2.01 Housing

Key facts

Why is it important?

Housing circumstances—such as tenure, affordability, the amount of living space and location—are key determinants of physical and mental health (Foster et al. 2011; Marsh et al. 2000). However, causal relationships between poor housing and poor health are complex, and directionality is not always clear. For example, poor housing circumstances can contribute to poor health, and poor health can result in households living in worse housing circumstances (Brackertz & Wilkinson 2017).

There are also indirect relationships between housing circumstances, health and socioeconomic factors such as education, income and employment (Thomson et al. 2013). Overcrowding, insecure housing tenure and homelessness have been found to adversely affect school attendance and attainment (Brackertz 2016), (Biddle 2014). Housing tenure and affordability have been found to have negative effects on children’s physical health, learning outcomes and social and emotional wellbeing (Dockery et al. 2013).

The recently established National Agreement on Closing the Gap has identified the importance of addressing appropriate and affordable housing with a specific outcome and target to direct policy attention and monitor progress. Reporting arrangements for the new agreement are being established. The data presented in this report predate the establishment of this target.

Findings

What does the data tell us?

Housing tenure

Results from the 2018–19 National Aboriginal and Torres Strait Islander Health Survey (Health Survey) showed that Indigenous Australians were less likely to live in a home owned by a member of the household and were more likely to rent social housing when compared with non-Indigenous Australians.

In 2018–19, 31% (151,560) of Indigenous adults lived in households that were owned or being purchased by a household member (referred to as home owners), 34% rented through social housing (i.e., state or territory housing authority or community housing), and another 33% rented privately through a real estate agent or other arrangements. For non-Indigenous adults, 68% were home owners, 24% rented through a real estate agent or other arrangements, and 3% rented through social housing (Table D2.01.20, Figure 2.01.1).

The proportion of Indigenous adults who were home owners increased from 2002 to 2018–19, from 27% to 31%. For the same period, the proportion of Indigenous Australians who rented privately or through other arrangements increased from 24% in 2002 to 33% in 2018–19. Indigenous adults renting through social housing providers decreased from 45% to 34% between 2002 and 2018–19 (Table D2.01.20).

Figure 2.01.1: Tenure type of persons aged 18 and over, by Indigenous status, 2018–19

Source:  Table D2.01.20. AIHW and ABS analysis of National Aboriginal and Torres Strait Islander Health Survey 2018–19 and National Health Survey 2017–18.

Similar to non-Indigenous Australians, older Indigenous adults were more likely to be home owners than younger Indigenous adults and less likely to rent from a real estate agent. In 2018–19, the proportion of Indigenous adults who were home owners was lowest for those aged 18–34 (25%) and highest for those aged 55 and over (42%). The proportion of Indigenous adults renting privately was highest for those aged 18–34 (40%) and lowest for those aged 55 and over (20%) (Table D2.01.14).

The proportion of Indigenous Australians renting social housing did not change much with age, ranging from 31–37% across all age groups. There was also little variation by age group for non-Indigenous Australians renting social housing (2–4%) (Table D2.01.14).

Housing tenure for Indigenous adults varied by remoteness. In 2018–19, the majority of Indigenous adults in Non-remote areas were either home owners (36%) or renting through a real estate agent (37%). The majority of Indigenous adults in Remote areas rented from a social housing provider (71%), noting that in many remote areas it is not possible for Indigenous Australians to own their homes (Table D2.01.13, Figure 2.01.2).

Figure 2.01.2: Household tenure type and landlord type, Indigenous Australians aged 18 and over, by remoteness, 2018–19

Source: Table D2.01.13. AIHW and ABS analysis of National Aboriginal and Torres Strait Islander Health Survey 2018–19.

Overcrowding

Overcrowding, according to the Canadian National Occupancy Standard (CNOS), is defined as a situation in which one or more additional bedrooms would be required to adequately house its inhabitants, given the number, age, sex and relationships of household members (AIHW 2014a). Data for overcrowding is collected in two forms:

• The 2018–19 Health Survey regards individual people. The values given represent the proportion of people in the population estimated to live in a household that is considered overcrowded.
• The 2016 Census regards households, which are defined as one or more persons, at least one of whom is at least 15 years of age, usually resident in the same private dwelling. Under this definition, all occupants of a dwelling form a household and complete one form. The values given represent the proportion of households considered overcrowded.

