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 2018c). 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 2023.
Based on 2016 Census-based estimates, about 3 in 5 (61%) Indigenous Australians lived in New South Wales and Queensland.
265,700 (33% of the Indigenous population of Australia in 2016)
221,300 (28%)
100,500 (13%)
74,500 (9.3%)
74,500 (9.3%)
28,500 (3.6%)
7,500 (0.9%)
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 areas.
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: Population by Indigenous status and remoteness area, 2016 (per cent)
|
|
Major cities |
Inner regional |
Outer regional |
Remote |
Very Remote |
Australia |
|---|---|---|---|---|---|---|
|
Indigenous population |
2% |
4% |
8% |
18% |
47% |
3% |
|
Non-Indigenous |
98% |
96% |
92% |
82% |
53% |
97% |
|
Total population |
100% |
100% |
100% |
100% |
100% |
100% |
Source: HPF Table D2 – AIHW analysis of Australian Bureau of Statistics (ABS) population estimates based on 2016 Census.
The Indigenous population is relatively young. 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 (see Figure 2.1).
Figure 2.1: Age structure of Indigenous and non-Indigenous populations, 2016
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).
A new study – 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. (Paradies Yin 2006); Priest et al. (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. (Paradies Yin 2016); Paradies & Cunningham (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 refresh of the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.
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).
This report will guide the development and delivery of future policy and programs, including the next National Aboriginal and Torres Strait Islander Health Plan.
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 coronavirus disease (COVID-19) 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.