcomes (Marmot et al. 2008; Pricewaterhouse Coopers 2017).

In Australia, 2020 also saw the signing of the National Agreement on Closing the Gap. This agreement is based on governments and Aboriginal and Torres Strait Islander people working in partnership and sharing decision-making to support better health and wellbeing outcomes among Indigenous Australians.

The data presented in this summary report largely reflects the ‘pre-COVID’ situation. But the COVID-19 pandemic and response, and the Black Lives Matter protests, have highlighted recurring themes from Indigenous health policy and research in Australia over the past three decades, including:

  • continuing health inequalities between Indigenous and non-Indigenous Australians
  • broader social inequalities between Indigenous and non-Indigenous Australians in areas that can affect health, including housing, education, employment, income, and access to adequate health care and other goods and services
  • how well the health system serves the needs of Indigenous Australians
  • how governments can work in partnership and share decision-making with Aboriginal and Torres Strait Islander communities and leadership in identifying and responding to health priorities.

More recently, in 2023, Australia is experiencing high levels of inflation, with increased cost of living and higher interest rates impacting on housing costs and household disposable income (Reserve Bank of Australia 2023).

COVID-19 among Indigenous Australians

During the first 18 months of the pandemic (January 2020 to June 2021), 171 cases of coronavirus disease 2019 (COVID-19) were confirmed among Aboriginal and Torres Strait Islander people (Indigenous Australians), representing less than 1% of all cases in Australia. Case numbers began increasing after this period, due to outbreaks of the Delta and then the Omicron variants.

By the end of 2021, the cumulative number of cases among Indigenous Australians was around 14,400 (AIHW 2022e).

In the subsequent Omicron wave, from 15 December 2021 to 23 October 2022, there have been 316,068 cases of COVID-19 notified for Indigenous Australians (3.5% of all cases in Australia) (Department of Health and Aged Care 2022).

Note that the accuracy of counts of COVID-19 cases has varied over the course of the pandemic, and there has also been variation in the proportion of cases of COVID-19 for which Indigenous status was missing: 3% of records when there were relatively few new cases in Australia; at least 19% between September and December 2021; just under half (49%) by mid-January 2022; and 20% by 10 April 2022

As at 23 October 2022, 279 deaths had been reported among Indigenous Australians, and 521 cases had been admitted to ICUs (Department of Health and Aged Care 2022) . The overall rate of severe disease (defined as ICU admission or death) for Indigenous Australians during the Delta wave (16 June to 14 December 2021) was 16.5 per 100,000, and rose to 76.3 per 100,000 by 23 October 2022 during the Omicron wave (Department of Health and Aged Care 2022). Based on surveillance data supplied by the Department of Health and Aged Care, the rate of severe disease during the Omicron wave to 3 July 2022 for Indigenous Australians was 1.4 times as high compared with non-Indigenous Australians (54.0 per 100,000 compared with 37.8 per 100,000 respectively).

For more information on the course of the pandemic among Indigenous Australians, including changes in the use of health services, see Australia’s Health 2022: Data insights.

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