In 2018–19, Indigenous Australians were 3.7 times as likely to be living in overcrowded conditions as non-Indigenous Australians. Eighteen per cent (145,340) of Indigenous Australians were living in housing considered overcrowded, compared with 5% of non-Indigenous Australians. The 2018–19 rate represented a decline in overcrowding since 2004–05, when almost 27% of Indigenous Australians lived in overcrowded households. This reduction in overcrowding also represented a narrowing in the gap between Indigenous and non-Indigenous Australians (from a gap of 22 percentage points to 13 percentage points) (Table D2.01.11, Figure 2.01.3).

In terms of households, data from the 2016 Census showed that the proportion of overcrowded Indigenous households was also around 3 times the rate of non-Indigenous households—10% of Indigenous and 4% of Other (non-Indigenous and Indigenous status not stated) households were overcrowded (Table D2.01.6).

Figure 2.01.3: Persons living in overcrowded households, by Indigenous status, 2004–05, 2008, 2012–13, 2014–15 and 2018–19

Source: Table D2.01.11. AIHW and ABS analysis of National Aboriginal and Torres Strait Islander Health Survey 2004–05, 2018–19; National Health Survey 2004–05, 2007–08, 2014–15, 2017–18; National Aboriginal and Torres Strait Islander Social Survey 2008, 2014–15; Australian Aboriginal and Torres Strait Islander Health Survey 2012–13 and Australian Health Survey 2011–12.

The 2018–19 Health Survey found that, in terms of people, overcrowding was highest for Indigenous Australians in the Northern Territory, where 51% (37,000) of Indigenous Australians lived in overcrowded households. Other states and territories ranged from 8% (600) of Indigenous Australians living in overcrowded households in the Australian Capital Territory to 20% (44,600) in Queensland. For non-Indigenous Australians, the proportion living in overcrowded households was highest in Victoria (7% or 412,000), and lowest in Western Australia (2% or 48,900) (Table D2.01.2, Figure 2.01.4).

The 2016 Census found that, in terms of households, around one-third of Indigenous households (34%) compared with 5% of Other households in the Northern Territory were overcrowded (Table D2.01.6).

Figure 2.01.4: Persons living in overcrowded households, by Indigenous status and jurisdiction, 2018–19

Source: Table D2.01.2. AIHW and ABS analysis of National Aboriginal and Torres Strait Islander Health Survey 2018–19 and National Health Survey 2017–18.

In 2018–19, the proportion of Indigenous adults living in overcrowded households was highest in Very remote areas (51%) and lowest in Inner regional areas (8%) (Table D2.01.1, Figure 2.01.5).

In 2018–19, Indigenous Australians living in Remote and Very remote areas of the Northern Territory (63%) and Queensland (34%) were more likely to live in overcrowded households than those living in Remote and Very remote areas of other jurisdictions. New South Wales had the lowest proportion of Indigenous Australians in Remote and Very remote areas living in overcrowded households (15%) (Table D2.01.2).

Figure 2.01.5: Proportion of Indigenous Australians (all ages) living in overcrowded households, by remoteness, 2018–19

Source:  Table D2.01.1. AIHW and ABS analysis of National Aboriginal and Torres Strait Islander Health Survey 2018–19.

Overcrowding can put stress on household infrastructure and affect physical and mental health (AIHW 2014). The proportion of Indigenous adults who reported overcrowding as a stressor declined significantly from 21% in 2002 to 7% in 2014–15. This change was greatest in Remote and Very remote areas, declining from 42% in 2002 to 9% in 2014–15 (Table D2.01.23).

According to the widely used density model of overcrowding—the CNOS—dwellings requiring at least one additional bedroom are considered overcrowded. In general, this model is a useful tool for assessing overcrowding. However, some studies have questioned whether CNOS is the appropriate method for measuring overcrowding within the Indigenous context due to the Indigenous-specific cultural and behavioural factors (Memmott Paul et al. 2011). Nevertheless, overcrowding, which causes stress to household members and pressure on dwelling facilities and resources, is a significant issue among Indigenous Australians. Of more concern is the high prevalence of Indigenous Australians living in severely crowded dwellings (that is, dwellings that needed four or more extra bedrooms). The 2016 Census showed that 16,400 Indigenous people (70% of all Indigenous people experiencing homelessness) were living in severely crowded dwellings—a rate of 253 people per 10,000 Indigenous people, compared with 16 per 10,000 for non-Indigenous people (AIHW 2019a).

Homelessness

The 2016 Census found that Indigenous Australians accounted for one-fifth of the homeless population nationally (20% or 23,440 people); that is, among people whose dwelling is considered inadequate, they have no tenure or their initial tenure is short and not extendable, and they have no control of and access to space for social relations. The 2016 rate was down from 26% in 2011. The 2016 Census found that of the total Indigenous population (649,000) 3.6% or 23,440 were homeless, a rate of 361 per 10,000. This decreased from 4.9% (26,700) or 487 per 10,000 in 2011 (ABS 2016.).

