Why is it important?
There is a strong relationship between health and social determinants, such as low socioeconomic status, in Australia and other developed countries (Marmot M. 2015; Turrell & Mathers 2000). People of lower socioeconomic status tend to bear a significantly higher burden of disease (AIHW 2016). The links between different forms of socioeconomic disadvantage such as poverty, unemployment, poor education, social dysfunction, stress, social exclusion, racism and poor health are well established and documented (Marmot M. 2015; Paradies 2006; Sassi 2009; Saunders & Davidson 2007). The association between socioeconomic disadvantage and health can explain a substantial part of the health gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians (Booth & Carroll 2008).
That said, for many Indigenous Australians, their culture, community and history also plays a fundamental part in their health and wellbeing. As Professor Ngiare Brown stated:
We represent the oldest continuous culture in the world, we are also diverse and have managed to persevere despite the odds because of our adaptability, our survival skills and because we represent an evolving cultural spectrum inclusive of traditional and contemporary practices. At our best, we bring our traditional principles and practices— respect, generosity, collective benefit, and collective ownership— to our daily expression of our identity and culture in a contemporary context. When we are empowered to do this, and where systems facilitate this reclamation, protection and promotion, we are healthy, well and successful and our communities thrive (Brown 2012).
Therefore, the index of disadvantage only reflects some aspects of the wellbeing for Indigenous Australians.
Socioeconomic indexes bring together a composite measure of advantage and disadvantage status and provides a broad basis for tracking progress in addressing Indigenous disadvantage across the spectrum of determinants of health.
Socio-Economic Indexes for Areas
The Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) ranks areas from most disadvantaged to most advantaged.
In 2016, Indigenous Australians were over-represented in areas ranked as the most disadvantaged quintiles by the SEIFA and under-represented in the other areas. Close to 5 out of 10 Indigenous Australians (47%) lived in areas ranked in the most disadvantaged quintile (the lowest-ranked 20% of areas), compared with fewer than 2 in 10 (18%) non-Indigenous Australians. Close to 1 in 20 (5.1%) lived in areas ranked in the most advantaged quintile (the highest-ranked 20% of areas), compared with 4 in 20 (22%) non-indigenous Australians (Table D2.09.2, Figure 2.09.1).
Figure 2.09.1: Population distribution by SEIFA advantage/disadvantage decile, by Indigenous status, 2016
In all states and territories in 2016, a greater proportion of the Indigenous Australian population lived in the most disadvantaged quintile compared with non-Indigenous Australians. The highest proportion of Indigenous Australians living in areas in the most disadvantaged quintile (the lowest-ranked 20% of areas) was the Northern Territory (66%), which was 10 times the rate of non-Indigenous Australians (6.7%). The Australian Capital Territory had the highest proportion of Indigenous Australians (36%) who lived in areas in the most advantaged quintile in the country, and the lowest was in Tasmania (1.3%) (Table D2.09.2, Figure 2.09.2).
Figure 2.09.2: Population distribution by SEIFA advantage/disadvantage quintile, Indigenous population, by jurisdiction, 2016
Comparable data was also collected in the 2011 Census of Population and Housing. Between 2011 and 2016, there was a 4.9 percentage point decrease in the proportion of Indigenous Australians living in the most disadvantaged quintile (51.6% compared with 46.7%). Across this period, the proportion living in the other four quintiles increased slightly, from between 0.4 to 0.9 percentage points. By jurisdiction, the greatest reduction to the proportion of Indigenous Australians living in the most disadvantaged quintile was in the Northern Territory (7.6 percentage points), followed by New South Wales (6.8 percentage points). The greatest increase for the proportion of those living in the most advantaged quintile was in Victoria (2.3 percentage points) (AHMAC 2017) (Table D2.09.2, HPF 2017 Table 2.09.2).
These results should be interpreted carefully. Indigenous residents often represent a small proportion of an area’s total population, and therefore the socioeconomic status of that area as a whole will not always reflect the socioeconomic status of its Indigenous residents (the ‘ecological fallacy’). One study found that Indigenous Australians consistently had a lower socioeconomic status than the SEIFA score for their area (Kennedy & Firman 2004).
Socioeconomic outcome indexes for Indigenous Australians
Biddle (Biddle 2009, 2013) has constructed several socioeconomic outcome indexes specifically for Indigenous Australians, based on data from the 2001, 2006 and 2011 censuses. These studies have consistently found a clear gradient of disadvantage by remoteness for Indigenous Australians. Capital city regions rank relatively well, while remote regions rank relatively poorly. Income, employment and education correlate geographically. Other measures of wellbeing show more complex patterns.
Within each region there is substantial variation across the smaller, underlying Indigenous areas. For example, although Sydney was the highest ranking Indigenous Area in all of Australia in 2006, the Indigenous Australian populations in areas such as Blacktown and Campbelltown had outcomes that were closer to those found in Remote Australia. Similar variation was found across Remote Indigenous areas, demonstrating that any geographic strategy for addressing Indigenous disadvantage must be targeted below the regional level (Biddle 2009).
Biddle’s (Biddle 2013) analysis based on the 2011 Census also found that in every location type, the Indigenous Australian population had higher levels of socioeconomic disadvantage than the non-Indigenous population. The gap between the two populations was smallest in city and regional rural areas (37–38 percentage points) and highest in Indigenous towns (89 percentage points) and remote dispersed settlements (81 percentage points).
Biddle (Biddle 2013) found that, over time, the ranking for most Indigenous areas remained similar. City areas, large regional towns and remote towns remained relatively stable. Over time there was a relative worsening of outcomes in small regional towns and rural areas and a relative improvement in Indigenous towns and remote dispersed settlements.
What do research and evaluations tell us?
The relationship between socioeconomic status and health outcomes is typically characterised by poorer health for those of lower socioeconomic status—that is, health outcomes follow a social gradient. People with greater socioeconomic disadvantage will tend to have poorer health than those with lesser socioeconomic disadvantage (Adler & Stewart 2010; Keating & Hertzman 1999; Shepherd et al. 2012). This pattern exists across many countries, among different societies, across history, and extends to most measurable socioeconomic variables (such as poverty, employment, occupational status, education, housing and income) and across a range of health outcomes (including most aspects of physical and mental health) (Adler et al. 1994; Bhattacharya et al. 2013; Keating & Hertzman 1999; Marmot Michael & Wilkinson 2005; Shepherd et al. 2012).
The research literature also shows evidence of socioeconomic status disparities among Indigenous Australians. Education, location, discrimination, health, disability, labour market discrimination and social norms all play a role in explaining disadvantage with no single factor dominating (Biddle 2015). Socioeconomic variables (such as weekly cash income, source of cash income and completed years of schooling) have been found to explain between one-third and one-half of the gap in self-assessed health status between Indigenous and non‑Indigenous Australians (Booth & Carroll 2008).
It is estimated that in the Northern Territory, socioeconomic status contributes between 30 to 50% of the gap in life expectancy between Indigenous and non-Indigenous Australians (Zhao et al. 2013).
The relationship between low socioeconomic status and health also exists in reverse. Poor health is a contributor to poor socioeconomic circumstances (Bhattacharya et al. 2013). A study in Australia found that people with serious chronic illnesses, and their carers, faced greater financial stress (Jeon et al. 2009).
This summary measure supplements what is known and reported in other measures about the relative disadvantage that Indigenous Australians experience across a wide spectrum of social and economic issues. Disaggregating data by socioeconomic status and by region across health and social outcomes, where the data allows, will help identify in which there is a high need. This will assist in addressing the broader social determinants to improve health outcomes and guide future policy responses.
The policy context is at Policies and strategies.
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