Of homeless Indigenous Australians in 2016, 70% (down from 75% in 2011) were living in severely crowded dwellings (needing four or more extra bedrooms under CNOS), 12% were living in supported accommodation for the homeless, and 9% were living in improvised tents or sleeping out (AIHW 2019b). This compares with non-Indigenous homeless people, of whom in 2016, 42% were living in severely crowded dwellings, 15% were in supported accommodation, and 6% were in improvised dwellings, tents or sleeping out (ABS 2016.).

• Of Indigenous Australians aged 15 and over, in 2014–15, 4 in 10 (41%) had experienced not having a permanent place to live. Among these, the reasons included problems with family, friends or relationships (40%) and having just moved back into a town or city (22%) (Table D2.01.27).

Governments across Australia fund a range of specialist services to support people who are homeless or who are at risk of homelessness (AIHW 2019b). In 2018–19, over 1 in 4 specialist homelessness services clients were Indigenous Australians; this was 68,850 people. The rate of services use by Indigenous Australians was 9 times the rate of non-Indigenous Australians (835 compared with 92 per 10,000), after adjusting for differences in the age structure between the two populations (Table D2.01.30).

The majority of Indigenous clients accessing services were females (61%). More than 1 in 5 Indigenous clients (22%) were children aged 0–9—a rate of use of 796 per 10,000 Indigenous children in that age range (Table D2.01.21, Figure 2.01.6).

Figure 2.01.6: Specialist homelessness services clients, by Indigenous status and age, 2018–19

Source:  Table D2.01.21. Specialist Homelessness Services Collection 2018–19.

More than half of Indigenous clients (55%) presented to homelessness services alone, and 35% were single adults with children. For non-Indigenous clients, the proportions were 64% and 27%, respectively (Table D2.01.22).

Domestic and family violence was the most common reason for seeking specialist homelessness services for both Indigenous (24%) and non-Indigenous (27%) Australians (Table D2.01.31).

The rate of use of specialist homelessness services for Indigenous Australians was highest in Victoria (1,599 per 10,000) and lowest in Tasmania (310 per 10,000) (Table D2.01.30, Figure 2.01.7).

Figure 2.01.7: Specialist homelessness services clients, Indigenous Australians, by jurisdiction, 2018–19

Source:  Table D2.01.30. Specialist Homelessness Services Collection 2018–19.

Of Indigenous clients who were homeless at the beginning of their first support period, 37% had been living in short-term temporary accommodation, 31% had been ‘couch surfing’ and 13% had been living without shelter. Among non-Indigenous clients who had been homeless before accessing support, 39% had been living in short-term temporary accommodation, 26% had been ‘couch surfing’, and 15% had been living without shelter (Table D2.01.32).

What do research and evaluations tell us?

The research explores several critical concerns about housing and its intersection with health and wellbeing. These are explored in further detail below:

• Overcrowding—Overcrowding and the associated health implications can emerge from an insufficient supply of housing, inadequate housing and community design, and poor housing conditions (Clifford et al. 2015). Overcrowded housing conditions can facilitate poor hygiene and the spread of infectious diseases (Clifford et al. 2015) and put additional pressure on facilities and infrastructure thereby limiting the ability of residents to employ 'healthy living practices' (Bailie & Wayte 2006) (see measure 2.02 Access to functional housing with utilities).
• Homelessness—Homelessness is directly linked to experiences of domestic violence, alcohol and drug problems, financial hardship and unmet need for public housing (Graham et al. 2014; Memmott et al. 2012). There are also strong interrelationships between homelessness and mental health. While a mental health episode can trigger homelessness, the isolation and trauma of homelessness (in particular that associated with rough sleeping) can also precipitate mental illness (Brackertz et al. 2018).
• Home ownership—Home ownership can provide various indirect health and socioeconomic benefits beyond simple security of tenure. For example, Fichera and Gathergood (Fichera & Gathergood 2016) found strong evidence that increases in wealth from rising house prices reduce non-chronic health conditions and improve self-assessed health. Their analysis suggests that increased wealth does not improve physical health through improved mental health, but through individuals being able to reduce their intensity of work.
• Affordability—Affordability of housing is an issue across different types of tenure in Australia. A lack of housing affordability can create stress, which affects a person’s sense of stability and control in their lives (Foster et al. 2011).

It is important to note that Indigenous Australian experiences of homelessness and overcrowding may differ from common statistical measures. For example, homelessness for some Indigenous Australians may include disconnection with one’s homeland or kinship networks, contrary to official statistics that may be based on characteristics of one’s typical living arrangements (Australian Bureau of Statistics 2014; AIHW 2014b). Some Indigenous Australian public space dwellers who chose to ‘live rough’ may not necessarily see themselves as homeless (Memmott et al. 2003).

The Remote Housing Review in 2017 (PM&C 2017) noted that while significant progress in reducing overcrowding has been made, a range of ongoing issues still needed to be addressed. For example, the Review estimated, after accounting for population growth, an additional 5,500 homes are required by 2028 to reduce levels of overcrowding in Remote areas to more acceptable levels. Half of the additional need is in the Northern Territory alone.

An evaluation of the Housing for Health Program found that those who received the Housing for Health intervention had a significantly reduced rate of hospital separations for infectious diseases—40% less than the hospitalisation rate for the rest of the rural New South Wales Aboriginal population without the Housing for Health interventions (NSW Department of Health 2010, 2019).

Bailie and colleagues (Bailie et al. 2011) supported existing Australian and international literature in their claim that housing programs that are focused on improving the functional state of the infrastructure have a limited effect on housing-related health risks, such as domestic hygiene, at the community level. For example, levels of overcrowding may remain high despite improvements to physical infrastructure, enabling poor domestic hygiene to persist. The authors propose hygiene promotion programs as important complementary initiatives to infrastructure improvement projects.

Implications

While there have been improvements in overcrowding, home ownership and a reduction in homelessness, there is a continued need for public policy that aims to ensure access to affordable, safe and sustainable housing for Indigenous Australians.

Remote housing programs have delivered improvements, but the persistent high rate of overcrowding in Remote areas show there is a long way to go. Involving communities in the design, construction and maintenance of housing can build capacity for improved housing-related health outcomes (Ware 2013).

The new National Agreement on Closing the Gap was developed in partnership between Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations. The Agreement has recognised the importance of addressing appropriate and affordable housing by establishing the following outcome and target to direct policy attention and monitor progress:

• Outcome 9 — Aboriginal and Torres Strait Islander people secure appropriate, affordable housing that is aligned with their priorities and need.
  • Target — By 2031, increase the proportion of Aboriginal and Torres Strait Islander people living in appropriately sized (not overcrowded) housing to 88 per cent.

Home ownership, particularly when in established housing markets, can lead to greater economic opportunities and create wealth for Indigenous Australians. However, there are also unique challenges in purchasing a home on Indigenous land, which all jurisdictions have a role in addressing (Select Council on Housing and Homelessness 2013).

Mainstream public housing and community housing services offered in Non-remote areas should be flexible in supporting Indigenous tenants to achieve and maintain tenancies by recognising that cultural values, kinship obligations and practices can affect the ability of tenants to comply with tenancy requirements. Inflexible and coercive tenancy requirements that lack formal incentives could disadvantage Indigenous Australian tenants. More flexible approaches could be effective, such as having culturally competent housing staff empowered to work locally with Indigenous tenants in constructive ways (Memmott et al. 2016). Flexible approaches could reduce the risk of evictions and entry into homelessness. The Wongee Mia project is an example of an innovative approach to working with the extended family’s needs rather than just the individual to prevent unnecessary eviction, including providing case-worker support and housing for other family members (Vallesi et al. 2020).

Specialist homelessness services have improved the rate at which Indigenous homeless clients were assisted into stable housing from 29% in 2012–13 to 38% in 2017–18 (AIHW 2019a). As these clients often have characteristics that make them particularly vulnerable, such as having experienced domestic violence, mental health issues, and drug and alcohol issues, it is important that housing, health and other services collaborate so that housing instability does not exacerbate these issues further. Not only should these services collaborate, but they should also be culturally appropriate.

A number of programs in Australia have been implementing a ‘Housing First’ approach that prioritises safe and permanent housing as a foundation for assisting an individual’s other health and social needs. This contrasts with the alternative approach that assists people to be ‘housing ready’ by addressing those other needs first. An international study of homeless people with disabilities found that ‘Housing First’ programs are more effective than programs that require clients to be ‘housing ready’ in terms of improved housing stability, reduced homelessness, health benefits and reduced health service use (Peng et al. 2020).

This measure has not fully explored Indigenous Australians’ use of social housing services, particularly in Non-remote areas, but this may be explored in future editions. The data have shown an increase in the rate of Indigenous Australians renting privately and a decline in the rate of those renting through social housing. Further research is needed to understand these changes and their effects, such as the influence of declines in the availability of social housing and the financial implications for Indigenous Australians that have moved to private rental arrangements.

The policy context is at Policies and strategies.

References

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